Time to speak

The experts: Professor Anton Emmanuel

Head of the NHS Workforce Race Equality Standard on changing processes to make the NHS a fairer workplace

Emmanuel at the NOC conference

Through the Time to speak series, OT profiles how discrimination in the workplace is affecting eye care professionals.

Professor Anton Emmanuel, head of the NHS Workforce Race Equality Standard (WRES), speaks with OT about measures to reduce racial inequality within the health service.

What is the Workforce Race Equality Standard?

The Workforce Race Equality Standard (WRES) has been running since 2015 and is now part of the NHS contract. All NHS trusts have to produce annual data collection to a template that we send out on the same nine indicators. They also have to produce a WRES action plan that targets the problems identified by data collection.

How does WRES measure racial equality?

There are indicators that are based around the annual staff survey – this examines things such as individual staff experiences of bullying, discrimination from a manager and the feeling that the organisation gives them the chance to progress equally.

We also look at representation in the Agenda for Change pay bands – how are staff distributed? Data is collected on recruitment and the chances of being appointed from an interview. The data reveals that 75% of trusts favour white colleagues being appointed from an interview. Another indicator is around referral to the disciplinary process. Half of our organisations have a race-related disparity in referrals. Data is collected on access to non-mandatory education – the vast majority of our organisations show equality around that.

On a personal basis, be an ally. That doesn’t mean putting a badge on once a year, but going out of the way to take action


The final indicator is around the make-up of a trust board. What we see nationally is that about 50% of the NHS population is BAME but only about nine or 10% of the board are BAME. There are some trusts where it is parity, there are some trusts where it is nowhere near.

Why do these indicators matter?

The outcomes for patients are directly related to how well staff are treated, whether it is based on gender, race, disability or sexual orientation. The fact is that staff who can bring their whole self to work perform most ably. That may sound like an emotional point, but it is borne out by the statistics. Organisations that perform well on equality indicators have good outcomes – both for staff and for patients.

Are there common themes in trusts that have turned their indicators around?

There are three points that are really cardinal: you need the right people, the right data and the right strategy. You need motivated leadership – a group of people who really want to implement change rather than just talk about it. Second, you need to have the data. The third thing is to have access to evidence-based policies to overturn the disparities you find. Data on its own is nothing – it needs to be allied to these other two things.

The fundamental point, if you are serious about reducing inequities in your team and workforce, is to focus on what the problems are. It is about tackling the process. Simply providing education does not work. What actually changes the culture of an organisation is changing the processes that see inequity bound in, such as recruitment, disciplinary action and board representation. All these other things can be the icing on the cake.

The fact is that staff who can bring their whole self to work perform most ably. That may sound like an emotional point but it is borne out by the statistics


What can optometrists do to address inequality?

Look at the structures – the employment profile. What proportion of staff are from an ethnic minority background and what positions are they in – are they in leadership roles or junior roles. Is there equity? Get the data and understand the workforce: that is the starting place always.

On a personal basis, be an ally. That doesn’t mean putting a badge on once a year but going out of the way to take action. If I see a situation where there is poor access for people with disabilities, mistreatment of female colleagues or someone facing a abuse for a religious item – whether it is a cross, a headscarf or a kippah – I have got to say something.

There is a lot of jargon around within equality, diversity and inclusion but one thing I really believe in is the idea of privilege. We have to recognise the privilege we have. None of us have all protected characteristics – we have something where we are in the majority and the world is in our favour. We have to recognise that.

What motivates you in the work you do?

As a clinician, one of the first things I remember seeing was a black man who came in with severe pain on his side. He had been labelled as being an opiate seeker by another hospital after a negative scan and was sent home. One day he was driving his bus and collapsed in pain. He was brought to our hospital. A new set of eyes saw him and found that he had liver cancer.

That could happen to anyone, but it happened to a black man. I wonder how quickly he would have been seen if he had been a middle-class affluent white woman – would they have made the same conclusion? Probably not.

That was an early memory where I thought ‘This stuff doesn’t just affect my day-to-day life but it affects patients.’ Once your eyes are opened to that you see what happens to disabled people, to people who wear symbols of faith, you see what happens to women. You think ‘This isn’t a way to run a health service’ even though we are proud of it in many other respects.

When you take an action and you see a result, that is empowering. For example, when a patient has a leaflet translated and that improves their care. Revolution isn’t going to get this job done. This is a societal issue and we each have to put our own brick in the wall.

If you would be willing to share your experience, please contact [email protected]