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We need to talk about this: racial discrimination in NHS recruitment

Roger Kline, 3 June 2013

A nurse recently said to me:  “I have told my children. I don’t care what they do after sixth form as long as they don’t go into nursing. They shouldn’t have to put up with the treatment I have had to put up with.”

An exceptional attitude? Unfortunately not. She is one of a dozen or so black nurses I have represented or advised over the last 12 months who could have said the same.

The NHS’s own data says their personal experience is all too common. Race discrimination is alive and well in the NHS and it’s really time we did something about it.

Five years ago, Health Service Journal surveyed NHS Trusts and found black and minority ethnic (BME) applicants for NHS posts were three times less likely to be appointed than white applicants, and one and a half times less likely to be appointed even if they had been shortlisted.

Today we publish a report of our own research of a cross section of 30 NHS Trusts, which found pretty much the same results. Most shocking of all is that even once black applicants have been shortlisted (and presumably met the person specification for the job) white shortlisted applicants are 1.78 times more likely to be appointed.

It suggests there has been little or no improvement in the last five years, and there won’t be over next five either judging by the diversity data at NHS England, which has just filled thousands of new posts and is supposed to lead on equality in the NHS.

For senior manager posts in NHS England, white applicants were between four and  six times more likely to be appointed than black applicants. The HR lead for NHS England said the ethnicity data “does not make for easy reading”. (Williams, D. 21 September, 2012). It certainly does not.

Survey after survey in the NHS over the last two decades has shown systematic discrimination in pay and grading, promotions, career advancement and disciplinary processes, and that black staff are more likely to be bullied at work. The grading pyramid with its snowy white peaks is complemented by occupational segregation as a quick look at almost any Trust’s own data will show.

Occasionally the issue receives public scrutiny, as it did last year when scientist Elliott Brown was awarded £1 million damages from a Manchester trust for systematic race discrimination. NHS-funded research demonstrates an intimate link between the treatment of staff and the quality of services provided. One part of that research looked at whether there was a connection between race discrimination against staff and the quality of care. There was.

The glacial pace of change (if there is any at all) is not through any lack of initiatives, but in too many local employers race discrimination against staff is simply not accorded the priority it should be, and ministers largely look the other way.

A generation ago the Macpherson Report defined institutional racism as "the collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture, or ethnic origin. It can be seen or detected in processes, attitudes and behaviour which amount to discrimination through unwitting prejudice, ignorance, thoughtlessness and racist stereotyping which disadvantage minority ethnic people."

Who can say that definition does not apply to large parts of the NHS today when it comes to the employment of black and minority ethnic people? After all, in how many Trusts is there any serious look at what its own data show (if diversity data are even collected now)?

Even before we consider whether some services to patients are themselves discriminatory, such treatment of staff is to the detriment of both staff and patients. How can the NHS argue it recruits the best people for the job when such patterns of discrimination persist?

Our report may be a source of great embarrassment to some. We hope it will help trigger serious discussion in NHS Trusts, involving all management and staff, and we are ready to help facilitate that.

The first step must be to acknowledge the problem, and talk about it. If ever there was an issue for employee engagement this is it – provided the engagement leads to action, action leads to learning, and learning leads to better practice.

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