In recent months, the Black Lives Matter movement and the adverse impact Covid-19 has had on BAME people have highlighted the inequalities that exist within the NHS that need to be addressed. As part of our response, we have ensured that 98% of our BAME colleagues have completed a risk assessment and we are working hard to reach 100%.
Our latest blog is written by Devesh Sinha (in fact, he’s written three for us). Devesh’s account of the racism he experiences working for the NHS may throw up issues for some readers. If you are a member of NHS staff and would like to speak to someone, The Kings Fund has published a list of support services.
“I lead a stroke multidisciplinary team who have made some fantastic changes and quality improvements in just two years. We have moved from one of the worst performers of stroke clinical care in London to one of the best. We did it with systemic changes; collaborative, inclusive leadership; and innovative ideas delivered on the clinical ‘shop’ floor.
All of these achievements have been recognised nationally and while we celebrated as an organisation, I did not dare to open up on the ugly bits which require a lot of courage to speak up about. Like most doctors of colour, I have experienced insults, microaggressions, racial gaslighting and, to put it frankly, prejudiced violence.
My experiences may be the norm for all trainee and senior doctors and may be something we never talk about openly. One works hard to deliver excellence in patient care and yet still get told it is 'only' sheer luck. When exciting opportunities come along, one is told that we only need the best people - implying bias, that with my colour such excellence is inconceivable.
It's everyday racism and structural racism that are the two main challenges in work. On everyday racism, I feel there should be a microaggression daily survival guide for juniors and senior doctors. I want to share some of my everyday experiences which have been truly harrowing. Some of my experiences are too ugly to share. I sincerely hope that what I have experienced does not remain the norm in the NHS.
Individuals like me have a passion for improving stroke care for every stroke patient and their relatives. We deliver our best. One beautiful morning I recall walking with my multicultural team into a cubicle of four patients and relatives to provide them with the best care. Imagine how it feels to hear - 'now Brexit is happening, these people will go home'. Usually, it is directed at the people of colour on the team who are improving patient care services by working twice as hard. It is more scarring when your white colleagues in the room are clueless, silent or even smiling, nervously. The buzzword of ‘teamwork’, in such circumstances, disappears into thin air.
What is the right approach? In an ideal world, such outdated, primitive ideas would be challenged by everyone present in the team. In reality, more often than not, it is brushed under the carpet.
I have received complaints, forwarded to me by PALS, that focus on how poorly resourced the NHS is. They have also contained, in every paragraph, ugly references to a doctor's nationality. As a BAME champion, I feel that nationality and colour should not be dragged into resources and constraint issues. It would be intriguing to study the pattern of these complaints. I wonder how the system would address the problems if the country of origin is implied as a reason for the poor performance.
As a BAME leader, you need to address your colleague's grief whose nationality has been dragged into resources and constraint issues. Being a foreign doctor in the NHS excludes BAME colleagues from some of the privileges reserved only for white counterparts to progress to the NHS executive boards on the basis of their ability. This is a form of cultural disability, and the NHS must want to help, talk and challenge.
As a person of colour, it is hard to get due credit, and mostly it is unconscious. BAME staff work hard to innovate, but white colleagues get noticed for acclamations. It does develop scars in the aspirations of BAME staff when due credit is stolen. Most of the time, it is the team who should get credit for the hard work.
However, I have found some coping strategies that might be useful for the reader. When people in positions of power unconsciously choose to appreciate white colleagues despite no real output, this should be challenged. I now, politely, question what made someone believe that I could not have innovated. It’s a usual stereotype (with microaggression) that people like me face every day.
A person of colour in a leadership role faces even more challenges. If a white colleague uses strong words when addressing a team’s performance, it is usually interpreted as ‘you need to remember he is a strong leader and says it as it is'. If a BAME colleague uses similar language they get labelled ‘aggressive’ and ‘troublemakers’. BAME leaders are asked to work on the double-edged sword of performance but are not expected to assert themselves in a way that a white colleague would.
There are other examples of everyday racism and microaggression that I have experienced. Here are a few further examples of unsettling comments I’ve heard:
'When people say that ‘you speak like a local’. It can be well-intended, but it contains implied bias.
‘You are not like other Asians around here; I wish they were all like you’. Believe me, this is not a compliment.
‘You fit the bill in the BHR as most of the patients in the area are like you’. What is the point of saying this?
‘These patients, in that generation, don't recognise doctors like you as a doctor. They have a different image of a doctor in their mind’.
‘If you don't like it here you can go back to your country’. This was said, during a conversation about the weather, to a junior doctor who is a third generation Nigerian.
‘I don't see colour, and I am colour blind when promoting’. If you don't see the colour you also don't see colour discriminations.
'We need a proper consultant leading on this’. The implication of this sentence was that a white consultant, with an authoritative style who wasn’t in the room, was needed. It was uttered by someone who champions equality.
‘Can I speak to a proper doctor who is local? I have the right to do so’. I know they are demanding a white doctor and I know the nearest white stroke doctor is 20 miles away.
‘I thought you were a GP as most of the GPs nowadays look like you’.
I now ask people to clarify such statements. I ask them what they mean and I point out that the underlying meaning is hurtful. I would encourage others, with similar experiences, to not let such comments pass unchallenged. If you don’t, generations to come will continue to ask, ‘Where are you from originally? You can’t be British and a person of colour.’
If the treatment of BAME staff in the NHS continues unchanged, then the time is not too far off when doctors like me will question the value of our hard work. I hope, having read my blog (the first of three), you will reflect on what I have written and view me for my skills, my talents and my achievements – and not by my colour and tone of voice.”