When MiP Summit delegates were asked to vote on a series of questions during the panel debate session, they provided some worrying answers. Some 58% said that their employer is not making progress on equality and diversity. More than three quarters said that bullying within management is a problem in their organisation. And a disastrous 88% said that their employer does not manage change well.

Panelists and audience members highlighted the connections between these three problems: tackling discrimination, for example, can help address bullying and ensure that jobs go to the best candidates—improving change management.

Part of the solution on equality issues, said MiP committee member Yvonne Richards—also the delivery and policy lead at NHSE/I—is the creation of better metrics to track diversity: “We need to be able to take the temperature and say: ‘What difference has that made?’” she said. “There’s a significant amount more to do, and part of that is about having the evidence.”

MiP chief executive Jon Restell agreed, suggesting that “we need to hold individuals to account more closely for outcomes. It’s very hard to challenge individual recruitment decisions: people can show they’ve followed the process. But if across 100 appointments you’re not seeing a balanced intake, then the question needs to be asked of individuals.”

But it’s hard to maintain progress on such initiatives, said Restell, in an environment of continual disruption. “Our number one issue as a union is the constant reorganisation of management structures,” he said. “It’s hard to invest properly in your organisation if you know it’ll all be knocked down again in a year or two. And people’s day jobs stop while systems are changing; the NHS could achieve so much more if it had more stability.”

Bidding members goodbye during her last Summit as chair, Sam Crane emphasised the problems around weak consultations and poor staff engagement during change programmes. “There are some good examples out there, but mostly what we’re seeing is people being ‘done to’ rather than real change processes,” she commented.

And when organisations are changing on every front—embedding new systems, filling empty roles, building new capabilities—they lack the stable platforms, experienced staff and management bandwidth to manage that change well.

In the words of Paul Maubach, chief executive of Dudley and Walsall CCGs: “You would have thought, given the amount of organisational change we’ve had—certainly on the provider side—that we’d be better at it by now.

“Why aren’t we? Maybe it’s because of the amount of organisational change!”.