Creating a level playing field can be an uphill task - The BMJ

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Creating a level playing field can be an uphill task As NHS trusts are told to give priority to employing UK and EU citizens over doctors from other countries, Surinder Sharma, the NHS’s equality director, is facing tough times 143

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Ask Surinder Sharma, national director of equality and human rights at the Department of Health, what achievement he is most proud of since he took up his newly created post 18 months ago and he doesn’t hesitate. “It’s seeing the issues being given greater importance. People are coming to us now,” he says, alluding to the ministers and officials in charge of policy who are starting to seek him out, unprompted, to ask about how to promote equality and diversity in the health department and the NHS. If this seems rather modest, it testifies to the fact that much of his job so far has been about getting a foot in the door on issues that the NHS has tended to view as “difficult.” The most recent example of such a difficult issue was the announcement by the health department that every

Overseas doctors will require work permits for junior doctor posts from this month 874

doctor from outside the European Union wishing to work in the United Kingdom will need a work permit. From this month, trusts will have to prove to the Home Office that they could not find a good enough candidate from the United Kingdom or the EU, a move that has angered doctors and has provoked allegations of racism. Broadly, Sharma’s role is to try to ensure that no NHS patient or employee is disadvantaged in terms of their health or job prospects because of their race, sex, age, faith, sexuality, or disability. It means looking at everything from an equality and diversity perspective—from training and regulation through to service provision and delivery and to employment practice—and forming alliances across the board. However, he said that he could not comment on the recent announcement regarding work permits. “If we can just get people to think about what impact their decisions will have on equality that will make a big difference. This isn’t about telling people what to do. It’s about better policies that everyone can be proud of,” he says. Sharma and his team have put together a new race equality scheme for the health department and have helped NHS trusts comply with their statutory obligations under the Race Relations (Amendment) Act 2000, which places a general duty on all public services to promote equality and eliminate racial discrimination. He has also created a means for trusts to audit their effectiveness in this regard and has published a guide for non-executive directors of NHS trust boards on how to promote equality and human rights. But there is a lot of ground to make up, because race equality is just one part of the equality and human rights agenda. He has to

consider whether the health service is meeting the needs of gay and bisexual men, for example, who have a higher suicide rate than heterosexual men, while black people are six times as likely as white people to be detained under the Mental Health Act. Women are still underrepresented in specialties such as surgery and cardiology, despite making up more than 60% of the medical student intake, while black doctors and those from other ethnic minority groups cluster disproportionately at the lower rungs of the NHS career ladder and are significantly underrepresented in leadership roles. Surinder Sharma is one of the exceptions. He came to Britain from Kenya in 1965, at the age of 8. His family, who originate from northern India, settled in Leicester. After taking a law degree at the University of Kent he started his career at the Commission for Racial Equality in 1978, working with local government and voluntary sector groups. As head of equality at BBC Television he boosted the proportion of ethnic minority employees from less than 3% to 12%. And as corporate equal opportunities manager at Littlewoods Retail he helped the company win a slew of awards for diversity, training, and people management. The first nine months of his current post were spent working one day a week for Ford, his most recent previous employer, whom he convinced of the business case for greater equality and diversity in its workforce and marketing. It is an approach he is also using with the NHS. He explains: “At Ford [these issues] were part of business planning, personal objectives, and the safety and quality of the products. They were not seen as separate. And they need to be part of the way we do our business in the NHS.” Quite apart from the moral imperative, such an approach would allow the NHS to provide more responsive, efficient, and cost effective services and to enjoy better and cheaper staff recruitment and retention, he insists. Seriously courted by several corporations when he decided to leave Ford, he found the NHS an easy choice, he says. “I wanted the chance to do something worthwhile—to make changes

Surinder Sharma has fought for ethnic minorities at the BBC, Littlewoods Retail, and Ford

that would have an impact on a lot of people.” And the climate was favourable. Six months earlier Nigel Crisp, until recently chief executive of the NHS, had launched the leadership and race equality action plan, making race equality a key tenet of health improvement and workforce development in the NHS for the next five years. At the time a raft of legislation was in the pipeline, including employment equality regulations, the Gender Recognition Act 2004, the extension of public sector duties to cover sex and disability, and the extension of protection on the grounds of sexual orientation and religion in the provision of goods, facilities, and services. The Equality Act 2006 has now established the Commission for Equality and Human Rights, and age legislation will come into effect this year. But he agrees with an Audit Commission report that noted in 2003 that the NHS had been slower than other public services to embrace the equality agenda. “I am not denying that we need to improve,” he adds, but he points out that the NHS has a better record than many organisations. He says, “7.5% of NHS executive directors, including PEC [professional executive committees] directors, are from black and ethnic minority communities.” He is resolutely optimistic. “There’s a willingness to do things over and above the job [in the NHS]. What’s lacking is cohesion. These issues have not been dealt with in a systematic way.” He adds: “Forty years ago sexual harassment was not an issue; it is now. So there will be change.” Caroline White London

BMJ VOLUME 332 15 APRIL 2006 bmj.com