What are medical professional bodies doing to address inequality? – A staff member’s insight

Issues around equality, diversity and inclusion (EDI) are not exclusive to paediatrics. As a medical royal college, we are part of a much wider network of professional bodies who have a responsibility to address and tackle inequality in all its forms.

I’m a member of the RCPCH EDI Staff working group, and felt it was important for us to review other stakeholders' work on EDI to assess where others are in this area and what some of their priorities are. Here are my reflections.
Zara Raffeeq
Zara Raffeeq

Diverse representation

Various royal colleges have recognised that they are lacking diverse representation, especially in leadership roles. This is across a number of protected characteristics including gender, ethnicity and disability. Our Putting Ladders Down report and subsequent Action Plan found that our own volunteer roles are not representative of our overall membership. Some other royal colleges have reported similar findings.

I believe it is important to attract diverse groups of people to leadership positions

The Royal College of Surgeons of England (RCSEng) recently published a diversity report that found that 60% of its membership do not do not believe the College represents people like them. While many colleges are striving to embed principles of equality and diversity across their work, there is a strong recognition that more needs to be done to ensure that college structures are more representative of the membership they serve.

How do we challenge this homogenous nature of leadership? The Royal College of Nursing (RCN) Courageous about Equality and Bold about Inclusion report set out its aims to inspire members to be college representatives and to acquire tools to help them exert influence. In a 2020 Equality, Diversity and Inclusion report, the Royal College of General Practitioners (RCGP) outlined its EDI framework to ensure access to representative role models and to lead conversation on the importance of diverse leadership.

I believe it is important to attract diverse groups of people, including underrepresented groups, to leadership positions: this reinforces a message of belonging. It will be interesting to see how the pandemic will affect this issue; as we see a move to more virtual routes of engagement, perhaps we will see a wider demographic of people who are able to get involved in the work of royal colleges and thus increase diverse representation.

Discrimination and career obstacles

In a 2021 diversity report, RCSEng found that “over 70% of LGBT+ medics had endured one or more types of experience short of harassment or abuse in the last two years related to their sexual orientation”. Similarly, a 2020 NHS Workforce Race Equality Standard report highlighted that “30.3% of BME staff, and 27.9% of white staff, reported experiencing harassment, bullying or abuse from patients, relatives or the public”. This report also found that ”white applicants were 1.61 times more likely to be appointed from shortlisting compared to BME applicants”.

Coupled with the fact that there has been no overall improvement in this particular outcome in the last five years, it is clear that it is high time to challenge discrimination and disparities of experience in the workplace, across a number of protected characteristics.

Medical royal colleges can take a strong leadership stance against discrimination and promote equality for all medical professionals

After analysis on fairness in referrals and differential attainment, the General Medical Council (GMC) found clear evidence of disproportionate complaints from employers about ethnic minority doctors. They also found evidence of discrimination in education and training. They have now set new targets to eliminate this disproportionality and inequaliities in training, which they hope to be met by 2026 and 2031. While medical royal colleges alone can’t fix this situation and the systems within the NHS, they can commit to eliminating differentials, take a strong leadership stance against discrimination and promote equality for all medical professionals in their places of work.

In their 2021-2023 Strategic plan (PDF), the Royal College of Psychiatrists (RCPsych) have pledged to develop guidance to support employers stamp out discrimination and the RCGP have committed to being an organisation that promotes dignity and respect to all and where no form of discrimination is tolerated. The RCN emphasises the importance of amplifying and reinforcing standards NHS trusts on ally-ship and bystander training. Hopefully, by using this type of messaging and assets, medical professional bodies will show the way to others.

Lack of data

One of the key problems we at RCPCH encountered when investigating EDI issues was a lack of adequate data. I found this to be a widespread challenge across our sector. It can be argued that a data-driven approach is necessary in developing EDI initiatives, but many organisations have limited EDI data or are not making use of the available data sets. The RCSeng diversity report, for example, found that ”available data on the ethnicity of the College is poor so it is hard to draw meaningful conclusions”. Collecting and analysing data is a key part of EDI work as it provides insight into what is working well and what needs to change.

A number of colleges are already collecting enhanced data on protected characteristics and tapping into data sets that weren’t previously being analysed. For example, the RCPsych is committed to encouraging all to make better use of mental health service data sets and the RCGP has aimed to develop tools to effectively analyse EDI data. Campaigning for better data and effective use of data will give a more complete picture of the issues at hand and help to develop more robust measures to eliminate inequality.

The reports mentioned here are only a selection, and there's a plethora of organisations working in this area.

In the NHS Workforce Race Equality Standard 2020, Prerana Issar, NHS Chief People Officer, said, ”No one organisation is doing everything well. There are pockets of good practice...but no single organisation is exemplary”.

The publication of our Working for Change report earlier this year was a moment for us to reflect. We will continue to listen, collaborate and learn from each other.