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?