I attended the above NHS England & Improvement meeting with RCOT as the BAME Occupational Therapy representative on the 20 July 2020 where issues around equality, diversity and inclusion within the Allied Health Professions (AHP) workforce were discussed. This event was attended by the full spectrum of AHP professional bodies, with around 40 attendees.
The discussions were based around the NHS Workforce Race Equality Standard report where NHS Trust data for 2019 was presented. The NHS data was examined and also discussed in relation to the current political and social context of Black Lives Matters, with an aim of addressing the ongoing injustices experienced by the BAME community and the opportunity to instigate improvements in the diversity of the NHS and AHP workforces.
The report indicated that as of August 2019 only 9% of the Occupational Therapy profession was from a BAME background which is far below the NHS BAME average of 20% and the UK population average of 13% (BAME). In comparison with other AHP groups, Orthoptics and Optics were the highest at 27% (BAME); Radiography at 22%; Dietetics at 12%; Physiotherapy at 10%; Speech & Language Therapy at 7%; Art, Music & Drama Therapy (6%) and Paramedics at 3%.
Discussions focused on exploring the reasons for the under-representation of BAME’s across the majority of AHPs, the historical context and complexities within these professional groups to attract individuals from (BAME) backgrounds and to deliver definitive strategies and actions to address such disparities.
Several key findings within the NHS Race Equality Standards report (2019) included:
- White applicants being 1.46 times more likely to be shortlisted across all posts compared to BAME applicants.
- BAME staff being 1.22 time more likely to enter the formal disciplinary process compared to white staff.
- The percentage of NHS BAME board members at only 8.4%.
- Percentage of BAME staff experiencing harassment, bullying or abuse from patients, relatives or the public in the last 12 months was 29.8% for BAME vs 27.8% for white staff.
- Percentage of BAME staff believing that Trust provided equal opportunities for career progression or promotion was 69.9% for BAME vs 86.3% for white staff.
- Percentage of BAME staff personally experiencing discrimination at work from a manager/team leader or other colleagues was 15.3% for BAME vs 6.4% for white staff.
The discussions encompassed issues around institutional and systemic racism, the discrimination faced by BAME staff from patients and their families. The need for institutional and cultural change was also acknowledged to eliminate discrimination and bullying from fellow colleagues and to ensure equality in opportunity. The impact of the ‘glass ceiling’ limiting progress and promotion for those from a BAME background was supported by the data which highlighted that:
- Whilst BAME staff are over-represented in the NHS in AfC band 5 and they are significantly under-represented in senior pay bands (AfC 8a and above). As the pay bands increase, the proportion of BAME staff within those bands decreases, from 24.5% at band 5, to 6.5% at Very Senior Management levels.
The focus of the Workforce Race Equality Standard, Phase 3 was aimed at enabling the NHS workforce and improving patient care through improving the experiences and opportunities for BAME staff in the NHS, with a particular focus on Leadership; Accountability; Engagement; Cultural change; Outcomes and Sustainability. Representatives took part in a series of interactive and participatory activities providing feedback and comments around the various discussion points and views around how to take things forward in fulfilling the Workforce Race Equality Standards. There was clear acknowledgement of the need for cultural and systematic change within the NHS, to ensure diverse clinical teams and to increase the BAME representation across the AHP workforce across grades and practice sectors too.
For our profession the outcomes of the report and available data highlight the urgent need for action on several fronts, suggestions included:
- Taking a more proactive and concerted approach in opening up the profession to a diverse range of communities and instigating community initiatives to attract a wider range of individuals from all backgrounds, including those from a BAME background to enter the profession.
- Educational providers ensuring that their curriculum addresses topics of human rights, equality, diversity, cultural safety, racism and discrimination.
- Mentorship and development structures being available to support under-represented groups including BAME occupational therapists to develop the leadership skills to make progress within their careers and futures.
- Acknowledging the feelings and experiences of those who have encountered racism and discrimination and the importance of a safe space for them to share, discuss and also initiate actions and solutions to address existing inadequacies.
An important aspect for RCOT is ensuring that members recognise how they can contribute and be influential in steering the direction of the profession; addressing key professional priorities including promoting more involvement from the membership to engage in mentorship, activism and leadership initiatives. The current sequence of health, community and societal circumstances, have critically positioned RCOT and the occupational therapy profession together to contest the status quo, embrace change and take positive action to face the challenges ahead.