The NHS is the largest employer in the country. In many ways it serves as a microcosm of wider society. NHS trusts – hospitals, mental health, community and ambulance services – employ more than one million staff and collectively account for £92bn of annual expenditure. As the largest employer of Black, Asian and minority ethnic people in the country, the NHS has a particular responsibility to recognise and confront the structural racism and discrimination that still exists within the UK.
Recently the minister for equalities, Kemi Badenoch, spoke in the House of Commons about the Commission on Race and Ethnic Disparities, led by Dr Tony Sewell, which recently published its review into the causes of disparity in four areas — health provision, employment, education and criminal justice. The review was set up in response to the murder of George Floyd, global Black Lives Matter protests and concerns around the disproportionate impact of COVID-19 on ethnic minority people last summer. Upon its release the publication clearly downplayed the presence of racism within British institutions and structural racism across wider society, while arguing: "the success of much of the ethnic minority population… should be regarded as a model for other white majority countries”. The Commission argued that Britain is no longer a country where “the system is deliberately rigged against ethnic minorities".
As the organisation that represents all NHS trusts and foundation trusts, we disagree. Within the NHS, there is clear and unmistakable evidence that staff from ethnic minorities have worse experiences at work and face more barriers in progressing their careers than their white counterparts. The NHS Workforce Race Equality Standard (WRES) data for 2020 evidenced the persistent disparities. For example, at more than four out of five trusts, a higher proportion of Black, Asian and minority ethnic staff compared to white staff experienced harassment, bullying or abuse from colleagues in the last 12 months. Staff from ethnic minorities were also more likely to report experiencing this behaviour from patients, relatives or the public than white colleagues.
Since Roger Kline’s 2014 report, The snowy white peaks of the NHS, there has been some, but not nearly enough progress, in terms of diversity on trust boards and at very senior manager level. However, the WRES data also found that white applicants were over 60% more likely to be appointed from shortlisting compared to Black, Asian and minority ethnic applicants; a comparison which has not only got worse since 2019, but is also the largest gap in the past five years. Black, Asian and minority ethnic staff were also significantly more likely to enter the formal disciplinary process.
The NHS staff survey results for 2020 found that ethnic background continues to be the most common reason for discrimination. The percentage of those citing this has got worse since last year. Meanwhile, the data also found that less than 70% of Black, Asian and minority ethnic staff said their organisation provides equal opportunities for career progression and promotion, compared with nearly 90% of white staff. This sizeable and concerning gap is larger than it was five years ago.
The list of concrete evidence goes on. It would be disingenuous to suggest these numbers exist in a vacuum: trust leaders have been clear that their Black, Asian and minority ethnic staff face a set of barriers to career progression and job satisfaction that are not encountered in the same way or to the same extent by white colleagues. They are also clear that the racism and discrimination experienced by ethnic minority NHS staff in their everyday lives is replicated in the workplace and that this of course affects their ability to prosper and progress within the NHS; a double whammy. It is a simple and hard-hitting fact: structural racism exists within the NHS, across other public services and across society. To pretend that discrimination does not exist is detrimental as is denying the link between structural racism and wider health inequalities.
We need to take action on this. For the NHS, the recommendations put forward by the chairs and chief executives ethnic minority network in a letter to NHS England chief executive Sir Simon Stevens will be good starting point. The co-chairs of the network, Raj Jain and Patricia Miller, who are both trust leaders, listed three recommendations to make a tangible difference, using changes to healthcare delivery as an opportunity. One of their proposals is ensuring leaders in every part of the health system are held fully accountable for how they are tackling racism and other inequalities in their organisations and in the services they deliver across their communities. They urge leaders to be anti-racist, proactively calling out inappropriate and racist behaviour.
Alongside that, at a national level, as we seek to tackle the huge backlogs of treatment that have amassed during the pandemic, there is now a much more meaningful focus on correcting the inequalities of access to healthcare that we know arise due to ethnicity or deprivation. Waiting lists are rightly being evaluated and prioritised according to need, with a particular focus on deprivation and ethnicity – two factors which are in themselves linked.
So, as we mark the 28th anniversary of Stephen Lawrence’s murder, any shying away from the fact that racism remains prevalent within our societal structures and institutions imposes further harm and serves to belittle the day-to-day experiences of real people behind the numbers. It is only through acknowledgment that mindsets can change and privilege and prejudices can be dispelled. The failure to have an honest conversation about racism, its structural roots and its impact, will continue to result in harm.