Disability representation of Non-Executive Directors on NHS Boards - The Boardroom Baddie #4

This is the topic of my MBA dissertation, because I am still confused why the numbers are so low, for what must be the largest health and social care system in the World.

This is a short summary of why I think it is important, read on to find out more....

Background

In the UK, the Equality Act 2010 defines disability as:

“if you have a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on your ability to do normal daily activities”

The banner picture above shows an excerpt from the House of Commons Library website which shows 24% of the UK population report having a disability. That is 16million people. That is virtually a quarter of the population.

It's common knowledge that there are countless disabilities, including cancer, mental health, autism, rheumatoid arthritis, and many will affect people differently.

Many of us prefer to consider the social model of disability that defines the environment and system as the impairing feature, not the person's condition. This can be less stigmatising, more empowering and generally more productive way of thinking about disability.

And here are some of the reasons why...

People with disabilities are more likely to report:

• loneliness

• lower rates of happiness

• harmful treatment at work and more severity than their peers

• anxiety

• lower employment rates

And if those weren't enough, the 2021 Census showed only 32% of people with disabilities reported 'good health'.

This is clearly a massive national priority!

National initiatives

Thankfully there have been a few approaches taken to support people with disabilities.

After EQ10, the Public Sector Equality Duty was published a year later, the main point of it was "public..organisations..must..consider..how they are promoting equality"

I am unclear what initiatives took place between then and 2014, when the DWP launched the Disability Confident Scheme. That intended to encourage employers to look at disability differently and intended to improve disability employment rates.

I have not seen a review done on this scheme - have you? And some reports have suggested it has hidden 'ongoing disadvantage', such as the Disability News Service in 2023.

On 3 December 2018, International Day for People with Disability, the Holmes Review published a damning report about the low percentage of people with disabilities in public appointments; this will include Non-Executive Directors (NEDs) on NHS Boards.

The figure was 3%.

Scroll back up and read about a quarter of the population having a disability. Even in 2018, the figure was 21%.

Lord Holmes was sensible though and made a solid recommendation for a target of 11.3% for disability representation in public appointments.

As before, I've not seen an update on this Review.

Is there one?

Enter DNDN

Off the back of the Holmes Review, the Disabled NHS Directors Network was established - an independent entity to support and advocate for, you guessed it, senior leaders with disabilities in the NHS. Members include both NEDs (external Board members, who usually have classic senior professional background e.g. law and finance) and Executive Directors (internal senior officers, CEOs, Directors of Quality, Directors of HR etc). They have 49 members, 39 are NEDs.

DNDN have done some fantastic work, such as developing a toolkit to improve recruitment and retention of disabled staff in NHS organisations, published in 2024.

Find out more about DND visit their website: https://disablednhsdirectorsnetwork.nhs.uk/. And download the Toolkit here: https://disablednhsdirectorsnetwork.nhs.uk/launch-of-the-dndn-toolkit/

Recent NHS data

So the inspiration for my dissertation, was borne from my interest - and passion - for governance (I've a decade of pro bono experience). I was Googling about NHS Boards and came across the Workforce Disability Equality Standard (WDES) data that launched in 2019.

What I found was quite shocking, and inspired me to decide that improving the situation was going to be my focus.

The number of NHS NEDs with a disability was 5% in 2022 and 6% in 2023!

In June this year, NHS England published the WDES data for 2024.

It is now 6.8%!

These are figures for the 143 Foundation Trusts and 62 NHS Trusts and data is released a year later.

What do you think about this?

Recent charity data

Data also published this year shows that 17% of charity Trustees have a disability. This is much closer to the national figure.

Colleagues within that sector have surmised it could be due to the age proportion of charity Trustees, although I suspect this is not completely dissimilar to NEDs in the NHS, and the average age of NEDs in listed companies is over 60. And we know that 83% of disabilities are acquired, rather than present at birth, although I've not seen data for the ages when they occur.

Current research

There is not a single piece of academic literature looking at disability representation on NHS Boards.

In fact, there is relatively little academic literature about people with disabilities, even in the workplace! Most of the literature on diversity for both Boards and work relates to gender and ethnicity - clearly important topics.

But we are talking about 1/4 of the population.

And how can the NHS guarantee inclusivity and accessibility for so many of their patients.

And their staff too, right?

I thought this was fascinating in January and decided this was going to be my dissertation topic.....

My dissertation

I have just started this process.

As part of my preparation for the first 6 months of this year I had conversations with experienced and supportive colleagues who are interested in my research which has helped me to realise the significance, establish options for my methods and consider

I had conversations with colleagues with the following roles:

• CEO of an Integrated Care Board (ICB)

• creator of the WDES data set

• EDI lead in an NHS organisation

• disabled NEDs and Directors

• NED recruiter in the NHS

• members of DNDN

• PhD student

• Director of Strategy at an NHS organisation

• governance experts

• public health lecturer and researcher

• CEO of a NED platform

I've also attended a numerous NED workshops and events, both for this dissertation and to progress my own NED journey.

Yes, again in true KP style, I have been busy! (And sincere thanks to all of those wonderful people for their time!)

My current research question is: "How can the NHS increase representation of people with disabilities on its Boards".

This is subject to change and my methodology is not quite finalised, so you might have to wait a little longer to hear more about this.

I'm also conscious that across the health landscape, many of my colleague are exhausted by the unexpected announcements, policy updates and changes. And although I want to ensure that my research is meaningful for the wider population patients, staff and prospective and existing disabled NEDs, I do not want to be causing any burden.

Personal interest

I have a massive interest in this topic, because for 13 years I was supported by Great Ormond Street, due to an autoimmune condition now called 'selective immunoglobulin A deficiency' (SIGAD), an antibody deficiency which often causes allergies, gastrointestinal and ear nose and throat issues and can lead to autoimmune conditions in adulthood. Clearly this could be a causative factor in my Type 1 Diabetes, which I didn't realise was a disability until I was discriminated against myself!

Allergies to cow's milk, eggs and beef in the 1980s before the 'free from' aisle was no joke, cue a packed lunch at birthday parties and not eating chocolate til I was 11. Also, every single winter without fail there was me with a serious ear ache and earmuffs on and in adulthood I've had my fair share of GI drama.

I spent 17 years in public health in local government working closely with colleagues in NHS England, PCTs, CCGs and ICBs. Alongside this, I've also got a decade of pro bono Board experience in the charity, housing and education sectors, am currently a Committee member for the development of a BSI standard and have been a Board Advisor for a global mental health organisation.

This background gives me ample awareness of why it's important to have a diverse Board, especially within the NHS and why its so important that the population is represented at Board level

Final words

So, I'm just going to end this by saying, this topic is super fascinating, the underrepresentation of people with disabilites on NHS Boards has significant implications for decision-making and without this important viewpoint, service delivery is overlooking a substantial part of the population.

I'm excited to find out more and make a valuable contribution to the evidence base.

Please share your thoughts below, and follow me if you want to hear more!

#DisabilityRepresentation #NHSGovernance #Boards #Research #NonExecutiveDirector

References are in the comments below