Intended for healthcare professionals


Don’t accept racist abuse, Hancock tells NHS staff

BMJ 2019; 367 doi: (Published 07 November 2019) Cite this as: BMJ 2019;367:l6425
  1. Abi Rimmer
  1. The BMJ

The secretary of health and social care in England has written to NHS staff to express his horror at the incidents of racial abuse that they face.

In a letter sent on 5 November, Hancock said that he wanted to send a clear message that this sort of abuse was unacceptable and would not be tolerated.1

“If you face abuse, do not accept it. If you see a colleague being abused, do not ignore it. If you know of an employee facing this, do not stand for it,” Hancock wrote. “The government takes a zero tolerance policy approach to dealing with racist abuse whenever it arises. Things should be no different in our NHS.”

Hancock also made reference to the case of the Blackpool trauma and orthopaedic surgeon Radhakrishna Shanbhag. Speaking to ITV News on 31 October, Shanbhag described how he felt after a patient had asked for a white surgeon instead of him.2 “It made me reconsider my position in the NHS because I thought, do I want to put up with this at this stage, after I have given my life, blood, sweat, and tears to the NHS? Do I have to put up with this?” Shanbhag said.

He also said that he didn’t know how his hospital would have supported him after the incident. He added, “I began to question myself, and I’m thinking, ‘Am I just the colour of my skin?’”

Hancock wrote that if a patient asks to be treated by a white doctor “the answer is ‘no.’” He continued, “Your management must and always will back you up.”

Is exclusion the answer

In June, Andrew Foster, the then chief executive of Wrightington, Wigan, and Leigh NHS Foundation Trust, said that a patient had made a formal complaint to him after they were told that although care was available from non-white doctors, a white doctor was not available to treat them in the emergency department.3

Writing on Twitter, Foster said, “This was hugely upsetting for the staff involved. Appalling.” He added, “I cannot believe the nerve of submitting a formal complaint against the hospital.”

Speaking to The BMJ, Foster said that he had originally intended to exclude the patient from the hospital but did not do so on the advice of clinical staff. “They explained that the patient had a number of illnesses and would not have any easy alternative to our hospital, so they felt it was inappropriate to exclude the patient,” he said. “So what you got was the staff demonstrating far more compassion for the patient than the patient demonstrated to the staff.”

Foster said that he tweeted about the incident in order to show support for the staff involved. While he received thousands of responses condemning the patient’s action, he said he also received several comments from people saying that racial abuse against NHS staff was not uncommon.

In fact, he said the doctors involved in the incident hadn’t even reported it because they were so used to similar incidents happening. “You shouldn’t just let it happen, you should report it,” Foster said.

In his letter to all staff, Hancock said that the interim NHS People Plan had set out a framework “for how the NHS will become the best place to work.”4 He also said that the workforce race equality standard (WRES) was fundamental in supporting black and minority ethnic (BAME) staff.

The WRES was launched in 2016 to ensure that NHS BAME employees have equal access to career opportunities and receive fair treatment in the workplace. The 2018 WRES report found that 28.7% of BAME staff had experienced harassment, bullying, or abuse from patients, relatives, or the public, compared to 27.7% of white staff.5

Hancock also called on senior management in NHS trusts to reiterate to their staff that racial abuse was unacceptable. “I therefore expect all that all appropriate steps are taken by organisations to ensure their staff know they can come to a workplace that is free from abuse and harassment.

Everyday racism

Ramesh Mehta, president of the British Association of Physicians of Indian Origin (BAPIO) welcomed Hancock’s letter. “I am pleased with the message that Mr Hancock is giving to the staff,” he told The BMJ. “I think it is quite bold and I congratulate him for being honest and ensuring that racism is not tolerated in the NHS”

He said, however, that for many years, senior management in the Department of Health had accepted that there was institutional racism within the NHS and that racist abuse towards staff was perpetrated by NHS managers, rather than patients.

“Unfortunately not only has the racism continued, it has gotten significantly worse,” Mehta added. “Dr Shanbhag is only one case. This is a day to day occurrence in all parts of the NHS.”

He said that BAPIO sincerely hoped that the NHS People Plan would be effective in its aims to improve the NHS as a place to work, and it would be willing to support any actions needed to get rid of institutional racism in the NHS.

“The concern that we have is whether it is going to be effective,” Mehta said. “This has been tried before in different ways and it hasn’t worked because when it comes to taking action against those who are racist it hasn’t happened. Strict action against the people who promote racism is the only way to get over institutional racism.”

Responding to Shanbhag’s comments, the chief executive of Blackpool Teaching Hospitals NHS Foundation Trust, Kevin McGee, said, “I’ve seen Dr Shanbhag to assure him of my personal support and that of the trust.”

He added, “This trust does not condone prejudice in any form. It is unacceptable and has no place within this trust or the wider NHS.”


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