Showing us that the NHS is anti-racist
Professor Partha Kar is a diabetes consultant in Portsmouth, and author of the first plan for addressing racism in and affecting the NHS medical workforce.
He is writing here in a personal capacity.
Let’s be honest about what we have seen over recent days in the UK. Under the garb of ‘protest’ and egged on by extreme right-wing political beliefs, we now have explicit race riots in this country.
The spark which led to this fomenting issue may be the tragic multiple child murders in Southport, but the stacking up of flammable accelerants and kindling has been a long time coming.
Today, if we think back to the high of the 2012 Olympic Games in London when the faces of Chris Hoy, Mo Farah and Jessica Ennis shone together as one country, it feels like a very long time ago. That Great Britain felt like a nation learning to live with post-Empire multiculturalism: an admission that we are here and in it together.
What brought us from there to here? A combined effort of the utter stupidity of Brexit (which satisfied no one, bar a few individuals); the impact of sustained austerity on public services; and the continued working of the until-recently-ruling political party ever further right, with its main, now-ruling rival deciding to edge rightwards too. All to win votes? It legitimised and mainstreamed anti-immigrant and racist discourse.
What’s happened this week is not really about protest. What we are seeing is the wet dream of some media-enabled grifter-politicians: scratching that deep underbelly of society; then making that sore bleed and watching the world burn … working on others’ misery by turning them against their own neighbours, friends, and family.
In the midst of it all, and picking up many of the pieces?
Sits the NHS. Which by all available definition, can be termed as institutionally racist.
This is not only my view. It’s as per the data sources (and if you must, do look up the definition as set by Sir William McPherson who led the Stephen Lawrence Enquiry ).
The colour of your skin matters, whatever your profession. As the Workforce Race Equality Standard’s most recent data shows us, 25% of NHS staff are of BME backgrounds.
Then there are the medical regulators. Step forward the Nursing and Midwifery Council, who seem to have lost any sense of the Nolan principles whatsoever. There was once upon a time when British institutions used to be seen as bastions of principles, where people resigned when they had failed the basics as regards fairness.
Yet egged on by Covid-era shenanigans in the highest offices of the land? No one resigns nowadays, until they are literally pushed out by their membership.
The NHS is – for want of a simpler definition - a magnificent thing. A thing which has all the potential to do much good - yet which is hamstrung by rules, regulations, weird financial trappings - and most importantly, leadership that is faltering.
Forgetting the wider issues regards health outcomes: if one looks at the differential ones based on the colour of one’s skin? It continues to be poor, with little to no improvement.
A great lack of doing
There are no lack of people or organisations saying the right thing, but there is a great lack of doing.
When the national leadership’s response is a combined strategy of ‘here is some data, can you please do something kindly?’, along with the utter lack of any response with teeth if nothing changes, we have a recipe that makes for no progress.
It puts a few people on the map for saying the right things, and challenging the narrative. Yet when it comes to actually shifting outcomes, we see no results. Or if there is any semblance of it in any reports, then it’s literally feeding on scraps.
People talk about representation, yet there are many examples in the political sphere where the phrase “skin-ship isn’t always kinship” is apt. This gets aided by personal ambition; self-centred views; or even the inner needs to please others.
Let’s never underestimate the power of colonialisation of centuries and its impact – akin to the ‘Stockholm Syndrome’. The Indian subcontinent didn’t have any almighty battle which they lost to the British empire before the whole area got taken over and looted for centuries. It was the political will and tactical nous of the British - but aided and abetted by many from the subcontinent who, for personal gains, sold out many.
History is always a fascinating subject, when taught properly. The throwback of that to NHS and its leadership regards representation is no different. It’s not the skin colour that matters: what matters more are the values.
Which brings us to the workforce. The many, many employment tribunal cases have been enough proof of the inherent racism the NHS has. Data sets from WRES programmes have barely shifted over a decade - yet the stunning response to that from NHSE WTE in 2023 was to shut down all work related to tackling racism.
Instead, it decided to merge all issues together into one homogenous mass called DEI, and made tackling anything literally impossible - bar of course churning out hashtags and glossy papers.
An inherent belief that tackling racism was the same as tackling sexism or homophobia has led us to tackling nothing. It disregarded the biggest issue about racial discrimination in the NHS workforce, in an effort to pander to politicians who felt this wasn’t an issue of any interest (or one which didn’t appeal to their voter base).
Such leaders serve no one bar themselves. They certainly do not help to tackle any of the evident racism that infiltrates this great institution.
I have a simple view personally: NHS staff are part of a society which has its evils of racism. To believe that individuals walk into the NHS, put on their NHS suit and turn into some sort of perfect angel is simply unrealistic and not possible.
What we need is systems that challenge such behaviour. We clearly do not have these. Instead, again and again we see those who face up to racism being gaslighted (if it is not actually left up to those facing racism to correct the injustice themselves).
And yes, black and minority ethnic people see worse clinical outcomes if you are a patient; worse regulatory body referrals; worse career progression. These things all lead to only one conclusion: that this is a structural problem, aided by leadership who are silent and, by definition, complicit.
Show, don’t tell
These are dark and hard times. This is where there is a need for national NHS leadership - and Mr. Streeting - to step up and show us that you care: show us that everyone matters.
Crucially, do not tell us this. Show us.
Show us that you can and will tackle racism in the NHS, and root out individuals with abhorrent beliefs. Show us how you will do this. I have spent 25 years working in the NHS, and there isn’t anyone who can say I don’t belong. I also have the privilege to be able to say that loudly and publicly. Yet, many don’t have this privilege - and this is where the national and political leadership need to step up to the plate.
We all belong. We all are part of this NHS, irrespective of the colour of our skin, the God we bow to or the country of our origin. That has been the principle of the NHS since its founding years when we asked the Windrush Generation to come here and help, followed by the tradition of international recruitment.
I want to see our national and political leadership saying and showing us this loud and clear, so as to ensure that many of us go to work without fear in any shape or form - or indeed have care which is lesser.