Racism remains part of NHS culture, researchers warn

The report ‘Too Hot to Handle: An Investigation Into Racism In The NHS’ found that many healthcare organisations were failing to listen to concerns raised by Black and minority ethnic staff and deal with them effectively.

“There has been some progress but overall the NHS needs to get a grip on this issue”

Roger Kline

The report’s findings are based in part on the results of an online survey run between May and July 2023 which was completed by more than 1,300 Black and minority ethnic NHS staff.

The survey found that racial discrimination was experienced by more than 70% of Black and minority ethnic staff who had been trained in the UK, and by 53% of those who had been trained abroad.

The forms of racial discrimination reported included having their performance receive greater scrutiny than that of White colleagues, reported by 63% of respondents, and not being offered development opportunities, reported by 52%.

In addition, 49% of respondents said they had been denied promotion opportunities, while a third said colleagues spoke to them rudely or in a different way to other colleagues, and a quarter were left without support when patients were racist towards them.

More than half (53%) had heard a colleague or patient make an assumption about someone based on race or nationality.

Three quarters of staff at band 8 or over said they had highlighted concerns of race discrimination to their organisation, but this was less common in staff at lower band level, with 61% of staff at bands 6-7 and 54% of those at bands 1-5 reporting they had raised concerns.

The main reason for not raising a concern of race discrimination, given by more than 75% of the survey respondents, was not believing that anything would change as a result.

Other common reasons for not raising concerns included not wanting to be seen as a troublemaker, reported by 64%, concern about repercussions from people in leadership positions (57%), and believing that the trust would not take the concerns seriously (54%).

Of those who raised concerns, only 5.4% said that they were taken seriously and their problem was dealt with satisfactorily.

The most common outcome when a concern was raised, reported in 43% of cases, was nothing happening. In 20% of cases claims of race discrimination were referred to mediation as if they were the same as any other workplace dispute, while in 5% the person raising the concern was themselves disciplined.

The report’s authors concluded that NHS employers needed to make more proactive efforts to tackle a culture of racism, rather than relying on individual staff to raise concerns.

They also recommended that healthcare organisations should adopt a culture where racism was spoken about routinely.

The report was co-authored by Roger Kline, research fellow in Middlesex University’s business school, and Professor Joy Warmington, Middlesex University visiting professor of education and Brap chief executive.

Roger Kline

Mr Kilne said: “Our report found that BME staff still face serious challenges in raising complaints of racism and this has an impact on staff morale, progression and recruitment, and potentially on patient care if staff feel under-valued and badly treated.”

He added: “In the NHS, where a quarter of staff have BME heritage and a significant proportion of patients do too, this is not a marginal issue and nor is it a new one.”

The latest report comes 10 years after publication of ‘The Snowy White Peaks of the NHS’, which found that Black and minority ethnic staff were largely excluded from senior positions in the NHS.

Mr Kline, who also led that report, said: “Too little has improved or changed since my report a decade ago.

“There has been some progress but overall the NHS needs to get a grip on this issue.”

Responding to the report, Royal College of Nursing general secretary and chief executive Pat Cullen said it was “critical” for nurses not only to talk about racism but also to act in a decisively anti-racist way.

“The NHS too often fails its minority ethnic staff. These colleagues are substantially less likely to be shortlisted for jobs, less likely to reach the top table, more likely to face disciplinary action, and more likely to report harassment, bullying and abuse from patients, than their White counterparts,” Ms Cullen said.

She added that trade unions and professional bodies must be at the heart of the change necessary to root out institutional racism.

“It’s vital that staff feel safe to challenge discrimination, and confident that the necessary change is taking place,” she said, adding that at a time when the government was focusing heavily on recruiting from around the world, more needed to be done urgently to empower internationally recruited staff to speak out.

“As their professional body we will take a lead role in that too,” she said.

“To see so many who feel driven out of their jobs in the middle of a recruitment crisis because of discrimination is sickening and adds to the peril patients face,” Ms Cullen concluded.

Sir Julian Hartley, chief executive at NHS Providers, said that the report highlighted the “pressing need” for systemic change in the NHS to address the impact of racism on minority ethnic staff, particularly those in lower pay bands.

“The experiences of racism shared are deeply distressing and must not be tolerated,” he said.

“Trust leaders are working hard to tackle racism in the NHS, but more must be done to ensure all staff feel empowered to speak up and are confident that their concerns will be acted on,” Sir Julian said.

He added that comprehensive onboarding and continued support for internationally recruited staff would help address disparities in reporting concerns, but that it was not up to those individual staff members to solve the problem.

He added that management and HR teams needed to be better trained to respond to racism and discrimination to ensure they were dealing with concerns raised by ethnic minority staff properly.

“Trust leaders should develop anti-racism strategies that actively dismantle inequities within organisational culture, setting clear standards of behaviour with a focus on allyship to reduce the double burden on ethnic minority staff,” Sir Julian said.

“Our race equality programme aims to change hearts and minds, improving the confidence and capability of trust leaders through emphasising good practice and embedding accountability at board level,” he added.

“Tangible action must trump tick-box exercises to drive real change promoting equity and inclusivity at every level of the NHS.”