Medical trade unions and medical staffing teams are instrumental on the continuous journey to explore and understand racism in its various constructs and how it manifests itself in the workplace so they can tackle these issues more effectively to build trust for all parties concerned including the medical workforce.

We have all felt the pain of being excluded. It hurts. Whether we have been missed off the lunchtime invitation, excluded from a mailing list of career opportunities, an invite to a party that friends attended, not invited to that important work meeting that discussed a project we were working on or were ignored when we tried to make a contribution in a discussion.

It really hurts. It can be more subtle too...not being included in an in joke with others, feeling your items are always last on a meeting agenda, not being credited for work done. For some people we work with, not being included is not an occasional inconvenience or frustration and annoyance, it is a regular occurrence and all the more painful when it is systemic, either through indirect or direct discrimination, through conscious or unconscious bias because of disability, race, gender or sexual orientation.

The journey to greater inclusion in the workplace has been a long one, through legislation and through workplace policies and procedures, equal opportunity policies, equality and diversity strategies and more recently equality, diversity and inclusion approaches along with the corresponding training and leadership programmes, all of which have contributed, in their own way to improvements in the workplace but all of which fall short on the socially just work places so many of us want to lead and enjoy.

What is really clear to us, is that legislation alone does not change the culture. Racism, in particular, has become more nuanced in recent years and as such hovers below eye level but is felt by those affected. What harms is the impact of those actions, inactions, systems, processes and behaviours of others who contribute, turn a blind eye, or fail to acknowledge, accept or even believe that these lived experiences are real and happening under their watch.

This can be further compounded when staff seek advice following a pattern of incivilities, and because they are not experienced by the majority are dismissed or disregarded. In the medical workforce, given its huge diversity of nationalities, this can also manifest between different races or because of religious beliefs.

Some of the most painful experiences are the things unseen but impact the invisible aspects of our physiology like self-esteem and confidence. Trade unions like the BMA have a responsibility to broaden the diversity of their spheres of influence to embrace difference. This provides the opportunity to gain a deeper understanding of equality and diversity from a human perspective so they can champion inclusive and anti-racist practices, leading to a more positive and inclusive culture.

So, what can we do in practical terms as medical staffing and trade unions towards this crucial change? We need to see equality, diversity and inclusion in the NHS as part of a wider social movement for change, in which medical staffing teams, clinical leaders and trade union reps have a crucial role to play in improving the medical workforce race equality metrics, which translates into improving the work lives of all our medics.

Today in 2022 there is a palpable difference for the better. But there is a lot of work to be done to achieve equality and diversity and abolishing racism. In the past couple of years, the BMA has created membership networks for BME medics which has opened a channel for the voice of ethnic minority doctors to be heard loud and clear. The challenge now is for wider participation in NHS staff networks by BMA members to grow. True culture change takes time but could be improved through a truly partnership lens of BMA representatives and members and their HR colleagues.

Within the newly created BMA FREE/BAME networks, we’ve shown our commitment to including and empowering more wide-ranging voices by not only getting more diversity around the table, of doctors with depth and breadth, of both clinical and lived experiences but also enabling their contributions to be heard. Inclusion must go beyond a seat at a table: it must now include enabling a microphone to speak with and be heard. 

We’ve raised BMA visibility through the BMA London FREE (Forum for Racial and Ethnic Equality & Equity) by reaching out to our HR departments across our region, but also working last year with the UN development programme.

Medical HR leaders and BMA representatives hold positions of power and influence in our organisations because the areas of work they choose to prioritise impact positively or negatively directly on the medical workforce. It is for this reason that they need to approach people issues with thought and compassion, but moreover with a drive to improve the current staff experiences as instruments for change. Actions could include:

• Seek education on race equality and lead by example. The NHS has some excellent medical and clinical leaders that deliver day in and day out on overall organisational priorities, but an area that has not kept pace is in ending discrimination and ensuring race equality. Until trade unions, clinical leaders and medical HR take the time to prioritise their own professional development around real race equality, the change will not occur. This means listening to staff, being curious and being willing to speak truth to power and demonstrate behaviours that lead to true allyship. These leaders need to commit to EDI training and development as they do fur professional CPD.
• Encourage and welcome ED and I teams in your organisation and union meetings and recognise they are positive disruptors to existing cultures. The NHS has invested, perhaps more so than other sectors, in appointing Equality, Diversity and Inclusion specialists in our organisations. This is vitally important, however from our conversations with many of these staff, a theme that keeps emerging is that they are not getting enough support from clinical and senior leaders to drive change. These staff are positive disruptors often observing and informing the organisation of uncomfortable truths, which can be silenced or not heard which leads to inaction. Invited to local negotiation committees and working in partnership with union representatives could result in a positive impact. 
• Accountability verses responsibility. How leaders hold themselves and others to account for delivery is a huge catalyst for producing results. Effective leaders know the importance of visibility, living by their values and role modelling. We also know that more diverse organisations and better-balanced boards deliver better patient care. We have incredibly diverse teams in our clinical services, but we know the diversity of our clinical leadership teams doesn’t reflect the racial diversity of the teams they lead. In 2020 the Medical WRES data confirmed 26.4% Of clinical directors and 20.3% of medical directors were from a BME background.The results in terms of medics shows that 12.3% of black minority ethnic members of the medical and dental workforce experience some form of discrimination as opposed to 6.1% of their white counterparts. We need to ask ourselves what deliberate action are we personally taking to improve the racial diversity of senior leadership within our directorates and divisions?  If we don’t address racial equality for leaders, we can’t credibly represent our members or lead our teams on creating inclusive cultures. Representation matters as it inspires and provides hope in a socially unjust society.  Good leadership requires us to surround ourselves with people of diverse perspectives who can disagree with us without fear or retaliation.
• Don’t be afraid of change. We can translate that sense of urgency into our approach to Equality, Diversity and Inclusion. We have an opportunity to embrace a deeper level of learning around racism, because until this happens, we will not see BMA members leverage their privilege for good to improve their own experiences, and those of the medical workforce who have some very poor experiences at the hands of their own colleagues and leaders.  Medical Staffing and the BMA together with the senior leadership of NHS Trusts are able to influence and set the tone and culture, as the standards we set based on the knowledge we have determines our level of tolerance and acceptance – this is why it is so important for Medical Staffing and unions to work together to improve their understanding and to be able to notice, detect and identify racism and to take decisive action that makes a difference. 

#InclusiveHR has launched the ‘5 Step Challenge to Change’ that has a clear focus for every HR & OD directorate to do the following and become the instruments for change:

1. Run the demographic data for the HR & OD directorate.
2. Review and analyse the data – what is this telling you about diversity and inclusion in your people function?
3. Understand the lived experience of HR & OD colleagues.
4. Identify the key themes for action and plan the interventions to deliver better outcomes.
5. Evaluate and shout about the work using #InclusiveHR

Trade unions are encouraged to go on the journey in partnership with HR & OD directorates, with a view to learning together, creating open safe spaces, sharing ideas, hearing the diverse lived experiences, and being part of co creating and supporting interventions that improve the staff experience. All of this will start to enable an empower unions and HR to collectively change the culture and ultimately the experience of all doctors within organisations. 

Being excluded is damaging – managers, leaders and trade union representatives need to embody the changes needed and it starts with us holding the mirror up, acknowledging areas for improvement and taking informed action and holding each other to account. 

This starts with a conversation within our own teams, our trade union members and management side which means actively listening to understand the lived experience and to take action. 

The power of true partnership working can lead to the creation of culturally inclusive organisations that are intolerant to negative behaviours but allow diverse staff to thrive. 

This is the difference that we can all make if we focus, listen and hold each other to account. Join the social movement for change.

Cheryl Samuels, deputy director of Workforce Transformation – London region and chair of Deputy Directors of HR Network (London)

Dean Royles, president HPMA

Andrew Barton, BMA London regional coordinator

Shobhna Shah and Ekene Clair Agbim, co-chairs of BMA London FREE