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How it started… how it’s going: the experiences of migrants and people from ethnic minority backgrounds working in the NHS


It’s undeniable that the history of the NHS is also the history of migration to the UK; the two are very much entwined. 22 June marks 75 years since the HMT Empire Windrush docked at the port of Tilbury in Essex. On board were more than 400 people from the Caribbean islands with various professional skills, who went on to work in a range of jobs in British public services and industries. Many of them were answering Britain’s call for people to help rebuild an economy weakened by the World War II and to work in the newly established NHS.

The Windrush anniversary leaves me with mixed feelings. On the one hand, descendants of those passengers rightly show us their pride in the pioneering spirit of their parents and grandparents. That period evokes images of Black Caribbean women dressed in their immaculately starched nurses’ uniforms – perhaps joined by nurses from Ireland, Africa and India too. On the other hand, history tells us how hostile and unwelcoming the working and living environment was for Black people and other people of colour who were newly arrived. Our exhibition highlights how the people whose labour was needed to build the NHS – who answered Britain’s call – were subject to shameful racism.

Moving forward some 75 years, racial discrimination is still endemic to the NHS workforce; it is built into its very fabric. The NHS is renowned for its ethnic diversity; 24.2 per cent of people employed in NHS trusts are from ethnic minority groups. However, ethnic minorities make up only 10.3 per cent of very senior managers and 13.2 per cent of board members. The vast majority of the most senior leaders and decision-makers in the NHS are white. Further, white people are 1.54 times more likely to be appointed to jobs from shortlisting and staff from ethnic minority backgrounds are less likely to report their organisation provides equal opportunities for career progression or promotion. Layered on to that, staff from ethnic minority groups are more likely to report discrimination at work from a manager or colleagues (17 per cent compared to 6.8 per cent of white staff) and 1.14 times more likely to enter the formal disciplinary process than white staff.

Our research on race inequality and inclusion in the NHS workforce highlights how racism plays out on a day-to-day basis for people. As well as being on the receiving end of various types of microaggressions, staff from Black and ethnic minority backgrounds do not feel they have equal opportunities to progress in their careers. Angela said, ‘because I am Black, I hold back’ from showing up as her authentic self at work and asserting herself where the senior leadership is dominated by white men who she feels do not necessarily have to be as reserved. Because of widely held stereotypical attitudes, she was constantly treading a line between being perceived by colleagues either as an ‘angry Black woman’ or as ‘passive and dumb’. There are strong parallels between the types of discriminatory attitudes and behaviours that Black people described in the NHS of the past and the present.

It is striking that the NHS is still so reliant on looking overseas to help fill significant workforce shortages. Migrant staff today are still demonstrating that pioneering spirt and playing key roles in the NHS’s development – take for example May Parsons, the nurse who delivered the first Covid-19 vaccination given outside clinical trials some 20 years after migrating from the Philippines. But, as the evidence shows, the NHS still has challenges in treating its people with fairness.

Recent analysis suggests discrimination and inequality are key drivers for staff leaving the NHS. This underlines how urgent it is that the NHS takes action to prevent the situation from worsening; the NHS has more than 124,000 staff vacancies and simply cannot afford to lose people because of poor staff experience. So, what is being done to promote equality and inclusivity for NHS staff? NHS organisations are embedding staff networks and identifying other ways to support staff from ethnic minority groups to speak up about their concerns at work. In London, there is a strategy for workforce race equality that aims to diversify senior leadership, implement a white allies programme and transform recruitment processes and workplace culture. At a national level, NHS England has just published an equality, diversity and inclusion plan to address racial inequality on different fronts, including career progression opportunities.

Time and again, research has pointed the way towards developing more inclusive cultures and leaders have publicly expressed their concerns about inequalities and inclusion, committed to racial justice and declared that Black lives matter. 75 years since the arrival of HMT Windrush and the first Black nurses joining the NHS, it’s time to turn words into meaningful actions. Given the intrinsic involvement of migrants in the shaping the NHS of today, it’s time to honour that contribution by changing how future generations of staff from ethnic minority groups are treated – fairly, compassionately and inclusively.

Groups of nurses

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