Racism: we have to stop looking the other way

This blog first appeared at: https://blogs.bmj.com/ebn/2023/04/02/racism-we-have-to-stop-looking-the-other-way/

In just one month the NHS has lost four Employment Tribunals in which judges heavily criticised NHS Trusts for race discrimination, another Trust had to apologise for repeated examples of racist behaviour by its staff towards colleagues and patients, whilst a national NHS body was found to have deliberately covered up racism. In three of the four Tribunals involved race discrimination against nurses and midwives.

Michelle Cox was a nurse manager of Black and Minority Ethnic (BME) heritage with impeccable NHS service, who raised concerns (which the Tribunal confirmed were accurate) about her own treatment at work and about a serious breach of legal obligations in respect of independent review panels

She was subjected, the court found, to a catalogue of detriment made worse by the repeated failures of NHS England, to investigate fairly, to hold a fair grievance appeal, and to understand the law. The Tribunal described Michelle’s senior nurse manager’s evidence as “continued evasion when challenged, and her failure to explain her conduct at the material time, on occasion providing new excuses not mentioned before or to the grievance appeal”. This nurse manager has since been promoted as have the investigator and the HR adviser. Michelle Cox has not worked since. Read the tribunal decision here.

Adelaide Kweyama was an agency nurse working in CNWLFT. She reported racist slurs from patients, including the n-word, and the following month, she reported how a patient was racially abusive towards her. Her manager, another nurse, then told her: “You need to get a pool of bleach and bleach your skin so that you come back tomorrow white and the patients will be nice to you.” The Court found there was no proper follow-up of her complaint about that incident and described it as an “absolute abdication of the positive responsibility on managers”. The tribunal decision can be read here.

Kemi Akinmeji was a midwife at the EKFT which had been previously found to have a toxic environment. The Tribunal heard how a previous grievance raised by another black midwife over how duties were allocated had highlighted the risk of unconscious bias, but plans to appoint a “race champion” had not been acted on. Adelaide eventually left after a number of concerns she had raised about how she was treated had been ignored. On her last day, a senior midwife said: “It’s Kemi’s last day – everyone check your bags” at a time when there had been actual thefts from staff. When the claimant asked the trust about action resulting from this, she was told that the midwife had since attended unconscious bias training and had been warned of the potential for disciplinary action if repeated. The Court, however, heard neither of these things had happened. Read the tribunal decision here.

In the same month, BHRUHFT was found to have racially discriminated after two scientists were increasingly marginalised and excluded because of their race and then penalised for complaining about that treatment. Click here for the tribunal decision.

The following week EEASFT apologised to BME staff after a report found multiple cases of “monkey noises and reference to banana boats were made” whilst colleagues fasting during Ramadan were openly laughed at. Just one third of BME staff there felt inappropriate behaviour or language would be dealt with. The tribunal decision can be read here.

Meanwhile at NHSBT, it was reported there were “deliberate attempts’ to conceal racism”. All this matters for many reasons.

• This treatment is traumatic for staff – research demonstrates that racism makes you ill

• This impacts on other BME staff who witness or learn about such treatment and the failure of managers to tackle racism.

• There is a financial cost to the NHS – increased turnover and lower morale, as well as compensation and lawyers fees

• This also impacts patient care – if staff experience racism, how are BME patients treated, not to mention the impact on the team work essential to safe care for all?

• There are growing numbers of BME patients whilst 24% of NHS staff are now of BME heritage too. What message does failure to tackle this issue send to these colleagues –and the recruits the NHS desperately seeks?

• In all these cases senior managers went AWOL when racism surfaced, and stressed the absence of any racist “intent” (blaming unconscious bias) as if that affects the impact or is a defence that would hold water in law).

• There was governance meltdown –why on earth did Trusts defended the Tribunal claims?

Finally, those nurses and midwives who discriminated are in breach of the NMC Code notably Para 20.2 requiring registrants to “act with honesty and integrity at all times, treating people fairly and without discrimination, bullying or harassment”.

When healthcare colleagues are disadvantaged through sexism, racism, homophobia, their disability or through bullying and harassment, it should never be left to those suffering detriment to stand alone against it. We all have a duty of care – as human beings, as NHS staff, and as registered nurses and midwives. Apologies are a start but the real apology is to prevent such discrimination happening again. A couple of hours of “unconscious bias” training may increase cognitive awareness but makes limited difference to decision making. Accountability is as crucially important for discrimination and bullying as for anything in the NHS. That means consequences (as well as training) including disciplinary action and/or referral to the NMC. The time has long gone when we can afford to look the other way.