Has NHS Scotland given up the struggle to eliminate racism ?

The overarching reason the law requires public bodies like Scotland's health boards to gather and publish equality profiling information on employees is to get them to use that information to show how they are meeting their general equality duty.  In other words, health boards [and the rest of the public sector] need to actively use the information they gather on their workers to show how, as an employer, they :

• Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Act.
• Advance equality of opportunity between people who share a protected characteristic and those who do not.
• Foster good relations between people who share a protected characteristic and those who do not.

Research carried out last month looked at the actual data published in April 2019 by Scotland's health boards on their employment of Black Minority Ethnic [BME] people.  The reason health boards are required to publish this data is to allow scrutiny of their performance in whether racial discrimination continues to exist in the employment culture and practices of health boards.  

There are at least 3 major talking points revealed by the research.

Firstly, 8 health boards chose not to comply with the law and publish their workforce data by 30th April 2019.  Various excuses for non-compliance were on offer and various promises that it would be published anytime between end-May and August 2019.  None of which excuses are relevant.  There is no sub-clause or 'get out of jail card' in the specific equality duties [see pages 21 and 22 of the research report] which allows health bo

Only the ... Cabinet Secretary for Health can insist
and ensure that all health boards comply with the law

ards to ignore the deadline for whatever reason.  One of the consequences of this casual approach to compliance with the law is that it means accountability and scrutiny are perverted by the inability to compare and contrast performance across all 22 health boards.  It also adds to the creation of a corporate workplace culture where compliance with the law on equality is somehow less than important.  Only the Equality & Human Rights Commission and the Cabinet Secretary for Health can insist and ensure that all health boards comply with the law.

Second, in order to know whether any public body has managed to eliminate racism from its employment practices and cultures, there needs to be the calculation of almost a 3-D model of what the workforce would look like if all racism had been eliminated, showing BME workers in an optimum profile along the horizontal [numbers] and vertical [pay scales] axis of the workforce.  Added depth and texture would come from data sets on length of service, reasons for leaving employment, access to training and promotion success indicators for BME and non-BME workers.  Any scrutiny of the reports published by health boards [hyperlinks are included in the research reports to allow access to what each health board has published] reveals that the only evidence of workforce modeling is a rather tired and inadequate reference to data from the 2011 Census.

For instance on page 18 of the NHS Health Improvement Scotland report, the benchmark used to compare actual BME numbers/ratios of staff is that of the 2011 Census.  NHS HIS is not alone in doing this.  Even Scottish government as an employer cites the same data benchmark when reporting on its performance in relation to employment of BME people [see page 114 of report] - 4% of the 2011 Census population identifies as BME.   This has always represented a flaw of such reports, as few if any of these and other Scottish public bodies of any size will recruit employees exclusively from within the borders of Scotland. Given that reality, it might be more germane to reference the census data for the UK – which estimates BME people to account for at least 14% of the population. 

The importance of an accurate benchmark when checking performance on delivering employment equality is underlined when looking at employers of staff drawn heavily from the population of central Scotland.  At one end of the central belt is Glasgow with 11.6% of the population identifying as BME as at the 2011 Census.  At the other end is Edinburgh where 8.3% identify as BME.  It would not be unreasonable to expect NHS Greater Glasgow, NHS Lothian and Scottish Government all to be aiming for a much higher proportion of their workforce identifying as BME than the Scotland-wide Census figure of 4%.  Factoring in the real geographic recruitment [international] pool from which the major NHS Boards and government find staff and it seems clear that a workforce profile of 4% identifying as BME would represent an under-performance and an indicator of continuing racial discrimination. 

Finally, this year's research examined reports for any evidence that health boards were using the data gathered to better perform the general equality duty.  The overarching finding is that not one of the 22 Boards has offered clear evidence that they have used the employee information gathered to help them better perform the general equality duty - eliminate discrimination, advance equality of opportunity or foster good relations. 

The data revealed by the reports of those NHS Boards which have complied with the legal deadlines, considered alongside an analysis of what has been done by those NHS Boards to use the data gathered to better perform the general equality duty, combines to reveal a sector which has become immersed in and focused on the process of gathering and reporting on data.  

This imbalanced focus by the public sector on process, to the exclusion of action on eliminating racial discrimination, was recognised as a significant flaw in previous decades of work on equalities by Scottish government when publishing draft proposals for the current specific equality duties in 2010/11. This research suggests that flaw remains robustly alive at the heart of the NHS in Scotland and that only equally robust strategic change and leadership will enable the NHS to embark on the scale of work necessary to eliminate the institutional racism which continues to disfigure the profile of the NHS Scotland workforce.  The NHS in Scotland is happy to expend time, effort and resources on the window dressing of race equality.  No amount of window dressing can hide the fact that the shelves are bare when it comes to evidence on work to eliminate racial discrimination.  It is as if NHS Scotland has simply given up the struggle to eliminate racism from its employment cultures and practices.