Racism in the NHS is hiding in plain sight – and we can all do something about it

As the world grapples with race inequality, the NHS must confront its complicity
Talk to colleagues about race

As the world grapples with the realities of race inequality for BAME people, the NHS must confront its complicity

Nurses need to have difficult conversations about racism in the NHS Picture: iStock

There is something about discussing race that seems to make everyone feel uncomfortable.

Gazes start to avert and new topics are quickly brought to the forefront. 

Racism is a public health crisis that concerns us all

However, the disproportionate number of COVID-19 deaths among black, Asian and minority ethnic (BAME) people, combined with international protests following the death of George Floyd at the hands of a police officer in Minneapolis have shown there's now no place to hide when it comes to discussing race.

Racism has been described as a ‘public health crisis’, meaning it concerns us all.

The NHS constitution is founded on values such as ‘everyone counts’ and ‘nobody is excluded, discriminated against or left behind’. Yet the disparities between the health outcomes for – and treatment of – white and BAME people do not always reflect these principles.

‘But I’m not racist,’ you might say. ‘I treat all my patients and colleagues the same.’

The thing about racism is that it isn’t always about spewing derogatory words. It’s stereotyping, misconceptions, prejudgement, bias and microagressions that silently manifest and trickle into healthcare services without you even realising.

These things affect how you treat and interact with patients and colleagues who don’t look like you.

Despite well-known health inequalities for BAME people, inconsistent care is common

Black women are five times more
likely than white women to die from
pregnancy complications Picture: iStock

The health inequalities of BAME people are well-evidenced. A 2019 report by MBRRACE-UK, a collaboration led from the National Perinatal Epidemiology Unit at the University of Oxford, found that black women were five times more likely than white women to die from complications associated with pregnancy. The risk for Asian and mixed race women were two and threefold respectively.

African-Caribbean people are also at a higher risk of sickle cell disease. The lifelong condition is one of the two most common genetically inherited diseases in the worldYet why can I only remember a very vague lecture at university on a condition that affects a large proportion of the population

I recall asking a patient about their experiences of having sickle cell disease and being treated in the NHS. They told me: ‘There’s a lot more healthcare professionals can do before people end up having crises –but they don’t really care.’

This comment echoes report findings of sickle cell patients often feeling like their health concerns are dismissed. The inconsistencies in care are far too common.

Racial inequalities in the NHS are hiding in plain sight

COVID-19 has brought into sharp focus the inequalities facing BAME communities.

Disparities in the health service have been known about for many years. The NHS Workforce Race Equality Standard (WRES) was established in 2015 and requires organisations to track staff experience using a number of indicators. 

BAME staff are over-represented in low grades and under-represented at senior levels across organisations, the 2019 WRES report found.

The infamous 2014 report The Snowy White Peaks of the NHS explored the lack of diversity among senior NHS trust boards. Yet, despite attempts to reverse this, recent reports from the NHS Confederation have found progress to be regressive or static.

‘As a black nurse in the NHS, you hesitate to speak out against injustice because you don’t want to be written off with negative labels that are often used to describe black people’

Being a black nurse in the NHS means living and breathing in a system that not only expects you to fail, but is designed to make you fail. 

You have fleeting moments of worry that people might not want you looking after their children because of the colour of your skin.

You hesitate to speak out against injustice because you don’t want to be written off with negative labels that are often used to describe black people.

Then there’s being confused with your other black colleagues because you ‘look the same’, yet noticing how your colleagues are more accepting of you as a British-born nurse than of the nurses with the same ethnicity as you who are from abroad.

Seeing very few people who look anything like you in senior positions, and wondering whether your professional goals will ever be attainable.

These are just slices of insight into how our lives are affected by the colour of our skin.

What can nurses do to make a positive change in the NHS and society?

Here’s how we can all act now to help create an NHS that reflects the standards it claims to have:

  • Acknowledge that racism exists and that there is institutional racism within the NHS. Listen to the lived experiences of your colleagues and your patients. Don’t dismiss what they say because it has not happened to you or you have not seen it happen.
  • Talk about it Get the dialogue going; any difficult conversation is a conversation worth having. This also includes the discussions that you have with yourself. Although not always comfortable, it is necessary.
  • Learn to be anti-racist You may have heard this term a lot recently – it means that being ‘not racist’ is simply not enough. There are plenty of resources to assist with this. I’d recommend starting with the book Why I’m No Longer Talking to White People About Race by Reni Eddo-Lodge or watching the TV series When They See Us, which is based on the true story of the false prosecutions of five black teenagers in New York in 1989.
  • Use your voice and hold others accountable. Speak up when you see a colleague facing abuse or being treated unfairly. Speak out against stereotyping and prejudgements.
  • Sign petitions Not only the ones related to healthcare but also those that will act as a catalyst for change in society. In 2020, it shouldn’t be necessary to have a petition that calls for training on how certain conditions present on black skin.

As healthcare professionals it is our duty to do better and be better.

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Nicola Wiafe is a staff nurse in a neonatal intensive care unit