Boardroom diversity falling in the NHS

A new report highlights a fall in female and BME non-executive directors and chairs on NHS boards.

table surrounded by chairs


The percentage of women in chair or non-executive roles on NHS boards has fallen from a peak of 47% in 2002 to 38% now in 2018 while men take 69% of chair roles, according to a new report.

The Chairs and Non-Executives in the NHS: The need for diverse leadership report by the NHS Confederation shows there has also been a fall in the percentage of chairs and non-executives from a Black and Minority Ethnic (BME) background, down from 15% in 2010 to 8% today [6% for chairs]. In just under half of all NHS trusts (including foundation trusts) there are no BME board members.

Seventy-seven per cent of the NHS workforce is female and 19 per cent is from a BME background. In addition, the report says the average age of those appointed as non-executive directors and chairs is considerably older than the average age of executive directors, NHS staff and the wider population.

The report highlights two factors which it says have had an impact. The first is the continuous change of those who are in charge of recruiting to these roles, starting with the abolition of the NHS Appointments Commission. This oversaw appointments to a range of NHS public bodies, including NHS trusts, and sought to make appointments which were independent from the executive, were gender balanced and reflected the need to promote a greater proportion of BME appointments. It also opened recruitment to those with disability and published news on progress in these areas annually. It was dissolved in 2012 and responsibility for appointments was transferred to the NHS Trust Development Authority (TDA) and now resides with NHS Improvement.

The report also highlights the creation of foundation trusts as a factor. It says that, as foundation trusts are independent public benefit organisations, any appointments to their boards are no longer considered public appointments and subject to the oversight of an independent agency.

It points out some of the dangers of a lack of diversity in the boardroom, such as ‘groupthink’ decision-making and a lack of commitment to diversity issues from recruitment onwards.

The report includes a series of recommendations, such as ensuring that an equalities and diversity framework is developed in collaboration with diversity and inclusion experts for the recruitment and retention of chairs and non-executives and a focus on best practice for recruiting diverse chair and non-executive boards are used. It says the latter means changing present search and recruitment methods to seek out alternative candidates.

Other recommendations cover working with and being mentored by other organisation which have been more effective in addressing the diversity gap and reviewing remuneration levels among chairs and non-executives to ensure pay and conditions are even handed and incentivise those who are interested in such roles.

The report states: “The benefits to the NHS of a more equal and diverse leadership are well understood. But if NHS organisations are to create a sustainable pipeline of diverse leaders that reflect the staff and the communities they serve, then the NHS must seek ways to accelerate this transition among chairs and non-executives. Such a diversification in the leadership of the NHS is more likely to champion patient and staff engagement and transform the culture of the health service for the benefit of patients.”

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