9 Jun 2014

The Snowy White Peaks of the NHS: a survey of discrimination

The researcher and author, Roger Kline, recently published a report he called The Snowy White Peaks of the NHS.  It could not have been more apt a title.


It was a survey of discrimination in governance and leadership and the potential impact on patient care in London and England. In other words, if there are not enough bosses in the health service who are not black or from an ethnic minority background, how can the NHS possibly represent the needs of the people they are treating?

Looking at the proportion of London NHS Trust Board members from a black or minority ethnic (BME) background, Mr Kline found that it was just eight per cent.  This was, in fact, even lower than in 2006 when it was 9.6 per cent. The number of chief executives and chairs from a BME background had decreased from 5.3 per cent to 2.5 per cent and two-fifths of London’s NHS Trust Boards had no BME members at all.

At a meeting of the NHS BME Network in London last week there were quite a few ‘tuts’ coming from the audience as he presented his findings but no real surprise.

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Because this was a roomful of people who have experienced discrimination and racism within the NHS either as employees or as a patients.  In a few cases, as both. It was a both and inspiring and disturbing meeting.  The title of the conference was BME Equity and the NHS – Time for Action.

Yet there were many in the audience who quite rightly said why were they here in 2014 asking these questions? The same questions and concerns that had been raised in the 1960s, 70s and every decade subsequently.  Why are BME workers not being promoted, why are they not on trust boards, why are they not chief executives?

It is not as if the legislation isn’t there.  And, as the chair of the NHS BME Network, Dr Vivienne Lyfar-Cissé, pointed out, there have been numerous reviews. Indeed, in 2004 the Department of Health published its Race Equality Action Plan. “We were,” Dr Lyfar-Cissé said.

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She added: “Assured that the NHS would give greater prominence to race equality by striving to reduce health inequalities; making race an important dimension of health strategy and targeting recruitment and development opportunities at BME people in recognition that their skills are often underused.

“The reality is ethnic health inequalities have not been addressed; all attempts have been made to dilute the race equality agenda and BME staff based on evidence face more disadvantages and discrimination in the workplace that ever before.”

It was disheartening but this was a meeting with ‘Time for Action’ in the title and much of the day was spent looking at how things could be made to change. Treat discrimination, for instance, as a risk to patient care.  It is self-evident that if a staff member is being bullied, harassed and racially abused, they are not going to be working to the best of their abilities.  They will be stressed and depressed. Why wouldn’t they be?

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If patients are not treated as well because of the colour the skin, again it is self-evident their outcome will be worse. And it is reflected in the data. The scandal at Morecambe Bay, for instance, found that just two per cent of mothers treated in the maternity unit in 2008 came from an ethnic minority and yet 83 per cent were involved in serious untoward incident reports.

It has not escaped anyone’s notice, either, that a large number of the whistle-blowers who have recently come to public attention are BME.  Are they being disproportionately punished for speaking out?  It looks like it? There were other suggestions:  delegates at the conference were exhorted to ‘demand a place at the table’, not wait to be asked.  And there was a proposal that equality impact assessments which are meant to be part of the process when services are being set up or put out to tender, should be made compulsory.

The new NHS Chief Executive Simon Stevens has already chaired a meeting on the Snowy White Peaks findings and has mentioned the issues of ethnic inequalities in the NHS in a number of speeches. This might have been expected to raise a glimmer of hope but mainly in that room that day it merely raised a few eyebrows.  And it is hard not to blame the delegates for being wary and weary.

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