Insidious and Murderous? Institutional Racism in the NHS

The thing about institutional racism is, like its insidious cousin cultural racism, that it’s not always obvious. Even to those on the receiving end and certainly not to those benefiting. The behaviour of the NHS towards its staff during the Covid-19 pandemic has demonstrated this all too clearly and it should shame us all.

The first medical deaths in this pandemic were BAME doctors. Within the first few weeks it was becoming clear that BAME people were more at risk of dying from this than their white counterparts. You would assume that any sensible manager would’ve undertaken a risk assessment and would seek to protect their staff as they are the precious frontline resource fighting the pandemic.

Yet that didn’t happen in the NHS. 20% of their staff are from BAME backgrounds but are accounting for around 60% of Covid-19 medical staff deaths.

Take Doctors. This is from the British Medical Association survey conducted in April 2020. At that stage out of 17 doctors who had known to have died from a coronavirus infection, only one was white.

Almost double the proportion of BAME doctors (64 per cent) have felt pressured to work in settings with inadequate PPE where aerosol-generating procedures are carried out exposing them to risk of infection. This compares with 33 per cent of doctors who identified as white.

Only four out of 10 BAME doctors in general practice said they had sufficient PPE for safe contact with patients with possible or confirmed COVID-19 or those with non-COVID-19 symptoms. A far greater proportion – seven out of 10 doctors who identified as white – said the same.

Let’s look at nurses. This is from the Royal College of Nursing survey in May 2020.

[…] for nursing staff working in high-risk environments (including intensive and critical care units), only 43% of respondents from a BAME background said they had enough eye and face protection equipment. This is in stark contrast to 66% of white British nursing staff.

There were also disparities in access to fluid-repellent gowns and in cases of nursing staff being asked to re-use single-use PPE items.

The survey found similar gaps for those working in non-high-risk environments. Meanwhile, staff reported differences in PPE training, with 40% of BAME respondents saying they had not had training compared with just 31% of white British respondents.

Then there’s the rostering of BAME staff to the frontline whilst their white colleagues worked in safer areas.

Whilst this may be due, in part, to minority ethnic groups often being over-represented at lower levels of the NHS – many respondents told ITV News they believed unfair or discriminatory decisions were also at play.

One respondent described treatment as “very unfair” adding: “All BAME nurses [have been] allocated to red wards and my white colleagues [are] constantly in green wards.”

Another said: “Only BAME doctors from the department have been put forward for deployment.”

Which is also supported by the comments made by Carol Cooper, head of equality, diversity and human rights at Birmingham Community Healthcare NHS Trust, in an interview with Nursing Times, where she said,

“BME staff feel that they are being put on Covid wards and exposed to patients with Covid over and above their colleagues,”

All things being equal, the proportion of BAME staff on the front line should be the same as their representation in their normal area of expertise.  This is obviously not the case, so the question is why?

There’s only one conclusion that can be drawn, that insidious serpent of institutional racism. You can mouth excuses about BAME staff members being more numerous than the higher grades (and then ask yourself why this is so) but provision of PPE?  As the BMC PPE survey shows, that has nothing to do with it.  It makes me want to weep, for if the NHS with its multi-national workforce can’t treat its staff fairly, what hope have we that other institutions do?

So if you’re white and working in the NHS, the next time you see the rosters perhaps you should check your privilege and ask the hard questions about proportionality.  If you don’t want to do it, contact your union and get them to ask for the data from the Trust.

Whatever you do don’t ignore your colleagues. If you truly believe that black lives matter then show it by using your privilege to question what’s happening.  They’re willingly putting themselves on the line to protect your lovely white selves – the least you could do is show some solidarity because at the moment, the institutional racism you benefit from is murderous.