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Racism and black nurses: why profession must get on the right side of history

Pandemic exposed consequences of inequalities, but also how quickly we can change things

Pandemic exposed consequences of inequalities, but also how quickly transformation can be achieved – let’s learn from that

Following the second world war, people from the Caribbean nations were invited to come to Britain to help build the NHS and work in industry.

Those arriving between 1948 and 1973 became known as the Windrush generation.

The nurses among them were not always treated with respect, dignity, and fairness; they were often marginalised and they faced discrimination.

Emergence of the Windrush scandal

In 2017, the Windrush scandal was exposed, revealing social segregation and even expulsions from the UK.

It emerged that hundreds of people had been targeted since 2012 under the UK

Pandemic exposed consequences of inequalities, but also how quickly transformation can be achieved – let’s learn from that

Picture: iStock

Following the second world war, people from the Caribbean nations were invited to come to Britain to help build the NHS and work in industry.

Those arriving between 1948 and 1973 became known as the Windrush generation.

The nurses among them were not always treated with respect, dignity, and fairness; they were often marginalised and they faced discrimination.

Emergence of the Windrush scandal

In 2017, the Windrush scandal was exposed, revealing social segregation and even expulsions from the UK.

It emerged that hundreds of people had been targeted since 2012 under the UK government’s ‘hostile environment’ immigration policy.

Essentially, this gave the NHS, landlords, banks, employers and many others the task of enforcing immigration controls. It aimed to make it impossible for undocumented migrants to live in the UK, and push them to leave.

‘The hardship and racial prejudice that our Windrush nurses experienced should never prevail again – history must not be allowed to repeat itself’

Many Caribbean migrants of the Windrush generation were denied healthcare during this time, and wrongly detained, deported and denied legal rights.

This approach amounted to an attempt to remove black people from British – and nursing – history by erasing the contribution of this group to post-war Britain.

Passengers disembark from Windrush to start a new life in Britain Picture: Alamy

Structural racism and health inequalities

The Windrush scandal was linked to structural racism.

Structural racism is not merely a result of personally-held prejudices, but of those produced and reproduced by rules, regulations, laws and practices that are sanctioned and often implemented and embedded by government through economic, cultural, and social systems.

Simply put, racism kills.

Longstanding inequalities, inequities and systematic discrimination in the UK means racism is a determinant of health that continues to shapes the lives of black people, leading to poorer physical and mental health outcomes

In today’s NHS workforce culture, encouraging healthcare workers to come to the UK and work is described as ‘international recruitment’ and, against the backdrop of a pandemic, the country needs overseas nurses more than ever.

But the hardship and racial prejudice that our Windrush nurses experienced should never prevail again – history must not be allowed to repeat itself.

What COVID-19 laid bare about the experience of black people

The fact that racism can be deadly has never been more evident.

There has been a disproportionate number of deaths of black and Asian nurses during the COVID-19 pandemic. Out of the 119 NHS staff known to have died in the pandemic, 64% were from a non-white background.

A report published last summer by Public Health England revealed people from black, Asian and minority ethnic backgrounds were more likely to die from COVID-19, while diagnosis rates for coronavirus were highest in black communities.

‘Silence is complicit and I call on all allies of black nurses to act now to dismantle structural and institutional racism’

The same analysis showed that those with Chinese, Indian, Pakistani, other Asian, Caribbean and other black heritage faced up to 50% higher risk of death than white British people. Yet there remained a struggle to get individual COVID-19 risk assessments for black and ethnic minority nurses including fit-testing for masks.

The COVID-19 virus does not discern race in the way these figures might suggest. But those who are exposed to societal inequalities such as poverty, adverse psychosocial circumstances, poor access to health services, structural and institutional racism provide an environment for the virus to thrive. COVID-19 binds itself to those who have experienced inequalities through structural racism.

Undermining of black nurses by organisations and individuals

Some black nurses have become the wall and fence – that is, the structural support and shield for others in their community – when addressing racial inequity and racism.

But some organisations and people have sought to topple these walls and fences. In everyday practice, black front-line nurses are being unfairly treated, with reports of harassment, bullying or abuse against them on the rise.

Some 30.3% of black and minority ethnic staff were reporting such experiences from patients, relatives or the public according to the latest Workforce Race Equality Standard report. In 2016, this figure was 28.4%.

Employers are more likely to refer black and minority ethnic nurses to their regulator than their white counterparts. Nurses of black African heritage made up 13.3% of new referrals to the NMC in 2019-20, despite only forming 7% of the register.

Based on fitness to practise (FtP) referral data for 13,805 cases between April 2019 and March 2020, employers made around half of all referrals of black registrants (49.9%, 1,082) and Asian registrants (50%, 519), compared with 40.7% (4,420) of referrals of white registrants.

We have seen how fast transformation can be

My message to all black nurses is that – as difficult as it may be – try to maintain your self-belief and confidence when organisations and individuals you seek support from have failed you.

The time is ripe for all organisations to weed out racism, once and for all.

For the nursing profession to grow and develop, we need to see anti-racist practice, and nursing leadership rising up against racism.

Silence is complicit and I call on all allies of black nurses to act now to dismantle structural and institutional racism.

One of the key lessons of COVID-19 is that transformation can take place in days rather than years.

Nursing should not be caught on the wrong side of history.


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