Workforce Race Equality standard Royal Cornwall Hospital Trust Baseline assessment for April 2015 Page 1 of 26
Introduction What is the Workforce Race Equality Standard? The Workforce Race Equality Standard (WRES) was introduced by NHS England on the 1 st April 2015 at the request of the Equality and Diversity Council. The standard has been introduced to address the evidenced 1 discrimination that exists for NHS staff from Black and Minority Ethnic groups (BME) compared to White British NHS workers and it requires all NHS provider organisations to publish information relating to their workforce by 1 st July 2015, and annually thereafter. The Equality Delivery System (EDS2) is designed to help local NHS organisations, in discussion with local stakeholders, review and improve their performance for patients, communities and staff in respect to all characteristics protected by the Equality Act 2010. The Workforce Race Equality Standard seeks to tackle one particular aspect of equality the consistently less favourable treatment of the BME workforce (NHS England 2015) - in respect of their treatment and experience. It draws on new research about both the scale and persistence of such disadvantage and the evidence of the close links between discrimination against staff and patient care. Being undervalued and discriminated against leads to disengagement, unhappiness, depression, poor performance and ultimately reduced effectiveness. Royal Cornwall Hospital Trust is embracing the opportunity to examine and improve the experience of its workforce. As part of the process of gathering evidence for the baseline assessment a group of volunteer staff were consulted with to help devise the action plan of improvements. 1 Kline, R (2014) Snowy White Peaks of the NHS, Middlesex University Stevenson, J; Rao, M (2014) Explaining Levels of wellbeing in BME populations in England, NHS Leadership Academy. Page 2 of 26
Workforce Race Equality Standard indicators Workforce indicators For each of these four workforce indicators, the Standard compares the metrics for White and BME staff. 1. Percentage of BME staff in Bands 8-9, VSM (including executive Board members and senior medical staff) compared with the percentage of BME staff in the overall workforce 2. Relative likelihood of BME staff being appointed from shortlisting compared to that of White staff being appointed from shortlisting across all posts. 3. Relative likelihood of BME staff entering the formal disciplinary process, compared to that of White staff entering the formal disciplinary process, as measured by entry into a formal disciplinary investigation Note. This indicator will be based on data from a two year rolling average of the current year and the previous year. 4. Relative likelihood of BME staff accessing non mandatory training and CPD as compared to White staff 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. KF 18. Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months 6. KF 19. Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months 7. KF 27. Percentage believing that trust provides equal opportunities for career progression or promotion 8. Q23. In the last 12 months have you personally experienced discrimination at work from any of the following? b) Manager/team leader or other colleagues Boards. Does the Board meet the requirement on Board membership in 9 9. Boards are expected to be broadly representative of the population they serve. Page 3 of 26
1. Percentage of BME staff in Bands 8-9, VSM (including executive Board members and senior medical staff) compared with the percentage of BME staff in the overall workforce Payscale White - British White - other Mixed - White & Black Mixed - White & Asian Mixed - Any other mixed backgroun d Asian or Asian British - Black or Black British Chinese Any Other Ethnic Group Filipino Undefined Grand Total Band 1 29 2 2 1 34 Band 2 1254 47 9 1 3 9 4 3 3 4 54 1391 Band 3 618 17 3 3 2 1 21 665 Band 4 487 9 1 1 2 1 2 14 517 Band 5 1187 42 4 1 10 6 2 2 74 1328 Band 6 757 32 1 1 4 5 2 1 39 842 Band 7 379 35 2 1 4 12 424 Band 8 - Range A 75 2 4 82 Band 8 - Range B 46 1 2 49 Band 8 - Range C 18 2 * 2 22 Band 8 - Range D 14 14 Band 9 7 7 Medical Staff 414 54 2 7 6 60 3 7 9 143 706 Spot / Other 36 2 2 3 115 158 Grand Total 5321 245 17 13 16 91 23 17 18 6 480 6239 *The star indicates that one member of staff from a BME background is a band 8A. As this may be identifiable the star was placed in the centre square. Page 4 of 26
The table shows that there is a total disclosed BME workforce of 201, of which 94 are medical staff. This equates to 3.24% of the total workforce, which is higher than the percentage of ethnic minorities living in Cornwall at 1.8% ( 2011 Census). The table highlights that there are 175 positions in bands 8 and 9 from which 166 are White/White British, 8 undefined and one BME. White British band 8/9 BME band 8/9 166 3.12% 1 0.5% It may appear that there are potential barriers relating to the career progression of staff from minority groups, be that perception or reality. We need to investigate what these barriers may be and how to overcome them. See Objective one in attached action plan Page 5 of 26
2. Relative likelihood of BME staff being appointed from shortlisting compared to that of White staff being appointed from shortlisting across all posts. There were a total of 16,345 job applications made via NHS Jobs for the period May 2014 to April 2015. The table below shows the ethnic breakdown of the applicants. Applications 16,345 Asian/Asian British Mixed Black/Black British Chinese other ethnic group other white White British undisclosed White British 13,345 81.6% White other 1178 7.2% Asian/Asian British 862 5.3% Mixed 126 0.8% Black/Black British 337 2.3% Chinese 38 0.2% other ethnic group 148 0.9% undisclosed 203 1.2% Page 6 of 26
Shortlisted 3524 White British White other Asian/Asian British Mixed Black/Black British Chinese other ethnic group White British 3082 87.50% White other 208 5.90% Asian/Asian British 78 2.20% Mixed 35 1.20% Black/Black British 35 1.10% Chinese 8 0.20% other ethnic group 20 0.60% Undisclosed 53 1.50% Appointed 813 White - British 729 89.67% White - other 33 4.06% Asian or Asian British 9 1.11% Mixed 5 0.61% Black/Black British 5 0.61% Chinese 1 0.12% Any Other Ethnic Group 2 0.24% Undefined 29 3.57% Page 7 of 26
Percentage success rate of the recruitment process by ethnicity (Including Kernowflex, excluding Medical & Dental) Ethnicity Applications As % Percentage shortlisted White British 13,345 90.29% 23.09% 23.65% Asian/British 869 5.87% 9.05% 11.54% Black 379 2.56% 9.33% 14.28% Mixed 147 0.99% 23.81% 14.28% Chinese 39 0.26% 22.86% 12.5% Percentage of shortlisted appointed There is currently a difficulty producing reports from NHS Jobs that provide the ethnicity of individuals who are appointed to positions, therefore the data provided for that element has been sourced from ESR (Electronic Staff Record) which does not exactly mirror the data held in NHS Jobs. Percentage success rate of recruitment process for medical/dental staff Ethnicity applications As % Number shortlisted As % Number appointed up to May 1 st 2015 (12 months) White British 86 11.84% 53 61.63% 98 White other 138 19% 49 35.51% 13 Asian/British 302 41.6% 47 15.56% 15 Black 55 7.57% 0 0% 2 Mixed 32 4.41% 5 3.12% 5 Chinese 5 0.69% 1 20% 3 Other Ethnicity 79 10.88% 20 28.57% 3 Undisclosed 29 3.99% 14 48.27% 95 Figures are from ESR which do not correspond with NHS Jobs figures. Unable to calculate percentage appointed See Objective 2 in attached action plan Page 8 of 26
3. Relative likelihood of BME staff entering the formal disciplinary process, compared to that of White staff entering the formal disciplinary process, as measured by entry into a formal disciplinary investigation Note. This indicator will be based on data from a two year rolling average of the current year and the previous year. The figures in the tables below are from September 2013 to April 2015 as cases were only entered in ESR from this start date. Ethnic Disciplinary Further ER Stages - Tribunal Origin Headcount Headcount % Headcount Headcount % Headcount Headcount % Workforce % Workforce A White - British 43 89.58% 75.34% 3 100.00% 75.34% CD White Cornish 4 8.33% 6.98% Unknown 1 2.08% 6.04% Ethnic origin A White British Headcount Grievance Headcount % Headcount % Workforce Headcount Harassment Headcount % Headcount % Workforce 6 50.00% 75.34% 3 75.00% 75.34% C White - Any other White background 1 8.33% 1.75% 0 0.00% C3 White Unspecified 1 8.33% 0.49% CA White English CD White Cornish 1 8.33% 1.48% 2 16.67% 6.98% 1 25.00% 6.98% Unknown 1 8.33% 6.04% Page 9 of 26
Research suggests that managers (NHS Employers & NHS Institute for Innovation and Improvement 2010) of BME staff are reluctant to raise issues of poor practice informally, for fear of being seen as racist. This then does not allow the staff member to correct their practice which as a result is more likely to become a formal disciplinary case. A manager of a white member of staff would discuss poor practice in the initial stage, enabling the staff to address issues more promptly, therefore, eliminating the need for formal intervention. The data above proves that BME employees are not involved in formal disciplinary cases within this Trust, however, it is apparent that staff are also not reporting cases of bullying and harassment either (see outcome 5, p.12). Further investigation into the reasons for BME staff not reporting will be undertaken, the results of which will support the implementation of improvements. See Objective 4 in attached action plan Page 10 of 26
4. Relative likelihood of BME staff accessing non mandatory training and CPD as compared to White staff The graph below displays the developmental training attended by members of staff for the period April 2014 to March 2015. Developmental training relates to all non-mandatory face to face training as this would assume that the training was agreed and supported by the manager. The figures relate to numbers of attendances of courses and not individuals. White British White other mixed Asian/Asian British Black/Black British Chinese Filipino undefined other White British 13289 78.12% White other 512 3% mixed 89 0.52% Asian/Asian British 151 0.89% Black/Black British 63 0.37% Chinese 49 0.29% Filipino 20 0.12% undefined 2427 14.27% other 22 0.13% not stated 388 2.28% Percentage of Ethnicity by total attended training Table 1 To understand how table 1 relates to individuals within the workforce please see table 2 which translates how training is accessed by each ethnicity, for example table 1 indicates that 20 courses were attended by Filipino workers, table 2 shows that these 20 courses were accessed by 6 people. Page 11 of 26
Developmental training attended sorted by individual workers %of total ethnicity White - British 3466 65.14% White - other 145 59.18% Mixed - White/Black/Asian/Chinese 26 56.52% Asian or Asian British 50 54.94% Black or Black British 15 65.21% Chinese 11 64.70% Any Other Ethnic Group 8 44.44% Filipino 6 100% Undefined or Data Not Available (e.g. Left Trust) 653 Not Stated 102 There is not a significant difference in percentage of training attended based on ethnicity. The lowest percentage is any other ethnic group but the number is extremely small which makes analysis difficult. Additionally, the number of undefined and not stated equates to 16.84% of the total which is a substantial unknown. There has been an improvement in the data held in ESR in the last year but there are further improvements to be made. The introduction of supervisor and self-service of ESR accounts will improve the data held, work will be undertaken to include the need for this data within the training for managers. See Objective 3 in attached action plan Page 12 of 26
5. KF 18. Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months According to the 2014 National Staff Survey 11% more Black and Minority Ethnic staff reported they had been abused by patients in the previous year than White staff. KF18 White BME % Experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months 29 40 Actual numbers completing the staff Survey 2014 This shows that 40% of 87 BME respondents to the survey totals 46 individuals. Page 13 of 26
There were a total of 302 incidents of patients abusing members of staff being reported via Datix from April 2014 to March 2015. Only 9 of this 302 were reports from BME staff which does not correspond with the National Staff Survey results showing 46 BME individuals had declared they had experienced bullying or harassment in the previous twelve months. The percentage of staff completing the ethnicity field within the Datix system is minimal therefore a search was completed using ESR information to try to identify the reporters ethnicity, however, not all individuals were identifiable. There were 46 names which could not be identified on ESR and 50 where the name was not clearly stated. Not always clear on Datix who the abuse was aimed at i.e. role contact, role of person involved. See Objective 4 in attached action plan Page 14 of 26
6. KF 19. Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months KF19 White BME Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months 30 45 Table 1 Table 2 Table 2 indicates that the Trust has a lower than average score for discrimination on the grounds of ethnicity. The information in tables 1 & 2 may appear conflicting or that the bullying/harassment experienced by BME staff was not perceived as discriminatory. Page 15 of 26
There were 33 reported incidents of staff on staff abuse recorded on Datix from April 2014 to 31 st March 2015. The graph below displays the ethnic composition of the identifiable 29 alleged victims. There is a significant number of unknown which needs to be reduced. See Objective 3 in attached action plan 7. KF 27. Percentage believing that trust provides equal opportunities for career progression or promotion KF27 White BME Percentage believing that trust provides equal opportunities for career progression or promotion 82 62 Page 16 of 26
A survey questionnaire was completed by 166 members of staff in February 2015 who have been through the recruitment process (including promotion) in the previous two years. From this total number of respondents, five (4.3%) were from a BME background. Four of those five people said they thought the process was fair. A change to the E Roster system has been made to enable recording of external developmental opportunities that may not be captured through ESR. This will improve reporting capability for the future. Work needs to be undertaken to understand why BME staff do not believe that career progression is fair within the Trust. See Objective 1 in attached action plan Page 17 of 26
8. Q23. In the last 12 months have you personally experienced discrimination at work from any of the following? b) Manager/team leader or other colleagues Q23b In the last 12 months have you personally experienced discrimination at work from a Manager/team leader or other colleagues 2% The above abstract from the National Staff Survey 2014 indicates that 2% of respondents said they had been discriminated against on the grounds of ethnicity by their manager; however, the ethnicity of the 2% is not known. This was one of the best scores attained for the Trust in the survey and was better than the national average score. Page 18 of 26
TOP THREE RANKING SCORES Page 19 of 26
9. Boards are expected to be broadly representative of the population they serve. According to the 2011 Census only 1.8% of the population of Cornwall were from a Black or other Minority Ethnic group. The Trust s workforce includes 3.24% of staff from a BME background. Total workforce BME Population of Cornwall (2011) Page 20 of 26
Total Very Senior Managers: 83 All Executive and Non-Executive Directors are presently White British. Total Medical staff: 634 Very Senior Managers within Medical: 68 The graphs above indicate that medical staff from a White British origin are more likely to progress to senior management positions. Page 21 of 26
Consultation with Focus Group Discussion Quotes from focus group relating to their experiences of career progression within the Trust Have progressed and have had no problems. Have progressed but have not managed to obtain contract for a substantive position Have seen, over many years, that there are differences in how people are treated but this is perception and difficult to prove. Is that because of the individual traits or because of their race, it s hard to define Haven t applied for a promotion as am happy with job role and staying handson. Department restructure has led to no promotion prospects as there are no higher band jobs available. Page 22 of 26
In the medical division the Clinical lead is passed down rather than applied for. Is this fair and transparent? Is the clinical excellence process fair? This process may need to be examined to ensure equitable. If there are difficulties with communication (pronunciation, accent or dialect) these should be addressed in a valuing, supportive way. They should not be ignored as this may lead to blocking progression for the individual. Recruitment Can we check reasons for not being shortlisted? People coming from abroad may not have British recognised qualifications, a valid reason. There needs to be a robust feedback process on the recruitment process to ascertain fairness and highlight possible further training required for interviewers. Need to police the recruitment policy is being adhered to i.e. a minimum of one panellist who has attended training. Grievances All grievance allegations should be followed up by HR. Training Unclear how training opportunities are offered. Criteria of selection process by some managers is not transparent. Comments relating to bullying and harassment from the focus group. There is a big difference in staff survey results and the percentage of BME staff datixing incidents of bullying/abuse. People aren t Datixing it. This could be because Datix is really difficult to use and is time consuming. People may not know how to do it. There should be a system of having someone to report to who will Datix it for them. There may be fear of consequences of reporting bullying on Datix e.g. if it was their manager. How confidential is Datix? Who gets to see what you ve written? Fear needs to be removed. Staff survey has higher percentage because it s confidential. Page 23 of 26
I wouldn t datix abuse from a patient because what would be done about it? Would the Trust bring patients back in for an investigation? Bullying is a problem across the Trust in all disciplines. I would tell supervisor. Problems with lower bands getting information about what s available What does zero tolerance (discrimination) mean in reality? It appeared that patients would not be challenged if they refused to be seen by a medic, another medic would be given to them. Need to spread the word that discrimination is not tolerated. Tell people what that means more implicitly. It is worse in Cornwall as there are less minority groups. Page 24 of 26
Recommendations Idea to improve career progression for BME staff Career mentors The individual needs to be proactive with their own career progression Appraisal system Could introduce career mentors i.e. buddy system pair up a band 6 person with a band 7 person so they can advise them on how they managed to progress. The consensus was that it shouldn t be buddying up between same race people, but a mixture. The appraisal system should cover how to progress your career. The appraisal is only as good as the manager supporting it. One person said their appraisal said the same for 4 years, doesn t help career. When qualification completed it made no difference to opportunities. Strengthen the Speciality Lead process to ensure it is equitable. If there are difficulties with communication (pronunciation, accent or dialect) these should be addressed in a valuing, supportive way. They should not be ignored as this may lead to blocking progression for the individual. Page 25 of 26
Recruitment There needs to be a robust feedback process on the recruitment process to ascertain fairness and highlight possible further training required for interviewers. Need to police the policy is being adhered to i.e. a minimum of one panellist who has attended training. Bullying/harassment The Trust could introduce a system where staff can access an independent person who will support the datix process and offer advice and support. Raise the profile of what zero tolerance means. Train managers to be valuing and respectful of their staff and how to deal with difficult situations which affect the team or individuals within it. Introduce a Minority Ethnic Group to provide support for staff if/when needed. Communication Face to face information giving. Higher managers coming into team meetings to talk about what s happening in the Trust and provide more support for the work you do so that all human rights, equality and inclusion issues are dealt with in the Trust as a regular issue rather than when forced to by edict. Changes being introduced into work areas should be e mailed to all affected staff so all bands, part-time and Kernowflex staff are aware and involved. Thank you to the focus group for giving up their time to support this. Page 26 of 26