Levelling-up across the NHS workforce

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In a new report commissioned by NHS Employers, Nuffield Trust examines the representation of under-served groups and provides a set of recommendations for change as the NHS strives to become an exemplar of equality, diversity and inclusion.

'Attracting, supporting and retaining a diverse NHS workforce' finds that issues such as discrimination and harassment are present at every level of the health service, and at every level there appears to be scope for the NHS to become a more inclusive, diverse and equitable workforce. Across an array of characteristics – including ethnicity, disability, gender and religion – some groups are under-represented in certain NHS careers. Despite efforts to improve equality and inclusion in the workforce and some improvements around diversity – such as in terms of minority ethnic representation in very senior roles – progress has been limited.

Key findings of the report:
• The moral and legal cases for NHS Trusts to increase the diversity and inclusivity of their workforce are indisputable. There is also a robust evidence base demonstrating the benefits, including: improved quality of care for patients; a more sustainable workforce supply; and increased efficiency of services
• However, discrimination and other forms of unfair treatment are evident within the NHS – at every stage of the career pipeline – despite efforts to identify and eradicate them.
• The COVID-19 pandemic has had a direct effect on equality in the workplace, and at no other time in recent history has the NHS’s duty of care to secure the health, safety and welfare of all its employees been as pressing.
• The research suggests that there are at least three conditions necessary to address these challenges but currently there is scope for the NHS to improve on them:
    Sufficient information and data to enable a more nuanced understanding of the challenges that staff experience, including within and across specific groups
    Clarity on ‘what works’ to address specific challenges, particularly in NHS settings
    Resources, skills and clear responsibilities within and across organisations to both implement and evaluate their intervention.

The report builds on existing work to develop practical policy recommendations that can improve the current situation. However, it should be borne in mind that the research was conducted at a unique time and the findings need to be interpreted in the landscape of a number of significant events that have brought inequalities and their root causes to the forefront of public and political debate. These include the COVID-19 pandemic, the murder of George Floyd and the prominence of the Black Lives Matter movement in the UK. The challenges and negative outcomes encountered by interviewees and the analyses highlighted in this report cannot be divorced from the wider structural discrimination and other systemic inequalities prevalent in society.

Read the full report here.



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