Tensions between Black and Asian people are a distraction from the real problem: systemic racism

 

Actions speak louder than words – but not nearly as often          (Mark Twain)

The publication of a new report by Roger Kline, Too Hot to Handle, is always something to anticipate. It is ten years since the publication of The Snowy White Peaks of the NHS which was pivotal in giving substance in data to the lived experience of Black and minority ethnic staff in the NHS – it went from being a topic which was either dismissed or not discussed at all, to one which could not be denied in the face of the nation-wide and institutionalised inequity that was shown in that data. Roger has co-authored many other reports - on just culture in organisations, on inequality in rates of referral of minoritised staff into fitness to practice processes, and most recently on summary of the research base on fair recruitment and talent management. Taken together, this represents a canon that should see inequity a thing of the past in the NHS. Regrettably, serial iterations of workforce data show little sign of improvement. Which brings us full cycle to the origin of Too Hot to Handle, which arose from the findings made public at an employment tribunal of the appalling racist treatment of a Black senior nurse manager, Michelle Cox. The report is based on a survey of over 1300 staff and a careful legal review of employment tribunals where race was an issue. Some key themes emerge as to why we still continue to have this eyewatering racial discrimination meted out to our minoritised staff, especially Black members of the workforce.

Roger and co-authors point, correctly, to an absence of accountability which lies at the heart of this lack of progress. In this absence there is a widespread lack of ambition to implement policy change – most leaders seem to lack the necessary compassion and concern to create a fairer workplace. Let alone the fact that race inequality is known to result in worse patient outcomes. And it is on this basis that I respectfully differ with one of the other conclusions the authors draw: namely that the topic of racism may seem too scary to tackle. I do agree that there may be some junior and middle grade staff who are insufficiently culturally literate and hence wary of discussion. But my personal view is that boards are perfectly aware of issues related to discrimination – most have attended equality, diversity and inclusion (EDI) courses. What they lack is the ambition to do anything about it because of that sense many have that EDI is a ‘tick-box’, that the problem is society-wide and therefore outside their control, that they lack resource. The latter is especially ironic as another of Roger’s reports points to the over £2 billion annual cost of bullying in the NHS – in other words, there is no way of improving services without addressing inclusion aspects in the workforce.

Beyond the ‘business-case’ argument, the absence of an empathic connection with the plight of minoritised staff drives the sense of alienation that many feel, with impact on retention rates, and hence further compounding financial shortfalls. The report points to the usually ineffective ‘actions’ that are taken to tackle inequality – rarely evidence-based, rarely targeting the needs of their most deprived staff. How does a mostly-White executive tier find it possible to spend resource on futile interventions knowing that the experience of their 25% Black and ethnic minority staff is mostly not going to be improved? The report highlights that the task of really understanding racism is all too often substituted for performative interventions. It should not be left to the bravest souls like Michelle to have go through the personal turmoil of an employment tribunal in order to prove that there was discrimination – let alone the costs to the taxpayer of these unnecessary proceedings.

So, what behaviours does a truly accountable leadership take to improve race equality based on reading this report. It listens to its minoritised staff, it values disrupters rather than just rule-followers, it sets and publicises the equality goals that reflect organisational need, and it seeks not to do harm to its staff. In short it lives by the principles laid down by Martin Luther King Jr – we are ‘caught in an inescapable network of mutuality…whatever affects one directly, affects all indirectly.’ That mutuality extends from leadership to every staff member to the patients we treat and the wider public.