At the end of last year, Dr Radhakrishna Shanbhag made headlines when a patient asked if he could have a white doctor instead of him.
In a powerful interview, Dr Shanbhag called our national health service a jewel in the crown, but one that needs to take appropriate action to stop the jewel from being tarnished.
He’s far from alone in experiencing racism as a doctor. The problem of racism in the health service is getting worse, according to new research.
The latest Workforce Race Equality Standard (WRES) report from NHS England showed that black and minority ethnic staff in the NHS are suffering from increasing levels of bullying, harassment, and abuse.
Black, Asian and minority ethnicity (BAME) respondents reported worse conditions since reporting began in 2016, in all areas, when compared to their white counterparts.
The number of BAME staff reporting bullying, harassment or abuse from patients, relatives or the public rose from 29.1% in 2016 to 29.8% in 2019.
For white staff, the number fell, from 28.1% in 2016 to 27.8% in 2019.
When you consider that nearly a third of the NHS workforce has a black, Asian or minority ethnic background worker, you realise just how significant these figures are.
The findings are part of a worrying trend of inequality towards BAME doctors and NHS staff who are also twice as likely to face disciplinary action.
What did the report find?
- The number of BAME staff reporting bullying, harassment or abuse from patients, relatives or the public rose from 29.1% in 2016 to 29.8% in 2019.
- The percentage of BAME staff experiencing harassment, bullying or abuse from staff and colleagues in the last 12 months , has seen the largest increase — from 27% to 29%. For comparison with white colleagues, white staff members went from 24% to 24.2%.
- The number of BAME staff believing their Trust gives equal career progression and promotion opportunities fell from 73.4 %to 69.9%. That gap grew from 14.9 to 16.4 percentage points.
- The share of BAME staff experiencing discrimination at work from a manager, team leader or other colleague climbed from 14 to 15.3%.
The racially unequal climate within the NHS is nothing new. A report conducted by Dr Aneez Esmail in 1993 found similar disturbing stats.
Published in the British Medical Journal (BMJ), it found that doctors with English names were twice as likely to move on to senior roles than those with ethnic names, despite having the same experience and training.
We spoke to Dr Esmail, who tells us that even at the time, people thought the state of things was fine, which is a similar story to today’s attitudes.
Dr Esmail tells us: ‘Sadly the evidence on the ground is that ethnic minority staff face increased levels of bullying and harassment both as employees and caregivers. And they continue to face discrimination in terms of access to services and in career progression.
‘This is important because there is such a shortage of staff in the NHS, and as the biggest employer of BAME staff, it needs to make sure that people are satisfied or they won’t choose to work in the NHS.’
But, Dr Esmail notes, the NHS has taken steps such as the WRES report, as well as its regular inspections into what happens to NHS staff within organisations.
He continues: ‘This is all good but there is a long way to go before we can say that NHS staff can realise their potential in an organisation where the senior leaders and decision-makers are overwhelmingly white.
‘What I’d to see happen is a greater focus by NHS management on tackling racial inequalities for both patient and staff. This is complex and difficult but much can be done.
‘It remains a fact that the metrics (for example access to services, bullying and harassment) for staff and patients has become worse (over the past 10 years).
‘Admitting there is a problem and then constantly improving is critical. Otherwise, people will refuse to work in the system.’
But 27 years after that report, the inequality is still being felt by BAME doctors from the very beginning of their careers.
Reports published last year showed that medical students who come from a minority background are less likely to get a job, with 75% of white applicants who sought speciality training posts being appointed compared to just 53% of their BAME counterparts.
In an investigation published in February 2020, the British Medical Association and the BMJ found that medical schools in the UK are ill-prepared to deal with the racism and racial harassment experienced by ethnic minority students.
And last year, the Equality and Human Rights Commission reported that UK universities recorded just 560 complaints of racial harassment over three and a half years, despite 60,000 students saying they made complaints.
The issue of racism in medical schools is important because BAME students make up 40% of medical undergraduates, nearly double the 22% in universities generally.
Melanin Medics, a group for African-Caribbean medicine students was set up to address this and to prepare aspiring medics on what to expect.
Founder Olamide Dada says: ‘Racism in medicine is not a new problem and the lack of progress in sufficiently tackling racism and racial harassment means that the issue has not been prioritised as it should.
‘It is rare that you speak to a medic from an ethnic minority background that has not had such an experience, whether it be in the form of microaggressions or overt racial harassment, such behaviour has become expected.’
Olamide thinks it is great that more conversations about racism in the workplace are being had, but it is important that these conversations lead to action.
She says: ‘The responsibility should not lie solely on the victim or a select few to address this behaviour but also on those around them to provide support by identifying and challenging this behaviour even when they themselves are unaffected. We need more allyship in the NHS.’
For women of colour in medicine, there’s the added layer of sexism on top of the racism they face.
Junior doctor Nabila Bakar tells us she’s often mistaken for a nurse or asked when the doctor will be arriving.
In her time as a medic, she and her peers have witnessed a number of racist incidents.
She explains: ‘We had a patient who refused to see an “Arabic” doctor as he said he’d been trained to shoot Muslims in Iraq.
‘Another one of my friends who is Pakistani went to see a patient as a medic and was told her English was very good. She was born in Surrey.’
What does the NHS have to say about the issue?
We asked the NHS how it feels about the WRES report which highlights the issue of racism.
Professor Sheona MacLeod, Deputy Medical Director for Education Reform, Health Education England tells us:
‘Health Education England is working with UK partners, the GMC and the Royal Colleges to better understand the factors relating to differential attainment. It commissions research, ensures recruiters have up-to-date training, employs a robust complaints and appeals process, delivers best practice guides and has established the Widening Access to Specialty Programme (WAST) to give international medical graduates experience of the NHS and support their applications into specialty training programmes.’
Sadly, the problem of racism in the NHS doesn’t only affect staff members. Prejudice and bias held by doctors also affect their patients.
49-year-old Serena Smith, who is a black woman, contacted us to say she has endured racism at the hands of doctors for the past three decades.
She says it’s ironic that the NHS is discriminatory towards black people as ‘the NHS was saved and propped up by Caribbean nurses of which my mother was one’.
She had one particularly harrowing incident where she went for an abortion but says she was ‘slut-shamed’ and given false information, which she thinks was influenced by the doctor’s personal prejudice.
‘He told me there was a six-month waiting list and so could not help me,’ she says.
‘I had done my research looking into all my options and obviously abortions have to be carried out within a certain amount of time. There was no six-month waiting list basically and he thought I was stupid enough to believe that.
‘I cried my heart out all the way home on the bus from the shame and humiliation I felt which was crucifying. I was already embarrassed prior to attending the hospital appointment.
‘Having to go private at a cost of £300 really affected my family. My father was retired and my mother had a part-time income. There was not enough time to restart the process on the NHS hence having to go private. We struggled with paying bills and buying food for months which caused tension and arguments in our household.’
Though the incident was 30 years ago, Serena thinks the racism has endured.
We’ve also received multiple stories about racism in the NHS and like other institutions that have a similar problem, it’s important for the organisations to recognise the problem, hold themselves accountable and take adequate action.
To understand the true extent of the problem, data must also be accessible – notably, Dr. Esmail was threatened with legal action by medical schools when he asked about obtaining figures for his report.
Universities and medical schools should be transparent about the realities of their institutions and take necessary action to call out racism in a quick and efficient manner.
After all, the NHS has been propped up by people of colour.
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