Whereas 17% of all NHS staff identify as non-white, only 8% on higher grades do so. The proportion is lower still in very senior management and at board level. Around 20% of NHS nurses but only 3% of nursing directors are from black or minority ethnic (BME) backgrounds.

Last year my company, Public World, published Discrimination by appointment, which drew upon data from 30 NHS trusts showing that, in all but one of them, over a 12-month period the percentage of BME appointments was lower than the percentage shortlisted, which in turn was lower than the percentage of BME applicants.

Our statistical analysis was by no means comprehensive and we drew no specific conclusions about what might explain the numbers. We merely noted that they reinforced other evidence suggesting the need for a renewed focus on race equality in the NHS.

Inequality rife among black and minority ethnic staff in the NHS Read more

From April 2015 all but the smallest employers of the 1.4 million NHS workforce will be required, in the words of NHS England, to “demonstrate progress against a number of indicators of workforce equality”.

The new Workforce Race Equality Standard (WRES), first proposed by NHS England’s equality and diversity council in July and mandated in October, will take the form of nine indicators announced on the NHS England website on 8 December.

It is a response to evidence that BME people are under-represented in the service’s leadership, over-represented in disciplinary hearings and negative staff survey indicators, and disadvantaged in selection processes.

However, I must confess to some anxiety about the potential effect of the WRES, which will be written into the standard NHS contract for 2015-16 and form part of the inspection regime from the following year.

There are three reasons for my concern:

1. Recent NHS history is littered with examples of unforeseen consequences of well-intentioned, centrally imposed and punitively enforced targets. Command and control has its place in emergencies but a poor track record in shaping NHS culture.

2. The WRES indicators have been designed without deep engagement within NHS organisations. According to NHS England, “key stakeholders” have been consulted, but there was only a two-week period for feedback, with a Christmas Eve deadline.

3. I wonder about some of the metrics, including the one that appears to have been influenced by the analysis in our own report. Employers will be required progressively to close the gap between the “relative likelihood of BME staff being recruited from shortlisting compared to that of white staff being recruited from shortlisting across all posts”. Without digging into the reasons for that gap – which may or may not be intrinsic to the NHS – isn’t there a danger of treating the symptoms rather than the causes?

Is the NHS institutionally racist? Read more

Against that, NHS England emphasises that the WRES is only “the first stage in a process of addressing workforce equality issues”. These negatively affect not only staff but also patients, as work by Jeremy Dawson and Michael West has suggested.

Moreover, I have heard passionate support for the WRES in recent months from a wide range of NHS leaders, black and white, who make a compelling case that the NHS must be made to finally tackle deep injustices that it has failed to tackle voluntarily.

So I raise my concerns in a humble spirit of support for the aims of the WRES and hope that NHS trusts will welcome it as an opportunity to engage in the difficult internal conversations we suggested when we published Discrimination by Appointment.

Public World’s work on staff involvement to enable sustained cultural change shows that shared vision and common purpose come only through carefully facilitated exploration and acceptance of difference. This time, ticking boxes simply won’t work, and open dialogue is essential.

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