Workforce issues When I asked Jane how she herself handled
poor treatment from colleagues and patients, Jane said that she simply chose to ignore it. She didn’t have confidence in management or other members of staff from senior positions to take her concerns further, as many of them also exhibited similar subtleties of racism and discrimination. Another possible reason many healthcare
professionals feel reluctant to speak up was illustrated in an observation made by my third and final interviewee, who currently works for the NHS as a dermatologist: “People do take things more seriously today than they did ten years ago, but there is a very negative whistleblowing culture in the NHS that traditionally has shot down the messengers. And you hear about that causing so many problems with patient management, patient care and various enquiries, so there has definitely been a culture of dismissal of concerns and also attacking people who are willing to open their mouths.” Aside from having a lack of faith in management to help tackle racism from both ends, it was also apparent to Jane that there weren’t many Black health visitors in the force to begin with, as pointed out by one of her patients whom she came to visit. However, Jane said that an effort was made by the colleges to take more Black nurses in for training. Indeed, such efforts are still being made
to diversify the healthcare workforce. In a message to the profession, Carrie MacEwen, chair of the General Medical Council (GMC), observed that, in 2021, more international medical graduates joined the medical register than UK graduates, and just under half of all trainees were from ethnic minority backgrounds. Unfortunately, as the following data soon illustrates, indicators of inclusion and equality generally “remain stubbornly fixed”. In a study conducted by the GMC on Tackling
disadvantage in medical education (published March 2023), some key findings showed that: l UK graduates of Black/Black British heritage have lower pass rates in specialty exams (62%) than UK White (79%), Asian (68%) and mixed heritage trainees (74%). Other factors such as socio-economic status compound the poorer outcomes. For example, the most affluent UK Black trainees had a pass rate of 67%, whereas the least affluent UK Black trainees had a pass rate of 59%.
l A larger proportion of UK Black/Black British trainees (5.3%) have had their training programme extended than UK White trainees (2.6%).
l A smaller proportion of UK Black/Black British trainees receive an offer when
applying to specialty training than other UK qualified groups (75% offer rate compared to 82% for UK White trainees).
l There is no evidence, yet, that the attainment gap between doctors of different ethnicities is significantly narrowing over time.8
While it is disheartening to see such marginal differences in change, it is equally just as encouraging to see that additional efforts are being made to combat discrimination in the workforce. In an article published by the BMJ, earlier this year, it is stated that the NHS had published a five-point action plan to tackle racism within the organisation. The aim of this initiative is to ensure that employees from ethnic minority backgrounds are given equal access to career opportunities and receive fair treatment at work. Exploring the action plan and its five domains in more detail, the article proceeds to outline its key areas and objectives: “The first domain aims to improve
consistency in decision making and reduce the disproportionate use of local disciplinary and regulatory processes for ethnic minority and international medical graduate doctors (…). The second domain focuses on increasing diversity in senior medical leadership positions, including recommendations that panels appointing senior staff have at least one senior independent member from an ethnic minority background (…). The other domains cover diversity in the Royal Colleges, support for international medical graduates, and parity for specialty and associate specialist (SAS) doctors.”9 The implementation of this action plan is
part of a response to the increasing number of patients on waiting lists, which puts significant pressure on health services that are already struggling to meet demand. It also comes at a crucial point in time where disparities between White British NHS workers and those of colour have contributed to a shortfall in the workforce, for as stated in the article: “Ethnic minority doctors and international medical graduates have a crucial role in meeting NHS workforce demand. Failure to attract and retain staff is an existential threat that inequality exacerbates.” Additionally, support is available for healthcare workers from BAME backgrounds to help aid conversation and implement change where possible. Among them, the NHS Employers website contains a list of online resources for healthcare workers to access, all of which explore solutions such as providing guidance on setting up staff networks for peer support, a BME leadership network that aims to improve the number of leaders from BAME backgrounds in the workplace, and a series of blog pages which encourage and explore diversity in the profession.10 Elsewhere, the NHS has produced an anti-
racism resource called Combatting racial discrimination against minority ethnic nurses, midwives and nursing associates. Made in partnership with NHS Confederation and the NMC, this resource is designed for nursing and midwifery professionals who experience or witness incidents of racism within the profession. It includes practical examples and tools for healthcare professionals to recognise and challenge racism in its many forms
August 2023 I
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