Workforce issues


and are faced with considerable challenges throughout their career. The recent coverage of a group of senior female surgical doctors who have faced sexual harassment during their training showed that almost one third have been sexually assaulted by a colleague and two thirds have been the target of sexual harassment in the last five years.4 Black and minority ethnic staff are more than twice as likely to experience discrimination at work from a colleague and nearly a quarter as likely to be a senior manager than white staff. Recent research also points to continuing pay inequities, with considerable variation in pay between ethnic groups across all NHS staff.5 The NHS survey reported that 25% of disabled


staff have experienced bullying from their colleagues compared with 16.6% of non-disabled staff. Similarly, 23.5% of LGBT+ colleagues face bullying and harassment at work compared to 17.9% of heterosexual healthcare staff.6 Neurodivergence is an issue which many line managers will experience at work, with their staff. 10% of the population are neurodivergent and many find the workplace difficult to deal with, due to a lack of knowledge and understanding by their colleagues. Support from managers and suitable ‘reasonable workplace adjustments’ may be necessary such as changes to shift patterns and training of colleagues to help to change attitudes.7


NHS England Improvement Plan The document, the NHS England Improvement Plan currently sits on chief executives’ desks and sets out six high impact actions to be completed, some by March 2024 in order to increase the diversity, inclusion and belonging in the NHS. The aim is to move towards inclusive workplaces – which are underpinned by staff engagement, retention, innovation, and productivity improvements. Those improved environments create psychological safety and release the benefits of diversity, for individuals and teams – and in turn efficient, productive and safe patient care.8


(See Table 2) High Impact Actions


1 Measurable objectives for Chairs, Chief Executives and Board Members 2 Address Health Inequalities within their workforce 3 Overhaul recruitment processes and embed talent management processes 4 Comprehensive induction and onboarding programme for international recruited staff 5 Eliminate total pay gaps with respect to race, disability and gender 6 Eliminate conditions and environment in which bullying, harassment and physical harassment occurs


Table 2


Equality, Diversity and Inclusion Training (EDI) The NHS Staff Council9


have provided a guide


to the now mandatory training and is described as an integral part of each organisation’s wider cultural change and organisational development activities. The People Plan introduced health and wellbeing conversations during which line managers are expected to discuss the individual’s health and well-being, flexible working and equality, diversity and inclusion. The target audience for equality, diversity and


inclusion training is all staff employed by the hospital Trust. In addition, it is expected that all non-executive directors will also receive training on their EDI obligations. Employers should work with contractors, bank staff providers and other employers which provide services to the Trust, to ensure an aligned approach. The guide suggests that staff who are promoted


The annual Staff Survey is a good indicator of how each organisation is doing relating to its culture – 24% of NHS staff in England still report that they are subject to bullying, harassment or abuse by fellow workers and managers, which impacts on intentions to leave, job satisfaction, organisational commitment, absenteeism, productivity and the effectiveness of teams.


16 www.clinicalservicesjournal.com I February 2024


to management roles should undertake the training as a priority and that all staff should undertake a refresher annually. Support for staff should be available as discussions around discrimination, bullying and harassment may be difficult for some staff. They should be able to find a safe space with access to trade union representatives and staff networks. Relevant bullying, harassment and freedom to speak up policies should be signposted with messages that NHS staff should be able to raise concerns without fear of detriment, and those concerns should be listened to. Links to psychological first aid training might also be useful.


Leadership for change One of the ways in which each organisation can measure its success is against a number of data points. The collection of national data is a requirement of the Workforce Race Equality Standard (WRES) and the Workforce Disability Equality Standard (WDES). This data should ensure that each organisation can benchmark itself and make an action plan as necessary. The annual Staff Survey is also a good


indicator of how each organisation is doing relating to its culture – 24% of NHS staff in England still report that they are subject to bullying, harassment or abuse by fellow workers and managers, which impacts on intentions to leave, job satisfaction, organisational commitment, absenteeism, productivity and the effectiveness of teams. In order to change this, there must be comprehensive action at local level, led by national strategies and action. It is notable that the descriptions of inclusion and belonging run counter to the culture in many NHS organisations experienced by the author. The NHS has developed over years, a widespread culture which looks upward to the hierarchy in Westminster, rather than to the service user in their Trust. If diktats are made in Westminster, managers at all levels have to ‘jump’ to deliver whatever is required even though it may seem counter intuitive to best patient care. This constant change of emphasis interrupts good clinical care and can also


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