Yvonne Coghill: cultural transformation through conversationBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m474 (Published 11 February 2020) Cite this as: BMJ 2020;368:m474
“Motivated, valued, and respected staff give much more, they feel appreciated and part of something. A fully included workforce improves patient safety, patient care, and patient satisfaction,” says Yvonne Coghill, director of the Workforce Race Equality Standard (WRES) for NHS England, who aims to bring about “cultural transformation” across the NHS.
WRES was set up in 2015 to draw attention to and help close the gaps in inequalities between ethnic minority and white staff in the NHS. As Coghill explains: “We knew there was a problem, but couldn’t convince people from white backgrounds that there was a real issue because we didn’t have the data or evidence to show that there is a gaping hole between the experiences of BME [black and minority ethnic] and white staff. Now we have that data, and nobody can argue that there aren’t real issues for people in our NHS and how they are treated, received, and able to progress their careers.”
The latest WRES report indicates that the proportion of ethnic minority staff in very senior managerial positions was 6.9% in 2018—much lower than the proportion of ethnic minority staff (19.1%) in NHS trusts.1 In addition, white job applicants are more likely to be appointed from shortlisting than ethnic minority applicants, and ethnic minority staff are more likely to enter the formal disciplinary process than white staff.
Fear on both sides
Coghill says that the disproportionate number of ethnic minority staff in disciplinary procedures is because “if BME staff are doing things that are not seen to be correct, then white managers are more inclined to go straight to HR [human resources] processes rather than have a conversation. They fear that if they challenge someone from a BME background they will say, ‘You are doing this because of my colour.’ We need HR colleagues to bounce it back and say why don’t you have a conversation, as opposed to going formal? There is fear on both sides, but the good news is that we are closing the gap as more organisations are beginning to question this.”
Coghill started her career as a nurse in the NHS in 1977 and says that she experienced discrimination. “I thought I was doing pretty well in my career. I was told to go and get a degree and then a masters. I applied for five director of nursing posts and didn’t get any of them. I was told that on the day someone was better than me. Those people were invariably white and even at that stage I thought it was something to do with me. What that does to you personally, to your self-esteem, self-confidence, and your sense of who you are and what you can deliver, is quite profound. You start to question yourself, rather than question the system,” she says.
As a result, Coghill left the NHS and says that she was “incredibly lucky” to become the mentee and private secretary to NHS chief executive Nigel Crisp. “I went to work in Whitehall in the Department of Health, and when you are sitting at a strategic national level you can see the issues very clearly. I was shocked and stunned at the derisory number of people at a senior level who looked like me,” she says.
Since the launch of WRES, Coghill says, the situation is improving, and “people’s understanding of why we are doing this has changed,” but she adds that there is “a long way to go—there are just eight BME chief executives [of 227] in the NHS.”
Coghill says that cultural change in the NHS is down to leadership. “The type of leadership we have has, to date, been transactional—these people have made their careers on being transactional and delivering on finance, on targets. Now we need them to be more transformational; to be the type of leader who will sit down and have a cup of tea and a biscuit with their teams and who asks questions and listens. We are targeting senior leaders and talking to chief executives to get them on side and to understand not just the moral case, but the business case—if people feel valued, they are less likely to go off and work for agencies or go off sick. It saves the NHS money and makes it easier to recruit, and those staff give higher quality patient care.”
Good communication is also vital, she says, “The comms world across the NHS is incredibly defensive and this agenda scares them witless. They would rather do nothing, or say we want good news stories—it’s not a good news story that people have different experiences in our NHS, but what is a good news story is that the NHS is doing something about it, to make things better for staff and ultimately for patients. Comms is key.”
She also says that ethnic minority staff need role models: “a reasonable number of people who look like themselves who have made it in the NHS. We need to look at the pipeline of people coming through.” And she adds, “We also need to celebrate the successes of all our people in the NHS. When you go to awards ceremonies, there are very few people from an ethnic background up on stage getting those awards and being lauded for the work they have done.”
Long term ambitions
Coghill says that she has backing from the highest levels in the NHS. “When we started this, I was given two years and £2m [€2.4m; $2.6m] to sort out race in the NHS—‘There you are, now off you go and sort it out and it will all be done by 2018.’ To the board’s credit, they see that we have only turned over the stone and found all the creepy crawlies underneath. I have been really heartened by the support I’ve been getting from the very top, but we have to think about putting more money into this. More and more people are seeing that this is not a side show but is core to the business of the NHS.”
She adds that her ambition for the next 10 years is that “there will be many more people who look like me at a senior level, that there will be fewer disciplinary processes, and if you are from a BME background you are just as likely to say I want to work for the NHS as for Google or whoever, so that we can consolidate our position as the best employer in the country.” But, she says, “the issue is that everyone understands it’s not just Yvonne Coghill’s job to do this. Everyone has a responsibility to help make that change.”
Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed.