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 2018, 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

1. Background narrative

a. Any issues of completeness of data

No

b. Any matters relating to reliability of comparisons with previous years

In previous years we did not use NHS Jobs so it was not possible to gather short listing data. We now have 2 full years of data so moving forward we will be able to report.

2. Total numbers of staff

a. Employed within this organisation at the date of the report

9332

b. Proportion of BAME staff employed within this organisation at the date of the report

30.7%

3. Self reporting

a. The proportion of staff who have self-reported their ethnicity

97.7%

b. Have any steps been taken in the last reporting period to improve the level of self-reporting by ethnicity?

Yes. All new starters are shown the functionality of Me@qehb, the multi-functional staff portal. This facility allows all staff to self-report against the protected characteristics. It is also explained why reporting is important and what the organisation does with the data. UHB NHS FT merged with Heartlands NHS FT on 1^st April 2018. We will therefore now embark as a trust in raising the awareness of reporting in a concerted campaign.

c. Are any steps planned during the current reporting period to improve the level of self-reporting by ethnicity?

Yes. It is our intention to launch a trust wide campaign to encourage staff to self-report across all of the protected characteristics to improve self-reporting across other indices as well as ethnicity. This was delayed from the last reporting period in order to ensure a new Trust wide approach post-merger.

4. Workforce data

a. What period does the organisation's workforce data refer to?

For the year 1^st April 2017 – 31^st March 2018. Staff headcounts are accurate for 31^st March 2018.

5. Workforce Race Equality 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

* VSM is staff on Bands 8d and 9, Executive Directors, Chair and Non-Executive Directors

Non-clinical staff (excludes medical staff)

Clinical staff

Background and implications

The total percentage of BAME staff in the workforce has increased this year from 29.23 to 30.7.

We acknowledge the difference in the percentage of BAME and White staff at different banding levels. BAME staff continue to be more represented in the lower bands.

BAME clinical staff have a higher level of representation at band 5. Post-merger we will endeavour to create career pathways to aid clinical staff to move into higher banded management posts in future years and address the idiosyncrasies across the four main hospitals that serve very different populations.

Actions taken

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. However, the merger by acquisition of Heartlands NHS FT provides UHB with a broader opportunity for staff mobility and increases the specialities in which they can work.

A BAME Staff Network continues to grow in membership and positively influence equality across UHB, with the newly established Queen Elizabeth Network now fully active. The Networks are active in their contribution to the WRES and scrutiny of other policies and procedures.

Unconscious Bias training has been included in the Consultant’s 4 week induction programme and as part of the Trust’s Recruitment and Selection 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

The Trust includes positive action statements on Band 8 and 9 job adverts.

The Trust has profiled the career progression of BAME staff from across the bands, including those from middle and senior management, as part of a Role Model campaign.

Actions planned

The Trust will explore options to introduce leadership programmes, which will include unconscious bias, to all managers in the trust to reduce bias and discriminatory behaviours.

The Trust will work with local BAME community groups to raise the profile of the Trust as a diverse employer.

The Trust will work alongside the local community to support local and sustainable recruitment. This involves working alongside local schools to raise the profile of the trust as an employer and advise on career opportunities.

Ensure access to mentoring (including reverse mentoring), shadowing, coaching and encouragement to join NHS Leadership Academy Programmes such as “Ready Now”, for BAME staff 8a and above.

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

Background and implications

We now have 2 years of consistent data from NHS jobs

There has been a slight increase in this indicator since 2017.

The information taken from NHS Jobs shows that BAME applicants make up 42% of shortlisted applications and 32% of appointments at QEH.

Actions taken

Unconscious Bias for Recruiting Managers has been incorporated into the revised recruitment and selection training for all managers with recruiting responsibilities.

The Trust has ensured, where possible, the interview panel is relevantly diverse and that the panel is made up of panellists from other areas of the Trust.

The Trust has formalised the recruitment process for ‘acting up’ and all internal positions to improve fairness and equality to opportunity.

Actions planned

Identify specific areas where there is a failure to recruit BAME staff – especially at senior bands and formulate an action plan to address.

Further investigation is required in order to understand the reasons for the disparity between shortlisted and appointed BAME applicants.

We will work with critical friends to identify areas for improvement and best practice.

We will require that at least the Chair of any panel will have received the Trust’s recruitment and selection training, which includes unconscious bias, to ensure objectivity and impartiality.

Post-merger we have a greater opportunity to draw upon expertise from across the new Trust. We will establish an external* panel member presence on interview panels, someone who knows the job but not the team to ensure greater objectivity and ensure that all interview panels are made up of a minimum of 2 plus the external panellist.

We will review 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 will look to utilise innovative ways to attract applicants, such as, greater use of social media platforms, in order to create a wider and more diverse talent pool from which to fill the Trust’s vacancies.

*External to the department, not the organisation.

Indicator 3: Relative likelihood of BAME staff entering the formal disciplinary process, 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.

Background and implications

This year our figure has decreased significantly since 2017. 21% of disciplinary cases are BAME from a workforce figure of 30.7% BAME

Nationally BAME staff are twice as likely to enter formal disciplinary processes and be disciplined for similar offences than White staff.

Actions taken

We have seen a consistent decrease from 1.96 in 2014/2015 to 1.76 (2015/16 and now to 0.78 in 2016/17 and to 0.78 in 2017/18.

This improvement may be due to the inclusion of unconscious bias training in all of our inclusion training and a specific 3 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.

The discussions regarding unconscious bias has also permeated other discussions, regarding patient care and approaches to patients and relatives who are aggressive or violent.

Actions planned

Continue to roll out Inclusion and unconscious bias training for managers and consider making this training compulsory for investigating managers.

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

We will work with critical friends to identify areas for improvement and best practice.

We will develop training programmes for managers with a particular emphasis on the protected characteristics, focussing on how workplace issues impact on personal performance and workplace wellbeing.

Indicator 4: Relative likelihood of white staff accessing non-mandatory training and CPD compared to BAME staff

Background and implications

The relative likelihood of BAME staff accessing non-mandatory training, compared to White staff, is 0.88, indicating the likelihood is very similar for both groups.

Actions taken

All staff have access to non-mandatory training, which is promoted via the intranet site and through management communication channels, such as Team Brief for staff where access to a PC is limited. In particular, annual appraisals identify training needs resulting in training uptake through an agreed Personal Development Plan.

In addition staff can access, independently of their manager, training via the me@QEHB portal.

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. Our figures indicate that BAME staff do not experience disadvantage.

Actions planned

Across the new combined Trust we will improve awareness and access to non-mandatory training, such as mentoring (including reverse mentoring), shadowing, coaching and encouragement to join NHS Leadership Academy such as ‘Ready Now’ for BAME band 8a and above, ‘Stepping Up’ for BAME band 5 to 7 and other courses.

Improved awareness and visibility of role modelling for BAME staff regardless of band or position.

Delivery of a senior leadership development course designed to reflect the Trust's new vision and values and supportive of transitioning into a new organisation, the management of change and resilience, and behaviours needed to create a positive culture, innovation and leadership beyond authority.

We will conduct 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 implementation of both mentorship (including reverse mentoring) and coaching programmes using the considerable experience of senior staff to help develop emerging talent.

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 meeting / CIAG.

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

Background and implications

This year we have noted a small decrease in BAME staff reporting that they have experienced harassment, bullying or abuse from patients, relatives or the public in the last 12 months. There has been a small increase for White staff.

In addition to last year’s increase in patients presenting with mental health issues and those with no right recourse to public funds. We have seen a ‘shift’ in the city whereby gang violence has shifted away from the city centre and to our immediate catchment area. This has increased reports of violence an aggression especially when rival gang members are being treated at the same time.

Actions taken

Although we have seen a decrease in BAME staff reporting there remains an aggregated increase over previous years. We have seen an increase in reporting of verbal racist abuse and in the number of sanctions handed out to patients and visitors. Flexible visiting has helped our visitors but an increase in violence and aggression generally has negated any improvement from flexible visiting.

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, be that from colleagues or patients/visitors, is circulated to a key group (including the Head of Inclusion and Wellbeing and Workforce Diversity Manager) at 08:00 every morning enabling immediate responses/intervention to issues raised.

In addition staff can access, independently of their manager, training via the me@QEHB portal.

Actions planned

We will extend our red and yellow card sanctions to include relatives and visitors as we have seen an increase in violence and aggression from these two groups.

We will further develop training and equip our staff with the tools to have difficult conversations that challenge discrimination.

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

Background and implications

This year we have seen a small increase in the percentage of White staff experiencing harassment, bullying and abuse from other staff, compared to a 1.96% decrease in the percentage of BAME staff.

Actions taken

Continued to improve awareness of the Freedom to Speak up guardian role that 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 with their race.

Continued to improve awareness of staff support and promoted other wellbeing initiatives that are available to staff.

Established the BAME staff network as a source of advice and support for staff.

Actions planned

We introduced the BAME Network to actively engage with our BAME workforce and complement the other Networks. We are aware that some Trans BAME staff and LGB+ staff have encountered hostility from other BAME staff when they have transitioned or come out. These are small numbers but there is need to address BAME on BAME LGBT+ discrimination.

We plan a multi faith approach to address the faith and cultural issues at play and link them to the relaunched Trust values by discussing with our faith team and agreeing an action plan.

We will develop a code of conduct for staff that reinforces positive behaviours that the Trust expects.

As part of the values and culture work stream, and to support the development of the Trust’s leadership programme, we will develop a DVD which shares the personal experiences of staff from underrepresented groups within our workforce. This will candidly raise awareness of negative behaviours that our staff have experienced and demonstrate that ‘it can happen here’.

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

Background and implications

The percentage of both BAME and Staff believing the Trust provides equal opportunities has reduced slightly for both groups.

Actions taken

We have improved awareness and promotion of access to leadership programmes such as ‘Ready Now’ for BAME Band 8a and above and ‘Stepping Up’ for BAME Bands 5 to 7 and others course.

Actions planned

Continue to encourage access to NHS leadership programmes such as ‘Ready Now’ for BAME band 8a and above, ‘Stepping Up’ for BAME band 5 to 7 and other courses.

Continue to profile BAME role models throughout the Trust and across the bands.

We will work with partners to develop an offering within the Trust of career surgeries and access to career advisors in order to provide advice and support to those staff looking to advance personally and professionally.

Indicator 8: "In the last 12 months, have you personally experienced discrimination at work from your manager, team leader or other colleagues?"

Background and implications

The percentage of White staff experiencing discrimination from managers and colleagues has risen slightly this year, whilst the percentage of BAME decreased slightly by 1.07%.

Actions taken

The Trust has unconscious bias training available for all staff to self-book on to the course.

Corporate induction includes an inclusion and unconscious bias DVD 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.

Actions planned

We will develop a code of conduct for staff that reinforces positive behaviours that the Trust expects.

As part of the values and culture work stream, and to support the development of the trusts leadership programme, we will develop a DVD which shares the personal experiences of staff from underrepresented groups within our workforce. This will candidly raise awareness of negative behaviours that our staff have experienced and demonstrate that ‘it can happen here’.

We have a disconnect between National Staff Survey data in this area of reporting and Trust internal reporting that needs further exploration.

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

Reporting year

Previous year

Background and implications

Our board has remained stable over the past 5 years, but has changed since the merger with Heart of England FT.

BAME voting Board members has increased by 1 member which is BAME. However as the Board has increased by 6 members the overall BAME representation is disproportionate to the overall BAME workforce and the BAME local population.

Actions taken

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. However, the merger by acquisition with Heart of England NHS FT provides UHB with a broader opportunity for staff mobility and increases the specialities in which they can work.

Actions planned

The Trust will continue 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.

6. Other factors or data taken into consideration in assessing progress

Nothing further than raised above.

7. Plans agreed by the Board

Actions relating to WRES will support evidence in respect of EDS2 and the annual equality monitoring report.