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A hopeful moment? Addressing race inequalities in the NHS workforce


It's not by design that we’re launching two pieces of work about workforce race inequalities and inclusion in the NHS at a time of heightened focus on racism in society. Our research about the lived experiences of ethnic minority staff and how inequalities are being addressed by three NHS trusts took place before the Covid-19 pandemic and the recharged Black Lives Matter movement. The current context regarding race is a febrile one and the disproportionate impact of Covid-19 on minority ethnic groups1  (including health and care staff) has led many to feel angry about the sheer injustice of it all. Time and again it is those from an ethnic minority background who suffer the consequences of racial prejudice and structural inequalities when it comes to employment, education, health, justice and more. Honestly, I find this hard to write because I am angry too.

Of course, it's not a revelation that the NHS has long struggled with serious issues of institutional racism. The pandemic has just sharpened our focus on the injustices caused by decades of bias against ethnic minority groups. Ethnic minority staff are under-represented at senior levels of the NHS, they are more likely than their white colleagues to report experiencing discrimination and bullying, harassment and abuse at work. More ethnic minority doctors are referred by their employers to the General Medical Council for fitness to practice reviews than white doctors. It is already known that ethnic minority staff often feel uncomfortable about challenging management decisions or speaking up when they have concerns about patient or staff safety. There is some emerging evidence that during the pandemic they have been more likely to feel pressured to work in settings without adequate personal protective equipment and that discrimination may have played a role in them being more likely to be deployed in roles with a higher potential exposure to the virus. Serious consideration must be given to whether these factors have contributed to the apparent higher mortality rate among ethnic minority health care staff.

Perhaps what the statistics don’t reflect is what the daily lived experience of ethnic minority staff is like at an individual level. Today we’re sharing the stories of 12 NHS staff from different ethnic minority backgrounds told in their own words. They told us they do not feel they have equal opportunities to progress in their careers, that they have been denied developmental opportunities that appear to come readily to their white counterparts. Very few people at the most senior levels of the NHS reflect them. And, on top of that, each working day can bring a range of micro-aggressions from other colleagues.

'Well, always the managers above you are white, so again the role models are missing.  You don’t see role models, any people of colour in the higher positions even within your own professional background.'

'…the area where I did the six month secondment, a lot of the nurses, especially the black and minority ethnic nurses, were not getting the same access to specialist training, and it was a specialist area, so you would need that specialist training to move on.'

Responses from two interview participants

How does this compare to your own experiences at work? Do these lived experience accounts offer a clearer sense of the processes and behaviours that shape how ethnic minority colleagues feel at work? If your answer to the latter question is ‘yes’, then what more will you do to help address these disparities? Or what’s stopping you?

Our research also explored how three NHS organisations were addressing workforce race inequalities and inclusion. The interventions put in place in our case studies included networks dedicated to ethnic minority staff and using the ‘Freedom to Speak Up Guardian’ role as a safe way for ethnic minority staff to raise concerns about bullying and discrimination without having to go through formal channels. Our report discusses the complexities of interventions like these – informed by the individuals involved in embedding them. We saw the reality of culture change; that it is neither quick nor straightforward, but also that there is potential for changing the lived experience to be more inclusive.

It’s striking that some NHS leaders are calling for these same interventions to be used to mitigate the impact of Covid-19 on ethnic minority staff in the NHS . If anything will prompt change, maybe the pandemic will.

Racism and discrimination in NHS culture needs our urgent attention; we’ve seen what the very human cost of institutional racism can be. Recent events show it is not good enough to treat this issue as the thing that is too hard, too uncomfortable, too much to deal with right now – or something that ethnic minority people can sort out for themselves. We need better allyship, as exemplified by the powerful letter sent by Roisin Fallon-Williams to staff at Birmingham and Solihull Mental Health NHS Foundation Trust. We are tired, traumatised but hopeful about the prospects for change. There is no time like the present to look to exemplars that have already made some progress, learn from their experiences and pick up the pace.

'A long way to go': ethnic minority NHS staff share their stories

Read about the experiences of staff from ethnic minority backgrounds in the NHS

Learn more