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nhsManagers.net

10th June 2026

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News and comment from

Roy Lilley



Enough...

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Short on time? Get yer ears-on and listen to Roy Lilley read this morning's eLetter... free!

The row over Kemi Badenoch's suggestion that public bodies should no longer be required to implement the Public Sector Equality Duty has generated plenty of heat...


... and not much light.


The immediate reaction has been predictable...


... supporters say it is a long overdue assault on bureaucracy and wokeness...


... opponents say it is an attack on equality and hard-won protections.


The truth is more complicated.


Let's start with the money. How much does it cost?


No one actually knows. That, in itself, is remarkable. All up, for the NHS; I’d guess £250m, but…


… there appears to be no authoritative answer… which is a story in itself.


Badenoch claims across government it costs hundreds of millions.


If she's right, taxpayers should know. 


If she is wrong, taxpayers should know that, too.


The fact that nobody can produce a reliable figure suggests we are debating a policy whose costs are largely invisible, while its benefits are largely assumed, and …


… that's an uncomfortable place for good management to be, but...


... that’s only part of the story.


The real cost is not diversity officers. It’s the machinery;


  • Training programmes.
  • Reporting requirements.
  • Equality Impact Assessments.
  • Board papers.
  • Staff networks.
  • Legal advice.
  • Tribunal preparation.
  • Data collection.
  • Committees.
  • Management time.


Each element may be perfectly reasonable. Together they add up to a significant administrative burden.


The NHS has become remarkably good at building systems around good intentions.


When a problem emerges, a framework is created. A dashboard appears. A committee is formed and a reporting requirement follows.


The original purpose can become obscured beneath layers of process, which does not mean the purpose is wrong.


Few people would argue against fairness, equal opportunity or protection from discrimination.


The question is whether the systems we've built are delivering those outcomes or merely documenting attempts to achieve them.


That’s where the debate becomes interesting, because …


… this is not really about the Equality Act, at all.


Nor is it really about wokeness, although that is the label often attached to it.


The deeper issue is whether public institutions should focus on what people have in common or what makes them different.


Many voters have become uncomfortable with what they see as an increasing emphasis on identity; race, gender, sexuality, religion and ethnicity…


… they worry that organisations spend more time categorising people than bringing them together. 


Underneath that sits another issue that politicians rarely discuss directly... migration.


Britain has experienced historically high levels of immigration over the past two decades. The NHS itself couldn't function without overseas staff, yet...


... many of the arguments about equality, diversity and inclusion are really proxy arguments about integration, belonging and social cohesion.


People are asking a simple question.


In an increasingly diverse society, what is it that binds us together? That is not a legal question. It is a cultural one.


That’s where the NHS becomes the nation's Petri dish.


Nearly a third of NHS staff come from ethnic minority backgrounds. The workforce represents almost every nationality, religion and culture imaginable. It is one of the most diverse organisations in Europe.


Yet ‘NHS staff’ are not a separate species. They are a slice of the nation.


They read the same newspapers. Watch the same news bulletins. Worry about the same issues.


Have relatives in conflict zones. Belong to diasporas. Carry their experiences, beliefs and prejudices through the hospital door just like everyone else.


No amount of legislation changes that.


Perhaps, the more interesting question is not whether equality matters, because it does…but how the Equality Act is used. 


It was intended as a framework for better decision-making, not a substitute for it. 


Too often in the NHS it is cited as a reason not to act, when its purpose is to help organisations act fairly, proportionately and with proper regard to consequences. 


The Act should be a lever, not an anvil to hammer out excuses; a tool to support judgement, not replace it.


There’s a danger that compliance becomes the objective and paperwork becomes confused with progress. 


The real test is simple; are we treating people the way we would want to be treated.  Yes or no…


… the answer is simple enough.

NEW-NEW-NEW

PODCAST

Dr Ian Higgison


If there is one clear sign that the NHS is not working, it is the state of its accident and emergency departments.


Across the UK, under all sorts of different political regimes, the story is the same...


...patients spend many hours even days, many waiting for a bed and incontrovertible evidence that thousands of lives are being lost as a result.


In their latest podcast Niall and Roy hear from

Ian Higginson

President of the Royal College of Emergency Medicine...


...who voices his anger and frustration as a system that is failing patients and staff. But, he argues strongly that this Gordian Knot will not be untangled by discouraging patients from turning up at A and E but by dealing with the ‘back door of the hospital, and...


.. on that, he clearly believes that while there is more that hospitals themselves can do to improve discharge procedures, more attention and resources need to be directed at social care and community health services.


As for the former Secretary of State in England, he is determined to make sure that Wes Streeting’s commitment is not forgotten! 

For all the previous

In the Loop

podcasts with

Prof Jim Blair

Learning Disability expert

Andy Burnham

Mayor of Greater Manchester

Nichola Ranger

ChEx Gen Sec RCN

Tom Dolphin

Chair BMA

David Gregson

founder of BeeWell

Dr Charlotte Refsum

Tony Blair Institute

Rob Webster

ICB CHEx

Sarah Woolnough

CEO of the King's Fund

Sir Jim Mackey

Dame Jennifer Dixon

Lord Darzi

Professor Tas Qureshi

Dr Penny Dash,

chair NHSE

Richard Meddings,

former chair NHSE,

Sir Jeremy Hunt,

Sir Andrew Dilnot,

Paul Johnson IFS

CLICK HERE


-oOo-


Probably, the most listened to

Podcast in the NHS!

FREE!

Want to contact Roy Lilley?

Please use this e-address

roy.lilley@nhsmanagers.net 

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Dr Paul Lambden


Life Expectancy and Health


Close inspection of the data for the twenty-one wealthiest countries in Western Europe, Scandinavia, North America and Oceania place the United Kingdom at twentieth out of the twenty-one. Only the United States of America has a population living overall with fewer years of good health. 

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__________


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