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NHS may be guilty of institutional racism, report claims

The NHS has left itself open to accusations of institutional racism after failing to ensure ethnic minorities are represented in senior roles, such as nursing director posts, suggests a new report.


The research highlights a lack of people from black and minority ethnic (BME) backgrounds in senior jobs across the NHS. The report − titled The “snowy white peaks” of the NHS − calls for urgent action to tackle “widespread, deep-rooted, systematic and largely unchanging discrimination”.

The report’s author, Roger Kline, told Nursing Times that efforts to tackle discrimination and promote racial equality should be given the same priority as safe staffing levels, because of the clear link between staff welfare and patient outcomes.

“It looks to me as if there may well be institutional racism”

Roger Kline

Mr Kline, a research fellow at Middlesex University Business School, looked at the ethnic make-up of trust boards in London, finding the vast majority of senior leaders were white, despite the ethnic diversity of the populations they served. 

He found the pattern was also repeated at national level, across key organisations like NHS England and the healthcare regulators.

It was a particular issue in nursing, he found. The proportion of directors of nursing from BME backgrounds had not increased in the last 10 years, remaining at around only 3%.

In addition, the proportion of BME nurse managers fell from a peak of 8.7% in 2007 down to 7.8% in 2012, while a recent survey of trusts found few BME nurses at bands 7 and 8.

Mr Kline said his findings revealed a lack of a clear national strategy and confusion over who was responsible for leading on the issue.

He argued that a failure to support and promote BME staff could be interpreted as institutional racism, similar to that uncovered in the police by the McPherson Report into the murder of Stephen Lawrence.

“We clearly have a problem with a lack of BME staff in senior positions”

Paul Deemer

“It looks to me as if there may well be institutional racism, but it really depends on how the NHS responds to this report,” he said. “In the past, there has been denial that things are as bad as they appear to be.”

Key issues for nursing included the fact BME nurses were more likely to go through disciplinary procedures or be referred to Nursing and Midwifery Council. “There are some big hospitals where only BME staff have been referred to the NMC in the last two years,” Mr Kline said.

One area for improvement was the induction, support and training available for nurses coming to work in the UK from abroad, he added.

“If we’re going round the world recruiting international nurses we have a responsibility to make sure that when they arrive they have the right support, rather than setting them to work straight away and being surprised when they do things differently,” he said.

Roger_KlineRoger Kline

Nursing directors also needed to review data on disciplinary procedures at their trusts to gain a better understanding of the reason why BME staff may be disproportionately represented.

In addition, the report suggested BME nurses are less likely to be put forward for career development opportunities and leadership courses. Mr Kline called for a far more “pro-active” approach and said managerial claims of “unintentional bias” were not an acceptable excuse.

“This isn’t just about ethnicity, it’s an issue of diversity”

Gail Adams

Unison’s head of nursing Gail Adams said there was “insufficient diversity in leadership across all disciplines”.

“This isn’t just about ethnicity, it’s an issue of diversity so the top is made up disproportionately of white men,” she said. “This about ensuring the whole spectrum of NHS leadership reflects the diversity of the NHS workforce and the population they serve.”

Career progression was an issue for all nurses, she added. “The reason I think BME nurses are under-represented is we do not have a clear career pathway for nursing full stop,” she said.

Bernell Bussue, Royal College of Nursing regional director for London, added: “These problems can only be addressed by a change of culture led from the top.

Bernell Bussue

Bernell Bussue

“The report is right to call for urgent action to better use the talents of all NHS staff, including those from black and minority ethnic backgrounds.”

Paul Deemer, head of equality, diversity and human rights at NHS Employers, said: “We clearly have a problem with a lack of BME staff in senior positions.

“We completely understand the report’s concern about institutional racism in the NHS,” he said. “This is a system-wide issue and will need system solutions involving national organisations and regulators.

He added: “We have been encouraged by recent public debates around the need for quotas and positive action, which were strengthened by clear voices from the government.”

An NHS England spokeswoman said: “We share Roger Kline’s concerns at the lack of BME staff at senior levels within the NHS and the potential impact on patient care in the NHS. 

“As an organisation NHS England will lead by example, implementing our Equality, Diversity and Inclusion in the Workplace Strategy to ensure that we have a workforce representative of the patients and population we serve,” she said.

“We are disappointed at the representation of BME staff in management roles in our organisation and we will work to improve the situation,” she added.

Readers' comments (21)

  • So all the ills of the NHS will be solved by having more BME applicants in managerial positions? I can't even be bothered to rip this rubbish apart. Hope you get lots of work from this Roger.

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  • so glad I no longer work in the NHS or in the UK. you say one word, perhaps in a moment of anger or frustration, and it runs the risk of being misconstrued causing any situation to escalate fast escalate out of control. we are all only human with all of our weaknesses and limitations which people tend to focus on rather than our strengths and the very rich and rewarding tapestry of interpersonal relations and everything everybody can, if permitted, bring to them. people need to learn to appreciate their own and each others differences instead of always looking for and perceiving them as failures.

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  • Anonymous | 11-Apr-2014 6:52 am

    If you read the report there is no suggestion whatsoever that "all the ills of the NHS will be solved by having more BME applicants in managerial positions"

    Other robust research (not by me), some of it funded by the NHS, does show the importance of treating all staff fairly and developing the talents of all staff.

    This is simply not happening at the moment. There is a wealth of research showing this.

    If we deny there is a problem we wont be able to solve it. And that would be seriously bad for all patients.

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  • I feel as if Mr. Kline has painted a starkly truthful picture that challenges people's perceptions of the NHS.

    Had I stuck to applying for jobs in the NHS I would still be a jobless nurse.

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  • I agree with every comment made so far how ever it does not apply to all the NHS Hospitals

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  • And is not only at work, even in universities and colleges it is somehow unfair, more especially for Nursing and other Health care courses, am sorry to say this, but it is true, no matter how hardworking and committed you are, you will always see reluctant people admitted in unis or colleges, and tomorrow they will be many stories about bad care or whereby people were not sure if they wanted to do the job.It is really heart breaking as an committed and passionate nurse to be in future, and struggling to get into uni though doing well in college and work.

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  • so we will now end up with positive discrimination, where ineffective and downright useless BEM nurses are promoted simply BECAUSE they are what they are. How about just sticking to the simple rules of any employment and only promoting those who are able to do the job? Sick and tired of bleating 'do gooders' who actually are only interested in getting their names in print. The next thing we will have is another £9million spent on a report on this, just to please these 'researchers'. Absolute rubbish

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  • I have been kept down because of colour in the past. I used to feel bad about it, but no more. Most important for me now is to do a good job and enjoy my life in my way.
    If I was younger though I would have more ambition.
    I would never like to see positive discrimination for any job. Always may the best professional get the post.
    We need leaders to be good, fair intelligent, hard working and have a real passion for high standards.
    I have seen too many failing, weak leaders.
    Time for good, strong leaders to lead the way in nursing and may I add in politics too.

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  • Well done Roger Kline for ensuring that this issue is brought (again) to the notice of the management of NHS and its staff.

    This is not about positive discrimination. It is about raising awareness to the fact that BME nurses who have the expertise and knowledge are not promoted and developed in the same way as their white, British colleagues.

    This is not about being a "Do gooder". It is an honest account of what is happening in the NHS and is reflected in other studies.

    There is racism in the NHS and we have to acknowledge that before we can move forward and address it.

    For the record, I am not from a BME background, but I see discriminatory practices from all levels within the NHS.

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  • To be honest on the day of the interview the best person gets the job.
    The nationality of the applicant doesn't come in to play that much.
    All applications as such are made to be so that you cannot tell who they are via computer.
    If some people do not interview well then this is what needs addressing. Teach staff how to apply for jobs and interview well. Show staff how to blossom and grow. Do not blame racism.

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  • Colour/Ethnicity are not vital factors when filling positions... How about the best person for doing the job? Surely that is a more relevant consideration???
    Political Correctness is one of the unreasonable reasons why the NHS and this nation as a whole is going down the toilet!

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  • As a union steward, I have wondering for a while now, why I continue represent an overwhelming numbering of BEM nurses in disciplinary and competency cases. As individual cases they are difficult to defend. Each and everyone will have made mistakes. However, can we really say that their practice is worse than that of their white colleagues. I really do not think so.

    Something is wrong somewhere. Is it about access to training, expectations of failure or just plain old fashion racism. It is probably a complicated answer but one that many in the health service just do not want to hear,

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  • There is also discrimination against whites. I work in a dept where a Muslim does as they like, whilst the rest of live in fear of raising any concerns and stick to policies. Guess who the boss is?

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  • So many of these comments inadvertently prove this article is correct. Of course the NHS is institutionally racist, it has a culture of institutional bullying and turning a blind eye when such things go on. It would be so typical of the nhs to react by putting a few people in senior positions while not tackling a culture where, among other things, racism can flourish and go unchallenged.

    Perhaps the speak out safely campaign should be extended to speaking out about conditions for staff not just for patients.

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  • the is institutional racist on both counts black to white and versa if they cant get there own way this is slaped around? ie if bem don't want to certain nursing skills if trained to do, why are you in nursing this applies to white people if you will not do the job get out!!!! and let some one else have it and not sit on their asses,when every one else is trying to keep jobs up to date.

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  • I'd buy this NHS racism spiel were it not for the fact that I've worked in areas where every single consultant was BME. Where the medical director was BME; where the director of finance and communications were BME.

    It's 2014, not 1960. I don't know anyone whose even bothered about a doctor or a nurses ethnicity. Only dinosaurs like the author keep this nonsense alive for their own personal gain.

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  • Agree with the being 2014 comments. In my Trust there are BME nurses in posts band 6 and above, and other professions.

    I think it should be as already said 'the best person for the job'.

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  • john warwick

    Gee did you just figure that out, I know its has existed for years and nothing is done the NMC and RCN are all white and most senior hospital chiefs and senior nurses are white . I know this to be true when I worked at ealing hospital, because in 1999 they were proven to have an Irish mafia group of senior white nurses who mistreated minority nurses. nothing changed and it is still the old boy network and whitewash. just look at the majority of nurses who are refered to the NMC are minorities, I have seen white nurse do ethical violations but nothing is done while any little mistake by minority staff was punished severely

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  • well in some places in the world..ah hem... USA positive discrimination is in full force. If you say anything about one's no good work ethic AND IT"S are considered a racist.

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  • Best person for the job!

    I have come to realise that it is only when we have personal experiences in situations that they become believable and we can begin to understand them. Racism is one of these things..... to the person who never gets discriminated against or see someone who has been, why would you need to open your mind to believe that it exist?

    The NHS has some of the best written policies to suppport Diversity and Equal Opportunities. But if you believe that this is more that a beautiful paper exercise you are mistaken. These policies are very difficult to implement or to challenge an organisation using them.

    The reason that there are so few black and ethnic minority individuals as senior managers or on Trust Boards are multiple factors...

    Fear of differences (physical, cultural)
    Lack of support to do these jobs
    Lack of access to training
    Lack of oppportunity to be considered for these jobs.

    Many BME get through the application process for senior roles if their names are english or they did their training here in England. However, at interviews I have felt that I should assist some managers to lift there jaws frow the floor when they see me.

    I have been to interviews where they seem to be interviewing me to justify not giving me a job.

    I have been to open compitition with others nationally for jobs, been to assessment centers and came out as the perferred candidate and then at interviews not been given a job.

    Feedback from one interviewer was that I was "so lovely"??

    I have been in some jobs where my seniors have much less experience and knowledge than myself? Therefore what does being the best person for the job mean? whose best?

    Following the recentent restructure of NHS organisations, I invite you to look at the breakdown of the high numbers of NHS managers from bme background who lost their jobs, given the small numbers of these staff who were in these jobs in the first place.

    So to those of you who have never experienced racism and I hope that you never do, please do no assume that it does not exist. Please ask yourself a question can all bme staff be bad at their jobs and the only ones to make mistakes? Do bme staff perform badly/or are poor at managements?

    There is something colonial about senior positions in nursing management in the NHS and I sugggest that there is a very "real" and "low" glass ceiling for bme nurses. Unless something is done they have no chance of progressing to senior management far less to a Trust Board..

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