Back to basics: why diversity and inclusion are critical to leading change in the NHS

Despite 30 years of investment the NHS England equality and diversity agenda hasn’t moved forward at anywhere near the pace we would have liked – indeed, many colleagues have lost sight of the value this work brings. Tracie Jolliff, head of inclusion and systems leadership at the NHS Leadership Academy, explores the need to go ‘back to basics’

Tracie Jolliff, head of inclusion and systems leadershipThe NHS is attempting to shift towards a preventative agenda: rather than treating people who are ill, it’s about making and keeping populations well. This means leaders need to behave differently, working across boundaries and outside of health.

We need to get involved and engaged in education, social services and voluntary sector groups which are right there in the heart of the community. The aim is to positively impact on some of the poorest and most excluded communities, empowering them in ways which give them choices about how they can live healthier lives which will, in turn, reduce the pressure on the NHS.

Some of our poorest, most excluded communities are the heaviest users of mental health services, for example. While it’s great that the services are being used and accessed by those who need them most, imagine how the need for such services would reduce if patients felt less excluded, stigmatised and isolated.

This change needs to take place at the very top and right throughout the system and a key part of this is having chief executives in position from a range of diverse backgrounds.

Why is this the case? 

Despite more than 30 years of investment by the public sector and other organisations we haven’t managed to move inclusion forward. Here are a couple of examples:

  • Of over 500 chief executives, only three are British Black, Asian, and minority ethnic (BAME)! Yet we often field comments from people in the NHS who are shocked that we offer positive action programmes for BAME colleagues.
  • A report published by the Stonewall charity in 2014 highlighted that a quarter of lesbian, gay, bisexual and transgender (LGBT+) people had experienced homophobic abuse in the past five years. No wonder so few people from these groups disclose their identities at work – we might all, possibly do the same.

Taking positive action

Let’s talk some more about positive action. Firstly, it’s lawful – and not discriminatory. It’s about recognising that, for groups who’ve been historically discriminated against, the starting point is different from everyone else. Work still remains the quickest way out of poverty but discrimination has stopped some sections of the community accessing more senior roles – or indeed, in many cases, working at all.

‘D’ is for discrimination: recognising it

Where there have been generations of discrimination and when social capital has also been degraded over that period, building from the reality of people’s lived experience needs to be the starting point. This is often about significant disadvantage which makes the rungs of the social ladder so far apart towards the bottom, that it becomes really difficult for people to climb up.

An example of this is a family I spoke with recently in which the three children under seven had lived a semi-isolated life due to the mother’s severe mental ill health. They had missed out on interactions with others and two of the children were behind in their speech and language development as a result. One can imagine that simply sending these children off to school, without the additional support they need to be successful in that educational environment, could have a domino effect at each stage of their development, curtailing the opportunities and life chances they’ll be able to take advantage of.

The children’s mother’s access to adequate mental health services is obviously a factor here and her reluctance to seek help was often linked to stigma. There is additional work to do to for many in order to pave the way towards equality.

‘D’ is for dehabilitation: overcoming it

Discrimination also prevents people who might have experience and merit from progressing according to their talents in a fair and just way. There are some winners though; discrimination also over-rewards some characteristics which means you can end up with people in roles they haven’t earned and who might not be as well-qualified as other, more diverse candidates might be.

As the saying goes, if you do what you’ve always done, you’ll get what you’ve always got. It’s time for new approaches that shift power from traditional hierarchies to the frontline and to community. One of the first steps in that process is to really listen to – and understand – what those most negatively affected by discrimination have to say about their experiences. They will tell us what we need to focus on to change the lives of the people we say we’re doing this work for.

We’re never going to address this problem unless decision-makers are themselves diverse, reflecting and having insight into the communities they serve. Diversity comes with innovative ideas about how we can move things forward and make the most of our talents and prospects.

At times it appears as if we’re still behaving as though it’s the 1950s, when there were more monochrome expectations about life and more predictability in how people operated. We need to catch up! Unless we have diverse groups in leadership, equality will always evade us.

About the author

Tracie Jolliff is head of inclusion and systems leadership at the NHS Leadership Academy. For more information about any of the NHS Leadership Academy’s programmes or activities, please visit, or follow them on Twitter: @nhsleadership

About the NHS Leadership Academy

The NHS Leadership Academy was launched in April 2012. Its purpose is to develop outstanding leadership in health, in order to improve people’s health and their experience of the NHS. The Academy brings together, for the first time, all the national activity supporting leadership development in health and NHS-funded services.

The Academy’s four key areas of work are:  

  1. Developing and embedding a common vision for health leadership: researching, creating, developing, refining, sharing and embedding tools, evidence and examples setting out what good leadership and good leadership development look like in a health care context.
  2. Leading the way in leadership development for a new health system: equipping leaders to meet the current and future challenges of the changing system.
  3. Supporting local leadership development: working with local Leadership Academies to embed a nationally-consistent, professional approach to leadership development while meeting local needs.
  4. Raising the profile, performance and impact of health care leaders: creating an environment in which leaders are required, and supported to, demonstrate proper readiness to fulfil their role.

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