Nadeem Moghal sets out the actions that can be taken by NHS leadership to enhance equality 

Hospitals have often become the largest employers in towns and cities across the land. They have become the “factories” that once employed multiple generations of families, sometimes whole communities. As public institutions they have taken on the anchoring effect in the communities they serve. Their leaders therefore have a responsibility to contribute to the national discourse.

Brexit means our nation is going to be even more dependant on the former colonies for its workforce. Hospital chief executives are investing in job lot recruitment from the Indian sub-continent. The racists and xenophobes among the population have not quite realised that because of Brexit the nation is going to be browner and blacker than ever. The face and voice of service staff will with increasing certainty, be different from the service recipient, from hamlet to metropolis. Together with the narratives unleashed by some of our politicians, this makes addressing racism matter more now than ever.

We can perhaps learn from the Stephen Lawerence Inquiry report, with its seminal definition of institutional racism:

“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”.

appropriate and professional service that includes the duty of the chief executives to his or her staff.

Every racist incident that goes unchallenged reinforces racist beliefs in the individual and community. Silence is appeasement.

Every day in every hospital a staff member will be experiencing not so subtle racism from a colleague, a patient or a carer. Most absorb it and move on. Staff have become acclimatised. They do not believe their employer can do anything or will do anything.

Chief executives must take measurable actions, protecting staff from racism from within, and without. Noisy actions that can be seen, felt and heard in and beyond their buildings, enforcing the letter and spirit of the law.

Following are nine actions that would cut through.

1. The mandated NHS Workforce Race Equality Standard audits are a beginning. With exceptions, many lack meaningful improvement actions that will result in measurable outcomes in our lifetimes. Chairs and chief executives need to look in the mirror, and around the board, and then set a non-tokenistic recruitment strategy.

2. Redesign the recruitment process for all staff to avoid bias – conscious and unconscious. Recruitment requires expertise not always found in trust buildings.

3. Every racist action by a patient or carer, must lead to swift noisy action – on the day of the incident. Any response to external purveyors of racism must state – Your behaviour, your language is not who we are. You will receive care from the professional you need. If you don’t find that acceptable, you are welcome to take your needs and racism elsewhere. Good luck with getting the care you need. Once that message is delivered, then send out a communication describing the action to all in the trust.

4. Every racist member of staff must be dismissed – there are policies and laws and they must be enforced.

5. Diversity training has to be taken away from the disinterested managers presenting mundane, dry slides. Let the experts transform how staff think, using the Stephen Lawerence Inquiry definition at its core.

6. Embed the principles of a just culture, but do not let the medical workforce escape from those principles – only then will the GMC data show a shift in the conscious and unconscious biases.

7. Demand and implement an NHS-wide policy designed to prevent institutional racism in the service that goes beyond the fluffy tweets of well-meaning folk.

8. Direct the communication teams to build strategies that constantly face into the local media and communities explaining the value and importance of staff diversity.

9. Embed social anthropologists in NHS organisations to enable evidence based strategies to manage and change the views of the service’s tribes and cultures. They will be cheaper and leave more lasting improvements better than any management consultancy.

These actions will give meaning to millions of words on NHS websites purporting to support zero tolerance to racism and racists.

NHS chief executives are the guardians of the most civil and civilising of institutions to come out of a time of serious British politics. They must stand up and speak, and take meaningful actions to protect their staff.