The NHS is 72 this year. This anniversary comes as the NHS and the general public face challenging times. The covid-19 pandemic is far from over, and while the long term impacts are still unclear, the pandemic will be remembered for exposing the disparities that exist in British society, and particularly the disproportionate impact that the pandemic has had on ethnic minority communities. The NHS’s record on health inequalities and treatment of staff from ethnic minorities has been consistently poor.
Over the last three decades there has not been a lack of Government effort to tackle inequalities. Since 1994 we have counted at least 14 separate reports or inquiries into inequalities in the NHS.* What is common with all of these is the lack of accountability to deliver meaningful improvements in outcomes.
The Macpherson inquiry into the racially motivated death of Stephen Lawrence, brought attention to the problem of institutional racism. Football authorities in the UK have been pushing for change within their sport using the “show racism a red card” campaign. But you would have to look hard for sustained changes in attitude in the NHS.
The acknowledgment of racism has been implicit in a number of actions, for example, NHS England set up the Workforce and Race Equality Standards in 2014. More recently NHS England and the NHS Confederation launched the NHS Race and Health Observatory. This is welcome as a wide range of research and surveys have shown the inequalities faced by ethnic minority staff and patients in the NHS.
However, there has been a lack of action to acknowledge the institutional and structural racism that exists and to tackle these disparities. The discriminatory attitude towards staff from ethnic minorities. This covers a wide spectrum of experiences. The BMJ’s recent Racism in Medicine issue revealed that medical schools are failing to monitor racial harassment and abuse of ethnic minority students. Furthermore, doctors from ethnic minority backgrounds face disadvantage throughout their careers. Staff from ethnic minorities are also more likely to face disciplinary actions compared to their white counterparts, and they are more likely to face sanctions from the General Medical Council.
The Windrush scandal and the recent death of George Floyd and the Black Lives Matter protests add another perspective to the challenges faced by ethnic minority populations.
This has been further highlighted by the disproportionate impact that covid-19 has had on ethnic minority communities and the high number of healthcare workers from ethnic minorities who have died from covid-19. Staff from ethnic minorities have also encountered difficulties having their concerns about personal protective equipment (PPE) taken seriously. Surveys and anecdotal reports indicated bullying and refusal to grant adequate PPE.
Covid-19 has thus completed a hitherto unfinished picture of racism that has existed in the NHS from its inception. Staff from ethnic minorities have relished working for the NHS, many have travelled thousands of miles to work in this wonderful institution, but not to lay their lives for it. And they should not be subjected to adverse working conditions, bullying, harassment, or racial abuse. The NHS now stands at crossroads. One road will lead it to a path of privatisation and self-destruction, the other to the moral high road of equality and fairness, and ultimately, survival. Race relations have never played a more crucial part in its continuing existence. The Race and Health Observatory has the scope to identify and tackle the specific health challenges facing people from ethnic minorities, but ultimately, if there is no government accountability we are unlikely to see any meaningful change.
So, on the NHS’s 72nd birthday, covid-19 has taught us some heart-wrenching lessons. The institutional and structural racism within the NHS have been laid bare. Racism still exists within our society, and it is now time to call it out and take deliberate and firm action against it. We must change the mindset of our society to make it just, equitable, ethical, and proud. This is the ethos that many doctors, nurses, pharmacists, care workers and other staff feel needs to be transplanted into the fabric of the NHS to win their hearts and minds.
JS Bamrah, Chairman, BAPIO, (British Association of Physicians of Indian Origin)
G Randhawa, Professor of Diversity in Public Health & Director, Institute for Health Research, University of Bedfordshire
K Chand, Past deputy Chairman, BMA
J Singh, Chairman, Coventry and Warwickshire Partnership NHS Trust
Declaration of Interests: None
References:
- https://www.theguardian.com/uk-news/2019/feb/22/institutional-racism-britain-stephen-lawrence-inquiry-20-years
- https://jech.bmj.com/content/70/7/653
- https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/686071/Revised_RDA_report_March_2018.pdf
- https://www.england.nhs.uk/wp-content/uploads/2020/01/wres-2019-data-report.pdf
- https://www.independent.co.uk/news/uk/home-news/racial-inequality-uk-racial-disparity-audit-government-report-theresa-may-bme-black-ethnic-minority-a7992016.html
- Cook E, Randhawa G, Large S, Guppy A, Chater A: A UK case study of who uses NHS Direct? Investigating the impact of age, gender and deprivation on the utilisation of NHS Direct. Telemed J E Health 2012, 18(9):693-698.)
- https://www.bapio.co.uk/bapio-raises-issue-of-ethnic-differences-in-covid-19-mortality-and-morbidity-and-offers-collaboration/letter-to-cmo-md-phe-nhse-7-4-2020-page-001/
- https://www.hsj.co.uk/exclusive-deaths-of-nhs-staff-from-covid-19-analysed/7027471.article
- https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/892085/disparities_review.pdf
* NHS Ethnic Health Unit (1994); Tackling Inequalities in Health — A Programme for Action (2002); National Director for Equality and Human Rights (2004); Race Equality Action Plan (2004); Spearhead Primary Care Trusts (2004); Health Survey for England — Minority Ethnic Groups (2006); Health Challenge England (2006); Race for Health (2007); Personal, Fair and Diverse (2010); Equality Delivery System (2011); National Lead for Equality (2013); NHS Equality & Diversity Council (2014), NHS Workforce Race Equality Standard (2015), Prime Minister’s Race Disparity Audit (2016).