A damning report has highlighted the extent of inequality and discrimination faced by ethnic minority staff in the NHS, who are less likely to be shortlisted for jobs or promotions and more likely than their white counterparts to suffer abuse and harassment.
A review of journal articles by academics at the University of Manchester, University of Sheffield and University of Sussex, found evidence of inequality across a broad range of professions in the NHS.
Black workers in particular endured significant racist abuse from colleagues and patients, but discrimination was experienced by all ethnic minority groups.
The review also looked at the inequalities and discrimination people from ethnic minority backgrounds face when using and trying to access health services.
The study finds that:
- international nurses described feeling distressed, confused and humiliated because of the covert and overt discrimination they experienced. Examples included patients refusing care from international or Black nurses, and managers being seen to apply more scrutiny to Black international nurses working in their team;
- Black African nurses felt that their experience and knowledge were not respected. Some nurses spoke of how they were made to look stupid if they asked for help with new procedures, while some were prevented from undertaking some procedures even when they were competent;
- overseas nurses were exposed to overt hostility and racism from patients;
- overseas nurses experienced exclusionary treatment in work allocation, for example being allocated direct care rather than “higher status” tasks;
- discrimination is reported far more by people in non-White groups (25.6%) than by White staff (9.5%);
- ethnic minority frontline workers were nearly five times as likely to report a positive Covid-19 test compared with a White general population reference group;
- ethnic minority staff in senior roles were nearly four times as likely to be working in patient-facing roles as their White counterparts during the Covid-19 pandemic, placing them at a higher risk of infection;
- 47% of those identifying as White reported receiving sufficient information on PPE, compared with 33% of those identifying as ‘BAME/mixed ethnicity’;
- limited research has been carried out into the impact of racist experiences on mental health, wellbeing and burnout; and
- there is evidence of an ethnic pay gap in most staff sectors in the NHS, which was most evident for Black, Asian, Mixed and Other groups and less so for Chinese groups.
Tackling racial disparities
Dr Habib Naqvi, director of the NHS Race and Health Observatory – the body that funded the study – said: “It is clear that existing evidence on the stark health inequalities faced by ethnic minority communities has not led to significant change – this is why the Observatory has been established: to synthesise what already exists, translate it into actionable policy recommendations, and to challenge leaders to act.
“This report should be a tool for them; highlighting the best quality evidence and making concrete recommendations for change. By drawing together the evidence, and plugging the gaps where we find them, we have made a clear and overwhelming case for radical action on race inequity in our healthcare system.”
The study recommends that:
- More research is needed to investigate the impact of experiences of institutional, structural and interpersonal racism on both the mental health and career outcomes of NHS ethnic minority staff.
- A systematic review of racist experiences in the workforce needs to be undertaken to see for which specific professions and settings there is evidence of racial abuse.
- National datasets need to ensure that all NHS staff in all sectors, including casually employed staff and those working in subcontracted services, are represented in order to present a comprehensive and accurate picture of workplace inequalities facing ethnic minority staff.
- NHS England and Improvement reviews recruitment and staff development procedures to understand where the greatest barriers to ethnic minority staff’s progression lie.
Dr Chaand Nagpaul, chair of the British Medical Association council, said the review was a “shocking indictment of the scale of harm that racism is causing millions of people in the UK”.
“The government must openly acknowledge structural racism within the NHS and the barriers that it creates – something it failed to do in its own race disparity report last year,” he said.
“Those responsible for our health service must develop a cross-government action plan with tangible outcomes, timescales and agreement across the NHS. Crucially this action plan must be done in an open and transparent manner with involvement from people from ethnic minority backgrounds.”
An NHS spokesperson told Personnel Today: “There is never an excuse for racism or any form of discrimination and it should not be tolerated by anyone, including our hard-working and dedicated NHS staff.
“The NHS has set out what local health services should be doing over the next year to make improvements in their local communities for patients, and will continue working closely with the Race and Health Observatory to drive forward the recommendations set out in this report.”