Increasing diversity: why and how?

Hospices are not diverse organisations. The staff, leadership, trustees and, in many cases, the volunteers tend to belong to certain demographic groups that can be flippantly characterised as white, middle-aged and middle class. 

Whilst this may sound shocking, it is entirely in line with charity boards and leadership across the UK. Where many other charities differ from hospices though is that they often have a more diverse beneficiary group whereas, unfortunately, those who benefit most frequently from hospice services tend to have a higher socio-economic status and do not come from minoritised groups.

Most of this will not come as a surprise to many reading this. Hospice UK and individual hospices have highlighted it, and lots of us have been trying to increase diversity of service users, staff, volunteers and trustees for some time, but with little success. 

So, should we just accept that we have tried but no one has applied or been referred? Is it really worth the effort when we have enough patients to treat and if we can fill our roles?  

The phrase that is commonly trotted out when speaking about the reasons behind increasing diversity of the staff, volunteers and trustees is the need to be “representative of the population” served. People then look at their local population, see that there is little ethnic diversity, and feel that they are representative. This falls foul of a couple of traps:

1. Diversity does not equal ethnicity 

When people talk about diversity they often default to ethnicity and this is both incorrect and lazy. The Equality Act (2010) identifies 9 protected characteristics and all of these help to make up diverse organisations. We can add to that social economic and educational diversity. Seeing “people like me” at a senior level makes people feel more likely to be included and safer about getting involved and importantly raising issues. It aids recruitment, retention, experience and safety. 

2. Diversity has to be about ethnicity 

When you look at each of the protected characteristics, the people who will have the worst experience and outcomes within that characteristic are from ethnically minoritised communities. Also, unless you are talking about ‘race’ the default for all other protected characteristics is white (and usually male). For example, when people think of LGBTQIA+ they think white, gay man; when they think disabled they think white person in a wheelchair.

So, even if you don’t have a particularly ethnically diverse population, there is value in trying to have some representation at all levels.

Why try to bring diversity to hospices?

So, if the ‘representation’ argument isn’t valid, why should we be trying to bring diversity to hospices? 

The experiences, perspectives, and cultural nuances brought by staff and volunteers can contribute significantly to shaping services and policies that resonate with a wider range of individuals, ensuring that hospices remain relevant and responsive to the diverse needs of their communities. 

They also help to ensure that hospices don’t slip into ‘group think’, as well as increasing innovation and creativity. 

Fear 

I’d like you to imagine that you’re in a place where some people are openly hostile to you and to people like you; where you are frequently treated as less than and less able than; where huge assumptions are made about you based on the way you look, who you love, the way you talk or move or the money you have. 

How likely are you to apply for a position in that place or trust the people there to care for you? 

Connection 

“Time is the only thing you can’t buy” ~ Warren Buffett 

People have a limited amount of time and will give that to things or people that have meaning to them. Someone that has little or no prior knowledge of hospices will have an equal quantity of connection with them. This means they will have very little interest in giving up their valuable time to support them or in building the trust that they will meet their needs.

It’s not enough to tell people that you want a more diverse workforce or service users, to send out adverts, posters and letters and then expect people to come to you; in fact it is an arrogant approach.  

Building connection and trust with individuals and communities is key. This can be done by going to where people are and where they feel comfortable. 

Seeking to establish commonalities is a great place to start; we all feel more comfortable with people like us. It’s also important to recognise that the people we’re building relationships with have a lot to bring; we can learn from them and acknowledging that from the start is important as is sharing some ways you may be able to support them.  

Diverse communities are used to being approached by an official body, being asked for views or participation, and then being dropped once that body has fulfilled its purpose. So, overcoming the natural hesitancy and suspicion that comes from those experiences is key. The way to do that is to seek genuine relationships and not just to do it to tick a box on the diversity dashboard.

It’s important to prepare the existing trustees, staff and volunteers for diversity too. It is extremely unfair and irresponsible to bring people from diverse backgrounds into an environment that has not already ‘done the work’. To do so is to risk exposing them to discrimination, including micro-incivilities. 

It’s also wrong to assume that one person ‘representing’ a group in your workforce is enough or that it is their role to ‘do equality and diversity’. Everyone needs psychological safety to thrive and contribute fully and creating that is incumbent on the hospice leadership and teams, not on the incoming individuals.

A diverse workforce and users is not something that can be done as a one-off or an add-on. True commitment to increasing diversity requires investment of both time and money. 

Steph Edusei is Chief Executive of St. Oswald’s Hospice, a large children and adult’s hospice based in Newcastle Upon Tyne. She is also a Non-Executive Director of The Newcastle upon Tyne Hospitals NHS Foundation Trust and is a Director of the North East England Chamber of Commerce.

Steph is a strong supporter of her local community and has been a leader with Girlguiding UK for over 30 year. She is also a dance teacher and Chair of the Eliot Smith Dance company.

Steph has a drive to create a fairer world. She has a passion for involvement of public and service users and is a strong advocate for equity, diversity and inclusion. Steph speaks publicly on compassionate leadership, racism and gender discrimination, and is a coach and mentor. In 2022, Steph created the Black All Year events and podcast, which highlight the challenges and issues faced by Black people as well as celebrates their successes and achievements.

Steph was named Northern Power Women’s Transformational Leader in 2022.