Using data to tackle inequalities in medicine | Equalities and the Medical Workforce Equality Standard (MWRES)

The Workforce Race Equality Standard (WRES) has been mandated in the NHS in England since 2016 to document the different experience of White and Black and minority ethnic staff in the NHS, and thereby identify the targets for improvement. The medical workforce differs from the rest of the NHS workforce – in terms of career progression, pay structure, postgraduate exam structure, revalidation – and a specific Medical Workforce Race Equality Standard (MWRES) was launched. The MWRES was published in 2021, a world-first dataset covering the range of experience from medical school to seniority, and incorporating both objective data on progression and disciplinary processes, as well as subjective data from the NHS staff survey.

It could be argued that such a dataset was not needed given the scholarly evidence and individual cases that had emerged over decades. However, it was clear that much of the medical leadership were ignorant of the depth, the extent and the impact of the race-specific inequality experienced by minoritised doctors. The MWRES therefore published on 11 indicators which covered the ‘journey’ of doctors from medical school admission through career progression, postgraduate exams, appraisals, disciplinary processes and experiences of discrimination. It is no coincidence that the timing of the publication was accelerated by the impact of the COVID pandemic, which saw the disproportionate death rate of Black and minority ethnic doctors compared to White peers (albeit that nursing and other clinical staff experienced significantly greater mortality). 

The data showed that 42% of doctors were from a minoritised background. That the inequity experienced was across the career span from reduced likelihood of medical school admission, to worse outcomes of appraisal and disciplinary process and greater likelihood of bullying and harassment. Minoritised doctors were underrepresented in consultant grade roles and academic or management positions while being overrepresented in ‘other’ doctor grades and doctors in postgraduate training. An undoubted failure of the report was to not specifically identify the ‘other’ doctor grades as SAS and locally employed doctor colleagues, and a clear pledge to do better on that was expressly articulated in the subsequent MWRES work.
The core of that work was articulated as an action plan, A commitment to collaborate. It was developed in a consensus format with the key national organisations, regulators, union and royal colleges. The intention was to commit the full range of national organisations to programmes of action focused on five specific areas of improvement.

These were:

• reducing disproportionality of entry into local disciplinary processes and referrals to the GMC for BME and international medical graduate (IMG) doctors
• improving diversity in senior medical leadership appointments
• increasing BME representation among the councils of royal colleges to proportionately reflect their memberships
• ensuring that there are meaningful local arrangements for initial and ongoing support for IMG doctors
• supporting SAS doctors to make progress in leadership roles and by review of the contract.

As the national focus on tackling race equality has fluctuated, the importance that trusts, regulators and stakeholder organisations undertake work on these defined areas is key. The MWRES is ultimately a dataset, and is not the tool to deliver equality. But it is vital in instructing these organisations where the data indicate the need for action, and providing a monitoring framework for improvement. Ultimately, progression on inclusion requires data accountability, which the MWRES provides, and the stakes in terms of reducing health inequalities are too great to not make changes to deliver that improvement.