Racism is everywhere in the NHS, we urgently need to find solutions

Zeshan Qureshi and Jameela Sheikh discuss what they have learnt from talking to healthcare professionals and medical students about their experiences of racism in the NHS

What has it been like being a healthcare professional during the covid-19 pandemic? While most healthcare professionals have experienced an outpouring of gratitude for their hard work, we haven’t experienced it equally, particularly those in ethnic minority communities. To understand this further, we spoke to UK healthcare professionals and students about their experiences of racism in the NHS during the pandemic.

Imagine providing treatment to a patient who in turn throws blood at you, threatens to give you covid-19 while using racially derogatory slurs and calling you a “foreigner stealing jobs.” Imagine being an Asian student and having your family mocked for eating bats and being accused of starting the pandemic. We heard of acts of racism as extreme as patients physically attacking staff. Others were more subtle,  for example, a patient requesting a doctor who speaks “better English.” Shockingly, acts of racism came not only from patients, but also from professional colleagues. For example, a colleague saying the name “Mohammad” is too complicated, so I’ll call you “Mo,” or flippant remarks about skin colour and heritage. 

Exploring the NHS’s approach to medical education, many students said that they felt that disease presentation in ethnic minorities was not adequately taught in either undergraduate or postgraduate medical curriculum. For instance, skin rashes are predominantly taught with images of white skin, despite often looking markedly different on black or brown skin. When asked about their experiences, one student reported overhearing a racist remark—being called “another bloody foreigner”—by an actor playing the patient during an exam.

The overall opinion of the healthcare professionals that we spoke to is that racism in the NHS is systemic and deeply ingrained at every level. Many felt that there is a lack of leaders from ethnic minorities in medicine. The majority felt that there was inadequate representation in medical education, in leadership roles in research, and in medical institutions. Many also felt that those from ethnic minority backgrounds are rewarded less for the same work and punished more for the same mistakes. Respondents agreed that ongoing racism impacted not only on their mental and physical health, but also on their ability to perform their job; thus, jeopardising patient care. Surprisingly, only a minority of those who we spoke to who witnessed or experienced racism claimed that they have always reported it. The top reasons for not doing so are unclear reporting guidelines, ineffectiveness of reporting, fear of a backlash, and normalisation of racist behaviour. 

What are the solutions to racism in the NHS, and what can we do as individuals and as a medical community to bring about change? 

First of all, race and diversity teaching should be better incorporated into the medical curriculum. One example of this being done well is the “Skin Deep” initiative which is being used by clinicians across the country, where ethnically diverse skin images are used in paediatric dermatology teaching. We need to see more educational initiatives like this. Alongside this, staff need to receive clear and ongoing professional training on diversity, inclusion, and equality in the workplace. 

How can we respond better when acts of racism occur? We need a clear and anonymous reporting system introduced across the NHS, as well as zero-tolerance policies, training on reporting racism, and systemic support for victims.  

Finally, it is crucial that we recognise and support staff from ethnic minority backgrounds to attain healthcare leadership positions. Having more representation at the highest level in the NHS would provide greater recognition, response, and reflection following racist acts. Furthermore, it would provide the necessary framework and role models for future ethnic minority leaders in medicine. 

We need to work towards the vision of living in a racism-free world. This vision includes healthcare professionals feeling safe, respected, and valued in their workplace. Not only is this the right thing to do morally, but there is good evidence that it will also improve quality of care and patient outcomes.

Zeshan Qureshi is a paediatric registrar based in London.

Jameela Sheikh is a medical student based in Birmingham

Competing interests: none declared.