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David Rose smiling in front of a view over London's skyline

BY Leo Hynett

Healthcare

Significant Institutional Racism in the NHS

Amanda Pritchard criticised the ‘appalling’ care sickle cell patients receive, highlighting the extent of institutional racism in healthcare.

JUNE 22  2022

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When Amanda Pritchard recently spoke to a patient with Sickle Cell Disease, she did not hold back on her criticism of the ‘appalling’ treatment many sickle cell patients receive.

‘One of the patients I spoke to asked: “If I was white, would I be treated like this?” She didn’t trust that the NHS as a whole viewed her as an equal. That has to change.’

This damning depiction of care given to a predominantly black patient community is a clear example of the institutional racism that is embedded deep within the NHS.

 

Care inequalities

The Sickle Cell Disease patients that Amanda Pritchard spoke to reported being treated so poorly in A&E departments and across the wider health service that ‘they have to think twice and often delay coming forward for care when they need it.’ Many patients have reported being treated like ‘drug users’ in A&E with staff suggesting they are simply seeking drugs and exaggerating their pain.

Sadly, this appalling treatment is nothing new – and nor is it unfamiliar to patients in this community. This vocal criticism of their care, however, especially from such a prominent figure, is relatively new.

Many patients have shared similar challenging experiences and some have had their lives placed in danger as a result. Failings of care for Sickle Cell patients have recently been thrust into the limelight following the fully preventable death of Evan Nathan Smith in 2021 and campaigners have strived to make this case the last of its kind.

Many Sickle Cell patients, understandably, distrust the healthcare system; this system that should be there to support them has failed them so many times that it can be hard to believe they’ll ever be taken seriously.

‘I’m determined that we need to make things better for this particular patient group,’ commented Amanda Pritchard. ‘This also speaks to how we need to improve experiences for all patients and earn the trust needed to ensure that every individual feels able to seek help when they need it and feels they will be listened to if they tell us something isn’t right.’

The recent No One’s Listening report challenged the lack of progress in Sickle Cell care and education, and the unchanged poor treatment patients have received over the years. There are many components involved in improving Sickle Cell care, but the problem underlying it all is the systemic racism that causes medical professionals to doubt the experiences and pain of black patients.

 

Institutional racism in healthcare

This criticism of Sickle Cell care from the Chief Executive of the NHS is promising; hopefully, this is the beginning of much-needed change. Unfortunately, institutional racism is embedded deep within the NHS, impacting everyone from patients to staff. Amanda Pritchard identified a clear need to address this at a systemic level so that improvements will be felt by minority patients across the country.

Sadly, this racism is also experienced by staff. Doctors are reportedly ‘anxious and depressed‘ because of the racism they experience in their roles, both from their peers and the very fabric of the system they work in. Dr Rachael Harlow, who spoke with the BBC, is acutely aware that ‘ethnic minority doctors are more likely to be complained about by their bosses, and are “highly scrutinised”’ in their roles.

A new report from the British Medical Association (BMA) found that 76% of respondents have experienced racism at work, and about 60% stated it has affected their mental health. More than 2,000 people took part in the online survey which was open to all UK doctors in medical workplaces, and 66% of respondents were from ethnic minorities.

Speaking up about these experiences is not easy. 71% of those who reported experiencing racism in the BMA survey did not feel they could report it. Of those who did report it, 58% said they faced a backlash for doing so. Out of all reported cases, the most common outcome (41%) was that no action was taken.

BMA chairman Chaand Nagpaul warned of a resulting mental health crisis among doctors. This mental health crisis would, in turn, have knock-on negative impacts on patient health and safety. ‘​​If doctors are mentally distressed because of their experiences of racism, if they feel isolated and unsupported, it’s going to affect their ability to provide the best possible care,’ Chaand Nagpaul stated.

Fighting to reduce the presence of institutional racism is not only an urgent matter of staff wellbeing but one of patient safety. The BMA’s recent Delivering Racial Equality in Medicine report found that ‘ethnic minority doctors are nearly twice as likely not to raise patient safety concerns because of fear of being blamed.’

On top of this, institutional racism is driving staff to leave their posts at a time when the NHS needs as much help as it can get to fight through overwhelming backlogs. The Racism in Medicine survey found that ‘nearly one third of doctors either considered leaving (23%) or left their job (9%) within the past two years due to race discrimination.’

 

Final thoughts

It is absolutely essential that the NHS becomes a system where patients feel that they can come forward for the care they need and trust that the people they see will take their pain seriously.

Likewise, staff must be made to feel that they can come forward about their own experiences of institutional racism in the NHS so that it can be worked on from within. Amanda Pritchard’s open criticism of how institutional racism has been handled in the NHS to date bodes well for change in theory, but only time will tell how that change will unfold in practice.

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