Black All Year - No More Box Ticking

The NHS is the UK's biggest employer of black and minority ethnic staff. What has it found it so hard to make progress on equality at work? How do we move from tick box exercises and make a real impact on equity and inclusion?

Anybody who is even vaguely interested in diversity, inclusion and racial equity in the NHS has heard of Roger Kline and so I was really keen to ask if he would take part in Black All year and honoured and excited when he agreed. Roger Kline is Research Fellow at Middlesex University Business School. He was the author of “The Snowy White Peaks of the NHS” (2014), and co-author of “The Price of Fear” (2018) on the cost of bullying in the NHS and co-author of “Fair to Refer” (2019) on disproportionate referrals of some groups of doctors to the General Medical Council. Roger is very active on Twitter and is well respected by many in NHS leadership.

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Transcript

0:07

Welcome, everybody to this Black All Year event. It's slightly delayed, we had to reschedule. If you've missed previous events just to say they are available on YouTube, and they're also available as a podcast. You can access them on www.blackallyear.co.uk. So, if you're watching this, or listening, after the event if you can like and subscribe, it'll make sure that you don't miss any future material, and it also helps us to find the content as well. So it's quite ironic really, that this has been rescheduled to October, which is Black History Month. Because Black All Year came about because of Black History Month and the fact that every single year, I was being asked to talk about leadership, about racism, about being a black woman and all that type of thing, and be really, really busy in October, and then nobody wanted to talk about it the rest of the year. And I've seen similar stuff actually on Twitter over the last couple of days. And it really frustrated me because if you're Black, you're Black all year round. So what I did was I created these events. And we've had about six or seven now. We've also had some podcasts only material as well. So it's going really well and I really hope that you're enjoying the series. I'm absolutely delighted today to welcome our guest. Anybody who is even vaguely interested in diversity, inclusion and racial equity in the NHS will have heard of Roger Klein. And so I was really keen to ask him if it would take part and I was delighted and honoured when when you agreed Roger. For anyone that doesn't know, Roger is a research fellow of Middlesex University Business School. He was the author of "The snowy white peaks of the NHS", which has been commonly shortened to Snowy White Peaks, and I think it's almost a hashtag now, and that was in 2014. He was also co author of "The price of fear", which was on the cost of bullying in the NHS, and co author of "Fair to refer" on the disproportionate referrals of some groups of doctors to the General Medical Council. And Roger is also very active on Twitter and very well respected. I think maybe even a little feared by NHS leadership, Roger. I'm a cuddly pussycat But you are very, very welcome. So thank you, and thank you for being so accommodating with the rescheduling as well because of the Queen's funeral. So Roger, obviously, the NHS is a huge employer anyway. But as was pointed out to me on Twitter by somebody who thought they were making a point that they weren't, it's also the biggest employer of Black and minority ethnic staff. So why has somewhere that has such a huge employee base found it so hard to make progress on equality at work. So three or four bits in answer, I'm going to spend most of my time on one of them, but just very briefly, we live in a society where racism is ubiquitous, it's everywhere it affects, sexism affects us, homophobia is all around us, the treatment of disabled staff and citizens is really awful. And it affects us literally from the cradle to the grave. But that doesn't explain why the NHS has failed to get to grips with this when it's so obviously it's the largest employer of people of Black and minority ethnic heritage. Yes, it's huge. It has the resources, and it has not really moved the dial. So I think there's there's two small reasons they're big reasons, but they're not the core reason I want to talk about. One is that there's been a culture of avoidance and denial. If I can find it, I've got a quote here from Robert Francis, who said, if I can find it. I can't don't worry. Basically, he said the NHS prefers to avoid difficult issues and engages in, there's an institutional instinct of denial. Now he was talking to about patient care in his Mid Staffs report a decade ago. And he went on to talk about, we prefer, we prefer messages that are uplifting and show progress rather than others. And what Mary Dixon Woods called comfort seeking, rather than problem seeking. So there's a real problem there. And I can give you loads of examples where I've walked into boards and said things and I get a look of just astonishment. For example, I said, you've got, to one board, I said, you've got a real problem with bullying for BME staff in this organisation, and the HR director said, "Well, that's what the staff survey says" he says, "but we've had no grievances". I said, "Well, you've got a double problem then haven't you. People being bullied, 39% being bullied, but nobody [reports it], they're fearful of the consequences or think it's a waste of time". So there's, there's an issue of avoidance and denial. The second one is we find it really hard to talk about. I'm White. White people find it really difficult to talk honestly about race. And we're terrified of saying the wrong thing, in case it upsets you. Or we might inadvertently put our foot in it and say something that might be seen as racist. So we kind of basically avoid the subject altogether. But of course, people spot this straightaway. So it's a conversation of car crash with real consequences, because it affects feedback from interviews, appraisals, and especially entry into the disciplinary process, which I'll talk about, because if you can't have an honest conversation, you'll say, we'll get someone to, to investigate. And that's it, isn't it that that that discomfort with talking about race means that people either get really clumsy or they just ignore it completely and it just makes things worse. No, no, there's a American author, David Thomas, who, writing about this, he calls it protective hesitancy. He was talking about mentorship, how the mentorship experience of BME students was different to the mentorship experience of staff rather, was different to that of white people. So with BME staff, this was in America, it was very technical, lots of technical skills, which for White people it was much more about socialising, raising profile, networking, etc, which has quite different outcomes in terms of your career trajectory. So that's the second one. The third one, which is the one I've really kind of focused on more is we've had a kind of paradigm of policies, procedures and training. We've said if we put in place the right policies, procedures, and training, that should move the dial on all forms of discrimination. There's no evidence base for this, what so ever. Indeed, the that evidence exists, says that if you rely on policies and procedures in isolation, they will make no differences a paper for ACAS by Justin Epson. And if you rely on training as a really brilliant paper by Karlev and Dobbin from the states who looked at 708 big companies who are doing affirmative action, and they found that the least effective way of improving the proportion of women and people of colour in more senior grades was diversity training. The least effective. Similarly,[indecipherable] who I've worked with when she did her piece for the HRC, which is literary review found training, diversity training and unconscious bias training can improve your understanding, your cognitive understanding, but there's almost no evidence it significantly affects decision making. So we've used a model; I mean, I sometimes say it's a bit like people going into the kind of London Underground using a map of the Paris Metro and then we're surprised we get lost. So lots of activity. But, you know, we haven't answered the question. If you're a nursing director and you went to the board, there's an outbreak of MRSA, you would expect to be asked the question, could you tell us why what you're proposing to do has a reasonable likelihood of succeeding? And if you can't people say, Why are we doing it? Finance Director the same? We don't do that with EDI. And I do hear that a lot actually, of the what we were doing a lot and we're we're putting in a lot of effort, and we're seeing some small changes, but it's just not good enough. And yet, nobody seems to think well, maybe we should be doing something different. It's just well, we'll just do more. If we do more, we'll see a bigger change. It's that whole kind of definition of insanity thing, isn't it? People think all of a sudden they're gonna get a different result by doing exactly the same thing, but just more. So fortunately, I do think there's a bit of change, maybe it's the innate optimism in me. But I do see some change in two senses. One, first of all, when I go into boards, I am much less likely to be asked, Why is this important and much more likely to be asked, What should we be doing? How do we tackle it? And secondly, there is now some evidence that people can't ignore the what we're doing isn't working, and that there's a better way of doing it. And I just had a piece of work a sort of review of recruitment and career progression in the NHS for NHS England, which is based on the piece of work I did called No More tick boxes. But it might be helpful if you thought, if you thought it was useful to talk about why discipline is a really good example of how you should use a different approach. So, the things that research tells us make a difference when it comes to culture and especially to EDI are three main things. What does the leadership do? Does the leadership understand the issue? Is it personally committed to change? Does it understand the narrative about why it should be a core part of the business case? And do they model the behaviours they expect of others. If if all four criteria are not met, it's really hard to move the dial and there's lots of research on that. If they are, you can then start to look at a second, the two other criteria that need to be met. One is much less focus on training, and much more focused on de-biassing processes, I'll give an example in a moment, and thirdly and crucially, inserting accountability, which doesn't mean beating people up all the time. But it does mean holding people to account and using that to drive him improvement. If I might give an example, Steph, disciplinary action. For years, first of all, we were in denial, there was a problem. The numbers were too small, I kept being told by Trusts to draw any conclusions. They would say but all Trusts have the same pattern, so there's a problem. Now it's part of the WRES. But what we've tended to do is improve the training, try and get better investigators stick BME people on panels and it still hasn't made much difference. And then about four years ago, quite separately, myself and Amanda Oates, who is HR director at, well now Chief People Officer at Mersy Care, quite separately, came to similar conclusions using a different evidence base. And what I managed to persuade a couple of the big teaching hospitals in London to do was to introduce a protocol, which said, if you're a manager, and you want to discipline anybody, Black, White, male or female or anything else, you have to explain to somebody at board level why that's the appropriate response to what has happened or is alleged to have happened. Because if you can't demonstrate learning, trumps punishment, and you're teaching people, the same, that you're teaching people the same irrespective of their background, why are you doing it? And in the last four years, the number of people being disciplined, the NHS has dropped by 36%. And the gap between the lighting of the BME people and White people who enter the disciplinary process has been radically reduced. And it's now just 1.12 times more likely that BME people willing enter the process rather than White. There are still things to do. And in some cases, managers have tried to find other ways of punishing BME people but the data, the data doesn't lie. And that's because if you insert an accountability nudge by saying you can't do that, unless you could put in writing why you think that's a good idea, what it seems to have done is lots of managers in the words of a Chief Nurse in one of the teaching hospitals I spoke to initially, they stopped trying to do it because they didn't want to put in writing the foolishness that they were using to justify sending someone off to an investigation. And of course, once you send someone into an investigation, it becomes a self fulfilling prophecy. They wouldn't be there, if they weren't guilty of something. We tend to ignore evidence that doesn't prove the hypothesis we think we're working on and attach great importance. So anything that looks like; there was a case on the news this morning of terrible death of a six year old, exactly the same thing happened within the police. So inserting an accountability nudge, a bias interrupter if you like, works much more effectively than putting for example a BME person on the panel to hear a case which shouldn't even be there in the first place. And you could apply the same kind of methodology to recruitment and career progression. That's what I've tried to do in No More Tick Boxes. And I could talk about that later if you think it would Yeah. And I think I mean, that's really interesting on a couple be helpful. of counts. So first of all, disappointing, but perhaps not surprising is that it wasn't, it wasn't that a senior leader was then saying this is inappropriate, it was that people actually worked out for themselves, it was inappropriate, but would have gone ahead with it anyway. So it's not that they didn't have that knowledge, it's just having that level of accountability, and someone checking your homework has made people pause and reflect and then go, yeah, actually, this isn't the right thing to do. So you kind of go, that's just, it's so frustrating, that that's what's needed to make people do the right thing. But also, I think the fact that so many, the solution for so many things seems to be, well, we need a diverse panel. We need to make sure there is a there is a brown person on the board, there's a brown person on the panel, that's really important that we do that. And before before we started, we were just having a brief discussion about why that's not as effective as it might initially seemed to be this idea of having a Black person on an interview panel, for example, why does that not work? Why does it not make a difference? Well, you couldn't look the other way around. Why, why do people think it would work? So the research on this is pretty mixed. And it applies to gender, as well as ethnicity. There is no solid research evidence that having diverse panels will necessarily give you better outcomes. So I'm not against them. In fact, I'm in favour of them. In the same way that I'm in favour of boards being diverse for all sorts of well evidenced reasons. But if you only have, so there's a lovely piece of work looking at women on boards, Norwegian piece of research, which is regarded as sort of pretty much the gold standard on this. It was only when there were three women on Norwegian boards, that they started to make a real difference to the way that board worked. One person, it's a bit, so one person on their own. What will happen is you get stereotyped. Oh, you're on a board Steph. I bet you are, I bet you're expected to be the person who leads on EDI and especially on race. Yeah. So. So what's everybody else do? Why, why, why? Because you're Brown is that a might be you want to, but actually the assumption is, you will somehow be the person who wants to drive this and I'll probably an expert, not necessarily the case. So I know. For example, when NHS England, put BME people on panels in their big restructure recently, I am told reliably, it made a difference of 0.6% to the proportion of BME people appointed. So I'm not against it. They didn't do any harm. But it really didn't do much good. It can make people more comfortable when they walk in. But sometimes women, BME people on panels actually holdmpeople like them to a higher standard, and want to be seen as favouring people who are different who look like them. So there are other things you can do that are much more effective. And anybody who is wading through No More Tick Boxes will know the sorts of things they are. Yeah, and I think I think you're you're kind of hit on a real thing there, in that if you are the only person of difference on that board, then there's a number of real challenges. So So surely, so this is so with, with race, sort of tentative you have to feel safe to speak up, which is a big deal. So you know, you're on the interview panel. All the panellists think phrases used is protective hesitancy. It happens with one way you think another way, actually having that ability and that confidence, and that, that psychological safety to speak up gender too. So I've been told by numerous women, about their is a big deal. But you're absolutely right. You know this, appraisals and their feedback from interviews is much softer they'll say, Well, we've got we've got somebody on the board who is Black, and therefore, they understand absolutely and much more vague than it is for men. So as often happens everything about every ethnicity on the earth. And not just that, but sexual orientation, gender, disability, we, because of the with BME colleagues, after an interview, you ask for some melanin in our skin, we're supposed to be experts on everything. What absolute nonsense. And it's almost, I feedback, what you're told"Well, you were pretty good on don't know why people won't speak up when there is a, a the day, Steph, but somebody else on the day was better". Black person on the board about things that are obviously not right. You know, I mean, you do you don't have to be an EDI Absolutely useless when what would happen with a bloke, is expert to spot some of this stuff. And yet, it's almost like maybe it goes back to this discomfort that White people much more likely to be, if it was me, "Okay, Roger, you, you have talking about race, but actually it's almost like, I don't feel like I can say something because you're the representative. were good in the interview, but your presentation was rubbish. So what we're gonna do is we're gonna get you to talk to Fred, about how to beef up your presentations". People, some men are still anxious about being direct, and honest with women about these things. And it's much more a case with White people, and BME people, and it's partly influenced by we don't really understand how deep and how powerful bias is. So the point about de-biassing. Is is the the evidence that training deals with bias is pretty thin. You have to actually de-bias the specific processes that prompt it, enable it and then insert accountability, as a reminder really to say, Don't do it. Or Yeah, I'm just thinking could, can we go back to what you were if you do you have to explain yourself because people who are watched and scrutinised, change their behaviours. I'm sure your children do. Mine occasionally did. All of us who are watched, we change our behaviours. saying about disciplinary processes, because there's quite a lot of interest in the chat. And if anybody would like to come on and discuss this, then you're more than welcome to. But actually, this this real disparity between disciplinary processes for people who are black and ethnically minoritised, compared to White colleagues, is is a real issue. And I know that for medics, the paper that you did about referrals through to the GMC, and the like, so that the example that you were giving, you said it a couple of trusts that have taken this new approach is that right, Well I think now a majority of trusts in one form or another, one I spoke out this morning, have realised; the NHS is a funny kind of thing. There's a lot of herd mentality. At the beginning, it was really hard to persuade people to do this it looked risky, there was a lot of pushback from managers, are you undermining my right to decide who should be investigated. Now, if you're not doing something like this, you look a bit like a kind of, you're an outsider. So I think there is progress there. But it will only be sustainable if leadership in the organisation understand why it's working and the importance of doing it. Because what happens around discipline is symptomatic of all the other things that happen to groups that are disadvantaged within the NHS, not just the BME people. So that understanding is really important, if it's to be sustainable, but you need the kind of the de-biassing, the bias interrupters, and the accountability and the accountability is, particularly, either in the way I've suggested or data driven. So you can say something's going on in Estates, why are they getting many more people disciplined? And you sit down with people say, Look, this is what the data shows? Is there a good reason why it's happening? Because there might be unlikely there might be, and if there isn't, we're going to change it, we'll help you to change. And if this pushback becomes a KPI, it becomes something that becomes mandated. But I'm in favour of trying to start with an improvement lens. But with people being clear that if that doesn't work, other things will, will happen. I think, you know, that's research. If you can get the frontline managers on on board. Much better to do it that way. If you can't, it's gonna happen anyway. Yeah, yeah. And I think that there is that, the only flaw I can see in things being referred of senior leadership, is it...it means that you need the senior leadership that are actually going to spot that this is inappropriate. And that again, you know, boards are quite reflective in some ways of the organisation, and therefore there's no guarantee that they're going to turn around and I suppose that's why there is still that, that gap in those trusts. So I'm looking at Evelyn, Hi, Evelyn. I've never met you but we swapped messages on Twitter, I'm looking at your comment, which which is absolutely spot on that in London, bizarrely, London, which has the highest proportion of BME staff in the country has the worst record on all WRES indicators. I mean, that alone makes it worthwhile having WRES indicators what on earth is going on there. And the comparison with East of England is a really good one because the leadership in East of England, and that was the region that published No More Tick Boxes, because NHS England nationally wouldn't publish it, they are committed, I think, to work on this and there's been a concerted drive, probably not in all Trusts, but across the region to try and improve these sorts of things. So leadership needs to understand. It's not for those who are disadvantaged by discrimination, to lead the charge in responding to it. It's for the leadership of the organisation to put step measures in place that enable them to know what's going on, and to react, prevent in a preventative, proactive, I call it a public health approach. Because otherwise, individuals, quite rightly, are reluctant to raise concerns, either because they think it won't make any difference or because they think it will make things worse. And they're right in many cases, so leadership needs to go, talk about making it safe for people to raise concerns, is only one bit of it. Why isn't the leadership intervening? So people don't even need to raise concerns? You should know, if I'm medical director, I pretty much know every single doctor who is remotely an outlier in my workforce. Why don't we do the same thing on EDI? Yeah. And I think this is one of the things that I find quite interesting, actually, is that even when you've got the the best will boards that are there, there can quite often be a disconnect between what the board is trying to do and then what we see at that middle and junior management level. Is that about accountability, that there's no accountability for not taking the correct actions? So good question. So I think, I think we we don't understand how deep. So first of all this, I distinguish between racists and racism, racists are relatively, they're nasty, but they're relatively easier to deal with. Trusts, not all Trusts, Trusts on the whole are a bit clearer on what they should do with overt racists, compared to racism, which is the much more subtle ways. So I always use, if I may give three examples of bias in recruitment. And when people were challenged about it, they said, Really! When one, one piece of research looked at, why were more men being appointed than women, what they discovered was when men had more experience, they're appointed because they have more experience. But when men have more education, than women, they're appointed, because they have more education. And when people would have this thrown at them they said Really! Second one was around Black managers, the fact that Black managers, it was more likely to be assumed that they got to where they were, because of help from other people, compared to White managers, and people were really defensive when this was put to them. And the third ones is when people's evaluation, so BME and women's evaluation of themselves, compared to other people, was poorer. And they over stated the abilities of other people. So a bit of impostor syndrome or something going on there. And it's lots and lots - you know, people make assumptions, if you're a mum in the way that they don't if you're a dad, etc. If you're dad and you mentioned children interview, well, what I lost what an hour's rounded character is, if you're a mom, it's like, so who's going to care for them? Or even more, if she planning to have any more? I think that is that is that kind of thing is even more so if you are Black and female because it's the well, obviously then you're caring for all of your entire family and all of your extended family. Because there are these assumptions that are made about the way in which you function the way your life works. So being clear about if you're clear about the leadership, what leaders do or don't do largely sets the culture in an organisation, you then have to focus on the other two things which are de-biassing processes and inserting accountability and there lots of practical, so discipline the way to de-bias the process is - Stop. You can't go further unless you can explain what you're doing. It's a mixture of de-biassing and accountability. With recruitment, you need to look at each stage and think through how does the bias creep in. So I often use the example. NHS job descriptions are kind of enormous with the 53 things you have to be able to do. That won't necessarily deter somebody like me as an old White man. Because I'm not bothered if I can't do everything on the job description, because I kind of learn it as I'll go along and probably discover that half of the things you don't have to do anyway. But if you're a woman, or even more, if you're a Black woman, you're gonna think "I know, I'm going to be held to a higher standard, I have to be confident I can do all the things there. Otherwise, I run the risk of at some point, hitting the buffers". So there's research that shows men are less bothered about long lists of things. Women and BME staff, for very good reasons, are more reluctant to apply for those sorts of things. So there's answers you can do things there. Similarly, if you have your typical interview, which consists of three people in a hurry, having a quick look, at shortlisting, and then caught, somebody cooks up some questions. There's no, nobody has any idea what a good answer a poor answer, or an average answer looks like. Nevermind scoring them, even if you do, you don't keep to it in a rigorous way. And at the end, if the person you thought was best, because they were the kind of best at selling snow to the Eskimos didn't get the highest score, somebody will say, well, you know what, I know Steph didn't have a brilliant interview. This won't happen to you. But the way, Steph didn't have an interview, but I've seen her in action. She's great, you know, so never mind the scores, Let's appoint her. And there's a lovely piece of work that says, panels confuse confidence and competence. And that particularly favours some groups of people. And related to that, think about how influential is the future line manager, in tending to choose people a bit like him or her, people they think will fit in? How do we know that's really important. There's lots of research that says that. But in the NHS, we have examples where the future line manager wasn't part of the decision process, and those who were appointed were much more diverse than would have been the case, when the future line manager was involved. Several big examples, I've written one of them up, which is about nurse recruitment. And when I say this in Trusts, they say, "oh, yeah, that's what happened when, yeah, Roger was off and the interview went ahead and we really surprised who got appointed". And yet, that is, that is almost the opposite of what normally happens. I mean, I've sat in discussions, where we've been recruiting a new manager, and it's kind of, well, we can't recruit their direct reports until we've got that manager in place, so they can be involved in the interview process. So yeah. Now you say it, it makes perfect sense, but it's just not the way that we've done things in the past. And interesting, going back to what you were saying about when you have a Black person on a panel, interview panel, for example, and that not wanting to be seen to favour people who look like them. And you know, doing a bit of soul searching myself, have I actually done that? And I think I've I've certainly had that discussion with myself about am I favouring this person, because they're like me, or am I scoring them fairly, based on the way they've presented? I'm sorry. And I'm just gonna say, but but actually, I suspect that my White colleagues do not have that same conversation with themselves. And one of the things that might affect what you do is you don't want to give your White colleagues or your male colleagues because the same to some degree applies to women, the impression that in any way you're doing any favours for someone because they don't like you. So there's a kind of, you know, of course, there's a small minority of people who pull the ladder up. But that's, that's a minority. But certainly, that's, that's why it doesn't make that much difference, it will do sometimes, it's made worse if the person who's different, the independent person on the panel is junior, because they're really going to think twice about the consequences of challenging. I must admit, I did hear about a panel of quite a senior role where somebody was brought in as the Black person to be on the panel, but wasn't allowed to be part of the decision making. So sit on the panel ask questions, but at the point where they're then discussing it, they then left and that was the and have their role and you kind of think well, what's the point? What is that that box ticking just extreme on another level that one? Or ask questions but not allowed to vote? I've had that too. Just crazy. In terms of some of this, so we've had some comments about the fact that that boards don't reflect the workforce, and particularly in London, but I think elsewhere as well. And as we said at the beginning, the NHS is very ethnically diverse, and normally more diverse apart from in London, more diverse than the local population. And yet, we don't see boards that reflect their workforce. How do we do that? And how do we get away from this? Well, we'll bring in some non exec directors who are Black, because non exec directors are great. I'm one, you know, we've got a fantastic role to play in all that type of thing. However, it's not the same, And of course, what the WRES data shows, is, there's been a significant increase improvement in the number of women and BME directors on boards, very significant compared to when I wrote the Snowy White Peaks. But, although the number of exec directors at that level, who are different, has improved a bit, there isn't really a pipeline behind it. That's for a number of reasons. I think it's partly because we don't really have a kind of management strategy in the NHS, there's no proper succession planning informed by inclusion. There's no, there's no deep understanding of all the talent that's wasted. Or of the fact that inclusive teams. So even if you increase representation, unless the group, the team, the board, you are joining is inclusive, welcomes your difference, realises you add something to the conversation, makes it psychologically safe for you to say hang on a minute, actually, adding a woman or a BME person to a board won't necessarily make any difference, and the contrary, might mean that people feel marginalised, disengaged and, although I haven't got any data on this, my sense is there's a higher turnover of BME people at very high levels, very senior levels in the NHS, because they are effectively disenfranchised, at that very senior. So, well as you being harder to get there, once you do get there unless unless the board or the team or the SMT are really inclusive, you're going to think people aren't really listening, I don't get called to speak quite as often people don't take quite as much notice of what I say I don't really get asked to go off and kind of lead projects and so on, you pick it up. And usually people pick it up. So the only way around it, as far as I'm concerned is right, we know that diverse, inclusive teams are more effective, there's a very solid evidence base for that. We know there's loads of talent that's not being tapped in the NHS. Let's have a strategy that says we're going to identify where blockages are. not just through positive action, but by removing the institutional blockages. I'm very critical trust and don't put loads of energy into positive action, but it's still twice as likely the White person to be appointed for shortlisting. So what on earth was the point of the positive action, you have to do both. So stretch opportunities for example, are key to development, so a piece of low hanging fruit is that every organisation should remove the line manager from the decision about who is going to act up, who is going to get secondment, who's going to be involved in projects. An increasing number of Trusts are now using talent pools and assessment centres to pull in people who want development and then they allocate them. It's the same thing about removing the line manager affinity bias, and to a large degree can address the sort of tap on the shoulder. So that's a very simple thing everybody can do it. Why don't people look at what the outcomes of appraisals are. Appraisals ought to be a key stage in people's development. Most of them are perfunctory and where they're scored. I've not seen a Trust where they're scored, where BME people don't come off worst. And I think one of the things that that the Trust we're that I'm non exec, so Newcastle Hospitals, have done which I was actually really proud of is that they they put in place a leadership programme for ethnically minoritised staff. They didn't have an entry banding on that, recognising the fact that actually if you say you've got to be band 6, before you can get to this, you're excluding a whole load of talent, who are just never gonna get to band , because of all the issues that we're aware of. So we've had and it's been a leadership programme, that has been about leadership, not about ethnicity, but it's been, some of that leadership has been discussed in the context of being Black or ethnically minoritised. The follow up to that is the thing that I'm now pushing on, because actually, you're exactly right. It's that Okay, so we've identified and invested in some people here, who have had real training. And they all had a change project to do. And I was at the first report out from the first cohort and really fantastic stuff done alongside doing a leadership course and their day job? So what next? How do we make sure that those people are mentored appropriately? How do we give them those stretch opportunities? And that I think is a bit that's quite often missing? That happens, perhaps, informally, if you're White? It does. So I think it's somebody put in there that who, it's Evelyn actually, who makes it refer to talent pool. The organisations that I know about it, you self refer, you ask to go into the talent pool. You're then assessed by people who are not your line managers, assessed by people who realise that in particular, it's not exclusively for people from underrepresented groups, but in particular, we want people from staff groups who are underrepresented in the more senior bands of the organisation to join it. If it's done by, if the referral was done by the line manager they can easily be blockers and I've forgotten your question. Yeah, it was about the fact that actually a lot of the, the networks, the mentoring, the access to stretch opportunities, is informal done informally, if you're White, and yet, and we have to formalise that, to make sure it happens for Black people One of the ways of formalising it is by inserting accountability. So particularly in terms of the end products. So the best Trusts, I'm working with one at the moment, is developing a real time database linked to the WRES, and eventually the WDES metrics, which will enable the board And I really, that part of me is really kind of disappointed that leadership who I think are committed to doing this, to be able to identify where the outliers are within the organisation to start with, Either the bits that are much better, or the bits that are much worse, and to sit down with them and say, Steph, we've looked at your data on appointments, you keep appointing, much more likely the men will be appointed than women. Can you talk us we have to, that we have to kind of put real levers and pressure through...or BME white staff rather than... Can you talk us through this? There might be a really good reason for it. Can you tell us what it is? Because there is no good reason generally. So fine. So we will help you we will come up with solutions that will help you deal with this, de-biassing and accountability solutions, if you push back, it's going to become on people to get them to change. But if we didn't, then this a KPI. So you how you start, in the same way that a medical director or nursing director knows what's going on quality wise, across the organisation. In fact, the person who's building this database has built quality databases for doctors, and chief the Chief Nurse in the organisation it's exactly the would be sorted by now, people would have, because the argument same model. You build it, you challenge people, it's real time data. And you try to have OD solutions, but evidence ones of the sort that I've talked about. And then you supplement with other things. So one trust, I mentioned this in passing and I didn't realise it been picked up. I then was told by somebody and then checked it. The chief exec I said, if when leaders about actually, you should be a good person, you should treat randomly check on what's going on behaviour changes. So this Chief Exec is White, a White man randomly occasionally rings up senior people have been involved in appointment panels and says I've just noticed the last four people you appointed are White men. Could you talk me through that? You don't want a second people fairly has been made. But that hasn't affected people's phone call from the chief executive about it. What's been happening is everybody has been picking up the phone that and saying bloody hell I've just had on the phone. We've been looked at. So the particularly when you when you start to control access to development opportunities in a much fairer way, you start to behaviours. And some of it is because it's not, you know, challenge people about what's happening in the interview process, People put too much emphasis on the interview process. In effect, the decisions are taken before the interview process by the opportunities that people have had. But you can still check. So again in that Trust, and there's others that do it. If you don't appoint someone from an they're not aware of their biases. But really nowadays, you underrepresented group, primarily women, disabled or BME people who are good enough to be shortlisted, you have to set out in writing, why you didn't appoint them, and what steps you're going to make sure happen, so they get the development opportunities, so they do better next time, and should be getting aware of your biases as well. But if that's that is checked upon. As long as having to explain, as well as having to explain why you made the decision you did, The cumulative effect of all that creates a climate in which people start to change their behaviours. There's still one last challenge, which is the frontline managers. And my view is, as far as possible, you engage your frontline managers, what we have to do, if we have to have that you are being you try to change their behaviour without beating them up. But at the end of the day, this is how it's going to happen. And those informal, you won't ever get rid of some of the informal stuff but you check on the outcomes. We're not interested in what you say you're doing. The outcome, says watched, and when you don't do what we expect you to do, we it's not happening. So it's going to change, and it's going to become something significant in your career. Otherwise, what you end up doing is you put lots and lots of emphasis on changing our mentorship and coaching and all those sorts of things that that can be helpful. But if you don't deal with those other want to understand why and you're gonna have to justify issues, actually, what happens is people say, I'm not, you know, I'm not staying here, I'm gonna go somewhere else. And people do. Why would, why would they stay. why, makes a lot more sense than we've got a Black person on the interview panel, so they are now the custodians of making sure that everything's fair. It's not fair to them to be in that position and it won't work. So there's two levels of accountability, there's, there's accountability within an organisation. And that should lie with the board, doing the sorts of things I've described. And then there's accountability in the system, which I think has been really poor. So we've had, you know, you're gonna have really poor WRES data, there are no obvious consequences. The number of times the CQC has downgraded a Trust in his Well Led domain because it's rubbish at race equality, I'm not even sure it's ever happened, if it has it's only happened once or twice. There are conversations going on at the moment about seriously beefing that up. And as far as NHS England's concerned, yep, it's in the standard contract, you have to do the WRES. But there are no other consequences from NHS England, if you if you behave really poorly on if your outcomes are really poorly on race. And dare I say at the risk of upsetting anybody from NHS England who is listening, it's not helped by the fact that NHS England itself doesn't model the behaviours we expect of others. I've lost count of the number of times that people have suddenly appeared in senior positions at NHS England without any obvious, without without even a job advert. And, you know, somebody who has recently been appointed to a job there said, I only got the job, because I know the person who appointed me. And I think that's true across the arms length bodies. There are people at very senior level who understand that and want to change it. But it's really that's got to change as well. So NHS England, need to think about what the consequences are. The CQC needs to beef up what the consequences are. I don't mean you just need to beating people up. But in terms of saying this is important. It affects patient care. It affects staff retention, the use of talent, we're in a staffing crisis, at the moment. I was in one trust recently where they lost 41% of staff within two years of starting. And much of that is about how how staff are treated not just on race, but generally how staff are treated. So we have to get this right. And NHS England. We're losing one in nine nurses last year. What is that about? Well we know what it's about. It's about overwork, not being respected, not being treated properly, can't cope anymore, stress and things like race. That's why there's more BME people, for example, working for agency, because then you don't, you can, to some degree choose who you're working for, at great cost to the NHS. So national leaders, and some of them really do want to do stuff about this, but I'm not convinced all do, need to get a grip on this. And they also need to stop engaging in things that are performative rather than evidenced. Yeah. And we've gota couple of minutes left. But before we kind of wind up, I just want to pick up on a comment that I think Nina has made around that social capital that you have, if you're straight, cis, White, male and things. And back in May, we did an event around power and privilege and used the wheel of power and privilege. And I really recommend people go back and listen to that, or watch that, because it really shows how very few of us actually sit at the area of disadvantaged in every element of our lives. I, for example, never hit disadvantage, being light skinned Black, and being straight and cisgendered. I just, you know, I don't have that I'm marginalised to an extent, but never hit that that outer layer. And I found that wheel in particular in that discussion to be really useful when I'm talking with White colleagues, and particularly White male colleagues, to explain what we know what we mean when we say privilege. And how power then comes with that. And you may not have that in every aspect of your life. But in certain contexts, and particularly in the workplace, it really has a massive impact. I've never, ever turned up for a job interview, where there wasn't at least one White man on the interview. You've lots of other examples, and people don't think about it. I think people are thinking about it a bit more than they used to. But but White people like myself, are still defensive when challenged about these things. So I'm in favour of where you can challenging. My dad had a phrase, speak softly, carry a big stick, speak softly, but but then you may have to back it up. But there have to be consequences eventually. People need to understand these things. But it's much better if you can at least start by trying to engage in a conversation around it. But but recognising you may have to step back and say sorry, that's not acceptable. And for senior jobs, why isn't inclusion, an absolute requirement? It's not just another aspect you're scored on. If you're no good on inclusion, you're going to be no good as a very senior manager. So don't appoint them. Absolutely. And I know, I know, our integrated care board has appointed a director of EDI at a senior level, and had a lot of pushback over that decision. And I think even GBnews decided that they were going to pile on when that went out to advert. But But the chief exec there has been really clear about this is important. And therefore we need somebody who is a strategic leader to take that forward. So I can't wait to meet the person that's been appointed to that role. Roger, we are almost out of time, it's flown by thank you, again, so much for for your time and your experience. It would be great if if afterwards some of the research papers that you've shared, if you would share them with me, and then I can share them with people that have been on the call today. And also, one of the questions I'm asked frequently is, where do you know that you're doing this well. So next time I get asked that on Twitter, I'm going to tag you in because you've obviously got some really good examples of places that that are doing it well, and it's something that a lot of us struggle with, because we just don't know. And it's a final comment, the paper I've just done about recruitment and career progression. I've complained bitterly, that it really is about time we had a proper system for identifying and then sharing good practice around EDI. It's astonishing. We don't have it. Sort of kind of word of mouth and you don't really know how good he is. We need not we need not whether somebody thinks it works. If you can't explain why it's worked, why are we, why do we think it could be replicated at scale? We're not doing that. And as I as I said in the board yesterday, last week, this is not it? Yes, it's a it's an individual issue, and it's about individual impact on people. But actually it's a quality and safety issue as well. Because if people don't feel safe to speak out, they want. If people don't think they'll be heard, they won't bother talking about things. And if we're not getting that diversity of backgrounds and experience and everything, we're not identifying where we've got group think, or where we could be doing better. So to me, this is not just oh it's af nice humanitarian thing to do. It is absolutely at the root of quality and safety. So, yeah. Well, thank you, everybody. Just for the sake of people that are listening, as ever, if you can like and subscribe, that would be great. It does help with directing people to the content. We've got more Black All Year lines up for the rest of the year. I'm just waiting to confirm dates. So if you follow us on Eventbrite, you'll get information as to when they go live as well. I hope everybody has a great Black History Month, and a great year because, yeah, we're Black All Year, aren't we? But thank you again, Roger. It's been wonderful and take care everyone. Thank you for inviting me. Cheers.