If I were an NHS CEO…

4 min read

Just now

I was reflecting earlier about what if I were an

NHS CEO and what changes I would like to implement. Obviously, I haven’t yet reached very senior management, but I have worked in the mental health sector for almost a decade and for various mental health NHS Trusts. I also have experience as a governor. This reflection was inspired by attending the second conference of the Amaree Women’s Network, which is for senior women leaders from the global majority working in the health and social care sector who are Band 8C and above. It was a beautiful event, just like last year, and I was able to reunite with senior nursing leaders and meet or see people I have gotten to know through LinkedIn.

I have always said I would like to become the CEO of an NHS mental health Trust, perhaps the first Somali one, if nobody else beats me to it. We don’t have Somali Chief Nurses either. Representation matters, and I felt seen, heard and inspired at the recent leadership conference. But we are not well represented at executive levels in the NHS due to systematic racism, discrimination, sexism, anti-Blackness and anti-Brownness.

London is a diverse city; however, the communities from the global majority are underrepresented. They are more likely to have access barriers, be misdiagnosed, be sectioned under the Mental Health Act 1983, be over-medicated and, unfortunately, even die due to biases and restraints. We talk about co-production in the mental health sector, but I don’t see diverse people. We talk about sharing power, but how do people from marginalised communities have a say apart from tokenism?

My first proposal would be a body of local third-sector organisations, led by global majority representation, faith centres, and diverse external mental health professionals, representing the local boroughs. These voices will be present in decision-making, consultations, and the recruitment of executive-level and (senior) management within the Trust, serving as diversity champions. I would propose a vote of confidence or no confidence in the very senior leadership, which also includes a vote for staffing. We need accountability for serving the local diverse communities and the diverse workforce. Regulation of management is part of the solution.

I strongly believe in justice and the importance of speaking up. At the moment, the structures don’t seem to make any difference. As we all know, people are either pushed, treated differently, or managers collude with HR to find faults. I want to establish a CEO pathway where individuals can bring their concerns, anonymously or face-to-face, and there will be internal investigations. These may involve placing an investigator anonymously to work in the department or conducting anonymous interviews. Nobody should feel that they are protected simply because of who they know or because they can get away with things because they are in management. Accountability will fall on management that doesn’t act or let toxic cultures flourish.

I would introduce changes to shortlisting. When

I was shortlisting for Link Workers and was surprised that there was no audit for fairness. The hiring manager can currently appoint anyone to be the second shortlister. I would introduce a random selection of second shortlisters from within the Trust and have a diversity champion present during the shortlisting process for accountability. I want to capture ethnicity data of people who are shortlisted and appointed from Band 6 to VSM (Very Senior Management). I would have HR complete audits and investigate where there is a lack of diversity in job appointments. The diversity champion from the local community will be trained and present at every interview. Interviews should be recorded, and interview questions should be released 72 hours beforehand to provide equal opportunity for people with neurodivergent needs, while also mitigating any potential leakage of questions due to nepotism. If anyone feels they were discriminated against during the interview, HR can review the scoring with the evidence of the audio.

Lastly, as an NHS CEO, I want any referral to regulatory bodies, whether it is the GMC, NMC, or HCPC, to go through an internal anti-racist panel that will determine whether any biases, racism, vexatious, or discriminatory factors were involved. Where the panel finds that there has been foul play, those involved will be referred to the regulatory body, as they are not safe to practice among diverse people or communities. I do believe in a no-blame culture, and the people should be supported in practice, but I have zero tolerance for racism and discrimination. A brilliant nurse academic recently said in the Asmaree conference that the NMC (a charity) should be led by nurses, which it is not currently.

Anti-racism training should be mandatory annually in NHS Trusts, and I would invite experts and individuals with lived experience who have either undergone fitness to practice or Tribunal Proceedings to speak with staff about the impact. All the changes I have mentioned should be documented in new policies and frameworks, ensuring the anti-racist work continues to evolve regardless of who is in charge. There should be yearly research and evaluation using an anti-racism framework, such as the one recently developed by the NHS Race & Health Observatory and the Institute for Healthcare Improvement (https://nhsrho.org/resources/mfi-ar-framework-guidance/). It is time for equality to be at the heart of what we do, and not just words. And as a CEO, you have the ultimate responsibility, and if you don’t serve the community and staff, they should have the power to demote you in a no-confidence vote.

Become the vision you did not see! ~ Mushtag Kahin.