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Promoting equality, diversity and inclusion

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We are committed to supporting and promoting equality, diversity and inclusion.

Strengthening our approach to EDI for regulators and Accredited Registers

We announced in Spring 2023 (7 June) that, as part of our strategic focus on equality, diversity and inclusion (EDI), we are changing the way we assess the performance of the organisations we oversee. This includes the 10 statutory regulators and the Accredited Registers.

The statutory regulators are assessed each year against our Standards of Good Regulation. Standard 3, which was introduced in 2019, considers whether the regulator understands the diversity of its stakeholders and ensures that its processes do not discriminate unfairly. Since early 2022, the threshold for meeting this Standard has been under review as we work towards increasing our expectations of the regulators’ performance, having seen improvements across the board since its introduction. We recently published an updated evidence framework and guidance for regulators on Standard 3, outlining our increased expectations for 2023-26.

Organisations in the Accredited Registers programme are assessed against our Standards for Accredited Registers. Following a public consultation earlier this year, a new EDI Standard will be introduced over the coming months which will look at how organisations which hold a Register demonstrate their commitment to EDI and ensure their processes do not discriminate unfairly.

Consumer research - Perspectives on discriminatory behaviour in health and care

We have now published the report of research we commissioned on perspectives on discriminatory behaviour in health and care. This is a piece of qualitative research looking at what constitutes discriminatory behaviour in health and social care and the different ways in which this behaviour may have an impact on public safety and confidence. This research arose from our observations outlined in Safer care for all in relation to how regulators deal with racist and discriminatory behaviour within the fitness to practise process. The report was published on 14 June to coincide with our Chief Executive speaking at a session on equality at the NHS Confed Expo 2023 in Manchester. We envisage that the research will help to inform a consistent and appropriate response by regulators and Accredited Registers towards the various types of discrimination.


Background/context to our first EDI action plan

The murder of George Floyd and the associated Black Lives Matter movement brought into focus the fact that society and organisations still have a long way to go in addressing systemic racial inequalities. The pandemic has further exposed inequalities in relation to race, sex, disability, and socio-economic status, as has the murder of Sarah Everard. The Authority is not unique in facing challenges in relation to its approach and track record on EDI. We have, therefore, been looking at our role.

In November 2020, we commissioned an audit by Derek Hooper to gain feedback from our staff and external stakeholders on EDI to identify areas for improvement. The audit included an assessment of how we were perceived by regulators. It identified key strengths, including the commitment of the leadership and staff to EDI and the work we had already done to encourage regulators to consider EDI as part of their obligations.

The audit also showed that, while the PSA has a commitment to EDI, it still has some way to go in making sure that every employee feels included and able to get their voice heard. Regarding its external role, the organisation was seen by its regulatory community to be lacking credibility on EDI due to its lack of visibility on these issues in the past. We therefore need to improve our performance in this critical area to demonstrate our commitment to EDI in spirit and in practice.

The audit highlighted the following areas for further work and development:

  • Culture
  • Leadership Development
  • Diversity profile of the PSA
  • Staff Development
  • Policy development and EIAs
  • EDI Communication and Messaging
  • EDI in regulation and the role of PSA.

Following that, we appointed Mehrunnisa Lalani to help us develop a plan to embed EDI into our work and culture. Mehrunnisa worked with our staff and Board to prepare an action plan for us to carry forward.

Our vision is to:

Live our values and foster a culture where all our people feel included and are empowered to achieve their best, where we welcome and celebrate diversity, where inequalities and unfair treatment is called out and addressed and, where we set the example for what good looks like for all those we interact with internally and externally.

We have developed three objectives that will give a focus to our work on EDI.

  1. We will develop our capability so that we have the knowledge and understanding to lead by example in creating an empowering and inclusive culture
  2. We will promote an inclusive workplace culture where everyone feels empowered, engaged and valued
  3. We will use our influence to encourage the promotion and progression of EDI across health and social care regulators and accredited registers.

You can download the action plan in Word or as a PDF.

Get in touch

Please let us know if you need our material in other formats. Email info@professionalstandards.org.uk

National Inclusion Week 2023

The week ran from 25 September to 1 October 2023 and the theme for this year was 'take action, make impact'. We took the opportunity to reflect on what action we have taken over the last few years and you can find out more in this visual summary.

We also asked some of our colleagues 'What does inclusion mean to me?' You can find out how they answered in the short vox pops below (but there are a few clues in this word cloud).

An image of a word cloud showing words associated with an inclusive workplace

'What does inclusion mean to me?' Watch our videos:
Amrat Khorana, PSA Associate Board Member

Nefo Yuki-Igbinosa, First participant on the PSA’s Work Experience Scheme

Christine Braithwaite, PSA Director of Standards and Policy

No more excuses - tackling inequalities in health and care professional regulation

This is the first chapter in our report - Safer care for all: solutions from professional regulation and beyondIt discusses how there are still unequal and unfair outcomes for protected groups in aspects of professional regulation. Find out more here.

Read our blogs

Race inequality in health and care. Who’s responsible?

Our report Safer care for all  launched at a Parliamentary reception on 6 September 2022. It highlights some of the biggest challenges affecting the quality and safety of health and social care across the UK today.

With the publication of Safer care for all, we started a debate on the issues highlighted in the report and the recommendations we put forward. As part of this debate, we are publishing a series of guest blogs written by stakeholders from across the sector. This blog is from Sam Rodger, Assistant Director, Policy and Strategy at the NHS Race and Health Observatory.


The NHS is for everyone, we are told. This is the promise of our most treasured national institution. The very first principle of the NHS constitution sets out a commitment to provide a comprehensive service, available to all, irrespective of a person’s protected characteristics. More than that, the NHS constitution outlines a “wider social duty to promote equality” through the services it provides. So, whose job is it to make this a reality?

 

Everybody’s job

The answer we often hear is that it’s everyone’s job. We’re told that considerations about racial and ethnic equality should be a ‘golden thread’ embedded in all discussions about healthcare. We are told that every policy decision should be underwritten by an Equality Impact Assessment. We are told that every member of staff in the NHS, from the CEO to each and every clinician, should be mindful of potential health inequalities, and should work to eliminate them where they find them.

This means each GP and practice manager should be thinking about ethnic health inequalities in their local population, and that individual nurses, receptionists, allied health professionals, and other members of staff should be culturally competent. It means that commissioners should be allocating funds according to the needs of our most marginalised communities, ensuring that nobody is left out of the great promise of an NHS for all.

More recently, we are told that the newly established Integrated Care Boards will have responsibility for taking a place-based population health approach to delivering services in an equitable way. The hope is that, by joining up the NHS with Local Authorities and other providers of essential services, we will make it impossible for the needs of marginalised communities to fall through the cracks, as has so often been the case in the past.

Nobody’s job

But what is happening on the ground? Is it realistic to expect NHS leaders to give their limited time and resources to race equity when they are under significantly more pressure to cut costs and reduce waiting times? Is it reasonable to expect members of staff – usually from ethnic minority communities themselves – to give their free time to the cause of achieving race equity?

As the old saying goes, when it’s everybody’s job, it’s nobody’s job. Across the system, we see a phenomenon whereby everyone thinks someone else should be responsible for making a difference. There’s not enough money, our leaders might say, to fund the extra community engagement required to properly cater services to our most vulnerable marginalised communities. I recently met a GP who claimed they would love to spend more time out in their local community fostering trust, but that they were already struggling to keep on top of the rising demand for consultations. And perhaps there wouldn’t be such a need to build this trust at a local level if cultural competence were considered at the outset of public health campaigns.

Part of the issue is accountability. Is anyone really held to account for delivering on race equity in the NHS? It is currently possible for a trust with among the lowest scores on the NHS Workforce Race Equality Standard (WRES) to still be rated ‘Outstanding’ by the Care Quality Commission (CQC). What message does this send to Black, Asian and ethnic minority members of NHS staff? What message does it send to members of the public when leaders are not held to account for the continued poorer outcomes experienced by these communities?

In a similar fashion, the NHS announced in 2020 that each provider organisation in the NHS (including both trusts and ICSs) was required to appoint a board-level accountable lead for health inequalities. In our research on these appointments, we found a huge variation in the levels of support available to these leads, and in the amount of power they felt they had to effect change. Moreover, at a national level, it remains unclear who is responsible for ensuring that these appointments have been made, or who is responsible for holding them to account. This is particularly concerning given the lack of representation among ICS Chairs and Chief Executives.

Most concerningly of all, we have recently seen that the NHS has dropped targets in its planning guidance aimed at ensuring an organisation’s leadership reflected the racial diversity of its workforce.

Moving towards an equity culture

As we have seen repeatedly in the past, we are reaching a point where the NHS is under such significant strain that considerations about equity are becoming an afterthought. When targets around equity are forgotten, so too is the dream of an NHS that serves everyone equally and with dignity.  Exacerbating this is an increasing tendency for efforts to promote equity to be dismissed as ‘wokery’ by some media outlets and politicians.

In truth, equity should be everyone’s responsibility. It should be a fundamental tenet of every job description, policy document and target that the health sector produces. But if equity is ever to be more than a tick-box exercise, it must be embedded in a holistic framework of accountability.

For regulators, this likely means considering their internal processes first – ensuring that their fitness to practise procedures and their role in clinical education are free of bias. Then, it means considering how members of the health and care workforce are encouraged and supported to champion equity in their work, but also how they are held accountable for doing so. What, for example, is the role of revalidation and appraisal in making a difference?

Most importantly of all, we must all look beyond our individual roles and consider how each of us can contribute to a culture of equity. A culture is not just carefully chosen words, or a list of generic ‘values’ on a corporate website. A culture is formed of human interactions and behaviours. A culture is formed when people ask questions, when they listen to the views of others, when they speak out in a meeting, when they recognise their lived experience – privileged or not – may be at polar opposites from others in the room.

Accountability is the start of a journey towards health equity. But an equity culture must be the shared ambition of everyone in our health and care sector if we are to move forward.


Find out more

Read our full report Safer care for all - solutions from professional regulation and beyond  or through chapter 1 -  No more excuses - tackling inequalities. There are also shorter versions available, including the executive summary, you can download these versions here.

Find out more about the NHS Race and Health Observatory here