We need to see equality, diversity and inclusion in the NHS as part of a wider social movement for change, in which line managers, leaders and trade union reps have a crucial role to play.

Line managers and leaders hold positions of power in our organisations because their choices can impact positively or negatively on the people they are leading. It is for this reason that they need to approach people issues with thought and compassion.

We have all felt the pain of being excluded – whether it’s being missed off the lunchtime invitation, excluded from a mailing list of career opportunities, not invited to that important meeting to discuss a project we were working on, or just being ignored when we tried to make a contribution to a discussion, it really hurts. Exclusion can be more subtle too: being excluded from an ‘in joke’, feeling that your items are always last on the meeting agenda, or not being credited for work you have done. 

For some people we work with, being excluded is not an occasional inconvenience or frustration, but a regular occurrence. It’s all the more hurtful when the result of indirect or direct discrimination, or conscious or unconscious bias, on the grounds of disability, race, gender or sexual orientation.

The journey to greater inclusion in the workplace has been a long one, through both legislation and workplace policies and procedures. Equal opportunity policies, equality and diversity strategies and, more recently, equality, diversity and inclusion (EDI) approaches, along with their corresponding training and leadership programmes, have all contributed to improvements in the workplace, but all have fallen short of delivering the socially just workplaces many of us want to lead and enjoy.

What is really clear to us is that legislation alone does not change culture. Racism in particular has become more nuanced in recent years and, as such, hovers below eye level but is still felt by those affected. What hurts is the impact of those actions, inactions, systems, processes and behaviours from those who contribute or turn a blind eye to these lived experiences, or fail to acknowledge, accept or even believe they are happening under their watch.

This hurt can be further compounded when staff seeking advice following a pattern of incivilities are dismissed ordisregarded because they are not experienced by the majority. Some of the most painful experiences are unseen but impact the invisible aspects of our physiology like self esteem and confidence. Trade unions and line managers have a responsibility to broaden their spheres of influence so they can be constantly alert to difference. This provides the opportunity to gain a deep understanding of equality and diversity from a human perspective so they can champion inclusive and anti-racist practices, leading to a more positive and inclusive culture.

So what can we do in practical terms as managers, leaders and trade unions in this social movement for change?

1. Educate ourselves and lead by example

The NHS has some excellent leaders and managers who deliver day-in and day-out on overall organisational priorities, but work on ending discrimination and ensuring race equality has often lagged behind. Managers need to prioritise their own professional development – only when we change within can we outwardly influence the wider workforce and organisation. This means listening to staff, being curious and being willing to speak truth to power and demonstrate behaviours that lead to true allyship. We need to treat our commitment to EDI training and development as we do our professional CPD.

2. Welcome and encourage EDI teams as positive disruptors to existing cultures

The NHS has invested, perhaps more than other sectors, in appointing equality, diversity and inclusion (EDI) specialists in our organisations. But our conversations with many EDI staff suggest they are not getting enough support from senior leaders to drive change. These staff are positive disruptors, often observing and informing the organisation about uncomfortable truths which can be silenced, leading to inaction. As leaders, we can ensure a high profile for EDI issues in divisional and directorate meetings, and give visibility to EDI staff so they can showcase their expertise and explain the workplace culture data they are familiar with. Your EDI staff would love to receive an invite to speak to your teams.  

3. Take reponsibility and be accountable

Leaders who holding themselves and others to account for delivery are a huge catalyst for producing results. As leaders, we know the importance of visibility, living by our values and role modelling. We also know that more diverse organisations and better balanced boards deliver better patient care. We have incredibly diverse teams, but we know the diversity of our senior leadership teams doesn’t reflect that diversity. 

We need to ask ourselves: what deliberate action are we personally taking to improve the racial diversity of senior leadership within our directorates and divisions? Seek out resources and toolkits from your organisation or trade union, such as MiP’s new guide to managing equality and diversity (mip.social/equality-guide). Representation matters as it inspires hope in a socially unjust society. Good leadership requires us to surround ourselves with people with diverse perspectives who can disagree with us without fear of retaliation. 

4. Don’t be afraid of change. 

We all know the importance of compassionate, supportive cultures and most of us are leading projects or initiatives to change and improve our cultures. Yet we worry about the potential unexpected consequences of changing the incumbent culture in highly complex organisations where care and compassion matter most. But with the support of our executive teams, we can take more risks and set more ambitious targets for equality and diversity, knowing there is a link to better patient care. Lockdown has taught us we can make changes in the workplace faster than ever thought possible. We can translate that sense of urgency into our approach to equality, diversity and inclusion.

And, if you are MiP or a trade union representative, you can work in partnership with management to create a compelling vision for greater inclusion and shape the culture of your organisation. You take on the role of representative because you want to make a difference, to improve your members’ experience of work and ensure all have access to justice. Black, Asian and minority ethnic staff do not routinely have access to justice, in all aspects of life. Trade unions have a responsibility to advocate for and support paying members. Union representatives need to be impartial but ready to speak truth to power and amplify the voices of marginalised groups so action can be taken to eradicate micro-aggressions and other incivilities that dampen the staff experience. Keep EDI high up  the agenda, update your own training, be an ally and make this a priority for action.

Managers, leaders and trade union representatives need to embody the changes needed and that starts with us holding the mirror up, acknowledging areas for improvement, taking informed action and holding each other to account. And we need conversations within our own teams, union members and management groups, where we actively listen in order to understand lived experiences and take action. The power of true partnership working can lead to culturally inclusive organisations that are intolerant to negative behaviours, but allow diverse staff to thrive. 

• Cheryl Samuels is deputy director of workforce transformation at NHS England London Region. Dean Royles is president of the Healthcare People Management Association. To join the movement for change on Twitter, use #InclusiveHR.