For most of my working life I’ve worked for the NHS, for different organisations and different Trusts, in a lot of different jobs. My very first job, even I trained as a nurse, was working for the NHS, it was back in 1984 and it was entering data into a computer, in an old prefab building in the grounds of a Liverpool suburban hospital.
I have seen many changes in the NHS over the years, many Governments have “reformed” it, and there have been many changes to its structure, and many of these changes have not been for the best. The one thing that has always been a constant is the staff. The NHS is the biggest employer in the country, and is the fifth biggest employer in the world (1), its staff are its biggest resource. An empty hospital never made anyone well, it’s the staff that work there that do.
So what is it like to work for this huge institution?
of working for the organisation. Since 2010 the NHS and its staff has been under enormous stress and pressure, budgets have been cut, there are staff shortages, pay has been frozen and yet demand on the NHS keeps increasing. Last winter, a mild winter, saw the NHS plunged into another “winter crisis”, now almost a yearly event. Therefore we would expect the NHS Staff Survey would be full of negativity and staff stress being vented, but it’s the opposite.
The latest Staff Survey (3) paints a picture of staff who enjoy their work and value working for the NHS. 75% see the NHS’s priority as patient care and 75% are enthusiastic about their jobs (4); 59% of staff said they always look forward to going to work and 60% would recommend the organisation they work for as a good place to work (4). Staff still value the NHS and enjoy their work. Sir Robert Frances (the QC who chaired the enquiry into the Mid Staffordshire scandal) said that the NHS was only being held together by the “superhuman efforts” of its staff (5).
So the NHS is a great place to work in for everyone. Well yes and no. Unfortunately, it is not the same for everyone.
Black and ethnic minority staff (BME) are much more likely to be bullied and harassed by white colleagues and managers, the first national review by NHS England (6) found. It found one trust were BME staff experienced twice as much harassment from colleagues than white staff, and in over 80% for Trusts BME staff faced far higher levels of discrimination from managers than their white colleagues. Yet levels of harassment from relatives and the public were the same for BME staff and non-BME staff (6).
In 2014 a damning report was published into the state of BME staff in the NHS, called The Snowy White Peaks of the NHS (7), a title that is more than ironic. Its findings are very uncomfortable. In all the NHS Trusts serving London, the most racially mixed city in the country, the vast majority of leaders were white. This was repeated at national level, with key NHS organisations and healthcare regulators having very few BME staff in top leadership roles. Only 3% of Directors of Nursing being BME nurses, a figure that had not changed in ten years. The number of BME nurse managers fell from 8.7% in 2007 down to 7.8% in 2012, with few BME nurses at Band 7 and 8 (7); 14% of the population of England and Wales is non-white (8).
This report maybe three years old but we just have to think about our own Trusts, how many of the senior managers are non-white. In the Trust I work the senior management is very white experience.
But it isn’t just racism that NHS staff face, the organisation is not free from homophobia either.
In 2015 Stonewall (the LGBT campaigning organisation) published Unhealthy Attitudes (9), their report
These statists may sound cold but the report also carried the realities behind them, it was full of personal quotes. The nurse who was told he should be hung for being gay, by another nurse. A nurse's manager told her that homophobic comments were “only banter”. A nurse who was ostracised by his whole staff team, at work and socially, when it came out he's gay. And many comments were trans people are called “it” or “she-male”. Then there were the NHS staff who almost wore their homophobia as a badge of pride. A Healthcare Assistant who said people are not born LGBT but “choose” this “lifestyle”. A doctor referring to anyone he doesn't consider “normal” as “deviants” whose needs shouldn't be “forced” on the majority.
This year’s Stonewall Top 100 Employers list (The top 100 employers who have worked to be inclusive and to be a safe place for LGBT people to work) is out (10), and only seven of them were Health and Social Care organisations. None of the top ten organisations were an NHS ones, and only one of the top fifty was an NHS organisation, St Andrews Healthcare at number 43. None of the big NHS Trusts or any of the famous ones even made it onto the list. This speaks volumes about how seriously NHS organisations take LGBT inclusivity.
How has the NHS got into this situation? Unfortunately, it reflects the wider society we live in, with all its prejudices and discriminations. We still do not value difference in people. NHS senior management is still dominated by white heterosexual people, and too often they promote people like themselves. We still often only pay lip-service to diversity, seeing as a tick box on the mandatory training list. My own diversity training this year was an online presentation, that took 15 minutes and it covered all “minorities”.
We need a culture that values all NHS staff, and values the differences people can bring to their roles. LGBT and BME people are part of our society that the NHS serves. If the NHS does not value and encourage its own LGBT and BME staff then how can we say we can offer non-discriminatory care to LGBT and BME patients?
The NHS is a far more positive place to work then it was in 1984 (When I first worked for it) but it still has far to go, though on the other hand there are worse employers to work for.