Our journey to equity and inclusion

In 2018, we published an independent review we had commissioned into the unfair dismissal of one of our nurses, Amin Abdullah, who subsequently died by suicide. It catalysed a major equity, diversity and inclusion improvement programme for our workforce.

The report highlighted flaws in our disciplinary processes, which were leading to an unfair over-representation of staff from Black, Asian and other minoritised groups. The revised processes we developed in response have helped to reduce the likelihood of people from these minoritised backgrounds being subject to formal disciplinary action—from 2.35 times more likely than their white colleagues to 1.5 times, with more work still to do.

 

These developments connected with other work we had begun at around the same time, to ensure we are all living our Trust values – to be kind, aspirational, collaborative and expert. They also led on to much wider work to improve equity, diversity and inclusion for our workforce.

 

The disproportionate impact of Covid-19 on minoritised communities – who were more likely to become seriously ill or die from the disease - as well as the racist killing of George Floyd by a police officer in America in 2020 – brought more focus and urgency to our journey to become a genuinely fair and inclusive organisation. It particularly highlighted the need for a step change in our focus on improvements for our patients and local communities as well as for our staff.

 

North west London has a population of 2.4 million people, with more than 200 ethnicities represented across its eight boroughs. Minoritised groups and people living in areas of high deprivation spend more years living with ill health and die earlier than people living in more affluent areas. Life expectancy for males born in the most deprived area of Kensington and Chelsea is 20 years lower than for those born in the least deprived area of Westminster.

 

While we have much further to go, we are starting to see evidence of our progress. We are also benefitting from increasingly strong and growing relationships with community organisations and other local partners.

Equity and inclusion developments for our workforce

Overhauling our disciplinary processes – The revised processes we developed in response to the investigation into Amin Abdullah’s dismissal helped to reduce the likelihood of people from Black, Asian and other minoritised backgrounds being subject to formal disciplinary action—from 2.35 times more likely than their white colleagues to 1.5 times, with more work to do. The new processes mean that local actions are scrutinised more carefully and, initially, around a third of decisions against staff members were overturned on review. We are now supporting managers with ‘just and learning culture’ training on how to handle mistakes and perceived poor behaviours in fairer, more constructive ways from the start.

• Driving inclusion with data – In 2020 we established a dedicated EDI (Equality, diversity and inclusion) team whose work is guided by data to spot gaps and set clear targets to improve access to opportunities for all staff. 
  
  
• Flourishing staff networks – The EDI team has also supported our staff networks to grow and flourish, increasingly playing a crucial role in speaking up for staff and shifting our culture towards real inclusion.
  
  
• Supporting career progression and diverse leadership – As part of efforts to make our recruitment processes fairer and more transparent, we mandated diverse interview panels and require hiring managers to justify decisions for band 7 roles and above to our chief executive. This initiative has helped to boost the representation of staff from Black, Asian and other minoritised groups in senior roles from 38 per cent in 2021 to 45 per cent in 2024. This initiative has been recognised in several national award schemes but there is still further to go. Our progress is monitored through a diversity dashboard.  
  
  We are actively developing leadership skills among staff from minoritised groups too. This includes our Healthcare Leaders Fellowship for nurses, midwives, allied health professionals, healthcare scientists and registered pharmacists from Black, Asian or other minoritised groups who have found it difficult to progress in their careers. To date, 75 people have enrolled, with 80 per cent achieving distinctions. Based on ideas from staff engagement sessions during Black History Month in 2023, we have developed a project to pair 20 staff from Black, Asian and other minoritised groups with executive directors for shared learning and development.  
  
  Our Improvement through people management programme is a structured way where we can support managers to become inclusive and compassionate leaders. We made this training mandatory in April 2023, and over 2,400 managers have completed it to date, giving managers the tools and skills to develop trusting relationships with their teams. 
• Tackling bullying and harassment – NHS data shows that staff from racially minoritised groups are 1.5 times more likely to face harassment or bullying from colleagues then their white peers. We’ve refreshed our policies and developed practical toolkits to help managers tackle these issues more effectively and as quickly as possible. Our whistleblowing policy and diverse group of Freedom to speak up guardians are available to ensure staff can raise concerns without fear.

Our 2024-2027 equality, diversity and inclusion workforce plan sets out next steps towards equity and inclusion, including actions to further improve our recruitment processes, make our environments more accessible for disabled staff and expand our staff networks. You can read the full 2024-2027 plan. We will also be focusing on how our commitments now need to shape additional work to help us on our journey to becoming truly a fair and inclusive organisation.

Equity and inclusion developments for our patients and local communities

We work with patients, staff, communities and partners to understand and address health inequity across our services.

To help us navigate these complex issues and maximise our impact, we have developed a Trust-wide health and equity framework with the aim of improving health, wealth, wellbeing, and equity for the communities who live around our hospitals. This includes achieving equity of access, experience and outcomes for all the patients we serve, across all of our services.

Aim: To improve health, wealth, wellbeing and equity within our local communities

• Embed health and equity in our core activities
• Integrate care around the needs of local communities through place-based partnerships
• Focus on our staff as a key part of our local population Understanding our local population and their needs
• Maximise our impact as an ‘anchor’ organisation in our local communities

Understanding our local population and their needs

We are committed to using data to monitor health inequalities and engaging with local community groups to use this data to drive change. We have made significant progress to improve our data quality on the ethnicity of our patient population and our understanding of where deprivation may be an issue for our patients. We have updated our existing operational dashboards to present data that allows staff to identify inequity by ethnicity and deprivation within services. We also work closely with our local public health teams and local community groups to identify needs, gather insights and listen to what matters most to our communities, supported by our user insight and community engagement functions.

We will report on the health inequalities metrics set out in NHS England’s statement on information on health inequalities during 2024/25. We are part of a working group of providers across north west London who are co-ordinating how we report on and develop action plans to address inequities in service delivery.

Improving equity within our core activities  

Using data, user-insights, and improvement methodologies, we have collaborated with patients and communities to identify issues and co-create solutions in the following areas: 

• Improving access to outpatients – We have identified a notable difference in Did Not Attend (DNA) rates linked to deprivation where the DNA rate stands at 13 per cent compared to the average of 8 per cent. This presents a chance to improve health and equity as missing the initial outpatient appointment can lead to later diagnosis and treatment, leading to poorer outcomes. We are collaborating with academic partners and patients to test approaches that can support increased attendance for patients from deprived communities or minority ethnic backgrounds. These include testing different text messages to find the most effective content and piloting an artificial intelligence algorithm to identify patients at high risk of missing their appointment. This is feeding into our wider outpatient improvement programme, so the redesign of the service will be more equitable from the outset. 
  
  
• Taking care and diagnostics into the community – In 2023/24, we opened the first two community diagnostic centres for north west London, in Willesden and Wembley. In June 2024, we added an eye care diagnostic centre in north Paddington. All have been located in areas that serve communities with significant health inequalities and will help us bring down waiting times and ensure fairer access to services. 
  
  
• Supporting patients to ‘wait well’ – Data shows that patients from the most deprived populations have a poorer experience and potentially wait longer for treatment. We are investing in ways to understand and improve the waiting experience, with an emphasis on patients from the 20 per cent most deprived populations. Working with our community partners and Imperial College London, we have co-designing initiatives to improve the waiting experience. 
  
  
• Evolving our services to help prevent ill health – Smoking is a leading cause of health inequity and poor health outcomes for our staff, patients and their families. We are working to create a sustainable smokefree environment and offer our patients who smoke opportunities to quit smoking. This includes providing an on-site tobacco dependence treatment service, timely nicotine replacement therapy and referral to community services. 
  
  
• Interpreting improvement programme – Patient interpreting, including sign language, plays a vital role in promoting equity, safety and quality in healthcare . Following feedback from our communities that our interpreting services are not good enough, we commissioned a review that made a case for a complete transformation of our offer. A transformation programme began in 2024 and immediate improvements including piloting a new, on-demand interpreting option, actions to encourage and empower staff to make patient interpreting more accessible for patients through better information, education and training. And we are working with patients, staff and partners to co-design our interpreting service requirements for the future.  

Building partnerships to improve health and wellbeing of our local communities

The vast majority of health outcomes are driven by factors beyond health services – including secure employment, access to high-quality education and living in a healthy, connected and safe place. Many of these determinants are directly impacted by services and infrastructure delivered by our collaborators and local partners. We are working with partners to improve health and reduce inequalities by connecting communities, researchers, industry, public sector and voluntary organisations.

• Maximising our role as an anchor institution – As a key institution in our local area, we run initiatives to positively influence the underlying social, economic and environmental conditions which support an equitable, healthy and prosperous local community. We invest in community recruitment, conduct local skills mapping for the health and life sciences sector, and organise community walks for staff and partners to deepen their understanding of local health needs and inequalities. Our Trust Green Plan and the redevelopment of our hospital sites also remain important contributors to this work.
  
  
• Paddington Life Sciences Partners – A collaboration of life science and community organisations with the Trust and our academic partner Imperial College London, centred around St Mary's Hospital. As well as driving research and innovation in healthcare, our partnership has enabled improvements in digital inclusion for local residents, helping to streamline referral pathways for residents who have difficulty accessing or benefiting from technology. We are also working with partners to provide opportunities for local residents to build skills and find high-quality work within this emerging life sciences eco-system.
  
  
• Westminster #2035 – Our partnership work with local communities is aiming to achieve the collective ambition of a healthier and fairer Westminster by 2035. Together with partners, we are focused on improving equity in access, experience and outcomes of services across Westminster, alongside joined-up work to support healthier, safer and cleaner environments, quality housing and giving children the best start in life.
  
  
• Investing in community based interventions – Our collaboration with the Chelsea FC Foundation, supported by Imperial Health Charity, leverages the interplay between sport, health and wellbeing. We are developing community-based programmes combining exercise, physical activity and peer support to improve participants’ physical and mental wellbeing.

We recognise the dual role we have to play in delivering high quality, equitable care, while also using our resources in imaginative ways to address health inequalities and improve the overall health and wellbeing of the communities we serve. This work will continue to be a major focus. 

Looking ahead

Our 2024-2027 equity, diversity and inclusion workforce plan sets out further steps to improve our recruitment processes, make our environments more accessible for disabled staff and expand our staff networks. You can read the full 2024-2027 plan.

We will also be focusing on how our commitments now need to shape additional work to help us on our journey to becoming truly a fair and inclusive organisation.