Ensuring we are an effective anti-racist organisation is one of my biggest challenges yet

Leading any organisation, whatever its size, brings its challenges. And after nearly 10 years of leading NHS Providers, I feel that I am currently facing one of my biggest challenges – how to ensure NHS Providers is an effective anti-racist organisation.

One element of the challenge is that our member trusts, staff and stakeholders tell us that we have been behind the curve here and that we've taken too long to properly engage with this vitally important agenda. For someone who's incredibly proud of what NHS Providers has achieved under my leadership, that's been a difficult message to hear. It's made me question how effective my leadership has been.

We feel we're a go ahead, can do, organisation that delivers effectively at pace. So another challenge has been to think carefully about how to become an effective anti-racist organisation.

There was a lot of pressure to jump straight into action planning and delivery. Particularly given the urgency of the challenge as these issues are so long standing. And we know that many ethnic minority leaders and staff are angry and frustrated with the NHS' collective failure to address them.

But we've deliberately taken initial time to discuss, listen and think. With the help of a group of race equality advisers and our own internal race equality and cultural inclusion group, we've invested time, effort and resource in a cross-organisation dialogue, with a particular emphasis on listening hard to the experiences of our ethnic minority staff.

A good number of the messages from that dialogue were painful and, initially, triggered a strongly defensive inner monologue in my head.

A good number of the messages from that dialogue were painful and, initially, triggered a strongly defensive inner monologue in my head.

Our dialogue told us that having an all-white director leadership team is a serious problem for our organisation as it has, for example, potentially deterred some people from joining NHS Providers. "But aren't we meant to appoint on the basis of merit alone", my inner monologue told me. I now recognise we haven't worked anywhere near hard enough to create a diverse pool of candidates from which to make director level appointments.

Our dialogue told us that our ethnic minority staff are less likely to feel valued and are less likely to say NHS Providers champions diversity and seeks out different viewpoints. "But our overall staff survey results are really good", said my inner monologue. I now recognise that we have to enable every member of staff to give of their best and that there is a particular responsibility, as an anti-racist organisation, to ensure that this is the case for colleagues from ethnic minorities, given the structural barriers they face.

Our work told us that we have done nowhere near enough on this agenda. "But look at the bold stance we took on the Sewell Report – publicly challenging the report for failing to acknowledge the links between structural racism and health inequalities" replied my inner monologue. I now recognise that NHS Providers' internal behaviours, approaches and structures need to match what we say externally on race. And they currently don't.

There were times when I have felt at sea. When I have felt every single one of my 58 years, and every inch of my white, male, middle class, privilege. Particularly in the face of younger colleagues, who seem to reflexively engage with these issues much more effectively than I do.

There have been times when, very rarely for me, I have become lost for words as I grapple with new concepts and new language, worrying that I am going to say the wrong thing.

There have been times when I feel that I am going right the way back to the beginning of my career to learn from scratch. A stark contrast to the rest of my job when I am usually very clear about what we need to do as an organisation and say publicly on behalf of our members.

And I feel the work has posed other really difficult questions like "how do I reconcile my responsibility for everyone in the organisation, when there may be some members of staff uncomfortable with concepts like white privilege".

But we are making real progress. We're working on an organisational anti-racism statement that will unite all of us behind a clear ambition.

We are now beginning to work on an action plan so we can objectively measure our progress. It feels like there are so many opportunities. To embed anti-racism in our board development and director induction work. To support our member boards to accelerate progress that is desperately needed here. To use our influence with organisations like NHS England and NHS Improvement and the CQC to ensure they play their full role too. To embed anti-racism in everything that we do.

There is currently a determined attempt by a section of opinion to attack the NHS, and other public services, when they seek to become anti-racist organisations.

There's one final element of the challenge where I want to make a wider personal contribution given that I have, hopefully, developed an effective public voice on NHS issues.

There is currently a determined attempt by a section of opinion to attack the NHS, and other public services, when they seek to become anti-racist organisations. I've deliberately called it "noises off, stage right".

The critical media stories about the salaries attached to equality, diversity and inclusion roles. The snide derision about "excessive woke-ry". The abhorrent personal attacks on people like Prerana Issar who have provided strong, visible, public leadership on these issues.

We have started to explicitly call this out and deliberately challenge it. I did it, for example, in a recent HSJ interview.

The NHS must not be deflected. There is clear and overwhelming evidence that health outcomes are significantly poorer, at an aggregate level, for ethnic minority communities. Our colleagues at the Race and Health Observatory, who are rapidly and effectively building a powerful presence on these issues, have clearly set out the evidence here.

The NHS staff survey continues to show shocking evidence that NHS staff from ethnic minority backgrounds suffer greater bullying and harassment, are more likely to face disciplinary action and experience much higher barriers to promotion than white colleagues.

It cannot be right that, in aggregate, whole sections of our population suffer worse health outcomes as a result of their ethnicity. And whole sections of our staff are unable to give of their best as a result of how they are treated, due to their race.

As in society as a whole, not being racist is far too low an ambition if we are to tackle these issues. The NHS is right to invest time, resource and money in being anti-racist and tackling health inequalities. We mustn't shy away from that. And we should be publicly defending that investment when attacked.

I am finding this a hard and challenging journey. But it is one that I, NHS Providers and the wider NHS must make. And we should be proud to make.