Race equality: Great progress comes from great discomfort

Written by Tracie Joliffe on 18 July 2017

The NHS has had ambitions around inclusion for a long time, but despite legislative progress such as the amended Race Relations Act in 2000 and the Equality Act in 2010, for many of us (who have been around for longer than we care to mention), we’re not in the place we envisaged we’d be in 2017.

The Snowy White Peaks report in 2014 reinforced this view. Black, Asian and minority ethnic (BAME) staff continue to be disproportionately disciplined and report greater levels of harassment, and when we look up, we can see how under-represented BAME talent is at a senior level.

I believe that the continuation of these trends is partly because historically we’ve not looked deeply enough into the nature of the problem we’re trying to fix to gain an understanding of it.

Because of this, we have attempted to address something that for the large part is unconsciously motivated, complex and challenging, with tools that have been far too simplistic to bring about the changes required.

Thanks in part to numerous past failures in progressing equality and inclusion on many levels, a desire to learn is now often accompanied by simultaneous high levels of anxiety, and fear of getting things wrong.

The NHS is a microcosm of society; there will be a minority of people that have attitudes which don’t chime with promoting equality and the NHS constitution. The majority however, have the desire to learn how to create cultures that are truly inclusive, with humanity, dignity and respect at their core.

But thanks in part to numerous past failures in progressing equality and inclusion on many levels, a desire to learn is now often accompanied by simultaneous high levels of anxiety, and fear of getting things wrong. Practice and progress in this area have therefore become stilted.

For the last few years, unconscious bias has come to the fore as a popular means of addressing the problems around equality, diversity and inclusion. This approach highlights the fact that all of us make assumptions around difference and sameness, and these assumptions consequently drive actions and behaviours, some of which create the conditions in which discrimination and harassment take place.

As unconscious bias training has rolled out, the critique of this approach as a universal cure is also mounting, as are questions about its efficacy. Many people still harbour the belief that to raise the issues about difference (disability, race, LGBT and gender equality for instance) is the cause of all the problems.

The implication being that if we just don’t talk about it, the problems will go away by themselves. This is faulty logic.

There’s no substitute for human enquiry

Process-driven tools like equality impact assessments have a role to play in addressing the issues relating to under-representation, equality and inclusion. The NHS Workforce Race Equality Standard (WRES) has been a significant instrument in highlighting problems within trusts. It has introduced a framework through which to have meaningful conversations, leading to focused action towards inclusion.

Such tools however are not a substitute for purposeful human enquiry, that rigorously considers the multiple dimensions of an issue such as race, and asks some critical questions about how effective change towards greater levels of equality can be achieved.

Human beings are relational by nature; it’s the relationships between us that create the cultures we work in. How people feel is an essential component of understanding inclusion and creating change, but we can’t count feelings.

The quality of relationships also determines whether or not people feel valued, but we can’t measure the worth of these using counting methods either. Knowing how we can achieve cultures where people feel valued is paramount, which means we need to engage more sophisticated means of enquiry to complement and introduce a depth of understanding to the data.

These include:

  • The nature and content of the conversations we have: The nature and content of the conversations we have can have a significant impact on culture. How these conversations are experienced and given meaning by people really does matter
  • Emotional intelligence: Where feelings matter, high levels of emotional intelligence also matter. Approaches which pretend that difference doesn’t exist will fail to pick upon the importance of how every-day language, attitudes and behaviours may have a negative impact
  • Acknowledging difference: Many people are very busy trying to appear fair by maintaining the pretence that they don’t see colour, disability or gender etc. (where race is concerned this approach is called colour blindness). In pretending that difference doesn’t exist, we also fail to recognise, engage with and understand the valuable lived experiences of that difference that people can offer; a vital component in aiding enhanced understanding of complex issues. We also miss the opportunity to work and learn from those that experience exclusion, using their valuable insights to change and transform our cultures and services for the benefit of all

Stepping into a space where we can be truly honest about race can feel very uncomfortable because we’re not used to doing it, but the benefits are huge. Considering where things currently are on race equality, for example, would suggest that pretending our differences don’t exist hasn’t got us very far.


About the author

Tracie Jolliff is head of inclusion and systems leadership at the NHS Leadership Academy


Read more from Tracie here

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