section six

This page forms part of the Transcultural Health resource, published in 2004, and is preserved as a historical document for reference purposes only. Some information contained within it may no longer refer to current practice. More information

In his first speech to the Labour Party Conference in 1997, Prime Minister Tony Blair referred to the under-representation of people from ethnic minority backgrounds in public office. He gave a commitment that the government would address this issue. He also gave a similar undertaking, this time in relation to the under-representation of Black people in senior positions in British institutions, shortly after the Stephen Lawrence Inquiry.

However, the position still remains bleak. Black and Minority ethnic people are still disproportionately poorer than the rest of the population and statistics generally point to them being four times more likely to be unemployed than their white counterparts. The figures also show that the more qualified Black and Minority ethnic people are, the more difficult it is for them to find a position commensurate with their qualifications.

There is clearly a link between the providers of service and the nature of services provided. A health trust that is representative of the community served is more likely to be able to reflect and serve the needs of its population in a much more sensitive manner. This applies not only to the total number of people employed but also the capacity in which they are employed. It is important to ensure that all levels of the workforce are representative of the community served as a whole in terms of ethnicity, gender and disability.

Despite the National Health Service's history as a major recruiter of Black and Minority ethnic people in the early 1960s, there is now recognition of there being serious recruitment issues in relation to the employment of Black and Minority ethnic staff. The NHS, like many other bodies openly recognises institutional racism and is considering a number of approaches aimed at redressing the situation. Later in this section we will look at current frameworks the NHS employs to address this through The Vital Connection (Department of Health, 2001b). However, first are some of the salient issues for consideration in determining strategies for more effective recruitment of Black and Minority ethnic people.

(a) Racism

Many people still try to rule out racism as a (possible) reason for unsatisfactory recruitment. Not to recognise that racism might play a part greatly reduces the potential for addressing the problem effectively. If Black and Minority ethnic people do join the organisation, their experiences are usually not positive because of this denial.

Both direct and indirect racism are prevalent in British institutions. Indeed, Tony Blair, after the debate in the House of Commons on the Stephen Lawrence Inquiry, declared that all institutions (not just the Metropolitan Police) must examine themselves in order to eliminate institutional racism. The then Secretary of State for Health, Frank Dobson, also pledged that the NHS would work to rid itself of institutional racism.

(b) Stereotypes

Numerous surveys have revealed that members of interview panels often make up their minds about a candidate within four to five minutes of contact. This is sometimes referred to as the 'halo' or 'horns' effect. If an interviewer's first impression is ‘good’, then she/he will seek evidence to support this. If, on the other hand, the first impression is ‘bad’, interviewers look for negative information to support their initial assessment.

What is happening here? One simple answer is - 'stereotyping'.

Why do we stereotype? People usually try to make sense of new information as quickly as possible so that they feel safe. Stereotypes provide a framework which accelerates this process. However, this can be very misleading and can lead to inaccurate judgements about people. This is compounded by the fact that many of the stereotypes we hold are difficult to break down.

In relation to recruitment issues, stereotypes are particularly dangerous because Black and Minority ethnic people invariably do not fit the stereotype of 'success', of being leaders, managers and so on, simply because they are not, generally speaking, in these positions. Stereotypes assume there are norms of appearance and behaviour to which everyone should seek to conform. Anyone who does not conform to the stereotype is somewhat 'suspect', an 'unknown quantity' or maybe a risk.

All of this interferes with impartial decision making in the selection process. Stereotypes in employment therefore need to be effectively challenged if Black and Minority ethnic people are to achieve genuine equality of opportunity in employment.

(You might usefully refresh your understanding of racism and stereotyping by revisiting the companion module: The Politics of Diversity).

(c) Barriers to effective recruitment

Threats to fair and objective interviewing can arise from three main sources:

the interviewer(s)
the candidate
organisational factors

1. Possible barriers for the interviewer(s)

poorly written job requirement. If interviewers are not really clear about which skills and abilities are necessary to do the job and, therefore, rely on their own theories placing undue emphasis on catch-all criteria such as 'ability to fit in,' the interview cannot be fair
lack of interviewing skill. Even where the interviewers know what to look for they may lack the necessary skills to elicit the relevant information in an objective and consistent way
perceptions and stereotypes:
- the interviewer(s) may have their own picture of the right person for the job and in many cases this may be unconscious. This picture, nonetheless, may prevent them from assessing the candidate on his or her own merit.
- interviewers are likely to have been influenced by stereotypes of groups in society which are perpetuated by the media and by role models, for example;
- - most secretaries are women therefore the assumption is that women are likely to make better secretaries than men.
  - black people and minority ethnic groups have been denied access to higher graded positions and their concentration in the lower grades reinforces the negative image that they are most suited for manual positions.
  - the traditional manual trades have been dominated by physically strong males who have been stereotyped as 'macho'. Therefore it is often assumed that gay men will not be working in these areas and that any women who apply might be lesbian or 'butch’.
  - it is often assumed that people with learning difficulties or mental health problems are unemployable and incapable of employment regardless of the extent of their disability.
  - most bank managers are white so this reinforces the stereotypes that white men make good bank managers.

These examples of stereotyping are very dangerous because they lead to inaccurate assumptions and consequently, to unfair selection decisions.

Stereotypes cause certain characteristics to be attributed to certain groups e.g. women are good at routine inspection. This may lead the interviewer to assume that a candidate has a particular skill instead of checking it out, leading to an inaccurate assessment of the candidate.

It is also possible to misinterpret non-verbal characteristics and patterns of behaviour. As a result, when interviewing people from different cultures, or people with disabilities, some applicants may be incorrectly judged on their social skills, etc.

Figure VI: Possible Barriers for the Interviewers Perceptions and Stereotypes

2. Possible barriers for the candidate

When attending interviews some candidates suffer from pressures which are additional to those that arise from the usual tension of the interview itself. For example:

They may expect to fail because of their experience of unfair discrimination in the past.
They may be experiencing community pressure to apply to areas of work traditionally done by members of ‘their group’.
For candidates for whom English is a second language, speech difficulties may lead to them being judged less able than those who are more fluent. Linguistic difficulties may also render a candidate more nervous and less forthcoming, leading the interviewer to fall back on stereotypes and assumptions when making a decision.
If the needs of someone with a disability are overlooked, e.g. the need for a sign language interpreter or advice on access to the building where the interviews are taking place, this can cause undue stress for the candidate.
If the needs of people with disabilities are not considered prior to the interview, it may be impossible to communicate i.e. if a sign language interpreter is not contacted if the person requires it.
If the panel are all of a different gender or different race to the candidate, it can substantially affect the candidate's performance because of their conscious or unconscious expectation of sexism/racism.

3. Possible organisational barriers

The organisation itself may unconsciously create barriers to fair selection, which provide a good example of how bad practice leads to institutional oppression.

In a climate of discrimination it is easier for interviewers to recruit ‘in their own image’ rather than to select people who are different from them.
An over-emphasis on non-ability criteria, such as appearance, personality, disposition, mobility or intelligence are likely to result in poor selection decisions.

(d) The JOANS model

As has been previously explained stereotyping, incorrect assumptions, ‘gut feeling’ and racism can play a significant part. The JOANS model seeks to regulate the process by ensuring that all assessments are based on relevant information that informs whether the candidate has the ability to do the job.

The model was developed by trainers at Nottinghamshire County Council along with an external consultant in 1990. Assessors need to determine that all evidence and criteria is:

Job Related
Objective
Assessible
Non discriminatory
Specific

Key themes

In our work with health trusts and other public sector bodies on issues relating to recruitment and selection, the following key themes consistently emerge:

(i) The pool for recruitment

It is often said that the pool for recruitment of Black and Minority ethnic people is low and this has often been given as a reason for low response rates to advertisements. Whilst this may be true for some posts, for the majority of the professional positions in the health sector, there is a large and growing pool of Black and Minority ethnic people who would, in general, fit the job criteria.

The issues here appear to be:

it is not acceptable to simply make the assumption that the pool for recruitment of Black and Minority ethnic staff is low without doing the necessary research;
the need to speak to other health or public sector bodies who have been successful in recruiting Black and Minority ethnic staff in order to discover how they achieved this; and
the need to speak to, and perhaps try to influence professional bodies to take up the issue. This has proved successful in some areas. For example, there were only a few Black social workers in the late 1970s to mid 1980s. The situation improved, however, after pressure was brought to bear on the professional body (CCETSW) by its own members.

(ii) Job descriptions / person specifications

Job descriptions and person specifications often do not relate to the 'job required' and the have criteria that do not relate to the person’s ability to do the job. This is potentially discriminatory and certainly has led to Black and Minority ethnic people being discriminated against.

A significant number of organisations are reviewing their job descriptions and person specifications to reflect the new approaches and ethos being developed in the public sector. Concepts such as Best Value, customer care, consultation skills are now key to most roles and demand new types of abilities.

This approach is beginning to encourage a more diverse spread of applications particularly from Black and Minority ethnic female candidates. Furthermore, it also ensures that criteria relate directly to the 'job’ and the ability to do that job.

(iii) Advertising

The use of Black and Minority ethnic press for advertising is a worthwhile recommendation. Sometimes people question whether there are business benefits to doing so, given that statistics often show a disproportionately lower rate of people stipulating that they saw the advertisements in this medium. However, there is strong symbolic value to advertising in the English language Black and Minority ethnic press as well as minority language publications in certain circumstances.

(iv) Panel composition

Mixed panels - based on ethnicity and gender are an important part of the recruitment process and is now commonly viewed as good practice.

Retention of staff

Issues pertaining to the retention of Black and Minority ethnic staff are being seen as increasingly important. There has been some significant research initiatives undertaken over the past five years that conclude that Black and Minority ethnic staff are more likely to feature disproportionately 'on the wrong end' of grievance and disciplinary procedures.

For example, research recently undertaken by the Institute for Employment Studies (2000) involved researchers in surveying the social services departments of eight London Boroughs on issues relating to:

disciplinary (behaviour);
poor performance (capabilities);
team conflict; and
performance assessment.

This research, which was aimed at exploring the managerial and organisational factors that may account for any observed differential treatment of Black and Minority ethnic staff, revealed that white employees are significantly more likely to be described in positive terms than Black and Minority ethnic employees (see below).

Table A: Percentage of described positive characteristics of employees (IES, 2000)

Positive Characteristic	White employees	Black and Minority ethnic employees
Commitment	55%	40%
Team working	64%	54%
Quality of work	63%	55%

It will be important therefore to:

Ensure that the implications of legislation, race (equality) policies and other good practice policies are included in staff induction.
Ensure new staff are informed about established networks and support groups.
Ensure that grievance and disciplinary procedures and practices do not disproportionately impact in a detrimental manner on Black and Minority ethnic staff. If this is the case - investigate and take corrective action.
Ensure that the Training and Staff Appraisal policies recognise issues concerning Black and Minority ethnic staff. Use positive action where appropriate.
Develop training programmes for managers on the detailed implication of the race (equality) policies including individual action plans and updates of legal and other developments.
Develop personal/professional development training to meet the particular needs and enhance the skills of under-represented (ethnic) groups. Also set up staff development schemes, which feature such innovative approaches as mentoring, coaching, work shadowing and access to self-help networks.

The NHS: recruitment and retention of black and minority ethnic staff

The NHS has published a number of documents in the post Lawrence period to improve the recruitment and retention of Black and Minority ethnic staff. This section will explore The Vital Connection (2001). Elsewhere in this module we have already looked at two other documents which also impinge on good employment practice the National Plan for Action to Tackle Racial Harassment and Positively Diverse (section 2). Insights into the employment experience of Black and minority ethnic staff can be found in ‘Getting on Against the Odds (2002) NHS’.

Recent policy approaches to race and employment issues within the NHS

In August 2000 the Department of Health published The Vital Connection to provide the NHS and partner organisations with a 5-year framework of action to implement equal opportunities policies. The framework aims at linking equalities issues in employment, education and training with overall improvements in service delivery within the NHS. It outlines the overall direction, priorities and expectations of the service and what is necessary on the part of NHS Employers to develop approaches to planning and accounting for progress in equalities issues.

The framework builds upon the earlier NHS human resource strategy ‘Working Together’, (1998), stating that an effective health service will only meet need across all the groups it is meant to serve through meeting three key strategic aims:

‘A workforce for equality and diversity’: That is employing and retaining a workforce that represents all the communities that it serves. This is based on the recognition that responsiveness to the needs of different service users is not based on a ‘one size fits all’ approach and that services will initiate increased confidence amongst users if staff reflect the diverse communities that they serve.
‘A Better place to Work’: through the creation of a working environment in which discrimination, harassment or stereotyped behaviour is not acceptable. The document outlines measures for monitoring and dealing with incidences of racial harassment. It also outlines measures for longer-term barriers to be removed such as the recruitment of staff from under represented groups through positive action. Or, for example undertaking partnerships with NHS employers, education consortia and training providers so that women, Black and Minority ethnic groups and the disabled can compete for opportunities in areas where they are under represented.
‘A service using its leverage to make difference’: Vital Connections recognises that as the largest employer in the UK the NHS has a key role to play in mainstreaming equalities issues not just as an employer, but also as purchaser, commissioner and contractor of various products and services. It works on the premise that the NHS can and should use its influence a to make a difference to creating longer-term opportunities in the wider community. Possible approaches to this which are outlined within the document are:
developing partnerships with local organisations in order to understand and tackle wider issues related to health and social exclusion.
Upholding a responsibility to communicate core values, particularly those related to equal opportunities polices to all suppliers that the NHS works with. A 1997 study of NHS Trusts found that only 56% enquire if outside contractors have equal opportunities policies in line with those of the NHS.
Placing an importance on recruiting locally based staff.

In order to ensure that these three aims are met the report outlines some key policy documents that NHS Employers need to produce. These include:

An Annual Equality statement
Equality standards
Equality Indicators
Performance management targets

Outlined below is an example of suggested equalities indicators that the document recommends managers employ and include in both regular reports to trust boards and in the equality statement within the annual report.

Equalities indicators

(i) Profile by ethnicity, disability, gender, age

Black and ethnic minority staff as % of total headcount employed
Female staff as % of total headcount employed
Staff employed in various age bands as % of total head count employed
Number of staff who declare themselves to be disabled.

(ii) Disability

Meet the criteria to use the Employment Service disability symbol (Two ticks symbol)

(iii) Recruitment

Ethnic and gender profile of recruitment episodes for each occupational group over the reporting year through all stages of the recruitment

(iv) Training and development plans

Staff having group or individual training plans as % of total headcount employed.

(v) Discipline and grievance procedures

Ratio of cases of formal disciplinary action to total headcount employed. Ratio of grievance cases (brought by staff/brought against staff) to total headcount employed.

(vi) Harassment

Ratio of recorded claims of harassment to total headcount employed.

(vii) Sickness absence

The amount of time lost through absence as a proportion of the staff time available together with reasons for the absence. This should not cover maternity leave, carers leave, or any periods of absence agreed under family friendly/flexible working policies but should include all unauthorised absence from work and long term sickness.

(viii) Violence

Ratio of violent incidents to total number of employees, measured over the course of the year.

(ix) Staff turnover

Number of leavers in 12 months as % of total headcount of staff in post at the end of the reporting year.

Flexible working

Number of staff returning at the same level after maternity leave of 12 months as % of staff taking maternity leave.

% of staff from professional groups working part-time.

Information for indicators (iv) to (x) should be analysed using the following variables:

Gender
Disability
Ethnic origin
Full time/part-time
Occupation
Length of Service with the employer
Age

(Department of Health, 2000b:50)

While the publication of the Vital Connection can be seen as a positive step by the Department of Health in tackling the harassment and recruitment of Black and Minority ethnic staff. Certain points need to be considered for the frameworks to be effective. The Department of Health Study on Racial Harassment mentioned earlier clearly indicates the following:

Although improved guidelines and monitoring were needed to tackle racial harassment in the workplace, many staff both white and Black were not aware of existing procedures and many Black and Minority ethnic staff were not confident that complaints would be taken seriously by senior level managers or that these complaints would be kept in confidence. This situation served to undermine the effectiveness of previous policies.
The commitment to race equality issues must be mainstreamed into all organisational practice in order to be effective. For this to occur good practice and commitment to equalities issues must be demonstrated by the leadership of the organisation. Once again the study demonstrated that Black and Minority ethnic staff did not feel that this had been the case in the past.
Racial Harassment is not always overt the NHS needs to consider alternative means to support staff who decided to take complaints of harassment forward.

For further information on the Equalities guidance for NHS organisation refer directly to The Vital Connection document which can be obtained from the Department of Health website.

At this point you may wish to revisit the earlier discussion in Section One on ‘Marketing and Corporate Image’.

End note

This module has introduced a wide range of contemporary policy initiatives that have the potential to positively impact upon the development of culturally safe health care practice in the United Kingdom. And in this module we have introduced other concepts that will aid an understanding of these policies and illuminate routes to implementing them. In their variety and different foci this literature can seem overwhelming. However, when employed in the practice of addressing the challenge of developing improved health care they become meaningful and useful tools.