‘All forms of discrimination undermine effective healthcare’

I recently wrote an article for the Nursing Times, which is available here or which you can read below.

Years of NHS underfunding at a time of rising health needs, exacerbated by Covid-19, have made it increasingly difficult for nurses, midwives and healthcare assistants to provide high quality, safe, compassionate care they want to.

Ministerial press releases, speeches and directives are demanding higher productivity to turn things around. But exhortation, league tables, individual performance related pay and downright bullying of NHS boards will not bring about the improvement needed.

Nor will cuts in staffing levels. Staff costs are two thirds of NHS expenditure but they are also the most valuable asset the NHS possesses.

Research has shown conclusively that how staff are treated makes a huge difference to the safety, quality and productivity of NHS services.

My latest report brings together the extensive evidence that how we treat the 27% of the NHS who are of Black and minority ethnic (BME) heritage is crucial to the improvement we all want to see.

This report, commissioned by the Seacole Group and titled Not an optional extra: the price of not tackling race discrimination in the NHS, draws together the extensive research evidence that:

• Teams where staff are treated respectfully, and where mistakes lead to learning not blame, are more likely to be innovative and effective

• Attracting, promoting and supporting staff fairly at every level is essential if those teams are to have the best possible mix of talent and potential. For individual staff, being supported and treated equitably is crucial to their discretionary effort and retention

• Innovation is best developed in teams where staff feel it is safe to raise concerns, admit mistakes, and promote new insights. Such teams must be underpinned by inclusion and psychological safety

• Such teams must understand and challenge the damage that discrimination of any kind does to staff health and well-being, organisational effectiveness and patient care and safety

All forms of discrimination undermine effective healthcare. Research and data repeatedly show the NHS has especially struggled to tackle race discrimination, whether it is overt, covert or unintended.

Tackling how staff are treated, and specifically discrimination, is not an alternative to focusing on reducing waiting lists or shifting resources towards community services and prevention. Rather, it is a precondition of achieving those goals in a sustainable way.

The latest NHS planning guidance seeks sharp productivity increases. But sustainable productivity does not mean staff working harder.

In many parts of the NHS, staff are working at an intensity well beyond what is safe to them or to patients as NHS staff survey data shows.

Instead, research shows that if the NHS does not treat staff fairly, inclusively, respectfully and compassionately, racism will:

• Adversely affect whether BME staff raise concerns with confidence they will be listened to and not victimised – which is what the Francis Report on Speaking UP (2015) found was happening

• Continue to make staff ill and worsen absenteeism and turnover

• Mean recruitment and promotion decisions are likely to be affected (unwittingly or otherwise) by discriminatory bias, notably affinity bias, thus wasting immense amounts of talent

• Continue to mean the bullying and harassment of BME staff (by patients and by colleagues) remains even higher than White staff experience

• Undermine the creation of inclusive and psychologically safe teams essential for safe care

Innovative research by Scott Page has demonstrated that diverse teams that are cognitively diverse and are underpinned by inclusion and psychological safety make better decisions, are better problem solvers, are more creative and inventive.

He then shows that this is particularly so when the cognitive diversity is strengthened by identity diversity linked to protected characteristics including race

Ministers are prioritising (they claim) tackling health inequalities and prioritising prevention. It is difficult to see how that will be achieved by teams that are disrupted by racism.

It is difficult to see how this is to happen if, as already appears to be the case in the current wave of restructures and redundancies, senior BME staff are being nudged out of the senior positions they worked so hard to gain.

Mutual respect and collaboration is essential if the NHS is to improve as ministers say they want it to. Such work builds on the moral obligation we have to treat our fellow human beings – whether as staff or as patients – with humanity and equitably.

This report brings together the evidence that tackling racism is not an optional extra. It is not only the right thing to do morally, but is essentially practically too if the NHS is to improve.