Recommendation 2

HM Government Deferred

The government agrees with the committee that NHS trust leaders should set clear expectations for tackling racism and fostering an inclusive culture. The NHS needs and deserves the best leaders who foster an open, inclusive and compassionate culture. There is significant work underway to ensure that NHS leaders are equipped to deliver transformation in the NHS and to ensure that they are held accountable should their actions consistently fall short of the standards expected of them. This includes initiatives within NHS England, the Care Quality Commission (CQC) and NHS Resolution. NHS leadership and expectations The government committed in its manifesto to establish a College of Executive and Clinical Leadership within this Parliament, which will: • play an important role in managing and championing the new NHS management and leadership standards, and code of practice • provide access to development for managers and leaders that is aligned with the leadership and management framework The manifesto also committed the government to introducing a regulatory system for senior NHS leaders, as there is in place for clinicians, within this Parliament, which will hold senior NHS leaders accountable for their actions. In July 2025, the government set out plans to achieve this through a disbarring mechanism, which will prevent senior NHS managers who commit serious misconduct from working in senior roles within the NHS again. The forthcoming new NHS Management and Leadership Framework’s code and standards will include clear and measurable expectations around: • inclusion • valuing diversity • embedding inclusivity, equity and safety for all • tackling health inequalities Board members and trust leaders All board members, including chief executives, have specific objectives for equality, diversity and inclusion as per the Board member appraisal guidance. All board members are assessed against the NHS leadership competency framework for board members, which includes a specific domain to ensure leaders are promoting equality and inclusion, and reducing health and workforce inequalities. Embedding diversity in leadership In terms of holding NHS trust leaders accountable for creating anti-racist organisations and improving maternity outcome inequalities, the public sector equality duty (PSED) sets out the main statutory duty that all public authorities must, in the exercise of their functions, have due regard to the need to: • eliminate unlawful discrimination, harassment and victimisation • advance equality of opportunity • foster good relations NHS organisations are required to publish their PSED reports in quarter one of each new financial year, reporting on outcomes from data in the previous financial year. Regulation and inspection To further enhance CQC’s role in effectively holding to account trusts that fail to make progress, NHS England has established a quarterly meeting with colleagues from CQC, as well as the Equality and Human Rights Commission, General Medical Council, Health and Care Professionals Council and NMC, to share intelligence on system progress on the implementation of the NHS equality, diversity and inclusion (EDI) improvement plan and its 6 high-impact actions, along with system compliance with regulatory frameworks. In addition to the programme, there is a specific requirement in the 2025 to 2026 NHS Standard Contract. Delivery of the implementation of the EDI improvement plan is mandated in England. Therefore, there is a requirement for NHS organisations to deliver the high-impact actions and measure progress and impact on organisational culture and delivery of services. Furthermore, NHS England is developing a Maternity and Neonatal Equity and Equality Dashboard. The first iteration will contain 12 important data metrics relating to inequalities. Bringing together a range of inequalities metrics will allow trusts to see data in one place and track progress of initiatives against metrics in real time. This will help to change culture to one where tackling inequalities is seen as a priority. Trust leaders will be expected to use the dashboard when considering progress and ongoing initiatives. As has been demonstrated in various reports, CQC recognises the critical roles that leadership and organisational culture play in: • improving the quality of maternity services and outcomes for Black women • tackling the structural inequality that contributes to poor experiences This is assessed through the ‘well-led’ inspection criteria, which looks at whether there is an inclusive and positive culture of continuous learning and improvement that is based on meeting the needs of service users. As part of its trust-level assessment process, CQC has invested in specialist advisers with a specific focus on population health inequalities and workplace equality, diversity and inclusion, strengthening how we probe and evidence trusts’ progress in addressing health care inequalities more broadly. Through this wor