Analysis

Racism in the NHS: why nurses say structural discrimination is not a thing of the past

Prejudice remains alive and well, insist black and minority ethnic nurses’ groups

Racial prejudice remains alive and well in the health service, say groups representing black and minority ethnic nurses, despite the findings of a report by the Commission on Race and Ethnic Disparities

  • Official report caused outcry by asserting the UK is no longer rigged against people from minority ethnic communities
  • Nurses groups have spoken out against the report findings and describe the glass ceiling many nurses encounter
  • Find out what to do it you are a nurse experiencing racial prejudice at work or you see it happening to colleagues

Nurses have spoken out

...

Racial prejudice remains alive and well in the health service, say groups representing black and minority ethnic nurses, despite the findings of a report by the Commission on Race and Ethnic Disparities

  • Official report caused outcry by asserting the UK is no longer rigged against people from minority ethnic communities
  • Nurses’ groups have spoken out against the report findings and describe the ‘glass ceiling’ many nurses encounter
  • Find out what to do it you are a nurse experiencing racial prejudice at work or you see it happening to colleagues
The NHS and healthcare generally is rich in racial and cultural diversity, yet certain groups of staff face measurable disadvantage Picture: iStock

Nurses have spoken out about structural racism in the NHS in the wake of a widely-condemned review of race and ethnic disparities.

The controversial report by the Commission on Race and Ethnic Disparities, set up by the government and published in March, concluded that ‘the system’ in the UK is no longer ‘rigged’ against people from minority ethnic groups.

Outcry from nurses’ organisations about race commission report

It said that while racism and racial injustice still exist, geography, family influence, socioeconomic background, culture and religion all have a greater impact on life chances.

The commission also rejected the common view that people from minority ethnic communities have universally poorer health outcomes than white populations.

19.7%

of all nurses in the UK have a minority ethnic background

Source: NMC

Since its publication, at least 20 individuals and organisations named as stakeholders in the report have distanced themselves from the report findings.

A number of UK nursing bodies signed an open letter asserting that many healthcare professionals were dismayed by the report, claiming it used ‘inflammatory’ language. Signatories included British Sikh Nurses, the Cameroon Nurses Association UK, the Nigerian Nurses Charitable Association UK, the Uganda Nurses and Midwives Association UK, the Filipino Nurses Association UK, and the British Indian Nursing Association.

The RCN responded separately, stating ‘structural racism is real and often exerted a powerful impact’ on the life chances of minority ethnic nurses.

Criticisms included that the commission failed to acknowledge ‘well-established’ links between racism, discrimination, and mental health, or critical points on racial health disparities, including that 90% of doctors and 70% of nurses who died with COVID-19 were from from minority ethnic backgrounds.

Commission chair Tony Sewell said he believed the report would be positively regarded in years to come.

Race commission’s recommendations for healthcare

The commission, consisting of ten people, was formed to investigate race and ethnic disparities in the UK at the request of prime minister Boris Johnson in 2020.

All bar one of the commissioners is from a minority ethnic background and they were drawn from a variety of professional areas, including education, the media, business and science. They were asked to look at race and ethnic disparities in education, employment, crime and policing and health.

They made 24 recommendations, including:

  • A need to review the Care Quality Commission’s inspections of healthcare providers to include disparities in the experience, progression and disciplinary actions taken against minority ethnic staff
  • Improvement in understanding of the ethnicity pay gap in the NHS in England through a strategic review of the causes of disparate pay and exploring measures to address any disparities
  • Establishment of an ‘office for health disparities’ that would focus on research, communications and expertise to reduce health inequalities
  • That the term BAME (black, Asian and minority ethnic) no longer be used

Race-based variation in COVID-19 mortality

3,307

nurses from minority ethnic backgrounds progressed to Agenda for Change band 6 in the year up to 31 March 2020

Source: NHS England

Race inequalities were thrown into sharp focus during the COVID-19 pandemic, with disproportionate numbers of people from minority ethnic backgrounds, including nurses and other healthcare staff, dying from the disease.

In October 2020, the Office for National Statistics found ethnic differences in mortality involving COVID-19 were most strongly associated with demographic and socioeconomic factors, such as place of residence and occupational exposure.

Filipino Nurses Association UK (FNAUK) founder Francis Fernando says: ‘It is an injustice to say there is no institutional racism in the NHS and other parts of our society.

‘Nearly 80 of my Filipino colleagues died due to COVID-19 here in the UK – the majority of them working in the NHS and care sectors as front-line workers.’

Black Lives Matter movement ‘an opportunity for change in nursing’

Over the summer of 2020, Black Lives Matter protests took place across the UK, sparking national debate about whether statues and other tributes to historic figures associated with slavery should be removed from public places.

British Sikh Nurses founder Rohit Sagoo says such events have not been lost on the UK’s nursing profession, a fifth of which are from a black, Asian or minority ethnic background.

‘We cannot pretend discrimination doesn’t exist in the NHS. There is clear evidence nurses from minority backgrounds face more barriers to promotion’

Rohit Sagoo, founder, British Sikh Nurses

‘Black Lives Matter gives us the opportunity to change and be more reflective of who and what we are as a nursing profession, as our workforce contains many people from minority ethnic backgrounds.’

A multitude of faith and cultural networks have formed in nursing because people’s individual voices were not being heard in the NHS, he says.

Picture: Alamy

Nurses in his association feel that race is, ‘without a shadow of a doubt’, an issue in the workplace.

Mr Sagoo, whose association has more than 30,000 followers on Facebook and 4,500 followers on Twitter, believes race inequality exists in the NHS and reflects wider society.

‘On far too many occasions, nurses from minority ethnic backgrounds get passed up for opportunities for progression,’ he says.

‘There has been little or no progress over the years and the glass ceiling remains – some nurses have seen white nurses with little experience bypass them to senior positions.’

Culture of favouritism in the NHS and managers ‘choosing their own’

Mr Sagoo says there can be a perception of a culture of favouritism by management and charge nurses or matrons of white origin, who opt to ‘choose their own’ for a job.

Nurses from minority ethnic backgrounds also report distressing experiences in their interactions with patients and colleagues, he adds.

‘I have heard of South Asian nurses being told to “go back home” by patients, or being told their accents are too hard to understand.’

‘Diversity is everyone’s problem: valued, confident staff who are treated with equality and respect are going to be better staff and will have a positive impact on patient care’

Paulette Lewis, president, Caribbean Nurses Association

Rohit Sagoo of British Sikh Nurses

He also points to higher referral rates for nurses from minority backgrounds to the nursing regulator – something borne out in data from the Nursing and Midwifery Council (NMC). An NMC report in October 2020 showed nurses from black and minority ethnic backgrounds were more likely to be reported for disciplinary proceedings and to see their case go to the fitness to practise adjudication stage than white counterparts.

Mr Sagoo says: ‘We cannot pretend discrimination doesn’t exist in the NHS and we need to be open about how damaging it is. There is clear evidence that nurses from minority ethnic backgrounds have worse experiences in the NHS and face more barriers to promotion.’

What can I can do if I experience or witness racial discrimination?

If you have been subject to discrimination:

  • Speak to your line manager about your concerns, advises the RCN. And read your employer’s equality and diversity policy. If the response is unsatisfactory, consider submitting a grievance
  • Contact the independent Equality Advisory and Support Service for individuals who need information, advice and support on discrimination and the law
  • If you are a member of a union, contact your local representative, or if an RCN member, call 0345 772 6100
RCN advice on the grievance process

If you witness discrimination or harassment:

  • The British Medical Association (BMA) suggests you consider becoming an ‘active bystander’. Active bystanding may mean giving a disapproving look when racist jokes or comments are made, or being confident enough to express disapproval verbally

Or you could adopt the ABC approach:

  • A – Assess for safety and ask the individual who is subject to the harassment if you can help safely in any way
  • B Be in a group as it’s safer to call out behaviour or intervene in a group, or report to others who can act
  • C – Care for the person and ask them how they are

Adapted from BMA guidance

NHS pay gaps based on ethnicity

The race commission report pointed out that in 2018 the NHS became one of the first public sector employers to publish breakdowns of pay for all staff by ethnic group.

‘But the picture presented by the overall NHS data is complicated,’ the commission says, describing examples of both positive and negative pay gaps between ethnic groups, as well as examples of parity.

‘The weight of the evidence tends to point towards the white group receiving marginally more pay in staff groups,’ it concludes.

Care minister Helen Whately will soon chair a discussion of the NHS ethnicity pay gap to hear from people on the issues facing staff and understand what action can be taken, the Department of Health and Social Care (DHSC) says.

Leadership mentoring for a group underrepresented in senior roles

Mr Fernando has set up a mentoring programme for Filipino nurses, who are under-represented in leadership roles, despite being the second largest workforce group by nationality in England’s NHS.

There are 15,397 Filipino nurses in the health service in England and, according to Mr Fernando, there are only 22 Filipino nurses at band 8b.

‘Another priority of the association is to address the issue of unfair treatment when it comes to NHS pay bands. Most of our colleagues who come to the UK to work are very experienced nurses and yet they are paid at the lowest band 5 rate compared to newly qualified nurses in the UK.’

Workforce Race Equality Standard data

Meanwhile, the Workforce Race Equality Standard (WRES) has been monitoring NHS providers in England for workplace equality since 2016 and expects to see evidence annually of progress from organisations.

Latest WRES data reveals the percentage of NHS staff from minority ethnic backgrounds experiencing harassment, bullying or abuse from patients, relatives or the public has increased from 29.8% in 2019 to 30.3% in 2020.

Only 40.7% of minority ethnic staff in clinical commissioning groups and 71.2% in NHS trusts believe their workplace provides equal opportunities for career progression or promotion.

This compares with 88.3% and 86.9% of white staff, respectively.

‘It is absolutely time to be bold and courageous in naming racism and seeking to tackle it in a concerted way’

Wendy Irwin, RCN equalities lead

A DHSC spokesperson says the WRES has showed some progress in numbers of staff with minority ethnic backgrounds in very senior manager pay bands and board positions.

‘But we recognise there is more progress to be made,’ the spokesperson said.

‘Data can tell you one story, but a person might tell you another’

12

The number of executive directors of nursing from a minority ethnic background in 222 NHS trusts in England in 2020

Source: NHS England

While the WRES does help provide a national picture of how well NHS providers are tackling workforce inequality, some feel collecting such data is only one part of the solution.

Caribbean Nurses Association president Paulette Lewis says: ‘We can collect as much data as we want but sometimes things are happening in some organisations that people are not confident in voicing – data can tell you one story, but a person might tell you another.’

Ms Lewis says everyone, from the top of an organisation down, needs to be willing to listen and implement positive action.

‘We can talk it and have a vision, but this has to be embedded in people delivering the service and there has to be more joined-up working with diverse people – it is about practising what we are preaching.’

She suggests nurses from minority ethnic backgrounds need to be able to share their experiences in a safe way.

Although black and minority ethnic networks can encourage some to do so, others are afraid to speak out as they fear it might affect their chances of promotion, she says.

‘It’s how we capture information and lessons learnt to improve and change behaviours and practice that is really important.’

Staff with minority ethnic backgrounds mentor more senior, white colleagues

Ms Lewis feels reverse mentoring schemes, in which junior ethnic minority staff are paired with more senior staff from white backgrounds to share their experiences and skills, has the potential to be successful.

‘We all come from different places and cultures and have different understanding and behaviours. Reverse mentoring helps people to understand other perspectives and experiences.’

‘Diversity is everyone’s problem: valued, confident staff who are treated with equality and respect are going to be better staff and will have a positive impact on patient care.’

Chief nursing officer for England Ruth May says NHS organisations should continue to take a zero-tolerance approach to all forms of discrimination.

‘It is unacceptable for anyone in the NHS to feel unfairly treated, have less favourable opportunities for progression, or be harassed or bullied by those they care for.’

RCN equalities lead Wendy Irwin says college members had spoken about their ‘severe and persistent’ experience of racism, and wants to see a cross-government race equality strategy to hold employers to account.

‘We reiterated our calls for a national strategy to reduce health inequalities. We are disappointed the report is silent on these issues.

‘It is absolutely time to be bold and courageous in naming racism and seeking to tackle it in a concerted way.’

Reporting race hate

Anyone who experiences a race hate crime can report it by calling police on 101, or 999 in an emergency.

Those not wishing to report directly to police can do so through True Vision.

Further information


Related articles


Want to read more?

Subscribe for unlimited access

Enjoy 1 month's access for £1 and get:

  • Full access to nursing standard.com and the Nursing Standard app
  • Monthly digital edition
  • RCNi Portfolio and interactive CPD quizzes
  • RCNi Learning with 200+ evidence-based modules
  • 10 articles a month from any other RCNi journal

This article is not available as part of an institutional subscription. Why is this?

Jobs