Katie Knight: Mind the generation gap

Generational representation should be seen as another important aspect of diversity, says Katie Knight

I would guess there was over 1000 years of combined NHS experience within the room. Chief executives, career NHS managers, board members, professors, postgraduate deans, chiefs of nursing, heads of HR. And mea trainee paediatrician, who depending on which definition you use, just about scrapes into the “millennial” category. Over a series of roundtable discussions we were asked to come up with “novel and innovative solutions” to a range of issues relating to the NHS Long Term Plan. We were acting as the assembled representatives of the NHS, although we were nothing like as diverse as a random sample of NHS workforce would be. I listened, nodded, and silently fumed at some commentsmore than once, “millennial lifestyle choices” were proposed as a main reason for the staffing crisis in the NHS.

Once I’d drowned out the impostor syndrome internal monologue, I dared to politely disagree on a few things and raise a new point here and there. My comments were warmly welcomed as a voice of “youth;” some senior leaders seemed unusually interested in what I had to say… then I had the sudden and uncomfortable realisation that some of these vastly experienced people had just never asked anyone in my relatively junior position what they thought about the systemic issues that affect all of us, or what we thought could be done differently.

I wish this meeting was the exception. I’ve spent the past few months away from clinical practice on a fellowship learning about NHS leadership and management. I’ve frequently found myself in meetings where I am the only trainee, while issues are discussed, and decisions made, that might drastically change our experience of working on the front line of healthcare.

The fundamental problem is this: the problems we face in the NHS today are complex and in need of radical solutionssolutions which might completely change the landscape of the way we deliver healthcare.

Without the input of those who will be working and leading in this environment in the next five, ten, twenty five years, what bright spark of innovation could we be missing? Are we designing systems in which they could or would not want to work? Could “solutions” proposed by an unrepresentative group of individuals have the unintended consequences of making things worse for the very people they are trying to serve?

There is no substitute for experience. The insight and knowledge of those who’ve gone before, plus the wisdom of hindsight is absolutely invaluable. But if you genuinely want innovation, surely combining all of this experience with the fresh perspective and long term goals of people who will be working in the system for decades to come is the only way to truly change the status quo.

The diversity and representation agenda within the NHS is finally waking up and stumbling towards the present. In 2019, I’d argue that efforts so far are limited and have been muted in their success. Some medical conferences are actively trying to curate a 50:50 gender balance of speakers, and to avoid all-male panels (manels). The Workforce Race Equality standard (WRES) has been in action since 2015/16; the 2018 report showed that the proportion of BME staff in very senior manager positions increased from 5.7% in 2017 to 6.9% in 2018. A very small shift, and still way off the mark in terms of the proportion of BME staff (19.1%) in NHS trusts.

There is so much further to go for the NHS to achieve anything like the diversity it should for all protected characteristics, across all leadership and management structures. And while we double down on these efforts, I believe that generational representation should be seen as another important aspect of diversity.

Younger generation representation can and should be happening everywhere. There is nothing to stop a trust board encouraging more junior clinical staff, or even undergraduate student representation, at executive or board meetings. Or for that matter, appointing a non-executive director who is under 30. How many consultant meetings or senior nursing meetings invite a representative from the junior ranks?

Let us millennial(ish) and gen-Z’s into the room. Let us soak up the experience of those who’ve been around the block—but also hear our opinions and give us a say in how big changes are made—after all we are the ones who will have to bear the consequences when we are (hopefully) still working within the NHS twenty, thirty years down the line.

Katie Knight is a paediatric emergency medicine registrar, National Medical Director’s Clinical Fellow at Health Education England, and Founder/Lead Editor, paediatricFOAM.com

Competing interests: None declared