28 October 2022 – NED webinar – Actually doing something about inequality

This week’s session opened in conversation with Jagtar Singh OBE, who has 40 years of leadership experience including 30 years in the fire and rescue service, and is currently chair of Coventry and Warwickshire Partnership NHS Trust.

Jagtar said: “Just yesterday I was involved in a Black History Month event, which was attended by quite a few of my retired firefighter colleagues, and we were talking about incremental change on equality and diversity. We very rarely see transformational change – but change does happen. When I speak to equality and diversity leads, they’re frustrated. When I talk to activists, they are frustrated and say that nothing’s changed. Well, things have changed. I’ll just give you one example. When we had the death of George Floyd, who was on the streets marching? It was all of us. It was people of colour alongside white British people. It was not the black activists of the 60s and 70s who were alone on the streets. So that’s changed. We have a coalition of the willing now, of far more diverse people that will go out on the streets and advocate for change.

“What are the ten things that can help us to melt the glacier? Leadership, governance, metrics, culture, the case for change, training, the use of the law, the language of diversity, the barriers that are real and perceived, and the tools you have at your disposal.

“In the fire service was a man called Sir Graham Meldrum, who I use as an example of great leadership when we talk about the great chief fire officers. Think about all the NHS leaders and chief execs you’ve had. Now write down what they stood for and what they changed. You’ll find a lot of them a vacant memory. You can’t identify what they stood for. Graham Meldrum changed the face of the British fire service and he was consistent on his leadership and equality and diversity. He set up the first equality and diversity team and he consistently supported it.

“When I look at the NHS, who was being a consistent leader on equality and diversity at the top? Simon Stevens. Whether you think he was good or bad, he always led on diversity and his legacy was that he set up the NHS Res team, he supported the Equality Delivery Council, he also supported the Equality Delivery System. But that’s easy, you can fund those things. Was he authentic? Yes, he was. He and I were the only senior people at the unveiling of the Mary Seacole statue. He would turn up to events when many others shied away.

“When I left the fire service to join East of England Ambulance Service, I thought I was going from a poor equality and diversity service to a good one. But I actually went from crap to crapper. I couldn’t find any of the tools for equality and diversity. First of all, there was no equality lead. Secondly, when I asked them about their equality strategy, they couldn’t find them. That also tells me something about my lack of ability to influence change as a board member. It took me 12 months to say ‘You keep pushing the ball into the long grass, you keep telling me you’ve got these schemes. You clearly haven’t, so let’s start from scratch.’ So we did and that service started to achieve well and the ambulance service itself started to have a good governance structure around equality and diversity.

“Before that there was no governance, there was no structure around equality and diversity, there was no equality committee. There was no way of getting even the basics of equality and diversity into board discussions. But by this time Graham Meldrum was the chair of West Midlands Ambulance Service and we set up a national equality and diversity group. That national group started to produce tools and that structure was from the very top to the ambulance service through the boardrooms. So governance structures are very important.

“Can you identify in your organisation how diversity and equality starts at the bottom and goes to the top? How the discussion from the top goes back to the bottom? Is there clarity of who’s responsible and where?

“Often people say to me ‘why do we need to make the case for diversity?’ In my early days as a consultant when I was going around boardrooms, as I talked about the moral case for equality and diversity, I could see the finance director just not getting it. As soon as I then spoke about the financial consequences of not conforming, they lit up. When I then spoke about the strategic purpose, the strategy director woke up. So when you’re talking about the case for equality and diversity, people like you will get the moral case. When it comes to the legal case, you can make that the bare minimum and make your organisation conform. By insisting on the equality impact assessments, by insisting on the annual report, by measuring those public sector equality duties.

“Then you’ve got the political case. If that is weak, we will not achieve. After the death of Stephen Lawrence, the political case for driving the equality and diversity was extremely strong and we achieved a lot. When the politicians are against you the equality and diversity metrics nosedive because the media is then against you.

“The next thing is metrics, which is what you’re going to measure on two fronts: staffing and patients. If you’re ever on an interview panel I’m on you’re going to be asked to define inequalities. And if you don’t give me the answer according to Marmot you’re going to be grilled. All you’ve got to say is that inequalities are avoidable and preventable. Did we do that during Covid? Did we go into the avoidable and preventable infection areas to prevent avoidable deaths? No, at the start we didn’t. We had a blanket message for everyone.”

Also overheard during the session:

“The inequality agenda and the case for tackling inequalities is not rocket science. Given the challenges if we need to set out a clear plan to address inequalities. We have the data on admissions, treatment and outcomes so why are we still unable to make progress. The solution lies at the door of Leadership at national, regional and local levels. There is then the inability of the CQC to assess culture and what makes a well led org. The ICS and ICBs have an opportunity to set their stall around equality, diversity and inclusion.”

“I think an area which is often not pursued in terms of concordance and governance as a lever for change is care act and safeguarding statutory obligations. if there are racially motivated behaviours – staff on staff – then scrutiny must be given regarding PIPOT and LADO processes. in the same way as if there were staff on staff sexual safety issues, or acts of violence.”

“Thank you so much for your time today. I'm a new NED (first few weeks) who has an activist background. Your input has shown me that my politics experiences and activism will have a place within my role, so welcome to understand. You are one of my new role models – hopefully our paths will cross in the future.”

These meetings are by invitation and are open to all NHS non-executives directors, chairs and associate non-executive directors of NHS providers. Others may attend by special invitation.

If you have any comments, questions or suggestions about these webinars, please contact: events@good-governance.org.uk