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Reflections on systemic racism in the NHS

Failures of care and racial prejudice still run deep in the NHS, write patient liaison group members Rowena Skinner and Kieron Blake

The International Day for the Elimination of Racial Discrimination is observed annually on 21 March since it was declared by the UN in 1966. Two members of the BMA’s patient liaison group, Rowena Skinner and Kieron Blake, have generously shared their experiences and reflections on institutional racial discrimination in the NHS.

38 years on and not enough change: my family and the NHS

I am a lay member of the patient liaison group and a 38-year-old black woman whose mother, Samantha Skinner, died in childbirth. I am sharing this because I read the recent article on a young black mother dying in a Liverpool hospital due to cultural biases impacting her quality of care, and was both horrified and triggered. My mother died of pre-eclampsia and there would have been signs in the lead up to childbirth but they were not investigated.

This is not the only failure of care my family has experienced. My aunt was deemed difficult after insisting that she see a doctor when she heard my cousin’s heartbeat during childbirth, as it had changed from earlier in her pregnancy. That insistence led to the discovery that the umbilical cord was around his neck and resulted in the emergency caesarean that saved his life. He would not have lasted another half hour.

That this failure of care is still happening to pregnant minoritised women in the NHS almost 40 years after it happened to my family was hard to read, and is a complete disgrace.

The article cited a 2023 report by MBRRACE-UK (Mothers and Babies: Reducing Risk Through Audits and Confidential Enquiries). It found that between 2019 and 2021 there was a fourfold increase in maternal mortality rates among women from black ethnic backgrounds and a twofold increase among women from Asian ethnic backgrounds, compared to their white counterparts. It is clear much more work needs to be done to combat the systemic cultural discrimination that is still present and causing avoidable harm in the NHS today.

Rowena Skinner is a queer black woman with several long-term health conditions. She was raised by her grandmother, Carmen Skinner, who had lupus, and so interacted frequently with the NHS from a young age. She is passionate about equitable care, and is the current PLG equalities champion. 

Unveiling cultural bias in the NHS: a cloak for institutional discrimination

In the heart of every society lies its healthcare system, often revered as a symbol of hope, compassion and equality. Yet beneath the surface of this noble facade lurks a pervasive issue that corrodes the very essence of its ethos: racism.

Within the NHS, racism manifests itself in subtle yet insidious ways, often veiled under the guise of cultural biases. This phenomenon – cultural bias – perpetuates systemic discrimination and undermines the fundamental principles of healthcare equity.

Cultural bias in the NHS is not merely a matter of individual prejudice but is deeply embedded within the structures and practices of the institution itself. It manifests in various forms, from disparities in access to healthcare services to biased decision-making processes within healthcare settings. While overt acts of racism are condemned, cultural bias operates in more covert ways, making it challenging to identify and address.

One of the most prevalent forms of cultural bias within the NHS is the perpetuation of stereotypes and biases against patients from minority ethnic backgrounds. Recently, a black woman died after cultural bias caused delayed care at a Liverpool hospital.

These biases can affect the quality of care individuals receive, leading to disparities in health outcomes. For instance, studies have shown that black and minority ethnic patients are less likely to be offered certain treatments or are subjected to longer waiting times compared to their white counterparts, even when presenting with similar symptoms.

Moreover, cultural bias extends beyond patient care and infiltrates the working environment of the NHS. Minority ethnic healthcare professionals often face barriers to career progression, unequal opportunities for training and development, and experiences of workplace harassment and discrimination. The lack of diversity in leadership positions further perpetuates these inequalities, hindering efforts to create an inclusive and supportive work culture.

Addressing cultural bias in the NHS requires a multifaceted approach that acknowledges its existence, confronts implicit biases, and promotes cultural competence among healthcare professionals. Training programmes that raise awareness of cultural diversity and sensitivity can help mitigate prejudicial attitudes and behaviours. Further, implementing policies that promote diversity and inclusion in recruitment, retention and promotion practices is essential for creating a more equitable workforce.

Fostering a culture of accountability and zero tolerance for discrimination is also imperative. Healthcare institutions must establish clear protocols for reporting and addressing instances of racism, ensuring that victims are supported and perpetrators are held accountable for their actions. Creating psychological safe spaces for open dialogue, difficult conversations and reflection on issues of race and ethnicity can also facilitate meaningful change.

Furthermore, promoting diversity in leadership positions in the NHS is crucial for driving systemic change. By elevating the voices of ethnic minority healthcare professionals and empowering them to participate in decision-making, the NHS can better reflect the diverse communities it serves and foster a more inclusive organisational culture.

Ultimately, combating cultural bias in the NHS requires a concerted effort from all stakeholders, including policy makers, healthcare providers, educators, and the broader community. By acknowledging the existence of cultural bias, challenging biased attitudes and practices, and promoting diversity and inclusion at all levels, the NHS can move closer to its ideal of providing equitable and compassionate care for all.

In conclusion, cultural bias within the NHS represents a significant barrier to achieving healthcare equity and undermines the principles of fairness and justice upon which the institution is built. It is imperative that the NHS takes decisive action to confront this pervasive issue, ensuring that all individuals – regardless of their race or ethnicity – receive the best quality of care. Only then can the NHS truly fulfil its promise.

Until then, let’s keep it real here. Let’s call a spade a spade. Cultural bias is just code for racism.

Kieron Blake is a member of the BMA PLG. He is also a mental health advocate as well an advocate for those suffering with asthma and other respiratory issues.

Read more

In 2022 the BMA undertook extensive research into racial discrimination in the medical profession, which included the following reports, findings and recommendations.

Why are we still here? The factors still affecting the progression of ethnic minority doctors in the UK: Effective leadership requires a deep understanding of the roots and characteristics of racial health inequalities.

Racism in medicine: survey and report: Many doctors are considering leaving or have left their jobs because of racial discrimination.

  • 23% considered leaving
  • 9% actually left their job
  • 16% took sick leave or time off work.

Delivering race equality in medicine: Medical education must be tailored to meet the needs of the ethnically diverse UK population.

Further, the Too Hot to Handle? report, which brings together learnings from a number of significant tribunal cases and survey responses from over 1,300 NHS staff, shows that the NHS is not addressing racism effectively, and that many organisations respond by challenging or ignoring allegations of racism rather than taking them seriously.