NHS organisations risk an “Obama” effect by improving Black, Asian and minority ethnic representation at top levels without tackling race discrimination affecting the rest of their staff, the authors of a new study have claimed.
Joy Warmington, chief executive of equality charity brap, visiting professor at Middlesex University and a non-executive director at Oxford University Hospitals Foundation Trust, said: “Representation is a really good thing but, of itself, it would not challenge cultural experiences.”
She also advised NHS organisations to consider their actions on discrimination and “let go of what is not making a difference”, adding: “You end up with organisations having huge action plans and they are not able to see what is making a difference.”
She said trusts might see an “Obama effect” – a Black man could become the president of the United States but this in itself did not improve the lives of those affected by race discrimination.
Report co-author Roger Kline, a research fellow at the university, added that there was a danger of “people drifting off” from discrimination and equalities, if they felt representation was “done”.
The most recent official NHS workforce race data, covering 2022, said the share of board members from ethnic minority backgrounds was 13.2 per cent – up 6.2 percentage points since 2016. But other measures of race discrimination – such as likelihood of being appointed from a shortlist, entering a disciplinary, or receiving training – had deteriorated or barely moved in the same period.
Their study, Too Hot to Handle, reviewed a series of employment tribunal cases that NHS trusts have fought.
It recommends NHS organisations take earlier action on cases involving racism to avoid tribunals.
It also looks at the wider experience of Black, Asian and minority ethnic staff in the NHS, especially those who raise concerns. It draws on a survey of more than 1,300 staff, mainly with a minority ethnic background, and reviews several key tribunal cases, including one which cost the NHS £4.5m.
Over three quarters of respondents said they were reluctant to challenge experiences of racism because they did not think anything would change as a result and more than three fifths feared they would be seen as a troublemaker if they did.
The authors call for change in how the NHS deals with these cases, highlighting a culture of avoidance, defensiveness or minimisation when concerns were raised.
“Part of what we are saying is that you need to be proactive and preventative,” said Mr Kline. “We are not saying anything that should come as a surprise. We are saying you should get a grip on it and deal with it.”
“We are holding a mirror up to the system and saying this is what is going on. But we are saying it is possible to deal with it.”
- Being willing to talk about race and covert racism in their organisations, and set behavioural standards including those around racism and discrimination. This should be backed up by a coherent antiracist strategy, which helps boards to understand how organisational culture can help maintain discriminatory practices.
- Developing HR capabilities to become “problem sensing and not comfort seeking” around race, including looking at potential patterns of detriment. One area highlighted is examining the motivation behind complaints, which may be manufactured to justify discrimination or as acts of retaliation, and can lead to NHS staff who have raised race discrimination concerns being subject to detriment.
- Organisations need to improve case management and administration of employment tribunal cases and ensure they understand the case law.
- Don’t litigate when the evidence is clear. Cases involving race discrimination should be dealt with as swiftly as possible and address the root cause rather than being taken to an employment tribunal.
- Employers should not employ external consultants to undertake culture reviews or investigations unless these consultants have a track record of understanding race discrimination and how to tackle it.