UK United Kingdom

‘Unwitting’ racism and rise in abuse makes it harder for NHS staff to do their job

Imagine going to work and starting the day by being told that a customer doesn’t want to deal with you because you are black. And the response from your employer is to ask your white colleague to serve…

Where colour blindness might be a good thing. deVos

Imagine going to work and starting the day by being told that a customer doesn’t want to deal with you because you are black. And the response from your employer is to ask your white colleague to serve them instead. For minority ethnic people working in health this happens more often than you would think.

Recorded racist verbal and physical attacks against those working in the NHS is on the rise; a Freedom of Information request by BBC radio 5 Live found that in 2013, the number of such attacks in the NHS had risen 65% since 2008. And between 2012-13, there were 567 racist incidents involving patients or visitors, 33 involving NHS employees.

Writing in the British Medical Journal, senior NHS doctor Nadeem Moghal was the latest professional to open up about the problem. He described how the parents of a child in a hospital where he used to work refused to have any doctors caring for their child who were other than white. He said: “The clinical director concluded that because of the nature of the disease and the clinical need of the patient, the parents’ request would be enabled.”

In other words, the hospital would uphold the parents' request. And until a board level inquiry reversed the decision – which the parents ultimately conceded to – care was organised so that only a white British doctor attended to the child.

Disturbing events like these aren’t peculiar to the NHS. In 2013, Tonya Battle, received US$200,000 from the Hurley Medical Center in the US, to settle a lawsuit against the hospital for discriminating against her by complying with a father’s request that no black nurses should care for his baby. Battle claimed that a note was posted on an assignment clipboard that said: “No African-American nurse to take care of baby.”

For Moghal, such cases are a part of the “institutional racism” that was described in the McPherson report into the police in 1999, following the murder of Stephen Lawrence. Institutional racism, as the report pointed out, is more than conscious racism. It includes “unwitting prejudice, ignorance, thoughtlessness and racist stereotyping which disadvantage minority ethnic people.” Although racism can be direct in health care, the ways in which it is also “unwitting” are rarely discussed.

When it was published, the McPherson report had a significant impact on public services. There was was discussion and development of initiatives for tackling racism in the NHS. Yet 15 years on, and despite diversity policies and mandatory training, racism continues to infect the health service.

The message that the clipboard note and the hospital’s decision to uphold the parents' request sends out is that it’s OK to accept racist views.

As the Radio 5 FOI showed, racism from patients and those close to them is still very much an experience of our modern health system and in hospitals where people work to help others. It’s also important to remember that black and minority ethnic people are a significant minority of the NHS, where they make up about 18% of the workforce.

Negotiating new forms

What is most often overlooked in discussions of health care racism is how racism can get entangled with illness, complicating what we might think of as “unwitting”. This is not to condone or excuse, but to highlight how legal and policies imperatives can miss the complexity and sheer trickiness of dealing with racism in health settings.

As the psychoanalyst Isobel Menzies-Lyth’s studies in the 1950s revealed, hospitals are not like other organisations. They heave and bubble with a heady mix of emotions – fear, disgust, envy and guilt – that are a consequence of being up-close to human pain and suffering. In Menzies-Lyth’s view, these heightened emotions, combined with the everyday proximity of illness and rude health, lead to anxieties and defensiveness in both patients and professionals.

Where racism is concerned, these intense feelings, together with very different experiences of illness, can mean that racism and dilemmas about how to deal with it, can vary between specialities. For example, a study of nurses in acute mental health services found that they sometimes saw racism from patients as part of a mental health condition and felt that it was inappropriate and ineffective to respond using standard procedures. In other words, their clinical sensibilities affected how they perceived and managed racist incidents.

How to deal with racist comments from people with dementia, is another emerging issue being talked about and by patients' relatives too. Greg, who penned Wits' End a blog about his experiences with his late mum’s dementia, wrote in one post after his mum called staff “negroes”:

I’ve never heard her use that term. The idea that she would even choose to mention the skin colour of the staff member totally dumbfounds and alarms me. My Mother has mixed with people of many different nations and ethnicities in her life – she lived in Pakistan, in Japan, in India and travelled extensively throughout my Dad’s career, taking in every continent. I don’t recall her ever being frightened by a skin colour. All I can imagine is that she reverted to some pre-1950s attitude – maybe the sort of language she heard her own parents use.

In my research into end-of-life care, I’ve found examples of different dilemmas. Doctors and nurses can be especially reluctant to tackle racism because of a sense of the futility of taking dying people to task. What good would it do to challenge someone’s racism in the last stages of their life?

To complicate matters further still, when people are dying their biochemistry can change because of advancing disease, drugs and their side effects. I have seen usually convivial patients become combative, abusive and sometimes violent towards caregivers. If this behaviour takes on racist overtones, what is it we are dealing with: unadulterated racism or disease-induced racism rising from a deep cultural unconscious?

It’s clear that racism can take different forms and that we need to recognise and tackle its variations. While it may be that staff dealing with those with dementia may need more support and preparation, the ambiguity of “unwitting” racism in such cases can’t be an excuse to do nothing. If we miss or ignore how and why racism is still alive and well in our health system - where someone in need of help feels able to demand care based on skin colour - what does it say about us as a society and how we value our doctors, nurses and other health professionals?

Sign in to Favourite

Join the conversation

7 Comments sorted by

  1. Thomas Goodey


    There's a saying in Japan, "The customer is God", and that's one reason Japan has come to the fore in the world. According to that philosophy, if a customer doesn't want to deal with you because you are black, especially a vulnerable customer such as a hospital patient, it is an entirely proper response from your employer to ask your white colleague to serve that customer instead.

    1. David Jordan

      Earth scientist

      In reply to Thomas Goodey

      But the NHS is not a business. It's a shared social enterprise funded by pooled tax income which is paid by people of all colours. Nor is Japan's ethnic mix anything like Britain's.

      And racism is probably more often bad business than good business in a society with a high proportion of "other" and mixed race clients. As a manager one might reasonably worry that pandering to one clients racism will damage your relationship with most of your other clients and potential clients.

      Oh - and racism is really stupid too. Stiil, I guess UKIP are a market of a sort.

    2. Thomas Goodey


      In reply to David Jordan

      The NHS is a business, because it is in the business of delivering health care. It is a non-profit business run by the Government, but it has customers (called "clients").

      Japan's ethnic mix is nothing to do with the matter. I was referring to the Japanese service ethic.

      UKIP is of course nothing to do with the matter.

      The fact remains that the first mission of the NHS should be to make everybody's stay in hospital as comfortable and pleasant as possible considering the adverse circumstances. If that means that a client doesn't want to be taken care of by a particular nurse, so be it; the client's wishes must come first. I personally would strongly object to be attended by a woman in Muslim dress. But that's my thing; other people have other things.

    3. David Jordan

      Earth scientist

      In reply to Thomas Goodey

      Interesting! So the social services, in the business of delivering social care? The Girl Guides, in the business of delivering fun to teenage girls? Businesses? Arguable, I guess, but - no, not really.

      And no, I'm not a client. I'm a patient. And, since I'm also a taxpaying stakeholder I get a say in what it is and what it's called - as do you.

      A patients wishes must come first (let's drop this "client" nonsense)? Sure - but there are other considerations. And if we can deliver good, cheap healthcare to our citizens by employing people who wear Muslim dress, Mickey Mouse costumes or fishnet tights I really wouldn't care.

      You are welcome to pay more for commercial healthcare which meets your particular desires. But a collective social enterprise like the NHS has to meet collective social standards - and that includes the discomfort of being cared for by people who don't come from your particular ethnic and social background.

    4. Thomas Goodey


      In reply to David Jordan

      The NHS calls them "clients".

      And the primary function of the NHS is to care for the client/patient, not to perform social engineering - especially upon suffering old people near the end of their lives.

      What do you propose should be done if a client/patient objects vociferously to some particular nurse? Throw him/her out into the road in a dressing gown?

    5. David Jordan

      Earth scientist

      In reply to Thomas Goodey

      I entirely agree. I don't imagine anyone thinks the NHS is there to perform social engineering or throw patients out into the road. That would be odd and rather against the spirit of a collectively-owned public service.

      You seem to be addressing problems which I don't see being posed.

      You aren't thinking of health services which really are businesses, are you? As in the USA, for example, where healthcare not only costs more than twice what it costs us but where, if you can't pay, you may well end up out on the road without a house because of the costs?

      But perhaps that's OK because you were a "client"?

  2. Ken Clark

    logged in via Twitter

    In the (financial?) year 2012-13 there were 33 racist incidents involving NHS staff? This is a vanishingly small proportion of the total number of interactions between non-white NHS staff and their patients. Surely the tiny proportion of interactions which result in a racist incident is a clear indication that the vast, vast majority of patients in the UK are quite happy to be treated by qualified staff of whatever ethnicity? The cause for concern here is what exactly?

    "Racism continues to infect the health service". Please justify this claim.