NHS Reset: Inconvenient truths – inequality in the NHS

At the time of writing, I have yet to read the Public Health England report entitled ‘Beyond the data – understanding the impact of COVID-19 on BAME communities’. This publication was delayed for reasons that are not entirely clear. But from the clips that I’ve seen on the news, it seems to say what I believe has been known for some time. It has also got me thinking about conversations that I’ve recently had with NHS staff. 

One such conversation was with a surgeon friend of mine. In his hospital, when surgical specialties were asked to allocate a staff member to the COVID-19 rota, he (the only BAME employee in his specialty), was selected. He later realised that all of his (white) colleagues had been consulted about their personal health and domestic circumstances beforehand – a form of risk assessment – which was not afforded to him.  

The recent publication by NHS Providers on Risk Assessments for Staff is welcome, and the measures within it need to be implemented as soon as possible. 

There are many BAME staff grade doctors who graduated overseas and came here to further their careers whilst serving the NHS. Many have performed competently and independently year after year at the consultant level - all but in name. The system is content for them to function as a consultant, while denying them the official title. Why is this? 

Unsurprisingly, report after report shows that BAME staff in the NHS feel they are treated differently. The 2019 NHS Staff Survey showed that the percentage of BAME staff believing that their trust provides equal opportunities for career progression or promotion was 69.9 per cent vs 86.3 per cent for white staff. 

One should note that nine out of 10 roles in the NHS are non-medical, therefore the survey could also be reflecting the fact that whilst BAME staff make up around 25 per cent of Band 5 staff, this figure drops to 7 per cent at the ‘very senior manager’ level. The NHS Workforce Race Equality Standard report for 2019 shows that 8.4 per cent of board members in NHS trusts were from a BAME background, which is significantly lower than the 19.9 per cent of the BAME workforce across all NHS trusts in England. Ethnicity pay gaps also exist in many areas.

When a Trust chief executive (Birmingham and Solihull Mental Health Foundation Trust) can describe herself as ‘culpable’ and ‘complicit’ on BAME issues, the time surely must have arrived to take action. In talking about how the health and care system should look post-COVID-19, it’s important to lay bare unpalatable, inconvenient truths in order to reset to a healthier work environment for all employees. 

Racial discrimination is a societal issue and not exclusive to the health and care system, so it’s important to learn from other sectors and demonstrate to staff that action is being taken. Not all approaches may translate well to the NHS but below are some that may be worth considering.  

Whilst some individual NHS organisations have signed up to the ‘Race at Work’ Charter, others should do so immediately and proactively demonstrate how they adhere to its five principal calls to action. These calls to action demand accountability from senior leaders, including appointment of an executive sponsor for race. It is the job of non-executive directors to hold the executives to account and if senior leaders do not meet published goals, there should be clear consequences. 

Some organisations, including universities, are training a cadre of BAME staff as Fair Recruitment Specialists to join interview panels at all levels, especially for senior roles.  This reduces the risk of hiring managers recruiting in their own likeness or going for ‘the devil they know.’ 

The UK Corporate Governance Code says, “there should be a means for the workforce to raise concerns in confidence and – if they wish – anonymously”. Some companies designate an independent Board member to whom staff are encouraged to raise concerns in confidence, others use an external provider with a confidential reporting platform.  

Many universities use a digital platform (Unitu) to capture the student voice for instant anonymised reporting of concerns, which can be addressed in real time. 

As a relative and friend to many working in the NHS, I would like to see the equivalent of the ‘Friends and Family Test’ for BAME NHS staff. It should cover staff whose primary qualifications were either from the UK or elsewhere. The anonymised results would quickly reveal the scale of the problem. Moreover, it would provide an opportunity to directly ask BAME staff for their suggestions on specific measures that would make a difference. 

It’s hard enough to speak truth to power at the best of times, but particularly for those who have come from a culture where authority figures are virtually never challenged, the least we can do is provide a channel for their voices to be heard… if we are willing to listen and then crucially, act.

Dr Bina Rawal is a non executive director of the Innovation Agency. This blog was first published by NHS Confederation as part of NHS Reset, a campaign supported by the Innovation Agency and AHSN Network.

17 June 2020