In his final blog on racism in the NHS, co-clinical lead for stroke and consultant Devesh Sinha discusses how racial inequalities have impacted BAME staff during the Covid-19 pandemic.

He also explains the important of understanding white privilege in order to make our workplace more equal. The term white privilege is further explained by John Amaechi, who is a psychologist, author and former NBA basketball player, in a video for the BBC.

We’d like to thank Devesh for sharing his lived experiences though his blogs, which have encouraged open conversations and have been praised by BAME and white colleagues across the NHS.

“I have written already about my personal, lived experience of everyday racism in the NHS and about my views on how our Trust has responded to these problems. Here, in my third and final blog on these issues, I would like to focus on the radical changes that are needed and my Covid specific experience. 

Covid-19 has exposed a structural racism that was there as an undercurrent for years. Covid management in the NHS has proved that doctors who look like me and who deliver direct patient care are three times more likely to die. 

When demanding equality, a safe space to work, PPE and better testing facilities, the dynamics have changed. I have noticed something new. When BAME people speak up about institutional racism, inequality in the Covid workforce and the chances of BAME doctors dying, they can be accused of being 'racist' towards white people. For example, it has been suggested that using the word ‘microaggression’ is racist towards white people. 'Why should there be a preference in risk assessment, Covid testing or PPE for BAME people?' The answer lies in the evidence that they are more likely to die. 

I believe that one can be prejudiced towards white people, but not be racist. How could one possibly be racist to white people in a system which benefits them and shields them from the experience of industrial or systematic racism? Drawing attention to white privilege leads to anxieties among white colleagues who fear something is going to be taken away from them. I wonder what that is. I believe that something is called privilege. 

If white people walked in the shoes of their BAME colleagues, they would see that - with their privilege - they don’t even need to think about what they take for granted. I have witnessed some sessions of reverse mentoring which were quite empathic. Others have occurred, that do not lead to the same acknowledgement of privilege. 

It is necessary to talk about privilege in order to understand the cultural exclusion experienced by BAME people. When you do, the majority of the reactions are conciliatory and are focused on developing ‘Allyship’ and making equality a priority.  On a few occasions, people attack the messenger by calling out names. The same groups who were fascinated by the success of the stroke clinical leadership will start gaslighting and become divisive, rude and aggressive as they struggle to accept their privilege. 

When you talk about everyday racism in the workplace, your friends – both white and BAME – start to warn you. ‘You are putting head above the parapet'. 'Be very careful, so you don't get framed in trivial clinical issues'. 'This organisation is not ready for these talks'.  'You have done well in stroke; look after your career and don't try to change the rest'.  And finally, my favourite – 'heroes get the bullet in the end'. 

It is a form of reprehension as well as a form of denial. It is a bigger problem than the racism itself as it doesn't allow for further open and uncomfortable discussions.

We worked in Covid times as a team, although the colour of the frontline had a slightly different feeling. My wife and I are frontline NHS workers, with one school going kid. With no family around, we worked almost every day, fearing for the worst for our small family. One disturbing night during Covid, we decided to write our will and plan for our child, in case something happened to both of us, working in the NHS. 

PPE rules were changing every day. It felt as if the rules depended on supply or the weather and not on science. You probably can’t adequately prepare for this pandemic. Five of my BAME juniors had Covid and one of the doctors lost their husband in the same hospital where she was working. As a leader, we never left the wards and we never showed that underlying anxiety or guilt to the team until the end. 

The newspapers were full of 200 odd pictures, a collage of innocent bystander staff casualties. Most of them looked like my colour. In that context, how can the need for BAME colleagues to have a risk assessment be described as a ‘special privilege’? Will a second wave be any different for BAME staff? My tired eyes have yet to see it. Are the people who make these decisions about resources representative of all staff groups? I think it is unlikely, and so my hope for no BAME deaths during the second wave will be dashed. 

I have worked on equality in our stroke team with people doing their job, regardless of their colour. Merit prevails and not colour, and we challenge every bit of everyday racism or microaggression with courage. It's possible to find a safe team huddle space and harmonise the equality characteristics. It’s also possible to find thankful staff and individuals who support each other, regardless of colour. 

As people of colour many of us are also biased, triggered and traumatised throughout our lives by other forms of discriminations like sexual preference and disability.  The creation of safe spaces in everyday working is something that can be achieved. We also need the creation of a healing plan with an antiracism and anti-discrimination pledge; open expression of painful lived experiences; the opening up of uncomfortable white privilege discussions where people are prepared to be challenged and potentially troubled by the process. Building accountability with Allyship needs to be part of daily business. 

Hopefully, BHRUT will see a new dawn that will make it safe to talk openly about discrimination and racism and follow up by making changes. It is nice to hear the antiracism pledge from the top of the organisation. Even better would be a time-bound pledge to deliver concrete action to make BHRUT the best organisation for its very diverse people. It will require an accountability framework, a focus on every type of equality and radical change to the way leaders think. 

We have shown, in the way the clinical stroke team has improved, that there is no harm in dreaming big and aspiring for the best.”

Read parts one and two of his blog posts.