Making Equality Work

By Christine Burns, Shahnaz Ali and Loren Grant

MAKING EQUALITY WORK combines background facts and theory about the history and nature of equality and diversity in Britain with the detailed description of how the authors set out successfully to raise the measurable levels of equality outcomes for the National Health Service in North West England.

The first half of the book is a theoretical primer. It explains how Britain changed over the last 50-60 years with the progressive emergence of all the diverse groups which we see today, and how society and the law responded to the demands from each group for social equality and protections. The authors explain why equality matters and why attempts to change public institutions to achieve it often fail. This is backed by an extensive literature review.

In the second half of the book the authors describe their own practical, evidence-led and strategy-driven approach within a public sector system of over 60 autonomous NHS trusts, and how that can be applied elsewhere. The book explains not only WHAT they did, but WHY they did it that way, and the benefits and pitfalls in hindsight.

The text is written in an accessible style for a wide range of readers and contains many references to contemporary published work from both academics and public sector sources.

"This is a huge 'little' book. A text book that reads more like an engaging novel. Full of facts, statistics and testimony. A brilliantly researched book with a strong narrative outlining the context for equality in the NHS and why, despite considerable progress, equality matters more today than ever before. What you get is written by people with a passion and an expertise, who have got their hands dirty, detailing a candid, system wide case study highlighting approaches and successes but realistic about progress and lessons learnt." — Dean Royles, Chief Executive of NHS Employers and Acting Chief Executive of the NHS Confederation.

"...a must read for all those who work not just in healthcare but in other sectors too" — Dr Kailash Chand OBE, Deputy Chair of the British Medical Association.

"It is refreshing to see a book which gives the important background and context of equality laws. This book is important in making equality laws understandable in Plain English." — Linda Bellos OBE, Chair of the Institute of Equality and Diversity Practitioners.

"This book provides a solid local, regional and national context to equalities and human rights in the UK and how and why they should be embedded into the work of public authorities. It is a refreshing reflection on real life experiences of equality work in the last 7 years of the NHS. Any due diligence in building new health and social care systems should pay regard to the lessons of the past. This book offers many of them." — Jackie Driver, Programme Head, Public Policy at the Equality and Human Rights Commission and Chair of Breakthrough UK.

"MAKING EQUALITY WORK is essential reading for equality practitioners as well as senior management in the health sector and beyond. In a refreshingly jargon-free way, the book shows how it is possible to work strategically to achieve positive change, against formidable obstacles, in a very large organisation where promoting equality was not always a priority." — Peter Baker, Men’s Health Consultant.

"...provides a model that has been shown to work on a large scale and presents it in a way that makes understanding it manageable. This is an essential textbook for those want to bring about real change in their organisations, and provides a roadmap to enable this." — Sîan Payne, Director of Organisational Development at the Lesbian and Gay Foundation.

"...an important and welcome publication, not just for the NHS but in any organisation or venture: it is not only a 'how to' book but also a 'why to' book. The 'why' is often the biggest barrier, and it is well tackled here." — Lorraine Gradwell MBE, former Chief Executive of Breakthrough UK

• Language: English
• Publisher: Christine Burns
• Release date: Feb 20, 2016
• ISBN: 9781310219665

Christine Burns

CHRISTINE BURNS LIVES in Manchester, England. For many years she was a professional IT and business consultant, working for a range of companies from global corporations to her own one-woman business. Her clients ranged from blue chip household name corporations to small businesses. She then consciously switched careers and built a second reputation as an equalities expert, in the course of which she was awarded an MBE by the Queen. Her interests range widely. Apart from being a published writer and poet, she has been a prolific blogger and podcast maker, a keen photographer and also likes to cycle for pleasure. Her publications have included the deeply technical and the mischievously trivial.

Book preview

Making Equality Work

Shahnaz Ali, Christine Burns and Loren Grant

Copyright © 2013-16

Dedication

In memory of Barbara Burford, who sadly died in 2010

Barbara Burford was a lifelong champion of equality and diversity in the health service and directly inspired hundreds of health professionals and managers through her work. Throughout her career, Barbara worked closely with the NHS, government departments, minority groups and public sector organisations to raise the profile of equality and diversity in the NHS.

It was as director of equality and diversity at the Department of Health, from 1999 to 2002, that Barbara was able to raise the national profile of her field. She spearheaded a number of initiatives including the development of the first practical guide to managing equality and diversity in the NHS.

The Authors

Shahnaz Ali, OBE, MA was the Director for Equality, Inclusion and Human Rights at NHS North West from December 2007 until the dissolution of the English Strategic Health Authorities in March 2013. Prior to that she was the Director of Education Commissioning for South Yorkshire Workforce Development Confederation, Director for Local Authorities and Wider Partnerships for South Yorkshire Strategic Health Authority and she has held various senior roles both in the NHS and local government in both the North and South of England. Her speciality lies in influencing, negotiating and managing change in large complex systems. It is Shahnaz’s strategic vision which underpins this book.

Christine Burns MBE, MSc, BSc (Hons), CEng, MBCS, CITP is Managing Director of Plain Sense Limited, a consultancy specialising in Equality, Diversity and Human Rights. Prior to setting up Plain Sense she was a senior level business and IT consultant, advising blue chip businesses in Britain and abroad. She also has experience of managing a medium size social care provider. As the Programme Manager for Equality and Diversity at NHS North West, as an advisor on LGBT health for the Department of Health, and as the former chair of the North West Equality and Diversity Group, she has been at the forefront of both formulating and implementing strategic development in this area for many years. Christine is the principal author of this book.

Loren Grant, MA, MSc was an Assistant Director for Communication and Engagement at NHS North West and worked within the equality, inclusion and human rights team from January 2010 until the dissolution of the English Strategic Health Authorities in March 2013. She has worked in journalism and in the public sector in the UK and specialises in the communications and engagement aspects of equalities and human rights. Loren is the book’s editor and academic researcher.

Reviews

‘Would the work of William Wilberforce have been described as political correctness gone mad in the 18th century? How far have we come on our journey to ensure everyone, yes everyone, in the UK receives healthcare free at the point need? This is a huge 'little' book. A text book for Equality and Diversity professionals that reads more like an engaging novel. Full of facts, statistics and testimony. A brilliantly researched book with a strong narrative outlining the context for equality in the NHS and why, despite considerable progress, equality matters more today than ever before. But this isn't just a book providing an overview and research. What you get is a book written by people with a passion and an expertise, who have got their hands dirty, detailing a candid, system wide case study highlighting approaches and successes but realistic about progress and lessons learnt. No hubris here just a brilliant opportunity to dive into the complexity of change management in the NHS.’

— Dean Royles, Chief Executive of NHS Employers and Acting Chief Executive of the NHS Confederation

‘This is the first comprehensive historical account of equality and diversity in the NHS that I have read, and it is a must read for all those who work not just in healthcare but in other sectors too. There are real examples of where there have been discriminatory issues, and what's more there are helpful solutions which I would encourage policy holders to adapt to their services. Shahnaz, Christine and Loren are to be congratulated for putting such a sterling effort into such a vital issue.’

— Dr Kailash Chand OBE, Deputy Chair of the British Medical Association

‘It is refreshing to see a book which gives the important background and context of equality laws. We would not have our legal rights against discrimination were it not for the brave struggles of men and women over the last 50 years or so. It is frustrating that so few people know how the law protects them and how they can seek redress if their rights are infringed. This book is important in making the equality laws understandable, in plain English. ‘Making Equality Work’ goes a long way to giving everyone the tools to fight back if we need to. It is also vital that we all know how we can ensure that we do not infringe the rights of other people. Well Done Christine and colleagues for making your work both available and accessible.’

— Linda Bellos OBE, Chair of the Institute of Equality and Diversity Practitioners

‘This e-book gives a solid local, regional and national context to equalities and human rights in the UK and how and why they should be embedded into the work of public authorities. It examines the case for past failures to truly embed and offers lessons learnt for the future. It is a refreshing reflection on real life experiences of equality work in the last 7 years of the NHS and any due diligence in building new health and social care systems should pay regard to the lessons of the past. This book offers many of them.’

— Jackie Driver, Programme Head - Public Policy at the Equality and Human Rights Commission and Chair of Breakthrough UK

‘Making Equality Work is essential reading for equality practitioners as well as senior management in the health sector and indeed beyond. In a refreshingly jargon-free way, the book shows how it is possible to work strategically to achieve positive change, against formidable obstacles, in a very large organisation where promoting equality was not always a priority. The NHS has been very good at talking about equality but much less good at implementing it. Shahnaz, Christine and Loren were at the heart of the most sustained and successful effort I know of to change the NHS’s approach and (most importantly) its outcomes. I was particularly pleased that, from the outset, they recognised that improving the unnecessarily poor health of men and boys was fully part of their remit. This book will hopefully ensure that their very valuable legacy is not lost in the reorganised NHS.’

— Peter Baker, Men’s Health Consultant

‘Making Equality Work is a key text for all those working within organisations that are hoping to increase their impact.  It sets out the struggle for equality that minority groups have faced, particularly throughout the 20th century, and places it in its rightful place as a key requirement for getting better outcomes, particularly in the health sector.  It also contextualises equality in modern Britain and provides a fresh perspective on why equality matters.  More importantly, it provides a model that has been shown to work on a large scale and presents it in a way that makes understanding it manageable.  This is an essential textbook for those want to bring about real change in their organisations, and provides a roadmap to enable this.’

— Sîan Payne, Director of Organisational Development at the Lesbian and Gay Foundation

‘What's different about Making Equality Work’ is that it not only examines why addressing diversity is important for organisations, but that it goes a way towards identifying why delivering equality is so elusive. Not only that, it offers tools and expertise to change this — tools and expertise that have been tried and tested. The work explains the importance, and the potential difficulties, of an evidence-based strategic approach, such as aligning equality aims with core organisational goals. After comprehensively outlining the work that they led on equality and diversity the authors conclude by considering how this work can be continued in the current rapidly changing landscape of the NHS.  This is an important and welcome publication, not just for the NHS but in any organisation or venture: it is not only a how to book but also a why to book. The why is often the biggest barrier, and it is well tackled here.’

— Lorraine Gradwell MBE, former Chief Executive of Breakthrough UK

Copyright

First published September 2013

Smashwords edition February 2016.

Copyright  ©  2013-16

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, screen shots, recording or storage in any information retrieval system, without prior permission in writing from the author.

The right of Shahnaz Ali, Christine Burns and Loren Grant to be identified as the joint authors of this work has been asserted in accordance with Section 77 of the Copyright, Designs and Patents Act 1988.

Cover design © Christine Burns 2013-16

Smashwords Edition, License Notes

This book is licensed for your personal enjoyment only.  This ebook may not be re-sold or given away to other people, If you would like to share this book with another person, please purchase an additional copy for each recipient. If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to your favourite ebook retailer and purchase your own copy. Thank you for respecting the hard work of this author.

Chapter One

Historical Background

Immigration, partly spurred by the post-World War II expansion of public services and the creation of the NHS, helped to enlarge notions of diversity in a Britain which, until the 1950s, was assumed to be largely homogenous. As the decades progressed, more and more groups became visible in the pursuit of equality.

The Secretary of State for Health Aneurin (Nye) Bevan  steered the National Health Service Bill through Parliament  in 1946 and it came into effect on July 5, 1948. The event was marked by the formal opening of Park Hospital (later renamed Trafford General) in Manchester, Britain’s first NHS hospital. It was the first of 2,571 hospitals to be handed over to the NHS. There had been a hostile reception from Conservative Party MPs, who voted against the NHS Bill on both its Second and Third Reading, and from the doctors’ main representative body,  the British Medical Association.

The Conservatives feared that the NHS would soon be bankrupted by the ‘feckless poor who would rush in to strip the chemist shops of every pill on the shelves, then head for the dentists' surgeries to have their mouths filled with gold and silver’. (Andy McSmith, The Independent, June 28, 2008).

The medical profession’s opposition was based on more complex reasons.  Many doctors believed that their professional freedom would be jeopardised, that they would treat fewer private patients and so lose out financially. They also believed that the NHS would not allow patients to pick their doctor – though this proved to be an unfounded worry.

By and large though, the NHS was generally welcomed as a pillar of the new welfare state. But the expansion in capacity required to run the new service created a demand for 42,000 staff members that could not be met from the domestic population in a country only just beginning to recover from the ravages of  six years of war (Snow & Jones, 2010a).

All types of staff were needed: nurses, midwives, ancillary workers, cleaners, cooks, and porters. The greatest need was for nurses in hospitals for the chronically sick, mental hospitals, and geriatric wards, but none of these specialties was particularly attractive to existing staff.

Drawing on the Commonwealth

The arrival at Tilbury of the Empire Windrush on June 22, 1948, brought 500 Caribbean men and women to the United Kingdom, marking the start of post-war mass immigration. They were responding to the need for workers across many parts of the economy (Kramer, 2007), Not everyone was destined for the NHS, but many were being actively recruited for that purpose. Nurses from Ireland were also arriving to fill posts In in the NHS, continuing a trend that had begun in the years of World War II. The 1950s and 1960s were a heyday for overseas recruitment, especially as the NHS offered women more jobs and better promotion prospects than could be found in Ireland or Commonwealth countries.

The pace of recruitment increased rapidly. By the time the Labour Government returned to power in the 1950 general election, some 5,000 Black Commonwealth citizens had already arrived in Britain to work or join relatives. By the end of the decade, between 20,000 and 30,000 a year were joining the UK economy. Selection committees had been set up in the Caribbean to recruit nurses for NHS hospitals and, 'by the end of 1965, there were between three and five thousand Jamaican nurses working in British hospitals, many of them concentrated in London and the Midlands.' (Snow & Jones, 2010b). Approximately one in three NHS doctors and nurses today are from Black and minority ethnic (BME) groups (Snow & Jones, 2010b).

Numbers continued to increase in the 1960s. By 1961, about half a million Caribbean and South Asian people had come to Britain, or approximately one per cent of the population (UK Census Reports, 1961). In 1962, Minister of Health Enoch Powell announced a 10-year plan for community care under an expanding NHS (Hansard, 1962). To meet rising demand, the country once more turned to the Commonwealth, recruiting more than 18,000 doctors from the Indian subcontinent.

Source: http://writefix.com/?page_id=924

The  influx of people from Commonwealth countries wasn't universally welcomed, as many of the newcomers recall. In 2008, NHS North West set out to compile a comprehensive history of the contributions of Black and Minority Ethnic (BME) workforce to the NHS, including filming interviews with many NHS staff, past and present. The contributors included Louise Garvey.  She trained as a cadet nurse at Congleton Hospital (now part of East Cheshire NHS Trust) and remembers that the early years in the NHS were ‘good because people sort of got on and supported one another’, but that both patients and staff could be racist.

Despite this, she set her sights on becoming a sister:

‘I did extra training, whatever was going in the hospital. Opportunities were always there for nursing but at the same time there was the racism and the feeling at the time that we were only there to do the bedside things. You put yourself forward to ensure that whatever internal training is being offered you got on board. I used to do what I called the watching game. I would watch and see what training was available, who was going for it and how often. I used to challenge the situation. I would say nurse A and B and whatever, she’s had x amount of training, why haven’t I? This training is available and I am interested, here is my application and that’s how you got on in those days. You had to fight for your chances.’

Through the 1960s, numbers of immigrants continued to rise, as men, who may have come on their own to begin with, sent for their families to join them. The obvious changes in the population, especially in the areas where immigration was concentrated, led to increasing disquiet. Some employers and service providers operated a so-called ‘Colour Bar’, refusing to employ or house black people. This type of practice continued until the mid 1960s and the arrival of the first non-discrimination legislation outlawing it (BBC, 1966). Ironically, considering his role in stimulating immigration, the social concern and anxiety was epitomised by Enoch Powell's 'Rivers of Blood' speech in 1967.

Immigration might have been the factor that most clearly marked a change in Britain's population, as visual and language differences were too obvious to miss. This may also be the reason why people often still use the term ‘diversity’ as  a synonym for race and ethnic differences. Immigration obviously changed the nature of towns and communities, but it wasn't the  only  factor signalling that British society wasn't as homogenous as people had assumed.

Women’s rights

Some parts of the nation's diversity were not imported but had been present all along. However, it required the development of awareness, brought about by people making their issues more visible, to put these concerns on the same footing as the obvious difference in people’s skin colours.

The 1960s and early 1970s saw the emergence, for instance, of a women’s rights movement, often referred to as ‘The Second Wave’ of feminism. The term ‘second wave’ in this context acknowledges the struggles of the suffragists in the early part of the 20th century — the first wave. As with racial civil rights, this was something that was happening in parallel on both sides of the Atlantic.

The early part of the 20th century had witnessed the first concerted calls for women's rights, in the form of campaigns for a voting franchise. However, the roots of the first calls for women's rights in Britain and the USA can be traced back beyond the Pankhurst sisters and their fight for women’s political equality (the term ‘suffragette’ was coined by the Daily Mail). In fact, as early as 1840, women from Britain and the United States had begun a debate about their status relative to men.

At the World Anti-Slavery Convention in London that year Elizabeth Cady Stanton and Lucretia Mott were among several female delegates denied the right to participate in the proceedings. It would still be many decades before any tangible progress was made on either side of the Atlantic; however, it illustrates the long gestation for some movements which then appear to erupt as if from nowhere when they are eventually noticed.

Over the next 50 years, women in many countries campaigned for equalities, including the right to vote. In 1881, the Isle of Man allowed women property owners to vote in parliamentary elections within the British Isles. Elsewhere within the British Empire, New Zealand and the Cook Islands were the first to acknowledge women's right to vote in 1893. South Australia followed in 1895. In Europe, Finnish women won both the right to vote and the right to stand for election in 1906, Norway followed in 1913, Denmark in 1915, and the Netherlands in 1919.

The British women’s suffrage movement needs to be seen in this context of a long build up, strong international precedent and the resistance to change. British women over the age of 30 obtained the right to vote in 1918, but it was only in 1928 that this right was extended to all women over the age of 21, on the same basis as for men.

The suffrage movement in Britain was helped by the social changes brought about during the First World War, where women were needed to undertake work that had previously been reserved for men. Apart from the new right to vote, however, the interwar years (1919-1939) were characterised by a retreat into traditional roles. Women were expected to relinquish their jobs in favour of men returning from the front. This persisted until mass male mobilisation in 1939/40 allowed women back into large-scale employment.

After the Second World War there was an expectation that women would once more relinquish the jobs they had performed for six years on the 'home front' and make room in the workforce for men. The ideas of psychiatrist John Bowlby, Deputy Director of the Tavistock Clinic , who pioneered the concepts of ‘Attachment Theory’ and ‘Maternal Deprivation’, were held to be reasons why women belonged in the home, raising children (Bowlby, 1951). However, on this occasion the retreat for women wasn't nearly so complete. In particular, the burgeoning public services, like the NHS, created by the post-war Labour government, provided more