NHS must tackle racial discrimination against staff and patients, report says

BMJ 2014; 349 doi: (Published 23 July 2014) Cite this as: BMJ 2014;349:g4781
  1. Matthew Limb
  1. 1London

Researchers have called for the NHS and wider society in England to act urgently on “persistent low levels of wellbeing” in black and minority ethnic (BME) communities resulting from experiences of racism, exclusion, and discrimination.

Their study found a marked difference in wellbeing among BME groups compared with their white counterparts, even after controlling for known factors that can influence wellbeing, such as employment, housing, and household income. It found “evidence of ethnic inequalities across every dimension of life”—contributing to lower levels of self reported wellbeing, as well as prospects of poorer health outcomes and reduced life expectancy.

Yvonne Coghill, who leads on inclusion and coaching at the NHS Leadership Academy, said, “This report is the clearest description and explanation of the scale and nature of race discrimination in England that I have read for a very long time.”

The review of ethnic “disparities” in wellbeing and their possible causes was funded by the University of East London and launched at a House of Lords reception on 21 July.1 It was co-written by Mala Rao, professor of international health at the university’s institute of health and human development, and Jacqui Stevenson, former head of policy at the African Health Policy Network and advocacy manager for ATHENA, the gender equity and human rights network.

The study consisted of a review of published literature; “qualitative” interviews with academics, clinical staff, and NHS, local authority, and other opinion leaders; and a discussion between experts from different organisations. The report described ethnic inequalities reported across society, including in the criminal justice, education, and employment systems, in the NHS, and in access to healthcare. Rao said that the evidence for inequalities was “overwhelming” and that they had a serious impact on health and wellbeing.

The report said, “The persistence of lower levels of wellbeing, both across different black and minority ethnic groups and across the social gradient, suggests a correlation between the experience of belonging to a BME group and experiencing lower levels of wellbeing.

“With respect to the residual deficit in wellbeing for BME populations, interviewees pointed to likely explanations such as higher mental distress and experiences of exclusion, racism and discrimination.”

The need to address racism and discrimination in the NHS was “incontrovertible,” the review said. It highlighted perceived barriers to career progression, unfair reward systems, and a lack of diversity in leadership positions on trusts’ boards. It highlighted a clear link between the wellbeing of BME staff and patients’ perceptions of care, with BME patients more likely to rate their care lower than the majority population and NHS staff from a BME background more likely to report lower job satisfaction.

“The findings point to the fact that, far from being an exemplar for staff wellbeing, the NHS helps to illuminate the impact and consequences of lower wellbeing, as well as specific drivers for differences in wellbeing between different ethnic groups,” the review said.

The authors called for a cross government drive to assess and tackle institutional discrimination in their organisations and workforces, as well as at other institutions within their sphere of influence. They also called for “zero tolerance” towards organisations that did not “collect appropriate ethnicity data needed to drive positive change.”

The report added that the NHS’s leadership needed to improve and ensure better training and support for staff. “The NHS must undergo a cultural change to increase understanding of and commitment to equality and diversity, with a focus on the benefits of diversity to staff, patients and the NHS system,” it said.

Deryck Browne, lead policy and research officer at the African Health Policy Network, which conducted the qualitative research work for the study, said that the report “confirms our suspicions and fears.” He said, “Health is not an accident. It is an outcome of inter-related factors linked to wellbeing such as lifestyle, structural influences, hereditary factors and environmental factors. Too often we tend to look to and within BME communities to understand and seek to address inequalities and differences in outcomes. We now have the ammunition to look to wider society and the external drivers that influence and inhibit health seeking behaviours at the individual level, and health opportunities at community level.”

The authors said that more research into disparities was needed, such as into the value of measuring and improving wellbeing and into links between age and reported wellbeing.

Nigel Crisp, a former NHS chief executive who was among the experts interviewed for the research, described the review’s findings as “powerful” and urged campaigners to raise the issues with MPs.

Roger Kline, a research fellow at Middlesex University’s Business School who has reported on diversity in the NHS, said that the treatment of BME staff was the best predictor of patient experience among all patients. “One of the best ways to improve health and wellbeing in this country is to improve the health and wellbeing in its biggest employer,” he said.


Cite this as: BMJ 2014;349:g4781


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