Birthday honours and inclusivity

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Queen Elizabeth the second celebrated her official birthday at the weekend. Her real birthday, the day she was actually born, is 21st April. Whichever birthday is acknowledged, being 87 years old is a phenomenal achievement in any ones book. I love watching trooping the colour; it’s so quintessentially British, full of pomp, ceremony and pride.

The Queen has been head of the commonwealth, a family of 54 countries spread across the world, for a long time – 60 years to be precise. The commonwealth consists of many nations, and for people born in commonwealth countries, Elizabeth is their Queen too. The Queen has seen Prime Ministers and Governments come and go, she has also presided over many changes in this country, not least the increase in immigrants from many lands, some commonwealth, some not over the years. At the last census carried out in 2010, 15% of the population were from an ethnic background, this is set to increase to at least 20% by the next census date in 2020. For her and us, things and the people have changed inextricably and irrevocably during her time on the throne.

On her official birthday and at New Year, it is traditional for the Queen to honour people; people that have worked hard and contributed above and beyond the call of duty in their respective roles. People in the military, public and private sectors, sports, media and in our communities are rewarded and recognised for their work. These awards are held in high esteem in the UK and commonwealth and most people are pleased and proud to receive them. These awards are not handed out to just anyone, in order to even be considered to receive one, several people, preferably of note, have to write glowing citations about your accomplishments, achievements and eligibility for such a tribute to be bestowed.

This year friends of mine received this honour, Joan Myers received an OBE for services to Children and Nursing and Professor Mala Rao received hers for services to public health. Many congratulations to Joan and Mala, you both deserve this accolade. Joan and Mala’s achievement, and the achievements of many other people from black and minority ethnic (BME) backgrounds, got me thinking. There are lots of people from ethnic backgrounds that are awarded DBE, CBE, OBE and MBEs, in fact I can name quite a few people who have worked in the NHS that have received them. Now here’s the rub, if we agree that in order to receive an award of this nature you have to go over, above and beyond the call of duty, it surely must mean that these individuals have worked exceptionally hard, be seen to work hard and ultimately achieve a great deal. They must be exceptional in some way. If that is the case and I believe it is, then the question is -why are there so few people from BME backgrounds with these letters after their names at executive director level or above in the NHS? This is a thorny question and one that people wrestle with to answer.

A few weeks ago, a report entitled Discrimination by appointment by Roger Kline was published. The report highlighted the fact that if you are from a BME background you are 1.5 times less likely to be short listed and a shocking 4.5 times less likely to get a job than a white person. Surely with the talent we have in the service, clearly evidenced by the number of people receiving honours, this shouldn’t be the case.

Now for the good news, (and thankfully there is some) the NHS recognises that this is a problem, it’s a problem on lots of levels, not least for patients and for the delivery of high quality patient care in the service. We know that an engaged and motivated workforce, a workforce that feels included and part of the decision making process delivers better care as there is ‘a spiral of positivity’ (quote from Professor Mike West in his report NHS staff management and health service quality) in their organisations.

The NHS has grappled with this issue for years, and though it’s frustrating and often irritating, if I’m honest I shouldn’t be too hard on the service, why? The issue of under-representation at the highest levels is a societal one, and not specific to the NHS. It is the same in most organisations in the public and private sectors.  No one anywhere has cracked this particular nut. I could actually write a thesis, (and one day might do) on what I believe the reasons are for the lack of progress on this particular issue, however for the purposes of this blog, let’s just say it’s historical and very deep rooted. It is based on values and beliefs which in turn dictate behaviours and actions which then design systems and processes to maintain the status quo, some conscious, some unconscious.

The current CEO of NHS England, Sir David Nicholson, sees the issue as something that should be tackled. To be fair, he has always felt that this issue is important. How do I know that?  Well in 2002, as a junior manager, I went to the first Breaking Through conference. It was held in Birmingham. At that time, there were twenty-eight SHA’s in existence, the halcyon days. Sir David Nicholson was the only one of those twenty-eight senior leaders that attended the conference. In fact, a friend and I actually had a conversation with him,  he actively encouraged us to keep trying to ‘break through’ this long before the then CEO of the NHS, Sir Nigel Crisp, launched the Leadership Race Equality Action Plan and it actually inspired and motivated me to keep striving to be the best I could be. Anyway, the fact that Sir David Nicholson is interested in working with us to do something practical to help with representation is good news. It’s good news because we know that this agenda needs help and support from the very top, not just verbal support, but demonstrable and highly visible support. Sir David has agreed that in the last few months before he retires to personally support and champion this work. I know the naysayers will say, ‘why has he waited so long to focus on this agenda’ and ‘why now’? Well, I’d reply by saying, try being CEO of the NHS for a day, with all the pressures that brings, and you will see how difficult it is to focus on everything that is asked of you and give all of them top priority. I for one will not be looking a gift horse in the mouth, better now than never I say. What I care about is being able to do something practical to support patients and staff in the NHS via the inclusion agenda, and if Sir David wants to do something practical to help in the let few months before he retires, then he will get my 100% support to help do that.

Lack of representation at the senior levels of the service is a deeply complex issue as I’ve already said – it involves people’s beliefs and values, their motivations as well as people’s feelings about power, class and status. It is not an issue that can be solved by legislation alone or ticking the equality impact assessment box. It needs consistent and persistent focus, from the top of organisations, from the people it affects and the people it doesn’t.

I sincerely hope we can make a difference, however small in what time Sir David has left, and hopefully it won’t be too many years before I write my blog congratulating BME people for gaining places as executives on boards as well as congratulating them for their achievements in being honoured by a very special lady, our Queen. Long may she reign.