Dear Secretary of State...

This is an open letter to the new Secretary of State for Health and Social Care from the co-authors of Too Hot to Handle, Roger Kline and Joy Warmington.

For the attention of:

The Rt Hon Yvette Cooper MP

Secretary of State for Health and Social Care

39 Victoria Street

London

SW1H 0EU

DEAR SECRETARY OF STATE…

Congratulations on your appointment.

When the Labour government took office in 2024, we wrote to the then Health Secretary about our report, Too Hot to Handle? Why concerns about racism are not heard or acted on. We highlighted the need for the NHS to respond more honestly and courageously to racism experienced by its staff.

Two years on, the evidence suggests the situation has not improved. In some respects, it has worsened:

• the Royal College of Nursing recently warned that racism has been allowed to ‘flourish’ in the NHS. Nursing staff reported racism more than 21,000 times over four years, with reported incidents rising by 78% during that period. In 2025 alone, nursing staff reported nearly 7,000 incidents of racial abuse

  
  

• recent reporting on BBC Freedom of Information data found that racist abuse against NHS staff in England rose from 7,002 reported incidents in 2023 to 8,235 in 2024 – a 17% increase in a single year

  
  

• the 2025 NHS Staff Survey also shows that the percentage of staff experiencing discrimination from patients, service users, relatives or the public is now at a five-year high

  
  

• the latest WRES data shows that several core inequalities have persisted despite a decade of action

Taken together, this points to something the NHS and government now need to name plainly: a crisis of racism in health and care.

But this is not just a crisis of racism. It is also a crisis of leadership, accountability, and workplace safety.

Too Hot to Handle showed that the NHS has not always provided a safe or effective route for staff to raise concerns about racism. The report found a recurring pattern: concerns minimised, evidence thresholds set unreasonably high, staff left unsupported, and organisations responding defensively rather than learning from what staff were trying to tell them.

The same pattern is visible now.

The importance of tackling racism in healthcare is self-evident. As a former Chief Secretary to the Treasury, you will understand that this is not only a workforce wellbeing issue – it is also a question of retention, sickness absence, litigation risk, and organisational productivity. Racism costs the NHS. It costs staff their health, confidence and careers. It costs organisations talent, trust, and credibility. And it costs patients because unsafe workplaces cannot reliably produce safe care.

We believe your appointment offers an opportunity to reset the national response. The NHS does not need another broad statement that racism is unacceptable. Staff already know it is unacceptable. What they need is evidence that the system will act.

We would urge you to strengthen accountability for building safer workplaces. Boards should be required to demonstrate how they are preventing racist abuse, supporting staff who experience it, and addressing the internal cultures that allow racism to be minimised or dismissed. This should include independent scrutiny of how race-related concerns are handled, proper support for staff who raise concerns, and clear safeguards against retaliation.

We also ask that the Department of Health and Social Care works with anti-racism specialists and others to develop a national programme of practical support. This should not be a one-off training package or a performative ‘sheep dip’. It should help leaders and managers build the skills to respond to racism in real time, including when it is uncomfortable or reputationally difficult.

In practice, this means:

• responding to racist abuse when it happens, rather than leaving individual staff to carry the burden

• supporting staff meaningfully, including through psychological support, independent advice, protected time, and visible management action

• building safer workplaces by changing the systems, cultures, and leadership behaviours that allow racism to be normalised and ignored

• treating racism as a patient safety, workforce, and governance issue, not simply an equality issue

• ensuring that migrant and racially minoritised staff are not praised as essential while being left unprotected when they are abused

• making boards accountable not only for whether incidents are recorded, but for whether staff can see that something changes as a result

The recently published Mann Review and NHS staff standard for tackling racism may help raise the profile of work to tackle racism but in isolation, evidence suggests they are very unlikely to make the difference the NHS desperately needs.

This is not only about individual members of the public behaving badly. The wider political climate matters. When anti-migrant rhetoric is normalised, when communities are played against one another, and when public debate repeatedly questions who belongs, it should not surprise us that some people feel emboldened to abuse the very staff on whom the NHS depends.

But the NHS is one of the clearest examples of a successful, multicultural public institution. And it is outrageous that some of its staff are now being asked to absorb the consequences of a public climate that makes their presence feel conditional.

The question now is whether the government will treat this as the crisis it is.

We would welcome the opportunity to meet with you to discuss how the learning from Too Hot to Handle and other workforce race equality evidence and lived experience from across the service can be translated into a practical national response.

Yours sincerely

Roger Kline

Research Fellow at Middlesex University Business School

Joy Warmington

CEO of brap and Visiting Professor at Middlesex University Business School