Blog Article

Enforcing equality enforces inequality

Posted by Lubna Haq

Lubna Haq

My heart sank when I read that NHS organisations are to be forced to increase the representation of ethnic minorities in senior positions or face contractual and regulatory consequences. I shudder when anyone talks about enforcing race equality standards and, reading this, I was transported back to the early 1980s when ‘quotas’ and ‘targets’ seemed to be the panacea to all inequality challenges.

Did it work then? Clearly not or it would not feel like déjà vu. In the early ‘80s I was a young, passionate, equality activist and remember talking in reverent tones about countries or organisations that aggressively tried to address the race imbalance in the workforce. I applauded places like Chicago where the Fire Service introduced different pass marks for entry depending on which ethnic minority background you came from. Their ambition was to have a workforce that reflected their communities.

But the scheme failed hugely. Did it help race relations or race equality? Did it support and help promote the self-image of people from those ethnic minority backgrounds? Did it make them feel like they were competing on an equal footing or that they were as competent and capable as their white colleagues? No it didn’t. What it did, very successfully, was to cause resentment from white Americans, defensive behaviour from BME groups who felt they had to justify their positions, a deeper schism between races and a lack of desire for developing understanding between people. It set up those it was supposed to support to fail spectacularly, but even more profoundly, it caused discrimination to become intentionally covert and to be forced underground. People did not feel they could talk about their concerns or question and challenge for fear of being labelled ‘racist’. It enabled prejudiced white Americans to say that even when opportunities were handed to ethnic minorities on a plate they couldn’t be successful because they weren’t capable.

The motivations of Simon Stevens and NHS England to do the right thing is unquestionable, and they may think are making a brave move. No one disputes the unacceptability of so few BME people being in senior positions in the NHS. However, it makes me sad to acknowledge that over the last 40 years – we don’t seem to have moved the discussion on or to have learnt from past mistakes. The focus is yet again on punitive measures if targets are not achieved.

The low levels of BME representation at senior level is unacceptable. But I am certain that these measures will stray far from engaging or motivating a workforce that is already contending with enough change. Where is the focus on engagement, dialogue and the need to nurture all talent in our organisations? We need some positive action initiatives, but not in isolation and certainly not the major strategy plank for addressing under representation.

If we want genuine and sustainable change, we need to have brave and honest discussions in our organisations. Let’s begin to engage those who feel threatened by change and start some open and authentic conversations. We’ve failed to do this over the last four decades in a meaningful or systematic way.

Only by creating genuine advocates from the most threatened and powerful groups in our organisations can we begin to have any meaningful discussions that create tipping points and genuine movements for change.

My dejected prediction is that by enforcing standards, we are only stockpiling problems for further down the track. We have the opportunity to change – through new leadership, new structures, existing change – so let’s take that opportunity.


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  1. Lesley


    August 1, 2014 at 11:34 am

    I agree 100% with you. This kind of targeting does everyone a disservice – and especially those people who would welcome some clear, honest and direct feedback about how they could improve or develop but don’t get it because their boss is frightened of the consequences.

  2. Simon Bird

    Simon Bird

    August 1, 2014 at 2:15 pm

    If there’s one thing the NHS knows well, it is that command and control doesn’t work – and so legislating/regulating quotas and numbers just can’t work in this area. The idea that putting in quotas will change beliefs, behaviour and action in a sustainable way is not a credible or proven one, and will have unintended consequences, some of which you mention here. But I wonder – what would your advice be to Simon Stevens be instead?

  3. Phil


    August 1, 2014 at 2:52 pm

    A well written blog. This type of targetting enforces the outcomes which top leaders should be instead develoing themselves, through greater understanding and appreciation of the value that diversity brings to their organisations. Going about change like this, through a top-down approach, could put back the improvements in leadership diversity for another decade.

  4. Scott Durairaj

    August 3, 2014 at 6:12 am

    Hi Lubna,

    I think your understanding of the proposal is misinformed. Firstly delivering race equality isn’t about reducing standards, or focussing on “training needs for BME staff” that is the deficit model of old.

    The standard that is proposed is a range of measures that look at ensuring that organisations are well led. There should be no shame in focussing on the longstanding and intolerable truth of race inequality within the NHS. It’s the focus that drives the change and the failures in the past have been because as you rightly say there are many in powerful positions many been there in charge for the last 10 years asleep at the wheel at best or worst purposely steering us in the wrong direction have not been engaged or held to account.

    Your suggestion won’t address the imbalance as we know with educational attainment it was the focus on some BME children’s attainment that has led to the improvement as if you focus on the mainstream those who are on the periphery or marginalised as always get left out.

    So to coin a Marmot phrase proportionate universalism is a focus to where the greatest inequalities lie but not forgetting the other marginalised groups on the way. Interestingly over the years I’ve been working in the NHS on the Stonewall workplace and health equality index not one person said it was wrong to focus on one group, or at least this group yet when it comes to a focus on race many feel uncomfortableness in the need, viability or projected outcome.

    Simply chatting to those at the wheel has never worked many have BME mentees which look great in the pictures but doesnt address the culture or outcomes of representation.

  5. Lubna Haq

    lubna Haq

    August 4, 2014 at 10:27 am

    Hi Simon

    My advice to ST would be not to treat equality as a numbers game and hope that this will lead to dynamic and creative teams delivering great performance.

    Whilst taking positive action is absolutely critical, it needs to be part of a whole people strategy. Good policies and procedures, support fora, training and development programmes, mentoring and coaching are all important. However, in my view, as important is sustained cultural change which can only come from authentic and honest dialogue and engaging those people who feel threatened or disenfranchised from equality initiatives.

  6. Alex


    August 4, 2014 at 12:56 pm

    Very interesting perspective on this. Really well written. The only thing I would ask is, how can we overcome these issues when the solution comes across as disrespectfully as concern?

  7. Angela


    August 4, 2014 at 2:23 pm

    Absolutely! Like you mentioned race equality is completely different from race relations. Yes, you may have a workforce that is representative of your environment or community but not necessarily tolerant/appreciative of its differences. By focusing on meeting targets/quotas, you risk creating a culture of ‘ticking the box’ and if you don’t already have a culture of inclusion ingrained within the organisation, then what should be considered as opportunities will be viewed as obstacles.

    Although fueled by good intentions, further thought needs to be given to the viability of such an approach.

  8. Mala Rao

    Mala Rao

    August 5, 2014 at 4:01 pm

    Dear Lubna,
    Having recently completed a review of lower levels of wellbeing in Black and Minority Ethnic populations in England which, perhaps you are unaware, lead to lower life expectancy and poorer health across the life course, I feel compelled to respond to your blog. Firstly, your assertion that the NHS is being ‘forced’ to increase BME representation in its leadership, and that makes your heart sink, implies very loudly that you do not believe there are BME people up to the job. If you did believe there were talented BME people available to take up leadership positions, your heart would not sink I assume?
    You contradict yourself when you rightly point out that the discussion has not moved in the past 40 years, but then go on to say that a more assertive action plan to bring about positive change now is unnecessary. I fully support your view that we need honest, brave discussions to underpin sustained change, but who is to engage in this? Lots of White leaders? Who exactly? What then is your opposition to BME leaders being appointed to represent the BME view at the top table of these discussions?

    As for the Chicago example, I do not know the background to it, but I could counter your example with hundreds of others where actions to bring about equality have transformed the landscape in the US. Please take a minute to reflect on the daily news of our most talented black actors only ever getting jobs in the US, a story which could not have escaped your notice.

    I salute Simon Stevens for taking a more assertive approach to tackling inequalities in the leadership of the NHS. This is one problem which does need a top down approach to overcome the fear and reprisals which accompany any efforts to tackle – BME staff of the NHS facing a higher representation in and harsher outcomes at every stage of the GMC fitness to practise procedures, pay inequality right across the career gradient among doctors and non-doctors, a greater chance of failing exams, and lower chances of being recruited to professional jobs. And these are only a few examples! To add to all this BME staff whose professionalism contributes to the NHS’s global reputation have to face daily struggles against racism and discrimination in the external environment, in every aspect of life, ranging from employment and education to law enforcement and media. Their voice deserves to be heard, and assertive action to improve their representation in the leadership of the NHS is essential. And far from the knee-jerk ill thought through sledgehammer approach which you imply, actions to strengthen BME representation in the NHS leadership on this occasion are being underpinned by thoughtful balanced discussions with many highly experienced and knowledgeable BME and White champions of equality deeply concerned to ensure sustained change and equity, contributing to them.

    Finally, despite the apparent failings of the drives towards equality in the US which you refer to, they have a Black President serving his second term. If we are to hope for ethnic equality in the UK, and your blog doesn’t suggest that you inherently oppose such a thing, then striving for equality in the leadership of its biggest employer, the NHS, is a good place to start. Simon Stevens, we are behind you all the way!

  9. Lubna Haq

    Lubna Haq

    August 6, 2014 at 12:48 pm

    I have read the various comments with interest. I am 100% committed to BME equality and this message was not intended to be diluted through my personal blog above.

    I believe BME staff are extremely talented but that the actions being taken in isolation do not lead to sustained cultural and organisational change.

    My concern therefore is that these changes will not be embedded and sustained.

    By all means, let us have positive action – but as part of a whole package of organisational change.

  10. Jide Odusina

    Jide Odusina

    August 8, 2014 at 3:27 pm

    Dear Lubna,
    Cheer-up, I believe it or not this time it can be different. I share your trepidations, and I would have been happier if it had been a ‘equality and diversity’ standard rather than just race, but given that the figures for representation, at least in London, seemed to be going in reverse, there was little choice but to act.
    The difference this time is that the motivation is clear evidence that poor treatment of BAME staff is associated with poor patient care. Although the evidence of the disproportionate negative impacts on BAME was overwhelming, it is the more recent growing body of research which shows the positive benefits of inclusive, collective forms of leadership and genuine popular staff engagement for patient care. Therefore anyone committed to the post Francis agenda for patient safety has to back equitable treatment for all NHS staff, especially BAME staff.
    This is now a service quality matter. That is what will make it sustainable.
    Yes, people can game the system, yes, there will be some tokenism and there will be resistance, and even ‘tick boxing’, but these things exist already, so what is there to loose?
    I think the initiative deserves the support of all of us who want to see, reduced health inequalities, and improved career prospects for the hundreds of dedicated NHS staff passed over because of their race. This is our chance, 65 years after the founding of the NHS and, 50 years after the passing of the first Race Relations Act, to right those historical wrongs.

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