Evidence of racism and sexism has been found in the structures and person-to-person interactions across the NHS.
Published in the BDJ, a new report makes recommendations for the UK government, healthcare leaders, the Care Quality Commission (CQC) and equivalent regulators, and the NHS, based on the findings.
‘The NHS cannot maintain legitimacy as a publicly funded healthcare system rooted in principles of fairness while perpetuating discrimination,’ the report reads. ‘Multilevel interventions are required to tackle racism and sexism.’
What are the recommendations?
For the UK government:
- Hold NHS leaders responsible for achieving the ambitions outlined in the NHS equality, diversity, and inclusion improvement plan
- Implement the independent Messenger report on inclusive leadership in full
- Give the NHS Race and Health Observatory (RHO) statutory responsibility for producing equity-based impact assessments of new NHS policies and programmes
- Mandate national research and health bodies to establish equality standards in all research grants, studies, and approvals of drugs, medical devices, and technologies
- Ensure that biases in existing advanced technology and artificial intelligence are identified and corrected.
For the Care Quality Commission (CQC) and equivalent regulators:
- Add an explicit inspection criterion for staff wellbeing to identify and tackle racism, sexism, and other forms of discrimination
- Hold leaders and organisations accountable for failures in addressing discrimination.
For the NHS:
- Collect and report transparent, accurate, disaggregated data on race, ethnicity, sex, and gender in all organisations
- Prioritise equitable research, with financial support from government research funders. Withhold funding where these principles are not met
- Implement the starkest findings of research on inequitable clinical care and ring-fence funding to support improvements
- Set national standards for diversity and inclusion to produce culture change
- Provide statutory protection for whistleblowers and update the NHS England long-term workforce plan to include the role of freedom to speak up guardians
- Make evidence-based training focused on reducing bias and discrimination readily available.
For healthcare leaders:
- Improve working conditions by facilitating flexible and remote working and reducing bullying, harassment, and discrimination
- Model anti-racist and anti-sexist behaviour to encourage similar conduct in employees
- Monitor staff diversity and track inequity across roles and career trajectories.
An ‘ethical and legal imperative’
The six expert authors concluded: ‘NHS leaders and the public must recognise that prioritising health equity is a proved strategic investment that leads to good patient outcomes, and better retention and recruitment rates of staff. It is also an ethical and legal imperative.’
They added: ‘Inaction represents an unacceptable choice that increases harms to patients and costs in terms of increased staff absences, sickness, resignations, and reduced productivity.
‘The evidence and policy options are abundantly clear. Political and institutional leaders must urgently choose to prioritise the elimination of these avoidable, unhealthy, and costly injustices, or face the consequences of a disaffected NHS workforce, and widening inequalities in health outcomes in the general population.
‘The recommendations we make, if implemented, will go a long way to make the NHS a happier and healthier place.’
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