Case Study

Inclusive culture: North East London NHS Foundation Trust

Find out how one NHS trust improved its culture by putting people first, engaging with staff and ensuring its recruitment process was inclusive.

12 May 2021

North East London NHS Foundation Trust (NELFT) recognised that there is a strong link between workplace culture, staff wellbeing and the productivity of the organisation.


The trust also understood that engagement and inclusion are closely linked, with staff less likely to feel engaged if they have a disability, are from a BAME background or the LGBTQ+ community.

To achieve an inclusive culture, the trust addressed its staff engagement and cultural awareness, and ensured its recruitment process was inclusive, and put people first.

Key benefits and outcomes

  • Developed an inclusive, accessible and bias-free recruitment process. Resulting in an increase of employees with protected characteristics.
  • Improved staff survey scores on management, safety culture and staff experiences.
  • Implemented an employee assistance programme to support their workforce.
  • Developed staff network budgets for leadership and development programmes.
  • Introduced a health passport to support staff with disabilities/long-term conditions.

What the organisation faced

NELFT needed to address the leadership teams’ accountability and commitment to the equality, diversity and inclusion agenda, their competencies and cultural awareness to work with diverse teams, as well as employing more people from under-represented groups.

The budget was another issue, the implementation of the Ethnic Minority Strategy required funds which at the time were not available. Since April 2020, each staff network now has a budget.

What the organisation did

NELFT has always strived for best practice across its policies and processes to ensure that it respects, reflects and can respond appropriately to diverse needs. The trust reviewed their EDI policy and reasonable adjustments guidance. Equality impact assessments are also used as a framework to address their impact on staff and patients.

Learning sessions

Alongside the mandatory EDI classroom based and e-learning training, where compliance is 97.9 per cent, NELFT has also organised a series of EDI specialist training sessions to include unconscious bias, interview skills, disability awareness and reasonable adjustments for managers.

In addition, a series of sessions were held on LGBT+ awareness and health, working with Roma, Asian, African communities, and spirituality groups. This has been made available trust-wide to understanding the culture and specific needs of diverse teams and different communities. The trust has also developed the following cultural guidance booklets:

  • Cultural and religious awareness and safeguarding - South Asian communities
  • Cultural Awareness for staff working with Black African and Caribbean service users
  • East European Roma Health Awareness Guide.

Supporting staff

An employee assistance programme was introduced, offering support and information on money worries, childcare, legal and social issues.

NELFT also promotes positive behaviours, including eliminating any form of discrimination and bullying and harassment, by empowering everyone to relentlessly challenge inappropriate behaviours in a respectful manner. The organisation uses flexibility as a strategic tool to support agile working enabling staff to effectively work from anywhere, improving their work-life balance.

Recruitment and selection

NELFT supports a fair selection and recruitment process that is inclusive, bias-free and accessible. This includes:

  • guaranteed interviews for candidates with disabilities who meet the essential criteria for the post applied, offering reasonable adjustments during interview process
  • provision of British-Sign Language interpreters and hearing loops if needed
  • diverse interview panels
  • extra time to candidates with dyslexia to complete assessment tests and provide written interview questions on the day of the interview.

Health Passport

A health passport was introduced, to assist with the swift and effective provision of workplace adjustments for employees with disabilities and long-term health conditions.

“There has been an increase in staffing from BAME backgrounds at all bands, and in particular Bands 8a and above.”

Staff networks

The trust has seven established staff networks: Disability Staff Network, Dyslexia and other Specific Learning Difficulties Forum, Hearing Impairment Group, Ethnic Minority Network, WoMen’s Network, LGBT+ Staff Network, LGBT+ Allies Network. Work is also underway to develop a Faith Forum and a Mental Health Network. The networks:

  • are actively supported, ensuring they have strategies and action plans to deliver on national frameworks such as the Workforce Race Equality Standard (WRES) and Workforce Disability Equality Standard (WDES), often acting as a consultative group for development of trust policies
  • support employees from protected groups and advise managers in the provision of reasonable adjustments. They also champion specific issues such as menopause, prostate cancer, healthy eating, autism, dementia.
  • act as communication channels, sharing information, identifying learning opportunities, supporting peers and raising awareness.
  • develop pathways and unique projects to support people in their personal development plans and careers.

Results and benefits

Over the last couple of years, the level of employees with protected characteristic has increased, thanks to the trust’s inclusive recruitment process, the provision of reasonable adjustments, developmental programmes for staff and fair opportunities for career progression.

  • The number of staff with disabilities has increased from 3.4 per cent to 4.3 per cent in a year.
  • There has been an increase in staffing from BAME backgrounds at all bands, and in particular bands 8a and above, for example, in 2019 band 8d increased from 17.6 per cent to 37.5 per cent and very senior managers from 7.7 per cent to 23.5 per cent.
  • The LGBT+ allies scheme launched in September 2019. Eighteen months on from the launch of the trust’s Rainbow Lanyards Scheme, it was able to attract LGBT+ talent to increase representation in the workforce. The number of staff declaring their sexual orientation as LGBT+ has increased from 70 to 100, the trust has also seen an increase in the number of staff who have declared their gender reassignment.

NHS Staff Survey results

  • EDI is scored 9 out of 10.
  • Fair organisation score has been 83-84 per cent for 5 years.
  • Reasonable adjustments score has risen from 71 to 79 per cent in the last year.
  • Flexible working is scored at 67 per cent - which is the best score in the sector.
  • Positive action on staff health and wellbeing score has risen from 27 to 42 per cent in the last two years.
  • Support from managers’ score is 7.5 which is the best score in the sector.
  • Staff engagement score has risen steadily for the past five years and is 7.2 which is better than the average.
  • The relative likelihood of white staff being appointed compared to BME staff is currently 0.9. Any score less than 1 is seen as a positive outcome for BME groups.

Overcoming obstacles

To ensure a bias-free process, NELFT has given consideration to the diversity of interviewing panels, eg gender, BAME representation and professional background.

  • As standard for all vacancies, an interview panel must include an involvement representative. These are former patients who have had interview training, making them experienced interviewers.
  • In-house e-learning recruitment training has been developed, and is mandatory for all interview panels, including board members and the appointment of doctors.
  • The recruitment and selection policy includes a requirement for a trained ethnic minority network representative to sit at all interview panels for posts band 7 and above.
  • Accountability - the trust’s EDI meeting is chaired by the executive director of workforce and organisational development, who is also the executive lead for EDI, and facilitates a two-way reporting system between staff and senior leaders.

Takeaway tips

  1. Understanding policies alone is not enough to build an inclusive workplace, we need to allow people to be themselves at work.
  2. Leadership is crucial, ensure leaders are talking the same language and show their commitment to the inclusion agenda.
  3. Use flexibility as a strategic tool to support employees’ work-life balance and job satisfaction.