The Sewell report’s depiction of the NHS belies the systematic disadvantage and discrimination that so many ethnic minority doctors have faced

Some of the conclusions and narrative of the recent report published by the government’s commission on race and ethnic disparity have received widespread criticism, including from the BMA. We firmly refute the report’s assertion that structural race inequality is not a major factor affecting the outcomes and life chances of many of our citizens.

Notably, the report promotes the NHS as a “success story with significant overrepresentation of ethnic minorities in high status professional roles.”

This portrayal fails to capture the lived experience of many of the 40% of doctors in the NHS who are from ethnic minority backgrounds. The NHS certainly owes its continued existence to our ethnic minority medical workforce who have been the backbone of our health service since its inception. In the 1950s and 60s and beyond many doctors travelled from all corners of the globe, working against all odds to prop up our NHS by taking up hospital jobs with unpopular rotas that no one else wished to fill. Meanwhile GPs toiled single-handedly in end of terrace houses without the necessary investment or support, but fuelled by an unstinting commitment to their communities. It is only right then that ethnic minorities are described as the “migrant architects” of the NHS.

However, the report’s depiction of our health service belies the systematic disadvantage and discrimination that so many ethnic minority doctors have faced.

The evidence speaks for itself. From the onset of a career in medicine, ethnic minority medical students report bullying and harassment at four times the rate of their white peers—such that, last year, the BMA produced a racial harassment charter for use in all medical schools. [1] It’s hardly “a success” that after qualifying, ethnic minority doctors continue to report bullying and harassment as a problem at their place of work at twice the rate of their colleagues and are twice as likely to be referred for fitness-to-practice processes by their employer. [2,3] In addition, ethnic minority doctors are nearly twice as likely not to raise patient safety concerns because of fear of being blamed. [4]

During the pandemic, it was deeply distressing that nearly nine in 10 doctors who died from covid-19 were from a black and ethnic minority background. This profound inequality was not even mentioned in the report, which further ignores the factors that may have led to this alarming statistic.

Compared to their white peers, ethnic minority doctors were twice as likely to say that they felt under pressure to see patients without adequate personal protective equipment (PPE), and three times more likely to say they were afraid to speak out about PPE, medicine, or staff shortages for fear of recrimination, or it harming their career. [5]

And while the report speaks of ‘the onward march of minorities into positions of power and responsibility in medicine’, the truth is only 10% of trust board seats are held by people from ethnic minority communities. [6]

Ethnic minority and overseas-trained doctors, as groups, have lower pass rates for postgraduate exams in the UK which inevitably affects their career progression. Research suggests that this differential attainment—even among UK trained ethnic minority doctors—is not due to a lack of ability, but to a lack of support, inclusion, and feedback which affects their confidence and learning. [7] Additionally, fewer ethnic minority doctors are offered consultant posts—the highest grade in hospitals—contributing to a manifest ethnicity pay gap where white consultants are paid nearly £5,000 more on average than their colleagues from minority communities. [8] Conversely, there is an overrepresentation of ethnic minority doctors in lower-paid and under-valued staff and associate specialist grades, reinforcing the career barriers facing many. The challenges faced by ethnic minority doctors intersect across other characteristics too—with ethnic minority disabled doctors being 20% less likely than their white disabled peers to report getting the adjustments they require. [9]

This reality, underpinned by research and evidence, depicts an NHS with deep-seated systemic inequalities that have painfully afflicted many ethnic minority doctors. Rather than spinning a narrative portraying the NHS as a race equality “success story”, it is vital to be open and honest about the systemic factors that disadvantage many doctors on the basis of race. In plain English, this represents structural racism, and we need to be open about it if we are to move forward with solutions to stamp it out.

Ultimately, we desperately need an NHS that gives all who work within it equal opportunity to achieve their full potential, with equal expectation of being professionally rewarded and valued. This would not only recognise the contribution of the “migrant architects” on whose shoulder we stand, but would ultimately benefit the patients we care for and the NHS we cherish.

Chaand Nagpaul, BMA UK Council Chair.

Competing interests: I am a member of the board of the NHS Race and Health Observatory.

References:

1. BMA (2020) A charter for medical schools to prevent and address racial harassment
2. BMA (2018) Caring, Supportive, Collaborative All-member survey
3. GMC (2019) Fair to Refer
4. BMA (2018) Caring, Supportive, Collaborative All-member survey
5. BMA Covid-19 member tracker surveys and BAME doctors hit worse by lack of PPE
6. NHS England (2021) Workforce Race Equality Standard Data Report 2020
7. GMC (2016) Fair training pathways for all: Understanding experiences of progression
8. Appleby, J. BMJ (2018) Ethnic pay gap among NHS doctors
9. BMA (2020) Disability in the medical profession: survey findings