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The Ward Round: It has to be better than before

Published on: 23 Feb 2023

Staffing is the issue keeping NHS leaders awake at night – and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, this week by HSJ workforce correspondent Nick Kituno, ensures you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce.

Recent events have underlined why NHS England’s restructure must improve, not diminish, efforts to eradicate discrimination in the health service.

This week we learned that Michelle Cox, a senior black nurse, has won an employment tribunal case against NHSE on the grounds of racial discrimination and whistleblowing detriment.

The Royal College of Nursing, whose counsel represented her during the process, has called it a “landmark” decision.

The judgment was published this week and said Ms Cox’s then manager Gill Paxton created an “intimidating and hostile and humiliating” environment, with judges also critical of NHSE’s handling of Ms Cox’s formal grievance.

Employment judge Marion Batten said: “Ms Paxton developed an animus towards the claimant which led her to operate in such a way that her actions made life difficult for the claimant and compromised the claimant’s ability to do her job.

“She subconsciously intended to exclude the claimant at every opportunity. This animus also tainted Ms Paxton’s approach to the grievance appeal.”

You can read the details of the case in my write-up, or in the full judgment. It largely focuses on Ms Paxton’s behaviour, but crucially, should also embarrass NHSE and some of its senior officials.

NHSE’s investigations failed to probe the “underlying reasons” for Ms Cox’s treatment and did not consider whether inferences could be drawn from this pattern of behaviour. When the grievance was partly upheld, this was not communicated to Ms Paxton, meaning it was “not effectively actioned”.

This feels like a significant case because of how the tribunal reached its decision, finding the cumulative effect of events amounted to racial discrimination.

It is an incredibly high bar to clear, and with good reason, given the seriousness of the allegation, but it is rare to see rulings like this, particularly when judges ruled unanimously in Ms Cox’s favour.

There must be some real soul-searching from NHSE leaders in the wake of this to ensure similar situations do not reoccur.

Many current and former NHS staff will read about the case and draw similarities to their own experiences, but do not feel comfortable enough to speak up, let alone take them to a tribunal.

Interestingly enough, NHSE’s latest workforce race equality standard report was published very shortly after the judgment was released.

A press release declared the NHS workforce “more diverse than at any other point in its history,” with staff from ethnic minority backgrounds now comprising nearly a quarter (24.2 per cent) of all workers

That equates to more than 27,500 people over a 12-month period, with ethnic diversity on NHS trusts’ boards having nearly doubled since 2016, from 7 per cent to 13 per cent.

The workforce race equality standard is a crucial programme in holding trusts to account. It mandates leaders to reduce the disparities seen in recruitment processes, disciplinary procedures, training and workplace experience, keeping track of their progress.

Its indicators have served as an effective metric to hold to account the NHS’s claims to be “doing something about it”.

Both Ms Cox’s case and the WRES underline why NHSE’s approach to divesity and discrimination in the new world after its restructure must be better than before.

HSJ recently revealed that senior figures were concerned that slashing EDI roles by more than a third could hamper progress on diversity and inclusion, as well as programmes such as the WRES and the workforce disability equality standard.

NHSE has announced up to 40 per cent of posts will be gone under its restructuring, but questions are being raised about how the same focus can be kept when previously standalone remits are being condensed into a few roles.

Could trusts and integrated care systems be held to account on recruitment, promotions, training and disciplinary processes with the same vigour by a handful of people?

Can NHSE still scale up new projects and programmes on enhancing diversity and inclusion with fewer staff and resources, despite public commitments to it?

Navina Evans, NHSE’s chief workforce officer, was right to point out gaps that must be filled. For instance, there is no “reliable” data on LGBTQ+ staff in the NHS and there are no standards on gender equality.

But you could forgive one for wondering whether having just a few roles dedicated to overseeing race, disability, gender, and faith together is sufficient.

The key issue is whether “mainstreaming” this agenda will mean it gets inadvertently sidelined, and therefore, strips back all the hard-won progress over the last half a decade.

If it does go backwards then questions must be answered.