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EDI roles ‘critical’, nurse leaders warn Steve Barclay

Nursing leaders have criticised the government after Steve Barclay penned a letter asking health bosses to cease hiring dedicated equality and diversity staff, suggesting they are a waste of money.

Professor Nicola Ranger, chief nurse for the Royal College of Nursing (RCN), accused Mr Barclay, the UK health and social care secretary, of “playing politics” with the issue of equality, diversity and inclusion (EDI) in the NHS.

“Evidence repeatedly shows there are stark inequalities in healthcare that must be tackled”

Julian Hartley

The health and social care secretary’s letter, dated 19 October, to the chairs of integrated care boards (ICBs) in England mentioned his department’s focus on moving resources “from the back office to the frontline”.

Mr Barclay wrote that he was “concerned” that local NHS organisations, such as ICBs, were actively recruiting people into dedicated EDI roles.

He wrote: “Current live adverts include jobs with salaries of up to £96,376, which is above the basic full-time pay for a newly promoted consultant.

“There are also examples of continued use of subscriptions to external organisations on [EDI] issues.

“I do not consider that this represents value for money, even more so at a time when budgets are under pressure as we work to tackle the backlog left by the pandemic.”

The health secretary went on to ask that ICB chairs stop recruiting dedicated EDI positions and stop subscriptions to “external” services in this area.

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He said resources should instead be redirected to the “front line” and added: “Should organisations wish to take a different path then they should be willing to justify in public why such roles add more value than additional medical or healthcare staff.”

However, nursing leaders such as Professor Ranger said they do not like the suggestion that patient care does not benefit from EDI work.

Professor Ranger said: “The discrimination faced by staff and patients alike is systemic, it perpetuates poor health outcomes for patients and impacts the wellbeing of staff, including pushing them out of the health service. This government and the next has to turn that around.

“Equality, diversity, and inclusion is critical to improving the culture of the NHS and delivering the best outcomes for all our patients.”

The RCN chief nurse accused Mr Barclay of creating a “false division” between healthcare staff working directly with patients, and those working on EDI projects.

Steve Barclay’s letter to the chairs of England’s integrated care boards (ICBs)

Dear colleague,

On 24 March 2023, I wrote to the Department of Health and Social Care’s agencies and partner organisations setting out how we should ensure good value for money when it comes to improving diversity and inclusion (DE&I) across the health family.

This included explaining that these issues are everyone’s responsibility and should be addressed through normal management processes rather than using external providers or dedicated roles within organisations.

In the Department, we have been focused on delivering efficiency so that we can move resources from the back office to the frontline. This has included reducing headcount (FTE) by one in six, and we have no standalone diversity roles. Much of this efficiency has been delivered by applying a recruitment freeze. Other parts of the health family, including NHS England, are also making progress on this.

I am therefore concerned that many local NHS organisations are actively recruiting into dedicated DE&I roles. Current live adverts include jobs with salaries of up to £96,376, which is above the basic full-time pay for a newly promoted consultant. There are also examples of continued use of subscriptions to external organisations on DE&I issues. I do not consider that this represents value for money, even more so at a time when budgets are under pressure as we work to tackle the backlog left by the pandemic.

I believe that we should devolve more to integrated care systems. Therefore, as you are responsible for managing a significant proportion of the NHS budget at a local level, I wanted to ensure that you are taking a similar approach to the Department to secure value for money.

I would appreciate it if you could work with NHS organisations in your area to review with a view to ceasing recruitment into standalone DE&I roles and external subscriptions to redirect these resources into frontline patient care. Should organisations wish to take a different path then they should be willing to justify in public why such roles add more value than additional medical or healthcare staff.

I also subscribe to the definition of diversity set out in the Civil Service D&I Strategy (available on GOV.UK) and believe that this is the approach we should adopt in delivering inclusion for all our people.

Yours ever,

Rt Hon Steve Barclay MP
Secretary of state for health and social care

“The health secretary is playing politics and trying to create a false division – frontline staff know the importance of diversity in leadership, even if this government is shunning it in a culture war,” she said.

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“Just [last week], the care regulator warned the health secretary of damaging and stark inequalities being experienced by patients.”

The warning about which Professor Ranger spoke was the Care Quality Commission (CQC)’s State of Care 2022-23 report, released on Friday, 20 October.

Part of its findings were that the quality of care in maternity services was “affected by racial stereotypes and a lack of cultural awareness by staff”, and that staff endured a “normalised” culture of discrimination from colleagues.

Sir Julian Hartley, chief executive at NHS Providers, also disapproved of Mr Barclay’s letter to the ICB chairs.

Sir Julian said in response: “Evidence repeatedly shows there are stark inequalities in healthcare that must be tackled.

“EDI can help create an NHS-wide culture where leaders feel equipped to deal with all forms of discrimination.

“The government-commissioned Messenger review concluded that EDI roles are vital and should be embedded at all levels of the health service to effectively tackle discrimination.”

Sir Julian added that work to create a more equal, diverse and inclusive health service was “essential” both for patient care and the psychological safety of staff.

He pointed to the 125,000-strong workforce gap in the NHS as a sign that retention needed to improve, and that EDI work was an important part of this.

A Department of Health and Social Care spokesperson said of the letter: “Taxpayers rightly expect value for money from every penny spent in our NHS.

“The health and social care secretary wrote to integrated care boards this week to reiterate that diversity and inclusion should be a part of everyone’s role, rather than having discrete dedicated roles within organisations.

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“The NHS has one of the most diverse workforces in the country and we will continue to work to improve outcomes for all.”

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