Breaking Barriers in Research and Policy: Shilpa Ross on Health Inequality and Inclusion

Are you intrigued by the inner workings of research and its profound impact on health policies? Join Professor Elaine Arnull and Julian Gwinnett in their captivating conversation with Shilpa Ross, a dynamic and passionate research fellow at the Kings Fund. We dive into her unique career journey, starting as a research assistant at the University of Hertfordshire, where she interviewed young offenders and discovered a heartfelt love for research. Shilpa offers an insightful peek into her family's reaction to her unconventional career choice and her exciting journey to influencing health and social care policy through groundbreaking research.

Their conversation takes an intriguing turn as they explore the challenges of embodying the public face of research and the critical importance of fostering a diverse research community. Shilpa revisits her impactful research that led to a recommendation to the ACMD not to criminalise individuals for cat use. This highlights how policy changes can significantly impact real lives. We ponder the importance of visibility of minority groups in research, a crucial step to build trust and ensure inclusivity.

In the final segment, we delve into Shilpa's experience leading a research project focused on race inequalities and inclusion in the NHS. She opens up about the daunting task of owning expertise in a field, especially as a woman in a position of power, and the urgent need to shine a light on the disparities in career opportunities between white staff and staff from black and minority ethnic groups. We wrap up our conversation by emphasising the importance of imagining a future where equality is a reality, and how collective effort can transform this dream into a tangible reality. So, if you're passionate about research, health policies, or social justice, this conversation with Shilpa Ross is an absolute must-listen.

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Transcript

Speaker 1: 0:00

We are recording this podcast at the home of Wolverhampton University's multimedia journalism degree in the Alan Turing building on City Campus. The radio studio we are sitting in is kitted out to the same standards as places like BBC Radio 4 and 5 Live. It was installed alongside two studios as part of the new Wolverhampton Screen School. If you want to pop in for a guided tour, to discuss booking the studios or to chat about the journalism undergraduate degree, just email the course leader, gareth Owen. His address is gowin3.wlvacuk.

Speaker 2: 1:00

I'm speaking with Shilpa Ross, who is from the Kings Fund and a researcher there, and we're going to be talking about research and research journeys. But I met Shilpa many years ago when she was Shilpa Patel and in my head she remains Shilpa Patel. So welcome Shilpa, and would you like to introduce?

Speaker 3: 1:19

yourself. Yeah, thanks, elaine. Thanks for having me. So I'm Shilpa Ross. I'm a fellow at the Kings Fund. The Kings Fund is a think tank aiming to improve health and social care in England and, as you've just said there, I've known you for a very long time, so it's like being, it's like a catch up.

Speaker 2: 1:43

It is, it is, and we had a catch up on the train this morning as well. So, shilpa, the conversation we're going to have, shilpa and I, is around research and staying in research, building a whole career in research and how you do that, because that's one of the things that I think it's. It's one of those. You don't meet that many researchers even, and you don't know how people build careers like that very often. So we met a really long time ago when we were both actually undertaking criminological research principally, and you've made that move into health research now. But so I just wanted to ask you what interested you in research in the first place and the sort of research that, when I advertised for a research assistant all those years ago, made you apply.

Speaker 3: 2:32

Yes. So yes, that was actually my first job, my proper job, out of university. So I did my first degree, which was in psychology and criminology. So that was the kind of subject area that I was that I was interested in, and I did actually want to go on to do a master's degree in forensic psychology. But to get there I knew that I needed to fund that master's somehow. So I saw this job. It was advertised in the Guardian.

Speaker 3: 3:09

You know, back in those days that's where you looked for a job in sort of academia and I, you know, spotted this research role and it looked like it was a fixed term contract and I thought, oh, I could do that because I did some research in my. So whilst I was doing my degree, as most people do, you do a dissertation and that involved doing some research, which was some interviews with people, and I really enjoyed that. So I thought, oh, that looks like a job that I can do and it's in an area that I'm interested in. So that's how I ended up working with you at the University of Hertfordshire and it was a really interesting job to do because it was about young offenders and it sort of brought me into contact and gave me exposure to all sorts of things that I could never have dreamed of.

Speaker 3: 4:13

That. And you know, there I was interviewing someone who had been, you know, arrested for and you know someone who had committed a crime and their their. I was asking them questions about themselves and it was just, it was kind of a wild ride, you know, something you could never imagine yourself doing, but was super, super interesting. And I think I caught the bug because I never went back to do that master, this master's, that master's actually never happened, so I just went from that first role to a see, onto a series of other research roles until eventually I ended up at the Kings Fund and and when you started this, so you said you you'd done your degree in psychology and criminology and you thought you'd like to do forensic psychology, probably because that's what people talked about and you heard about and learned about there.

Speaker 2: 5:16

But did you know anyone ever who'd done a career in research that you wanted to emulate or be like?

Speaker 3: 5:25

or no, really not. So it's not something that anyone in my family, for example, had, you know, established a career in. None of my friends or peers had like a similar job it was. Yeah, quite it was. It was a bit like breaking ground in into sort of new territory, something that was new to me but I definitely had an interest in and I sort of and I enjoy the process of discovery and, like I enjoyed the process of discovery and that dissertation and you know all of the research that I've done since then, every single project and there's been numerous it's that element that keeps me going and what did other people think about your decision?

Speaker 2: 6:17

what did your um? I mean, I know, much later on, mrs Patel's food became quite legendary in the research team we worked in, which is your mum's food. But you know, what did people that you were surrounded by your family and friends make of this? Did they think, oh, this sounds like a really good career.

Speaker 3: 6:33

Or did they think hey, um, it's probably more on the side of hey, um, I don't think to this day. So, mrs Patel, or um, uh, that's that's my mum, um is. I don't think she fully understands or could explain or describe what my job is. I did ask her at one point mum, what is it that you think I do? Um, and what she'd taken away from my descriptions was, um, that I go into prisons and tell people not to take drugs, and that's not quite right. Um, there were, you know um, aspects of uh, aspects of those that that description were in the right area. But no, that's that's not what my research job or my research career has entailed, definitely not, um, so it is kind of it's not very well understood in um sort of in in my family, but you know, I think they've made their peace with it that, um, I have a job and uh, you know she seems to be doing all right. So, yeah, very good yeah and I think I

Speaker 2: 7:44

mean, I think research is quite like that, isn't that?

Speaker 2: 7:46

yeah isn't it? Because I know the very first conversation we had over coffee this morning. Uh, julian as well, you said you know people don't necessarily know what a research career is, or they don't know what you do or how you get there, and I think that's still true. I would say my family are much like. What do you actually do? I think one of the things like appearing I remember, you know, appearing on lots of news programmes talking about research we did which was around girls in the youth justice system, or when we worked together and people suddenly were a bit like, ah, that's what she does every day.

Speaker 4: 8:25

I think we're so used to watching TV news programmes where we'll have like a sort of like an expert from a think tank and research from a think tank and people have an association with these people and the role they do as being from a background. That's not like them, and I'm very interested to hear how you're talking to yourself about how your sort of like pathway into research was almost a happy accident in a way.

Speaker 3: 8:51

I think that sums it up.

Speaker 4: 8:52

And without that perhaps you wouldn't have got into research, and I feel like we almost need to be thinking about how we sort of like present research as a career. The people understand, so when people are at school and they're going for the career's decision making process, they have an understanding of what a researcher is and also equally as well relating back to your experience their parents also understand what a research career is as well, so it doesn't seem alien or strange, but we fully understand the importance of it and the importance to it in terms of actually sort of like moving forward within our society and literally putting forward some of the ideas that come out of research into practice.

Speaker 3: 9:42

Yeah, I think very good point, and especially in a role such as mine. So I work now at the King's Fund, where our work is around influencing policy in health and social care. So how is health and social care set up, organised, delivered and how do people experience either of those services? And if people like me and my colleagues don't reflect the people that are essentially on the receiving end of those services, what does that say about how informed that policy is? So I think it's really important that anyone sees themselves in a job like mine, if that is your interest, really truly true for the stars, because it needs to be as diverse as it possibly can be.

Speaker 2: 10:58

And we're going to touch on that, aren't we? We're going to talk about that. So we moved forward a little bit and one of the things we wanted to talk about was how you made this move really from being someone who because your mum wasn't that far off we did spend a lot of time going into business, talking about drug use, certainly in substance use and its links with crime, and we did a lot of that research together, and one of the ones actually also that you are very well known for, was an absolutely seminal, groundbreaking piece of work on cat use in the UK, and I wonder if you want to?

Speaker 2: 11:36

I remember because we were a self funding research team and we had to earn our money as well, we were based in Middlesex University in London South Bank by that time, but we had to earn our money. But we also did bits of research individually that people were interested in, didn't we? And I remember you coming with the cat piece and saying you really wanted to do this and this was going to be your first really big leadership piece on your own as well, and about being able to take those steps in research, actually working independently as well as part of a team and driving forward. But that piece was for the home office.

Speaker 3: 12:14

So, yes, to give some context and sort of catch up with the timelines, because Elaine and I go back a long time and we've moved around to several places in that time so we then so, after the University of Hertfordshire, we then worked together again at an organisation called NACRO, which is the National Association for the Care and Resettlement of Offenders, and we were in the research and evaluation team there. And that's when a piece of work that the home office wanted to commission came in and the research was about the use of a substance called cat, which I hope my mispronunciation is forgiven there, but it's spelt K-H-A-T. It's a stimulant and it's got a sort of long standing history of use in sort of Eastern African region, particularly amongst Somali people. Just before I went to work with you at NACRO, I'd worked at the Drug and Alcohol Foundation where I'd done a piece of research for them about substance misuse in communities where English was not the first language and therefore how do people engage with therapy or counselling for their addiction. So it was understanding about that.

Speaker 3: 13:42

But that is where I first heard of this substance called cat and, as it goes, at the same time. So this was the mid-2000s. Don't we all feel old now. The home office wanted to actually repeat some previous research on Somali people who'd migrated to England and were using a substance called cat. My role was to lead that piece of research because I'd had a bit of experience in doing research about substance misuse so quite taboo, sensitive subjects and in minority communities, shall we say. My role was to lead that project from beginning to end and, bearing in mind I think I was in my mid-20s at that point, so definitely a good experience and I learned so much through that.

Speaker 2: 14:46

And it was one Chilpa. I remember that people had really strong feelings about within the community, didn't they? Absolutely. So there was quite a lot of negotiation with people in the community about how the report would look, how you gathered the evidence, how you reflected on that.

Speaker 3: 15:03

Yeah, lots of issues there about trust and about what it means to be, you know, in many circumstances, a migrant in a country where you are excluded from a number of things. And you know there was a lot of disadvantage going on, a lot of exclusion going on, social exclusion going on. At the same time, some people were continuing what's you know what was quite a normal cultural practice of using this substance called cat to in a social setting. It's got a history as a social substance to use and sort of misuse is not really. It wasn't really conceptualised in that way.

Speaker 2: 16:01

However, in so that was you know it was also gendered, as I recall, wasn't it?

Speaker 3: 16:06

It was, and so when you sort of so the pattern did change. So when people the Somali people and you know, and people from other backgrounds were using the substance, at that time it was unclassified. In England it was relatively cheap to buy a bunch of cat. However, if you're talking about families where there isn't a lot of money anyway and what you know what could be useful money is being spent on, you need to sort of to sort of fully feel the effects of cat.

Speaker 3: 16:43

You're using it for you know a number of hours, so you're away, you're, you know sort of you're in a cat venue with mostly men and that sort of taking time away from the you know the household. So particularly women were feeling understandably quite frustrated that money was being spent in that way. You know money that was not in huge supply was being spent and that you know men were not there to sort of be part of the household and support and so on. But there were other you know objections as well. It's also something that the you know the wider population didn't really understand.

Speaker 2: 17:30

Most of us who worked in substance use hadn't even heard of cats actually at that time.

Speaker 3: 17:35

Yeah, and it could, and you could see sort of quite you could see tensions sort of occurring because there would be groups of Somali men, for example, hanging around a venue, and you know there was a lot of distrust, sort of mistrust of that.

Speaker 2: 17:54

And some people in the community were worried about criminalization of the community as well. Exactly yeah.

Speaker 3: 17:59

So the piece of research was to understand patterns of cat use, also whether there was any other substance use related or unrelated, but happening as at the same time, whether there were any patterns of criminal behavior and a few other things as well. And it was research that it would be impossible for me as an Asian woman to, who had been sort of born and brought up here to you know, go up to a group of Somali men who possibly weren't born and brought up here to you know, ask them some pretty nosy questions about their cat use. So the point of the research was to engage a group of peer researchers, so people who are Somali who could carry out this research. So the research involved, as I said, some peer researchers and that would have been quite early use of peer research methodologies as well, yeah.

Speaker 3: 19:04

Yeah, and in valuable, there is no way I could have accessed those views on my own. And quite right, it's so. Research about a particular community or group it, I think it's much easier to do and probably more rich if carried out by you know researchers that reflect those characteristics. And yeah, it was across four cities in England, so I was here, there and everywhere.

Speaker 2: 19:40

Yeah, so, and I think that's one of the things like the varied requirements of research, it's not just an ability to engage with people and if it's qualitative research, ask them nosy questions, as you put it but also if it's quantitative research, being able to handle data or information in various ways, or research we often did which was bringing data and qualitative data. So quantitative data and qualitative together was, you know, in terms of mixed methods research? Yeah, but you're also working with other people to get them to once talk to you. Yeah, you know whether, from different perspectives, some people may be policymakers, some might be politicians, some might be people who are using a substance or living in a community. So it draws on lots of skills, doesn't it, as well as teamwork.

Speaker 2: 20:39

But you did this piece of research and then you were asked to go and speak to very senior policy Yep Body and I remember the fear, I remember you feeling you absolutely couldn't do this. Do you want to? Because and I think that's that translation, isn't it? What difference does doing research make and what conversations also need to take place for that difference to occur?

Speaker 3: 21:08

Yeah, sure, so this was the. So, as I said, this was in the mid 2000s and given the concerns that had been raised about the use of the substance, cat, and also the fact that that substance was banned in some European countries at that time and also in the US, so there was there was this sort of building building concern and the it was the advisory council for the misuse of drugs was the policy body that you you mentioned. There they were convened to assess whether or not cat should also become a classified substance under the misuse of drugs act and I was asked to present the research which was at the time. It was the only up-to-date study of cat use in in this country and it is. It's very we laugh about it now, but I was absolutely terrified.

Speaker 3: 22:08

It's for me to sort of talk you through that, that that feeling. It's one thing to do the research and you can feel, you know you can feel passionate about it and really engaged in it and it really matters to you to to do it and to do it well. But it is another thing entirely to be the face and name of a piece of research, to front it. But you have to do that. That is a necessary part of ensuring that that research doesn't just sit there. It has some impact and you can use the research, so use the data to influence some sort of change.

Speaker 3: 22:53

And and yeah, it was, as I said, I was, you know, fairly young at that time. But, interestingly, even to this day, when I'm, you know, in my mid 40s, I still feel that fear when I am called upon to be a spokesperson or to front something it can feel quite exposing it doesn't really suit my, you know my personality traits and you know I'm quite, you know I can, I can be quite introverted and I can feel quite, you know, like a rabbit caught in the headlights. But it was so important and you kind of have to get over yourself and feel the fear and do it anyway yeah, feel the fear and do it anyway.

Speaker 3: 23:41

And you know, the more and more you feel the fear and do it anyway, and then you realize, oh, that wasn't actually that bad, you know, and you've come down your heart rates back to normal and you've had a bit of time to sort of process and digest it, that wasn't that bad and I didn't do a bad job. It was, you know. You did a good job. It was. Yeah.

Speaker 2: 24:02

So actually your recommendation carried. It was carried by the ACMT at that time you're quite right.

Speaker 3: 24:08

Yeah, so at that time the recommend. So I did present the research and I, but I also drew, you know, attention to the fact that not enough is known about the use of the substance in the country. As yet we don't have all of the data that we need, but we also know that this is a community experiencing a high level of disadvantage. Anyway, there is, you know, what the data was telling us, is there, there wasn't really an association between cat use and any other substance use or any other or criminal activity. So it would have been, quite it would have been.

Speaker 3: 24:45

I'm sure if really and you know it could, it was. There was a real risk of criminalizing a group of people for for something that it didn't feel at that time the data was suggesting that was warranted and you know, driving something like cat use underground. You know that the the risks, I think you know, outweighed any benefits of classifying the substance, so that that was a recommendation that was making to the ACMD and they did at that time make the decision not to classify cat. It has, unfortunately since then been knocked out again and the substance has now been classified under the misuse of drugs out and I think that's one of the things we were reflecting on on the train, isn't it?

Speaker 2: 25:38

as we came up that, both through our career journey so I'd worked around drug treatment and testing orders and both the research and sort of campaigning with governments who not have those included in the criminal justice bill originally for people under 18, and at that time that was successful. Now policy changes and governments change and political opinions change, so things may change, but at that time your research makes that difference. You bring those conversations and actually people may reflect on those and come back to those. Yeah, and I think there were two things I wanted to pick up from what you'd said about talking about that experience, about research, and one thing was of the two things it was. The first thing was about you.

Speaker 2: 26:26

You talked about not wanting to be the person necessarily has to go in front. That and I'm pretty sure at the time if you could have made me go in into the room, yes, and speak, you would have done and you refused it. I did, I did reviews because it was your research and you needed to own it and I think that's the thing. But it's part of that is personality, because you are a quieter person and you don't seek the attention of the room necessarily, but partly as well. You're very unusual in that space. At that time Still pretty unusual, but at that time very unusual, and that was because you're an Asian woman. I think that actually you are always more visible and speaking major visibility even.

Speaker 1: 27:17

Exactly, yeah, even more visible.

Speaker 3: 27:19

Yeah, and it is. It's an uncomfortable part of the journey. But yeah, looking around in my sector it's not particularly diverse and you often feel like you are the only the only one and sometimes it suits you to just keep your head down and not draw attention to yourself, even when there is a burning question inside about this isn't right and you know questions about like, should it be this way? And yeah, even if you want to sort of raise questions or you know challenge why something is the way that it is, it's not a comfortable feeling to sit with and I don't always feel like I have the power to raise that challenge. What might the consequences be? Might I look like you know some sort of you know classic brown woman banging on about race, for example? It's not always attention that I've wanted.

Speaker 2: 28:37

Yeah, and I think that's the balance, isn't it around attention that you're seeking for your subject matter, or attention about yourself, but also being someone who was, who was driving a change just by being in a place, and that's certainly one of the things, wasn't it, julia? And I think that interested you as well is about how do people? Become those things?

Speaker 4: 29:04

And also, as well, the need for it as well, because you were talking a little bit early about how the need to actually win the trust of a community in order to be able to get them to actually be fully, sort of like, involved and willing to be involved in the research in which you're doing, and that obviously means that we need to be much better at actually having a more diverse research community, because that is one of the clear ways in which you actually do that when people from the communities actually see themselves represented in the people who actually come in to ask questions about those communities.

Speaker 3: 29:42

Yeah, it does I now, yeah, the lesson learned the kind of hard way or in a strange way, but yeah, I think it does. If we want to make positive change and if we want social justice, if we want the inequalities that exist to not be there anymore, we're going to have to do this research, we're going to have to roll up our sleeves and get stuck in, and it's not going to be possible until the research community is more diverse and is more capable and sort of culturally competent and has that awareness that's needed to come alongside people and ask some difficult questions about their lives and what might help you If it doesn't look like we have any kind of any common ground, you know.

Speaker 2: 30:46

Yeah, let's have some resonance, some basis of trust, some ability to engage with people, and people feel this might be coming from the right place. So owning that space and that's you know. We have known one another a long time, so I know how hard that is for you to take that step and say I own this space, this is who I am, this is coming with me into this space and I am going to tell you about that as well, so that you did that. But you also then made this move to this very prestigious, national, very well known research organization. Difficult to get into and in research, careers are quiet.

Speaker 2: 31:37

As you said, short term contracts and things like this Kings Funds are a proper job. You know you've got a job, so it's very prestigious all the way around. How did you? How did that happen? Because you moved out of criminological research in a way although substance use appears to be related and to health and you moved into this prestigious organization. And the person who moved into that organization is you, and you already know that there's not many people like you floating around in a research space.

Speaker 3: 32:12

Yeah, yeah. So, as you said it was, this was back in 2009 actually is when I first started the Kings Fund and I saw the job advertised again, I think it was the Guardian. I knew of the work of the Kings Fund and I saw the job and I thought, oh, I can actually see myself in that. I think I bring some transferable skills in doing qualitative research and, you know, I had a few years experience at that point doing research around substance misuse, as you said, which is, although you know it's quite specific, it does fit into sort of a healthcare space. You know the bit about transferable skills. Actually, that was true and that definitely helped because you can, at that point, you could just, you know, plonk me into an interview with a stakeholder and I knew what I was doing.

Speaker 3: 33:13

However, I did have a lot to learn, a lot both about what is health and social care. There were so, so many acronyms to learn. It really felt like. It felt like sitting down to watch a movie that had already started a couple of hours ago. You were trying to catch up. You were trying to catch up, you know, and I've been on a very steep learning curve, even though it's been well over a decade now, about what is health and what is health and social care, but also about influencing policy, which I didn't have that much experience in until I landed at the Kings Fund, and this is the really exciting bit. This is about using research to make a difference and working at somewhere like the Kings Fund, which is, you know, really widely known, well-respected, very established as being like an independent and authoritative voice on matters. When the Kings Fund speaks, people listen, people in power listen, and it's a little bit intoxicating, I have to say.

Speaker 2: 34:27

And having that direct relationship in a way that universities don't necessarily have.

Speaker 3: 34:33

And it just necessarily meant just having to up my game and you're really owning that. I do. You know, I do need you know. If I've done a piece of research, I need to front it and I need to say that I am an expert in something and you know this is why you need to listen to me. So it just it evolved in my time at the Kings Fund, so it's that sort of growth through being who you are.

Speaker 2: 35:02

Growth through knowing you know the job but also the prestige of the organisation around you in part becomes you it does.

Speaker 3: 35:13

You know it just kind of all naturally sort of converges. And you know I wouldn't want to make out that it's an easy journey. I think I think it. You know it's possible that you know, particularly women feel this all the time that they are imposters and there is, you know we're not the most expert and we don't know anything Because you're kind of, the messaging seems to be. You know that. You know women have a place and that's not necessarily a position of power. So it is. You know it's a constant thing that you come up against, whether it's you know something that you might feel from within or you know some vibes that you're getting from elsewhere. So not an easy, you know, smooth journey, but a journey nonetheless.

Speaker 2: 36:06

And then you decided to take the journey forward a little bit more, because you in the Kings Fund, you both undertake commissioned research, but you also suggest research projects. Don't?

Speaker 3: 36:18

you.

Speaker 2: 36:19

And propose them. And so you thought you just jump in on nice big one really and do some stuff around workforce and race inequalities and inclusion in the NHS, yeah, and I think I mean I always remember when you were proposing that and do and then doing that research it was. It was a big step really.

Speaker 3: 36:43

It was. So, again, to give some context, I'm so issues around workforce and culture is something that interests me, but I've been having some conversations with others who work at the fund and there was, you know, there were some rumblings. It was it was known that the experience of staff who are from black and minority ethnic groups is different to white staff. Opportunities for career progression are different. There are people from black and minority ethnic backgrounds who work in the NHS more likely to report bullying or harassment or being on the receiving end of discrimination. So there is a disparity there.

Speaker 3: 37:41

And you know I'd had a few conversations with colleagues about that and I just really, you know that led on to really wanting to investigate this further and to draw attention to it. And you know, what can we discover here about? What is it like? What is it like if you are black or from an ethnic minority group and you work in the NHS? What's it like for you at work, because this does have implications for what it's like as a patient, but what is it like? But also, what is the NHS doing to tackle this?

Speaker 3: 38:25

So yeah, following these conversations, I kind of put together a plan of how we might do this piece of research and, at the time, that involved. So, as Elaine mentioned, the Kings Fund can essentially commission ourselves to do some research or analysis if it's in an area that we want to have some influence, and culture and leadership definitely is one of those. Yeah, I remember going along to the planning committee, you know, with my, you know, with my hands quaking, with my sheets of A4 paper in my hands, thinking, you know, I'd assumed the answer would be no, but I was wrong. There was interest in committing resource to doing this, to doing this study, and someone remarked to me after that meeting. She said that's never happened before. That, you're, you know that research proposal has just sailed through.

Speaker 2: 39:36

So the people knew you needed doing. Yeah it needed someone to say we should do this and this is how we can do it. Yeah, yeah, and it was vision.

Speaker 3: 39:46

It was and it was. It was a kind of that there had been some hesitation about doing research like this before, but that's because, you know, the Kings fun didn't have a track record in doing research about race inequalities. But that's got to start somewhere, right? Yeah, so someone, yes, and I think that was the mood in that in that room. And then, yes, so I led a team of researchers and we did this piece of research that involved, in part, talking to people, interviewing them and asking them about what what it's like for them, but then also some case studies where so we went to three and HS trust, where it looked like they were promising signs of some action being taken around making the organizations more inclusive and tackling their issues around racial discrimination and just trying to understand what is it that they've done?

Speaker 2: 40:56

So yeah, trying to model on, look at, identify what's good practice and build models from good practice.

Speaker 3: 41:02

Exactly, yeah, so the piece of work is about raising awareness, putting some sort of adding some depth to what so the big date. There are big data sets about staff experience in the NHS, but we wanted to get underneath that and get you know, and that that's where really qualitative research comes into its own, because that's how you draw out the meaning of things and so just it.

Speaker 2: 41:36

So just in case anyone doesn't really understand what that means. So in a sense you might see patterns of people so you can see that you've got I don't know. 50% of the workforce is from a black or a minority ethnic group and 50% from the what I don't know the figures. On making them up 50% from a white workforce At level one, but at level two it becomes 60 or 70% white and 40 or 30% black or minority ethnic. And by the time you get to level five or something, which is the top level, it's from 80 or 90% white and five or 10% black or minority ethnic is. You can see the big data and everyone knew what the data was.

Speaker 2: 42:22

But maybe they'd say well, really, that's because some people are more on as ambitious, or it's the levels they work at in the organization, or do, do, do, do. So what you wanted people to do is tell you actually what happens in a day to day basis. That's the qualitative bit, and what does that feel like? So why? Why are you in the overrepresented in levels one and two and not represented properly in level five?

Speaker 3: 42:47

Yeah, that's, that's essentially it. So yeah, not quite those percentages I should.

Speaker 2: 42:53

I should stress.

Speaker 3: 42:54

Now.

Speaker 3: 42:55

I made those up, but that is actually the pattern that is quite well established about the NHS. It's called by another very prominent researcher, it's called the snowy white peaks of the NHS. That, yes, the higher up the hierarchy you go, it is majority white. I think it is changing. The pattern is changing in terms of gender diversity, but it is. You know, the NHS actually is, you know, a reasonably diverse employer. But it's where that diversity exists and it seems to be a much harder thing to do to progress right up to the very senior management levels or, you know, running the NHS.

Speaker 2: 43:49

And what do people say to you? Just very briefly, I'm not going to ask you loads about you what sort of things do people think there were around culture, Because I think that's quite general that many of us could learn from. What were the things? You know, I know universities are very interested in the culture and you know Julian runs the podcasts around diversity and inclusion and what sort of things did people say to you that that meant that that they were experiencing within that culture, I think the key thing that stood out was people did not feel that they had an equal chance to progress and they felt that there wasn't.

Speaker 3: 44:30

They were either actively denied opportunities to progress and were left wondering is this about the colour of my skin? And also it felt not very transparent where and how the decision making happens about senior jobs and they felt they didn't necessarily fit into or were included into the kind of you know, into the networks of power. Basically, and it's you know, career progression and lack of opportunities to progress was one of the key things that stood out from what people were describing, as well as you know what you might expect around you know, sort of being on the receiving end of microaggressions, etc.

Speaker 1: 45:25

Right.

Speaker 2: 45:28

So you did this piece of. Were you going to pop out? I was just going to say so.

Speaker 4: 45:33

So, in a way, to sort of like summarise from that. As I understand it, you have the big data set that basically just tell you how something is now, how something looks, but it doesn't tell you why. And it's that, that detail, that's missing. And that detail comes from actually hearing the individual stories. Now, one person's individual stories, one person's individual story. But when you start to combine that with many others, and which from that you start to actually glean patterns, that ends up providing you that information, that understanding of why the information you see in the big data is actually happening.

Speaker 3: 46:12

Absolutely yeah, I think, I think and I think people's stories are incredibly powerful and you know, and drawing them out through more qualitative research methods, I just think, makes for much richer, better and more accurate data.

Speaker 2: 46:31

Yeah, I think it enables you to understand the mechanisms that work, doesn't it? Absolutely. You can see what the patterns are, but it helps you to unpick and understand and tease out how those mechanisms impact in real life and practice. So the outcome of that research was it actually got a lot of attention, didn't it?

Speaker 3: 46:52

It did, and it's not lost on me that you know getting attention for something that is quite grim.

Speaker 3: 47:02

You know the irony of that is not lost, but it was.

Speaker 3: 47:05

You know, hopefully, the good that comes out of people you know sharing quite quite awful experiences about what they'd endured at work was that we were able to and this is, you know, the sort of intoxicating thing that I was talking about at the King's Fund, where we are able to use research and data to influence, and twice now I've been asked to give evidence at the Health and Social Care Select Committee, which is about MPs who you know across both you know across all parties, I should say who are, you know, carrying out an inquiry into.

Speaker 3: 47:55

You know many different things. One thing that was quite pressing is about workforce in the NHS and the fact that experiences are unequal and that this inequality is going on and they needed an evidence-based opinion and that so we were able to use the research to highlight what's going on, like the extent of discrimination that exists, but also what can the NHS do about it. And it keeps the pressure on and hopefully that means that, with that level of attention, that the requirement is that the employers do put in and do tackle discrimination and the exclusion that goes on.

Speaker 2: 49:11

Yeah, and I think that journey of this person who says so I don't really like to speak in a room who then says I've got this great idea for research, but I'm a bit scared about suggesting it, but suggests it and people say yes, and who then ends part of that conversation by saying so I've been asked to give evidence twice to the Select Committee I think that's quite a journey, isn't it? That's quite a journey in terms of both your personal journey of hearing your own voice and thinking it's worth listening to, but also a journey about a research career, from starting out with someone with a degree who says oh, I found that quite interesting, asking people questions.

Speaker 3: 50:02

Yeah, I know, look at me now.

Speaker 2: 50:06

And I think, because lots of the things are that people think that research doesn't make a difference, don't they? Yeah?

Speaker 3: 50:12

Yeah, or that you know that's very privileged being able to sort of investigate why something goes on. How about you know the reality of, actually you know, trying to make a change, but it's you know, research has its own unique contribution to making that change.

Speaker 2: 50:31

And I think one of the interesting things you said to me on the train up was that one of the ways you do present some research now is to imagine that so we're in 2030. And in 2030, we no longer have any difference in career progression in the NHS. How did we get there? What steps did we take? And I think that's quite interesting, imagining it that way around and trying to one pick those. So I don't know if you want to tell us what the driving force of doing it that way is and how you unpick that.

Speaker 3: 51:09

Sure. So I should say I've borrowed that idea. Shout out to Toby Lewis thanks. It's especially with a subject like culture change. It can make people feel quite stuck and it's really hard to know what to do. And this is so hard. People get sort of plonked quite squarely in the too hard not now, yeah.

Speaker 1: 51:34

I'll do that one tomorrow.

Speaker 3: 51:35

Yeah, yeah, or we don't have enough data, or there is, you know, there is always something or some reason, but I just think the stakes are so high. How can you not, how can you not want to change this, to make people's lives better, and it needs. I think people need a bit of shaking out of that feeling of it's too hard, and I think what can help is showing it's possible. You know, let's visualize it. Let's, you know, let's collectively think about a world that you know is better and there is less inequality. Doesn't that feel good? Right, come on With that in mind.

Speaker 1: 52:23

What are we going to do?

Speaker 3: 52:25

What are we going to do now and tomorrow and the day after? And not just you. What's your, you know, what are the people around you going to do?

Speaker 2: 52:33

Yeah, how are we going to do it together?

Speaker 4: 52:35

Yeah, and also as well, I think we far too often we think about what the cost might be involved and how difficult it might be to do this and what the benefits would be, because I think all too often we focus on and how it might actually impact on the lives of individuals, which of course, is absolutely important, but we never think about how it actually benefits all of us, how it actually benefits the whole of our society, and how an organization such as the NHS would potentially function so much better if there was much more, you know, equality, if people actually felt as they were, respected and valued at every level within the organization, how that would filter through to an improved level of performance across the entire institution. Absolutely that everybody would generally benefit from.

Speaker 3: 53:21

Yeah, High five for you, Julia. Not something that comes across on a podcast, I understand, but absolutely it does. You know, what matters to staff who work in the NHS is important because it will matter to what happens to patients and you know, you've got something like the.

Speaker 3: 53:39

NHS, which was, you know, it's set up to be the most fair, equitable, inclusive service you can imagine Free at point of entry, free at the point of entry, and you know how. You know it's actually so baffling that in that environment, in that same environment that was set up with those you know, with those goals in mind, this inequality can exist for patients and staff, I should say.

Speaker 2: 54:11

Yeah, because we know that health inequalities are really high.

Speaker 3: 54:15

Absolutely.

Speaker 2: 54:16

For things around maternity care or cancer care and things like that. So what next, Gilpa? What does what next in terms of research, but also what next in terms of you? And if you've got the, you know, if one of the people listening is the young Asian woman or an older somebody or other who's wanting to change their career, or anyone who thinks that could be me, knowing what you know, knowing who you were when you came in, what would you say to them? What would you say? How do you imagine yourself in that space?

Speaker 3: 55:06

Right, oh gosh, all the big questions. Thanks, elaine. So I think, in terms of advice, I was in preparation for this. I was thinking about what, how have I got here? How have I ended up here? And I think it's important here to shout out the people that I think have made the difference. It wasn't, this isn't just me, this is this. Was you, elaine? This was the next fierce woman manager that I worked with. That's Jill, and then you know a whole group of fierce women at the Kings Fund that I worked with, you know, for a number of years now, and one of those fierce women, ruth I'm going to shout her out as well. She gave me such a good piece of advice once and it's because I struggle with self-belief and self-confidence she said to me and it was almost through gritted teeth. She said she'd given me, you know, some good feedback.

Speaker 3: 56:20

And I was doing the sort of trying to deflect, and explain it away and minimize my role and, oh, I did nothing. And she said take the compliment. And I just thought that's actually quite a profound piece of advice, because the more you take it and stop questioning it and dismantling it, the more you might actually believe it one day that you did a good job, that you know what you're doing. And I think my advice is about so. It is take the compliment. But it's surrounding yourself with people who champion you and people who make you tick and you know who bring out the best in you and hopefully you bring out the best in them too. But you know, I think where I've got to is real sort of credit to you know the fantastic women that I've worked with along the way. You very much included Elaine, and it is practice. So, as much as I resisted, as much as 20 something year old me was, you know, running around the building trying to get away from you.

Speaker 3: 57:33

I think you were telling me to go and front this piece of research with the ACMD, you know, thank God. I did it because it's practice. You know these opportunities don't come along that often, so when they do it is about deep breaths. Do whatever you need to do to calm those nerves and get through it.

Speaker 2: 57:53

And the person won't be asking you to front it if they didn't believe that you could do it.

Speaker 3: 57:58

Yeah, exactly, and do they need to know all of the you know all of the inner turmoil? No, they don't. They need to know what you're expert in, that you can, you know, tell them in spades, because you've just been studying it, right?

Speaker 3: 58:11

Yeah you know better than anyone Exactly, and you know the more that you practice and practice and practice, the more you realise it wasn't that bad, it wasn't that terrible, and the more yeah, the more feedback that you get that that was that thing that you told me is really helpful. I think that that's the encouragement that you need and the sort of the fuel that you need to keep going.

Speaker 2: 58:40

And I think the thing with the NHS research and making the difference was the feedback from people who you ask what really happens to you, who were able to tell that story and see that story actually have an impact, rather than feeling like they told many people many times and nothing changed. Nothing happened. But actually this time they told a story, someone was able to get that story into the channels that would actually make a difference, where people would say we've got a serious problem around culture here and we need to change it.

Speaker 3: 59:18

And this needs to change exactly.

Speaker 4: 59:19

And that's why it's important that you're there, yeah, yeah, it's a very good way to end the conversation, wasn't it?