Sunday, March 03, 2013

An OBE from the Palace and a P45 from the NHS

Shahnaz Ali

This is Shahnaz Ali OBE.

Shahnaz has been the Director for Equality, Inclusion and Human Rights at NHS North West since 2007.

This coming week she will be taking her family to Buckingham Palace.

There they will watch her receive an OBE for 'Services to Equality and Diversity'.

Three weeks after that event Shahnaz will receive her P45 from the NHS.

That's right. Her P45.

Redundant and Pensioned Off

The NHS has no place for a leader of her calibre, with a well-documented catalogue of successes wherever she has gone.

Instead, equality strategy at national level will be in the hands of a team who (as far as I can determine at present) are all far more junior and less experienced.

How that has come about raises significant questions about the probity of the recruitment process setting up the national organisations which will oversee the quality and effectiveness of the 'modernised' NHS.

Successful career

Shahnaz's successful career in the health and local government sectors spans 30 years.

Beginning her post-academic working life in a Citizens Advice Bureau and Tribunals unit in the Chapeltown area of Leeds in the early 1980s, she soon moved to a senior policy role in the Chief Executive's Department of Leeds City Council.

Roles as Principal Health Policy Officer and Head of the HIV unit followed in the London Borough of Newham, before she moved back to become Training and Human Resources Manager for Community Health Sheffield.

She was then promoted to Director of HR Development within that same trust before becoming Director of Workforce Diversity and Equality and then Director of Education and Workforce Expansion for South Yorkshire Workforce Development Corporation.

In these roles Shahnaz made a real difference. Her work means that, for instance, South Yorkshire's paramedic teams come from significantly more diverse backgrounds than had previously been the case. She used her oversight of tens of millions of pounds in the NHS education budget to call Universities to account on the selection criteria and syllabus for training new doctors.

These are the kinds of strategic interventions which have impacts for generations.

By 2005 Ali had become Senior Director for Local Authorities and Wider Partnerships for South Yorkshire Strategic Health Authority. Then, in 2007, she accepted the invitation to lead on equality, diversity and human rights for NHS North West, which had been created by the last major NHS reorganisation.

Her CV documents how, in each role, she has led an effective improvement programme and changed peoples' lives. I've written about her innovative approach (and my part in helping her deliver it as her programme manager) here, here, here, here, here, and here.

I've also written previously about Shahnaz's voluntary leadership roles and experience, which contributed to the reasons why she is receiving an OBE now.

One very senior NHS figure said recently of Shahnaz,

"[She] stands out in this area because the vision she developed with the benefit of research and evidence  was developed using her wide network of contacts in the NHS and the broader public sector as well as colleagues in other sectors. [She ensures] that strategy and action plans are focused on outcomes as opposed to the traditional E&D approach of process and  inputs.  In doing this she has developed and pioneered the first regional approach to measuring and performance managing equality outcomes and it is this which marks her apart from others. Shahnaz achieves so much because of her excellent networking skills.  She uses these relentlessly to scope ideas and promote the north west at every opportunity.  She is also enormously generous with her time and expertise willing to meet colleagues, peers,  and more junior staff in equal measure."

Real strategic leadership

In creating the Equality Performance Improvement Toolkit (EPIT) as part of her evidence- and outcome-driven strategy, Shahnaz piloted the first and most successful framework for objectively measuring progress on equality in the NHS's history.

EPIT demonstrated the ability to double the tangible measures of real progress on outcomes in the North West in just eighteen months. As part of a wider strategy for transforming the culture and leadership approach in the region, Shahnaz demonstrated what really could be achieved.

The approach was later adapted (badly) by a team set up by the NHS's Equality and Diversity Council (EDC) to create the so-called Equality Delivery System. The EDS failed for very predictable reasons to echo the success of the EPIT approach … but that's a discussion for another day.

The EDC also adopted the first ever national Competency Framework for Equality and Diversity Leadership, instituted again by Shahnaz and our team.

National-level innovation

Other Shahnaz-led innovations became nationally utilised assets too.

The Health Equality Library Portal soon became the country's best place for anyone to research evidence material for equality strategy.

The Health Equality Stateholder Engagement approach demonstrated an effective and genuinely sustainable approach for getting the best out of partnership with third sector expertise.

Shahnaz's determination to help avoid discrimination in the conduct of the new Medical Revalidation process caused her to create another toolkit ("A Fair Route to Revalidation") to fill an obvious national need. The toolkit has draw wide praise since it was launched in November 2012.

Health Inequalities

Shahnaz's vision also encompassed Health Inequalities as well as Workforce and Patient Equality strategy.

Her regional strategy set the tone in 2008 with a long list of evidence for the kinds of inequalities which the region needed to tackle, and why cultural awareness of diversity was key to tackling them.

She influenced this by working in conjunction with peers developing the quality of Commissioning Strategies (and the Joint Strategic Needs Assessments which should underpin them). She refused to sign off PCT Commissioning Strategies which failed to address such inequalities. NHS organisations also discovered that they could not claim to be Achieving in the relevant parts of the EPIT performance system unless they had evidence of actual progress addressing these areas.

Financial support for good ideas

She also provided strategic funding to clinicians who had innovative ideas to tackle big inequalities.

One clinician-led project has concentrated on reaching out to Black and Minority Ethnic Women to ensure they understand the importance of cancer screening and use the services provided locally.

Primary Care Trusts have been encouraged to work with expert stakeholder organisations, such as the Men's Health Forum and Lesbian and Gay Foundation to come up with innovative schemes reaching out to groups of people who have traditionally not been screened effectively for a range of conditions.

The 'Pride in Practice' scheme was created with funding from Shahnaz to develop the capability of GPs to tackle LGB health needs. Research into transgender health needs was funded. A local community radio station was used to convey important guidance on diabetes to South Asian listeners.


Yet this expert in transforming the outcomes experienced by you and I in the health service has no place in David Nicholson's brave new NHS.

Over the last year I have watched as Shahnaz has patiently and professionally sought out senior roles which she would have been eminently qualified to take in the new NHS structure.

I have cross-checked for her that every requirement in the various job descriptions has been more than amply covered with evidence of her capability and very real achievements.

I have also watched as, each time, she has mysteriously failed to be shortlisted for such posts. I have witnessed the inability of leaders to provide credible feedback for such decisions.

Shahnaz Ali is not alone in this experience. Her experience forms part of a much larger betrayal of a very experienced and respected equalities leadership community within the NHS structure which is about to be disbanded.

This is a story which I will doubtless come back to.


Laura Marcus said...

Utterly shameful Christine. Entirely agree. But I do hope it doesn't spoil Shahnaz's day at the Palace on Thursday.

Christine Burns MBE said...

I feel sure that Shahnaz will enjoy her day, although it sounds as though the Queen (just hospitalised with a gippy tummy) will miss the opportunity to meet her.

Jawed Siddiqi said...

Clearly Shahnaz has been successful in attacking health inequalities
improving the life of patients from all sectors of the population and helping to shape the NHS
so that it is fit for purpose for all - so she is sacked!!!!!!

David Nicholson who was promoted from being the Chief Executive of the Strategic Health Authorithy

in which there have been needless deaths under his watch
he got promoted to be the Chief Executive of the NHS Commissioning Board

Shahnaz must be livid

The NHS is not in Safe Hands
those who are committed to improvements are removed
and those that practice command and control cuts are promoted

The time hascome to rise up and get the NHS back in our hands!!!!

Joanne Byndloss said...

It is a real pity that a person of such a high caliber who is held in such high esteem by so many people should be dispensed in a nonsensical dismissal of an individual with a plethora of skills that have allowed for Shahnaz's to be so successful in her role. Such a shame, I can only hope that her quality will be recognized and considered for further employment in the future.

Anonymous said...

Maybe Shahnaz and co have done such a good job in the North West that health inequalities are at a zero level and equality is everywhere to be seen?? The Competency Framework has proved difficult to implement. EPIT was criticised by Equality & Diversity practitioners working in the North West. The Equality Delivery System (EDS) was not based upon EPIT. The EDS continues to be a success across the England. It has been implemented by over 97% of all Foundation Trusts across England and by nearly 100% of all Clinical Commissioning Groups. It has been endorsed by the regulators. Do these facts and statistics smell of failure?

Christine Burns MBE said...

Nice try anonymous. Trying to make an argument like this by assertion just doesn't wash though.

Of course health inequalities aren't at zero ... any more than they are anywhere else. The starting point in the North West is a set of inequalities greater than most of the rest of the country. There's no magic solution to those. Shahnaz's strategy began by obliging commissioners and providers to acknowledge that although they might have thought they were addressing some of them, their efforts didn't measure up. The first step towards change is a reality check.

The Competency Framework was a joint publication with the Department of Health. I certainly encountered HR Directors who were highly resistant to addressing what it very clearly required them to do ... upskilling E&D leads personally and positioning the role appropriately ... but that wasn't about finding it 'difficult' it was about resistance to the very principle. Managers who don't want to do something will always find ways to excuse why they don't want to do it. The framework remains the only attempt ever to professionalise leadership in this field. The response, if you think you could do better, is to put up an alternative, not rubbish the attempt.

Yes, EPIT was opposed when it was first introduced. Some organisations went over Shahnaz's head to try and avoid it. Organisations, once again, didn't like a tough process which advertised their weaknesses. Many wanted to rate themselves far higher than they deserved, so of course they would not like the process saying otherwise. By the time EPIT was repeated 18 months later, it was a very different picture. More and more organisations told us how they finally 'got it'. Also, by highlighting how E&D leadership was important to the whole organisation, organisations were far less inclined to make E&D leads redundant in the move to cluster PCTs. In other parts of the country the skill was decimated. That's no failure.

Finally, on EDS, I'm afraid that your claims don't tally with the independent research which I carried out across a number of SHAs with the assistance of their E&D leads. The picture is as I described and I will continue to describe it as a failure for the reasons given. I know there have been valiant attempts to apply lipstick to that particular pig though.

But why be anonymous, anonymous? I publish my words under a very clear title. And in the current climate it is to be hoped that NHS managers, too, would come out of the shadows. Until then, your comments serve as a magnificent example of the kind of backstabbing that a change agent like Shahnaz faces.

Christine Burns MBE

Anonymous said...

I am a member of the public who has taken an interest in the issues under discussion (prompted by the big changes underway in the NHS).I am surprised you are so aggrieved by someone leaving their comments anonymously. If you don't like it, then it would make sense not to allow it as an option!

Christine Burns MBE said...

As a member of the public you're quite welcome to post here anonymously if you wish. I allow anonymous comments because I sometimes write about issues where people have genuine need for anonymity and could not contribute to discussion without it.

The above commenter has identified themselves (by the nature of their claimed insider knowledge) to be a member of NHS staff. They are using a cloak of anonymity to make unsupported claims about a colleague, in breach of the NHS Code of Conduct.

That isn't an appropriate use of anonymity. It is cowardice indicative of a culture which I've commented on in a subsequent article.