Guidance for NHS trusts and foundation trusts: assessing the well-led key question

Page last updated: 8 April 2024

Workforce equality, diversity and inclusion

We value diversity in our workforce. We work towards an inclusive and fair culture by improving equality and equity for people who work for us.

What does good look like:

The trust takes an anti-discriminatory approach to continually review and improve the culture of the organisation in relation to equality, diversity and inclusion. All staff are treated equitably, including those with protected equality characteristics under the Equality Act 2010 and those from excluded and marginalised groups. The trust takes necessary steps to fully empower these staff in their roles throughout their employment.

The trust develops equitable processes and structures, ensuring that all staff are treated ethically. It uses national mandated programmes relating to workforce equality to achieve this aim. Any interventions taken as a result are monitored to evaluate their impact.

There is evidence of actions the trust has taken to prevent and address bullying and harassment at all levels. This has a clear focus on those with a protected equality characteristic and those from excluded and marginalised groups. The trust is taking active steps to promote diversity by ensuring:

staff equality profiles are representative of local communities
staff at management grades and leaders at board level reflect the staff profile.

There is fairness in recruitment and career progression with equally good outcomes for staff in equality groups. The trust takes action to address ethnicity and gender pay gaps.

Disciplinary and capability processes are fair and are evaluated to ensure no detriment based on any protected equality characteristic. Reasonable adjustments are made to support disabled staff to carry out their roles well.

There are effective and proactive ways of engaging with and involving staff. These have a specific focus on hearing and empowering the voices of staff with equality characteristics, including staff equality networks. Their concerns and ideas result in positive change to shape services, create a more equitable and inclusive organisation and address health inequalities. When improving equality and inclusion, the trust considers the experiences and needs of staff working under different contractual arrangements such as agency, bank and contracted-out staff.

Feedback from staff reflects both the data from nationally mandated programmes and corresponding feedback and commitments made by senior leaders regarding workforce equality.

Further detail and context:

Equality standards

There is strong evidence to suggest that providing equitable working conditions has a direct impact on the quality of care for patients. Analysis of the NHS workforce shows that inequalities experienced by some staff groups have become an entrenched part of their working experience. Further inequalities can happen as a result of having more than one equality characteristic, resulting in some individuals experiencing multiple forms of discrimination or workforce inequality. To improve, trusts need to have aligned and co-ordinated approaches to enable national benchmarking and improvement through best practice. They also need local flexibility so they hear and act on the voices of affected staff.

The NHS EDI Improvement Plan sets out 6 high-impact actions to help improve equality across the 9 protected characteristics of the Equality Act. These also address social mobility and the intersectional impacts of discrimination and bias. The 6 actions provide a blueprint of how organisations can effectively progress equality and inclusion. If they are implemented successfully, this will be reflected in improved mandated workforce metrics such as the NHS staff survey and others, including:

The Workforce Race Equality Standard (WRES) helps NHS organisations to plan and show progress on workforce race equality for staff from ethnic minority groups using a nationally-agreed set of measures. It is a requirement in the NHS standard contract. The experiences of ethnic minority staff and patients are linked.
The Workforce Disability Equality Standard (WDES) enables NHS organisations to better understand the experiences of their disabled staff. It supports positive change for all staff by creating a more inclusive environment for disabled people who currently work or would like to work in the NHS. Like the WRES, it is based on a set of specific measures. It is also mandated in the NHS contract.
Gender pay gap reporting aims to focus an organisation on taking action to reduce gender pay inequalities, focus effort on improving staff experiences and improve retention. Annual reporting on the gender pay gap is mandated for organisations with 250 or more employees.
The Equality Delivery System 2022 helps NHS organisations improve services for their local communities and provide better working environments, free of discrimination, while meeting the requirements of the Equality Act 2010. It encourages organisations to use the outcomes of the WRES and WDES to improve the health and wellbeing of staff. It is also mandated in the NHS Standard Contract.

Equality diversity and inclusion (EDI), workforce and leadership

The NHS People Plan includes ‘Belonging in the NHS’, which has a focus on tackling discrimination for staff. This is further developed through the NHS EDI Improvement Plan, which includes all protected characteristics and social mobility. The NHS Constitution also includes provisions in relation to workforce equality.

Inclusive Britain: government response to the Commission on Race and Ethnic Disparities made recommendations to improve ethnicity pay gaps and CQC oversight of workforce race equality. CQC’s internal review of the regulation of workforce equality with ongoing work to improve in this area.

Leadership for a collaborative and inclusive future (the Messenger review) also made recommendations to improve workforce equality, diversity and inclusion. It highlights the need to embed inclusive leadership practice as the responsibility of all leaders, promote equal opportunity and fairness standards, stringently enforce existing measures to improve equal opportunities and fairness, and enhance the role of CQC in ensuring improvement in EDI outcomes.

Best practice / guidance

Link to regulations

Regulation 17: Good governance

Regulation 18: Staffing