Diversity: to understand there’s a problem you have to listen

by Ian Moston

04 November 2020


I’ve been a director for over 15 years, been part of some of the best run organisations in the NHS and have, until recently, considered myself successful at building and developing great teams and nurturing talent. But answering an interview question on equality and diversity barriers, and what I have done to make the organisation more inclusive, has made me think differently.

As I uttered some hollow words about no personal bias, I was presented with the stark truth that I have been at best passive on the issue and at worst looked the other way.

In the end, I was fortunate. My poor response didn’t prevent me from getting on the development programme I was applying for. And participating on it has given me the chance to reflect on the issues in a way I hadn’t previously.

One of the things I’ve realised is that to understand there’s a problem you have to listen, and properly listen. Listen to the experiences of those who are brave enough to speak out and listen to what the data is telling you.

This week the HFMA and Future-Focused Finance (FFF) are sending out trust specific diversity reports, providing a local view of the diversity picture within the NHS finance function (See census report for national figures).

Looking back at previous versions of this data, I can see now how little has changed since I first took on a leadership position. There was evidence that I didn’t give sufficient attention to. The positive this time is my listening skills are improving and I can use this report alongside the other things I’m doing to better understand and make a difference.

I still can’t claim to be an expert, but my learning log so far includes three things.

First you have to commit focused time to the subject. There’s a wealth of reading material available. Roger Kline’s The snowy white peaks of the NHS: a survey of discrimination in governance and leadership and the potential impact on patient care in London and England, from 2014, is a good place to start, offering a stark presentation of the lack of diversity in NHS boards and its impact on patient care. A report from the NHS Confederation in 2019 shows the continued lack of progress. And Reni Eddo-Lodge’s book Why I’m no longer talking to white people about race is a challenging read that addresses the subject head on.

Reading has helped, but listening to the stories of colleagues in my own organisation has been even more powerful for me.  Having a staff buddy to reverse mentor me has helped me to explore issues in a way I haven’t been able to previously. Also, building on the listening we’ve done through our established equality, diversity and inclusion (EDI) forum, we are now also giving time on board and committee agendas to listen to staff stories. In the same way that patient stories have shaped our behaviour and practice, I’m confident that listening to staff experiences will have the same powerful impact.

My second learning point is that you have to measure what matters. You need comprehensive data and that takes time. Time to understand the data that does exist, so you don’t jump to conclusions. And time to collect the baseline data that doesn’t exist.

We’ve been building an inequalities dashboard, which has been insightful and challenging, but you need to be open to new ideas.  At a recent board meeting, Owen Williams, chief executive of Calderdale and Huddersfield NHS Foundation Trust, talked to us about their use of the index of multiple deprivation (IMD) and lower layer super output areas (LSOAs) to influence decision making. In one hour, he has dramatically challenged our understanding of how to measure and think about inequality.

My final note in my learning log so far says that leadership is about making a personal impact. I wrote it after sitting as the external assessor for a finance director interview. I insisted on asking the same question I’d been asked when interviewed for that development programme – about how they would make the organisation more inclusive.

All the candidates struggled with their answers, but more importantly, after the interviews, the organisation’s chair admitted he could not answer it either. He committed there and then to take the organisation through a year-long development programme.

Having made a start, it becomes easier to see other ways to listen, engage and make an impact. For me this has involved working with our local university to mentor students starting their careers, becoming a sponsor as part of the FFF diversity programme, and questioning when our organisation’s actions don’t match its words.

It has also meant for me changing a 15-year-long practice. As a finance director, I’ve always met everyone who starts in finance to say thank you for choosing us, to encourage them to innovate and the importance of asking for help when needed. Now I also talk about my journey in terms of diversity and inclusion and ask them to help me make it important.   

It is a small change, but the small changes add up. And the key first step is taking personal responsibility for making a difference.


Ian Moston is also chair of the HFMA Policy and Research Committee