‘All together now? Developing ethnic minority leaders in the NHS’

Leadership development in the National Health Service (NHS) has a long tradition and is wide-ranging, including programmes for new graduates, providing medical and clinical leadership training, helping middle managers and developing ‘top talent’ at executive level. The NHS also arguably contains the most ethnically diverse set of organisations in the UK. Within this long and laudable history, however, is a question which arises from time to time – should leaders/ aspiring leaders of colour in the NHS receive leadership development with their peers through special programmes with bespoke designed input, or is this a shortcoming in mainstreamed programmes which should be able to not simply accommodate difference but value and promote it? 

There has long existed a tension between these two opposing views, with attitudes and policy oscillating over time. A basic starting point is the by now thoroughly discredited and reductive notion that “if you treat everybody the same, that’s fair”, which takes no account of history, context or differential starting points. But why does the NHS run programmes specifically for people of colour at some points and not others? On the one hand, there is a compelling argument that the issues and challenges facing ethnic minority leaders in the NHS are so pernicious and so emotionally painful that a safe developmental space is essential where these can be opened up and explored with empathetic peers and expert leadership facilitators. On the other, it can be equally strongly argued that even the very idea of bespoke programmes and the need for ‘safe spaces’ is a damning indictment of existing development activity and programmes, and it is those deficits and shortcomings that should be dealt with. There is a fine line between specialised safe spaces and – however unwitting or unintended – de facto segregation and exclusion.

Learning and growing together propels human connections, and with it the potential to understand and value diversity and inclusion. Development does not happen automatically, however. Feeling safe is a starting point; feeling understood a staging post; feeling valued something different again. It is a sad fact that for some people of colour these factors cannot be taken for granted in every environment, and this is especially important if we are asking people to be open to learning and development or to enter their own discomfort zone to do so. Not everybody starts at the same place, and not feeling understood, perceptions that one is unwelcome or learned behaviour about the need to be guarded is not conducive to being open to and fully participating in learning and development, especially when this touches increasingly on relational skills and aspects rather than knowledge inputs. I myself, to this day, often notice when I am the only person (or one of very few people) of colour in a room, and although diminished over time, this can easily have an inhibiting effect, even if subconsciously. None of us ‘start afresh’ each morning – we are all aggregations of our past experiences, both negative and positive. 

The NHS, in which I worked for over two decades before moving to academia, showcases what is best about racial inclusion on the one hand, and sometimes (sadly) what is worst about racial discrimination on the other. That is not to be overly critical – the NHS cannot stand alone or apart from wider society so what there is inevitably reflected and replicated elsewhere in groups, systems and organisations. Great strides have been made, and great strides are yet to be made. In my own experience as a former NHS executive and now as a practitioner-academic, I have heard both sides of the debate about how best to design and practice leadership development and how people of colour are best served. I have heard voices that programmes targeted to and designed for minority groups allowed for the sharing of pain, an understanding of context and a celebration of achievement that would not have been possible with peers who did not have a deep understanding of and insight into the specific issues facing ethnic minorities. And I have heard expressions of discomfort, bordering on feelings of exclusion that participants may be thought of as ‘lesser’ because they were on a targeted, and not a mainstream, programme.

There is no easy or ‘correct’ answer to these questions. The debate connects to the notion of the role of equality, diversity and inclusion specialists in organisational life – are they necessary experts who can help organisations recognise and overcome structural and deeply ingrained inequalities, or a perpetual ‘grievance industry’ as the political Right often assert? It can be argued that over time the concept of EDI specialists should have a built-in obsolescence, in that organisational systems and processes will adapt and evolve until they are perceived to be fair and lead to equitable outcomes, and institutional cultures are open to challenge and constant improvement. This, though, still needs an impetus or initial spark, and for that flame to be nurtured until it is well established. 

So, should ethnic minority leaders in the NHS be developed separately, or does this indicate a shortcoming in mainstream programmes? The messy response is probably “a bit of both” and that different environments are appropriate at different times, and for different people. As is so often the case, there is rarely a single, simple answer or a one-size-fits-all. The important thing is the debate, and we at HSMC, along with the NHS, continue to grapple with these complex questions.

Steve Gulati is an Associate Professor and Director of Healthcare Leadership at HSMC and was a former NHS senior executive.