‘GOOD ENOUGH TO DIE – BUT NOT GOOD ENOUGH TO BE LEADERS’
As Boris Johnson announces yet another race commission, we investigate lack of diversity in NHS Trusts...
ASIAN and black people are dying needlessly and disproportionately because they are not being represented in senior ranks of the NHS, doctors, parliamentarians, and health bosses have told Eastern Eye.
The paper can also reveal that a further 17 BAME doctors have died in the past 10 days from Covid. The doctors’ union, the British Medical Association (BMA), said that brings the total deaths to 33 out of 35 since Public Health England’s (PHE) six-week race review. It was announced on April 16 and the review was published on June 2.
“Black, Asian and ethnic minorities are very good to do all kinds of things, except leadership,” said the BMA’s honorary vice-president, Dr Kailash Chand.
“They are good enough to die, but they are not good enough to lead. Even today, things are going backward, not going forward.”
It is not just the health service where lives are being disproportionately and negatively impacted, said MPs. Every aspect of British society – public and private organisations, the civil service, business, sport and the arts – needs examining to see how racial inequalities cause serious harm to minorities, they said.
The judiciary too is not exempt from the accusation of systemic racism. Government figures show that only six per cent of judges are non-white. One confided to Eastern Eye, “I have had the worst five years of my professional life in the judiciary. The Bar and solicitors have a long way to go. I won’t comment on the judiciary, save to say that it is like the 1980s, and you will remember those days only too well.”
The former shadow equalities secretary and Brent Central Labour MP, Dawn Butler, told Eastern Eye, “It is systemic so it means it is hard-wired into every area of society. We have to have the uncomfortable conversation without anyone feeling alienated. This isn’t a blame game. This is about trying to instil fairness in society and its structures.”
In this week’s Eastern Eye, director of the British Future think-tank, Sunder Katwala, writes, “A third of FTSE 100 companies and six out of 10 FTSE 350 companies still have all-white boards. The black presence is absurdly miniscule, so corporates tweeting the Black Lives Matter hashtag need to turn symbolic support into real change.”
Official government figures show that almost a third (32.2 per cent) of the 277 NHS trusts in England does not have a single black Asian minority ethnic on its board. The latest race equality data reveals that Asian and black health workers are more likely to be harassed, bullied or abused by their managers; face a higher chance of being formally disciplined; and are less likely to get a job when shortlisted for an interview.
Experts believe a lack of representation in the upper echelons can have a devastating effect on the treatment of ethnic minority patients.
“If we don’t have people at the top from a BAME background, clearly those decisions, those policies, will not be as culturally sensitive. That will make a difference in terms of health outcomes,” said Dr Chaand Nagpaul, chair of the BMA.
“It’s really important to have a proper mix of people at the top tier of management so those in leadership positions make sure the policies are culturally sensitive, prioritising the sorts of issues that affect BAME communities.”
Eastern Eye investigated the make-up of Trust boards in towns and cities with high numbers of ethnic minorities. The paper then matched the data with racial inequalities examined by the latest NHS workforce race equality standard (WRES) report and the number of Covid deaths per 100,000 people. It reveals a worrying lack of Asian and black representation and potential for structural racial inequalities.
For example, black and Asian staff at Berkshire Healthcare NHS Foundation Trust were almost six times (5.6) more likely to end up in formal disciplinary hearings, compared to white colleagues.
Of the 13 board members only two are BAME, and the Office for National Statistics (ONS) says 70 in every 100,000 have died from the virus. The Trust covers Slough, which is 54 per cent non-white, according to 2011 census figures that are almost 10 years out of date.
Slough’s Labour MP, Tan Dhesi, lost his grandmother, uncle, and his brother-in-law’s father to coronavirus. He has been actively campaigning for several years for greater diversity in the boardroom.
Dhesi said, “Representation matters because when we have a diversity of thought at the very highest echelons, with their personal knowledge of the black and Asian communities, they would have ensured discussions were had on obesity, diabetes and other health issues and changes implemented. So, we could have had a greater concentration on issues affecting BAME communities. That’s why we need to change the way things are at the top.”
BAME staff at Camden and Islington NHS Foundation Trust are almost 11 times more likely to be disciplined than their white colleagues. Ethnic minorities make up 33 per cent of Camden and 32 per cent of Islington. Yet only two of the 15 board members are black or Asian. ONS figures show that 81 in every 100,000 people have died from COVID in Islington and 55 per 100,000 in Camden.
In the Midlands and the north of England, at least 13 Trusts have no ethnic minority representation. These include Oldham, Manchester, Derby, Nottingham and Liverpool, all of which have substantial BAME communities.
“You’re asking all the right questions, but that’s what the board should be doing,” said one former hospital Trust board member from northern England, who spoke on the condition of anonymity. “The non-execs should be telling their chief executive and directors to take the data and map them with the deaths from Covid in high BAME towns and cities.
“The problem is that they don’t put ethnicity on a death certificate. The government’s already said that black and Asians are dying disproportionately from the virus, but no-one is asking the right questions, never mind joining up the dots.”
Eastern Eye has been highlighting the structural and systemic racial inequalities faced by the BAME community in, and those using, the health service, pointing out how this has led to disproportionate numbers of Asian and black people dying from coronavirus. Public Health England (PHE) reached the same conclusions in a report published on Tuesday (16). It makes the same recommendations from experts speaking to this paper over the past six weeks. They include proper risk assessments, adequate personal protective equipment (PPE) often denied to BAME health workers, and better data collection on the ethnicity and occupation of those who have died.
The chair of the Derbyshire Community Health Services NHS Foundation Trust is Prem Singh. He is also a senior independent trustee on the NHS Confederation, and a former CEO of the Derby City Primary Care Trust.
At the start of the pandemic, he held focus groups to make sure his organisation involved staff in devising the way risk assessments for workers were carried out. Does he agree that lives are being lost needlessly?
“Yes, because I think we can do more in senior leadership positions. I can do more, and I’m working hard to do that. This is all about leadership and so it has to play a part, but I think we need to think wider than representation at the top.
“We need to think about culture, about the commitment of a cross-section of our staff who represent a cross-section of society. So how do we gain a social movement to create committed staff who are culturally competent so that everyone’s concerned and not just BAME staff?”
His Trust is operating a ‘reverse mentoring’ scheme where junior BAME colleagues mentor more experienced non-BAME leaders. Singh is being counselled by a disabled member of staff.
“We’re learning, and we’re not 100 per cent there. We need to make sure the entire NHS staff are more culturally equipped. We’re encouraging white colleagues to join the BAME network because when we have white members of society marching with BAME people, showing their anger at what happened to George Floyd, we start to see social movement.”
Singh’s call to change culture across the NHS is echoed by the doctors’ union.
“Our BMA surveys show that twice as many BAME doctors don’t feel able to speak out when they have concerns about safety,” said Dr Nagpaul. “That’s because they feel excluded, they feel they may be blamed, they feel it might affect their career prospects.”
The neighbouring Derbyshire Healthcare is only one of eight Trusts in England with a BAME chief executive. Ifti Majid told Eastern Eye that his Trust collaborated with black and Asian staff to create a personalised risk assessment process.
“To date, 441 risk assessments have been completed, and we are asking that these be reviewed on a monthly basis,” said Majid. “While diversity at senior levels in the NHS must be improved, all healthcare leaders have a responsibility to set the tone in respecting others, respecting difference and valuing diversity.”
But Eastern Eye has also found that the number of BAME board members may not necessarily mean racial inequalities will be fewer. At the Walsall Healthcare NHS Trust, white applicants shortlisted for interviews were almost three times (2.73) more likely to get the job compared to BAME candidates, according to data from the NHS Workforce Race Equality Standard. Of the 18 board members, six are black or Asian, including the chair.
One board member who wished to stay anonymous said, “In some cases, being the only black or Asian NED (non-executive director) can be difficult because your voice can be drowned out. If you are the only director, and you’re not a medic, then you either don’t feel confident to challenge or you don’t want to scupper your career. So, the government might want greater diversity on boards, but they need to be the right NEDs.”
Eastern Eye approached the Trusts named in this report for comment, but most declined.
A spokesperson for the Wirral University Teaching Hospital NHS Foundation Trust, where none of its 17 board members is BAME said, “It is not possible to predict, and there is no evidence to determine whether a BAME board member would have made a difference to our approach to BAME risk assessment. We took proactive action to include BAME factors in our risk assessments.”
Meanwhile Barnsley Hospital NHS Foundation Trust, which too has no BAMEs on its board and a four per cent non-white population said, “The apparent disproportionate impact of Covid-19 on BAME colleagues in healthcare is an issue affecting all healthcare organisations and is one that Barnsley takes very seriously.”