Racial discrimination still exists in NHS organisations but can be eradicated if the attitudes and processes used to improve patient safety are adopted, says Roger Kline
By every possible measure, black and minority ethnic (BME) staff and job applicants in the NHS experience discrimination. There is no sign whatsoever that matters are getting better: every survey over the last decade has shown that in shortlisting and appointment, promotion or in disciplinary processes, the discriminatory treatment of BME staff is undeniable.
‘An NHS that recruits, develops, pays, treats and disciplines staff on the grounds of their ethnicity denies patients the best possible staff or care’
The snowy peaks of the NHS fail to reflect the staff they manage. Despite the best efforts of those who have tried to change this, the various strategies − even those such as Breaking Through and Positively Diverse − have largely failed, faced with the resistance (that must be the word) of the large majority of NHS employers locally and nationally.
I’ve personally seen the unfairness, the shocking evidence of wasted talent and the undermining of morale when advising and representing BME staff. But I’ve decided blame is pointless − not least as we all (including myself as a trade unionist) have much to answer for.
An NHS culture that demonstrably recruits, develops, pays, treats and disciplines staff on the grounds of their ethnicity denies patients the best possible staff or care. As Jeremy Dawson found, there is a correlation between reported discrimination against BME staff in the workplace and several areas of patient experience.
So where next? Do lessons from patient safety have any application to tackling endemic NHS race discrimination?
Roots of the problem
Improving patient safety requires accurate data, openly discussed. That’s a real problem in race discrimination because much of what’s needed to plan policy and change practice appears to not even be collected, let alone analysed.
Public World’s research on NHS recruitment earlier this year revealed large gaps in published recruitment data analysed by ethnicity. Research on NHS disciplinary processes in 2010 found a similar pattern, as did the Equality and Human Rights Commission in 2012.
Data is useless unless it is shared, analysed and understood. Public World’s analysis of recruitment data suggests very few trusts, even among those that collect data, seriously analyse it.
‘Below the radar, most BME staff know how fatal for one’s career any questioning of discrimination can be’
Not one trust whose published recruitment data we analysed presented the information in a way that showed it had calculated the comparative statistical likelihood of white and BME staff being shortlisted, after having applied for a post. Nor did it analyse the likelihood of being appointed having been shortlisted on a trust-wide basis, and certainly not by department or occupation. Yet that was the key ratio.
Bruce Keogh, Don Berwick and Michael West have all stressed the importance of listening to staff and patients. There are many BME networks, but little evidence of their being listened to and influencing employment policy.
Parallels with patient safety
Patient safety improvement is predicated on changed culture and leadership. So is the treatment of BME staff. At present, the formal challenge to discriminatory policy comes largely through individual grievances and employment tribunal claims.
The real challenge is not just the glaring absence of senior BME staff, but many trusts’ responses when race discrimination is suggested as a cause. Many respond with embarrassment and denial, even faced with their own data. Below the radar, most BME staff know how fatal for one’s career any questioning of discrimination can be.
Patient safety requires an open, transparent culture built on learning from data, staff and patient experience, and mistakes. It requires an end to macho management and for staff to be valued, treated with respect and not bullied. Such a culture can have no place for discriminatory practices that damage patient care, staff morale and the selection of staff on merit.
Tackling the issue
What should good employers do? Make sure they collect ethnicity data, publish it and analyse it − not just across the trust as a whole, but by department and by profession. They should engage with staff, including BME employees, to explore their findings and develop practical responses to deal with any discriminatory practices they discover.
‘The deep cultural changes needed to improve patient safety and care run parallel to those needed to challenge discrimination’
All managers should have training to specifically avoid the unintended consequences of “appointing people like us” or of stereotypes in disciplinary hearings. The chief executive must lead by example, or the approach is doomed to fail.
Employers should respond seriously to malicious or wilful discrimination, but learn from difficulties including systemic shortcomings, without blame, rather than hiding from them.
Given the intimate link between staff treatment and care quality and safety, how BME staff are treated − indeed, how all staff are treated − might even reasonably be part of the regulator’s inspection process.
But as in patient safety, organisations have to want to change. If we are serious, let’s consider whether we can use the momentum of patient safety to ensure all NHS employers stop the waste of talent, undermining of morale and damage to patient experience being created by our current failings with BME staff.
The deep cultural changes needed to improve patient safety and care run parallel to those needed to challenge discrimination. Who doesn’t want to do that?
Roger Kline is a director of Patients First, an associate of Public World and research fellow at Middlesex University