Nurse leader calls for bravery in fight against racism

Felicia Kwaku has called on the professions to have “honest conversations” about the true level of racism that exists within healthcare and beyond and to make sure Black and minority ethnic (BME) staff are protected and supported.

“We have to shift the ideology on racism and do everything we can to combat it”

Felicia Kwaku

Ms Kwaku this month stepped down as chair of NHS England’s chief nursing chief nursing officer (CNO) and chief midwifery officer (CMidO) Black and minority ethnic strategic advisory group, a post she has held for more than four years.

The group has played a pivotal role in placing a spotlight on race equity issues in healthcare and has provided essential professional and pastoral support for BME nurses and midwives working in the NHS in England.

In an interview with Nursing Times to mark the end of her tenure, Ms Kwaku has reflected on the successes of the group and has set out key priorities and challenges going forwards.

The strategic advisory group was set up in 2001 by England’s then CNO, Dame Sarah Mullally. Since its inception, the group has been tasked with helping NHS England address the significant challenges facing BME nurses and midwives.

“Our mission is to advise the CNO and CMidO on matters relating to race equity, to be an expert voice in the space [and] to advise on policy and matters that impact BME communities,” Ms Kwaku said.

The group has evolved over the last two decades, amplifying its reach across all corners of the country.

Since it expanded its leadership structure in 2016 to align more closely with the regional CNOs, the group has now become NHS England’s “voice [on] the ground” for BME staff, said Ms Kwaku.

It comes as the latest Workforce Race Equality Standard report, published in March this year, found that BME staff made up more than a quarter of the NHS workforce in England (26.4%) and more than a third (33.6%) of nurses, midwives and health visitors.

Meanwhile, recent data from the Nursing and Midwifery Council (NMC) revealed that 49% of new joiners to the register in the last 12 months were educated outside the UK. This means that internationally educated staff now make up nearly a quarter (23%) of the register.

BME nurses and midwives have a longstanding legacy in the NHS, bringing a wealth of knowledge, experience and expertise to the settings in which they work.

The role of the strategic advisory group has arguably never been more imperative, to ensure that their concerns are represented at a national level.

Ms Kwaku, who is associate director of nursing at King’s College NHS Foundation Trust, became chair of the BME strategic advisory group in April 2020.

Under her leadership, the group’s size has quadrupled, from around 75 representatives to almost 350.

In October 2020, Ms Kwaku was awarded an Order of the British Empire (OBE) for services to nursing during the Covid-19 pandemic.

She was pivotal during this time for raising the alarm nationally on the disproportionate impact of Covid-19 on BME staff.

“As I came into post, we were just getting lots of intelligence from the ground – nurses and midwives were very worried,” explained Ms Kwaku.

“We were starting to get reports that people just felt really, really vulnerable [and] they didn’t know who to speak to.”

Working with the group’s regional networks, Ms Kwaku delivered engagement events with staff, providing them with a space to discuss the impact that the pandemic was having on them.

“It just takes a few of us to stand up and be brave and speak out so that we can facilitate change”

Felicia Kwaku

“Their experience was harrowing,” Ms Kwaku said.

The strategic advisory group gathered all the concerns and used them to compile a list of recommendations for the CNO at the time, Dame Ruth May.

“Those recommendations really pointed and steered towards making sure that people were protected, that they had the proper risk assessments in place [and] that they could speak up freely,” Ms Kwaku noted.

The recommendations were then incorporated into a wider national action plan for minority ethnic nurses and midwives, published later in 2020.

The inaugural plan spanned a range of actions with a common goal to ensure all BME nurses were valued and respected, and have equality of opportunity. 

Since then, the group has gone from strength to strength, acting as a driving force to promote the voices of BME staff across all NHS organisations.

Across the regional groups, bespoke leadership programmes for BME nurses and midwives have been set up, to support staff to pursue and secure promotions at work.

Meanwhile, the group has also represented BME voices at a national level, for example by advising the all-party parliamentary group for sickle cell and thalassemia, and sitting on the government’s advisory group on mandatory Covid-19 vaccinations for healthcare workers.

Ms Kwaku said the group had a “strong sense of advocacy” underpinning its ethos, supporting staff who have been subjected to race discrimination at work and working with diaspora and internationally educated nursing groups across the UK, to understand the important issues affecting BME nurses and midwives.

“We support a lot of people that way, in terms of mentoring, advocacy and supporting them and steering them in the right way. That advocacy work is making sure that they are represented,” said Ms Kwaku.

In recent weeks, there has been a surge of racist violence and disorder taking place across the UK, which in some cases has been directed at healthcare workers.

Earlier this month, swathes of far-right protestors took to the streets across the UK.

The riots first broke out following a misinformation campaign on social media which had falsely claimed that the perpetrator of a mass knife attack on a group of children in Southport, Merseyside, was Muslim.

The subsequent disorder was characterised by racist chants, demands to deport migrants and violence against police and BME members of the public.

Filipino nurses were among those targeted by the far-right rioters, while other minority ethnic nurses had their homes vandalised, explained Ms Kwaku.

“This is really heinous stuff that’s happening, and we need to protect our workforce,” she added.

Separately, a beloved statue of the 19th-century Black nurse Mary Seacole was also vandalised around the same time that the riots were taking place.

The statue, located outside of St Thomas’ Hospital in London, was defaced by vandals who splattered it in paint. Many believed that the vandalism was racially motivated.

Following the incidents, BME staff felt “vulnerability, anger and upset”, Ms Kwaku said.

“Staff do not always feel safe, and they need to feel safe so their expectation is that they will be protected, and that the organisations that they work in will do their utmost best to protect them.”

In response, the strategic advisory group has been running engagement events with BME NHS staff across the country to “measure what’s happening on the ground”.

However, Ms Kwaku argued that, across the whole healthcare system, there needed to be “honest conversations” about the level of racism that exists within it.

She added: “Sometimes people say race and discrimination is too difficult to talk about [and] it’s too sensitive.

“But you need to talk about it and face the realities and the truth of what’s out there. It’s a massive safety issue and it should be at the forefront of people’s minds about what people are going through.”

And Ms Kwaku noted that racism against NHS staff predates the recent race riots across the UK.

“We have those discriminatory practices within our organisations, irrespective of the civil unrest,” she said.

“At this current time, we need to really upscale and really have some of those conversations, the right kind of conversations, around how we manage and handle race discrimination within the workplace.”

An investigation by Nursing Times, published in June, revealed that incidents of racism against NHS staff have been on the rise every year.

Some nurses reported being physically and verbally abused on shift, while others said they had been subjected to more covert racism, such as being the subject of gossip or being denied promotions and development opportunities.

“We want the group to go from strength to strength”

Felicia Kwaku

Against the backdrop of what is a very frightening time for many healthcare staff, Ms Kwaku said it was imperative for nurses and midwives to check in with their BME colleagues.

“These are the times to really check in and really be authentic in understanding the experience of what it means when you are targeted and when you experience racist behaviours,” she said.

In addition, NHS organisations must ensure their policies are up to date and are able to effectively tackle racism and support those who speak up about it, she said.

“We have to do this work and we have to shift the dialogue. We have to shift the ideology on racism and do everything we can to combat it,” urged Ms Kwaku.

“It just takes a few of us to stand up and be brave and speak out so that we can facilitate change.”

NHS England announced last week that two new chairs have been appointed to lead the CNO and CMidO BME strategic advisory group, following Ms Kwaku’s departure.

Vinice Thomas, director of nursing and quality at NHS England in the London region, and Gifty Markey, associate chief nursing officer for mental health, learning disability and neurodiversity at North Bristol NHS Trust, took up the joint post in August.

The group has several priorities it will be focusing on in the coming months. For example, it wants to support NHS England to rollout anti-racist guidance and also play a key role in informing the roll out of the new CNO strategy.

“When that rolls out, we are going to be really focusing on elements around race equity that’s embedded within those work streams,” said Ms Kwaku.

Other priorities include supporting the new Labour government to implement policies that centre around the important issues relating to BME nurses and midwives.

In addition, the group will work to hold the NMC to account, as it makes necessary changes to its organisational culture, following a recent damning review.

Ms Kwaku said the group would work to ensure that the voices of Black and minority ethnic nurses and midwives were “integral in that [NMC] work going forwards”.

Reflecting on the group changing leadership, she added: “We want the group to go from strength to strength. When we change chairs, we’re looking that the group becomes better.

“We just want it to blossom and grow, that’s what we want – the legacy to continue.”