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Appendix

Introduction

  1. Merriam-Webster Dictionary (2024). Available at: https://www.merriam-webster.com/dictionary/racism.
  2. Kendi I (2019) How to be an antiracist. Bodley Head.
  3. Campbell-Stephens R M (2021) Educational Leadership and the Global Majority. Palgrave Macmillan.

The statistical case for going further

  1. NHS England (2024) NHS Workforce Race Equality Standard. Available at: https://www.england.nhs.uk/long-read/workforce-race-equality-standard-2023-data-analysis-report-for-nhs-trusts/.
  2. NHS England (2020) 2019 WRES data analysis report for eleven arm's length bodies. Available at: https://www.england.nhs.uk/wp-content/uploads/2020/09/WRES-Data-Report_ALBs-2020.pdf. & Spencer Private Hospitals (2020) WRES Report 2019-20. Available at: https://www.spencerprivatehospitals.com/about-us/workforce-race-equality-standard. & Nuffield Health (2023) Workforce Race Equality Standard (WRES). Available at: https://www.nuffieldhealth.com/about-us/how-we-are-governed/workforce-race-equality-standard-wres.
  3. NHS Education for Scotland (2023) Equality Monitoring Report 2022/23. Available at: https://www.nes.scot.nhs.uk/about-us/equality-diversity-and-human-rights/employment-equality-monitoring-and-equal-pay/.
  4. Welsh Government (2022) Anti-racist Wales Action Plan. Available at: https://www.gov.wales/anti-racist-wales-action-plan-contents.
  5. Health and Social Care Northern Ireland (2023) Equality Action Plan. Available at: https://www.northerntrust.hscni.net/wp-content/uploads/2023/06/Equality-Action-Plan-2023-2028.pdf.
  6. Nursing and Midwifery Council (2023) The NMC register. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/data-reports/may-2023/0110a-annual-data-report-full-uk-web.pdf. & NMC (2019) Equality, diversity and inclusion at the NMC. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/annual_reports_and_accounts/edi/2018-2019_annual-edi-summary-final.pdf.
  7. NHS Staff Surveys (2024) Results. Available at: https://www.nhsstaffsurveys.com/results/.
  8. NHS England (2024) 'WRES indicator 9' and 'WRES indicator 3', NHS Workforce Race Equality Standard. Available at: https://www.england.nhs.uk/long-read/workforce-race-equality-standard-2023-data-analysis-report-for-nhs-trusts/.
  9. Nursing and Midwifery Council (2022) Ambitious for change phase two summary: Research into NMC processes and people's diversity characteristics. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/ambitious-for-change/nmc-ambitions-for-change-report-summary.pdf. & Royal College of Nursing (2021) Employment Survey 2021. Available at: https://www.rcn.org.uk/Professional-Development/publications/employment-survey-2021-uk-pub-010-075.
  10. NHS England (2024) 'WRES indicator 1' and 'WRES indicator 9', NHS Workforce Race Equality Standard. Available at: https://www.england.nhs.uk/long-read/workforce-race-equality-standard-2023-data-analysis-report-for-nhs-trusts/.
  11. NHS Education for Scotland (2023) 'Workforce composition', Equality Monitoring Report 2022/23. Available at: https://www.nes.scot.nhs.uk/about-us/equality-diversity-and-human-rights/employment-equality-monitoring-and-equal-pay/.
  12. NHS Confederation (2024) Action for equality in Wales and Northern Ireland. Available at: https://www.nhsconfed.org/publications/action-equality-wales-and-northern-ireland.

The legislative and policy-based case for going further

  1. Equality Act 2010, Section 4. Available at: https://www.legislation.gov.uk/ukpga/2010/15/contents. & The Race Relations (Northern Ireland) Order 1997. Available at: https://www.legislation.gov.uk/nisi/1997/869.
  2. States of Guernsey (2022) Prevention of Discrimination (Guernsey) Ordinance 2022. Available at: https://www.guernseylegalresources.gg/ordinances/guernsey-bailiwick/d/discrimination/prevention-of-discrimination-guernsey-ordinance-2022/. & Jersey Government (2013) Discrimination (Jersey) Law 2013. Available at: https://www.jerseylaw.je/laws/current/Pages/15.260.aspx. & Isle of Man Government (2017) Equality Act 2017. Available at: https://www.gov.im/categories/working-in-the-isle-of-man/employment-rights/equality-act-2017/.
  3. Equality and Human Rights Commission (2022) Our litigation and enforcement policy. Available at: https://www.equalityhumanrights.com/our-work/our-legal-work/our-legal-powers/our-litigation-and-enforcement-policy.
  4. NHS England (2024b) Equality, diversity and health inequalities. Available at: https://www.england.nhs.uk/about/equality/objectives-for-22-23-and-23-24/.
  5. NHS Scotland (2024) NHSScotland 'Once for Scotland' workforce policies. Available at: https://www.gov.scot/publications/consultation-nhsscotland-once-scotland-workforce-policies/pages/3/#:~:text=The%20Equality%2C%20Diversity%20and%20Inclusion,the%20Public%20Sector%20Equality%20Duty.
  6. Welsh Government (2022) Anti-racist Wales Action Plan. Available at: https://www.gov.wales/anti-racist-wales-action-plan.
  7. Public Health Wales (2024) Strategic Equality Plan 2024-2028. Available at: https://phw.nhs.wales/publications/publications1/our-strategic-equality-plan-and-objectives-2024-2028/.
  8. Equality Act Regulation 5 and Regulation 8 (2011) Statutory Duties (Wales). Available at: https://phw.nhs.wales/services-and-teams/equality-impact-assessment-in-wales-practice-hub/the-equality-act-welsh-specific-duties/#:~:text=The%20general%20duty%20of%20the,conduct%20prohibited%20by%20the%20Act.
  9. GOV.UK (1998) Northern Ireland Equality Act, Section 75. Available at: https://www.legislation.gov.uk/ukpga/1998/47/section/75/enacted.
  10. Royal College of Nursing (2023) Council's report to members on Congress 2023. Available at: https://www.rcn.org.uk/Professional-Development/publications/councils-report-to-members-on-congress-2023-011-273.

The patient-driven case for going further

  1. Raleigh V (2023) The Health of People from Ethnic Minority Groups in England, The King's Fund, 17 May. Available at: https://www.kingsfund.org.uk/insight-and-analysis/long-reads/health-people-ethnic-minority-groups-england. & House of Commons (2023) Black maternal health: Third Report of Session 2022-23. Available at: https://committees.parliament.uk/publications/38989/documents/191706/default/.
  2. House of Commons Women and Equalities Committee (2023) Black maternal health: Third Report of Session 2022-23, p. 6. Available at: https://committees.parliament.uk/publications/38989/documents/191706/default/.
  3. Department of Health & Social Care (2023) Maternity and neonatal care: How are we improving services? Gov.UK, 31 July. Available at: https://healthmedia.blog.gov.uk/2023/07/31/how-are-we-improving-maternity-and-neonatal-care/. & NHS (2019) NHS Long Term Plan, p.8. Available at: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf.
  4. Edmondson A C (2018) The Fearless Organisation: Creating Psychological Safety in the Workplace for Learning, Innovation and Growth. Wiley. & Hewlett S, Marshall M, and Sherbin L (2013) How Diversity Can Drive Innovation, Harvard Business Review, December. Available at: https://hbr.org/2013/12/how-diversity-can-drive-innovation. & Nathan M and Lee N (2013) Cultural Diversity, Innovation, and Entrepreneurship: Firm-level Evidence from London. Economic Geography, 89(4), pp. 367-394.
  5. Rock D and Grant H (2016) Why Diverse Teams Are Smarter, Harvard Business Review, November 4. Available at: https://hbr.org/2016/11/why-diverse-teams-are-smarter. & Phillips K W et al. (2008) Is the Pain Worth the Gain? The Advantages and Liabilities of Agreeing With Socially Distinct Newcomers, Personality and Social Psychology Bulletin, 35(3), p.p. 336-350.
  6. NHS England (2018) Links between NHS staff experience and patient satisfaction. & Bailey S and West M (2022) What is compassionate leadership?, The King's Fund, February 15. Available at: https://www.kingsfund.org.uk/insight-and-analysis/long-reads/what-is-compassionate-leadership. & Cheraghi M et al. (2021) Creativity in Nursing Care: A Concept Analysis, Florence Nightingale Journal of Nursing, 29(3), pp.389-396.
  7. Francis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (HC 947). Available at: https://www.gov.uk/government/publications/report-of-the-mid-staffordshire-nhs-foundation-trust-public-inquiry. & Kirkup B (2018) Report of the Liverpool Community Health Independent Review. NHS Improvement. Available at: https://www.england.nhs.uk/publication/report-of-the-liverpool-community-health-independent-review/.
  8. Stoewen D L (2020) Moving from compassion fatigue to compassion resilience Part 4: Signs and consequences of compassion fatigue. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7560777/.

The ethical case for going further

  1. Soutar G et al (1994) The Impact of the Work Environment on Ethical Decision Making. Journal of Business Ethics, 13(5), pp.327-339.
  2. Presidential Commission for the Study of Bioethical Issues (2016) in Hoskins K, Grady C, and Ulrich C M (2018) Ethics Education in Nursing: Instruction for Future Generations of Nurses, Online Journal of Issues in Nursing 23(1). Available at: https://ojin.nursingworld.org/table-of-contents/volume-23-2018/number-1-january-2018/ethics-education-in-nursing/.
  3. Nursing & Midwifery Council (2018) The Code. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf.
  4. Mello M (2023) Anti-racism in nursing practice - our professional duty to act, The Queen's Nursing Institute, July 27. Available at: https://qni.org.uk/anti-racism-in-nursing-practice-our-professional-duty-to-act/.

The economic case for going further

  1. Kline and Lewis (2019) The price of fear: Estimating the financial cost of bullying and harassment to the NHS in England, Public Money & Management, 39(3), p.p. 166-174.
  2. NHS England (2020) Civility & Respect Toolkit. Available at: https://www.socialpartnershipforum.org/system/files/2021-10/Shortened-Version-NHSEI%20-Civility-Respect-Toolkit.pdf.
  3. Nursing and Midwifery Council (2023) 2023 NMC Register Leavers Survey. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/data-reports/may-2023/annual-data-report-leavers-survey-2023.pdf.
  4. The King's Fund (2023) International recruitment in the NHS. Available at: https://www.kingsfund.org.uk/insight-and-analysis/data-and-charts/nhs-international-recruitment-nutshell. & Foster A (2023) Overseas doctors will remain 'crucial' despite recruitment drive - regulator, BBC News, 12 November. Available at: https://www.bbc.co.uk/news/health-67378621.
  5. NHS Shared Business Services. (2022). Improving Staff retention with Workforce Analytics. Available at: https://www.sbs.nhs.uk/case-study/workforce-analytics/.
  6. Modern Society Initiative and Healthcare Workers Foundation (2021) in Rayment L (2021) NHS staff exodus to cost government £21.7 billion, Charity Today, March 30. Available at: https://www.charitytoday.co.uk/nhs-staff-exodus-to-cost-government-21-7billion/.
  7. Royal College of Nursing (2023) Valuing Nursing in the UK. Available at: https://www.rcn.org.uk/Professional-Development/publications/valuing-nursing-in-the-uk-uk-pub-010-695.
  8. Wallace L (2023) Hidden costs of Employee Attrition, Forbes, March 21. Available at: https://www.forbes.com/sites/forbeseq/2023/03/21/five-hidden-costs-of-employee-attrition.
  9. Hunt V et al. (2015) Why diversity matters, McKinsey, January 1. Available at: https://www.mckinsey.com/capabilities/people-and-organizational-performance/our-insights/why-diversity-matters.
  10. Gomez L and Bernet P (2019) Diversity improves performance and outcomes, National Medical Association 111(4). doi:10.1016/j.jnma.2019.01.006.
  11. Naqvi H et al (2022) Workforce and workplace racism in health systems: organisations are diverse but not inclusive, The Lancet, 400(10368). doi:10.1016/S0140-6736(22)02395-9.
  12. NHS England (2017) Improving through inclusion. Available at: https://www.england.nhs.uk/wp-content/uploads/2017/08/inclusion-report-aug-2017.pdf.

The values-based case for going further

  1. NHS Improvement (2009) The Value of Values.
  2. NHS England (2023) 'NHS Values', The NHS Constitution. Available at: https://www.gov.uk/government/publications/the-nhs-constitution-for-england/. & NHS Scotland (no date) Principles and values. Available at: https://workforce.nhs.scot/about/principles-and-values/. NHS Wales (no date) Values and Standards of Behaviour Framework. Available at: https://nwssp.nhs.wales/a-wp/governance-e-manual/living-public-service-values/values-and-standards-of-behaviour-framework/. & Health & Social Care in Northern Ireland (no date) Health & Social Care Values. Available at: https://jobs.hscni.net/Information/23/health-social-care-values.
  3. NHS Commissioning Board (2012) Compassion in Practice. Available at: https://www.england.nhs.uk/wp-content/uploads/2012/12/compassion-in-practice.pdf.
  4. Nursing & Midwifery Council (2022) Combating Racial discrimination against ethnic minority nurses, midwives, and nursing associates. Available at: https://www.england.nhs.uk/wp-content/uploads/2022/11/B1897-combatting-racial-discrimination-against-minority-ethnic-nurses-midwives-and-nursing-associates-061222.pdf.
  5. Royal College of Nursing (2017) RCN Group Value Statement. Available at: https://www.rcn.org.uk/Professional-Development/PDFs/rcn-group-values-statement.
  6. HCA Healthcare UK (2018) Code of Conduct. Available at: https://www.hcahealthcare.co.uk/about-hca-uk/mission-statement. & Nuffield Health (no date) Our Values. Available at: https://www.nuffieldhealth.com/about-us/how-we-are-governed/our-values.
  7. NHS England (2023) The NHS Constitution. Available at: https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england.
  8. NHS Blood and Transplant (2017) Values Based Interview Questions (including Diversity). Available at: https://peoplefirst.nhsbt.nhs.uk/NHSBT-DOCUMENT-LIBRARY/Recruiting/Document-Values-Based-Interview-Questions.pdf.
  9. RCN Magazine (2023), Race discrimination: Imagine a world without it. Available at: https://www.rcn.org.uk/magazines/Action/2023/Oct/Michelle-Cox-Imagine-a-world-without-race-discrimination.

Unconscious bias

  1. Frith U (2015) Unconscious bias, The Royal Society. Available at: https://royalsociety.org/-/media/policy/Publications/2015/unconscious-bias-briefing-2015.pdf.
  2. Barragan A et al. (2019) The Irony of Choice in Recruitment, M@n@gment, 22(3), pp. 466-486. doi: 10.3917/mana.223.0466.

Microaggressions

  1. Merriam-Webster Dictionary (2024). Available at: https://www.merriam-webster.com/dictionary/microaggression.
  2. Sue D W et al (2019) Disarming Racial Microaggressions: Microintervention Strategies for Targets, White Allies, and Bystanders, American Psychologist, 74(1), pp. 128-142.
  3. Sue D W et al (2007) Racial Microaggressions in Everyday Life: Implications for Clinical Practice, American Psychologist, 62(4), pp. 271-86.
  4. Bravely (2021) Intent vs. Impact: Closing the gap, Bravely, January 23. Available at: https://workbravely.com/blog/diversity-equity-inclusion/closing-the-intent-impact-gap/.
  5. Imperial College Healthcare (2023a) Toolkit: Challenging microaggressions. Available at: https://www.imperial.nhs.uk/-/media/website/about-us/how-we-work/equality-and-diversity/microaggressions-toolkit_14_03.pdf.
  6. Baryeh K and Rasool L (2023) Where are you really from? Racial microaggressions and how to be an ally or active bystander, British Journal of Hospital Medicine, 84(8). doi: 10.12968/hmed.2023.0259.

Psychological safety

  1. Gallo, A (2023) What Is Psychological Safety? Harvard Business Review. Available at: https://hbr.org/2023/02/what-is-psychological-safety.

Allyship

  1. Imperial College Healthcare (2023b) Toolkit: Being an Ally. Available at: https://www.imperial.nhs.uk/-/media/website/about-us/how-we-work/equality-and-diversity/allyship-toolkit_14_03.pdf.
  2. Wallach M A, Kogan N, and Bem D J (1964) Diffusion of responsibility and level of risk taking in groups, The Journal of Abnormal and Social Psychology, 68(3), 263-274.

Have honest conversations

  1. Singleton G E (2014) Courageous Conversations About Race: A field guide for achieving equity in schools. Corwin. & Sue D W (2016) Race Talk and the Conspiracy of Silence: Understanding and facilitating difficult dialogues on race. Wiley.

Celebrate diversity

  1. PWC and The Diversity Project (2018) Diversity is the solution, not a problem to solve. Available at: https://www.pwc.co.uk/financial-services/assets/pdf/pwc-diversity-is-the-solution.pdf. & Bourke J (2016) Which Two Heads Are Better Than One? Australian Institute of Company Directors.

  1. Equality Act 2010, Section 4. Available at: https://www.legislation.gov.uk/ukpga/2010/15/contents. & The Race Relations (Northern Ireland) Order 1997. Available at: www.legislation.gov.uk/nisi/1997/869. & States of Guernsey (2022) Prevention of Discrimination (Guernsey) Ordinance 2022. Available at: www.guernseylegalresources.gg/ordinances/guernsey-bailiwick/d/discrimination/prevention-of-discrimination-guernsey-ordinance-2022/. & Jersey Government (2013) Discrimination (Jersey) Law 2013. Available at: www.jerseylaw.je/laws/current/Pages/15.260.aspx. & Isle of Man Government (2017) Equality Act 2017. Available at: www.gov.im/categories/working-in-the-isle-of-man/employment-rights/equality-act-2017/.
  2. Nursing & Midwifery Council (2018) The Code. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf.
  3. Advisory, Conciliation, and Arbitration Service (2022) Questions about discrimination at work: Asking your employer. Available at: https://www.acas.org.uk/asking-and-answering-questions-about-discrimination.
  4. Royal College of Nursing (no date) Grievance. Available at: https://www.rcn.org.uk/get-help/rcn-advice/grievance.
  5. NHS England (no date) Speaking up to NHS England. Available at: https://www.england.nhs.uk/ourwork/freedom-to-speak-up/how-to-speak-up-to-us-about-other-nhs-organisations/.

  1. NHS Race and Health Observatory (2021) survey. Available at: https://www.nhsrho.org/.
  2. Campbell-Stephens R M (2021) Educational Leadership and the Global Majority. Palgrave Macmillan. Available at: https://www.amazon.co.uk/Educational-Leadership-Global-Majority-Decolonising/dp/3030882810.
  3. GOV.UK (March 2023) International Women's Day 2023: Equity vs. Equality. Available at: https://lifeathmrc.blog.gov.uk/2023/03/08/international-womens-day-2023-equity-vs-equality/.
  4. NHS (2024) Workforce Race Equality Standard. Available at: https://www.england.nhs.uk/about/equality/equality-hub/workforce-equality-data-standards/equality-standard/.
  5. NHS (2022) Combatting racial discrimination against minority ethnic nurses, midwives and nursing associates resource. Available at: https://www.england.nhs.uk/long-read/combatting-racial-discrimination-against-minority-ethnic-nurses-midwives-and-nursing-associates/.
  6. United Nations (2023) Outreach Programme on the Transatlantic Slave Trade and Slavery. Available at: https://www.un.org/en/rememberslavery/observance/2023.
  7. GOV.UK (2021) Commission on Race and Ethnic Disparities: The Report. Available at: https://assets.publishing.service.gov.uk/media/6062ddb1d3bf7f5ce1060aa4/20210331_-_CRED_Report_-_FINAL_-_Web_Accessible.pdf.
  8. United Nations (2021) Press release: UN Experts Condemn UK Commission on Race and Ethnic Disparities Report. Available at: https://www.ohchr.org/en/press-releases/2021/04/un-experts-condemn-uk-commission-race-and-ethnic-disparities-report.
  9. Mind (2024) Racism and mental health. Available at: https://www.mind.org.uk/information-support/tips-for-everyday-living/racism-and-mental-health/.
  10. The Stephen Lawrence Inquiry: Report of an Inquiry by Sir William MacPherson of Cluny (1999) Available at: https://assets.publishing.service.gov.uk/media/5a7c2af540f0b645ba3c7202/4262.pdf.
  11. University of Leeds (2024) What is racial harassment and racial microaggressions? Available at: https://reportandsupport.leeds.ac.uk/support/what-is-racial-harassment-and-racial-microaggressions.
  12. Nursing & Midwifery Council (2018) The Code. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf.
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