Sewell report ignores ‘well-documented’ evidence of structural racism in the NHS, says BMA

by BMA media team

BMA Press release

Location: UK England
Last reviewed: 1 July 2021

The BMA highlights structural race inequality – a legacy of historic racist or discriminatory processes, policies, attitudes or behaviours that continue to shape the organisations and societies today - as a major factor affecting the outcomes and life chances of many ethnic minority healthcare workers, in its response to the Commission on Race and Ethnic Disparities’ (CRED race) report, and firmly refutes the report’s overall findings.

The Association’s full response1, published today, states that the CRED “Sewell” report’s findings do not give a true picture of the barriers, including factors related to institutional racism - racist, or discriminatory processes, policies, attitudes or behaviours within the healthcare sector - faced by many people from ethnic minority backgrounds. The BMA says the Commission is missing opportunities to identify effective solutions to tackle racial inequalities within the UK.

In its response, the BMA analyses the CRED race report’s doctor-specific findings based on preceding research and well-documented disproportionate outcomes and negative experiences of many doctors from ethnic minority backgrounds in education, training, and the workplace - including the Associations own submission to the Commission. The response also critiques the elements of the report that relate to inequalities in health, such as the fact that the 85% of the doctors who died from Covid-19 were from ethnic minority backgrounds, and the ongoing disproportionate impact that the pandemic has had on people from some ethnic minority groups.

The Association highlights that the main downfall of the CRED race report is that its narrative - which underplays the role of structural racism - is misleading and so widely rejected that its recommendations, which were valid, were lost.

Dr Chaand Nagpaul, BMA chair of council, said:

“The way in which the authors chose to analyse the data and evidence submitted to the Commission questions the validity of the entire report. They made sweeping statements of success and as such showed little acknowledgement of the indisputable disparities in experiences and outcomes for doctors from ethnic minority backgrounds. When the NHS began in 1948, short-staffed positions were filled with staff from UK colonies and former colonies. As such the NHS has always been more racially diverse than the UK population itself. While the report celebrates this diversity, it ignores the lived experience of many ethnic minority healthcare workers as well as the wealth of evidence which shows that for these staff working in the NHS has been, at best, unfair and unequal. There simply hasn’t been enough progress made here.

“What the evidence does show is that structural racism is prevalent in the NHS. A recent BMA survey, which was submitted to the Commission by the BMA, found that 16.7% of ethnic minority staff compared to 6.2% of white staff reported experiencing discrimination at work from a manager, team leader or other colleagues as well has reporting twice the level of bullying and harassment. Race disparities in the pass rate of postgraduate exams; unequal opportunities to progress into more senior roles; and the fact that several studies have shown there is a significant pay gap between doctors from an ethnic minority background compared with doctors from a white background, all demonstrate continued systemic racism. So the authors’ decision to ignore the well-documented facts presented to them, failed to use the Commission as an opportunity to address the root causes and provide a plan to create a post-racial society in the UK – which by their own admission, the UK has not yet reached.

“The documentation of racism occurring at a systemic level within the NHS is enormous, tough to process, very often not addressed and assumed to be part of the job for ethnic minority doctors and healthcare workers. This should not be the case and it is hard to comprehend how the CRED race report failed to see this. Having missed an opportunity with this report we’d strongly urge the Government to take the BMA’s response seriously and begin to tackle structural racism within the health service so that the values of fairness and equity we ascribe to patient care applies equally to those that work within the NHS. We hope that Sajid Javid, the first health secretary at Westminster from an ethnic minority background, will press forward in making the changes needed to address the structural racism within the healthcare sector.”

Dr Radhakrishna Shanbhag, Trauma and Orthopaedic surgeon and BMA Council member, said:

“Racism at work blights the lives of most ethnic minority doctors, nurses, and healthcare staff. I’ve experienced racism on many occasions yet despite this every time a sense of shock, shame and devastation overcomes me. I can recall an incident when just before their surgery a patient asked me if the operation could be done by a white doctor. They were sent home and booked in for another appointment. It made me feel worthless and I even considered leaving the NHS after 20 years of service.

“Following that incident, the former Health Secretary, Matt Hancock, wrote to NHS Trusts calling for a zero-tolerance approach to racism. But I know from my own experiences, as well as colleagues across the NHS, that the reality is when racism occurs the health and care system’s approach to dealing with it is often awkward and ad hoc. NHS leaderships’ general process here is unclear and lacks a uniformed zero-tolerance approach. This discourages people from even bothering to report incidences and this is systematic. It is not just reflective of racist individuals but rather shows a system that has processes and attitudes which are not fully equipped to deal with racism. Denying this is terribly damaging and sets us back by 20 years. Racism should not be accepted as an occupational hazard for the NHS’ ethnic minority staff.”

Dr Nitin Shrotri, Consultant Urologist and BMA Council member, said:

“During my time in the NHS I applied for national awards seven times and, despite being told that my applications were ‘deserving’, I was rejected every single time. In fact, in that hospital not one doctor from an ethnic minority background has received a national award in the last 10-15 years. I also noticed, at the time, that no one from an ethnic minority background had reached a senior position. I raised this issue with successive CEOs, but it did not seem to make any difference.

“Having spoken to many other doctors I’ve learned that my experience wasn’t unique or down to the failing of an individual hospital, but rather colleagues across the entire NHS are experiencing the same or similar issues. This is reflected in NHS England’s own Workforce Race Equality Standard (WRES) data. Very often doctors from ethnic minority backgrounds are discouraged from applying for senior roles and unsupported if we do manage to break through glass ceilings and progress.”

A Consultant Psychiatrist said:

“Throughout the course of my training as a doctor I have experienced too many examples of racism to count. Most of which I've repressed to preserve my ability to keep doing my job. I will never forget a patient complaining about not wanting to be treated by Africans - openly using the ‘N’ word and demanding to be seen by a white clinician. Unsurprisingly, the debrief from the team leader that followed was completely dismissive. They said that they had been called ‘all sorts’ and that it shouldn’t be taken personally because the patient was ill.

“Very often patients and colleagues, who I’ve not worked with before, address junior white medical staff and hardly acknowledge me, claiming I don’t look like a doctor. This is what I find the hardest. The constant microaggressions, insidious comments and behaviours which are just subtle enough you feel powerless to call it out but no less hurtful.”

Despite being critical of much of the report, the BMA is in broad agreement with several of the recommendations put forward by the authors including:

  • The call for a review of the Care Quality Commission’s approach to disciplinary actions taken against ethnic minority staff. This is in line with what the BMA have publicly called for in its Caring, Supportive and Collaborative report.2
  • The call for an improved understanding of the ethnicity pay gap in the NHS in England. The BMA’s submission to the Commission urged further research into the ethnicity pay gap in the NHS.
  • The call for the establishment of an Office for Health Disparities. The BMA welcome this long overdue focus on health inequalities as part of the wider conversation about race in the UK, however there’s a need for clarification of the relationship between the recently established Race and Health Observatory and any new office to avoid duplication and wasted resources.
  • The call for an evidence-based pilot that diverts offences of low-level Class B drug possession into public health services. As set out in the BMA’s submission to the Commission, it supports a ‘health in all policies approach’ however this must be accompanied by sufficient funding for public health services.
  • The call for an inclusive teaching curriculum. The BMA’s submission to the Commission highlighted its agreement with the Baroness Lawrence review that societal prejudices are learned from an early age. Efforts to diversify the national curriculum would help with this, as well as ensuring that future generations of medical students will begin their medical training with a better understanding of the diversity and history of the UK’s population.
  • The calls for the use of data in a responsible and informed way and to disaggregate the term ‘BAME’. The report is right to conclude that assessments of racial discrimination based on a collective ethnic minority group may not be effective at addressing barriers for individual groups.

Notes to editors

The BMA is a trade union and professional association representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.

  1. A missed opportunity: BMA response to the Race Report 
  2. Caring, supportive, collaborative: a future vision for the NHS
  3. Race inequalities and ethnic disparities in healthcare