When you’re happy you enjoy the music, when you’re sad, you understand the lyrics

 

When you’re happy you enjoy the music, when you’re sad, you understand the lyrics – the duality of supporting the England football team

The decisive penalty in the Euro 2020 final had no sooner been saved than the overwhelming majority of black and ethnic minority people knew what was to come. The subsequent waves of racism and hate were neither surprising in tone nor in the fact that much of it originated from apparently ‘decent’ people who would conceive of themselves as ‘not having a single racist bone in their body’. This latent, but frequently palpable, xenophobia is something ethnic minority people are very attuned to, and familiar with. It is what makes many uncomfortable about waving flags of St George or unconditionally cheering the team: the transition from ‘English star’ to ‘winger of Nigerian parents’ is quickly made in the media. What made ethnic minority people more openly supporting of the national team this time was the inclusive and brave leadership of Gareth Southgate plus the cohesion and social conscience of the players themselves.

In the NHS too there are gifted and courageous leaders with an appetite to change. There are healthcare workers from the most diverse backgrounds whose talents are brought to the public benefit. But what is true in both sport and healthcare is that at times of greatest stress, the latent institutional racism comes to the fore.

This racial disparity has been highlighted by the evidence of disproportionate effect of COVID-19 on ethnic minority groups, as demonstrated in both the first and second phase of the pandemic in the UK. This data shows that the mortality risk from COVID-19 among ethnic minorities is twice that of white British patients independent of age, gender, wages, education and socioeconomic deprivation factors. Even after adjusting for age and gender only a small part of the excess risk is explained by a higher prevalence of medical problems such as cardiovascular disease or diabetes among BME people, or by higher levels of deprivation. The most recent NHS staff survey found that 47% of BAME staff said they had worked on a Covid-19 specific ward or area at any time compared with 31% of white staff. In addition 23% of BAME staff said they had been redeployed due to the pandemic at any time compared with 17% of white staff. Looking at the impact of COVID-19 on the workforce reveals that  95% of medical deaths and 64% of nursing ones were among black and ethnic minority staff.

In sport, one can measure the performance of players and teams, and good performance leads to success. In that way sport can be an example of what society should be – successful leaders and organisations can be identified and celebrated. Their actions can be captured and their tactics copied.  This discrepancy in workforce outcomes is a reflection of system wide inequalities. In looking back at five years of data from the Workforce Race Equality Standard (WRES) it is evident that there are persisting disparities in the day to day experience of black and minority ethnic (BME) people in the NHS. BME staff are concentrated in lower work bands with less than 7% in the highest management bands (despite making up 21% of the workforce) and are more than twice as likely as white colleagues to feel their organisation fails to provide equal work opportunities. White applicants are 1.6 times more likely to be appointed to posts than BME ones, even after shortlisting. BME staff are more likely to be put through disciplinary processes and almost twice as likely to report experiencing discrimination from a work manager. Taken together, this litany of evidence strongly leads to a rejection of the Commission for Race and Ethnic Disparities (CRED) Report, published earlier this year, stating that structural racism does not exist within the NHS. This disparity is seen for all ethnicities, so we also reject the report’s thesis that some groups have adapted better than others within the UK.

Institutional racism does exist and is associated with ethnic disparities in health outcomes. We need to understand what the term ‘institutional racism’ means, based on the Macpherson report, namely that there is a collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture, or ethnic origin. The definition continues that such racism can be seen or detected in processes, attitudes and behaviour which amount to discrimination through unwitting prejudice, ignorance, thoughtlessness and racist stereotyping which disadvantage minority ethnic people.

This systematised discrimination connects to a sense that diversity and inclusion poses a threat to some people’s sense of Englishness, and in turn fosters the culture that results in the social media abuse directed at the black English footballers. There is a disconnect between the overt racism of one section of society and the dignity of another. This has been highlighted in the last few days: following Nigel Farage’s repellent description of the RNLI as a ‘taxi service’ for migrants there has been a remarkable 30-fold increase in public donations to the lifeboat charity.

The NHS, like the RNLI and the current English football team, are well regarded by the public. In many ways these institutions are part of what define us as a nation. We have a chance to be proud of an anti-racist NHS that transforms itself for the benefit all of its staff and every citizen.