Intended for healthcare professionals


Ethnic minority staff and patients: a health service failure

BMJ 2019; 365 doi: (Published 21 May 2019) Cite this as: BMJ 2019;365:l2226

Ethnic minority staff

Checking the Government website today (, it gives this overview of the duty of equality across public services including the National Health Service (NHS):
"The public sector Equality Duty (PSED) requires public bodies to have due regard to the need to eliminate discrimination, advance equality of opportunity and foster good relations between different people when carrying out their activities."

Poorer quality care for patients from ethnic minorities has been documented in many British institutions.[1] In this letter I will focus on the inequalities experienced by clinicians from Black and Minority Ethnic groups (BME). A wise colleague (and fellow teacher) told me this starts long before BME professionals are in practice. So I began by looking just one step before professional practice. To qualify in the UK, clinicians all spent extended periods in higher education. Recent research in two multi-disciplinary London universities by AdvanceHE [2] was driven by the same need to enhance diversity at the top of organisations described in this Editorial.[1] Discrimination is already present in academia. However, participants in a Diversifying Leadership programme reported “that using diverse role models and speakers can help convey the message that leadership can take many forms and can incorporate different identities and cultural backgrounds.”[2] Equality of recognition and promotion came up as sensitive issues for many BME staff. Over the year of the Diversifying Leadership programme, ratings of “My formal appraisal/performance review is useful/ valuable” improved significantly.

Here are three recommendations for developing new academic leaders,[2] that might also apply to the NHS:
a. Pay particular attention to the advertising strategies employed for senior posts, identifying ways to increase the breadth of the audience reached.
b. Initiate discussions with BME staff to explore what barriers they face to progression and leadership within the institution and more broadly.
c. Implement equality impact assessments as a standard accompaniment to all decision-making agenda items.

Actually, these recommendations are a Duty.

1. Kmietowicz Z, Ladher N, Rao M, Salway S, Abbassi K, Adebowale V. Ethnic minority staff and patients: a health service failure. BMJ 2019;365:l2226
2. Fook J, Archibong U, Kim T, Aldercotte A. Cracking the concrete ceiling: Tracking the impact of the Diversifying Leadership programme. London, AdvanceHE, 2019.

Competing interests: No competing interests

23 May 2019
Woody Caan
Occasional teacher or trainer
Duxford, Cambridge