More needs to be done to build diverse NHS boards across Wales and Northern Ireland

Several NHS boards in Wales and Northern Ireland are composed entirely of white members, according to a new report authored by an Exeter academic expert.

Action for Equality in Wales and Northern Ireland: The Time is Now has been jointly launched by the NHS Confederation’s Health and Care Women Leaders Network, the Welsh NHS Confederation and Northern Ireland Confederation for Health and Social Care (NICON).

It builds on previous NHS Confederation reports published in 2017 and 2020, which examined the steps the health service in England needed to take to reach the target of equal gender representation on boards by 2020. 

Based on data from 2022, the research finds that NHS boards in Wales are gender balanced both individually and overall, with a nationally proportional representation of people from racially minoritised backgrounds when viewed as an aggregate total.

However, two of the 12 boards in Wales were found to be entirely composed of white members, and while boards across Northern Ireland were gender balanced overall, six of the eight individual boards were not – and seven of the eight boards were entirely white. 

The report, authored by Professor Ruth Sealy from the University of Exeter Business School, sets out to establish benchmark data for boardroom diversity across the health and care services in Wales and Northern Ireland, focusing on gender parity and assumed ethnicity.

As part of the research, all 20 board chairs in Wales and Northern Ireland were interviewed to ascertain their approaches to boardroom diversity and inclusion.

They agreed on the importance of diverse boards that are representative of staff and the communities they serve, to ensure “all voices are heard”.

The report found there is more to be done to ensure the benefits of diverse boards are fully realised, and called on healthcare leaders and governments in Wales and Northern Ireland to embed a strategic approach to diversity and inclusion within boards, governance and the appointments process.

This approach needs to be both inclusive and measurable, with a clear commitment from leaders at the top.

The report makes a number of key recommendations to drive continuous improvement, which include:

• Ensuring that data on the diversity of board composition of healthcare boards in Wales and Northern Ireland is made publicly available, in an accessible format.

• A commitment from leaders to embed a more strategic approach to diversity and inclusion at board level, recognising the tangible benefits this brings and ensuring, alongside gender and ethnicity, that this considers all protected characteristics including age, religious belief, disability and sexual orientation.

• Developing effective guidance and training on good governance processes and how a unitary board functions.

Professor Ruth Sealy of University of Exeter Business School and author of the report said: “The findings show that while the gender balance achieved is a positive starting point, the situation is more complex.

“Chairs of the most diverse boards clearly articulated some of the benefits they are experiencing – from better decision-making, scrutiny and challenge; to developing talent and improving patient outcomes.

“The next step now is for leaders to develop a clear roadmap of action to ensure diversity and inclusion is fully embedded.

“Among its recommendations, the report stresses how vital it is for boards in Wales and Northern Ireland to develop effective guidance and training on good governance processes and how a unitary board functions.

“This would include greater clarity around roles, responsibilities, relationships and accountability – to support the embedding of diversity and inclusion.”

Samantha Allen, chair of the Health and Care Women Leaders Network said: “We know that boards that fully reflect the staff and communities they service leads to stronger decision-making and better patient outcomes.

“While the gender balance on boards in Wales and Northern Ireland is encouraging, there is still much more to do. It is vital all leaders commit to shaping inclusive, diverse, and compassionate leadership across all Boards and to share practice and learning in order to make further progress.

“This starts with accessible, transparent and publicly available data on the diversity of Boards across the whole NHS.”