Whose business is it anyway? Equality, diversity and inclusion in the NHS

Recently the Health Service Journal reported that posts which focus on Equality, Diversity and Inclusion (EDI) are being drastically reduced in the ongoing restructure of NHS England. Should those interested in the promotion of respect and inclusion in the NHS be concerned?

There has long been a debate about how the aims of EDI are best achieved in the NHS. Should this be through specialists working with others in NHS organisations to ‘inform and educate’? This approach emphasises facilitation rather than the specialists ‘doing the doing’, and puts the onus for the development of local initiatives and implementation on leaders and teams closest to service provision. At the other end of the spectrum is the argument that true mainstreaming of EDI should mean that it is everybody’s business. Indeed, it can be argued that ‘success’ in the field of EDI is when functional specialists are no longer needed, because the moral case is overwhelming and accepted, and awareness and expertise is widespread. However laudable an aspiration, it feels as though the NHS is a long way from that at present.

So, should we be concerned by the planned reduction in specialist EDI posts? It is reasonable to promulgate a case that EDI is too important to be housed in specialist posts and that all NHS employees are accountable for it. However, this won’t happen automatically and cannot be separated from wider, sometimes deep-rooted, context and culture. There is a persuasive argument that when something is ‘everybody’s business’, it can easily become ‘nobody’s business’. The issues are indeed complex and nuanced, with an ebb and flow of ideas over time; however, the proposed reductions in EDI-focussed posts, if accurate, are substantial and send a strong signal around culture and priorities, something which can’t have escaped the minds of those leading and implementing the current changes at NHS England.

Given the shrill tone and language used by Government ministers in recent times about ‘wokery’, it is hard to escape the whiff of political interference here – not the transparent direct diktat to ‘cut EDI posts’ (although of course that could have been the case) but the age-old skill of NHS leaders in picking up which way the wind is blowing and working with, rather than against, that. In some ways, this is more insidious than direct diktat, as it indicates that ideas have seeped into, or are at least affecting, organisational culture. Railing against perceived ‘wokery’ has for some time now been a touchpoint for those with certain political affiliations and forms a significant plank in the culture wars approach that some politicians feel could yield electoral advantage as a wedge issue. But matters of dignity, respect and value in the NHS – for staff and for patients, service users and their carers and families – have real impact on real people. There are many stories of careers blighted, mental health degraded, culturally insensitive commissioning, unjustifiably inequalities in health outcomes and so on. So this is about more than revised organisational structures, numbers of posts or reporting lines. When fundamental matters around human dignity and the value of diversity in health services becomes a political football, we are all diminished.

Steve Gulati is an Associate Professor and Deputy Director of HSMC and was a former NHS senior workforce executive.