Comment / Black Lives Matter

Who can fail to have been moved by events surrounding the brutal killing of George Floyd in Minneapolis at the end of May? Who can have missed the toppling of the slave trader Edward Colston in Bristol this week by Black Lives Matter protesters? And who can have missed the fact that these events came in the middle of a global pandemic that is disproportionately impacting on black, Asian and other minority ethnic (BAME) communities? It’s shocking, and we must continue to feel shocked and angry at what’s happening, because that will fuel our energy and commitment to do something about it.

We must stand together to put an end to racism. We must stand in support of Black Lives Matter. I’ve been thinking about how we can do this at the HFMA – what can we practically do, that will result in social justice, and not just end with well-meaning statements?

I think there are two broad categories of actions: the first around how we actually deploy public funding, and the second around how we treat our staff.

First, we need to ensure that resources are effectively targeted towards reducing inequalities and promoting social justice. And we need to ensure that, in our jobs, we understand the inequity that public policy can cause. We know that most health issues are mainly impacted by behavioural and socio-economic circumstances, so let’s really understand that. Let’s identify populations where inequalities are particularly stark.

For example, how many people have analysed their waiting lists by ethnic group?  We did that at my hospitals and found a high association between ethnicity and living in a socio-economically deprived area, with those of black ethnicity 75% more likely to be from the 40% most deprived areas.

Furthermore, people living in those areas were twice as likely to have a mental health condition, 80% (yes 80% - that’s not a typo) more likely to DNA (did not attend) and 65% (again, not a typo) more likely to breach the cancer 62-day target.   

I know that the reasons are complex. We need to get underneath these statistics and really understand them in the same way that we need to understand why the Covid mortality statistics look so disproportionately skewed.  

We need to understand what’s driving this at a new level of detail so we can target the appropriate resources to more effectively support communities and individuals. As healthcare accountants I think that is part of our role in helping the NHS recover.  

We must also act to ensure a fairer future for our staff. We know that the NHS finance function has some way to go to address the fact that, while 18% of our staff are from BAME backgrounds, only 4% of finance directors and chief finance officers are BAME. That is such a glaring and embarrassing disparity that we have to call it out, and work to address it.

HFMA will work on this issue – building on the trust-specific diversity metrics that were issued by the HFMA and Future Focused Finance to organisations alongside the last finance function census (and due to be refreshed this summer) – and support finance leaders to get this right.  

Many, if not most, NHS organisations will be able to recite their workforce race equality standard (WRES) data, and tell you that BAME staff are more likely to be disciplined, and less likely to be promoted, and most organisations will have made whole hearted commitments to getting this right. I hope that the recent events will catalyse our actions and give some real speed to the delivery of those promises.