Discrimination and NHS staff: stepping bravely into the grey

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Sadly, but perhaps unsurprisingly, as our recent report for NHS England discusses, a significant number of NHS staff still experience discrimination as a result of being gay, or Muslim, or disabled, or black African.

Our report is based on data in the 2014 NHS Staff Survey. Data is, of course, important, in highlighting the issues but only tells part of the story. For me, what is missing is the conversation, the human part of the story: the real-life experience of the hospital porter, the nurse, the doctor, the patient or carer who is experiencing discrimination.

As human beings we are designed to be aware of difference – that is, the psychological distance that people perceive between themselves and others who are dissimilar. Or, as my colleague Michael West puts it, ‘…the human impulse (even instinct) [is] to categorise others, on the basis of the flimsiest of differences, into members of "in-groups" and "out-groups" and to discriminate in favour of other "in-group" members or against "out-group" members’. It is human to be aware of this difference, but it is difficult to talk about it. We must acknowledge the need for – and provide the space to have – open, honest and safe conversations about difference and what it is like to be discriminated against. A space where you can ask me what discrimination feels like, and I can tell you my truth – that it hurts, and that I feel ashamed. A space that exists neither in the black nor the white but in the grey.

I believe that it is in giving voice and narrative to the experience, to the unspoken that is confined to the grey area, that we can begin to make progress. It will not be easy; we ought to expect resistance, challenge and difficulty, but that is even more reason to have this conversation publicly. It would raise our awareness of the more covert, subtle forms of discrimination that are much harder to identify, assess and eradicate.

Leaders at every level in organisations must take responsibility for creating a culture in which difficult topics can be talked about openly, honestly, and without fear of repercussion. They need to reinforce the value of a diversity of voices, views, skills, experiences and backgrounds to ensure creativity, innovation, good decision-making and effectiveness in teams. And they need to behave in a way that reinforces this. We know from our work on creating cultures of compassionate care that the key elements for a culture of inclusion are also those associated with high-quality health care. They include vision and values; clear objectives with regular feedback on performance; positive people management; emphasis on quality improvement, learning and innovation; teamworking and collective leadership.

In our report, we refer to an intervention that asks people to take the perspective of those in discriminated-against groups, for example, ‘If I spent a day in this organisation as a black person I would probably experience…’. In the words of Beverly Powell (in a recent tweet in response to the publication of the report): ‘If I could wave a magic wand it would be for a colleague non-BME to walk in my shoes for 24 hours.’

@WestM61 @rogerkline @positiveimagep if I could wave a magic wand it would be for a colleague non BME to walk in my shoes for 24 hours.
Beverley Powell (@sundaycherry), November 19, 2015

We know from our report that black staff report 12 times more discrimination than white staff, so this intervention could be very powerful. By asking ourselves what it is like to be that person, if only for a day, we are beginning an honest dialogue. For example, what did it feel like for the BME doctor caring for a child when the parents demanded a white doctor to treat their child and the hospital leadership agreed to this, effectively legitimising the discrimination?

We have to ask ourselves why the statistics no longer shock us, why report after report is telling us the same thing and despite well-evidenced research telling us what works, very little has worked in addressing this issue in the NHS over the past 20 years.

We need to be bold, we need to be courageous and we need to address the issue of discrimination one real conversation at a time. We need to create the conditions and culture in which it is safe to have these discussions without fear, without judgement and with real honesty in order to begin to understand how we can make the difference using the interventions outlined in our report.

We need to move beyond the black and the white and step bravely into the grey.



Comment date
21 February 2020

What happens if the staff are the ones being discriminatory against patients? What happens if they profile you racially and only offer to see you when you produce a passport? What happens when the staff allows white couple to walk through the door during a protected meal time but uses their body as a shield preventing you from going in after the couple? What happens when you make a complaint and the response you get is that the nurses did not recollect this event (meaning this didn't happen) the evidence you provide (WhatsApp with time stamp) was not accepted because the trust does not accept such evidence even though there was time stamp and information clearly stating passport were going to be collected because it was requested.

On claiming there was racist behaviour re: using body as shield by the auxiliary nurse (witnessed by a 2nd year doctor with the incidence been reported to a student nurse) the complaints manager still claimed this incidence wasn't racism and the actual nurse had never been reported eventually stating white couple were visiting dying relative (all in a bod to wriggle out of being referred to as racist). Even after escalating this case the trust claimed they are apologised and resolved it. Their apology was based on incidence that was not recalled and no racism according to them. After accusing them of apologising for no reason (no sane person apologises for not doing anything wrong) I was invariably called a liar since my evidence was inadmissible and totally ignored. I respect the work that is done by these people but I REFUSE TO STAND FOR INJUSTICE and will continue to fight until they acknowledge all these incidence happen and they apologise genuining.


cited/acclaimed as one of the top 40 people of Asian Origin to have influenced the development and shaped the NHS;,
Comment date
06 January 2016
this is a better report; it gets to the heart of the issue- the issue is RACISM not a proxy called discrimination. It has been happening for over 40 years; nice word don't bring about change; action does-
“The health service was built on the backbone of migrants. We are not just the backbone of the Service, the NHS is the backbone of us. It is us who took the strain”. Nurturing the Nation: The Asian Contribution to the NHS since 1948 http://nurturingthenation.org.uk/

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