Despite years of trying to address issues of racism in the NHS, there has only been a limited amount of success. We have seen many short-lived race equality initiatives designed to improve the experiences of BME staff, but unfortunately, with no long-lasting or significant effect. Strategies are often defeated by deep-rooted cultural norms.
There is no substantial evidence that any singular intervention will make a significant difference. For instance, reverse mentoring on its own will not address racial inequalities unless seen as part of a wider set of initiatives.
We understand that this lack of progress is complex and that this is an uncomfortable issue. To address the structural racism, we must all:
- Acknowledge the problem and take this seriously through demonstrable action
- Improve our understanding of the depth and complexity of the issue
- Ensure that commitment is followed up with positive and targeted action
- Be prepared to be held accountable and hold others to account
- Be prepared to face the consequence of our behaviour is unacceptable and causing harm to others
- Create equality of opportunity for under-represented groups if in a position of power and privilege
Centuries of racial discrimination have hard-wired inequality into our institutions and people’s ways of thinking. These inequalities have ensured that White people get better chances in life. These issues are complex, and a sustainable strategy should be based on educating, supporting and challenging.
There has always been a fundamental need to change these realities, but this extraordinary year has seen a shift in rhetoric and understanding around race disparity in England and worldwide. The disproportionate impact of Covid-19 on BME people in the UK and elsewhere, combined with the increased awareness of the Black Lives Matter movement, have shone a spotlight on structural inequalities and institutional racism in British society that have been tolerated for too long.
There is a structural, historical bias that favours certain individuals in the UK and the NHS today. This bias does not just stand in the way of ethnic minorities, but women, those with disabilities and others. But unless we are focused and determined to make significant progress in addressing racial injustice, the other aspect of inequalities will continue to be a significant problem. If we put our effort, commitment and action into addressing racism, we are more likely to have a bigger impact on other areas.
There are competing demands between protected groups for a focus on specific inequality issues. NHSE&I recognise the importance of getting this right for all groups. However, our current priority is on racism because we also know that if our staff are from a BME background, they are likely to experience the double or triple penalty of discrimination if they are, for example, gay and disabled.
If we truly want to be inclusive, we expect everyone, regardless of their protected characteristics, to stand up together to fight against racism. But we should not ignore or neglect other areas of inequalities. Although a treasured institution, the NHS is not immune from these forces, and the WRES continues to show disparities. Tackling inequality is critical because a diverse workforce positively impacts staff experience, patient outcomes, and organisational efficiency.
Recommendation to tackling racism and other types of discrimination
These recommendations are for short term goals for 3-6 months (S), medium term goals for 6-12 months (M) and long term goals for 12 months (L).
- Organisations must demonstrate that they provide opportunities for all staff (white and BME) to have difficult conversations about racism without fear of repercussions. (S)
- All Organisations need to report progress on WRES and WDES metrics at a system level. (S)
- All organisations should implement a white ally programme and a similar programme for other protected groups that should be part of the anti-racist action plan. (M)
- Cultural safeguards need to be in place to ensure that white allies are acting responsibly, building trust, working co-productively and led by expertise and lived experience whilst progressing on their journey towards becoming an anti-racist leader. (S)
- WRES Experts should get protected time to act as change agents within each of the 11 STP/ICS. (S)
- The national team will establish a ‘code of civility that everyone can understand and sign up to. (M)
- Organisations must ensure all staff have the skills, knowledge and a clear expectation of acceptable behaviour to create an inclusive environment that is anti-racist. (M)
- All staff Personal Development Review (PDR) must include a personal objective in addressing race inequalities. (S)
- All organisations must develop a method of reporting to system leads on the number of cases (formal and informal) regarding all forms of incivility, including racism, bullying, harassment and discrimination. (M)
- ICS/STPs and organisations need to capture the lived experience of staff regularly by protected characteristics. The data capture needs to include issues such as: (M)
- Do staff feel a sense of belonging where they work? If not, why not?
- Would staff recommend friends and family to their place of work?
- If staff have reported bullying, harassment and discrimination, have this been dealt with appropriately?