Improving equality, diversity and inclusion – an NHS plan

By Alice Sorby, RCM Director of Employment Relations on 14 June 2023 Maternity Services RCM UK Midwives Midwifery Workforce Midwifery Equality and Diversity NHS England

As NHS England launches its Equality, Diversity and Inclusion Improvement Plan, RCM’s Director of Employment Relations Alice Sorby shares why this is important to have as she shares concerning statistics from recent surveys and research studies looking into culture and EDI in the NHS.  

Over a decade of underinvestment in maternity services and the wider NHS has seen the shortage of midwives in England widen to 2500. These shortages impact the safety of services and mean morale is at rock bottom. In addition, discrimination, bullying and harassment is all too common , this is why we have welcomed the NHS England Equality, Diversity and Inclusion Improvement Plan (EDI plan).

The EDI plan aims to improve cultures and experience of staff at work and support retention. The RCM has long being calling for action on retention. We cannot solve the workforce crisis in maternity services if we don’t retain midwives and MSWs. To do that we have to improve their working lives. This will sit alongside the Government’s workforce plan for the NHS in England which we are still waiting for.

The EDI plan is based on six high impact actions. These include; making chief executives, chairs and board members accountable for specific and measurable EDI objectives; embedding fair and inclusive recruitment processes; eliminating pay gaps; addressing health inequalities within the workforce; implementing induction and development programmes for internationally-recruited staff and addressing bullying, discrimination, harassment and physical violence at work.

Within these headlines are specific actions for trusts to take and metrics for measuring progress. They include; widening recruitment opportunities within local communities; implementing effective flexible working policies; wellbeing conversations; reviewing disciplinary and employee relations processes; ensuring safe and effective policies to support staff affected by domestic abuse and sexual violence; and creating an environment where staff feel able to speak up and raise concerns.

Crucially of this will be measured, by data monitoring by protected characteristic, improvements in NHS Staff Survey results, Workforce Race/Disability Equality Standards and National Education & Training Survey (NETS) results.

This offers a real opportunity for improving culture in the NHS. There is an awful lot of work to be done but these actions and the fact that they come with targets and accountability and oversight means that we can use the plan to influence.

For RCM workplace representatives this means getting EDI on the agenda at local partnership forums and in discussions with Heads of Midwifery because we know these are issues that impact our members.

In May 2020 Turning the Tide found that just 10 maternity units in England had a Head or Director of Midwifery of the global majority (7.4%), this is despite global majority midwives and MSWs making up 12-14% of workforce. Since Turning the Tide was published there has been some meaningful change in London.

An RCM member survey in 2021 found that of the members who had requested reasonable adjustment because of disability, only one quarter of those had those adjustments made.

We know from the NHS Staff Survey that disabled staff have fewer opportunities for flexible working patterns. The NHS Staff Survey also shows that one in five LGBTQ+ staff experienced violence from patients or relatives compared to one in seven of their colleagues, with bi and trans staff experiencing particularly high rates of violence.

Predominantly women workers, midwives and MSWs often have caring responsibilities and have to plan childcare that often requires set days and standard hours.

An RCM member survey carried out in 2021 found that 67% of midwives and MSWs who had left or were considering leaving the NHS could be encouraged to return if there were greater opportunities to work flexibly and the same survey found that over a third who had made a request to work flexibly had their request rejected.

We must also factor in the understanding of systemic discrimination across protected characteristic and intersectionality that perpetuates poor culture in our society. We must acknowledge the lived experience of the voices not yet captured in research research but those that feel bullied and harassed in the workplace. We hope this plan is a good start. We will continue to build on all voices and experiences of all of our members.  

The inequalities faced by midwives, MSWs and staff across the NHS are widespread and are exacerbated by a workforce crisis that is predominantly driven by the numbers of staff leaving. Addressing discrimination must be central to the retention of staff, the actions set out in this plan are a good start, but we need to see action on the ground. We need to see employers working in partnership with trade unions and we need to see all of this backed up by investment in maternity services and our NHS.