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The Challenge of Diversity in the Allied Health Professions by Dr Nicky Eddison and Dr Ros Leslie

Although the Allied Health Professions (AHPs) are a diverse range of professions in terms of their skill set. The workforce which makes up the professions lacks diversity, having been shaped by a set of distinct social forces, relics of a post-industrial era. At the start of the 21st Century, the stereotypical AHP is still predominately middle class, white and female. Diversity refers to the variety of differences between individuals. Including race, gender, age, sexual orientation, physical abilities, religion, education, socioeconomic background, language, and culture. AHPs make up the third-largest clinical workforce in health and care but have one of the lowest percentages of black, Asian and minority ethnic (BAME) workers, at 12.2%, which is lower than the  UK population average of 13.9% and below the NHS workforce average of 19.9%. This figure drops to well below 10% when considering BAME staff at band 8a or higher. There is further disparity within the professions with radiographers having the highest percentage of BAME staff (27%) and paramedics having the lowest (5%).

The AHP workforce is also highly feminised with a suggested gender divide in the order of 70% female to 30% male.  However, eight of the professions have a gender divide of over 70% female, with five over 80% (Art therapists (86%), Orthoptists (89%), occupational therapy (92%), dietetics (93%), and speech and language therapists (96%)). Only three of the AHPs have a gender split of less than 70% (prosthetists and orthotists (58% female), operating department practitioners (60% female) and paramedics (40% female).  Researchers have suggested that the historically dominant male profession of medicine has used social closure to constrain access to the profession.  However, the gender divide in medicine has recently been reported to be a more equitable 53% male.

The recent Health and Care Professions Council (HCPC) diversity survey reports that there are approximately 0.3% of trans people in the AHP workforce, this is below the estimated national average of 1%. There appears to be better representation in terms of sexual orientation with 4% of the AHP workforce surveyed reporting they are either gay, bisexual or queer, which is higher than the national average of 2.7%.

In terms of education, 15%  of AHPs surveyed by the HCPC reported that they attended independent schools, which is significantly higher than the national average of 6.5%. Lending to the stereotype of AHPs being middle-class professions.  The professions with the highest proportion of independently educated registrants are art therapists (22%) and physiotherapists (22%). With only two professions (operating department practitioners (7%) and paramedics (7%) below 11%.

When the spotlight is directed at the inclusion of people with disabilities, reports show that on average only 8% of the AHP workforce consider themselves to have a disability.  With several professions having rates of less than 8% (speech and language therapists (7%), radiographers (7%), orthoptists (7%), physiotherapists (6%), dieticians (6%) and prosthetists and orthotists (5%). The UK government reports that 16.5% of working-age adults in the UK have a disabiity.

The AHP workforce at the Royal Wolverhampton NHS Trust (RWT)

RWT employs nine of the fourteen Allied Health Professions accounting for a registered workforce of 593 staff.  79% (n=470) of which are female. Of the nine professions employed, eight have equal to or over a 70% female workforce. Ranging from 100% (n=37) in speech and language to 70% (n=53) in operating department practitioners. Only podiatry has a rate lower than 70% (52% n=10)). 22% (n=130) of the workforce are from a BAME background. Which is higher than the national AHP rate of 12.2% and higher than the national NHS average of 19.9%. However, there is a disparity between the representation of BAME staff across the AHP services at the Trust.  With BAME radiographers accounting for 48% (n=62) of the BAME AHPs at RWT, which is in line with the national picture of radiographers having the highest number of BAME staff. Encouragingly, only two services (speech and language (8%) and occupational therapy (10%)) have BAME representation which is lower than the UK population average of 13.9% and five of our services have a BAME percentage higher than the national average for the NHS.

Initiatives to drive diversity within the Royal Wolverhampton NHS Trust AHP workforce

The under-representation of minority groups in AHP undergraduate programmes has been a long-recognised challenge in the UK among other countries. A sense of ‘otherness’ has been a recurring feature, based on the AHP identity as white, middle class, mature and female, emphasising difference and alienatation.

At RWT we recognise that apprenticeships can offer a sustainable pipeline for securing a skilled AHP workforce for the future. The key component of our plans is to use high-quality level 3, level 5, and level 6 apprenticeships as entry routes to a broad range of AHP careers. Working with our local schools and communities we will grow a workforce that is reflective of our local population. Workforce Race Equality Standard indicators demonstrate that white applicants are more likely to be successful at interview when compared with BAME colleagues. Therefore, work is underway at RWT to embed cultural ambassadors in the recruitment process. Plans include the involvement of cultural ambassadors as an advisor and critical friend in senior appointment processes, with constructive and pro-active involvement from an early stage.

Diversity in the workforce is essential for providing a greater range of talent, a wider spectrum of creativity and providing a diverse range of perspectives.  Driving innovation and bringing a different range of skills together to cultivate an idea. Furthermore, a diverse workplace allows a range of voices to be heard. When we embrace and celebrate our differences it encourages acceptance and staff feel valued. Which in turn increases morale and encourages employees to actively engage in their work environment. If we want to provide care and treatment for our diverse communities, we must have a workforce diverse enough to represent those communities and provide insight into their needs.

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