Purpose of report

The report sets out University Hospitals Birmingham NHS Foundation Trust’s performance information against the nine mandatory NHS Workforce Race Equality Standard (WRES) metrics. The metrics cover the workforce profile, staff survey, and board composition by ethnicity. The report also details the calculations and analyses the results against each metric, with recommendations for improvements where appropriate. The report is due to be published in August 2019, in line with the NHS England mandate.

Report on the WRES indicators

The NHS Standard Contract includes a Workforce Race Equality Standard which requires large health care providers and CCGs to demonstrate progress against nine workforce race equality metrics, including a specific indicator which looks at the ethnic composition of boards.

The nine metrics

• Metric 1: Percentage of staff in each of the Agenda for Change Bands 1 – 9 and VSM (including executive Board members) compared with the percentage of staff in the overall workforce
• Metric 2: Relative likelihood of black and minority ethnic (BME) staff being appointed from short listing compared to that of white staff, across all posts
• Metric 3: Relative likelihood of BME staff entering the formal disciplinary process, compared to that of white staff
• Metric 4: Relative likelihood of BME staff accessing non-mandatory training and continuing professional development (CPD) compared to white staff
• Metric 5: Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in the last 12 months
• Metric 6: Percentage of staff experiencing harassment, bullying or abuse from staff in the last 12 months
• Metric 7: Percentage of staff believing that the organisation provides equal opportunities for career progression or promotion
• Metric 8: Percentage of staff that have personally experienced discrimination at work from manager, team leader, or other colleague in the last 12 months
• Metric 9: Percentage difference between the Trust's board voting membership and its overall workforce

NHS England has produced technical guidance for the NHS Workforce Race Equality Standard, detailing the requirements and how organisations should report their information against the metrics.

Baseline data has been produced for each metric together with an analysis of the results. The data for metrics 5 – 8 is based on the results of the 2016 NHS Staff Survey.

Report on the WRES indicators

Indicator 1: Percentage of staff in each of the AfC Bands 1 – 9 and VSM* (including executive Board members) compared with the percentage of staff in the overall workforce. 

*Excludes medical and dental staff

Background and implications

As at 31 March 2019 there are 28.10% BAME staff compared to 26.68% BAME staff in 2018 in the overall workforce. BAME staff are underrepresented overall when compared to the local population surrounding the four hospital sites (BAME local population = 42%). BAME staff are further underrepresented in senior positions, and compared to the previous year’s data, although the Trust has seen a slight increase in BAME staff in the senior bands, the numbers are disproportionate to the overall percentage of BAME staff in the workforce. Note: the 4.55% increase in Non-Clinical band 8d relates to the gain of 1 BAME staff member (total number of staff in band 8d = 22). For VSM non- clinical posts in 2018, there were 27 VSM staff all of which were white. In 2019, this number increased to 49 VSM of which 4 are BAME.  It is a similar picture for VSM clinical posts, in 2018 there were 3 VSM staff of which 1 was BAME. In 2019, this increased to 17 VSM of which 3 are BAME. The increase in the number of VSM staff in total can be contributed to the merger and the reorganisation amongst the most senior bands.

Actions taken

There have been a number of successful actions and initiatives implemented throughout 2018/19 which include:

• The Trust’s BAME staff network continues to grow in membership and positively influences equality initiatives across UHB.
• Unconscious bias training has been included in the Consultant’s 4 week induction programme and as part of the Trust’s Recruitment and Selection training and HR Masterclasses, including disciplinary and grievance training.
• The Trust has incorporated an Inclusion DVD for all new starters joining the Trust as part of Corporate Induction which covers cultural awareness amongst other inclusion topics.
• The Trust includes positive action statements on all Band 8/9/VSM job adverts.
• The Trust is developing an internal portfolio of leadership programmes which will include unconscious bias and will be made available to all managers in the Trust in order to raise awareness of how the different types of bias and discriminatory behaviours can occur in day to day management.
• The Trust has invested in a leadership development programme for the senior leaders which includes a session on inclusive leadership and recognising bias. To date 60 managers have attended and 8 of those are BAME.
• The Trust has improved access to mentoring (including reverse mentoring), shadowing, coaching and supported staff to join NHS Leadership Academy Programmes such as “Stepping up” for BAME bands 5 – 7 and “Ready Now” for BAME staff 8a and above. A number of Trust BAME staff are currently undertaking these courses and will feedback at the BAME staff network meetings.
• The Trust in partnership with the BAME staff network has invited a number of guest speakers to attend the network meetings to inspire and motivate staff. These include Dame Elizabeth Anionwu and Paul Reeves from NHS England.
• In October 2018 the Trust held a successful Black History Month conference which heard from a panel of external experts and internal staff who debated a range of subject matters including, BAME health inequalities, BAME leadership opportunities, BAME representation and the impact of WRES, amongst others. Plans are well underway to hold another Black History Month Conference in the Trust in October 2019.

• Following the success of the Trust’s Black History Month Conference in 2018, a new initiative called “Aspire” was established to support professional development and good recruitment practices at all levels of the organisation. Open to any internal candidate who feels they would benefit, with a particular emphasis on candidates from under-represented groups, or who have accessed the careers clinics, Aspire coaches internal candidates prior to their interview. This is part of a holistic approach to leadership and professional development and the Trust’s commitment to a positive and inclusive working culture.

Indicator 2: Relative likelihood of staff being appointed from shortlisting across all posts

The information taken from NHS Jobs shows there have been more BAME applications (55%) than White applications, (45%) for all positions across the Trust. However, even though there are more BAME applicants than White applicants, the numbers appear to even out at the point of shortlisting with 48% BAME candidates shortlisted and 52% White candidates shortlisted. Yet despite the relative even number of BAME and White candidates shortlisted there appears to be twice as many White candidates appointed (64%) compared to (36%) BAME appointments.Background and implications

When compared to the analysis of national data undertaken by the National Workforce Race Equality Standard Team for all NHS Trusts, the average across healthcare providers is 1.60 times greater, which is representative of the data for UHB.

Actions taken

The Trust recognises that further investigation is required in order to understand the reasons for the disparity between shortlisted and appointed BAME applicants, however, a number of actions have been implemented to address the disparity in the recruitment and selection figures including:

• Unconscious Bias for Recruiting Managers has been incorporated into the revised recruitment and selection training for all managers with recruiting responsibilities. We require at least the Chair of any panel to have received the Trusts recruitment and selection training.
• The Trust has ensured, where possible, the interview panel is diverse and must consist of at least 3 panellists, one of which must be "external" to the hiring department, someone who knows the job but not the team. This is to ensure cognitive diversity, objectivity and impartiality to challenge the decision making process amongst the panellists.
• The Trust has formalised the recruitment process for "acting up" and all internal positions to improve fairness and equality to opportunity.
• We have worked with critical friends to identify areas for improvement and best practice, such as, attendance at the National WRES forums where Trusts share their experiences with each other in order to improve the disparity amongst the recruitment and selection figures.
• We have reviewed the wording of our job descriptions and person specifications to make them more intuitive, inclusive and not so NHS experience orientated so as not to exclude outside applicants.
• We have looked to utilise innovative ways to attract applicants, such as, greater use of social media platforms and job fairs, in order to create a wider and more diverse talent pool from which to fill the Trust’s vacancies.
• The Recruitment Manager conducts a regular monthly audit on a random selection of recruitment files to ensure the correct process has been followed and a report of the findings is presented to the Director of HR. This recently introduced initiative has sent out a strong message to hiring managers that the Trust takes fairness in recruitment and selection very seriously and that scrutiny will be paid to ensure that a fair and evidence based process, without bias, has been followed.
• The Trust has implemented a new initiative called "Aspire" was been established to support professional development and good recruitment practices at all levels of the organisation. Open to any internal candidate who feels they would benefit, with a particular emphasis on candidates from under-represented groups, or who have accessed the careers clinics, this new initiative will coach internal candidates prior to their interview and support interview panels with good recruitment practices.

Indicator 3: Relative likelihood of staff entering the formal disciplinary process, as measured by entry into a formal disciplinary investigation. 

Background and implications

Nationally BAME staff are twice as likely to enter formal disciplinary processes and be disciplined for similar offences than White staff. The Trust recognises that further investigation is required in order to understand the reasons for the disparity between the relative likelihood of BAME staff entering a formal disciplinary investigation. 

Actions taken

There have been a number of actions implemented over the most recent 12 months including:

• The Trust has introduced Unconscious Bias training into the HR Masterclasses, including disciplinary and grievance training, for all managers in the Trust.
• HR has continued to ensure that managers receive training on the relevant Trust policies, including the disciplinary policy, and that the training will include raising awareness of how biases can occur and reinforce the need for fairness and consistency when applying Trust policies.
• The Trust has introduced internal leadership programmes for managers which includes an emphasis on the protected characteristics and focusing on how workplace issues impact on personal performance and workplace wellbeing.

Indicator 4: Relative likelihood of staff accessing non-mandatory training and CPD.

Background and implications

Results based on the data taken from Easy Learning, as of March 2018, suggest that BAME staff are more likely to access non-mandatory training.

Actions taken

A number of actions have taken place over the past year which includes:

• Improved awareness and access to non-mandatory training, such as mentoring (including reverse mentoring), shadowing, coaching and encouragement to join NHS Leadership Academy programmes such as "Stepping up" and "Ready Now" and other courses.
• The personal and professional progression of BAME staff in the Trust was profiled as part of the Trust’s role model campaign to inspire and motivate others.
• Delivery of a senior leadership development course designed to reflect the Trust's new vision and values, the management of change and resilience, and behaviours needed to create a positive and inclusive culture.
• The Trust offers a series of monthly short leadership masterclasses / workshops across a range of leadership developmental activities topics designed to bring managers / leaders together in a discursive way.
• The creation of shadowing opportunities for staff either new in their role or those wishing to gain exposure to senior leadership activities e.g. observing a board meetings / CIAG.
• As part of our leadership development strategy, we are introducing a mentoring programme to enable colleagues to benefit from the vast experience and expertise of our senior leaders. We want UHB to continue to be a place where people can grow their careers and where we actively nurture our people, ready to take up future leadership positions across the organisation. In the pilot phase of the programme, we will be offering mentoring to our top 300 senior leaders, while increasing the number of mentors we have over the next 12 months. 
• The Trust has invested in purchasing a suite of training video material from an external training provider, Skills Booster, which includes videos on cultural/racial awareness, micro aggression, inclusive leadership, amongst other related topics. The videos are available to all staff on the Trust’s training platform Moodle.

Each of the following four indicators compares the outcomes of the responses for White and BAME staff. The results are taken from the Trust’s National Staff Survey Results 2018.

Indicator 5: Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months

Background and implications

The results for BAME and White staff indicate a similar experience of harassment, bullying or abuse from patients. The data shows there has been an increase in the percentage of BAME staff and White staff reporting harassment, bullying or abuse from patients since the previous year.

Actions taken

During the last 12 months the Trust has:

• Continued to implement and embed conflict resolution and resilience training to support staff.
• The BAME staff network continues to offer a source of advice and support for staff.
• A Challenging Behaviour Steering Group has been established consisting of key stakeholders in the Trust aimed to address the increase in abuse from patients and relatives and will further develop training and equip our staff with the tools to have difficult conversations that challenge discrimination.
• A poster campaign, led by Security, was launched throughout the Trust which consists of a series of posters which say the Trust will not tolerate any form of violence or abuse towards our staff. The posters have been placed in all patient areas. One poster has been specifically designed to address racial abuse from patients or the public.

Indicator 6: Percentage of staff experiencing harassment, bullying or abuse from staff in the last 12 months

Background and implications

The results for BAME and White staff indicate a similar experience of harassment, bullying or abuse from staff. The data shows there has been a slight decrease in the percentage of BAME staff and White staff reporting harassment, bullying or abuse from staff since the previous year.

Actions taken

The Trust has carried out the following actions during the last year:

• Continued to improve awareness of the Freedom to Speak up Guardian who will support a group of staff acting as confidential contacts. This provides a confidential service for staff to approach for advice where they feel they may have experienced harassment and that this may have been associated to their race.
• Continued to improve awareness of the Trust’s confidential contacts and recruited specific BAME confidential contacts as well as promoted other well-being initiatives.
• The BAME staff network offers a source of advice and support for staff by actively engaging with our BAME workforce.
• The Trust has held a number of forums with staff to understand better the positive behaviours which are aligned to the new Trust values. This will be part of a wider work stream to develop a code of conduct for staff.

Indicator 7: Percentage believing that the Trust provides equal opportunities for career progression or promotion

Background and implications

Whilst there has been a slight decrease for both White and BAME staff in the reported belief that the Trust provides equal opportunities for career progression, the percentage of BAME staff is significantly lower than the percentage of White staff. The implications maybe that BAME staff may not put themselves forward for career progression.

Actions taken

During the last year the Trust has implemented a number of actions which include:

• Formalised the recruitment process for "acting up" and all internal positions to improve fairness and equality to opportunity.
• Improved awareness and promotion of access to leadership programmes such as “Ready Now” and “Stepping Up” for BAME staff.
• The personal and professional progression of BAME staff in the Trust was profiled as part of the Trust’s role model campaign to inspire and motivate others.
• The Trust continues to work with partners to develop an offering of career clinics and access to career advisors for staff in order to provide advice and support to those looking to advance personally and professionally.

Indicator 8: In the last 12 months have you personally experienced discrimination at work from any of the following: Managers/Team Leaders or other colleagues?

Background and implications

The proportion of BAME staff saying they have personally experienced discrimination at work from their manager, team leader, or colleague has remained the same as the previous year. However, the number of BAME staff is over double that of White staff which is disproportionate to the overall number of BAME staff in the workforce.

We have a disconnect between National Staff Survey data in this area of reporting and Trust internal reporting that needs further exploration. This suggests BAME staff are not actively reporting discrimination via Datix when it occurs during their day to day work life.

Actions taken

• Implemented the Trust’s revised Dignity at Work policy that will provide effective support for staff experiencing harassment.
• The Trust has included Unconscious Bias training to all managers in the Trust.
• Corporate Induction includes an Inclusion video for all new starters to promote equality, fair treatment and inclusivity in the workplace.
• Continuation of the BAME staff network as a source of advice and support for staff.
• The Trust has commenced engagement forums for staff that reinforce the positive behaviours aligned to the Trust’s new values.
• Increased engagement opportunities to hear and listen to staff and using staff feedback to shape programmes of work to enable change.

Indicator 9: Percentage difference between the organisations' Board voting membership and its overall workforce

UHB Trust Board consists of 24 members of which 2 are BAME (both of which are Non-Executive Board members)

• 28% of the total workforce is BAME
• 8% of the Trust Board is BAME

BAME voting Board members has remained the same as the previous year with 2 members who are BAME. However, the overall BAME representation on the Board is disproportionate to the overall BAME workforce and the BAME local population. It should be noted that the Trust has a very stable management structure at senior level which leads to few opportunities becoming available for staff to progress to higher grades. The recent merger provides the Trust with a broader opportunity for staff mobility and increases the specialities in which they can work.

The Trust has taken the following actions:

• Job advertisements for positions on the Board include language which invites candidates who could help the Trust engage effectively with the diverse population that we serve, especially those from a minority ethnic background.
• The Trust continues with the review of the advertisement routes and options to attract BAME candidates to the Board.
• The Trust continues with the positive action statement on all job advertisements for Board Members and will look to innovatively utilise routes for recruitment in order to attract from a wider and more diverse talent pool.

Next steps for 2019/20

Following the merger, inclusion at UHB is the responsibility of the Executive Chief Nurse. Under her direction the Inclusion Team will work on developing our inclusion strategy and work plan which will provide robust governance and measurable objectives in order to enable change for staff and patients particularly from our underrepresented groups.

This will include:

Deliver a seminar to Trust Board on Inclusion

The Executive Chief Nurse, supported by the Inclusion Team, will deliver a seminar to the Trust Board on Inclusion in order to raise awareness and improve understanding. The seminar will provide reassurance to the Board of the activity undertaken in the Trust to reinforce inclusion and foster a culture of acceptance. This will include details of the statutory inclusion reporting requirements, staff training and initiatives and ways in which staff are able to be seen and heard by the Trust Board through the governance structures in place.

Responsibility: Executive Chief Nurse.

Trust Board approval of the Inclusion Strategy

The Executive Chief Nurse, supported by the Inclusion Team, will present the Inclusion Strategy and objectives to the Trust Board for approval. The newly developed inclusion strategy will include WRES, WDES, EDS, Stonewall, Gender Pay Gap and measurable objectives to be achieved over an agreed timeframe.

Responsibility: Executive Chief Nurse.

Changing the way we make decisions on application of the disciplinary process.

The introduction of a senior review panel for all employee relations casework will review all cases and includes individuals with a key protected characteristic or where the case relates to a protected characteristic. It will mean reviewing allegations and initial facts before any casework is commissioned to determine whether formal action is justified and equitable and there will be fortnightly reviewing of any cases that are commissioned.

Responsibility: Deputy Director of HR for Operations and Deputy Chief Nurse.

Changing the way we conduct recruitment and selection processes

A task and finish group will be established to understand better the experiences of BAME nurses in the Trust and the barriers they are experiencing to career progression. Alternative methods for selection, rather than sole reliance on the traditional interview, will be explored such as assessment centres for nurse promotions and high volume nursing recruitment.

Responsibility: Deputy Chief Nurse.

The Trust will explore innovative ways of selection which will reduce the emphasis on the face to face interview. This will involve working with national and local partners to share best practice and implement new ways of conducting recruitment and selection in the Trust. In addition, to attract recruit and retain from a more diverse pool of talent the Trust will forge links with key community stakeholders and showcase UHB as an inclusive employer of choice.

Responsibility: Head of Inclusion and Deputy Director of HR.

Increase knowledge, skills and confidence for senior and middle management

The Trust will develop a comprehensive inclusion training offer for leaders in the Trust to increase confidence and the use of discretion.  This will include a focussed inclusion programme to ensure equality of access to training and development opportunities including Nursing Associates, Specialist Practice and leadership roles. The Trust will develop a portfolio of internal leadership programmes which will be available to all staff and will provide the knowledge, skills and confidence to advance in their careers.

Responsibility: Head of Inclusion and Head of Staff Experience and Deputy Director of HR.

Extend and develop the Trust’s staff networks including the BAME staff network

The Trust will extend and develop the staff networks as a source of advice and support for staff as well as a forum to consult, influence, inform and celebrate change. This will involve formalising the role of the network groups, the Chairs, and setting measurable objectives and outcomes.

Responsibility: Head of Inclusion.

The Trust will monitor and measure the performance against these specific objectives through the WRES and quarterly reports presented to the Inclusion Stakeholder Steering Group.