What Lived Experience Tells Us About the Ethnicity Pay and Progression Gap

Dr Guddi Singh sits down with Professor Doyin Atewologun, chief executive and founder of Delta, and Dr Nabeela Kajee, a medical doctor and consultant at the organisation, to explore their work on the ethnicity pay and progression gap in the NHS. 

Grounded in lived experience, the conversation gives voice to the realities faced by ethnic minority staff. Together they examine how structural barriers, organisational culture, and everyday workforce decisions shape pay outcomes and career progression over time.  

The episode explores what the gap feels like, how it impacts confidence and opportunity, and the disconnect that can exist between leadership listening and leadership acting, asking what it truly means to value lived experience in efforts to drive change. 

Transcript

SPEAKER_03 0:00

Hello and welcome to Race and Health Matters, a podcast produced by the NHS Race and Health Observatory. I'm your host, Dr. Goody Singh. In this episode, we discuss lived experience and give voice to the realities faced by ethnic minority staff. We talk about structural barriers and organizational culture and how they shape pay outcomes and career progression and how this actually feels for ethnic minority staff. Well, look, welcome ladies to Race and Health Matters. Now, in this episode, we are starting with lived experience and with what the ethnicity pay and progression gap feels like from the inside and what that live reality can tell us about, tell us that actually the headline data is not able to tell us. Now, I'm so grateful to you both for joining us for this conversation. So I'm joined by Professor Doyen Adologan, who is a psychologist, a scholar practitioner and a founder of C and CEO of Delta, and Dr. Nabila Kaji, who is a medical doctor, health equity researcher, and a consultant at Delta. So welcome.

SPEAKER_00 1:02

Thank you.

SPEAKER_03 1:03

Thank you.

SPEAKER_00 1:04

Great to be here.

SPEAKER_03 1:05

And I want us to really kick off with this, I guess, the central question in this episode for me, which is that what does lived experience really reveal about the causes of the ethnicity pay and progression gap that data alone cannot answer and cannot show? So it's a very general question. I'm just going to throw it out there and then let's see where we go.

SPEAKER_00 1:26

It's important for us to think about what lived experience is as a data source. And it may be worth listeners kind of just thinking through the ways in which what like when people hear about lived experience, like how they compare that to other data points.

SPEAKER_03 1:42

Yeah, maybe you can actually speak to why lived experience is actually important if we want to understand this properly.

SPEAKER_00 1:47

Absolutely. So often, and I anticipate that many people listening to the podcast will kind of have a rough idea that when we think about research, there's broadly two buckets or categories. There's like quantitative, stats, patterns, like numerical, and then there is more narrative, more qualitative, more lived experience perspective. And when we think about the ways in which you understand complex, multifaceted phenomena like how people show up as themselves when we think about issues of identity, but are faced with um more in more kind of explicit or implicit barriers to their experience to showing up authentically at work. Because the answers to that question are quite complex and multifaceted. It is very important for us to understand the views, perspectives, ideas, experiences of individuals on the receiving end of these phenomena. Yes. And that is the key value of lived experience and research in the in the broader sense of just trying to understand the complexity of lives.

SPEAKER_03 3:11

And I think it's important to establish that because so often in science in general, quantitative is privileged over qualitative as a baseline. And then even within that, lived experience can sometimes feel like it's a throwaway thing that's kind of almost nodded to in healthcare settings, but not really respected in the in the same way. So, Doyen, just staying with you for a second, what do organizations miss if they privilege metrics over experience?

SPEAKER_00 3:39

I've I've hinted at that. I think there is a nuance and complex and multifaceted like understanding of the human experience in the workplace or you know, in society more broadly. And sometimes, particularly as humans, so as you know, you said, I'm I'm I'm a psychologist, and we understand the bias of simplifying, um, you know, a desire to just really understand, focus on like one key headline or story or perspective. And I think the value of lived experience, the importance of lived experience and the added value it brings, is it brings alive in a very compelling way the complexities and the nuances of an individual's story. And that might involve things like how, for example, just as an example, how uh for me, maybe my experience as a Nigerian British uh woman working in a professional, kind of global professional context influences what it means for me to be seen as a leader. Right? So immediately there are a number of intersecting factors, there are a number of explicit and implicit assumptions of what leadership and opportunity might look and feel like, and that complexity will not be captured solely by a, you know what, actually we've got one more one more X in a leadership role?

SPEAKER_03 5:17

Yes, yes, yes, yeah. The stat doesn't tell you the real depth of what's going on there. And Nabila, from your perspective, as a clinician and a researcher, what kinds of truths about the workplace become visible for you only when you attend seriously to that well to what people are saying who are actually experiencing it?

SPEAKER_01 5:36

Thank you. Such a powerful question. I think we need to know what the numbers show. That's important, but equally we need to understand the how, the when, and the why. And that comes from talking to people. Surprise, surprise. Exactly. It's not always easy, you know, to ask people and to listen. But there's a lot to be learned from talking to people that are on the ground in healthcare in the UK and in the NHS, and I think that's the advantage of this piece of work.

SPEAKER_03 6:11

I mean, I get it, I I mentioned it before. I kind of get the sense that lived experience is a bit of a trendy word. And it's used a lot right now. I mean, there's lots of trendy words right now intersectionality, health inequalities, co-production, and lived experience is another one of those words that institutions particularly like to pretend they've got the badge on, we're doing it, guys, but they're not really doing it, right? And um let me put it this way they're not doing it to the extent that it's actually challenging the notion the institution has has of itself. Right? So they're not actually inviting the truth, right? The depth of what could be said by those lived experience voices. And so I wondered whether you might be able to speak to a little bit about like what lived experience looks like when it's done badly, and what does it look like when it's done well, like when we actually engage with lived experience in a way that's how it's meant to be done.

SPEAKER_01 6:59

When you ask about lived experience, what we're really asking is whose lived experience and whose lived experience matters. And so really the instrument of gathering this research is the researcher, and as Doyen spoke to quite well, the researchers themselves bring a certain what we call worldview. And myself as a medical doctor, as someone who is South African, living and working within the UK, similar to Doyen's story, you know, we bring certain perspectives around internationalization, around healthcare in the global context, recruitment, um, thinking about how gender intersects with ethnicity, how other aspects of nationality, culture, language, etc., across also the protected characteristics, and there are many, intersect with how we look at research. And so, really, intersectionality, having an appreciation for intersectionality in the deeper sense, is so important in asking that question and really thinking about what we call lived experience, because if we can't appreciate the ways in which the different parts of that individual intersect, then we are only capturing a unidimensional picture. And I know Dorian intersectionality is your thing. It is a thing.

SPEAKER_00 8:38

Yeah. So I think the question around what is good and bad lived experience is a very pertinent one. Um and permit me to maybe just kind of backtrack a little to just say a little bit about the history of the of lived experience. Please do, yes, please, right? So lived experience research is like one of the ways in which we many, many researchers in so in the social sciences, like it's one of the key methodologies, right? And this is because like back in the day, in the early days when people were studying like culture, anthropologists, for example, it would be typically be, you know, right. You know, had no understanding that they existed. And needed to be described and described, like, would sit outside with their pen and paper and skinning in hand, measure and sticky in hand, and make, you know, informant notes about the the other, right? Right. And so that it was so important when we think about the history of, you know, kind of social science research, for us to turn the gaze, or maybe not necessarily turn the gaze yet, but draw attention to the fact that the position of the individual who is putting themselves as the, you know, the expert gazing and being the they're holding a position of expertise with regards to telling that other story, that that needed to be disrupted and dismantled. So it's about turning the gaze again, like going back to what you said, Nabila, like whose lived experience, whose perspective is valued. But what I really love, just building on what Nabila said, was because that kind of like going back to the history, you know, again, anthropology or cultural studies, the assumption that this detached position gives you, you know, a new position of neutrality such that you can fully capture this other thing that you're observing, has moved, has been challenged and moved us to a position where we acknowledge that both the observer, quote unquote, the researcher, and the quote-unquote research, the subject, have a perspective in terms of how they're gathering data and telling this story, this truth or this version of truth. And so good lived experience research acknowledges that you know mutual subjective, that idea that I am I am asking you questions from my perspective and my vantage point, and you're sharing and I'm valuing your perspectives from your vantage point. Yes. I also wanted to add just one one more thing, which is I think it is important for um listeners to understand that there are there are frameworks, there are methodologies, there's systematic ways of conducting this research. It's not just, well, you know what, just get a bunch of people and just listen. Listening, of course, is the beginning, but we try to be very transparent with regards to the types of questions that we ask, the ways in which those questions are come from a body of um maybe like uh I would say a body of literature that helps us decide what are some of the I don't want to use the word hypothesis, but I'll use it because a lot of people will understand it, but you know, what are some of the things that we want to test and explore? And then we are quite systematic in terms of how we analyze the data, sometimes using an intersectional framework. And so there is a science to that as well, and I think that's another really key point when we think about the difference between good lived experience work and not so good lived experience work.

SPEAKER_03 12:48

It makes me think so much of um the biomedical gaze itself, right? Which is all about neutrality and detachment and um almost are like an erasure of one's own positionality, right? As if as if we don't come as human beings with bodies, histories, and an interior psyche and all that, right? Um and so there are so many parallels, and I think maybe that's why in health settings it becomes double, double the problem, right? It's not just like the research framework, there's also that the way that we are trained as professionals, even to view ourselves in that setting, which means that you know it's changing, but how many doctors were trained to really listen to that lived experience? So there's not just the history for data's sake, but the history for like oh humanity's sake. And thank you. It's on that issue of humanity, actually, that I want to move us on, right? Because we're talking about some terms that which might sound quite abstract actually when heard um without understanding what this is. We talked about lived experience, but we're what we're really talking about actually is the ethnicity pay gap. So what does the ethnicity, pay, and progression gap feel like uh in ordinary professional life?

SPEAKER_01 13:57

What does it feel like? I really love that question because I I think to your point about thinking about pay and progression, this research team itself constitutes people who are not just researchers but practitioners who've themselves been in the wards with patients. Many of us, many of us have researched patients directly and healthcare providers or been at the forefront, not necessarily perched up in the ivory tower. And to that point of, you know, sort of thinking about how it feels. I think for people who researchers, healthcare practitioners, I speak from my vantage point as someone who has worked within healthcare systems, has felt what that means to be staring at progression and looking across the room and wondering what is it that I'm seeing, and is it the same situation for everybody, or is this just my vantage point? And I think that's what I feel when I think about pay and progression is what is the playing field? Is it level? Well, we are looking into that, aren't we? Just right? I think we all know that it's not. The question is, how is it not? And why is it not? And how might it be different? Sure.

SPEAKER_03 15:22

Ask actually from an organizational psychology side, what the impact is of this, of this repeatedly looking across and seeing that the playing field is not in fact level. So in that under-recognized, under appreciated, under-sponsored, being read as less ready. We're all brand women in this room, we understand what that means. Yes. Like what is the impact of that, of that happening repeatedly for organizations and for us psychologically psychologically?

SPEAKER_00 15:48

Those are powerful words that you use, you know, unrecognized, unappreciated, unseen, right? So, you know, when we speak to individuals, it's not unusual, for example, for people to tell stories of, well, actually, I started my career or I started this job with the same person, with this other person, you know, we started at the same level or the same role. And but over the last few years, I've seen how this person is given opportunities, is granted, you know, like other people talk about them and they're giving stretch tasks or you know, highly, more highly visible work. And I'm asking myself questions about what else I need to do, why I'm not um being like invited to those rooms. So there's often a sense of like just seeing like people when when we speak to them often play back that, you know, over time, just that sense of being left behind, which yeah, for for for a number of individuals, um it's one of those things where you know like I just said, it's you see it in time like over time, and you you they haven't been able to like put a name to it to put a finger on it, like in that moment, it's a cumul accumulation of many, many really small um or maybe not small, but you know, at that time potentially deemed innocuous or harmless or little microaggressions. Right, the everyday microaggressions. Absolutely. So, you know, on one hand, you're going back to your question in terms of what does that mean from a psychological perspective, there is often a sense of um, you know, I would use that word again, that sense of invisibility, unseen, like sometimes a sense of sometimes a sense of uh never being enough. Having said that, one of the things we find over and over again, not just with the um within the NHS, but with other contexts, is that the the reverse is being seen because you are in a small focus group with other people whose experiences are similar to yours. At that moment, there is often a sense of, oh my gosh, at least this I'm not creating, I'm not, this isn't it. I'm just imagining this. Yes, yes, yes. There's actually other people, so I am now validated, right? I am like the the things I couldn't put my finger on, the things I couldn't, you know, I thought, oh right now, and potentially if my organization or employer is taking this seriously, we are sharing these stories so that this so that work and effort and resources will be committed to shifting this and so it doesn't happen to the people coming after me.

SPEAKER_01 18:52

Yes, many people listening and watching, they will say, Well, oh we know, we know deeply. But this is the piece is moving from anecdote to evidence, and that I think is the power of work like this is to give anecdotes the opportunity to be measured and to us to see, well, how does this stand up to like how does the research hold up? Who, where, why, right? People are not all equal, situations are not all equal. Um, to have that sense of pragmatism that we aren't just doing this to measure it for the sake of measuring it. So importantly, absolutely.

SPEAKER_00 19:32

One example comes to mind with one organization that we worked with to just bring some of this alive a little. So we were working with a uh it's in the in the private sector, a large organization, and they had these headlines, i.e., for example, their minority ethnic staff were leaving at a larger at a higher rate, weren't progressing at the same rate. And they did, you know, so they had the headlines, but they wanted to understand what was going on, what the story was. And what we did was we worked with a number of individuals within their organization using um qualitative research with uh not just the minority ethnic colleagues but their counterparts. So the early career white colleagues, for example, as well as the minority ethnic colleagues, the senior minority ethnic colleagues and the senior white colleagues, but we asked them the same question. So we have this method where we we have a kind of a comparative process, and so we asked questions around like culture, what does it take to succeed around here? And one of the things that we found uh that which was really quite powerful was everyone described the culture in a very similar way. This is a high performing, high um, you know, we're it's a really ambitious um organization. We all need to kind of really work hard, we're proud to work here. But white colleagues, in addition to talking about that, talked about how priva talked about how much support they had in the everyday with the senior leaders to kind of reach out and say, you know what, don't worry, um, it's a late night, but hey, I'm gonna order some pizza for you, I'm gonna check in on you with regards to this kind of pizza project that you're working in. And minority ethnic colleagues did not have stories of support. So in that way, we were able to see with that example that actually there are two different sets of experiences in here beneath that headline to explain how well, you know what, you get a bunch of talented people in here, regardless of their backgrounds. But what's happening is for some people, they're getting all of the support they need, the social support, the encouragement, the nervous. And for others, they're not. And I think that was a really for for that organization, a really powerful way of just of X of showing how really understanding the vantage point of the lived experience.

SPEAKER_03 22:14

And I think you know that's a beautiful example of the value of lived experience, right? Which is not just identifying a problem, but then being able to get to the granularity of actually potentially even a solution there, right? Because you've identified what the mechanism is, at least in some regard, for one of the groups, right? To what's protective and what's really exposing the other group, right? And and uh, you know, just to pick up on so many things that both of you have just said so wonderfully, first of all, it's just an accumulation over time, right, of these small daily microaggressions or just being, as we said, being under an unseen, right? Which on its own, that thing of not feeling like you belong. Yeah, absolutely. I mean, that on its own. Yeah. None of us really grows up from being that kid at school who just wants to belong, ultimately. I'm a pediatrician, of course. I look at it from that way. But that's that's ultimately what we're talking about. And institutions may step in, may step in if we are able to show the pay disparity, if we're able to show that there's stalled progression, potentially, because at least that's like something tangible. But they don't pick up on the fact that there's no belonging in a team, right? Or that some people are being sidelined or there's some exclusion, right? And of course we want to prevent, we don't want to have to just act at the end of a long line of misery. Um, and I said, I just wondered, you know, how can we use lived experience to to help raise that issue earlier as opposed to waiting?

SPEAKER_01 23:37

I think it's so important to remember that behind all of these numbers are just real people that go home to their families every day. And these are the people that are driving our healthcare systems. You know, I said to people in the room when we were starting this project that let's not forget these are the same healthcare workers that brought us through COVID-19. Yes. These are the same healthcare workers that put their own lives on the line every single day and continue to do so.

SPEAKER_03 24:04

The same healthcare workers who are also not given PPE at the height of the pandemic. Absolutely.

SPEAKER_01 24:09

And so there's so many reasons, there's so many reasons to be supporting this workforce, to be protecting this workforce, to be ensuring that there's a fair chance to move forward in one's career, no matter what your occupation is within the NHS, to know that you have a place and that you have a sense of belonging and that you are here for the healthcare of the nation, and the nation is here for you. And that is hopefully what this work will show is that there's a chance for real change.

SPEAKER_03 24:44

I'm interested in how this um the ethnicity pay gap and progression gap is material, of course, right? We're talking about money, we're talking about your ability to progress in your in your career. But of course, we've all just already just talked about the emotional toll, right? The thing that you come home with every every evening. So it seems like you're suffering in in two ways, right? Not only do you not feel like you belong, but actually let's let's just face it, you're taking home less money to your per your family as you as you get there. But I imagine that a lot of our colleagues will not see it as their responsibility, because they see it as a structural issue. And it's very easy when you say it's a structural problem, or it's a system to wash your hands of it. Even if you're you know a well-intentioned manager or human resources person, whatever, whatever role you're taking. Um how do we bridge that gap from the individual responsibility and structural responsibility? Because of course, you know, we really have different kinds of agency in this system. Absolutely. And I'm curious as to what how you see that.

SPEAKER_00 25:43

Yeah, well, we we do a lot of work generally in terms of kind of developing leaders' capability to see their people and get and get the best out of their people. So, for example, we work with psychometrics to really help individuals in positions of power think through what are the ways, what are the specific behaviors that I'm engaging in that are contributing positively or not to the well-being and the um performance of the people around me. So when we think about there's like you said, there's the there's the sometimes if we think at systems at a level of, you know, this is all one kind of big system I'm trapped in and I don't have much agency at one extreme and the other extreme, it's like actually that, it's you know, that person's every day, but these are like really tiny things and I can't catch catch them. I think people in positions of power, so for example, just like just to use general words like leaders or line managers, but of course those labels vary depending on the institution. I think there is a lot of evidence that actually says, here is the set of behaviors that you can engage in yourself, whether at a level of actually what is my own um, how what is what is my own um like intrapersonal, what are some of the things I do individually in terms of do I have courage, do I show humility, do I ask questions, what do I think, what what are the things I do with other people in terms of like letting them know that I am kind of listening and responding to their needs? What am I doing with regards to the level of the team? I.e., am I, do I have transparent processes where people understand how um uh what the what needs to be done and people get a fair chance at those things? And do I stand for justice in terms of like championing fairness, championing inclusion? So we I think it's I I I feel very strongly that um there are many ways, for example, using tools like the tools that we use for individuals to actually say, This is the thing that I can do as someone in a position of power to disrupt these findings that we have. And it really is just a matter of just doing. Like I love what you said, like moving from anecdote to evidence and then impact. Like there's work, there is there, there's specific sets of behaviors that people can do.

SPEAKER_03 28:32

I wondered whether you had any thoughts on that, because that's beautifully described that we need to think about the different levels at which one can act. And you focus there on leaders, because of course, at some level, they should have more responsibility, right? But it is, you know, when you were talking, it struck me that we have this really strange way that responsibility falls out, right? Which is that on the one hand we have those who are being who are the victims, who have the responsibility almost to raise the flag and to fight fight the fight and to make the case and all the rest of it, and topple topple the system. And on the other hand, you have the the system itself through the way that it suddenly becomes diffuse and abstract, washing its hands of it entirely. You know, it's always almost absolved of the problem because it's almost like it's oh well it's society, oh it's you know just the way that it works, or even to the fact, well, well, we don't see this, we don't see this as a problem, right? But but again, like how can we connect that individual agency to the structural um problem while fairly divvying out a responsibility, right?

SPEAKER_01 29:34

You know, I think a lot of people who are listening will be thinking about exactly that, which is how do we move into an action-based approach, a solution-based approach, and we don't get stuck in the problem itself, get tangled in the problem itself, right? And I think with the backgrounds that we have that intersect with research, clinical work, pragmatism, um, you know, even the consulting experience, being able to see the bigger problem solution network. You realize that, you know, we categorize some of these issues within what we call the wicked problems, some really difficult problems to solve, right? But that does not mean that they're not tacklable, if you can't solve them. And I think that's the piece that hopefully we can start to, you know, really get to with this work is going into the specifics of what works, what does not work, why. And if we can understand the problem from an action-based perspective, recommending actions is easier. So I think it's it's a lot about how we're asking the questions, and are those questions being asked in a way that help us to find the solutions themselves. Because those solutions won't come from us as researchers. We will find those solutions from those that work amongst those problems.

SPEAKER_03 31:03

I 100% believe you. And I believe that for all sorts of problems, whether it's race or not, actually, we need to ask people on the front line who are like literally at that friction point for what the solution should be. Again, not just professionals, our service users, patients, whoever, they might know the answer. But how do we find that out in institutions that are otherwise not listening, not looking, or overlooking, or you know, like doing the show of listening and yet not really then acting? I mean, you you you're clearly an action-oriented person, right? You're talking about wanting to shift from that research to implementation, right? Yeah. But there's something here about um what does it take to do that, right? To really just I think people like to commission research and they like to have reports on their table. Very rarely do we see that then translating into something tangibly different on the ground. And actually, it comes to lived experience again. And I'm curious about this because I do a lot of co-production work, but what does it feel like for people to have been invited into a process to share their experience and then for them to see that little has changed as a result?

SPEAKER_01 32:13

That's important because if we want to see translation, which is what you're saying, how do we go from point A to point B? How does the research get us there? We have to be able to use the tools available to find out what is necessary for us to solve the problem, not just to find out everything. Because I think this is the problem sometimes when we do research, is at the expense of finding the solution, we try and ask too many questions. Those questions are not targeted and not specific to the problem we are trying to solve. And I think in doing so, if we are able to move beyond and ask relevant, pertinent, pragmatic questions of those that are involved in this, the NHS workers, the health workforce, we won't be wasting time, wasting resources, eroding trust. We want to do the opposite. This is what this work is built on the foundation of trust. That our team has got health professions, workers, we have researchers, we have you know people who are on that front line who understand that. And I think that's the difference as well, is that the focus on this research is not simply to do a glossy report exercise. Although, yes, we love a glossy report. Um, it is to help inform policies. But the thing is, and I think you you appreciate that, we appreciate this, that change is collaborative. We will need to have the buy-in, the hand holding of politicians, of people on the ground to make the findings relevant.

SPEAKER_03 34:03

Yes, right? Yes, absolutely.

SPEAKER_01 34:05

Whatever those findings might be.

SPEAKER_03 34:07

And Doyen, why do you, or maybe you could speak to this question, which is like, why is there so often this disconnect between the leadership who are apparently listening and the leadership who are actually, as Nabili would have us acting? Like why is there that disconnect?

SPEAKER_00 34:21

Why is there that disadvantage or a gap?

SPEAKER_03 34:23

And what are your thoughts on that? I know that you may not have the answer.

SPEAKER_00 34:27

Well, so I was thinking as, you know, as I was in in the last few minutes, so we've been having this conversation, um, with one one organization that we were working with, we kind of did the work, and um, and then I went back to them because I was like, okay, so you know, what's happened with the recommendations? Because we'd said to the people who'd told their stories, you know, that you know they were going to um uh work, act on the recommendations. And then the leaders were like, well, you know, actually it was it was so rich, there was a lot in there, there are many recommendations, we don't know what to do, we're still thinking. And then I said, Well, fair enough, but tell the people. Yes, right? So I think that's the first thing in terms of actually going back out to say, we have we've thank you so much for the time you've taken. Um, that work has been um your your stories have been analyzed to distilled, um, you know, kind of have informed some practical recommendations. And what we're now going to do is we're going to take some time to reflect on or to prioritize which recommendations we're going to act on. That is has more value than going into than people thinking that this work has, you know, I've committed, I've taken my time to tell my story and nothing is happening. However, what is the difference? And then so that's one thing. I think what when you say what is the difference between uh leaders who act and leaders who don't, leaders who do act are ones who are very intentional about sharing where they are in their in where they are in their journey to acting, rather than what's that expression, you know, like not quite hiding away, but kind of drawing away from the from the commitments that they made several months before then to do the work. One of the other things that we found again, I think the three of us, this would resonate with us, that idea of like co-production, like essentially having a convert, providing fora that essentially are like, okay, these are some of the things that we're thinking about. Which of these, you know, we're gonna, we might start with this because this is a quick win. We might start with that because, you know, we've got resources. So let's have a let's work together with regards to which of these recommendations we're going to prioritize. And lastly, we don't do enough of this, organizations don't do this enough of this. Evaluate the impact of the various recommendations. Yes. Nabila, we're saying what's working, what's not working, and why. The only way we will get those answers is for us to have a reflective approach, like an approach to implementing action, where we're like, what did we learn from having implemented those actions? Yeah. And how would that improve? And what do we then when we get the answer to those questions? How do we then reject it? How do we then well, how do we then adjust the thing that we said we were doing? So it's there's an ongoing like loop there, an ongoing process. And that's what I've seen is the difference between leaders, it's an ongoing process between leaders who are like, okay, I'm going to do something with this, and leaders who don't.

SPEAKER_03 37:43

The reason I ask that question is because I feel um that so often the language of justice is being absorbed by institutions in a way that sounds good on paper, but really is just preserving their elite comfort, right? And I say that knowing that there are many good people who are trying to change this, and I'm not saying that everyone is against social justice, but it is very easy now, I think, to use the right words and not actually translate that into genuine change. And I but what I keep hearing from both of you is that actually what's one of the key things that's missing here is actually a two-way conversation. So lived experience is one thing, yes, but maybe the people who just gave you their experience want to hear back from you. And that's what I think you're saying is that actually leaders need to not be so leadery and they need to actually have be part of that co-production. It's not just about co-production from the ground up, actually. Come down, it's grassroots, yes, and and be part of that, like getting messy and figuring it out. What are our priorities as a community, possibly, as opposed to like as the NHS Trust. And that conversation, I think, doesn't happen anywhere near as frequently. Absolutely. Um, absolutely. And then, you know, how could we facilitate that?

unknown 38:59

Yeah.

SPEAKER_00 39:00

Can I build on that? So there's uh one project that comes to mind that Nabila is very familiar with, where one of the things that's differentiating the leaders who, you know, like you're saying, getting their hands hands dirty from other clients, is a real sense of like personal commitment to this work and the change, the transformation we're working towards. A real sense of actually, I am part of this institution, or I'm part of this profession, or I'm part of this community, and therefore I have a role to play, and I have access to power, resources, you know, all of those other things. And I think to the extent to which people in power or people who maybe belong to historically dominant, overrepresented groups see that at, you know what, this is I have skin in this game too. This is important for me and what we stand, what I stand for as part of you know, yeah, what we're working towards to the degree that that happens, the change will come.

SPEAKER_03 40:14

We've been talking around the ethnicity and progression gap, and I just wondered whether, again, you could just give us a little bit of context. Like, what how big is this gap? Like, what are we talking about here? We're talking about like a crack in the pavement, or are we talking about the Grand Canyon? Like, what's what's happening?

SPEAKER_00 40:33

So I love that question because that is like the headline question. I mean, people don't want to know about that. Yes. So what we will be doing is we will be, and that this is like again, the value of like stats and headline data versus like, you know, qualitative and lived experience. So the piece of work that we're doing is to explore the ways in which people's the how people make sense of the gap rather than what the gap is. And so the quantitative team is going to like provide all of the different kind of data points and the report with regards to the different uh patterns when we think about different occupational groups or the different ways in which a range of different factors, such as um where in the country you work, how long you've worked for, how that statistically explains or accounts for some of the gaps. Now, when we talk about like how people make sense of the gap, like just to go back to you know how big that gap is. So what I'm struck by is the stories to go, it it's just to go back to something Goody, you said earlier. Like, what is it like when people are just feeling this thing, right? Yes, right, and the feelings, right? We've there are people in the NHS who've worked 40 years and it feels for some people ginormous, yeah, out of grasp. Wow. And one of the things that we've talked about is how important it is to acknowledge and appreciate the individuals who, despite the decades of or who's who are coming with the decades of experience, who are still saying, you know what, the NHS isn't where I want it to be, but I'm going to contribute to this by telling my story. So it certainly felt deeply.

SPEAKER_03 42:43

I mean, you're just saying that my my father also worked for the NHS for 40 years. Wow. And I think did not get the recognition, appreciation when he finally retired, right? There was no sense in which there was any thank you. Yeah. Right? But it is what you said, right? These decades are not just decades of experience, they're decades of dedication. Absolutely. Right? Absolutely. People come to this world with so much honor and so much love and care for the professionalism that you need to bring to this job. And so I'm wondering if in your research you're hearing that sense of betrayal when institutions do this, where they almost turn their back on you and these like crux moments.

SPEAKER_01 43:21

Yeah, you know, it's an interesting thing to be a healthcare worker. And I'm sure people who work in health professions will relate to this, that we work in very tough conditions. We're trained to work in very tough conditions, right? This is the nature of the work, right? We withstand, we're resilient. Oftentimes, even going through the COVID-19 pandemic, healthcare workers were characterized as heroic because of the degree, the degree to which the commitment levels to show up to the jobs that we're talking about. Right, to nurse people through to through illness, to to prescribe and to witness illness in its most severe kind, to rehabilitate and provide physiotherapy for people that are incredibly injured and and you know need to learn how to do everything from talk and walk again, right? These are these are the things we're talking about. And so to your question, you know, and we abstract that of the level of is there a sense of betrayal? I think I think there is so much more that we should be doing for health professions and for the workers in the NHS, and this is only one piece of that, and that that is because that duty of care that healthcare workers are providing for their patients, the NHS is incumbent on providing to its workers. And so so I think there is a much bigger question than betrayal, which is do we care? Right? Wow, yes, yes, yeah.

SPEAKER_03 45:02

This that question haunts me because it doesn't feel like a healthcare system all of the time, right? Yes, yes.

SPEAKER_00 45:09

But the example that comes to mind, oh gosh, just uh they're so powerful the last few moments. Um is we we heard an there was a conversation recently around how a healthcare professional responds to a service user, sorry, a patient who is treating them uh quite badly. Right, who's been racist or violent, and the response from someone who described herself as a nurse and who said, as a nurse, my commitment to the profession will trump the concern I have for the impact this is having on me. Wow. Right. So going back to what we've been saying, that like what so if if I am committing as a nurse to care for an individual who is treating me, who is potentially threatening and has a potentially is hard, there's a potential that they will harm me, right? Where do I get the care? It is hopefully from my colleagues, from my employer.

SPEAKER_03 46:26

But is it there? I mean, what are you hearing?

SPEAKER_01 46:27

We get to we're yet to study because we've been called to study, right? Like we've been called to this because there are concerns, real concerns. And I think this is this is something that you know, this work of the ethnicity, pay, and progression gap has been long pushed and pulled like a sack of potatoes by many people before us. And so we are here to do a piece of work, yes, but actually, this work has been building across not just healthcare, not just the NHS, countrywide by individuals who have championed the importance of a fair opportunity for people in their workplaces. That if you put the work in, you should move forward, you should not get stuck, yes, you should not be held back. Yes. What is holding people back? And that is what is important, you know, in terms of we need to carry the momentum and help healthcare workers where we can to have a fair chance at paying progression.

SPEAKER_03 47:34

You're from South Africa. Yes. And it just struck me right now that if this was a country we were talking about that was treating a whole group of people so differently, there would be protests, there would be sanctions, there'd be embargoes. And I'm not saying that we need to do that the NHS, but it's really interesting, isn't it? Like we put up with it in our workplaces.

SPEAKER_01 47:53

Well, doctors are here striking, right? Well, yes, yes, for pay. Yes, yes, yes.

SPEAKER_03 47:58

Not too far off. Not too far off. But I mean, we and it's not just race, right? There's a gender pay gap too. There's all sorts of gaps, right, that we tolerate.

SPEAKER_01 48:06

Yeah.

SPEAKER_03 48:06

And um, again, it just speaks to this idea that institutions have a very high tolerance for inequality.

SPEAKER_01 48:12

Absolutely.

SPEAKER_03 48:13

And again, how do we change that conversation? How do we start making it intolerable that this is happening? Just like eventually we were able to do in South Africa, right? Apartheid is not okay. So what do we do? How do we make it not okay that this gap exists anymore?

SPEAKER_01 48:27

I think you're asking a question which is what is the straw that will break the camel's back?

SPEAKER_03 48:31

Thank you.

SPEAKER_01 48:31

Yes. You put it much better than I did. How do we know? How do we, not at all, you did an excellent job. How do we actually get us, how do we get us there? And you know, I think something I want to say, because I think it speaks to that, is for the mum that is the nurse, and of course across professions, but the nurse that's going home every day and counting out the money and saying, you know what, sorry, actually, this birthday we're gonna have to skip it. There's no there's no birthday present this year because you know what, we have to cover the groceries, we have to cover the rent. There's lots and lots of things that you know prices are going up, cost of living is high, you know, and you know, it's gap pay gaps, pay gaps influence people very deeply. And when we start to think about it into on in terms of real applications of how that translates in people's lives, being able to offer their children quality education, being able to re afford to retire, being able to access the same resources that others have access to in the work that you're doing, right? This is as much a dignity issue as it is an issue of values within the NHS, which is are we going to act on the evidence to make this a fair place for the people that work here? And it's not a small number of people, it's a very large number of people. And so I think just decentering to your question around what would be that thing, I think, and of course there are, you know, there are many drops of water that build into an ocean. But I think I think something that is a big part of this is critical mass, which is are the voices that are speaking the evidence to power, are those voices carrying it. And this evidence is only as powerful as the people that are speaking it, that are using it, that are sharing it. And so, but you know, from a research perspective, we have to do our best to communicate the work clearly and confidently around what we find in a way that is pragmatically useful. But we also need to be able to hand it to the people that can do something about that. Because voters are watching, those that are in the NHS are watching. This is an issue as much as for our conversation as every other newspaper in the UK.

SPEAKER_03 50:58

And I love that you look at your research in that lens, which is that it is for a purpose beyond the publication, before the beyond the, you know, even the uh the results, right? It's it is you kept you've said repeatedly, action, you've used pragmatic, like those are words that often researchers don't use, right? So it's so wonderful to see that it is oriented towards a goal and a philosophy beyond beyond the the research itself. And you know, as we draw this to a close, I am I am very interested in action. I am interested in change, and I want to think about what you know, you we talked, you used that beautiful analogy of what is the straw that will break this camel's back. Let's talk to the camel, right? So now let's imagine that the NHS leaders are listening to you right now, which they might be. How are you? Are you listening? Um We hope so. Let's imagine they genuinely want to act, right? So they're people who actually want to make that change. Where should they start doing?

SPEAKER_00 51:56

I'm going to try to be both um abstract because they're I say abstract because there are many, many, many scenarios and specific.

SPEAKER_03 52:06

Well, so so one thing, one, one, one model I use with um in workshops is to talk about a baby step you can take and also the big like power, the power shift. Yeah. So so you so you can give something of like, oh, you can do that tomorrow. Sure. And then also be like, here's my blue sky, like I want the world to change.

SPEAKER_00 52:22

Yeah, but I think the first thing, which isn't is before you know those specific is what is my what is my sphere of power? Whatever it is, how much power do I have? What is my source of power agency resources? I think that is important. And within that, and so that's why I said, like, you know, at the beginning, you'd need to kind of just I'd need to be a little more abstract. Like, just figure out like what power do I have? Yeah, love that question. Because just to kind of build on what Nabila was saying, you know, in answer to your question, things will shift when people with power intervene and shift things. Yes, right. So figure out what, but we all have power in different ways, right? So that's the first piece. And then to go back to your like, what is a baby step for versus what is a big thing? A baby step, particularly if you have power, is get as many other people who have power on site. That's a great one, yeah. Use it. Use your power.

SPEAKER_03 53:24

Beautiful, I love it. Right? But also because you're talking about collectively taking action, right? Is no hero in this, right?

SPEAKER_00 53:30

Absolutely. And collectively, I mean, we we know from the research that actually, if I'm speaking to let's just say, an older white man about why this is important, he's more likely to have his eyes glaze over. Well, you know, actually, this is who it is. She's a little activist, she's got a chip on her shoulder. If two, if another white man is like, you know what, hey, bro, let's kind of like have a cigar and talk in the club. This is important, it's much more likely to have impact. This is allyship though, rather active allyship. It is, and it's so there's there's allyship, which is I'm going to advocate for that group, and then there is I am going to talk frankly to someone who sees me as, you know, one of them. As one of them about why this is important for us. Brilliant. Yes, yes, yes. For us. Brilliant. Right. So we need to move away from, you know what, this is the thing for them. We're doing it, you know, like benevolently. Yes, yes. This is the thing we need to do for us. Wow. Whatever that us is, you know, or whatever that kind of again sphere of kind of power or influence is. So for me, that's the first action. Get as many people, like speak to your people and get them on side. More blue sky is along the lines of investigate within your domain, whatever that is, whether that's your team, whether that's your department, whether that's your institution, whether that is your country, what are the policies, like what are the things that we do? What are the like what are the the the things that we do that have a differential impact on different people? So whether that is at a very simple level, many people will be familiar with actually, what our promotion process is, whatever that is, that promotion process, what is happening there, yes, right, such that some people have greater access to possible positive outcomes and other people don't, and change it. Change it. I know there are many, many, many, many different ways in which you can change it. That is it. So, first is get your people with power. Yes, love it. And the second is evaluate your policies or practices and just focus on one. Just focus on one. I'm gonna end this bit with I've had so many people. So many people like, okay, just tell me what should I do? What is the thing we should do? Tell us what to do. And I'm like, just pick one thing. It doesn't matter. Just do one thing, do it consistently. Wake up tomorrow and say, this thing that I'm gonna do, I am going to do it every day. And when you stop, when you do it, teach other people to do it, right? And when other people don't teach them to teach other people to do it. It doesn't matter. I don't care what you do. But because there's so many things you can do. Yes. Pick one and be consistent.

SPEAKER_03 56:30

Wow, powerful. That's a great message. Nabila, you also have the ear now of every NHS leader. Oh, and you know what?

SPEAKER_01 56:38

Tag them if they're not listening. We want them to listen, right? So, what should they hear from you about how we are going to tackle this? This is an NHS of many languages, of many national anthems, of many people, right? People that come with many different lived realities, but should come to an NHS where they're all able to progress. Yeah. And I hope that the work of looking at the pay and progression gap across ethnicities helps us help the NHS to take a very close look at what's happening on the ground and take that evidence and use it. That's all.

SPEAKER_03 57:22

Yeah, because we talk about a rainbow NHS, right? But is that rainbow like shining brightly right now or not? I mean, it isn't, right? And this conversation has been so wonderful. Thank you so much for like sharing your expertise, your passion. Um, but it it leaves me with this idea that there's, you know, the ethnicity uh pay and progression gap is not a workforce anomaly, right? It's a way, it's a symptom of a deeper disease, right? Absolutely. It's a moral signal about what we value, who we value, trust, authority, what is possible for certain people in our society, and how that is distributed within an institution. And so it's it is a sign that things need to change. It's what you said, like pick something and change it. And so it's like it's like an early warning system, right? Yes, listen to it because the system is in danger. And I wonder whether that's like something else that comes out of it. Which is like this is not something that we can expect to do.

SPEAKER_01 58:19

This is precious to us, the NHS is precious, and I think it's something that we can all be incredibly proud of, right? But it also is something that is not guaranteed. Um, and we we know that, and so we have to protect the people that are holding up the walls of the NHS. Yes, yeah.

SPEAKER_03 58:38

Well, on that very powerful point, I'm gonna draw this to a close. Thank you so much, ladies. That was a fantastic conversation. Thank you so much. Thank you. No, thank you.