Diversity: balancing up

03 September 2019

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Diversity

It’s been made clear from finance departments up and the Finance Leadership Council (FLC) down that NHS finance must address diversity in the workplace. Indeed, the FLC has encouraged initiatives to tackle the issue in England. There is little doubt there is a problem, but how should the finance function go about addressing it?

A recent Future-Focused Finance conference looked at practical steps to bring greater equality to employment and promotion decisions. They included recognising and eliminating unconscious bias, reverse mentoring (see box overleaf) and how to measure progress.

Equality is not new to the wider NHS – there have been measures going back years – but it seems its time has truly come. Health and social care secretary Matt Hancock is committed to moving the diversity agenda forward. Last year, he set a new target of eliminating the ethnicity pay gap, with black, Asian and minority ethnic (BAME) representation in senior roles matching that across the rest of the NHS, by 2028. BAME representation among the non-medical NHS workforce stands at 17%, but only 11% of senior managers are from a BAME background. This falls to 6.4% at very senior level.

Mr Hancock told the King’s Fund in November that 40% of hospital doctors and 20% of nurses in the NHS are from a BAME background, yet BAME representation on NHS trust boards is only 7%. More than half of all NHS trusts in England have no black or ethnic minority staff at the very senior manager (VSM) level.

‘Over 75% of the NHS workforce are women, yet at board level that figure is just 40%,’ he said. ‘We need 500 more women on boards to make them gender balanced,’ he said – a message he has since reiterated.

Mr Hancock continued: ‘However, it’s not just a question of fairness and justice. Diversity of leadership is a diversity of experience, a diversity of perspectives. Different ways of thinking, fresh ideas, new solutions to old and seemingly insurmountable problems.

‘Diversity of thought is essential to the future of the NHS. It is essential to make the best, and most intelligent use, of the £20bn a year extra we’re putting into the NHS.’

New goals published

In July, NHS England and NHS Improvement published guidance outlining goals for health service organisations to reduce the disproportionate rates of disciplinary action taken against BAME staff compared with white staff by 2022.

The position in NHS finance is similar to that in the wider NHS. In the 2017 NHS finance function census, women outnumbered their male colleagues in every grade up to and including band 8b. Women accounted for 61% of the finance workforce, but only 28% of finance directors. Two-thirds of women working in NHS finance were at band 6 and below, compared with 46% of men.

While 70% of the NHS finance workforce in England said they were white British, some 86% of finance directors were white British. However, it should be noted that 11% of organisations did not disclose their employees’ ethnicity.

Success in promoting diversity and inclusion could be measured by whether organisational, cultural and personal beliefs had been shifted, Edward John, FFF’s diversity programme lead, told the conference. Of these, cultural changes would be the trickiest, he added.

Targets could be set and reached, but people in protected groups had to feel welcome and included. They must be supported. ‘We can set targets – great,’ Mr John said. ‘But what about the softer stuff? What makes somebody lack confidence because they think they don’t talk or look the right way?’

He praised the introduction of a BAME representative on interview panels in some trusts – something he believes should be rolled out across the NHS. But he added: ‘In NHS finance, we are behind the curve and need to make an impact. It’s taking a bigger priority and we all need to be behind that.’

Paul Deemer, head of diversity and inclusion at NHS Employers, told the conference about how Australian airline Qantas had turned a AU$2.8bn deficit in 2013 to an AU$850m surplus in 2017. The airline’s chief executive believed this was largely due to the introduction of a culture of inclusivity and diversity.

Business benefits

It’s a bold statement and it attracted the attention of Deloitte, which looked into the business benefits related to diversity and inclusion. It spoke to 50 of its biggest global customers and reported there are eight ‘powerful truths’ on diversity and inclusion. These included:

Diversity of thinking, rather than in numbers and demographics, was the most significant factor in a lot of the organisations’ success

  • Diversity had to be more holistic that just meeting targets – it had to be inclusive too
  • Inclusive leaders cast a long shadow – committed senior board members makes a huge difference
  • Middle managers matter – Mr Deemer said this was often forgotten. This layer of management implements strategy, so their buy-in can determine success or failure
  • Tangible goals must be set.

Asked what finance departments should be doing now, Mr Deemer said they should make equality impact assessments of their recruitment processes. ‘I would also encourage you to speak to your HR colleagues and see if there’s any way to integrate some of your work with their work to get cross-fertilisation of ideas, which I find really exciting,’ he said.

In a session on unconscious bias, delegates heard that everyone holds unconscious prejudice or stereotypes. The key to addressing these is first to pay attention to your reactions to people, news or social media posts and have the courage to be honest that you hold these biases, according to consultant Desiree Silverstone.

These thoughts can be countered using a range of strategies, including avoiding generalisations; being more positive about people you have stigmatised; putting yourself in someone else’s shoes; and increasing opportunities for contact with a diverse range of people, she added.

Speakers shared their own experience of discrimination. Arnold Palmer, a coach and mentor, and former NHS finance director, said: ‘I remember going to my first finance directors’ meeting in London and being the only black face there. It’s not like that now and I am really pleased the NHS is moving in the right way.’

Many speakers and delegates spoke of imposter syndrome – a feeling of inadequacy based on looking or being different from peers, despite doing the same job just as well. Lei Wei, deputy chief financial officer at North West London Collaboration of CCGs, spoke of her discomfort at her first regional meeting. ‘I looked around and thought, “I don’t think I belong here” as I was surrounded by middle-aged men in grey suits. At first, I wanted to run out but then one of the speakers called me over.’

But instead of words of encouragement, he was asking for help as he thought she was one of the conference support team. The key was to draw strength from these difficult situations, she said. ‘It was quite difficult at first, but it is important to remind yourself that this is something you really want to do. If it is what you want, keep going and don’t let some bad experiences scare you away.

 ‘We need to set a good example; speak up and challenge bad behaviour and put diversity and inclusion in our day-to-day work. We must listen to the views and good ideas of people from diverse backgrounds. Gradually, people will listen, and the culture of the organisation will change.’

While much of the attention has been on discrimination on the grounds of sex and race, the event included a welcome focus on discrimination against people with disabilities. The conference heard that though only 3% of NHS staff declare a disability on their electronic staff record, around five times more said they are disabled in the (anonymous) NHS staff survey. It appears that 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.’

The promotion of diversity and inclusion is now at the top of finance departments’ agendas – as it is in the wider NHS – and finance leaders will seek to use some of the tips provided at the conference to find a better balance. 
Reversing the trend

Many finance managers will have experience of mentoring, but not so many will have experienced reverse mentoring, whereby they are mentee to a more junior member

of staff. A new project aims to use the latter to help address issues of diversity and inclusion in the NHS.

ReMEDI (reverse mentoring for equality, diversity and inclusion) expands reverse mentoring to include mentors to people with less (perceived) power, in a more disadvantaged position or under-represented group or from a marginalised or oppressed group.

Stacey JohnsonStacy Johnson (pictured), programme lead and University of Nottingham associate professor, told the event that there was growing evidence that reverse mentoring can stop individuals acting in a discriminatory way, change organisational culture in gender and race equality, and contribute to organisational diversity and inclusion.

ReMEDI has been operating across around 15 NHS organisations. It is being evaluated, though Ms Johnson recognised that individual organisations are at various stages in their development of reverse mentoring to improve diversity and inclusion.

The programme has been welcomed, she said. One board member had told her that being a reverse mentee was the most important piece of work they had done in 30 years in the NHS.

Finance leaders were particularly keen to be involved, she added. ‘I believed the finance professionals would be the hardest nut to crack but my stereotypes are so not borne out.’

Her assumption was that finance staff would be cynical and uncaring about patients. ‘But finance directors have been a revelation – that’s why I’m so pleased to be here [at this event].’

She highlighted Guy’s and St Thomas’ NHS Foundation Trust chief financial officer Martin Shaw who filmed a video (available on YouTube) with his reverse mentor – no-one else had done this, she added.

The programme aims to disrupt the traditional power dynamic by giving lower band staff an opportunity to speak up without consequence. But, to be successful, reverse mentoring had to go beyond cosy chats about cultural differences, she added.

‘If you want inclusion, you can’t limit the conversation just to culture. And you can’t just pick two people and hope for the best when you are pairing mentor and mentee. We want to facilitate different conversations – not just about culture. You want conversations that are uncomfortable.’

Going beyond

The London-based Going beyond programme continues to evolve and grow, with strong support from London regional finance director Ann Johnson.

The programme aims to support and expand the number of women and BAME finance staff at senior levels. It focuses on supporting these staff in bands 8c and above to step up to finance director posts.

Going beyond is now part of a new umbrella structure, explains Central and North West London NHS Foundation Trust chief finance officer, Hardev Virdee, who, along with Chelsea and Westminster NHS Foundation Trust chief financial officer Sandra Easton, is leading the programme.

An overarching London finance talent board has been established to bring together several workstreams on diversity and inclusion, as well as those supporting talent development in general. In addition to Going beyond, the workstreams include projects from the HFMA London Branch, the NHS Leadership Academy and FFF.

Hardev VirdeeMr Virdee chairs the talent board, with Ms Easton providing representation at a national level. Both are due to move to new roles shortly, but will continue their work with Going beyond and the talent board.

Six modules have been developed for Going beyond and approved by the talent board. The modules, which are due to be launched shortly, are designed to help staff take a step up. They include:

  • Understanding yourself – defining career goals, understanding skills gaps and addressing confidence issues
  • Understanding the organisation – relationship management, working with peers and non-executives and managing poor performance in others
  • Understanding the role – how to influence and make an impact, negotiation and leadership
  • Understanding the environment – change management project, system leadership, working with partners and engaging with the private sector
  • The interview – CV review, simulated interview, recruitment agency support and feedback
  • Lived experience – delivered by chief finance officers, candidates look at ‘what it takes’ to do senior jobs and they gain shadow experience.

‘We are working with the HFMA branch and with FFF to help people understand what we are doing and how we can best support them in terms of diversity and inclusion,’ Mr Virdee says.

‘I think we are seeing more good practice as a result of what we are doing. It seems more commonplace to have more diverse interview panels at senior level and shortlisted candidates from a wider background, so we must ensure that we build on this.’

Though focused on London for now, other regions have shown interest in Going beyond. ‘It is designed so it can be easily replicated. I expect it will be rolled out across the country as good practice,’ he adds.
Supporting documents
Diversity balancing up