Roger Kline: 'Denying race bias exists in the NHS is damaging to everyone'
In every aspect of NHS employment and in some aspects of patient services, evidence of racism is common, says Roger Kline
Fifty years ago women were less likely to be appointed to senior NHS jobs than men. It was deemed perfectly acceptable to ask women at interview if they planned to have children and, if so, to not employ or promote them. Women were paid less and got smaller bonus payments for doing the same job. It wasn’t seen as discrimination; women just weren’t as “good” as men.
All sorts of explanations were given why such discrimination was appropriate or wasn’t really discrimination at all. We were told employers should appoint and pay people on merit, not on gender. It just so happened men were better.
We all hold prejudices. They come from families, friends, schools, communities and the media. When prejudices turn into discrimination, it leads to unfair treatment.
Fifty years ago NHS discrimination against women, black and minority ethnic and Irish nurses, doctors and cleaners was common, although many people denied it existed or justified it.
Today, women become senior managers, and BME and Irish doctors can become medical directors and chief nurses (although not very often), not least because many practices common 50 years ago are unlawful now. However, discrimination in the NHS continues, albeit less openly.
The evidence of such subtle, unconscious NHS discrimination is overwhelming. The Discrimination by Appointment report by social enterprise Public World, for example, showed that shortlisted white applicants were nearly twice as likely to be appointed as shortlisted BME staff. Presumably, all shortlisted candidates met the person specification, so we need to know what happened, since this result suggests ethnicity influenced appointment decisions. Research shows similar patterns in promotion, discipline and grading.
‘All that is sought is a level playing field that allows those with the best potential to be appointed and treats all staff fairly irrespective of their skin colour - or indeed their gender, sexuality, disability or religion’
In every aspect of NHS employment and in some aspects of patient services, evidence of racism is common. Yet, on the last two occasions I set out the evidence in Nursing Times, I have been astonished at the responses that deny the existence of race discrimination or question the motives of those pointing to the evidence.
If we were discussing patient safety, we would say let’s look at the data, listen to staff and patients and act on the evidence. When presented with uncomfortable or unexpected information, it is right to question it but, when it overwhelmingly suggests a problem, we need to act.
Mid Staffordshire Foundation Trust responded to the indications that the hospital was failing with denial. Many people deny climate change is man-made despite the evidence. We should be wary of treating evidence of race discrimination similarly.
I don’t argue - and I don’t know anyone who does - that staff should be selected for jobs or not disciplined because they are in a BME group. All that is sought is a level playing field that allows those with the best potential to be appointed and treats all staff fairly irrespective of their skin colour - or indeed their gender, sexuality, disability or religion.
Staff who deny race discrimination exists in the NHS should ask themselves if they could recognise unconscious bias towards colleagues or patients. In patient safety, we start with the data, listen, then act. We should take the same approach with racial discrimination. This is not only because it matters to staff - research at Aston Business School reported a correlation between such adverse treatment and the patient experience.
Nurses who deny that racism exists in the NHS do themselves, their colleagues and patients a disservice. We need to talk about it.
Roger Kline is research fellow at Middlesex University and an associate consultant with Public World