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Why are there fewer Black & Ethnic Minority Leaders in the NHS:

Itayi Matambo
4.3 Organisational Barriers Racially biased recruitment and selection practices: This was reported by the focus group as a major organisational barrier. This is true, not only in the NHS, but in most larger organisations, as evidenced by the research published by LloydsRoberts, (2004). In the NHS, this kind of recruitment practice is only done at higher levels. In lower level recruitment, the NHSs resource departments do not use names, but codes, where recruiting members do not know the persons name. However, in higher positions, most of the posts are not advertised, but appointed to people within the same networks. The focus group went on to report that in non clinical areas, the NHS recruits from within for lower level positions and the NHS suggest that there is no funds to recruit from outside, but posts should be filled in by internal staff only, but it changes the goal post and goes out to recruit from outside, for higher level positions, before you know it, they will email you to say that they found someone more experienced for the post, but you only discover they are not more experienced than you. In other instances, the NHS would be justified to recruit from outside when there are no suitable staff internally. Under valuing of overseas work experience: The views of the Focus Group and Coghill et al (2008), agreed that the NHS was undervaluing overseas experience and expertise, which undermines their transferable skills (Williams, Dunn, and Bast, 200). Nurse participants on the programme qualified overseas. When they came to the UK, they had to undergo an intensive 3 months or a standard 6 moths adaptation period. Once they finished their adaptation, they started at the lowest possible entry position for a qualified nurse, but some had more than five (5) years experience in a country that used a training system which was similar to that of the UK, since she came from a Common Wealth Country (former colony of Britain). However, the NHS needs to put patient safety first. These people should prove that they can do what they say they can, before they are promoted to a higher level.

Tokenism: There was also a belief that, the NHS like any other big UK organisation, there is a lot of tokenism that take place. The results from the literature review suggested that most of staff from a BME background had not progressed further than they are now because they are from a BME background. BMEs need to critically look at why this is taking place. What actions have they taken? The focus group had indicated that, BMEs who come from outside the UK, face more obstacles due to their accents, cultural and religious beliefs, as compared to even fellow BMEs who were born in the UK. Women and from BME stated that they felt they faced even more barriers, and this has drastically reduced workforce diversity at top level, which have an effect on how the organisation functions. Glass ceilings: The Focus Group also highlighted that after Band 6 of the NHS, gender and race in the NHS takes a lot of precedents on who is to be promoted. They anonymously agreed that the NHS it is still a long way from solving this problem because some non BME staff hold their racist views, and are still holding very authoritative, influential and rewarding positions of the organization and they continue to recruit only non BMEs. Immigrants and Remuneration: Most professionals from a BME background reported that they earn less than their non BME colleagues. This was as a result when some of them came here as immigrants, which affected their rewards. Some bargained for the wages whilst in their country of origin, they had little bargaining power and entered employment at low entry. They just wanted to leave their country of origin. That is not the problem set by the NHS. It is up to those individuals to rectify what they have done wrong. They should not blame the NHS for their lack of bargaining power. However, the NHS should not have taken advantage of these people. The NHS has rectified this by introducing Agenda for Change, which stopped people from bargaining with the interviewing panel.

Institutional Racism was another barrier which was identified by the focus group, and not identified by the report by Coghill, et al (2008), but identified by Phillips (2010). Institutional racism was defined on www.guardian.co.uk, as a collective failure in processes, attitudes and behaviour by an institution to give an appropriate service to the people as a result of their ethnic origin, culture or skin colour and it amounts to an extent of discrimination through ignorance, stereotyping, prejudice, thoughtlessness and racist behaviours towards a disadvantaged community. Stereotyping (Coghill, et al, 2008) and preconception of roles and abilities were mainly identified by the focus group as a result of the lack of knowledge and appreciation by non BME colleagues. They stated that non BME colleagues, have access to immediate supervisors or line managers, who they can report false or exaggerated information about what took place and who to blame if something went wrong during an activity. 4.4 Individual barriers Extended Family: One of the barriers that was identified by the Focus Group, but was not highlighted in the literature reviewed, was that of extended family. The Focus Group felt that extended family issues in most African and Asian families are major barriers in BME career progression. It was agreed by the focus group that most BME staff work longer hours to be able to remit money to their extended families they left home. In addition to remitting this money, they also have bills and mortgages to pay here in the UK. No one can then blame the NHS for not promoting BMEs if they have not resolved this problem. They then fail to have spare time to continue or pursue further professional studies, which are directly or indirectly related to their profession. This leads to have a stagnant career. When senior jobs are advertised, they do not have the necessary academic theory to back their experience. The Focus Group also stated that following that, BME staff also find themselves not well prepared for the challenges that come with senior

positions. They are not sure how the more challenging senior roles will fit it their busy lifestyle. Lifestyle: Another individual factor which was not raised in the literature, but raised by the focus group was that of personal lifestyle. Those BMEs from Africa (especially women), stated that because they did not smoke, drink or go out, they find themselves staying alone in the office when most of their non BME colleagues go out together. They went on to state that even the most junior staff, to the most senior staff in the department, they all congregate outside to smoke, chat, discuss possible opportunities coming. Also those BMEs who were of African origin have strong Christian beliefs and they did not drink alcohol. As a result they do not go out with other White colleagues after work or on Fridays, they are again excluded from this informal network. The same informal networks are formal networks during working hours. BMEs remain in their informal networks, praying and carrying out bible studies. Most of them are in the same professional field and similar positions, which do not have any influence when it comes to knowing what is happening in other departments within the same organisation. They went on to suggest that before you know it, that most junior staff is elevated and is now your senior. Networking: Another individual barrier was that of lack of skill on how to build networks. Networking is a way of getting to know other people, their interests, abilities, what they do and their connections in order to have a mutual benefit.(Flynn, 1995) It is about knowing the right people, who can help you to help with career/professional development (Smith, 1994). It is important for BME professionals to realise that people with more and solid networks move on more on their careers (Rex, 2005), they know what is happening and their knowledge is increased (Flynn, 1995). People in your networks also know what you are capable of doing, like your skills and experience because they will have seen you doing some of those skills (Smith, 1994).

According to one (1) member on the focus group, building networks amongst BMEs involves the belief that it is all about who you know, and not what you know. This reminded her of some of her experiences from her country of origin, where this was taken as employing someone under nepotism circumstances and this does not give everyone an equal opportunity (Scoppa, 2009). Communication and Fitting in: Due to the levels at which BME feel that they cannot fit in, they are too busy with their life style, they have to work too hard to meet their extended familys financial needs, they are then automatically excluded from both formal and informal networks. It therefore, fits in the hypothesis that BME have themselves to blame for the lack of their career progression. They should find the best ways of planning their work and life balances. Some do not know how to start a networking process (www.nationalnhsbmenetwork.org). They lack the confidence and assertiveness to engage in the communication process that creates networks, should learn the best ways, change culture. Culture Change (is both organisational and individual). The other organisational barrier was the lack of change in relation to the organisational culture. The NHS went global, by recruiting from all over the world. However, it did not appear to have clear diversity goals drawn at the same time they started recruiting from outside. When the NHS embarked on massive international recruitment drive, and the free training of student nurses from all over the world, was it ready to change the recruitment processes and practices that existed. In any change initiative, different people react differently to change. Depending on the levels of understanding, it might take some people to accept other people from other cultures or backgrounds. Culture is reported to be shared norms and behaviours learned by members of an organisation, that shape their way of working (Hill, 2005). They are the shared values, beliefs, norms, expectations, history and traditions, useful for understanding an organisation, orientation for new staff (Verbeke, et al, 1998 and Hemmelgarn et al 2006). The impact of organisational culture has an effect on staff quality and quality

of its services. For example, the way decisions are made and how problems are solved. This culture is also observed in the policies and procedures, to show commitment to the people it was recruiting. Had the NHS reviewed and changed its recruitment policies at the time of overseas recruitment, it would have made a more awareness trainings to try and affect individual culture and perception of other people from outside the UK. The NHS needed to spell out all its values and goals once staff are informed of these, they will commit, even if it takes time (Hemmerlgarn, et al 2006, cited by Sailor, Dunlap and Sugai, 2009). Also under individual barriers, culture was looked at two different ways. Culture can be looked at from the BMEs and non BME staff, which have eventually affected BME career progression. 50% or 9 people of the focus group agreed that their culture can have a negative effect on their career progression. They agreed that they have been stuck in their cultural belief that if they work hard, they will be noticed and get elevated. They agreed that most BMEs believe that you need to be humble, look and learn and respect those in higher authority. It has been very difficult to challenge those people in authority. As a result of this, it is assumed that they will not be able to assertively take on challenging roles where difficult communication may take place between more senior employees and the BME senior employee. Another 50% felt that non BMEs have to change their culture and accept that BMEs have more to offer. They felt that bad publicity by the press on immigrants have contributed to that. In the cultures of non BMEs, a few more examples were used to explain the resistance. They felt lack of knowledge about other cultures, unwillingness to learn about other cultures which are presumed to be primitive and inferior. Understanding and valuing these differences will make problem solving easier, (Conroy, 1993) Invisibility. 100% (18 participants) on the focus group agreed that they are invisible within a team or organisation. Information is passed to a lower grade staff who is

from the non BME, but that information will not have filtered to a BME staff who might more senior. This factor was not raised in the literature review. They contributed the invisibility to the fact that BMEs are not well connected to managers in the organisation. One BME member gave an example that university credited study modules were given to non BME. When more senior BME staff queried it, they were informed that because they were on a work-permit, it was going to be too expensive for the Trust to pay for their fees. But when they followed it with their union representative, they were informed that, each NHS Trust had contracts with local universities and that did not matter whether one was on a work permit or not. Little or no first level management experience. The focus group and the

literature review showed that because most BMEs are not given or shown how to do simple managerial tasks on a day to day operation of the organization, for example, being a shift leader or shadow a shift leader in a ward when a White Sister is on duty, they do not learn how to manage. The non BME senior staff teaches or shows her other White colleague how things are done, at first level management. This leads to lack exposure to challenging and mentally stimulating assignments. If job vacancies with more managerial roles, the experienced BME found themselves in limbo, whilst the less experienced non BME staff excels at the interviews because they have done it. They contributed this to stereotypical thinking (Posthuma and Campion, 2009) and fits well in the institutional racism category (Phillips, 2010), where people are intentionally left out of normal on the job learning. BMEs therefore get frustrated, they have no one to look up to, because those BMEs who are promoted mostly behave like non BME people. Lack of role models and mentors: Since there are fewer BME leaders in the NHS, the focus group felt that they have no one to look up to. Those BMEs who have made it to the top make it feel as if it can be done easily, it was smooth sailing and they did not face these barriers that current aspiring BME leaders are facing. One group, within the focus group, sent interview questions to the Professor Lord A Darzi, asking him what he would advice to aspiring BME members.

Professor the Lord Darzis answers did not only focus on BMEs, but on all aspiring leaders. Maybe, as a leader he did not want to sound biased. Although the participant did not find this helpful, it was probably a good strategy which would make any aspiring leader to look at, because in the real world good leadership qualities are a requirement for all leaders, whether BMEs or non BMEs.

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