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Racism remains embedded in NHS organisational culture - study

06/02/2024
New MDX-backed report shows the health service is still falling short in tackling discrimination

Person walking in a hospital

NHS leaders are urged to listen to, and act on, the concerns of their black and minority ethnic staff following the launch of a new report today (6/2) by Middlesex University academics and human rights charity Brap that found racial prejudice remains embedded in the health service despite initiatives to remove it.

The 66-page report, Too Hot To Handle: An Investigation Into Racism In The NHS, shines a light on the problem and the failure of healthcare organisations to provide a safe and effective means for listening to and dealing with concerns raised by BME staff.

The study, co-authored by Roger Kline, Research Fellow in the University’s Business School, and Prof Joy Warmington, Middlesex University Visiting Professor of Education and Brap Chief Executive Officer, found there was a culture of avoidance, defensiveness, or minimization of the issue from their employer if they did so.

The report’s findings were partly based on a survey of more than 1,300 NHS staff, who were asked if they experienced racism and what form it took. Among the results, the survey found:

  • 71% of UK-trained staff complained of race discrimination.
  • 63% said their performance or behavior was subjected to a greater degree of scrutiny than that of white colleagues.
  • Over half (52.5%) said they had not been offered development opportunities.
  • Over half (53.2%) said they heard a colleague or patient make an assumption about someone based on their race or nationality.
  • 49% said they had been denied promotion opportunities.
  • A third said colleagues spoke to them rudely or in a different way to other colleagues.
  • Almost a quarter were left without support when patients were racist towards them.

Many respondents said they were reluctant to challenge experiences of racism, with
the most common reason (75.7% in the survey) that they did not believe anything would change. Staff who did not raise concerns were worried about being seen as a troublemaker, or worried about repercussions from their line manager or other organisational leaders. Of those who raised concerns, only about 5% said their problem was dealt with satisfactorily.


“Our report found that BME staff still face serious challenges in raising complaints of racism and this has an impact on staff morale, progression and recruitment, and potentially on patient care if staff feel under-valued and badly treated,” said Mr Kline.

“In the NHS, where a quarter of staff have BME heritage and a significant proportion of patients do too, this is not a marginal issue and nor is it a new one.”

The investigation was prompted by several recent NHS employment tribunal race discrimination cases, most notably that won by senior nurse Michelle Cox which highlighted the shortcomings of how the health service in England handles incidents of racism.

It draws on lessons from those tribunals as well as evidence from the survey which aimed to understand both personal experiences of racism and the institutional responses that followed when allegations of discrimination were raised.

Pulling this evidence together, the researchers found extensive correlation between the survey responses and findings that emerged from the tribunals they examined and other recent literature they reviewed.

“Our report shows that the NHS is not addressing racism effectively, and that many organisations respond by challenging or ignoring allegations of racism rather than taking them seriously,” said Prof Warmington. “BME staff are still anxious about raising concerns, worried about the consequences if they do, and see little or no action if they do raise concerns.”

This latest report comes 10 years after The Snowy White Peaks of the NHS, a landmark study by Mr Kline which found that BME staff were largely excluded from senior positions in the NHS, especially in London.

“Too little has improved or changed since my report a decade ago,” he said. “There has been some progress but overall the NHS needs to get a grip on this issue.”

Drawing on their research and the wider literature, the researchers make recommendations to NHS Trust boards and human resources departments.

Healthcare organisations need to adopt a culture where racism is spoken about routinely and understood as being maintained by organisational culture. Trust boards can create an early reporting system that flags up opportunities for intervention. Increasingly, NHS organisations are adopting ‘behavioral standards’ which govern values and employee behavior and this also provides an opportunity for employers to introduce expectations of behaviour with regards to ‘race’ and the consequences for breaching them.

The report argues that NHS employers need to be proactive and preventative, not relying on individual staff to raise concerns but instead be problem sensing and curious.

The research coincides with a series of webinars launched by Middlesex University Business School to explore key concepts of leadership, culture, and treatment of staff and patients in the NHS. The issues being covered in the webinars are a prelude to a Doctorate in Business Administration course being launched in September 2024 which will focus on leadership and culture in healthcare.

Read the full report: Too Hot To Handle: An Investigation Into Racism In The NHS,

Photo by Hush Naidoo Jade Photography on Unsplash

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