Too much employer-based activity on EDI is performative, driven by good intentions not by evidence-based practice. That has to change. It has to demonstrably be about improvement not just compliance, about uncomfortable discussions and measurable outcomes anchored in moral courage. Otherwise, all EDI work will feel the cold winds of Trumpite cowardice:

“Senior figures in British business have described a chilling effect on diversity, equity and inclusion (DEI) initiatives, saying they are being “rebranded” to avoid attracting unwanted political attention.”

Anyone who thinks this will not impact the UK public sector needs to wake up and smell the coffee.

If we are going to seriously address the inequality and discrimination that is embedded in public sector workplaces, including the NHS, we need to have a serious rethink about what passes as EDI initiatives at the moment.

When I meet NHS Boards and senior leadership teams, I ask this question: “what confidence do you have that what you are doing (or proposing to do) has a reasonable likelihood of achieving its goals. And if so, why?”

In too many organisations there is an embarrassed silence.  It is a reasonable question. No Chief Medical Officer or Chief Nursing Officer would take a proposal to a board to mitigate a significant problem – for example if there was an outbreak of MRSA – without being able to answer that question.

Too many public sector organisations have equity, diversity and inclusion policies that driven by good intentions but not underpinned by research evidence. Too many “EDI action plans” are performative and are spring cleaned year after year without bringing about the improvement everyone says they want and which are needed.

The examples are myriad. Organisations with:

• diverse interview panels (a good thing) but without any accountability for decision making.
• positive action recruitment and development programmes (which may risk being a deficit model) but without debiasing the selection processes those graduating from such programmes then face.
• lengthy career progression strategies which still permit the “tap on the shoulder” for the all-important stretch opportunities.
• ever more sophisticated speaking up procedures and policies without Boards asking why leaders fail to hear, listen, and then act on the concerns raised – and ensuring no detriment to those who do raise concerns, especially those raising concerns about discrimination.
• Board behavioural standards on bullying and harassment which are not modelled by all Board members or not followed by sustained action and learning, especially if the concerns are abuse of staff with disabilities or subject to homophobia, or are not acted on when staff are brave enough to challenge sexual and racial harassment.
• BAME, LGBT+, disabled staff, neurodiverse and women’s networks whose leaders are clapped and showcased but not listened to when they bring difficult messages.
• Board reports trumpeting improvements in representation but which are not underpinned by inclusion, and will therefore not leverage the multiple advantages of diversity.
• Leaders who wait for staff to raise concerns of discrimination without being actively proactive and preventative – being comfort seeking not problem sensing.

Many (most) NHS organisations rely on policies, procedures and training to give assurance of fairness and to protect those who might raise concerns. But research is absolutely clear. Evesson, for example is clear that in isolation policies and procedures will not change culture whilst Kalev is clear that diversity training is the least effective way, for example, of improving career progression for women and BME managers. This approach in isolation will not change workplace culture as has been argued elsewhere.

What is needed are the key steps identified by research

• a clear narrative setting out the moral importance of EDI and the practical benefits that can arise for productivity, innovation, creativity, problem solving and decision making.
• Teams build on the evidence that cognitive diversity underpinned by identity diversity and inclusion makes for better decision making, problem solving, innovation, creativity, productivity and retention.
• accountability (which may be nudges or may be more direct) driven by data for decision making just as we would for any other issue
• an emphasis on debiasing processes rather than just relying on unconscious bias training
• leaders who are inclusive in their behaviours, modelling the behaviours expected of other, and actively stepping in when staff face detriment
• leaders at every level who are proactive and preventative, not waiting for individual staff to raise concerns, and committed to transparency on every level.
• ensuring active breaches of Trust standards such as preventing staff raising concerns or being actively involved in discrimination must be seen as “never events” with appropriate sanctions. By the way, let’s see if that is in the forthcoming Code of Conduct for NHS Managers (it wasn’t last time I looked).
• leaders prepared to make themselves uncomfortable when tackling challenging issues, notably but not solely, race discrimination and take personal responsibility for leading the work.

All this requires one other change.

EDI must be seen as a core part of improvement (of services as well as the workforce) not simply a matter of compliance and risk. That requires a rethink of the role of those charged with leading on EDI in the NHS at every level. We need staff with courage, with values, with active support, and with direct access to senior leaders – and who are no longer seen as compliance and risk advisers but actively drive service improvement using evidenced interventions.

Those principles, incidentally, apply more widely to how we conduct other aspects of employment relations – and indeed, dare I say it, how we plan the current restructuring of the NHS.

If we don’t do all this, then inevitably more people will ask why so much of what is being done appears to be performative. After all, the WRES data is hardly moving – and by the way where are the 2024 WRES and WDES data reports?

Equity, diversity and inclusion strategies with the right focus, based on evidence, with a clear narrative are absolutely crucial if we are to improve public services. Many good people in the NHS agree. Ministers, please note.

Author

Roger Kline

Roger Kline is Research Fellow at Middlesex University Business School. He authored No more tick boxes: a review of the evidence on how to make recruitment and career progression fairer and “The Snowy White Peaks of the NHS” (2014), designed the Workforce Race Equality Standard (WRES) and was then appointed as the joint national director of the WRES team 2015-17. Other publications include the report Fair to Refer (2019) to the General Medical Council on the disproportionate referrals of some groups of doctors (co-authored with Dr Doyin Atewologun), The Price of Fear (2018), the first detailed estimate of the cost of bullying in the NHS, co-authored with Prof Duncan Lewis and most recently (with Joy Warmington) Too Hot To Handle (2024) on why concerns about racism are not heard or acted on.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.