In his Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry in 2013, Robert Francis QC wrote that, in the NHS:
there lurks within the system an institutional instinct which, under pressure, will prefer concealment, formulaic responses and avoidance of public criticism
and
an institutional culture which ascribed more weight to positive information about the service than to information capable of implying cause for concern. https://tinyurl.com/45s3zaxm
Proof that such a culture is alive and kicking came down the road from Stafford exactly one decade later. Thanks to the assiduous homework of Emily Townsend from Health Service Journal, and the determination of a Non Executive Director, we have learnt that Shropshire, Telford and Wrekin (STW) Integrated Care Board (ICB) commissioned a report into racism across its main health providers in 2022, received its findings in November 2022, and have suppressed it ever since. https://tinyurl.com/3tzyphcw
NEDs raise concern
The racism report was mentioned at an ICS Board meeting last month (April 2024) after a Non-Executive director repeatedly requested to discuss the report findings that the ICB's Chief executive received in November 2022.
Key findings included:
That 79 per cent of non-white staff and 56 per cent of white workers agreed racism between colleagues was a problem in their workplace, while 85 per cent of non-white staff and 50 per cent of white employees agreed racism from patients and families was an issue.
Nearly three-quarters of non-white staff interviewed expressed “a reluctance and a fear to discuss, challenge or report racism, whether experienced or observed”.
That health and care staff across Shropshire, Telford and Wrekin ICS overall experience more racism than national and regional averages.
The report found non-white staff members reporting they were “shunned by white colleagues who avoid interacting with them” Responses from non-white interviewees experiencing racism included being “subjected to untrue comments such as ’you have come in to take all our jobs’”; being “shunned by white colleagues who avoid interacting with them”, and “false allegations based on assumptions that people like them are not good at doing the job”.
Eighteen (18) months after the report was received, the Integrated Care System (ICS) Board has not discussed or agreed an Action Plan in response to the appalling findings.
David Sidaway, Telford and Wrekin council chief executive officer, told the recent board meeting: “If these kind of results were driven from a staff survey, I was responsible for, I would have to have an action plan that followed it within seconds. And I would say as an [ICB] board member…it’s incumbent on all of us to get an action plan in place and put this right because it’s nothing short of a disgrace.”
According to the 2023 workforce race equality statistics (WRES) for the STW ICS 18 per cent of non-white staff experienced discrimination at work, which is among the worst-performing ICSs nationally, although it is down from 23 per cent in 2021.
However, of those who responded “yes” to experiencing discrimination, 90 percent (equivalent to 161 staff) said this was on the basis of their ethnic background a 10 percent deterioration in 2021 and the worst score nationally.
The report’s headline figures were only included on the ICS board agenda last month following repeated requests since April 2023 by non-executive director Meredith Vivian for executives to discuss it publicly.
When asked by HSJ , the ICB was unable to explain the delay or produce an Action Plan. The ICB has still not published the report in full and did not respond directly when asked by HSJ to explain the delay in publishing the report.
Expectations of ICB Boards
The ICB’s own Equality and Diversity Policy states
“The promotion of equality and diversity will be actively pursued through policies and ensure that employees receive fair, equitable and consistent treatment and ensure that employees, and potential employees, are not subject to direct or indirect discrimination.” https://tinyurl.com/hbmfnrc8
It is difficult to see how this obligation – never mind the Equality Act 2010 requirements to promote equality – can be met when crucial equality information is hidden from the very Board responsible for implementing it.
The revised NHS England Fit and Proper Person Test (FPPT) Framework for board members https://tinyurl.com/3yyct7pm sets (Regulation 5) a requirement that any Board member:
“has not been responsible for, contributed to or facilitated any serious misconduct or mismanagement (whether unlawful or not) while carrying out a regulated activity or providing a service elsewhere which, if provided in England, would be a regulated activity.”
The Framework reminds us that “ICBs, together with the CQC and NHS England, are within scope of this Framework.”
NHS board members, in their capacity as public office holders, are expected to abide by the ‘Nolan Principles’ as defined by the Committee on Standards in Public Life. Principle 5 states:
“5. Openness. Holders of public office should act and take decisions in an open and transparent manner. Information should not be withheld from the public unless there are clear and lawful reasons for so doing.”
The Guidance for NHS Boards on Freedom to Speak Up in NHS trusts and NHS foundation trusts (July 2019) published by NHS Improvement, NHS England and the National Guardian’s office states:
“it is the behaviour of executives and non-executives (which is then reinforced by managers) that has the biggest impact on organisational culture. How an executive director (or a manager) handles a matter raised by a worker is a strong indicator of a trust’s speaking up culture and how well led it is.” https://tinyurl.com/yc3bn2u9
The same should apply, rather obviously, to a concern raised by a Board member.
Potential consequences
On the basis of what is currently in the public domain, the Fit and Proper Persons Framework might be relevant to some of the ICB’s actions including:
Repeatedly avoiding sharing a report with Board members on a crucial issue directly related to the Board’s statutory obligations;
Apparent failure to either prepare, publish or act upon (and quite possibly all three) an Action Plan arising from the report;
Apparently suggesting that an Action Plan had been developed and was being acted on when it may not have been;
Potentially not complying with its statutory duty in respect of the Equality Act.
NHS England and the Care Quality Commission (CQC) have both seen the HSJ article. They are responsible for ensuring ICBs implement their statutory duties on equality, and adhere to the Nolan Principles and to the FPPT Framework.
Presumably, both will want to ask whether the ICB has made their Regional Directors aware of these apparent shortcomings and what their Regional Directors response has been. Key elements of being “well led” appear to be compromised, no doubt prompting consideration of a formal inspection.
And what about the staff?
A final thought. My experience over many years is that when apparent failures like this occur, they are the tip of an iceberg impacting wider issues of governance and the treatment of the organisation’s staff, STW ICB’s recent staff survey results are telling - 8th from the bottom for ICBs on whether staff who would recommend the organisation as a place to work. I would strongly suggest that a crucial requirement here is to investigate how staff (especially Black and Minority Ethnic staff) employed by the ICB, including senior staff, are being treated.
If there is one thing worse than failing to address discrimination, it is trying to hide the evidence of it.
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