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”
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”
“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.
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”
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.
“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.