After the worldwide Black Lives Matter protests last summer in the wake of the killing of George Floyd in the US, the UK government established the Commission on Race and Ethnic Disparities. Under the chairmanship of Tony Sewell, the commission was set up to investigate race and ethnic disparities in the UK. The Sewell report released on 31 March 2021 has significant implications for race relations in the UK.  While we acknowledge that there are elements in the report which provide a useful narrative, we are deeply disappointed that it seeks to ignore the reality of racism in the United Kingdom.
The 258 page report looked at four key areas: education and training; employment, fairness at work, and enterprise; crime and policing; and, health. It examines the intersectionality between these and the following: ethnicity, socioeconomic background, geography, and culture and degree of integration. The authors suggest that the report is the first to use data from the Cabinet’s Race Disparity Unit and the first government commissioned study on race to seriously engage with the impact of the family unit on outcomes.
The report draws heavily from key policy documents, but with one significant omission, the Scarman report, which was commissioned in the wake of the 1981 Brixton riots.  The Scarman report concluded controversially that institutional racism did not exist.
The Sewell Report similarly seeks to write that history again, and threatens to turn the clock back on the fight against racism by 40 years in the UK. The dangerous narrative in the report includes: “Put simply we no longer see a Britain where the system is deliberately rigged against ethnic minorities. The impediments and disparities do exist, they are varied, and ironically very few of them are directly to do with racism. Too often ‘racism’ is the catch-all explanation, and can be simply implicitly accepted rather than explicitly examined. The evidence shows that geography, family influence, socio-economic background, culture and religion have more significant impact on life chances than the existence of racism.”
Justification for its findings is emphasised on the basis that the people holding four senior positions in the government, the Chancellor of the Exchequer, the Business Secretary, the Home Secretary, and the Attorney General, are from an ethnic minority background. This ignores documented disparities that exist in society and within the NHS, where many of us have spent a considerable part of our lives. Data from the Workforce Race Equality Standards (WRES) show that 82.7% of NHS Trusts report a higher percentage of ethnic minority staff experiencing bullying, harassment, and abuse from colleagues than white staff over the previous 12 months. 
In medicine, racism starts in medical schools and percolates through the many layers of training and employment as we have previously reported.  The government’s own body, Public Health England, has demonstrated in a wide ranging review on covid-19 mortality that people of Chinese, Indian, Pakistani, other Asian, Black Caribbean and other Black ethnicities had between 10 and 50% higher risk of death when compared to White British populations. 
The literature on racism in the NHS has left most people in no doubt that the problem exists and that it needs to be tackled. Indeed, Michael Marmot, a lifelong researcher of health inequalities, said at the BAPIO conference in 2020 that there is structural racism within the NHS. He praised the actions of Simon Stevens, the chief executive of NHS England, in first setting up WRES and then the Race and Health Observatory as testament to Stevens’ belief that there is unquestionable evidence that the problem exists. It requires a concerted, co-ordinated approach, not just for the sake of the NHS workforce, but also because, ultimately, leaving a significant part of the NHS workforce demoralised risks our healthcare service not providing the best care to patients, or achieving the best outcomes.
Another matter that has recently received more attention is the recommendation that the term Black and Minority Ethnic (BAME) should be abandoned because of the heterogeneity of this group. Many people agree that using the term BAME to represent people with multiple cultural, religious, or migrant identities is not fit for purpose. But they are united by the experience of bias they face in society, which eventually leads to the multifactorial deprivation that is so readily recognised in the report.
Of course, there are differences among BAME people’s experiences, as there are between White people. In the UK the BAME community largely comprises people from a number of communities—Africans, African Caribbeans, Pakistanis, Indians, Bangladeshis, Chinese, Filipinos, and Sri Lankans. The existence of deprivations, such as differential educational attainment, limited opportunities for employment and career progression, biased experience with policing and justice systems, social exclusion, and crowded housing, are among many such experiences they all have in common, though within the group experiences will differ, and some may face more disadvantage or discrimination than others. Similarly, there are regional and cultural differences between White English, Irish, Welsh, and Scottish communities. We believe that it is important to recognise the systemic discrimination that the term BAME represents, even if some would want to do away with the term itself, and how it mars the social capital and progress of the individuals who fall under its label in modern British society. We have the sophistication of data that help us to better understand the differences within these communities, as well as studying the similarities that exist between them.
Significant segments of our society continue to deny that racism and structural racism exists, and this includes people in positions of authority and responsibility who have the power to influence and change policies. It is ironic that the first broad theme of the Sewell report is about building trust, given that the report itself has not achieved this. The responses of many organisations and individuals suggest that the report has in fact fractured the fragile trust that we were beginning to see being built. But, equally, the report has united many in their response, with a number of organisations denouncing the core finding of the report: that structural racism does not exist in our society. [6-10]
Since the release of the Sewell report, there has been some backtracking by the Commission, forced undoubtedly by the backlash they have faced from so many quarters.  However, if the government intends to engage with its stakeholders in taking some of the recommendations forward, then it must first try and heal the raw wounds it has unnecessarily opened up in ethnic minority communities with this divisive report. That would be best done by acknowledging that structural racism exists and is damaging.
JS Bamrah, chairman, BAPIO; consultant psychiatrist, Greater Manchester Mental Health NHS Foundation Trust.
Indranil Chakravorty, chairman BAPIO Institute of Health Research; consultant in Acute and Respiratory Medicine, St George’s Hospital, London.
Parag Singhal, honorary secretary, BAPIO; consultant in Endocrine Medicine, University Hospitals Bristol and Weston NHS Trust.
Joydeep Grover, medical director, Medical Defence Shield; consultant in Emergency Medicine, North Bristol NHS Trust.
Geeta Menon, vice chair, BAPIO Institute of Health Research; Consultant Ophthalmologist, Frimley Health NHS Trust.
Ramesh Mehta, president, BAPIO; retired consultant paediatrician.
Competing interests: none declared.
- Commission on Race and Ethnic Disparities – Commission on Race and Ethnic Disparities: The Report – March 2021 (publishing.service.gov.uk)
- BBC NEWS | Programmes | BBC Parliament | Q&A: The Scarman Report
- Workforce-Race-Equality-Standard-2020-report.pdf (england.nhs.uk)
- The NHS is 72 this year, covid-19 has taught us some tough lessons – The BMJ
- RCPsych response to the report of the Commission on Race and Ethnic Disparities
- To pretend discrimination does not exist is damaging – NHS Providers
- Response to the report of the Commission on Race and Ethnic Disparities – NHS Confederation
- FPH Statement on the Commission on Race and Ethnic Disparities Report – FPH
- Race is a function of racism; we ignore that reality at our peril, say leaders – NHS Confederation
- Statement from the Commission on Race and Ethnic Disparities – GOV.UK (www.gov.uk)