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This report by Roger Kline brings together a range of research evidence to suggest practical steps NHS employers can take to reduce inequalities in staff recruitment and career progression. It specifically focuses on the treatment of female, disabled and BAME staff. Written for practitioners, it summarises some of the research evidence on fair recruitment and career progression. It highlights principles drawn from research that underpin the suggestions made for improving each stage of recruitment and career progression.

As the UK emerges from the COVID-19 pandemic ‘Build Back Better’ has become the mantra. Important, but we need to Build Back Fairer. The levels of social, environmental and economic inequality in society are damaging health and wellbeing. The aim of this report from the Institute of Health Equity is three-fold: To examine inequalities in COVID-19 mortality. Focus is on inequalities in mortality among members of BAME groups and among certain occupations, alongside continued attention to the socioeconomic gradient in health – the more deprived the area, the worse COVID-19 mortality tends to be. To show the effects that the pandemic, and the societal response to contain the pandemic, have had on social and economic inequalities, their effects on mental and physical health, and their likely effects on health inequalities in the future. To make recommendations on what needs to be done.

In a project led by the Race Equality Foundation, the Men’s Health Forum teamed up with Faith Action and Clinks to develop a community-centred programme to offer blood pressure testing and raise awareness amongst black African and Caribbean males. The programme was piloted in barbershops, a bus depot and a local church in three London boroughs. It demonstrated that offering blood pressure checks in community settings could help overcome the reluctance amongst black African and Caribbean men to have their blood pressure checked. The report, following evaluation between February-March 2020 in the London boroughs of Southwark, Hackney and Brent, concluded: 'The community blood pressure programme was welcomed in all community settings. The pilots engaged a considerable number of men in an accessible environment that they were comfortable in. There was a willingness from community stakeholders for the programme to be implemented over a longer period of time, and healthcare providers may wish to consider the practicalities of delivering blood pressure testing in similar settings for specific target groups.'

Research has found that variations in cardiometabolic factors, vitamin D levels and socioeconomic or behavioural factors do not adequately explain why COVID-19 disproportionately affects black, Asian and minority ethnic populations. In this study published in the Journal of Public Health, Raisi-Estabragh et al. examined whether the greater severity of coronavirus disease 2019 (COVID-19) amongst men and Black, Asian and Minority Ethnic (BAME) individuals is explained by cardiometabolic, socio-economic or behavioural factors. They found ethnicity differential pattern of COVID-19 was not adequately explained by variations in cardiometabolic factors, vitamin D levels, or socioeconomic or behavioural factors. This, the researchers said, suggests that alternative biological pathways or genetic susceptibilities may have importance in driving the higher rates of severe COVID-19 in BAME populations and should be investigated.

In October 2021 the government announced a review into leadership across health and social care, led by former Vice Chief of the Defence Staff General Sir Gordon Messenger and supported by Dame Linda Pollard, Chair of Leeds Teaching Hospital Trust. The results of the review have now been published and recommendations made. The 'Leadership for a collaborative and inclusive future' review (also know as the 'Messenger review', led Sir Gordon Messenger and supported by Dame Linda Pollard, focused on the best ways to strengthen leadership and management across health and with its key interfaces with adult social care in England. Findings Cultures and behaviours The review found that the current cultural environment does not lend itself to the collaborative leadership needed to deliver health and social care in a changing and diverse environment. Leadership is seen as a job role rather than a characteristic that runs through the workforce. Staff respond reactively rather than constructively and respond to high levels of pressure from above. There is also a lack of accountability and authority in some areas. Although not universal, acceptance of discrimination, bullying, blame cultures and responsibility avoidance has almost become normalised in certain parts of the system. Equality, diversity and inclusion (EDI), which is about respectful relationships and underpins a wider culture of respect, is partial, inconsistent and elective. In some places it is tokenistic. There is a lack of psychological safety to speak up and listen, despite progress being made. The Freedom to Speak Up initiative can be perceived as just relating to whistleblowing rather than also organisational improvement. Standards and structures The review found that management tend not to be perceived as a professional activity and there is a lack of universal standards for management competence and behaviour. There are inequities in how managers are perceived, valued and trained and inconsistencies in appraisals. Regulation and oversight There is a positive view that the Care Quality Commission (CQC) can influence collaboration across the whole of health and social care through its inspections, and welcome its increasing focus on teams and systems. However, there is sometimes an over-emphasis on metrics which can be counter-productive. The review welcomes the shift in emphasis from a punitive model to a remedial one. Clinical leadership The review found incidences of the flawed assumption that simply acquiring seniority in a particular profession translates into leadership skills and knowledge. Doctors are often not properly trained or equipped for leadership roles. Allied health professionals often highlighted that they felt their career opportunities in management were limited. Management and leadership training should be an integral part of all clinical training pathways. Leadership delivery in the future The move towards health and care integration and the work currently underway to merge the arms-length bodies and create a new NHSE offers the opportunity for a fresh approach to preparing leaders and managers in the future. Recommendations 1. Targeted interventions on collaborative leadership and organisational values A new, national entry-level induction for all who join health and social care. A new, national mid-career programme for managers across health and social care. 2. Positive equality, diversity and inclusion (EDI) action Embed inclusive leadership practice as the responsibility of all leaders. Commit to promoting equal opportunity and fairness standards. More stringently enforce existing measures to improve equal opportunities and fairness. Enhance CQC role in ensuring improvement in EDI outcomes. 3. Consistent management standards delivered through accredited training A single set of unified, core leadership and management standards for managers. Training and development bundles to meet these standards. 4. A simplified, standard appraisal system for the NHS A more effective, consistent and behaviour-based appraisal system, of value to both the individual and the system. 5. A new career and talent management function for managers Creation of a new career and talent management function at regional level, which oversees and provides structure to NHS management careers. 6. Effective recruitment and development of non-executive directors (NEDs) Establishment of an expanded, specialist non-executive talent and appointments team. 7. Encouraging top talent into challenged parts of the system Improve the package of support and incentives in place to enable the best leaders and managers to take on some of the most difficult roles. All 7 recommendations have been accepted by the government and publication of the report will be followed by a plan committing to implementing the recommendations.

In April 2022, Whose Shoes were invited to run a workshop in Croydon in support of the HEARD campaign - Health Equity and Racial Disparity in Maternity. Women and families from Croydon came together to talk to healthcare professionals about what makes a difference in maternity care, and raising awareness of some of the issues faced by people from Black, Asian and Minority Ethnic communities - not just the 'service users' but staff experiences too.

Maternal outcomes for Black women are significantly worse than for white women - Black women are four times more likely to die during pregnancy, labour, or postpartum and are twice as likely to have their baby die in the womb or soon after birth. They are also at an increased risk of readmission to hospital in the six weeks after giving birth. This report by the organisation Five X More presents the findings of a survey into black women's experiences of maternity services in the UK. The survey aimed to understand how maternity care is delivered from the perspective of women from the Black community, and 1,340 Black and Black mixed women responded, sharing their experiences. It seeks to highlight the real life encounters behind the known disparities in maternal care. Women reported far more negative experiences than positive, and most of these experiences centred around interactions with healthcare professionals. The authors highlight three factors related to healthcare professionals that contribute to damaging interactions, to do with their attitudes, knowledge and assumptions. The report includes many quotes from Black women about their experiences of NHS care and the damaging long-term consequences of this, such as fear of having another baby, reluctance to engage with health services and mental health issues. Key findings Antenatal care Engagement with antenatal care was high with 96% engaging with maternity services in the first trimester of pregnancy and 95% of women engaging fully with midwifery, doctor and sonography appointments. However, for women who experienced miscarriage or pregnancy loss, 61% report that they were not offered any additional support to deal with the outcome of the pregnancy. Labour and birth Just over a third (36%) of respondents reported feeling dissatisfied with how concerns were addressed during labour. 43% percent reported their pain relief options were not explained to them and 52% of women who did not receive their choice of pain relief said there was no explanation as to why it was not given to them. Postnatal care A third of respondents (31%) were concerned about the healthcare they received from their midwife during the birth recovery period. However, 69% of respondents said they were somewhat or very satisfied with the postnatal health check-up performed by the health visitor. While 78% with health concerns after birth those with concerns said they raised their concerns with a Health Care Professional, 36% of respondents said that they were not confident to ask for help on the postnatal ward. Recommendations The report makes the following recommendations to NHS England and NHS Improvement, the Healthcare Safety Investigation Branch, The Department for Health and Social Care and Integrated Care System leaders: An annual maternity survey targeted specifically at Black women Increased knowledge on identifying and diagnosing conditions that are specific to and Improve the quality of Ethnic coding in health records More community-based approaches must be used to improve maternal outcomes An improved system for women to submit their feedback and/or complaints specifically for maternity Ensure that individuals involved in training health care professionals are aware and have an appreciation of the disparities in maternity outcomes

Older generations are becoming more diverse than ever, but also more unequal. Tackling these inequalities is important to ensure that everyone is able to live a good later life. This set of downloadable 'evidence cards' by the Centre for Ageing Better highlights the severe inequalities experienced by Black, Asian and Minority Ethnic groups approaching retirement age, and what causes these inequalities. The evidence cards are available to download as both PDF and image files.

In this blog for Refinery 29, journalist L'Oréal Blackett discusses the additional risk and associated worries faced by black pregnant women in the UK. With black women four times more likely to die in childbirth than white women, and 40% more likely to suffer a miscarriage, she examines what action the government is taking to improve outcomes for black women and their babies. She speaks to a number of campaigners who highlight the importance of including black women at every stage of research and policy to tackle race-based health inequalities, and who question whether this is being done by the UK government's new Maternity Disparities Taskforce. She also argues that empowering women to make informed, evidence-based decisions is the most effective way to improve maternal safety for black women.