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Diagnosing racism in the NHS

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BME staff in the NHS are still having to deal with BME staff in the NHS are still having to deal with prejudice from both colleagues and patients

The NHS’s commitment to caring for all has been a progressive beacon in Britain since the 1970s. But it is not immune to the problems of society as a whole. Specifically it’s treatment of BME staff still shames the service.

The release of the inaugural NHS Workforce Race Equality Standard (WRES) revealed that BME NHS staff still face more harassment and bullying than their white counterparts.

Roger Kline, co-director of the WRES implementation team, told Independent Nurse that these results ‘in the absences of any other explanation [show] significant parts of the NHS appear to be institutionally racist’.

The WRES report also revealed that harassment didn’t just come from patients but also other members of staff.

Some 65% of all community provider trusts reported a higher proportion of BME staff reporting experience of harassment, bullying or abuse by staff. The same percentage of community trusts reported a higher proportion of BME staff experience harassment from patients and the public.1 Data was also collected from acute trusts, ambulance trusts, mental health and learning disabilitiy trusts. It is important to note that no data was collected from general practice.

‘It is clear the NHS suffers from large scale race discrimination and has done for many years, failing to act effectively. This in my view is the first evidence based attempt to oblige all organisations to act on this,’ says Mr Kline.

Danny Mortimer, chief executive of NHS Employers, says that the WRES report makes for a sobering read and again compels the NHS to recognise that it is failing to make the best use of the talent available to us. ‘Employers in the NHS take this feedback from their BME colleagues incredibly seriously, and accept that we must change our cultures, attitudes and behaviours as well as improve our processes and policies.’

However, while researching for this article not a single person responded to a Twitter request from IN to speak about their experiences as BME nurses in the NHS. It seems that prejudice and racism is still a topic people tiptoe around and are afraid to speak about. But it cannot be resolved unless more people are vocal about racism.

Speaking up
‘I overheard the family of an elderly patient ask another member of staff whether it was possible for somebody other than me to be part of [the patient’s] care because of my ethnic background. At first I couldn’t quite believe it as we had worked very hard for this patient and treated their family with a lot of respect,’ one BME doctor, Clarence (not his real name) told IN.

He recalled that he had received a lot of support from colleagues ‘unquestioningly’, which made it easier to solve the issue.

Interestingly Clarence said he had actually experienced very little discrimination over his career. He attributed this to the perception of doctors as positions of authority. Clarence said he had seen greater incidences of bullying towards nurses (not just BME nurses) by patients and other members of staff. This could be because they were less likely to be thought of as having authority.

He also said that nurses on the frontline are very often the prime target for unpleasant behavior as they are the first person a patient sees when they are highly stressed or panicked.

However, Mr Kline says that there is no evidence that demonstrates that nurses are more susceptible to bullying from other members of staff. ‘In terms of bullying by patients there may be something in that would need to be checked,’ he says. He also says that this might differ between individual trusts.

He says that the CQC are now using their inspections to challenge Trusts on their strategies for supporting BME staff and that some Trusts are successfully implementing strategies to support BME staff.

‘Others are doing it because they have to and a few are finding this really hard because they arent convinced by the arguments or don’t think they are important or are just overwhelmed by other problems,’ he said.

Joan Sadler, the associate director of the NHS Confederation and the co-chair of the NHS England Equality and Diversity Council, says it’s important for any staff who feels like they are facing discrimination to know that they are not alone. ‘By building up allies and contacts across the board, you can grow support networks. It can be incredibly difficult to speak up about such incidents but you have to ensure that your wellbeing is being looked after. Nobody needs to be a martyr.’

The only way for such incidents to become less frequent is for those who experience them to be given the courage from colleagues and managers to speak up and take a position of zero tolerance against prejudice.

For nurses, who are guided by the 6Cs, they can use compassion to ensure that they are supporting each other when faced with such a situation.

Learning from other public services
Around two years ago a news story came to the fore that a couple had spent over a year demanding that only a ‘white British doctor’ should treat their child. The hospital subsequently allowed the care of the child to be transferred to a doctor that fit the family’s requirements.

This led Dr Nadeem Moghal, the medical director for Barking, Havering and Redbridge University Hospitals NHS Trust, to write an editorial for the BMJ highlighting that pandering to such requests only perpetuates the situation.2

Dr Moghal drew on the Macpherson report, released in the wake of the murder investigation of Stephen Lawrence in 1999, into racism in the Metropolitan police force, to examine the behaviour of the hospital staff.

‘Any organisation might find it hard to accept that it had behaved in an institutionally racist way but the Macpherson definition allows an understanding and creates an opportunity to strengthen the policies of public and private institutions, adding to diversity training, with the aim to make the enabling of racist requests a never event,’ he wrote.

Mr Kline says that when he first began this work he had hoped that the NHS would be able to learn from other public services but now he is not convinced that other public services are any better than the health service. ‘We now receive queries from other organisations about what we are doing well,’ he says. He also stresses it is important for Trusts within the NHS to learn from each other.

One example is the Bradford District Care Trust. It has developed a set of agreed metrics and KPIs to measure the impact of its BME strategy.

Part of the strategy is run in partnership with Bradford College and targets students on the second year of the Social Care Diploma to widen applicant field. Some 80% of these students are from a BME background. The Trust has also set a number of priorities to be progressed during 2016: these include promoting BME role models to help inspire colleagues to move into more senior roles, developing a support programme for unsuccessful BME job applicants to help them with future job applications and interviews and developing local workforce representation objectives.

As Mr Kline says there are certain Trusts and areas that through the implementation of strategies are helping to challenge racism.

It is concerning that archaic attitutes towards race and ethnicity still overshadow the most important purpose of the NHS: the care of a patient. Choosing a clinician based on their ethnicity or race shouldn’t ever be considered as a factor when drawing up care plans.

The NHS must take a non- negotiable stance on this and set this as a standard across the organisation. Only then might fairness and equality become tangible.

Workforce Race Equality Standard (WRES) report key points
  • Higher percentages of BME staff report the experience of harassment, bullying or abuse from staff, than white staff, regardless of trust type or geographical region. Community provider and ambulance trusts are more likely to report this pattern.
  • BME staff are generally less likely than white staff to report the belief that the Trust provides equal opportunities for career progression or promotion. This pattern is strikingly widespread regardless of type of trust or geographical location.
  • BME staff are more likely to report they are experiencing discrimination at work from a manager, team leader or other colleague compared to white staff, regardless of trust type or geographical location.
  • Community provider trusts and mental health and learning disability trusts generally report a higher percentage of BME staff experiencing harassment, bullying or abuse from patients, relatives or the public when compared to white staff.
  • Following learning from the WRES baseline returns and engagement with the NHS, key initiatives are underway to further support WRES implementation, including simplified and improved WRES data returns for 2016 and beyond.
  • Sharing replicable good practice and processes will be an essential element to help facilitate system-wide improvements in workforce race equality.

NHS Workforce Race Equality Standard:


1. NHS Workforce Race Equality Standard. 2016

2. Moghal, N Allowing patients to choose the ethnicity of attending doctors is institutional racism. BMJ 2014;348:g265

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