By Dr. Hein Scheffer – Director of Strategy, Culture and Education

October 2023

The history of EDI in the NHS

Over the past 20 years, the NHS has spent a great deal of time focusing on the issue of inclusivity and equality – and rightly so given the increasingly diverse population that the NHS serves. However, while huge strides have been made in capturing data - for example through the through the Workforce Race Equality Standard (WRES) - we are still a long way from an NHS that is truly diverse.

 

The first debates about EDI started in 2004, when Prof Martin Powell et al, pointed out that fewer than 1%  of Chief Executives in the NHS (Powell et al., 2012) were black or minority ethnic (BME).  Nigel Crisp, (then CEO of NHSE) stated that the NHS should ‘reflect the make-up of the country as a whole’.  Later in 2012, Prof Ian Cummings (former CEO of HEE) wrote about the ‘talent gap’ and sparked the third call for equality in the NHS and finally Sir Simon Stevens challenged NHSE to have a 19% BME workforce with a challenge to all Trusts to achieve the same by 2025 (Carvel & Shifrin, 2004; NHSLA, 2014; Stevens, 2020).

 

Whilst it is not clear how far the NHS has come in achieving this ambition, we are making very slow progress at EEAST with our current BME status at 4%. To achieve these ambitions, I believe that it is important that we talk about race and racism.

What is racism?

A short definition of racism is: “the belief in the inherent superiority of one race over all others and thereby the right to dominance” whilst arguing that racism is “a system of ignorance, exploitation, and power used to oppress [ethnic minorities] ... and other people on the basis of ethnicity, culture, manner-isms, and colour” (Lorde and Marable, 1992, as referenced by Solórzano, Ceja, & Yosso, 2000, p. 61).

 

Racism has its roots many centuries ago - as far back as 1391, during the Spanish Inquisition,  when anti-Semitic discriminatory laws were introduced against the ‘coversios’, the converted Jews, who became Christians following the 1391 forced conversion of Jews to Christianity under the slogan ‘convert or die’ (Wolf, 2008). 

 

Solórzano et al (2000), explains the concept of critical race theory (CRT) to offer some helpful definitions of racism, with three key principles:

 

• One group believes itself to be superior to another.
• That group believes itself to be entitled to carry out racist behaviours in an ignorant, exploiting, and domineering manner; and
• Racism affects multiple racial and ethnic groups.

Within the NHS, we see numerous examples of racial biases which leads to many black, international and ethnic minority healthcare professionals being subject to disproportionately high numbers of complaints or disciplinary procedures, as well as stagnant career progression. The NHS Race and Health Observatory was set up to identify and tackle inequalities, including structural racism and bias which impact on our health and care workforce.  This open statement from the NHS Race & Health Observatory describes the destructive impact this has on culture and people.

Educating ourselves

The reality is, throughout the globe, we have different people, with different values, cultures, languages and ethnicity. Not all white people are the same, equally not all black or Asian people are the same.  A black person from Mozambique will be different from a black person from Namibia, for example.  So, educating ourselves about these differences, and our own biases and fears are important.  Understanding our own ‘privilege’ or ‘fragility’ is key to this:

 

• ‘White Privilege’ describes the accepted and unearned set of advantages, or benefits bestowed upon people solely because they are white and, as such, have been born into these privileges. Their whiteness has been an enabler to their success. Generally white people who experience such privilege do so without being conscious of it.

 

• ‘White Fragility’ describes the discomfort and defensiveness on the part of a white person when confronted by information about racial inequality and injustice. Defensive responses, including anger, fear and guilt, might lead us to respond by remaining silent, or saying what is expected in order to diffuse or deflect the discomfort. Without action this diffusion or deflection only addresses the immediate issue, and the core issues remain.

 

However uncomfortable we feel, I believe that we need to challenge our own ignorance and prejudice through self-education. We can start to do this by asking our colleagues about their experiences, listening attentively and acknowledging the inequality that still exists in many parts of our health service and society in general.

If we are to change our culture and become more inclusive, then let’s talk about race. We need to do this, not in a way that will accumulate personal benefits for us only, referred to as ‘performative allyship’, but as a genuine effort to learn, to understand others better, and to call out bad behaviour, prejudice, and ignorance.  It is not sufficient to be non-racist, we must be anti-racists, so, let’s talk about race.

References

Carvel, J., & Shifrin, T. (2004, 23 June 2004). Wasted Talent, Newspaper. The Guardian, 23 Jun 2004.

NHSLA. (2014). Survey Infographics on Executive Recruitment

Powell, M., Durose, J., Duberley, J., Exworthy, M., Fewtrell, C., MacFarlane, F., & Moss, D. (2012). Talent Management in the NHS Managerial Workforce.

Solórzano, D., Ceja, M., & Yosso, T. (2000). Critical Race Theory, Racial Microaggressions, and Campus Racial Climate: The Experiences of African American College Students. The Journal of Negro Education, 69(1/2), 60-73.

Stevens, S. (2020). Diversity of Health Service. NHS Chief Pledges HQ Will Match Diversity of Health Serivce. Retrieved from https://www.england.nhs.uk/2020/03/nhs-chief-pledges-hq-will-match-diversity-of-health-service/

Wolf, K. B. (2008). Sentencia-Estatuto de Toledo, 1449.