The number of executive directors from ethnic minority backgrounds on the boards of English NHS trusts has declined for the first time since records began to be collected four years ago, a report has revealed.
The annual workforce race equality standard report, published by NHS England today, showed the figure has dropped from 155 in 2020 to 144 in 2021.
The total has dropped in every NHS region except for the Midlands and the North West. Before this year’s figures, it had risen nationally year-on-year since 2018, when 111 executive directors from ethnic minority backgrounds were recorded on trusts’ boards.
London had the largest drop, falling from 51 in 2020 down to 41 in 2021, while some regions have made little progress since 2018.
In the East of England, the number of ethnic minority directors on trusts’ boards has gone from 13 to 10 between 2018 and 2021, from just four to five in the South West and from 15 to 17 in the North East and Yorkshire over the same time period.
It comes amid repeated calls for trusts to increase the number of executive directors from ethnic minority backgrounds on their boards.
When comparing the overall proportion of NHS staff from ethnic minority backgrounds in each region with the percentage of board directors from those backgrounds, the WRES report shows the South and the East fare worse than the North and the Midlands.
Only 8.2 per cent of board members are recorded as being from an ethnic minority background in the East of England, compared with 23.9 per cent of the overall workforce who are from those backgrounds.
Closest to achieving a balance is the North West, where 10.7 per cent of its board directors are from an ethnic minority compared to 13.3 per cent of its staff.
The rise of ethnic minority NEDs and VSMs
In contrast to the situation with executive board directors, the WRES report showed the largest rise in non-executive directors from ethnic minority backgrounds on trusts’ boards in three years. This figure climbed from 181 in 2020 to 278 in 2021, having risen every year since 2018.
The report also found the average gap between ethnic minority representation on NHS trusts’ boards, compared with the overall workforce, had improved from minus 10.6 per cent in 2018 to 8.9 per cent in 2021
However, this improvement was largely attributed to the increase in non-executive directors from ethnic minority backgrounds, which fell from minus 9.5 per cent in 2018 down to minus 5.3 per cent last year (see graph).
Among executive directors, it worsened from minus 11.3 per cent in 2018 up to 12.6 per cent three years later.
The report also found the number of ethnic minority staff at very senior manager level had nearly doubled from 153 in 2020 to 298 in 2021.
In 2020, HSJ analysis found nearly 100 trusts had no VSMs who had declared to be from an ethnic minority background.
New to this year’s WRES report is a “disparity ratio” table. This illustrates how staff from ethnic minority backgrounds progress through NHS pay bands compared with their white colleagues (see table).
In the table, “lower” refers to the Agenda for Change bands 5 and below, “middle” to bands 6 and 7, and “higher” to 8a and above.
A ratio of one reflects parity of progress between white and staff from ethnic minority backgrounds, while values higher than one “reflect inequality, with a disadvantage for BME staff”.
According to the table, every region improved its ratio for the movement between the middle and higher pay bands, except for the Midlands (1.28 to 1.29) and the South West (1.56 to 1.67) between 2020 and 2021.
The North East and Yorkshire (1.29 to 1.18) and the North West (1.47 to 1.36) each had the biggest improvement at 0.11 each.
London had the highest “disparity ratio” of all the regions for movement between the middle to higher pay bands (2.07) in 2021, followed by the South West (1.67), the South East (1.66) and the East of England (1.44).
When it came to the movement from lower to higher brackets, London was again the worst of all regions (3.58) but only marginally as it was followed by the South West (3.5), the South East (2.5) and the North West (2.13).
However, all four regions saw a reduction between 2020 and 2021.
National and regional outlooks
The overall national picture showed some indicators had improved and others stagnated, but there were significant differences across some regions.
For example, white applicants remained 1.61 times more likely to be appointed from a shortlist compared to those from ethnic minority backgrounds. This ratio stayed the same for both 2020 and 2021 at a national level.
In the East of England, the ratio worsened from 1.32 in 2018 to 1.69 in 2021, and in North East and Yorkshire, it rose from 1.33 to 1.70 during the same year. In contrast, the ratio improved from 1.65 to 1.5 in the South West during the same time frame.
White applicants were considered significantly more likely to be appointed than ethnic minority applicants in 71.5 per cent of trusts, according to the latest WRES report.
Another indicator showed the relative likelihood of staff from ethnic minority backgrounds entering formal disciplinary processes compared to white staff has only marginally improved — from 1.16 in 2020 to 1.14 in 2021. There had previously been a steady fall from the 1.56 recorded in 2016.
The East of England showed the most dramatic improvement from 2017 to 2021, reducing its ratio from 1.43 to 1.06, and there were also improvements seen in the Midlands, the North West and the South West. The North East and Yorkshire came close to parity during 2020 before it saw an uptick in 2021.
London remains the clear outlier, with a ratio of 1.54, with the South West coming second at 1.17. The South East, which had a ratio of 1.01 in 2021, has effectively been close to parity for the past two eyars.
Meanwhile, the WRES report also showed there were more than 300,000 staff from ethnic minority backgrounds working for NHS trusts in 2021, an increase of more than 74,000, or 29 per cent, since 2018. The number of white staff working across NHS trusts has risen by just over 71,000, or 8 per cent, during the same time frame.
More than a third of trust staff from an ethnic minority background work for trusts in London.
The NHS Race and Health Observatory said: “Whilst there may be some slight improvements, the latest WRES figures illustrate that the NHS, as the biggest employer of black and ethnic minority staff in Europe, needs to reinvigorate its commitment to tackling the persistent and heinous challenge of race discrimination experienced by its staff.
“This is particularly true, given the record levels of discrimination faced by black and ethnic minority staff during the covid pandemic.
“This reinvigorated commitment requires a comprehensive plan of action for maximum impact.
“Whilst appointing more board members from diverse backgrounds is positive, this progress is unfortunately not mirrored across the board table, as fewer executive directors from ethnic minority backgrounds remain on those same boards.”
The observatory said national action was required to better understand the ethnicity pay gap across the NHS, adding it is “ready to support” with information and advice on addressing workforce inequalities.
Anton Emmanuel, head of the NHS’s WRES, said the last two years had been the “most challenging in NHS history” and that ethnic minority representation in senior positions had “never been higher”.
Professor Emmanuel added: “There remains a lot of work to do to change the experience of black and ethnic minority staff, but it is clear that when monitoring targets are set and evidence-based actions pursued, it is possible to shift staff experience, and the challenge now is to ensure this happens across the whole of the NHS.”
Em Wilkinson-Brice, NHSE’s acting chief people officer, said this year’s WRES report showed the NHS had made “impressive progress” on ensuring staff had an equitable experience at work, “regardless of race”.
She added: “But there is much more work to be done and NHS England is continuing to take action to improve diversity within the health service including through trialling inclusive recruitment programmes and continuing to rollout diverse staff networks.”