Authors

Dr Esraa Sulaivany, Consultant Palliative Medicine, Medical Director St. Rocco’s Hospice, Warrington, North Cheshire and Mersey NHS Foundation Trust 

Dr Fran Hakkak, Medical Director, Compton Care, Wolverhampton

Dr Despoina-Elvira Karakitsiou, Locum Consultant Palliative Medicine, Northern Ireland Hospice, Belfast

Trudie Roiz de Sa, Equity, Diversity & Inclusion Lay Trustee, Association of Palliative Medicine

Introduction: A health system in flux demands inclusive leadership

Palliative care is changing fast: rising demand, workforce pressures and evolving models mean traditional ways of working are no longer enough. As services adapt, we need leadership that not only understands clinical quality, but also who uses those services and how they reach people from all backgrounds.

Yet our workforce still doesn’t reflect the diversity of the populations we serve. Without inclusion built into leadership, we risk perpetuating inequities in care access, workforce opportunities, and the cultural responsiveness of care.

Our EDI Committee engaging with members at the Palliative Care Congress in Brighton. Simon Callaghan Event Photography

Workforce diversity matters – evidence from palliative care

Underrepresentation in the workforce:
Studies in palliative medicine indicate that doctors from socioeconomically disadvantaged and ethnic minority communities are significantly less represented across the career ladder, from training to senior roles. This matters because clinicians who reflect the population can bring insight, trust and lived experience into care decisions.

Palliative medicine has one of the highest proportions of women in consultant roles across UK specialties. This is a strength we can build on. But representation isn’t consistent across all groups – significant gaps remain, particularly around ethnic diversity, overseas-trained doctors, and disability inclusion across the workforce and leadership.  (https://spcare.bmj.com/content/12/1/49)

Inequities in research and involvement:
A framework developed through the RE-EQUIPP Care Partnership emphasises that palliative care research itself must be diverse and inclusive. It used co-designed resources and shared learning to improve participation of people from diverse backgrounds in patient and public involvement (PPI), recognising that research shaped without inclusive involvement risks perpetuating gaps in care. (https://eprints.whiterose.ac.uk/id/eprint/210591/)

Gaps in clinical practice:
A broader review of equity, diversity and inclusion (EDI) in palliative care highlights that addressing disparities must go beyond individual actions – training, education and inclusive research structures are needed to ensure equity across the continuum of care. (https://link.springer.com/article/10.1186/s12904-023-01185-6)

Inclusion in palliative care cannot focus on workforce alone:

At its core, palliative care is about patients. Our patient population is increasingly diverse, and experiences of illness, dying and decision making around this are deeply shaped by culture, faith, language and identity. Inclusive leaders must foster environments where cultural humility and responsiveness are a core part of clinical care, ensuring that care plans reflect individual values, beliefs and needs of each person receiving our support.

What inclusive leadership looks like in practice

Inclusive leadership in palliative care isn’t about numbers or policies alone. It means:

• Listening to diverse voices – from underrepresented professionals and patients with lived experience 
• Advocating for equity in access – addressing known disparities in referral patterns, care outcomes and trust in services amongst minority communities
• Using data to drive change – asking who is represented in our workforce and whose voices are absent
• Embedding inclusion in decision making – not as an add-on but as a daily practice

This is reflected in our 2026-8 Association for Palliative Medicine (APM) strategy, with EDI woven into it as a core aim rather than treated as a separate priority.

APM’s approach: From strategy to action

Rather than positioning EDI as a standalone aim, the APM will now strive to embed it across the whole organisation. We already have an EDI Committee (set up in 2022) that spans all protected characteristics and inclusion priorities, alongside our Race Equity Committee (set up in 2021), focusing on racial equity and workforce representation. Key priorities now include:

• Committee leadership: supporting each of our 10 Committees to apply EDI principles in proportionate, practical ways
• Decision tools: introducing a simple EDI reflection tool to guide inclusive decisions
• Feedback loops: using members’ self-reported demographic data to understand and respond to inclusion-related issues
  

Embedding EDI across strategic priorities increases visibility and accountability, while ensuring that initiatives remain feasible for a membership that is largely clinical and operationally stretched.

APM members connecting at the Palliative Care Conference in Brighton. Simon Callaghan Event Photography

Lessons learned: What we got right – and what we’d do differently

What’s working:

• Creating space for structured conversations about race, identity and workforce representation through the establishment of the REC and ECHOs
• Listening sessions with underrepresented clinicians to surface real experiences
• Embedding EDI language in strategy – signalling organisational commitment

What we’re aiming to avoid:

• A one-size-fits-all approach: Different communities face unique barriers; our strategy must be adaptable
• Using shorter-term action plans: Clear near-term goals help maintain momentum.
• Siloed learning: The more we collaborate across under-represented groups, the stronger the evidence base for inclusive practice becomes.

Take Home Messages

• Inclusive leadership is essential to quality palliative care – it improves relevance, trust and access
• Embedding EDI into strategy and everyday decisions builds organisational resilience and responsiveness
• Progress requires measurable actions, not just aspirations
• Inclusion must start with patients – culturally responsive care is core to compassion and quality of service.

References

1. Iqbal M, Afuwape S, Caplan G. Lack of racial diversity within the palliative medicine workforce: does it matter? BMJ Supportive & Palliative Care. 2022.
2. RE-EQUIPP Care Partnership. A framework for more equitable, diverse, and inclusive PPI in palliative care research. 2024.
3. Hudson P et al. Enhancing equity and diversity in palliative care clinical practice. BMC Palliative Care. 2023.

Declarations of Interest

Dr Esraa Sulaivany:  None.
Dr Fran Hakkak: None
Dr Despoina-Elvira Karakitsiou: None
Trudie Roiz de Sa: I am the EDI Lay Trustee of the Association for Palliative Medicine of Great Britain and Ireland.