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!
Wonderful article Shilpa. Please could you ask Locum drs & Locum nurses who have been targeted with micro and macro aggressions on daily basis ? Innate traits of the powerful authorities and Judgemental people ( both staff and patients ) perhaps ?
I have worked in the NHS for 30 years. Time and again I was bypassed for promotion or jobs. Many times blatantly recruiting a white person with less experience and qualifications. I had secured funding from the DOH to study for an MBA and was refused time off. How painful was that when I had worked so hard for the organisation. I left and joined another NHS organisation to be able to continue my studies. Time and again, I have found people who want to bully, talk over you or simply ignore your presence. I have so much expensive and knowledge, but now I can no longer tolerate the culture and have decided to move and do something else.
Well, one aspect of your submission that I would like to contribute is bias in recruitment. This is so dear to my heart because as a BAME person I have been a victim on more than a couple times. The latest was a job in which the most essential aspect of the dob description i.e. essential qualification, was binned. I had all the qualifications but in the end the job was handed over to their crony. Even when other white persons within the department were so sure that the job had to mine. Aside the essential qualification debacle, everyone knew the work rate of both us. In the end I was told that this person performed 'slightly' better than me. So my manager mistakenly asked me to see him (he wasn't on the interview panel) if I needed some explanation. I obliged.
I went to his office and he went on and on about how there will be other opportunities for me blah blah blah. Then he asked if I had any questions. So i put it to him if he knew the person who got the job did not meet essential qualifications and that if that if it was not required then some of our colleagues (mostly white people) could have also applied and hoped for the best. It came to him as a surprised.
Unsurprisingly, there were rumours that I was not going to get the job because, for that person to have applied even though did not meet the essential qualifications the person was going to get it due to the relationship with the panel members. Lo and behold it happened!
In a couple of weeks I applied for similar post elsewhere who have diversity in their workforce and I got my Band 7 job. Since my departure, two other BAME persons have left for the same reasons. And we are talking about a hospital which struggles to recruit at all levels.
I had an exit interview but it was moot in that I was interviewed by the same group of people. I tried to be honest with them but where DO YOU THINK that will go? Perhaps to the shredder.
There has to be a novel approach to recruitment - one based on merits. BUT this requires massive institutional reforms.
I call my department the friends and family department with 2 mums and daughters in the same department what is fair about this they all came in via mum being a BAME in the same department working part time the unwritten rule is part timers dont get promotion and if you know the bosses that means if you smoke and drink with them your promotion is coming