Diversity is hugely important in recruitment. It has benefits for staff, organisations, patients, and society in general. As one of the largest employers in the world, the NHS really should be leading the charge in diverse recruitment. But is it? We’re going to examine the current picture of diversity and representation within the NHS and look at how healthcare recruiters can help to improve it.
If you’d like a quick refresher on the value of diversity, check out our blog post here.
How diverse is the NHS?
It is important to put diversity in the NHS into context. We’ve looked into the current state of diversity in UK workplaces, and things aren’t looking great. So, how does the NHS compare?
How ethnically diverse is the NHS?
Overall, the NHS has a relatively ethnically diverse workforce. Of the 1.3 million employees:
- 77.9% are White
- 10.7% are Asian
- 6.5% are Black
Medical personnel are doctors with medical degrees. All other staff, ranging from nurses to cleaners, are non-medical personnel.
In terms of medical staff:
- 54.0% are White
- 30.2% are Asian
- 5.2% are Black
For non-medical staff;
- 80.3% are White
- 8.7% are Asian
- 6.6% are Black
How gender diverse is the NHS?
The picture around gender diversity in the NHS is complex, with women significantly overrepresented in the NHS as a whole but under-represented in several specific areas.
Of those who gave their gender, 23% of NHS staff identified as male and 77% female. When it comes to very senior management, on average, 47% are female. Though a 2020 report found that those numbers varied wildly across organisations, fluctuating between 15.4% and 77.8%.
For medical and dental staff, 55% were male and 47% female.
When it comes to recruiting, the NHS needs to bring more women into senior roles. Progress is being made, with 5.7% more women in management roles than in 2017. But there’s still room for improvement before the NHS hits its goal of gender parity.
How diverse is the NHS for socioeconomic groups?
As such a large employer, with such a wide range of roles, the NHS employs people from across the social classes. To understand class diversity within the NHS, we need to look at the distribution of socioeconomic background within high prestige roles.
Notably, only 4% of doctors came from working-class backgrounds. In fact, 80% of applications to study medicine come from just 20% of schools. With numbers like these, the stereotype of upper-middle-class doctors looks secure for some time to come.
Information on the degree of socioeconomic diversity among medical staff is widely available and discussed. Similar information for senior NHS managers is proving harder to locate. It’s unclear whether any NHS trusts are collecting this data, implying that widening accessibility here is not a high priority.
What is the NHS’s record on neurodiversity and disability?
The NHS is taking steps through the Workforce Disability Equality Standard (WDES), which aims to understand the position of disabled workers within the NHS. The 2020 WDES report showed that 3.5% of the overall NHS workforce reported a disability. This fell slightly to 3% of board members.
73.8% of disabled staff report that their employers have made sufficient adjustments to allow them to carry out their work. Once shortlisted, non-disabled candidates were 1.2 times more likely to be offered a job than disabled candidates.
Data on neurodiversity is largely absent from discussions of diversity in the NHS.
What do all these numbers mean?
The main message we can take away from the numbers above is that the state of diversity and representation within the NHS is profoundly mixed, with areas of excellence beside sections of deep inequality.
Overall, the NHS is slightly more ethnically diverse than the overall working population, which is 85.6% White. This is great news, but improved ethnic diversity hasn’t yet reached senior posts. Nearly half of all trusts and boards in London have no BME members at senior or very senior levels. The picture is similar across the country.
This isn’t limited to the most senior positions. BME staff are underrepresented in posts from grade 7 and above, which includes positions such as deputy payroll manager.
With medical staff, the picture is similarly skewed. Senior doctors are more likely to be White than junior doctors. While Asian doctors are also well-represented at different levels, fewer Black doctors are in the most senior roles. This can be especially important because medical textbooks often overlook how different symptoms appear on Black skin.
The picture on gender diversity in the NHS is more optimistic, but issues remain. There is an underrepresentation of men, particularly in nursing and support roles. This can have a substantial effect on the experiences of male patients, especially the elderly.
Female representation at the highest levels of the NHS does tail off, but not as steeply as other areas of diversity. This may be an area where we can continue our current (successful) efforts.
Current figures suggest that the NHS is not helping increase social mobility in any meaningful way. As the UK’s largest employer, this is a huge opportunity that we should be eager to take advantage of.
While the picture is improving for disabled workers within the NHS, it’s important to note that nearly 1 in 4 disabled workers didn’t feel that their employers had made sufficient adjustments to allow them to do their job. Not giving staff the support they need is a false economy and a waste of valuable talent.
What can recruiters do to improve minority representation?
Understand the need for improvement
The first step towards fixing a problem is understanding what is wrong. To improve diversity and representation within the NHS, we need to keep paying close attention to the diversity data.
And we can’t just rely on national data. We must monitor our own recruitment strategies for diversity. Asking the right questions and collecting diversity data is essential to making progress. Filling in the gaps in the data around neurodiversity and the socioeconomic background of employees would be an excellent first step.
Make inclusion the cornerstone of your recruitment strategy
Improving diversity and representation can’t be an afterthought in your recruitment strategy. It needs to be at the very centre of your planning and decision-making.
For each stage of your hiring process, ask yourself how your decisions might impact each of the minority groups you are looking to recruit.
Diversify your recruitment panels
It’s hard to make progress on diversity if all of your recruitment decisions are made by the same people using the same decision-making processes.
Having a diverse panel of interviewers helps in several ways. Members of minority groups may have additional insight into the challenges faced by candidates from those groups. This may be particularly valuable for candidates with disabilities or neurodiverse candidates.
Candidates may also benefit from increased confidence after seeing people they can relate to on their interview panels.
Commit to diversity training
Managers and leaders throughout your organisation need to be fully on board with your efforts to improve diversity and inclusion. They also need to be knowledgeable about the challenges faced by minority groups within the NHS.
One of the best ways to achieve these aims is by providing high-quality diversity training. This kind of training can help educate managers and leaders about the benefits of diversity, including the benefits it will bring to their own productivity and the patient experience.
Diversity training also helps managers work on their empathy and provides them with the information they might otherwise lack about the kinds of adjustments they can make to help diverse candidates excel.
In some cases, managers may have concerns about making diverse hires. Having open and honest conversations can alleviate these concerns. Managers often worry about hiring disabled candidates, in particular, because they are concerned about what adjustments they may need to make to their working practices. In reality, the adjustments required are often more minor than managers expect.
Focus on inclusion
Hiring diverse candidates is essential, but we also need to make sure that those new hires feel welcome, respected, and supported. They need to feel included.
We may talk about diversity and inclusion as separate ideas, but it’s almost impossible to have one without the other. There’s no point making your workplace inclusive for a wide range of people if you don’t get them through the door in the first place. Similarly, you won’t achieve a diverse workforce if your diverse hires feel unwelcome and leave within a few months of being recruited.
Making your workplace inclusive means that your diverse hires will stay with you for longer. People working in inclusive workplaces are happier, more productive, and more comfortable speaking up about potential problems or areas for improvement.
So how can you make your workplace more inclusive?
Welcome a wide variety of voices
Giving employees the chance to be heard is absolutely essential to creating an inclusive workplace.
Make sure that your staff have a variety of different ways to give their opinion. Not all employees will feel comfortable communicating in a particular way, so it’s vital they have other options. Some neurodiverse workers, for example, may prefer to provide written suggestions. LGBTQ+ staff who are not yet out may only feel safe talking about their experiences if their comments are anonymous.
Be willing to have awkward conversations
We believe that having meaningful conversations about diversity is essential. If we, as leaders, aren’t willing to talk about difficult topics, we won’t be able to create an environment of trust and respect with our workforce.
Check out our in-depth guide if you’re unsure how to start talking about diversity with your team.
Prepare for minority groups you’re not employing yet
If there are particular minority groups that you’re not currently employing, don’t hold back on preparing to meet their needs until you have a new hire ready to start. The time to start making changes to make them feel welcome is now before they’ve even applied.
Diversity-related changes can lead to some awkwardness and even resentment on the part of existing employees. Creating inclusive policies ahead of time can help you avoid challenging interactions with new hires. If there are going to be difficulties around unisex bathrooms, for example, it is better to resolve them before you have a trans employee caught in the middle.
Don’t try to develop your strategies alone. You can’t be expected to know what kinds of accommodations to put in place for every minority community. So ask. Talk to members of communities you’re trying to reach out to. Ask what would help them feel more included.
Diversify your leadership
We’ve seen that the NHS is much more diverse at lower levels of the organisation. As we reach more senior levels, the degree of diversity can tail off quickly. Addressing this trend will accelerate improvements in diversity throughout the NHS. Make hiring diverse leaders a priority.
Diverse leaders make more diverse hires and not just members of their own community. They may recognise particular candidates’ obstacles and understand the additional effort required to overcome bias.