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NHS organisations must face up to institutional racism

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It seems hard to believe the NHS could be a racist organisation. After all, its workforce is highly diverse and the people who work in it care passionately about reflecting the culturally diverse communities they serve

But does the service really do all it can to support the career development of all its staff – regardless of their background and heritage?

Recently I read Professor Dame Elizabeth Anionwu’s memoirs, Mixed Blessings from a Cambridge Union, which include recollections of her time in nurse training. One of her student peers believed that although Dame Elizabeth was extremely intelligent, she would never progress to being a ward sister because she was mixed race. Fortunately, Dame Elizabeth only heard this astounding revelation recently while researching the book, so she was unaware of the script that had been written for her, and went on to achieve truly great things in her career.

However, Dame Elizabeth was certainly aware of the other challenges she faced as a result of her cultural background. She changed her family from the distinctly British sounding ‘Furlong’ she had inherited from her mother, to her father’s name ‘Anionwu’ when she was an adult. And she speaks of how differently people perceived her when she gave what she describes as an ‘alien’ name.

But Dame Elizabeth was talking of a different time, the 1970s and 1980s – when racist ‘banter’ was the stuff of prime-time television comedy. Surely now, the world is a more fair, kind and just place?

Not so, according to Roger Kline’s 2014 report Snowy White Peaks, which revealed the inherent racism in the NHS. It revealed how staff from black and minority ethnic (BME) backgrounds fail to reach higher management positions due to discrimination. The number of BME people sitting at management or board level is shockingly low when you consider how many BME staff are employed in the NHS. And this isn’t only a problem for NHS staff. If senior managers making decisions about how services are run don’t reflect its diversity they will find it harder to recognise and understand the needs of large sections of the community they serve.

And it is not just at senior levels that you can identify such institutional racism.

I have sat in many sessions at Nursing Times conferences in which nurses have shared shocking discrimination and prejudice they have endured in their jobs. Often the stories concern being passed over for promotion because of unconscious institutional bias, but sometimes BME nurses describe having been actively penalised for their race or the colour of their skin, used as scapegoats and blamed for incidents that were beyond their control or for which white British colleagues should also have faced consequences but got away unreprimanded.

This week, we have heard something the unions have always suspected – that a disproportionately high number of BME nurses are referred for fitness to practise cases to the Nursing and Midwifery Council.

Recent research carried out on behalf of the NMC suggests that many of these cases do not go through the whole FtP process and are thrown out early, but the findings do indicate that people are referring more BME nurses for no good reason far more frequently than they do their white British nurses.

It is shameful that a service that is so reliant on BME (and overseas) staff can be so prejudiced. The chief nursing officer for England has set up a BME advisory panel, and that work is to be applauded. However, more needs to be done not just to highlight this issue, but to fix it.

Last year, a team at Barts received a Nursing Times Award for its work in helping to eradicate unconscious bias, and supporting staff to be proud of their heritage, gender and sexuality. As a result the trust is developing a more culturally diverse workforce that better reflects the East London community it serves.

It seems to me that if prejudice and discrimination are to be eradicated from the NHS the task cannot be left to a central body dictating a change of attitudes; change must come from within the service itself. And the Barts model appears to be working; over 150 BME staff have completed a course run by the team to help with career development, and gone on to accomplish personal and professional goals. So why aren’t more trusts focusing on that? After all, we have a retention crisis, and wouldn’t something that supports, listens to and helps staff to realise their potential also help ease that?

  • 6 Comments

Readers' comments (6)

  • I absolutely commend this article. This is something generations of BME nurses have been suffering on top of the challenges faced in practice. The fear of speaking out is because of being shut down and being told we're using the race card or playing victim when it's our reality. Unfortunately the people in the position of power cannot relate to being discriminated against and therefore cannot empathise with our plight. I believe in the good in nurses, however this particular monster is so ingrained into the culture I find it hard to believe it will be eradicated in our generation. Pessimistic, maybe, but my mother was a nurse for 30 years and really suffered racism at work, I'm new in the profession and have started experiencing the same, the only difference in that it's far more implicit for me. I doubt I will see real change, but I'm determined to actively challenge it.

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  • I applaud this article for exposing a sensitive and genuine reality that has often been overlooked. Changing a system of ideologies begins by acknowledging the problem and accepting it's prevalence. Sadly, NHS top governance teams don't accept that this is happening. Hence the situation is a norm in majority of Trusts. Arguably, the NHS has the most culturally diverse workforce in the United Kingdom but it's management does not reflect this fact. During my Nursing training, as a matured black adult Student Nurse I had to work three times harder than my white counterparts in order to get a pass in most of my placements. I was severely criticised and made to pay for minor incidents that my white counterpart make every day and get away with without any criticism. Sadly this is still happening. In all of this I make bold to say that we can testify of some positives. I have witnessed genuine NHS white management that are willing to bring about an uncommon change by treating everyone the same and providing equal opportunities. I believe so much in the NHS and I am confident that things can change. However, the actual change must begin from the top Governance teams and spread down.

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  • Excellent Jenni and thank you. The big question though is what can we do to make a difference? How do we sensitively and supportively address these issues without leading to further problems? Not an easy nut to crack but I for one would love to help try and break that shell !

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  • I'm a white senior nurse, having worked for the NHS for 20+ years. I've worked in ethnically diverse areas and have in my career been one of few white nurses working in a team, (which i have no problem with at all). In my field (mental health nursing) in London, BME nurses are over represented at Band 6, well represented at Band 7 and under represented at Band 8 and above. More should be done at Board level to give senior nurses a taster of what working at this level would look like. I believe the NHS for all its pluses is still guilty of cronyism and being too corporate. More should be done to support networking within the profession and encourage senior staff to mentor junior staff. At board level BME nurses should be well represented and the reason they aren't has nothing to do with ability or qualifications. What are organisations doing to tackle this? It seems an insurmountable progression for me also, I might add ;-) A glass ceiling for sure.

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  • Mertha Nyamande RMN

    I am fascinated by such articles and how the leaders are not keen and or able to take a stance on their systems. Institutionaliased racism has been highlighted in almost all government organisations, especially the public services. These kind of issues require courage; being able to take actions that most are afraid to take.
    My stance on this is that as a nation, you are required to set parameters for your people, and as immigrants come, they have to follow those parameters regardless. As I once read in one of the recent articles about immigrants fleeing from whatever place due to the oppression of their governments as a result of their systems based on their religions and culture, yet they want to bring that very religion and culture with them. How ridiculous is that for the receiving hosts to accept this?
    If you choose to go to Rome, you do what the Romans do. Isn't it that simple.
    Would you allow a visitor to your home to dictate to you how your routines should be?
    I believe that as visitors, regardless of how long immigrants stay, we remain visitors and should be treated as such.
    Political asylum is not a permanent status either; as politics in wherever states change, that asylum should be reviewed.
    I acknowledge that this view seems harsh, but I think it's a fair one.
    We can argue slavery and reparations, but you don't camp outside a prison because you have been wrongly imprisoned, or do you? You return home, regroup and adress whatever injustices with the support of your family and community.

    I therefore think there should be firm systems that encourage people to explore and experience whatever pursuits and safe passages, but to ultimately return to their homes despite intergenerational structures that exist.
    International immigration policy, by me.

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  • Finally the truth comes out! I'm a black foreign student nurse who has wrongly been referred to FTP twice! These referrals and all the wrongful allegations that come with it, are attached to my record as if they were true! If I wasn't so passionate about care work, I would have quit a long time ago.
    I have questioned nursing care when I didn't think it was up to standard, just to be shut down and later on realise my suggestion was accepted and followed, but not as mine (as of the very same person who had shut me down). Sad times, when going to work in a hospital feels like going to court, constantly having to prove you deserve to be there... instead of making a positive contribution in people's lifes! So much energy that could be redirected to better use... nursing should be about patients and not a "war" about cultural background or ethnicity.

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