Diversity,InclusionandPa4entcare

LondonWomen’sLeadershipNetworkLaunch12thMay2016

DaghniRajasingamFMLMNa4onalLeadforInclusion

90per100,000materni4es

1952-54

MaternalMortalityintheUK

11per100,000materni4es

2006-08

2009-12

10per100,000materni4es

3

BMJQualityandSafety,Sept2013[onlineearly]:hRp://www.lums.lancs.ac.uk/nhs-quality/

Maternaldeathrate2003-12(Threeyearrollingaverages)

0

2

4

6

8

10

12

14

16

2004 2005 2006 2007 2008 2009 2010 2011

Rateper100000m

aterni4e

s

Mid-yearofeachthree-yearperiod

DirectandIndirectmaternaldeathrate

Directmaternaldeathrate

Indirectmaternaldeathrate

48%reduc4onindirectmaternaldeathrate,p<0.001Nosignificantdecreaseinindirectmaternaldeaths,p=0.73

Interna4onalcomparisons•  MBRRACE-UK–  10.1per100,000materni4es(95%CI8.9-11.5)for2010-12

•  MDEIreland–  8.6per100,000materni4es(95%CI5.2-16.6)for2009-11

•  FranceConfiden4alEnquiry–  10.3per100,000livebirths(95%CI9.1–11.6)for2007–09

•  NetherlandsConfiden4alEnquiry–  5.0per100,000livebirths(95%CI3.5-6.9)for2009-12

MaternalmortalityratebyethnicgroupRateper100,000

materni4es95%CI Rela4ve

risk(RR)95%CI

Ethnicity(Englandonly) White(inc.notknown) 9.0 7.8-10.4 1 Indian 20.5 11.9-32.8 2.27* 1.30-3.74Pakistani 13.9 7.8-22.8 1.53 0.84-2.60Bangladeshi 11.1 3.0-28.4 1.23 0.33-3.20OtherAsian 8.1 2.9-17.6 0.90 0.32-1.99Caribbean 18.5 6.0-43.2 2.05 0.66-4.87African 26.9 17.6-39.4 2.98* 1.90-4.51Others/mixed 10.2 5.6-17.1 1.13 0.61-1.94*Significantlyraisedcomparedtowhitewomen

Maternalmortalityratebyareaofresidence(IMDquin4le)

Rateper100,000

materni4es95%CI Rela4ve

risk(RR)95%CI

IMDQuin4les(Englandonly) I(Leastdeprived/ highest

20%) 8.2 5.6to11.6 1 -II 8.2 5.6to11.4 1.00 0.60to1.67III 8.9 6.4to12.0 1.09 0.67to1.77IV 11.0 8.5to14.0 1.34 0.87to2.12V(Mostdeprived/lowest20%)

12.1 9.7to14.9 1.48* 1.00to2.29

*Significantlyraisedcomparedtowomeninleastdeprivedareas

Whatisthegap/need?

Womenwithchronichypertension2001-11

Black(N=564)

White(N=367)

*AdjustedOR

S4llbirth 11(2%) 3(1%) 2.41(0.67-8.71)Gesta4onatdelivery(w) 38(33-40) 39(38-40)** -Delivery<34weeks 59(10.5%) 12(3.2%) 7.25(2.67-19.74)Delivery<37weeks 129(22.9%) 41(10.8%) 2.91(1.68-5.03)Birthweight(g) 3060

(2560-3500)3300

(2920-3700)*-

SGA<5thCen4le 72(12.8%) 32(8.4%) 2.04(1.11-3.75)SGA<10thCen4le 109(19.3%) 48(12.7%) 1.81(1.11-3.00)NICUadmission 57(10.1%) 19(6.0%) 2.79(1.29-5.73)

LucyChappell2014

TrustboardmembersinLondonanalysedbygender

Male Female Unknown

%female

Chair 28 10 26.3Chefexec 29 12 30.8

Execu4vemembers

132 96 42.1

Nonexecu4vemembers

137 89 39.4

Boardtotal

326 207 38.8

TrustBoardmembersInLondonanalysedbyethnicity–Jan2014

White BME Unknown

%BME

Chair 37 1 2.5Chiefexecu4ve

37 1 2.5

Execu4vemembers

195 17 8.7

Nonexecu4vemembers

194 22 11.3

Boardtotal* 463 41 8.9

BlackandMinorityEthnic(BME)Staff

•  1.3millionpeopleworkintheNHS

•  18%stafffromBMEBackgrounds

•  28%DrsfromBMEbackgrounds

•  38%ofHospitalDrs•  >5%seniormanagers

fromBMEbackgrounds

20%NursesandMidwives(qualifiedandunqualified)Risingto50%inLondon4BMECEOs1Exec&4DirectorofNursing>3%MedicalDirectorsSource:HealthandSocialCareInforma4onCentre

Educa4onandTraining

hRp://www.gmc-uk.org/MRCGP_Final_Report__18th_September_2013.pdf_53516840.pdf

Theevidencebase…

•  Whitestaff1.744mesmorelikelytobeappointedonceshortlistedthanareshortlistedBMEstaff(Kline2013)

•  BMEstafftwiceaslikelytoenterdisciplinaryprocessandmorelikelytobedisciplinedforsimilaroffences(Archibongetal2010)

•  Blacknursestake50%longertobepromoted(RCN)andarelesslikelytoaccessna4onaltrainingcourses

“TheSnowyWhitePeaks”found…

•  1in40chairsandnoCEOinLondonisBME

•  17of40TrustshaveallwhiteBoardsbutover40%ofworkforceandpa4entsareBME

•  DecreaseinBMEBoardmembers

•  NotoneBMEexecdirectorinMonitor,• CQC,NHSTDA,NHSEngland,NHSLA,HEE

• Thisisbestevidencedbythelinkbetweenethnicdiscrimina4onagainststaffandpa4entsa4sfac4on.

•  Thegreaterthepropor4onofstafffromablackorminorityethnic(BME)backgroundwhoreportexperiencingdiscrimina4onatworkintheprevious12months,thelowerthelevelsofpa4entsa4sfac4on.

•  TheexperienceofBMEstaffisaverygoodbarometeroftheclimateofrespectandcareforallwithinNHStrusts.

• (NHSStaffManagementandHealthServiceQualityResults•  fromtheNHSStaffSurveyandRelatedDataWest,Metal(2012)

ProfessorMikeWest–NHSQualityandStaffEngagement

Healthcareinnova4onhampered…

•  Thereisevidenceofalinkbetweendiversityinteams(ateverylevelincludingBoards)andinnova4on.Ata4mewhentheNHSneedstotransformitscare,lackofdiversitymaycarryacostinpa4entcareforeveryone

•  TheHealthyNHSBoard2013:ReviewofGuidanceandResearchEvidence

Whyworkforceracediscrimina4onisbadforallpa4ents:

•  Preventspa4entsgeungbeststaff•  Impactdivertsresourcesfrompa4entcare•  Discrimina4onmakesstaffill•  Howstaffarecaredforimpactsoncarethey

provide•  Diversityimprovesinnova4on+teamwork•  Unrepresenta4veBoardslesslikelytoprovide

pa4entfocussedcare

Theendofdenial-SimonStevensMay2014

• “Itcan’tberightforexample–asRogerKline’srecentresearchhaspinpointed–thattenyearsaMerthelaunchoftheNHSraceequalityplan,while41%ofNHSstaffinLondonarefromblackandminorityethnicbackgrounds(similarinproporQontotheLondonerstheyserve)only8%oftrustboarddirectorsare,withtwo-fiBhsofLondontrustboardshavingnoBMEdirectorsatall.SimilarpaSernsapplyelsewhere,andhaveactuallybeengoingbackwards.”

• Knowingisnotenough• Wemustapply• Willingisnotenough• Wemustdo