Management must do more to ensure the NHS is free of racism

If it cannot treat its own employees fairly it has no hope of providing ethnic minority patients with the service they have a right to receive.

Data in this week’s HSJ reveals a consistent pattern of a worse deal for black and minority ethnic staff compared with white colleagues.

The data covers an entire region, and there is every chance it broadly reflects the employment pattern in the wider NHS.

BME staff are less likely to be appointed from a shortlist, more likely to be disciplined, involved in a grievance, be involved in a bullying or harassment dispute or pursue a case through an employment tribunal.

The appointment figures are the most striking; the proportion of BME staff employed is, on average, less than half the proportion on the shortlist.

At board level too, BME representation is neither a reflection of the workforce nor the diversity of the local population.

The only time BME staff appear to be better off is when it comes to redundancies. At first glance, relatively few losing their job might seem to be good news, but a more challenging interpretation is that white staff tend to get first pick when it comes to pay-offs.

Underlying causes

The data does not provide explanations of the underlying causes. It is possible, for example, that in some trusts the skewed appointment figures are caused by well intentioned managers trying to encourage BME advancement by pushing candidates through to the shortlist who are not good enough to be appointed - although this in turn would raise questions about whether BME staff are getting the training and support needed to succeed.

But it is the consistent picture painted by the data of BME staff across an entire region having a tougher time at work than white colleagues which is so troubling.

These difficulties are not apparent if one reads only the trusts’ self-declarations on race equality core standards for the Healthcare Commission. The majority claim to comply with the need to “challenge discrimination, promote equality and respect human rights”, as well as address under-representation of minority groups. Whatever the returns to the commission say, the detailed data indicates many trusts are to be found wanting.

Poor compliance

A Healthcare Commission survey has revealed scandalously poor compliance with race equality legislation. As HSJhighlighted last year, the commission found fewer than one in 10 trusts had honoured their duties under the Race Relations Act 1976 to publish workforce data, race equality schemes and race equality impact assessments. Just one in three trusts appeared to be monitoring the ethnic makeup of their workforce and fewer than one in six has published equality impact assessments. Almost a quarter had not even published a race equality scheme.

And last month chief medical officer Sir Liam Donaldson used his annual report to highlight racial discrimination in medicine.

Taking the Healthcare Commission findings and the figures revealed in this week’s HSJ together, there is prima facie evidence that the NHS is failing to ensure it is free of racism.

Each strategic health authority and trust needs to look to its own record and procedures, be honest about its failings and robust in its determination to change.

To their great credit, several trusts involved in this study have already declared their intention to do just that.

Far from just meeting basic requirements, the NHS should be an exemplar of best practice on equality. The values of the institution itself and the overwhelming mass of its staff support equality, yet many parts of the NHS are failing to ensure this translates into fair and equitable treatment for all its staff, whatever their race.