The NHS is in crisis. Ambulance delays and wait times for A&E are at their worst on record. The NHS is struggling to attract staff with ten percent of posts vacant, resulting in major staff shortages and the UK being left with fewer doctors and nurses than many European counterparts. Funding cuts, lack of staff, and weakened morale have created an intolerable work environment, leaving NHS workers feeling like they have little choice but to strike.

In addition to the stark working conditions affecting healthcare workers across the country, Black NHS staff are continuing to face heightened inequalities from discrimination at the institutional and daily level.

As reported by NHS England, 44.9 % of London’s NHS staff are from Black and minority ethnic backgrounds, including the majority of doctors, nurses, and midwives. However, the NHS leadership demographic statistics tell a very different story. Of the 92,484 Black and minority ethnic members of staff, only 54 are working in a senior pay band, with White NHS applicants in London being 1.6 times more likely to be appointed to senior positions.

And if the challenges of structural racism weren’t enough, staff tell of being subjected to racism from patients and colleagues alike. Just this week, Olukemi Akinmeji, who worked as a midwife in Ashford, successfully sued East Kent Hospitals University NHS Trust for discrimination and victimisation. Her case is, sadly, not an isolated one.

Everyone suffers if Black people are mistreated

Victor Adebowale is Chair of the NHS Confederation and one of the of the most influential leaders in healthcare policy. Speaking at The Conduit, he explained that the current NHS leadership is leading some people, some places, some of the time, and that’s not enough for the system to function effectively.

“Every NHS establishment where Black people are treated badly, the services will be bad”, Victor explained. How can a Black midwife who’s being subjected to bullying and a toxic workplace be expected to perform at her best and serve patients who are at their most vulnerable under those conditions? When you then factor in being overworked, underpaid, and overlooked for promotion, and extrapolate this across thousands of staff, it quickly becomes apparent that these conditions are a problem for the physical and mental wellbeing of the staff dedicated to caring for society’s most vulnerable. This is therefore an indirect threat to the safety of patients themselves.

“We need to hold up a mirror to the healthcare system and ask: why isn’t there more room for Black people?” – Victor Adebowale

What makes the NHS special is that it was created by the people, for the people. Over time, this has been forgotten. For social engagement to be effective, Victor assertde that evidence is needed that people are being listened to, outcomes must be co-produced, transfer of power must be measurable, and the outcomes must be describable. What staff and patients desperately need are leaders that lead everyone, everywhere, all the time.

Setbacks for women’s health

In January, the government rejected a recommendation to strengthen protections for women experiencing menopause. The proposal was for the Equality Act to include menopause as a protected characteristic for women, which would provide women legal protections against discrimination. As a response, the government rejected the proposed protections on the grounds that it could “discriminate against men”. The government then refused further appeals for a wide scale pilot on menopause leave in England as it was not “necessary or productive”.

Victor argued that the rejection based on possible discrimination against men is ignorant to the fact that women are discriminated against, and Black women even more widely, by men and unequal structures in our healthcare system.

In 2021, the Hologic Global Women’s Health Index ranked the United Kingdom relatively low for women’s health, on a par with Kosovo and Kazakhstan. This should have been a wakeup call for policymakers that women’s health was not adequately being protected or provided for. Almost as concerning is the lack of backlash against the inequalities experience by women and ethnic minotiries in healthcare. Amidst a torrent of critical concerns about the current state of the NHS — pay, conditions, discrimination, waiting lists, outcomes, misused budgets — NHS leadearship really needs to take the opportunity to hold a mirror up to itself.

An NHS that’s fit for the Brtiain of today might do well to look deep into its past to revisit the principles of a system that was established to provide a fair service to everyone, everywhere, all the time.

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