The evidence is stark. Black and minority ethnic staff get fewer senior job opportunities and report higher rates of undermining and bullying than their non-BME counterparts. The Workforce Race Equality Standard data shows that Muslims are particularly under-represented at senior levels. According to the Kings Fund NHS staff from all religions report discrimination but this is by far highest amongst Muslims.
Across all professions, Muslim women have the lowest employment rate in the UK, below that of disabled women. In 2016, the House of Commons women and equalities committee reported that Muslim women are some of the most economically disadvantaged in the UK. Discrimination against women in medicine has long been exposed.
Muslim female doctors then, face a triple penalty of gender, race and religion in our NHS. When the then health secretary Alan Johnson announced that all healthcare professionals should be ‘Bare Below the Elbows’ (BBE) in 2007, there was no explicit recognition of the major equality and diversity impact that this national policy change would have.
Three years later, it had become apparent that faith groups, including Muslim women who cover their forearms for faith reasons, were being negatively affected by this poorly evidenced policy. The Department of Health’s own impact assessment found that ‘some staff had had such difficulty with those dress code provisions … that they could no longer continue in their jobs’.
The Department of Health updated its guidance, calling upon trusts to address indirect discrimination by implementing a range of options for Muslim female healthcare professionals, including providing staff with disposable sleeves.
There is still no national guidance relating to the wearing of head coverings. In surgical theatres, the default head garment is a semi-transparent scrub cap. This default provision may be challenging for faith groups including Sikhs who wear turbans and for Muslim women who normally wear an opaque head garment (hijab) that covers the hair, neck and upper chest.
From 2011, the Equality Act’s public sector equality duty required trusts to promote equality of opportunity between those with and without a protected characteristic e.g. race/religion, by removing or minimising disadvantages, meeting the specific needs of religious groups and encouraging participation in public life where groups are underrepresented. BMA policy has called for restrictions on dress codes to be loosened to ‘facilitate religious practices’ since 2005.
In 2014 BIMA, the British Islamic Medical Association, started hearing reports that Muslim female staff were feeling undermined during clinical placements over policing of dress codes. BIMA conducted national research, which is about to be published, highlighting the ongoing undermining and bullying of Muslim women trainees over dress codes in NHS hospitals. Feeling shamed and frustrated, trainees reported moving away from hospital and surgical careers towards general practice. We heard comments such as ‘[I am] always aggressively/rudely challenged’ and ‘[I have] been scolded by theatre staff, puts me off going [in]to surgery’. Despite DHSC guidance, participants were unaware of any trust flexibility over BBE or alternative head covering provision in surgical theatres.
Was this due to participant lack of awareness or lack of trust policy? BIMA research found that only 9 of 33 trust dress code policies audited had incorporated the 2010 DHSC guidance. There is no national equality and diversity guidance on surgical head coverings in theatres and this affects local organisations’ policies – or lack of. Our survey found that only three trusts offered guidance for faith groups.
BIMA continues to receive enquiries from women feeling undermined over dress codes. Students and juniors have told us they have been threatened with escalation and dismissal, denied training opportunities and marginalised due to faith concerns over BBE/surgical head coverings at cost to their mental health.
Yet the solutions are simple. We need trusts to update their dress code policies in line with DHSC guidance on BBE and address headwear in theatres. We need BMA members to find out whether their trusts’ policies comply with good practice standards – BIMA has produced toolkits on BBE and theatre hijabs, which include examples of acceptable solutions. We need local negotiating committees across the UK to raise the issue at trust equality and diversity committees to begin this important conversation that affects a number of faith and cultural groups.
How does your trust meet the public sector equality duty when it comes to dress codes? How do we engender a diverse workforce? For more information on our recommendations visit:
http://www.britishima.org/hbbe-toolkits/ or email [email protected]
Emma Wiley is a microbiology registrar and infection control fellow at University College Hospital London and executive committee member of the British Islamic Medical Association. She is currently a member of the BMA’s equality, diversity and inclusion advisory group
There is no evidence for this ridiculous policy- US journals. It’s just spin from DHE and gives them a stick to beat drs and other healthcare workers over. If I ever have to remove my watch or ring I will leave.... if patients suffer then there will be plenty of GPs to take my place,
I thought medical practice was evidence based. So, where's the evidence that BBE improves the quality of health outcomes? There isn't an iota of EBM to support the practice! Only a stick for the NHS to continue their discrimination under the guise of dress policy.
I was in a European capital recently, in the university hospital, where the doctors all wear white coats, many with dangling, unhygienic bug-laden ties. It really was disgusting and turned my sensitive stomach. Oddly, on checking the relative published figure, this backward mhealthcare system reports a lower rate of hospital acquired infection and post operative infection than the NHS. I am also confused as to how it can be that the NHS appears to perform less well now that consultants are not allowed within a half mile of the hospital wearing a waistcoat...
Whilst the impact upon certain groups may be apparent because of religious issues, there is a wider aspect, which is that doctors overall have been disadvantaged and “bullied” into a dress code that is not useful, appropriate or indeed evidence-based. I would suggest that this is a symptom of the wider malaise of the NHS, lacking focus, understanding, evidence or purpose. What it is not lacking is dedicated and capable medical staff. When will someone recognise the discrepancy and start addressing the toxic problem of the NHS - management and executives.
It's time for all us to get dressed as doctors again, that is the white coat to return.
White coats now.
Lets get smart again on the outside.
Then we will be thought of as smart between the ears too!
Why has the comment I posted yesterday not been added?
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