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NHS diversity gap at the top widens

The chairs and non-executive directors on boards that run NHS organisations in England have become less diverse over the last 15 years, with fewer people of black and minority ethnicity (BME) and women occupying the positions.


A report from the NHS Confederation calls for a review of the current appointments process after it found that the percentage of chairs and non-executives of NHS Trusts from a BME background has nearly halved in the last decade – from 15% in April 2010 to 8% today.


The report also points out that the percentage of women in chair and non-executive roles has fallen from 47% in 2002 to 38% now. At the same time there has been no increase in the proportion of non-executive leaders with a disability – this has remained static, at between 5 and 6%.


Commenting on the report, Joan Saddler, Director of Partnerships and Equality at the NHS Confederation and co-chair of the NHS Equality and Diversity Council, says: “This report must be a wake-up call for a health service which is heading in the wrong direction and becoming less diverse at board level. That is not right for patients and staff working in NHS organisations.


“We support the autonomy of Foundation Trusts but we must find a way of developing inclusive top teams that provide example and leadership, and set expectations throughout their organisations. Chairs and non-executives heading NHS organisations must be accountable to and representative of the communities they serve and the staff for whom they are responsible. It is about fairness but also simply about good governance and improving the quality of patient care and engagement - and it needs to start at the top.


“We acknowledge that efforts are being made by NHS England/NHS Improvement to address this deficit, particularly among executive board members, but we are yet to see more progress when it comes to chair and non-executive appointments.”


Saffron Cordery, Deputy Chief Executive of NHS Providers, describes the findings of the report as “depressing,” adding that they highlight how much the NHS has yet to do in order improve the diversity of its leadership.

“It is particularly disappointing to see that among chairs and non-executives, we appear to have gone backwards. There is compelling evidence linking diversity in leadership to improved performance, quality and patient experience, and we need to follow through on this.

“We know some Trusts have done really good work to improve diversity, but it is incumbent on us all to better reflect the communities we serve.”


In March this year the NHS Confederation launched a new network to strengthen the voice of BME leaders in England and support health and care organisations to meet the needs of all communities. 


The BME Leadership Network aims to help leaders address the barriers to delivering the NHS Constitution’s commitment to meet the needs of all communities. It is chaired by Danielle Oum, Chair of Walsall Healthcare NHS Trust and Ifti Majid, Chief Executive of Derbyshire Healthcare.


The network enables BME leaders to come together to improve the understanding of equality, diversity and inclusion and publish the benefits to help deliver better care for all; to improve and sustain the number of BME leaders working in the NHS; and to profile the diverse range of BME leaders delivering solutions across the health and care system.


This gap in diversity at the top is also apparent within Estates & Facilities. The data presented at the HEFMA Forum by Fiona Daly, National Sustainability and EFM Workforce Lead at NHS England & NHS Improvement revealed that 23% of the workforce is non-white, but in leadership positions only one in 20 is non-white. Furthermore, although the workforce is split roughly 50/50 between male and female, in leadership roles men outnumber women by five to one. In spite of this, however, the three finalists in HEFMA’s 2019 Leader of the Year award were all female.