Profile: Christine Hancock

Christine Hancock, general secretary of the Royal College of Nursing (RCN), caused a furore at the organisation's annual Congress last year by acknowledging that the organisation was institutionally racist. Since then, the RCN has agreed a major plan of action in relation to race equality issues, as well as continuing its equality activity in other areas, such as promoting employee-friendly working and challenging nurses' low pay. We talked to Christine Hancock about the RCN's equality initiatives both within her organisation and within the NHS.

The Royal College of Nursing is the UK's largest professional nursing association, having a membership of 320,000 registered nurses and student nurses. Its membership is overwhelmingly female and overwhelmingly white. Latest figures indicate that around 4% of its membership are from ethnic minority communities. Three-quarters of members work in the national health service (NHS), where ethnic minority nurses make up just under 8% of the workforce, but fewer than 1% of directors of nursing are from ethnic minority communities.

Hancock, a nurse herself, was appointed general secretary in 1989 and confides: "The organisation was quite open to setting up a women's committee when I first took up my appointment, but nobody had thought about racism at all, and I had to push for a race and ethnicity committee. These were significant developments at the time." She also created the post of equal opportunities adviser within the RCN and a black officer was appointed. Progress was made, but she admits that until last year's Congress, "there was still little understanding of how race discrimination was an issue for the RCN".

Institutional racism

The intense debate at the RCN Congress in March 1999 about the existence in the RCN and NHS of institutional racism, came immediately after the publication of the report into the murder of Stephen Lawrence (EOR 84), and, according to Hancock, was a "cathartic" experience for the RCN. She firmly believes that institutional racism does exist in nursing: "Nurses are not, on the whole, overtly racist - it does not fit with the ethos of the job - but there is still much ignorance about subtler forms of race discrimination and why it should matter to the profession. However, the RCN is now doing a massive amount to eradicate this kind of unwitting exclusion."

Since last year's Congress, a whole programme of action in relation to race issues has been agreed and begun to be implemented. Equality issues have been confirmed by the RCN's governing council as one of its top four priorities for the next two years.

Equality initiatives

Council members, who include one black representative, and chief officers have attended two racism awareness training seminars run by external consultants. These focused on increasing awareness of discrimination and prejudice both at an individual and institutional level, as well as helping participants to manage effective anti-discriminatory policies throughout the planning and decision-making processes of the organisation.

Jobshadowing and mentoring schemes to support equality of opportunity are also being looked at by the RCN. A review has started of personnel policies and practices with the intention of the RCN becoming an equality-proof organisation. Other initiatives include a pilot programme for RCN local representatives and staff, which aims to provide a cohesive training and development plan about understanding diversity, with a specific emphasis on racism. The initial focus will be on RCN officers as the agents of change.

Work is also underway on a resource for representatives and officers to help them influence strategy when negotiating with employers. This will enable them to evaluate policies in relation to diversity, so that they can deal with the issues both at an individual and strategic level. Support and guidance will also be provided for RCN representatives and staff so that they can audit what progress regarding diversity is being made by NHS and non-NHS employers across the UK.

Equality networks

The RCN has also provided formal support for the eight regional equality networks for nurses from ethnic minorities, although local ownership will remain a key feature. The networks facilitate the discussion of nurses' concerns, provide briefings on the Government's latest initiatives and coaching opportunities for job interviews. As such, they form an important component of the RCN's strategy to get more ethnic minority nurses onto its committees and into the higher echelons of the NHS.

"In an attempt to get more ethnic minority nurses involved in RCN activities and broaden their experience," Hancock explains, "one day at the national Congress last year was dedicated to equal opportunities, and we offered to help members of a network to attend by paying their fares and helping with accommodation expenses. We will be repeating the initiative this year."

Focus on racism

Much of the work within the RCN during the course of last year, has focused on race discrimination and there has been some comment within the organisation about an undue concentration on racism at the expense of other forms of discrimination. For the moment, Hancock believes that it is right for the RCN to place the emphasis on race discrimination: "There are always women sitting round the table to raise gender issues, but as yet, we have not got enough individuals from ethnic minorities to ensure that their perspective is included at the decision-making level."

She points out, however, that the issue is not just about fairness within the RCN but a matter of urgency for the NHS. Hancock highlights the dramatic drop in applications from ethnic minority communities: "Nearly 25% of nurses over 55 are black or Asian, but fewer than 3% of nurses under 25 are from ethnic minority communities. The younger generation has obviously listened to the older generation's experiences of racism and harassment and decided that they do not want to go through the same thing.

"Yet the NHS is facing a huge shortfall of nurses. We have got to tackle discrimination within nursing and make it more attractive to those from ethnic minority communities." Hancock is clear, though, that the profession needs to be made attractive to all.

Gender

As a profession, Hancock believes that nurses have suffered because they work in a female-dominated occupation and because of the "service" ethos: "Gender discrimination within nursing takes a different form to that facing ethnic minorities. It is the profession of nursing that is discriminated against and not individuals as such. Traditionally, 'women's' work has always been undervalued. Nurses' pay and career structure fails to reward them properly for the work that they do. As a result, we are facing the worst shortage of registered nurses in 25 years."

The RCN estimates that there are approximately 17,000 full-time registered nurse vacancies in the UK and argues that this chronic shortage is now impacting on the quality of patient care. To help address these problems, the RCN has consistently argued for better pay for nurses and more employee-friendly working practices to help retain them in the profession.

Equal pay

Nurses' pay still lags behind other professions. Newly qualified nurses start at salaries 9% lower than qualified teachers and 11.5% lower than people entering the police service. Similarly, nurses can expect to earn less during their career, compared with other professions which have similar levels of education. For instance, a nurse who qualified in 1995 and was promoted to become a senior staff nurse would earn £16,465. A police constable would expect to earn £19,533 over the same time and a teacher £17,274. While pleased with recent NHS pay awards, Hancock is adamant that: "These will only help to keep nurses in the NHS if the real-term increases are continued year on year."

As well as campaigning at a national level for what it sees as proper remuneration, the RCN is actively seeking to pursue equal pay for equal value cases and is currently looking at around 20 cases in both the NHS and independent sector. Suitable comparators could include an accident and emergency practitioner with a junior doctor; a midwife with a junior doctor; a staff nurse with an estates manager; and an occupational health nurse with a health and safety officer or production supervisor.

The RCN is also consulting with Government over the Government's Agenda for change proposals, which look at future changes to NHS pay, career structures and conditions of employment. "One of the main aims is to try and resolve pay inequalities," says Hancock, "and so we would expect equal value to be one of the key principles on which any new pay system is built. The RCN's own work on job evaluation, RCN Equity, is informing the development of the Agenda for Change job evaluation system."

Employee-friendly working

Promoting employee-friendly working is also a major issue for the RCN, particularly in relation to shift-working. Hancock points out: "It costs £35,000 to train a nurse, yet at least 12,000 nurses leave the NHS every year. Employee-friendly working practices would go a long way to preventing this." The average age of nursing students is now 27 and the average of NHS nurses is 39.

"Given that, on average, women are starting their families at 28 and that 60% of nurses are caring for children and/or adults," Hancock continues, "it is madness that only a third of nurses have access to childcare facilities and only a quarter of these make use of them. The main reasons for nurses not using childcare are that it is too expensive or the opening times do not fit in with nurses' shift patterns."

Legal success

The RCN backed the successful sex discrimination case brought by two nurses who were made redundant from an NHS trust, as they could not work a new shift rotation system because of family responsibilities (Hale and Clunie v Wiltshire Healthcare NHS Trust (DCLD 39)). "The case has enormous implications for all employers in terms of employee-friendly working and ensuring that policies are not discriminatory," says Hancock.

Following the decision, the RCN and Equal Opportunities Commission sent a joint letter to all NHS trust chief executives highlighting the importance of the case and urging them to consider the impact of shiftworking on staff with caring responsibilities. A copy of the RCN's Shifting the balance, which offers best practice guidance in relation to shift-working and patient care was also included. "We believe the case has had an impact," asserts Hancock, "and certainly there is a heightened awareness among employers that they must consult thoroughly when considering changing shift patterns."

The RCN has recently run a campaign with the Nursing Standard, which highlighted good practice in shift-working and annualised hours. In Hancock's view: "What is needed is pragmatic support - step-by-step advice on how, say, to introduce a self-rostering system. In the RCN's guide, Having a life, we also stress that nurses have a role in thinking of new ways in which work and shifts can be organised and challenging traditional ways of working."

Disability

The RCN is also starting to tackle disability issues within the profession, and will be launching its "Workability" campaign at its Congress in April, aimed at helping disabled nurses back into nursing. Hancock says: "We are particularly pleased that NHS Direct, the nurse-led telephone consultation service, has enabled some disabled nurses to return to the NHS and use their nursing skills."

Equality and inclusion

Hancock believes that "equality and inclusion is now at the heart of the RCN's working. We have stepped up our support for ethnic minority nurses with the full endorsement of the RCN council and members. However, we are committed to ensuring all nurses and student nurses have a voice in the RCN - wherever they work in the UK, whatever their ethnic background, whatever their mobility, and whoever their employer. The RCN will continue to push the equality agenda both within the organisation and in the public and private sectors."