In his second blog about his lived experiences of everyday racism in the NHS, consultant and co-clinical lead for stroke Devesh Sinha writes about the structural racism which limits BAME representation at senior levels of the NHS. He also discusses the role of white colleagues in being part of making change happen.

“I wrote about my everyday lived experience of racism within the NHS in my blog that was published last week. Here, I want to focus on the structural aspect and my perception of the equality changes that have taken place.

There are many examples of structural racism in the NHS; a very topical one is non-training grade doctors. It is worth looking at the creation of non-training grade doctors and their use (or abuse) within the context of BAME staff. When I was applying for training posts I was told, "Don’t bother, it is not for you, you should apply for non-training jobs and stop dreaming of consultant positions". I didn't listen to such advice; I worked even harder, and I achieved what I have and received high accolades. However, I see every day the plight of the non-training grade doctors. They are competent, but are stopped systematically in their progression by institutional racism. 

It works for the NHS’s snowy white peaks to keep them, use their 'floor work', but not allow them to progress. In most places in the NHS, the majority of them are members of the BAME community. It makes me wonder, what if the majority of them were white? If so, would institutional structures have been put in place to ensure their progression? 

What is more concerning about all of this is that it is terrible for patient care. While most trusts are struggling to find competent senior decision-makers, these doctors could have been an asset, but instead are left entrenched with no progression. 

These patterns of structural racism continue, even after you have become a consultant. You are asked not to apply for 'posts above your reach' as a predetermined white person is in the queue, so there is no chance for further leadership roles. On top of that, there is no consciousness of cultural biases and support systems that lead to near 100% white Boards in organisations where there are 50% BAME staff on the shop floor. 

I joined the equality force in 2016 and chaired the first BME network at BHRUT. It was an eye-opener for me. I was not given any time to do it as part of my day job, and I was asked how much time I was giving to this equality work, and was it in my job plan? My probity was being questioned by people who were beating the drum for equality and the BME Network. 'It is not an industrial activity. Is it not in your job plan; are you honest as per GMC?' 

With no real voice into the Board, these networks are in danger of being just a tick box; a token, and nothing more. As a BAME leader within the four walls of the BAME Network, you will hear the story of the grotesque racist experience of an employee of the Trust at the hands of their colleagues, but you are powerless to challenge the culture. I also learned during these years that the problem of institutional racism would not be solved by four people of colour crying or shouting in the room under the banner of the Network. 

It has more chance of being addressed by people understanding their white advantage and unlocking the doors of equality. The Network itself needs to be inclusive to all, invite all, and challenge all. The healthy conversations are not what happen behind the closed door of the Network. They occur when an organisation has the courage and creates the safe space to have such conversations openly in the presence of white colleagues. Yvonne Coghill, the Vice President of the Royal College of Nursing, describes this well as ‘Authentic Allyship’. It is the responsibility of the NHS and of the Trust’s Executive to make this space for such open dialogue. 

The Board representation in many NHS trusts, including BHRUT, is similar to the glass ceiling above which only whiteness prevails (with the snowy white peaks effect the academic Roger Kline has referred to). It is neither representative of our diverse population nor of our majority BAME staff. 

I don’t for a minute advocate tokenism of colour at the Board. It is more dangerous to have a token person of colour placed to balance the Board, who is either conformist or silent. Putting token people of colour on the Board and in senior committees would be a one-trick pony that hasn't worked and wouldn’t work. There is no lack of token representatives who never put the ladder down and become ‘whiter than white’ in their mindset. 

Only now, BHRUT has started talking about equality at the top and providing a Network on the shop floor - but this leaves a hollow approach in the middle. Most of the management structure still lack proper representation of BAME staff and lack an understanding of everyday racism. Both of my claims are not difficult to substantiate with hard and soft evidence. However, there is no data which can show unawareness among senior leaders and middle management if they hold racist beliefs at an unconscious level, unless they open up. 

The equality issue, currently, is just talk; fluffy, and a point-scoring topic. It is missing from the daily business of Board, Trust Executive Committee (TEC), divisional management and departmental meeting minutes. It appears to be an organisational tick box responsibility to meet targets. So, it is not surprising that the Workforce Race Equality Standard (WRES) score for the Trust hasn't shifted significantly in the last five years.

The status quo should be very concerning for an accountable organisation that has the highest BAME staff ratio in London and the lowest senior representation.​​”

Read part one and part three.