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The NHS has a racism problem – to deny this is putting both patients and staff at risk

Although it is important that the NHS retains its independence, we will not change deep-seated cultural problems without a clear demonstration of political will

Victor Adebowale
Thursday 08 September 2022 18:20 BST
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The RHO’s report in February this year detailed clear evidence of racial bias in the treatment of people from BAME communities in the NHS
The RHO’s report in February this year detailed clear evidence of racial bias in the treatment of people from BAME communities in the NHS (Getty Images)

The NHS has always struggled to relate to race, even while relying on BAME staff to provide the care the population depends on.

In the 1950s and 1960s my mother, a nurse for over 40 years who qualified in Nigeria, experienced racism at its most direct. One attack by a patient left her with a permanent neck injury. Racial abuse of staff was standard until the 1980s, rarely tackled by the NHS leadership or seen as something they needed to address or even acknowledge. Thankfully, my mum retired some years ago, but she can still remember her suffering alongside the other Black, Asian, and Minority Ethnic (BAME) nurses.

We are a nation that struggles to talk about race, to relate to it, or accept that it has played a significant part in the history of our country. It is therefore not surprising that our most beloved institution, the NHS, contains a microcosm of the same dynamic in its culture.

This matters to me because of my six years on the Board of NHS England, and role as the current chair of the largest representative body of health and care leaders in the UK. I also persuaded Sir Simon Stevens, the last CEO of the NHS, to fund the NHS Race & Health Observatory (RHO) as an independent body capable of holding a mirror up to the NHS, so that it could truly see its inaction on racial disparities.

The RHO’s report in February this year detailed clear evidence of racial bias in the treatment of people from BAME communities in the NHS. It also discussed the lack of progress on improving treatment of NHS staff from BAME communities. A previous study by the NHS Workforce Race Equality Standard (WRES) found a failure to support BAME staff; to provide equitable access to career opportunities; to stamp out bullying and racist behaviours; and to provide appropriate cultures of care for BAME staff. All this had a direct impact on the quality of care for all patients, regardless of race.

The NHS requires greater scrutiny on such issues because it deals with matters of life and death. The disproportionate poor treatment of Black staff and Black patients in the NHS shows that though we may all pay for a service, if you are Black, you run the real risk of being treated badly.

The evidence for the most effective interventions that change racist cultures is pretty clear; the actions of leaders make the most difference to culture. If we want to ensure that the NHS is both value for money and value for all people, NHS leadership has to take responsibility for the culture they are paid to create and lead.

The fact that the Health and Care Act 2022 has imposed a statutory duty on the NHS to focus on reducing health inequalities is an important step forward, although it is disappointing that the Act did not specify racial inequality within this new framework. This legal duty is something that we must keep under review. If the Health and Care Act 2022 fails to make a difference in the next few years, we may need to take additional steps to clarify the legal responsibilities for NHS bodies to tackle racial inequality, within an overall drive to ensure that every part of our society has access to high quality health and care services.

Political leadership is also essential to changing and improving the NHS’s culture. Although it is important that the NHS retains its independence, we will not change deep-seated cultural problems without a clear demonstration of political will. Ministers should be asked to give an annual statement on the efforts being made to combat racial discrimination and inequality within the NHS. This political pressure will force leaders in the NHS to keep working on this agenda.

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But words alone will not be enough and inaction needs to have consequences. In the NHS, one of the central motivators for change is money. We are now building the infrastructure to enable the NHS to collect consistent data on race. NHS bodies that consistently fail to make progress in tackling racial discrimination within their organisations should face financial penalties. An example could be looking at pay awards for senior leaders within the organisation. People who want the pay that comes with leadership roles need to demonstrate leadership on race.

Some may say that this is extreme, but racial discrimination has very real financial consequences for our country; from the loss of healthy working years, to poor access and diagnosis creating demand for more expensive acute interventions later down the track.

Leading all the people, all the time, everywhere, means making the undiscussable discussable. It means talking about race, racism, and inequality as though it matters to them, whether the leader in question is Black or white.

Lord Adebowale CBE is the chair of the NHS Confederation and the chair of Social Enterprise UK. This piece is an edited version of his essay in the new collection An agenda for action: New approaches to tackling racism and racial inequality in Britain, edited by Bright Blue and British Future

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