Blog: Yvonne Coghill

Published on 20 November 2018

Yvonne Coghill, CBE, OBE is the director of the NHS Workforce Race Equality Standard (WRES) and Deputy President of RCN. She talks frankly about her route to the top and the obstacles she’s faced.

I’m a nurse, a health visitor and a mental health nurse. Having worked in the NHS for 41 years, I have seen that although we have a constitution that tells us we should be fair and equitable to everyone, I know from my own and other people’s experiences that people are not always treated equitably.

I went for five jobs as a director of nursing and didn’t get any of them. That does something to your self-confidence, your self-esteem; it makes you feel inadequate. To begin with, I was told I didn’t have enough qualifications. So I went off and got some - two masters degrees. For three of the jobs I was told that although I was a good candidate, there was someone else better on the day. There was never any feedback about what I could have done differently and invariably it turned out that ‘someone else’ was a white middle class man or woman. It made me feel that although I was good, I wasn’t good enough.

Fortunately I was identified and mentored by Lord Nigel Crisp, who was the chief executive of the NHS and permanent secretary of the Department of Health at the time, in 2004.

Working for him private secretary, at what is now the Department of Health and Social Care, gave me the opportunity to develop my skills and stretch myself. In those three years, I held several strategic posts including programme director for the Cleaner Hospitals Programme and external relations nursing officer to the chief nursing officer of England.

Those years gave me an overview of the NHS and what I found was that if you were from a black or minority ethnic (BME) background, you’d be less likely to become a senior leader.

At the time, in 2004, we had five chief executives and 12 directors of nursing from BME backgrounds. It made me wonder what was going on in our NHS – something wasn’t right. It fired me up to know what was going on and to want to make some changes.

I became director of WRES in 2015 and my team digs into the detail. It produces robust data, collected from NHS trusts, on the experiences of BME staff and white staff, using nine indicators.

Four are work force indicators, from electronic staff records (ESR) kept in all organisations. Four are from the staff survey – cultural indicators and one final indicator is about board level representation. We then look at the gaps in the nine indicators.

What we’ve found is that BME nurses and midwives are less likely to be appointed from shortlists and once in the role more likely to be disciplined and less likely to be sent on non-mandatory training.

I don’t believe that people are deliberately discriminatory on a personal basis. It’s just that the systems we have built in the NHS over many years, give us what we already have: which is many more white senior leaders going through the system more quickly and easily than BME staff. People like to say we have equality of opportunities but the evidence shows that is not the case therefore we have to have interventions which will correct the anomalies.

The facts speak for themselves. Today, despite there being 450,000 BME nurses in the NHS, out of 231 NHS trusts, there are five BME CEO’s and six directors of nursing.

So what’s going on?

BME staff are less likely to be appointed from shortlists and then once they are hired, much more likely to go through formal disciplinary procedures.

The reasons are complex, but broadly, BME nurses are over-represented in the workforce at bands five and under, working on the wards with patients. We call it the ‘sticky floor’, meaning they tend to get stuck at that level and it takes them much longer to progress to bands six or seven.

As you get to band eight and above, management level, you tend to have much less contact with patients. And that is also where cultural disconnect comes into play. There are more white nurses are at that level and rather than risk a perhaps awkward conversation about poor performance with a member of BME staff,
the manager would rather take notes and go to HR. However once the matter gets to HR it becomes formal. A letter goes out, unions are involved, feelings are polarised and things escalate.

A new approach

I think the NMC’s new approach to dealing with complaints about nurses and midwives is a good one, and that looking at contextual factors is really important. It’s fantastic to see that equality, diversity and inclusion are at the heart of the NMC’s thinking in this area.

What we all need to do: NMC, the RCN, RCM is work much harder to understand the diversity we have in our workforce. 21% of our workforce is BME and that figure is set to grow. For example last year the NHS lost 1,500 white nurses and gained 5,000 BME nurses.

We need to have nurse leaders who are switched on to this agenda and understand the importance of having a workforce that feels valued, irrespective of background or ethnicity. We need to talk to each other more, understand that we’re all here for the patients.

Organisations need to take responsibility for all their staff, think about how they can diffuse situations and make things better themselves without getting the NMC involved. The new strategy gives the opportunity to sit and think about what practical steps they can take to enable member of staff to perform in a way they think is more acceptable.

What the NMC has to do is to work with all nurses to help improve professional practise and in doing so make things better for all patients.

Related content

Find out more about our new approach to Fitness to practise

Find out more about our work on Equality diversity and inclusion (EDI)


Watch our exclusive interview with Yvonne Coghill

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