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Open discussion would help challenge denial of race-based discrimination and dispel the myth that it is unusual, but staff and managers remain reluctant to raise it
There is a culture of denial about the existence of racism in the NHS workplace and a lack of appetite for much-needed ‘race talk’ among employers, research reveals.
Nursing Standard. 39, 6, 23-25. doi: 10.7748/ns.39.6.23.s9
Published: 05 June 2024
Senior nurses have used the findings to call for institutional racism to be rooted out of the health service.
The analysis by Middlesex University researchers and equality charity ‘brap’ reviewed eight NHS race-related tribunal cases and carried out a survey of 1,327 NHS staff – of whom an overwhelming majority of respondents were black or from minority ethnic groups – to explore their experience of raising allegations of racism in their NHS workplaces.
Three quarters of respondents (75.7%) said they were reluctant to challenge racism in the workplace, saying they did not believe anything would change. Of the 67.2% of respondents who raised concerns, only about 5% said their problem was dealt with satisfactorily.
Report co-author Roger Kline says: ‘Black and ethnic minority staff are afraid to raise concerns as they don’t believe they will be taken seriously. On the contrary, they have to consider whether their work life is going to be made a misery.’
Mr Kline, a research fellow at Middlesex University, says: ‘It’s a calculation before you raise a concern as you know it is going to cause turbulence, so many people don’t. They either believe it won’t make a difference or it is going to make things worse.’
The way concerns are dealt with needs a more radical approach, he adds. ‘We tend to concentrate on making the processes easier so staff can report issues, but we haven’t focused on who is hearing those concerns and who and how they are acted on. So the end results don’t change.’
Filipino Nurses Association founder Francis Fernando says denial culture in the NHS is affecting the mental health of staff as well as patient outcomes.
Mr Fernando says: ‘I strongly agree there is a culture of denial around racism in the NHS – just look at the annual NHS Workforce Race Equality Standard (WRES) reports.
‘Time and time again it has emphasised that there are disparities in the way white and global majority staff are treated in the NHS and yet, there are few actions that come out of it.’
The latest WRES data from NHS England show that 17% of black staff or those of minority ethnic heritage experienced some form of discrimination from colleagues in 2022, compared with 6.8% of white staff.
‘Very few NHS trusts are recognising there are issues of racism and discrimination, and proactively addressing these concerns,’ adds Mr Fernando. ‘As we celebrate one year of [senior nurse] Michelle Cox’s landmark employment tribunal victory against NHS England for racism and discrimination, global majority staff in the NHS continue to live and struggle with the abhorrent behaviours of some managers in the NHS.
‘Our NHS and British values are not reflected in these behaviours. NHS staff are supposed to be caring for each other, especially as we are still recovering from the aftermath of the worst pandemic the world has ever witnessed. And yet, there are managers who perpetuate racism and discrimination and get away with it.’
Three race discrimination tribunal cases from 2023 that had positive outcomes for the staff complainants:
» Michelle Cox was a senior nurse working for NHS England who unanimously won her claims of discrimination, harassment and victimisation in a case that exposed shoddy procedures in NHS England and prompted scathing comments from the judge about her managers
» Adelaide Kweyama was an agency nurse who was racially abused by patients. Her manager told her she would receive less racist abuse if she bleached her skin. She won a race-related harassment case against Central and North West London NHS Foundation Trust
» Olukemi Akinmeji, who was a midwife at William Harvey Hospital in Ashford, Kent, successfully sued East Kent Hospitals University NHS Foundation Trust for discrimination and victimisation. Ms Akinmeji faced a ‘toxic’ work environment in which her colleagues ‘ganged up’ on her
Source: gov.uk
Defensiveness is a common reaction to allegations of racism in organisations, according to the research. Complaints are often not taken seriously, it says, and may be dismissed as a misunderstanding or the person responsible ‘didn’t mean it’. Worse still, complainants may be regarded as ‘playing the race card’.
One Freedom to Speak Up guardian from a large NHS trust told the survey about battles to get racism acknowledged among colleagues. ‘When I highlighted cases where I perceived race to be the issue, these were downplayed …One HR manager sat in a meeting and said “he’s playing the race card”.’
Another respondent who raised concerns about inequitable treatment was told: ‘If you are going to play the race card, I will shut this meeting down.’
Even when a staff member has experienced behaviour deemed to be to their detriment, employers are often reluctant to accept that race discrimination is the root cause and instead often opt to categorise it merely as ‘poor behaviour’ or ‘poor management practice’.
And what constitutes racism in the workplace is often misunderstood. A common theme in the review of tribunals was that employers did not understand the law on racial discrimination and many assume that actions have to be proved to be intentional. Courts have made it clear that unconscious discrimination is also prohibited. This can lead to staff being given misinformation, and undue stress and upheaval for the person who is subject to the discrimination. Tribunals regularly find that management witnesses, including investigators and panel members, are not credible. Yet there do not appear to be any consequences for those responsible, even when it is clear they lied or were complicit in a cover-up.
Moreover, Mr Fernando believes that some managers use regulator referrals as a ‘weapon’ against staff who lodge grievances against employers. ‘Data shows that there are disproportionately high numbers of global majority nurses referred to Nursing and Midwifery Council (NMC) compared to their white colleagues,’ he adds.
‘Racist managers continue to treat staff deplorably and will use NMC referrals as a weapon to retaliate if concerns are raised,’ he says. ‘According to a recent Freedom of Information request I submitted, there are about 900 Filipino nurses who are referred to the NMC annually.’ For comparison, the total number of referrals to the NMC in 2022-23 was 5,068.
42.7% of NHS race discrimination concern cases had the outcome of nothing happening
5% of cases of a race discrimination concern being reported resulted in the individual who raised the concern being disciplined
41.8% of survey respondents left their jobs as a result of their treatment
Source: Too Hot to Handle? report tinyurl.com/hot-to-handle
The Too Hot To Handle report lays out a number of actions that the authors believe can bring about change in the workplace. These range from better record-keeping and data-collection by HR departments, to better use of Freedom to Speak Up guardians. The report offers a comprehensive action plan for how to tackle an embedded culture of racism.
But Mr Kline says before any of this can happen, the organisation must recognise and accept the problem.
‘The first thing is organisations have to accept that there’s a problem and they need to talk about it. And unfortunately, lots of boards struggle with that. It’s better than it used to be, but they don’t really own the problem, so they are not comfortable talking about race, and they’re not comfortable talking with black and ethnic minority people.
‘Time and time again people have said they fear discussing race. They fear saying the wrong thing, in case something lands the wrong way and it sounds racist. Being able to talk about race and everyday racism helps people get past the belief that racism is an unusual occurrence. It helps create conditions where racism is spotted, believed, and referred to more routinely.’
‘Being able to talk about race and everyday racism helps people get past the belief that racism is an unusual occurrence’
Roger Kline, co-author, Too Hot to Handle? report
Mr Kline says employers should use the data they collect to identify culture problems. Data on staff attrition, complaints, disciplinaries, sickness and staff turnover can be key indicators of cultural issues in the organisation. He says employers should use this information to be proactive and adopt a preventative approach, rather than wait for staff to raise concerns.
Former RCN general secretary Pat Cullen, speaking before she stepped down from the role last month, said: ‘It’s critical we not only talk about racism but act in a decisively anti-racist way.
‘The NHS too often fails its minority ethnic staff. They 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.’
She added that unions and professional bodies should 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 change is taking place.’
» Develop an appetite for ‘race talk’ Being able to talk about ‘race’ and in particular covert ‘everyday’ racism helps people get past the belief that racism is an unusual occurrence. It works the muscle of understanding, lessens the fear of discussing it, and helps create conditions where racism is spotted and credence is given to complaints
» Set standards of behaviour that challenge everyday racism Interventions should be improvement-focused, for example, taking the form of coaching for individuals so they understand more about the impact of their behaviours
» Be more comfortable with staff speaking out Employers must recognise that organisations are experienced differently depending on an individual’s role, position and identity. The result of this is that staff hesitate to make allegations of racial discrimination because there is good evidence that they will not be believed, and raising a complaint will make things worse
» Commission the right kind of support for staff Think about commissioning development rather than training, and be clear about the distinction. Common flaws with training opportunities are: they are not long enough; they are not engaging; and they do not help staff to gain a more critical understanding of race and racism
Source: Middlesex University tinyurl.com/hot-to-handle and brap.org.uk
British Sikh Nurses founder director Rohit Sagoo says that, with international recruitment plugging nursing workforce gaps, the issue of tackling racism is more pertinent than ever.
Mr Sagoo says: ‘We are seeing an influx of nurses from south India and the Philippines, and I know they have race concerns, and these will only increase.’
Latest NMC data show that half of the 52,148 new joiners on the UK nursing register last year were educated overseas, up 610% since 2018.
Mr Sagoo points out there are some positive findings in the data to keep in mind. ‘While there is a long way to go, some staff are progressing and having positive experiences,’ he says. ‘The NHS has some good initiatives to combat racism operationally, but sadly, when dealing with it face-to-face, staff experience this denial.’
Mr Sagoo says past reports have not led to fundamental change but role-modelling and leadership could help.
‘We need a fearless leader. Someone who has walked in our skin and our shoes and stood up to the NHS – someone like Michelle Cox. She’s a hero and a leader.’
Racism and discrimination at work: what support is available? rcni.com/discrimination-support
