Targeted training improves diversity in NHS leadership roles

Overview

Unquestionably, the talent and dedication of staff across the NHS is a reflection of a diverse workforce where over 100 nationalities are represented. However, In 2022 the NHS workforce race equality standard (WRES) ⁽³⁾ reported a fall in the number of black and ethnic minority executives in the NHS. In the East of England, further evidence for inequalities was highlighted in a regional Maternity and Neonatal staff survey (2021) and Suffolk and North-East Essex’s Local Maternity and Neonatal System staff survey (2020). Regional WRES Midwifery data (2020)⁽⁴⁾ showed that 40% of black staff had experienced discrimination from colleagues.

Through 2023, Health Innovation East partnered with the ‘East of England Maternity & Neonatal Ethnic Minority Workforce Working Group’ to launch the ‘East of England Ethnic Minority Maternity and Neonatal Staff Leadership Development Programme’ to support NHS band 6 and 7 maternity and neonatal staff from ethnic minority groups to move into leadership roles. Eleven of the nineteen participants achieved a promotion of at least one NHS band within six months of completing the programme.

For more information on this project, contact Tendai Nzirawa – Maternity Clinical Improvement Lead on tendai.nzirawa@healthinnovationeast.co.uk.

The importance of diversity and the challenges of inequality

Unquestionably, the talent and dedication of staff across the NHS is a reflection of a diverse workforce where over 100 nationalities are represented. Inequalities of any kind are at odds with the values of the NHS and fair treatment of staff is linked to better clinical outcomes and better experiences of care for patients ^(3)(4).

Recent data show that black and minority ethnic colleagues in the midwifery and neonatal workforce experience inequality. According to NHS Workforce Race Equality Standard (WRES) ⁽³⁾ midwifery data, in the East of England only 55.6% of black and minority ethnic staff believe that the  NHS Trust they work for provides equal opportunities for career progression or promotion, falling to just 26.7% for black midwifery staff. WRES also recognised that in 2020 40% of ethnic minority staff reported experiencing discrimination from a manager, team leader or colleague in the previous 12 months ⁽⁴⁾ .

In 2022, WRES data showed a fall in the number of ethnic minority executives in the NHS, and issues were also highlighted about the amount of time higher-banded midwifery staff (NHS band 6 and 7) remain at their existing band ^(4).

A partnership-led approach

The ‘East of England Ethnic Minority Maternity and Neonatal Staff Development Programme’ was developed by the ‘East of England Maternity & Neonatal Ethnic Minority Workforce Working Group’, and ran between May and October 2023.

Tendai Nirzawa, maternity clinical improvement lead at Health Innovation East, led the programme’s development. The programme provided training for midwives and neonatal practitioners, supporting and enabling them to them to step up into higher-banded NHS roles in their areas of expertise. The training involved the wide representation of partners including the Chief Midwifery Officer’s team at NHS England, NHS Leadership Academy, Royal College of Midwives, the National Maternity Lead for Equality, Association of South Asian Midwives, and the Co-Chair of Milton Keynes Maternity Voices Partnership.

The targets for the partnership were to address discrimination experienced by Black, Asian and other ethnic minority staff in areas including, but not limited to; belonging and inclusion, job interviews and recruitment processes, and ‘stretch opportunities’, opportunities for shadowing and mentoring.

A comprehensive six-month experience

A six-month training programme was developed for midwives and neonatal staff at NHS Band 6 or 7, with full-day sessions running every fortnight. Participants were given the tools and training to develop their personal and professional skills and confidence to help overcome the barriers to their career progression. The cohort learned leadership and quality improvement skills via workshops and invited experts. Topics covered included:

• Psychologically safety within the workplace
• Addressing bias and racism in the workplace
• Collaboration skills and creating success
• Co-production with service users and voluntary sector organisations.

The participants were also encouraged to access and participate in:

• The Healthcare Leadership Model 360 diagnostic tool for personal leadership development – commissioned by the NHS Leadership Academy.
• Coaching sessions via NHS Leadership Academy career and leadership portal.
• Authoring a reflective account of their leadership journey.
• A Quality Improvement (QI) project, as part of their role within their NHS Trust to help build familiarity with important QI principles.

11 of 19 participants promoted within six-months

The programme ran from May to October 2023, with 19 participants completing the course, of whom 15 were midwives, three were maternity and neonatal nurses, and one was a middle-grade doctor.

11 of 19 participants were promoted to a higher NHS pay band within six months of the programme finishing. Participants reported more confidence, knowledge gained and opportunities to recognise and seek additional career opportunities over the same period.

Two participants started a Community Interest Company- in addition to their substantive NHS roles, and others took on additional leadership roles, such as co-chairing the regional equality group. The programme was also shortlisted for Outstanding Achievement of the Year at the National BAME Health and Care Awards.

Growing the programme the across the East of England

Building on its initial successes the programme was adapted for use outside a maternity and neonatal setting. It was further rolled out to serve other nursing staff, Advanced Health Practitioners and social care staff. Having been promoted across the East of England region 183 applications were received for 45 NHS England funded places.

The second cohort began in March 2024, and funding is currently being sought to continue the programme, or similar, across the East of England. Elements of the curriculum have also been adopted for the NHS’s national maternity leadership development programme.

Read the programme’s full report here

Improving the quality of the programme

During and after the first programme it’s conveners identified opportunities to improve the experience for subsequent cohorts. These included:

• Working with the cohort, and their managers, to help create protected time in which to consolidate learning through practical action. Such as undertaking or leading quality improvement projects to which newly acquired leadership skills can be applied.
• Delivering the programme in person where possible. Face-to-face training enabled a learning environment and networking opportunities which best met the needs of participants.