People talked to us about experiencing ‘othering’ (ie treating someone as intrinsically different or alien to oneself) or micro-aggressions (defined as ‘brief, everyday exchanges that send denigrating messages to people of colour because they belong to a minority group’). This could come from patients and colleagues.
‘…there’s the feeling that sometimes you’re not understood or you’re treated maybe a bit differently… Or sometimes there could be comments made about your culture, your food, languages you might speak or where you’ve lived, where you’ve grown up. There might be some microaggressions going on… and they happen constantly…’
‘…patients really can be difficult. I mean, recently I had a patient who told me that I was the wrong colour to be English’.
Although much of the NHS is relatively diverse compared to many other workplaces, some people experienced feeling highly visible because of their ethnicity, for example being ‘the only’. At the same time, people felt invisible, for example being bypassed for career development and progression opportunities. The view commonly held among interview participants is that recruitment practices and decision-making are not fully transparent and appear biased in favour of White staff. Participants felt there are ‘in-groups’ (staff more likely to progress in their careers) and ‘out-groups’ (staff who did not have close enough relationships with the decision-makers, but equally or more qualified for progression).
‘… progression or recruitment… happen[s] via relationships; people tend to have relationships – especially White males [who] are dominating in central teams in [a national body]... Which is quite hard to stomach actually when you work extremely hard… I’ve not been quiet about this. And every time it’s a positive meeting when I meet the senior people to talk about some of the issues, that yes, we need to look at it. But then there’s death silence. Nothing ever happens past that.’
Although it is difficult to prove there has been any wrong-doing in recruitment practices, it was striking how often this theme came up across the different roles and parts of the NHS. People’s sadness and frustration about this point in particular was palpable.
Perceived bias in recruitment and promotion opportunities is a major factor in the lived experience of ethnic minority staff we spoke to. And when people have raised this issue with managers, they have found themselves silenced.
Many will be reading this with a distinct sense of deja vu. The writing has been on the wall for decades about racial discrimination in the NHS. In 1984, we published a paper on race and employment in the NHS in which Black nurses described ‘continual job rejections, difficulties getting accepted for basic post-training, and poor promotion prospects’. In 2019 there are workforce race equality standard (WRES) metrics showing how differently White and minority ethnic staff experience working in the NHS.
Even faced with compelling data, there is doubt – or possibly denial – that institutional racism is a reality in the NHS. And it’s possible that denial is a barrier to addressing inequalities.
To those in denial, I’d say try looking at the NHS work environment from the point of view of an ethnic minority person. For example, deciding not to wear a hijab or turban in order to make working life easier; or wearing a wig after being told unstraightened afro hair looks unprofessional; or moderating your tone of voice so as not to come across as too loud and aggressive.
'…we have staff that call it the plantation coming to work… I think as the Black staff are generally [employed in] lower bands and the managers are all White, so it becomes like a slave master type situation… there’s a lot of hurt and pain in that to say that you’re coming to the plantation but I know exactly why they’re saying it… you know, that constant reinforcement of we’re here and you’re there, we progress, you don’t. [You]’re more likely to go to disciplinaries, you’re likely to get sacked, all those things, messages that are proven with data. They’re constant.'
In her blog about inclusive leadership earlier this year, Tracie Jolliff (Director of Inclusion at the NHS Leadership Academy) pointed out how ‘deep work’ is needed for NHS leaders to understand and address discriminatory practices. A good starting point is making it safe to talk openly about discrimination and exclusion and follow up by making changes grounded in that valuable knowledge.
It’s important to note the outlook isn’t entirely bleak and there are reasons to be hopeful the NHS can work towards to inclusion for everyone. Examples of good practice can be found within the NHS – even if progress has been stubbornly slow. As well as learning about people’s lived experiences, we are also carrying out research in three NHS trusts where there have been promising signs of change, which we will share next year.
This valuable initiative to document the experiences of victims of racism is highly commendable. Compelling data indicating institutional racism in the NHS can be denied but it most definitely cannot be doubted.
I am reminded of the terrible tragedy of Stephen Lawrence whose death forced us to accept that institutional racism plagued the police force. I wonder how many healthcare workers will have to die before we open our eyes to this reality in the NHS!