1. 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 2017, in line with the NHS England mandate.

2. Background

The 2016/17 NHS Standard Contract included a new 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.

2.1 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.

3. Matters for consideration

3.1 Summary of UHB's results against each metric

Workforce indicators

For each of these four workforce indicators, the standard compares the metrics for white and BME staff.

1. Percentage of staff in each of the Agenda for Change (AoC) bands 1–9 and VS (including executive board members) compared with the percentage of staff in the overall workforce

29.23% BME staff in workforce overall.

Non-clinical staff

Clinical staff

The total percentage of BME staff in the workforce has increased this year from 27.9% to 29.23%.

However, we note a difference in the percentage of BME and white staff at different banding levels. BME staff are more represented in the lower bands.

However, at clinical bands 5–7 there is a higher representation of BME staff. We will endeavour to create career pathways to aid clinical staff to move into higher banded management posts in future years.

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 Trust has developed a middle management leadership programme at 8a and b which will be extended to levels 6 and 7 to ensure that all staff at these grades are given the opportunity to progress to the higher level 8 grades over time.

2. Relative likelihood of BME staff being appointed from shortlisting compared to that of white staff being appointed from shortlisting, across all posts

The data used is from April 2016 – March 2017.

Data for the previous year was recorded differently and we must exercise caution in comparison. Next year’s WRES will give us comparative data in order to make clear comparisons.

We have cautioned against a direct comparison. Improvement may be attributable to inclusion training, and in particular unconscious bias training, but it is too early to claim a direct correlation.

Action

We will make unconscious bias training mandatory for all managers involved in interviewing with the target in year one of at least one member of the panel being trained and able to challenge unconscious bias where applicable.

3. Relative likelihood of BME staff entering the formal disciplinary process, compared to that of white staff, as measured by entry into a formal disciplinary investigation

Note: this indicator is based on data from a two year rolling average of the current year and the previous year.

This year has seen a decrease to 1.52 times more likely. This decrease follows a further decrease from 1.96 in 2014/2015.

This improvement may be due to the inclusion of unconscious bias training in all of our inclusion training, and a specific three hour long session for senior managers on unconscious bias. The focus of the training specifically challenges managers to reflect on their unconscious bias with regard to initiating formal process for their staff and in their recruitment.

Action

Continue to roll out inclusion and unconscious bias training for managers, and consider making this training mandatory for investigating managers.

Add bespoke targeted HR training where ‘hotspots’ are noticed across all workforce metrics.

4. Relative likelihood of BME staff accessing non-mandatory training and CPD, as compared to white staff

The relative likelihood of BME staff accessing non-mandatory training compared to white staff is 0.98, indicating the likelihood is very similar for both groups. The likelihood has also remained static over the past year.

All staff have access to non-mandatory training, which is promoted via the internal intranet site and through management communication channels. In particular, annual appraisals identify training needs resulting in training uptake through an agreed personal development plan. Additionally, staff can access, independently of their manager, training via the me@QEHB portal.

Our staff survey result of 4.11 (out of 5.0) indicates the quality of our non-mandatory training is highly rated by staff.

Mandatory and non-mandatory training is seen as key to staff performance and ability to do their job. As such there is significant emphasis on training and development across all staff groups.

National NHS staff survey findings

For each of these four staff survey indicators, the standard compares the metrics for the responses for white and BME staff for each survey question.

5. (Q15a) Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in the last 12 months

This year we have noted a 5% increase in BME staff reporting that they have experienced harassment, bullying or abuse from patients, relatives or the public in the last 12 months. Last year’s WRES also showed a 5% increase

The percentage of white staff reporting has stayed static, although is at a higher level than that of BME staff.

We have seen an increase in patients presenting with mental health issues and those with no right recourse to public funds. With both groups we have seen an increase in violent and aggression.

We have noticed an increase in reporting of verbal abuse asking staff “when are you going home?”. This typically comes from an older generation. The Trust has robustly supported staff with clear messages from the CEO, and a reiteration of our intolerance of the bullying and harassment of our staff.

The 2016 NHS staff survey reported the average for acute Trust staff experiencing bullying, harassment and abuse is 27%. Despite being lower than the national average, this increase in abuse of BME staff indicates an area for concern.

The Trust has recently introduced flexible visiting and published a Visitor Charter. This charter makes explicit reference to violence and aggression and what our expectations are of visitors. Importantly, the charter also makes clear what visitors can expect from staff.

• View the Trust’s Visitor Charter

The Trust’s online Datix reporting system is a ‘live’ system that enables immediate reporting. Daily summaries of violence, aggression and harassment reported by staff, whether from colleagues or patients/visitors, is circulated to a key group (including the Head of Inclusion Engagement and Wellbeing) at 08:00 every morning enabling immediate responses/intervention to issues raised.

Action

Conflict resolution training will, in future, contain increased content, definition and description of what constitutes bullying and harassment and will encourage reporting.

6. (KF 26) Percentage of staff experiencing harassment, bullying or abuse from staff in the last 12 months

This year we have seen a 4% decrease in the percentage of white staff experiencing harassment, bullying and abuse from other staff, compared to a 5% increase in the percentage of BME staff. This means the difference between white and BME staff experiencing harassment and abuse from other staff has increased.

When at work, staff should be free from abuse, harassment, bullying and violence from any source. At UHB, we encourage staff to report immediately any behaviour that falls into these categories (see Datix entry above and conflict resolution training).

We also have a Freedom to Speak Up Guardian (FTSUG), who is there to support staff who wish to raise a concern or report any inappropriate behaviour if necessary. This role is shared with the Head of Inclusion and Engagement and Wellbeing, and the Lead Nurse for Quality and Clinical Standards, to ensure organisational awareness of issues raised.

Action

• We will introduce a BME Network in the next 12 months to actively engage with our BME workforce and complement the existing networks
• We will carry out bullying and harassment campaigns to highlight all aspects of bullying and harassment across the protected characteristics
• We will use staff survey data, where possible, to ‘drill down’ to identify hot spot areas and provide additional training and support

7. (KF 21) Percentage believing that the Trust provides equal opportunities for career progression or promotion

The percentage of both BME and White staff believing the trust provides equal opportunities has reduced slightly for both groups, with the percentage of white staff agreeing decreasing by 2%, compared to a 4% decrease among BME staff.

The 2016 staff survey Trust average was 86%, compared to a national average of 87%. This indicates we are at the average for acute trusts.

The Trust ensures strong support for Black History Month, with the CEO launching the month. This year, we focused on the experiences and achievement of our own staff with screensavers and poster exhibitions of their lives, both in the NHS and outside, in their own words. We were keen to make the connection to people who others could meet and speak to, rather than historical or national figures where there would inevitably be a degree of detachment.

8. (Q17b) Percentage of staff reporting having personally experienced discrimination at work from a manager, team leader or other colleagues

The percentage of white staff experiencing discrimination from managers and colleagues has remained stationary this year, while the percentage of BME increased slightly by 2%.

The percentage of BME staff experiencing discrimination from managers and colleagues is 2.5 times greater than that of white staff.

Action

In addition to the establishment of a BME network we will arrange a number of confidential ‘listening events’ for staff, to hear directly what issues staff are experiencing. We will robustly follow up issues raised so that staff can be confident in raising their concerns.

Boards

Whether the board meet the requirements on board membership, as per indicator 9.

9. Percentage difference between the Trust’s board voting membership and its overall workforce

Reporting year

Previous year

Our board has remained stable over the past five years, with our percentage of white membership staying at 94.1% compared to 5.9% BME.

One new appointment to the board has been made in the past five years. We are aware that the current board is not representative of the ethnicity of the local population we serve. However, a stable board has been noted as a positive factor for supporting neighbouring trusts in the local health economy.

It is worth noting that managers immediately below board level are a more diverse group of people, providing representation and sitting in the pipeline as future board members.

3.2 Recommendations identified to support the Trust's performance against the metrics, where gaps have been identified between white and BME staff

Recommendation 1: Extension of middle management leadership programme to bands 6 and 7

• The Trust has developed a middle management leadership programme at bands 8a and 8b which will be extended to bands 6 and 7, to ensure that all staff at these grades are given the opportunity to progress to band 8 over time
• Marketing and communications about the extension will target band 6 and 7 clinical staff, as this has been identified as an area with a higher representation of BME staff

Recommendation 2: Continue to address unconscious bias, making unconscious bias training mandatory for all recruiting managers

• Continue to roll out inclusion and unconscious bias training for managers
• Unconscious bias training will be made mandatory for all managers involved in interviewing, with the target for year one of at least one member of an interview panel being trained and able to challenge unconscious bias where possible
• Add unconscious bias training to bespoke targeted HR training, where ‘hotspots’ are identified across all workforce metrics

Recommendation 3: Address bullying and harassment within the Trust

• Continue to respond to daily Datix reports on bullying, harassment and abuse, ensuring that action is taken immediately and face-to-face interventions continue
• Carry out bullying and harassment campaigns to highlight all aspects of bullying and harassment across the protected characteristics. We will use staff survey data where possible to identify areas of concern and provide additional training and support
• Conflict resolution training will in future contain increased content, definition and description of what constitutes bullying and harassment, and encourage reporting

Recommendation 4: Establish a BME staff network

• We will introduce a BME network within the next 12 months to actively engage with our BME workforce and complement existing networks
• We will arrange a number of confidential listening events for staff, to hear directly about the issues that staff are experencing, with robust follow up on issues raised so staff can be confident in raising concerns

4. Implications (including financial, consultation, equalities, HR and legal)

The WRES has implications under the Equality Act 2010, and supports the Trust to undertake its obligations under the public sector equality duty. The WRES is a mandatory requirement under the NHS standard contract.