Toxic race equality climate persists in the NHS, RCN warns

Short-term initiatives 'fail to deal' with discrimination against black and minority ethnic talent.

Short-term initiatives 'fail to deal' with discrimination against black and minority ethnic (BME) talent

White peaks
Illustration: Daniel Mitchell

The RCN has warned there has been a ‘negative and toxic climate’ about race equality in the NHS that has been extremely unproductive in terms of seeking solutions and bringing discrimination to an end.

The college says the health service has a history of attempting short-term initiatives that fail to tackle the ‘inherently structural nature of the problem of race discrimination’ and wants the government to develop a coherent and long-term race equality strategy.

This strong stance is part of the RCN’s response to a call for evidence by Baroness McGregor-Smith who is leading a review on the issues faced by businesses in developing BME talent.


One of the review’s aims is to identify the barriers BME groups can face in the labour market and why educational attainment and ability does not always match up to position in employment.

The RCN response adds: ‘We do not believe that the situation currently experienced by many BME nurses and healthcare support workers can be explained by reference to perceived differences in motivations and ambitions, or as a result of the view that BME workers lack qualifications or formal skills.

'The RCN is clear that employers should not rely on ‘single, short-term, poorly funded and little-understood interventions to tackle matters of the size and complexity of the issue of race discrimination’.  

The college says that organisations should recognise that culture change and progress are not simply the operation of good fortune or accident, but must be properly resourced over time.

NHS England report

NHS England published the first NHS workforce race equality standard (WRES) report in June with key indicators on the experiences of BME staff across every hospital and trust and these data analyis reports are due to be published annually. 

Although this report is welcome, many equality and diversity experts are still extremely concerned about the current situation in the NHS.

Statistics revealed in The Guardian in August highlighted that only 2% of NHS trusts are chaired by people from a BME background and that they make up 4% of executive directors and 7% of non-executive directors on trust boards.

Carol Baxter is non-executive director at an NHS trust, a former research fellow in the department of primary care and public health at Imperial College London and a trustee at the employer’s network for equality and inclusion.

Deep wounds

Professor Baxter, a former nurse, midwife and health visitor, explains: ‘In terms of participation and experience the wounds inflicted on many BME NHS staff run deep and may never heal. There is now a great deal of cynicism among some of our brightest and best and they are looking to other sectors.

‘Leadership and seniority in the NHS is still seen as an exclusively white domain. So-called interventions such as leadership development, mentorship and coaching are then paraded as special, generous and remedial help designed to "fix" BME nurses, midwives and health visitors when this is in fact merely an employer’s duty of care.

'We need to call this out for what it is – unprofessional and unethical behaviour. As a publicly funded body NHS leaders should be held to account.'

Snowy white peaks

Roger Kline
Roger Kline. Picture: Neil O'Connor

NHS England joint director of the workforce race equality implementation Roger Kline is author of the 2014 report The Snowy White Peaks of the NHS, a survey that found an exclusion of BME staff from managerial and board positions.

He says: ‘We now know the obstacles that BME staff face in recruitment, development, promotion and treatment in the NHS. There is a large scale loss of talent which has an impact on patient care when talent is undervalued, not encouraged or developed. For example, 26% of band 5 nurses are from BME backgrounds but only 2.8% of band 8 nurses.

‘What we know is that many of the methods previously used to redress the imbalance in opportunity do not work.’

Club culture

Mr Kline says holding panels to account and checking all aspects of the recruitment process for fairness this prevents the ‘club culture’ in recruitment and promotion.

NHS England’s workforce race equality implementation team provided its own evidence for the review, which stated that policies will not be effective and sustainable unless the narrative behind them is also understood by middle management and the frontline supervisors who implement them.

‘Managers unconvinced or uncomfortable with policies must be able to share their concerns but in the knowledge that the goals on greater diversity are an ‘organisational imperative which they will be expected to implement.’

Promoting inclusion and opportunities for BME staff

In its response to Baroness McGregor-Smith's review, the RCN called on the government to commit to race equality so BME staff are able to fulfil their potential.

The college highlighted a Trades Union Congress analysis published this year that revealed BME workers with degrees earn 10.3% less on average than their white counterparts, irrespective of qualifications and experience.

It also warned that discrimination affects career prospects and wellbeing of BME staff.

'There is a cogent case for BME nurses and other support workers being employed at all levels across healthcare organisations,’ the RCN said.

‘Failure to deliver this means that patients and the wider health communities do not benefit from the innovation and insight that is delivered by using the cultural and linguistic capital of BME healthcare professionals.’

Staff representation

Joan Myers, nurse consultant at North East London NHS Foundation Trust (NELFT) and chair of the chief nursing officer’s BME advisory group, explains that the trust developed its own three-year ethnic minority strategy.

Joan Myers
Joan Myers. Picture: Barney Newman

NELFT has won an award for its work to promote inclusion and opportunities for BME staff and part of the strategy includes a BME representative on interview panels for bands 8A and above which has led to a significant increase in senior BME staff members.

Ms Myers says: ‘NHS England does need to do something about this but it cannot be done in an organisational silo. We know what the problems are and we need to have a proper discussion including people from BME backgrounds who are in the middle of all this to find a way forward.’

This article is for subscribers only