Voyage of discovery

by Emma Knowles

17 July 2019

NHS finance has a diversity problem in higher paid roles, but it is on a journey of improvement

True diversity and inclusion in the NHS finance function will be a journey. As with society in general, there is no magic spell that can eliminate years of learned behaviours, discrimination and prejudice, but at least NHS finance has now set out for this destination.

Future-Focused Finance is driving NHS finance’s work on diversity in England and it recently held a forum on how individuals and organisations can make a difference. Listening to speakers and delegates it soon became clear that there are some uncomfortable truths – for example, that we all have unconscious bias that is hard wired and dates back to early in our evolution.

But there was also hope. Our brains can be rewired and the moral case for diversity and inclusion is without question. There is also evidence that organisations are stronger and make better decisions if they are more inclusive.

There’s no denying NHS finance – as well as the NHS as a whole – has a diversity problem in higher-paid roles when looking at gender and ethnicity. Look around many NHS finance departments across the country and you might think there’s no issue – censuses have shown that women and those from a black and minority ethnic background (BAME) are well represented compared with the general population.

But look at their responsibilities and pay grades and another picture emerges – the proportions of female and BAME staff are generally good until band 8 but then the faces become predominantly white and male. In 2017, the finance staff census showed that 28% of finance directors were women, even though women account for 61% of the NHS finance workforce. And while 70% of the finance workforce in England identified as white British, this rises to 86% for finance directors. However, 11% of employers did not disclose their employees’ ethnicity.

Finance departments are not all starting from the same place, but all will need to work on their diversity. At the forum, Edward John, FFF’s diversity programme lead said success would mean shifting organisational, cultural and personal beliefs – cultural changes would be the trickiest, he added. Targets could be set and reached, but people had to feel welcome. ‘We can set targets – great,’ he said. ‘But what about the softer stuff? What makes somebody lack confidence because they think they don’t talk or look the right way?’

Perhaps one of the most practical examples of how to make a difference was set out in a workshop on reverse mentoring. Introducing the programme, which pairs a junior worker as mentor to a more senior staff member, Nottingham University associate professor Stacy Johnson said early signs had been positive. Though the mentor sharing their experiences of being part of a disadvantaged group was a step forward, she said the relationship had to be more than a ‘cosy chat’. It had to lead to positive actions by the mentee.

Of course diversity goes beyond gender and ethnicity, as demonstrated by the list of protected characteristics set out in the Equality Act 2010. The event included a welcome focus on discrimination against people with disabilities.

Though only 3% of NHS staff declare they have a disability on their electronic staff record, around five times more said they are disabled in the (anonymous) NHS staff survey. While the reasons for this gap are unclear, many staff with a disability fear discrimination if they notify their employer officially.

Hayley Ringrose, Stockport NHS Foundation Trust chief financial analyst said being invited to speak at a HFMA costing event gave her confidence to take the podium at this and other events. ‘I got an email asking me to lead a workshop and I replied, “You do realise I have a speech impediment?” They said they did know and wanted me to lead the workshop.’

Referring to the gap between those who declare a disability in ESR and the staff survey, she said. ‘Some of us don’t have a choice and because of that I feel I have to be seen as a role model – to promote and challenge, not through what I say; not through going to the board and saying, “We don’t have enough disabled representatives or BAME representatives”, but just by being the best you can be in every role. We will break through those barriers, but it will take time.’

True diversity is a journey, but Ms Ringrose is right. This is where we need to get to – where all NHS finance staff are judged and promoted just on their expertise and the quality of their work.


Following the forum, the HFMA is working with FFF to produce a summary of the event, focusing on the actions that individuals can take to improve inclusivity in their organisations. It will be available later on this summer.

FFF is holding an event to celebrate diversity in NHS finance on 7 November in London. You can book your place here.