Over recent weeks, we have seen a number of employment tribunals, independent reviews and an active petition to the UK Government to commission an independent inquiry into injustices suffered by Black, Asian and ethnic minority NHS staff. These are a sad reminder of exactly where the healthcare system is on its journey of tackling workforce race equality. They also remind us to pay attention to the hurt, trauma and long-standing impact these experiences have on individuals and their families, as well as the collective damage to the morale of Black and ethnic minority staff working across the healthcare system.
Tackling racism needs to be a fundamental leadership responsibility for everyone. This is not just about leaders recognising and understanding racism, but owning responsibility to be proactively anti-racist, both individually and collectively. Simple pledges and commitments are not enough, and neither is adopting the notion that this agenda should be ‘a golden thread through all that happens’ without a concerted and focused effort to tackle this scourge head-on. This means acknowledging and confronting racism in all of its forms – interpersonal, structural, and institutional – and taking explicit, practical steps to eliminate it.
This evidence is abundant. Not only is there long-standing, annually published, data from the Workforce Race Equality Standard, but more recently the General Medical Council also highlighted discrepancies in attainment for UK medical graduates from Black backgrounds who score the lowest in specialty exams. The British Medical Association (BMA) has also consistently made public, via member surveys, studies and reports, the racial bias which leads to many Black, international and ethnic minority healthcare professionals suffering disproportionate complaints or disciplinary procedures, as well as stagnant career progression. As a result, the BMA produced a Racial Harassment Charter which is now in operation in the majority of UK medical schools.
The last few years have seen a proliferation of initiatives aimed at tackling race inequity. As recently as November 2022, NHS England, in collaboration with the Nursing and Midwifery Council and NHS Confederation, launched a new anti-racism resource designed to support nurses, midwives and nursing associates with the tools to allow open discussion, investigation and challenge when it comes to witnessing or dealing with racism at work. One of its key aims is to support those in leadership roles to become inclusive leaders.
Sombre, first-hand accounts from nurses were also laid bare in the 2022 Nursing Narratives report, led by Sheffield Hallam University. This research details the experiences of UK, Black, Asian and ethnicity minority nurses, midwives and healthcare staff, all sharing their accounts of racism through the Covid-19 pandemic, leading to a call for an Anti-Racist Manifesto for change.
Prior to the Nursing Narratives report, the Royal College of Midwives also introduced ‘Race Matters’, a campaign pledging to tackle race issues within maternity services, giving support to midwives, maternity support workers and pregnant women. Finally, those organisations that continue to perform poorly on race equality in the workforce will keep receiving lower ratings as part of the Care Quality Commissions’ ‘Well Led’ assessments.
The evidence is overwhelmingly clear, and whilst we recognise that the above anti-racist policies and interventions are a step in the right direction, they are not sufficient on their own. The lessons should have already been learned, and the responsibilities should have been owned. Now is the time for comprehensive and holistic action.
Leaders must look towards the evidence-base of what works, and the practical action they can take to eradicate the root causes that lead to differential experiences and opportunities for Black, Asian and ethnic minority staff. They need to be supported to do so with stringent accountability and clear targets for improvement. We know that ensuring a more inclusive working environment for all staff is not only key to workforce recruitment and retention, but it also benefits patient care and saves the NHS millions.
The NHS Race and Health Observatory exists to identify and tackle inequalities, including structural racism and bias for ethnic minority communities, including members of our health and care workforce.