As a person from an ethnic minority working in health policy, for many years I’ve actively avoided talking about race. In a previous job, I was told that people from ethnic minorities always “play the race card” when things don’t go their way. Anxious not to fit this stereotype, I vowed never to complain about race issues and in an instant my voice was taken away.
If I wasn’t offered training opportunities or was overlooked for promotion, it simply meant that I wasn’t good enough. I kept my head down and avoided sharing my views at work, in case they were different to my colleagues’.
When the opportunity to research race inequalities in the NHS came up, my instinct was not to get involved. But after several years working at The King’s Fund, an organisation that is beginning to have honest conversations about racism and race inequalities, I was becoming more open to the idea. After an internal struggle, I decided to stop shying away from issues of race and tackle them head on.
The stark statistics on ethnic minority staff in the NHS are well-known; they are more likely to face disciplinary action, have fewer opportunities to progress and regularly report discrimination. The NHS has a huge number of BAME people working for it (19.7% of the workforce), but a vanishingly small minority (6.5%) are deemed suitable for the most senior positions.
With all this existing data on inequalities, and countless commitments to improve things voiced by senior leaders across the NHS, why does racism still persist in the NHS? We knew cultural change in the country’s largest employer was never going to be easy, but progress has been agonisingly slow. We reflected as a research team that while the numbers don’t lie, they don’t speak very loudly on their own.
We decided to listen to the stories and impact of racism on the people behind the statistics. We heard from NHS staff who had experienced racism and discrimination in all its forms, from overtly racist insults to subtle microaggressions.
As a predominately ethnic minority research team, we weren’t surprised to find racism alive and well in the NHS. We’ve all experienced the pervasive persistence of racist attitudes throughout society. But talking to NHS staff who had experienced so much racism, and hearing how it blighted their daily lives, was emotionally draining.
I met truly inspiring staff from ethnic minorities with the will to tackle the impervious racism in the NHS, a tireless and unforgiving task. It takes energy and time. My own personal gratitude to ethnic minority staff willing to fight for equality on behalf of people like me cannot be underestimated, but it was also clear that it is a fight for everyone. Levelling the playing field for all NHS staff requires allyship. We need white people to see the injustice of race discrimination and be willing to put the energy into changing it.
Initiatives like the collection of Workforce Race Equality Standard data are important to shine a light on racism and help the system move in the right direction. Data and standards give us tools to measure progress and highlight examples of good and bad practice. They also prove objectively that inequalities are “real” and not imagined, as I’ve been told before. Data allows us to start conversations about race inequalities, but rarely changes hearts and minds by itself.
At the time we were about to launch our report, the brutal killing of George Floyd occurred in the United States at the hands of police officers. The Black Lives Matter movement has never been more important, and clearly highlights that everyone—regardless of race—needs to stand against enduring race inequalities and racism. We must also acknowledge our own privilege and question our own assumptions, which is never easy.
The NHS faces significant challenges in the years ahead, not least dealing with the fall-out of covid-19 and preparing for the threat of a second wave. With so many competing pressures, you might ask why the service should prioritise tackling inequalities? The answer is simple: it’s the right thing to do. The discrepancies in opportunities and rates of disciplinary action between ethnic minority staff and white staff is truly shocking and cannot be explained away—no matter hard one might try to justify it. There is no justification.
From our research, I would say the key to tackling inequalities is the willingness to engage with the issues. It all starts with an open and honest conversation about why it’s important. Are people across the organisation ready to talk about race, from the board members to frontline teams? If not, why not? We all need to be open to conversations on race—even though they may not be easy to hear.
Joni Jabbal, Policy Researcher, The King’s Fund
Competing interests: None declared