Guest blog: People of Colour must take ownership of the diversity debate in the NHS and beyond
By NHS Frontline Clinician in Primary Care
Having recently qualified, Anonymous works as a frontline clinician in a busy inner city general practice. Before this, he worked extensively in the public and private sector.
It is a Tuesday morning. But right now the days feel like they merge into one another. At our daily briefing session, we stand two metres away from each other, listening to the new set of guidelines, which seem to change on a daily basis. All around me I can see fatigued faces, bravely showcasing a stiff upper lip - an auto response brainwashed into our psyche. During this session, I find myself drifting away to something I read earlier on in the day. Stupidly, when I woke up I decided to read up on national COVID-19 statistics, which on the day read 88,621 confirmed cases and 11,329 deaths. Although it is widely acknowledged that the accuracy of the statistics are questionable, at best.
As a person of colour working in the NHS, I’m horrified at the proportion of front-line staff passing away who are from BAME background. Recent analysis conducted by the Guardian based on the number of known deaths within NHS staff found a staggering 68 percent were from BAME background. A similar figure was also suggested in research conducted by Sky. This figure is even more painful to process given that the recent election was decided on the basis of immigrants - and hostility towards people of colour was openly accepted by large sections of the population and our politicians.
Worryingly, while accurate scientific knowledge on the virus is understandably sparse, supposed credible institutions are quick to outline potential reasons for this ranging from genetics, ‘weaker’ immune systems and people living in crowded housing. Although time will reveal the credibility of these theories, less emphasis has been placed on the role of health inequality. And in the wider context - inequality in itself. For the sceptics - consider this: the doctors and consultants, who have died, were earning salaries on the higher income threshold in the UK. Why would they be living in cramped or overcrowded housing? If people of colour have weaker immune systems, is it their immune system or lack of adequate protection on the front line that should negate this factor as a bigger, more logical reason?
I am completely unconvinced by this. It leads me to think about what people of colour’s experience within the NHS actually is. When looking into this, it transpires exactly how it could be possible for people of colour to represent such a high proportion of fatalities. Prior to the outbreak of coronavirus, results were published in February 2020 from the recent workforce race equality data - the results were pretty dire. This was based on an initiative set up by NHS England five years ago to tackle inequality within the NHS. A whopping 29 percent of BAME staff reported being bullied or abused by other NHS workers, an actual increase from the last time the data was collected in 2016. Furthermore, more BAME staff report being discriminated against by their manager at 15.4 percent. The report also highlighted that BAME staff are more likely to be disciplined in contrast to their white colleagues. Let me make this clear: initiatives were put in place to improve experiences of BAME staff but the results have actually gone backwards.
Research conducted by ITV at the end of 2019 highlighted another startling but not surprising statistic. Seventy percent of the Foundation Trusts they surveyed reported an increase in racism against their staff by members of the public. The number of recorded racist attacks against NHS staff increased from 589 in 2013 to 1448 in 2018. Anecdotally, there were countless accounts of staff being reduced to tears from the abuse they received. All for the cost of trying to care for the public. Unfortunately, the inequality does not stop there. BAME staff are also not remunerated for the same service they provide. Research conducted by Unison and NHS Digital found that BAME doctors earned less than their white equivalents with the worst hit often being black male and female doctors. Disparity in pay based on race was also found amongst other health care professionals and staff within the NHS.
From my own personal experience, I do not believe that racial inequality is taken seriously by most white contemporaries. During my professional training, I was studying the ethical component of health care. The topic of racism within the NHS was brought up in particular about opportunity. A classmate with previous experience of working in the NHS stated that he believed there was institutional racism within the service. However, the ferocity and hostility directed to him from other white classmates was shocking in what felt like a coordinated response. They seemed to be outraged and dismissive at the very suggestion. Other minority students in the room who witnessed an astonishingly confident denial of this statement were muted - of course their lived experiences didn't matter. If we, as people of colour, that are part of a system where we are subjected to abuse from other staff, abuse from superiors, abuse from patients, economically abused and are more likely to be disciplined - then how can we be confident that in times of crisis our lives will be protected? Are we just canon fodder?
These statistics and accounts provide a sobering experience of working in the NHS as a person of colour. And I can’t help but feel tired of the British state leaning heavily on people of colour during times of crisis. It seems our value only comes to light during these times. But during these times we’re expected to stay silent and continue taking the abuse rather than question our actual worth within these borders. For those with short term memory loss or a poor education in this respect, here is a reminder outlining some examples of when people of colour have helped Britain during her times of crisis:
During World War 1, the colonies were used for both labour and resources. Over 1.3 million indian troops were listed as part of the colonial army, 16,000 men from the West Indies served.
As the war proceeded finance was key. The West Indies contributed nearly £2 million from tax revenue and voluntary contributions. India contributed over £150 million throughout the war. This was all done under the auspices of colonial rule where independence would not be granted until decades later.
Post World War 2, Britain was a wreck and needed rebuilding. They needed a workforce that did not exist domestically. Yet again the British state called upon its ‘coloured’ subjects to help in its time of need. How were these citizen’s rewarded? In the case of the West Indian community, Windrush springs to mind.
In fact the very inception and implementation of the NHS was reliant on people of colour filling key positions.
Today, foreign doctors wanting to work within the U.K. are faced with a mountain of fees and red tape having to provide thousands to get a Visa and administrative costs. However, the Home Office has just announced that if they require annual renewal, the fees will be waived. How generous of the state to ease their financial burden but at the cost of them working in life threatening environments only with the threat of having to cough up fees once the state reneges on its apparent goodwill come the next renewal.
Make no mistake - the non-participative debate around the impact of BAME people is tragic. To the few who are defending us, we need to stop falling into the game of the good migrant and the bad migrant in relation to our contribution to the nation. It is dangerous to frame our contribution and participation in this way. If I was to apply this faulty logic, does it mean that I am worth more than a white family who have never worked and ‘live off the state?’ To make it crystal clear, I see us as equals. Not a statistic on a spreadsheet or tax code.
To those reading this blogpost, this may have sparked a multitude of thoughts and emotions. It is perfectly reasonable for you to feel that in times of national emergency, now is not the time to raise these issues - we should remain a-political during these turbulent times. I disagree, political ambivalence or silence has usually meant greater risk and death for people of colour. I would urge you to read Maya Goodfellow’s excellent book Hostile Environment. Action is the only option. This is a watershed moment. Things cannot go back to the way they were pre-Corona. I implore other people of colour: do not allow history to repeat itself, it is not for us to wait on others to accept us - but for us to rightfully claim our right as equals!
Surprisingly, the coping mechanism I have chosen to adopt in these times is poetry. I find myself being soothed by the 13th Century poet Rumi and this line stands out for me: “In a night full of pain and darkness, be a candle spreading light until dawn.” Let us never forget those that died and what this means for our future as NHS workers and as citizens of this country.
Read Charity So White’s live position paper “Racial Injustice in the Covid-19 Response” - including information on the impact on BAME communities and on health inequalies.
