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Fighting the system from within

BRIGHT SIDE OF LIFE: Yvonne Coghill by the King's Fund entrance (Photo: Bart Chan)

SUMMER IS in full swing. Yvonne Coghill bounds into the King’s Fund, central London, wearing a bright red polka dot dress. The woman who is going into her 35th year at the NHS clutches a John Lewis shopping bag; she could not resist the sales, she laughs, before apologising for being late even though she is on time.

While offering to buy me a drink in the building where “the who’s who of the NHS meet”, Coghill mulls over the best place to be interviewed. It is a disused office overlooking Cavendish Square Gardens. In the corner is a stack of cardboard boxes containing a plethora of files and paperwork. She politely asks if the room is okay, as she drags a chair into position.

“I went for three director level jobs,” she explains. “I decided that I wanted to become a senior leader, I wanted to become a director in the NHS, because that is kind of like the pinnacle, that’s where everybody wants to be, and that’s where everybody’s headed.”


Lack of ambition seems to have never been an issue for her, what has been though is the lack of leadership opportunities available to people from black and ethnic minority backgrounds – or the “visibly different”, a term Coghill employs to capture the demographic.

Coghill was born in Guyana and came to the UK at the age of seven. She has given her professional life to Britain’s health service, and has not been afraid to affect change where she has deemed necessary. Arguably it was rejection that spurred her into action, working for greater fairness and equality within the system.

Three times the response was no when Coghill applied for those senior jobs between 2002 and 2003. The former nurse who began her training back in 1977 recalls those moments of refusal. “I was told that somebody was better than me on the day.

“I’d given a lot to the NHS, I had worked exceptionally hard, and I felt I could, should, would and was able to contribute at board level. So when I didn’t get those jobs I became really, really unhappy and very de-motivated. And what happens to a lot of black and ethnic minority people, and others who go for jobs and don’t them, you lose your confidence, don’t you?”


In 2003, Coghill looked outside the NHS and was offered a job to work for the London-wide medical committee. Only two weeks into her new role, the office of then NHS chief executive Nigel Crisp got in touch with her. Crisp was preparing to launch his “brainchild”, a leadership, race and equality action plan – Coghill was asked to interview for the position of private secretary to Crisp.

Fourth time lucky. It was a turning point in Coghill’s career; by getting the job she was privy to a macro view of how the NHS operates. “It gave me what I call ‘helicopter vision’”, she says. “I was able to see what going on across the whole of England.” Crucially the new job bequeathed a mentor; Crisp became hers. “Mentoring has been the single most important thing that’s ever happened to me. Without one it’s like poking around in the dark. They open the door for you.”

The guidance and support from Crisp, new skills acquired, and her mission brief meant Coghill was able to bring change to the health service. She wanted to minimise the chances of other “visibly different people” experiencing something similar to her triple rejection to the coveted director position. Coghill realised her refusals were “actually not unique.

“It was incredibly common, and at that time there were only three black and minority ethnic nurses at executive-director level, out of something like 150,000 nurses.”

In 2004, the NHS chief executive unveiled the National Breaking Through Programme (NBTP). Coghill says Crisp “recognised there was a real issue that there weren’t many people at senior level from black and ethnic minority backgrounds, and that fact that we were becoming an increasingly diverse population.

“He felt that it was only right and sensible… So we could actually make [more informed] decisions for our population.”

When the leadership post for NBTP became vacant, Coghill successfully applied for the post. It was her time to show what she could do as a leader. Immediately she asked herself: “Why was it that some people constantly got to where they were going even if they weren’t fantastic, and other people, if they were brilliant, because of their backgrounds never got there?”


The theory of people hiring people like themselves crops up, and Coghill does not shy away from telling it how she sees it. “If you were to walk into a room full of chief executives in the NHS, you’d probably think that they were all clones, because actually they are all men in grey suits, aren’t they?

“And they all look alike, sound alike, a lot of them have been to the same schools. And if you always did what you always did, you’re always going to get what you always got.”

Diverse leadership facilitates cultural sensitivity in governance, Coghill predicates. “Think about this, if you’ve got a community in Southwark, for example, the population is from the West Indies, from Africa, from India, and you have middle-class white people who invariably live in the suburbs, if not further out, designing and commissioning services for them. They’re not going to have the full understanding of what that population needs and wants.”


Thus, it is more than simply making minorities in a workforce know they can aim higher. Coghill firmly believes everyone will benefit: “Unless you have people who understand the populations, designing and commissioning the services, the population isn’t going to get what the population needs.”

Nonetheless, patients may also reap the rewards of a higher quality service if all nurses and healthcare workers feel more included. Coghill cites the study made by professor Mike West of Lancaster University; “He said you could actually measure directly the satisfaction of patients by the happiness of the black and ethic minority staff.

“There’s a positive correlation”, she adds. “When you feel disenfranchised, disengaged, you don’t give that extra bit, and it’s that extra bit that patients need when they’re feeling vulnerable.”


Since the coalition government came to power in 2010, many people in NHS have had to adjust. Coghill included. “It was a shock to everybody’s system”, she says about structural changes initiated by the Tories. The organisation she has been a part of, the Institute of Innovation and Improvement, will wind-up in 2013. Yet because leadership is recognised as critical in the NHS, the Leadership Academy was conceived. The work of the former will pass to the latter.

Coghill allows herself a little hoot when asked whether the move has been cost-effective. She regains her composure: “It’s too early to tell, because we’ve only just started to work.”

The NBTP also no exists – a fact that Coghill remains “heartbroken” about. What has replaced it is an expanded version called the Leadership for Equality. And the energetic Guyanese lady opposite me is its senior programme manager. Her mission now encompasses minorities which are not only ethnic, but also other categories such as women, homosexual and transgender people.


“I think the jury is out”, says Coghill, unconvinced by this expansion. Opinion is divided she thinks “because each of those groups have got different issues, different problems and barriers to entry.”

The comparison of leadership programmes to a finishing school sits well with Coghill. “With our programmes we try to get people’s confidence up”, she says, the enthusiasm for her job transforming into a broad smile. It seems learning to be a self-aware social animal is high on the agenda.

“We talk to them about the importance of networking,” she says. Which does not simply mean giving out a business card, according to Coghill. “You have to be able to get into people’s hearts and heads. You make a connection. A lot of people don’t realise networking is a real art and skill. You have to work at it.”


Often that requires going to the pub with your colleagues. Coghill puts on a humorous, whiny impersonation for those inclined to find excuses: “‘Well, drinking is against my religion’”, she reverts back to her usual voice, “you can drink water!” Showing face and allowing others the chance to get to know you, are necessary ingredients to professional development in her opinion. “If you go to your bedroom and read your books, it’s not going to work for you.”

Back to helicopter view. The reason why programmes like hers are necessary, she says, is “the fact that the NHS is incredibly slow to identify talented people from black and ethnic minority backgrounds, and promote them, and keep them in the system.” In the NHS, return on investment is critical, along with delivering what is expected, Coghill points out. Therefore, her leadership work has been measured, and she is pleased with the statistics thus far: “68 percent of the people that went on the programme went on to take higher level positions.”


Furthermore, Coghill is keen to draw attention to the good others are doing within the system to break barriers to top levels – banishing such systemic nicknames as ‘Guinness effect’ and ‘snowy peaks’.

She name checks Jim Easton, national director of improvement and efficiency, and Paula Vasco Knight, a chief executive in the South Devon healthcare foundation, as “incredibly positive” examples who want to “make a difference.”

What does the woman who has spent three and a half decades employed by the NHS stand for? “Equality, inclusion and high-quality patient-care. Those are the things that really, really matter to me”, she replies rather self-consciously, probably not wanting to sound like a politician.

Despite those “enormous” structural changes from the Government – “We had a budget of £110 billion in the NHS, they want to reduce that down by 20 percent and want to do that by 2014, before the next election” – Coghill is adamant her leadership and equality work will remain on the system’s agenda.

Her spirit cannot be expunged. The only black girl who “learnt to fight” at a Bristol school of 1,700 becomes apparent in Coghill.

“If you don’t have good leaders then everything is going to fall apart.” Leadership, she says, is “being able to stand up for your values, and what you believe in and work to those values.

“You have to live them, everyday of your working life, so that people know what you stand for, what you believe in.”

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