Hiding behind the curtains of systemic racism - our staff, our patients, our students

Written By Shajada Ahmed

With the recent events around the world, I couldn’t help but find myself reflecting back to my own personal experiences with racism. With the recent surge in social media posts regarding the racism and discrimination faced by so many, the reality of the discrimination within the NHS has become more and more apparent.

As a future doctor (inshaAllah) I think it’s my responsibility to learn about the injustices in my future workplace, allowing me to be prepared and aware of what I can do to prevent it from happening to myself, my colleagues and my patients. (inshaAllah)

*All the topics discussed below have been referenced for those interested in reading the direct source.

– When the injustices of racism are spread through systematically, a generation of white privilege is harboured and fostered. Advocating against such discriminations and injustices, allows for the “dominant” group to be held accountable. This is one of the many reasons why learning about our own biases, speaking out against the systemic racism that we may be a subject to or we may witness is essential towards the path of change.

 
 

1. What is institutional racism?

The concept of white superiority can pervade through all systems and aspects of society consciously and subconsciously – where the idea of a white culture/ society/ people/ livelihood becomes the default and the aspiration. Understandably, the various dimensions of institutional racism within the NHS cannot be addressed in depth in just one post, in doing so it would be a disservice to all of those who have suffered and who are continuously suffering. For this reason, the aim of these next few posts is to bring forward my thoughts on the topic as well as a few key findings from studies, with the hope to help shed light to someone like myself – wanting to learn and take a stand.

Institutional racism – racial discrimination that has become established as normal behaviour within a society or organisation (Legal/political/governmental/ education/ healthcare)(1) 

The institutional racism being perpetuated within the NHS is having irreparable and long standing effects throughout all layers of the organisation. Affecting our healthcare professionals, students and our patients. This long standing culture can be attributed to a hostile environment at work, the lack of effective teamwork, and outdated work models undervaluing the contributions of BAME healthcare professionals. Amongst many other things.(2)

The idea that there is racism within the NHS both explicit and implicit may be a hard fact to swallow. The NHS is our national service, providing care to people at the point of contact, saving those during times they are most vulnerable.(3) Discovering the various examples of discrimination and injustices being carried out behind the very rooms that people go to when they are in most need of help, may be difficult to accept.

Unfortunately, these cracks are present, and are affecting a large proportion of the individuals holding the organisation up. The implementation and spread of systemic racism across our NHS restricts people of colour from being able to contribute to the organisation and fosters a hostile workplace. It also increases the sense of isolation between staff, fuelling this idea of “them vs us”, decreasing the effectiveness of a team and ultimately jeopardising patient safety.

 
 

2. Statistics – 

Below are a few findings from various studies of the different ways in which institutional racism has manifested in our hospitals and affected our staff. (4) 

  1. Although nearly a 1/5th of the staff in the NHS are people from BAME background, only 6.9 % of senior managers are BAME staff. (4)

  2. Basic pay for consultants from ethnic minority backgrounds was 4.9% less than for white consultants in 2017, equivalent to £4644 a year. (5) 

  3. Median basic pay for white consultants was higher than for all other ethnic groups, varying from around 5 % higher than black or black British consultants to more than 6 % higher than mixed or dual heritage consultants. (5) 

  4. BAME doctors are reported to the GMC at more than twice the rate compared to white doctors. (6)

  5. Black NHS staff report the highest incidence of bullying and harassment from their colleagues. (6)

  6. 31 March 2018, 88.1 % of NHS trust board members were White. (7) 

  7. Doctors from a BAME background have more than double the rate of being referred by an employer compared to white doctors. (8)

  8. “BAME staff were found to be 1.24 times more likely to enter the formal disciplinary process compared to white staff, despite year-on-year improvements.” (4)

As you can see from the findings above, the disparities within BAME and white staff in the NHS runs through many elements. From a difference in pay, difference in succession in awards and differences in harassment and reports. In addition to this, some of the studies cited above have been conducted as far back to 1987 – emphasising just how long this has been a problem.

Understandably then, the dismantling of this racial discrimination may require a substantial and prolonged effort.

 
 

3. What can we do?

Our NHS is rich with staff from over 200 different non-British nationalities. (9)` For this reason, working in a diverse team encompasses the nature of our NHS. Staying silent during a time of injustice towards any of our team members is a disservice to the essence of our NHS.

There are many things that we can do as individuals and as a team –

  • If you are subject to racial abuse from a colleague, try to address it with them – tell them that their behaviour is unacceptable. If nothing changes, try to escalate the matter to a senior staff member/ line manager. The same can be said if you face any racial discrimination from patients.

  • Always make an account of the incident, either in writing or in an email.

  • Challenge the many forms of microaggression – if you feel like someone may be saying something indirectly, you might want to respond by “what exactly do you mean by that?”

 
 

4. Core principles for a healthy workplace – 

As humans, we have three core principles which need fulfilling in the workplace, these are –

  • Competence – reflects our need to be able to have a positive effect on the work environments we find ourselves in, as well as to get valued outcomes.

  • Autonomy – Having our free will respected and a safe space to practice this.

  • Relatedness – Feel connected to others, to care for and to be cared for. (10) 

Staff need to feel valued for their contribution at work and believe that they are given opportunities irrespective of who they are or where they are from. (6) “When they do, they are more likely to be engaged and motivated at work, less likely to take time off for sickness, and more likely to put forward new ideas. These are all reasons that higher levels of engagement contribute to employees being more productive at work.” (6) So, to see a positive change within our NHS, we need to ensure that we create a safe, welcoming and non-judgmental space for all our colleagues.

 
 

5. Improve through inclusion –if there is no seat for you at the table, then you must bring your own chair – 

As I’ve discussed above, the dismantling of such widespread malpractice cannot be done with a simple list of actions alone. To have a stable roof over our organisation, we must tackle the faults in the foundations and walls first. For this reason, more people from BAME backgrounds must be included in higher positions to allow an appropriate representation and recognition of the workforce.

Together, tackling the injustices higher up the organisational ladder, as well as those on the surface of our NHS may be the start to creating a fairer workspace – where staff are rightfully made to feel like an important and valued member of the team. Where their voice can be heard and they can express any concerns openly, all of which is key to this push for change.

So to any one reading this, whatever workforce you may be a part of – do not be a passive bystander. Raise awareness, challenge others appropriately and sensibly. And most importantly be kind to others, be understanding and speak out against injustice.

I hope you enjoyed reading this piece and my first post into this series – Hiding behind the curtains of systemic racism – our staff, our patients, our students. I pray that together we can help create a better environment for ourselves and those around us inshaAllah.

– On a final note, I am not an expert on this topic, the information discussed is based on my own personal opinions and reflection. –

 
 
Shajada Ahmed

Shajada is a final year Medical Student at the University of Leeds. A key interest of hers is widening access into medicine. She believes that utilising the position we are in to support aspiring medics, and mobilise the social change within Medicine is crucial, not only for the field of Medicine but for our patients.

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