Socialist Worker

Equalities report shows the institutional racism facing workers in the NHS

The latest equalities figures show that black workers in the NHS aren’t reaching the highest pay rates—and are more likely to be disciplined, explains Tomáš Tengely-Evans

Issue No. 2585

Cleaners on strike over pay last year

Cleaners on strike over pay last year (Pic: Guy Smallman)

The NHS was built by black and asian workers and still relies on migrants to run. But despite fights against racism, they still face institutional discrimination in the health service.

A national survey found that staff from a black and minority ethnicity (BME) background said they were “more likely to state that they have experience discrimination from their manager”.

And the figures in east London reveal what this looks like on the ground.

Barts Health NHS Trust spans three of the most multiethnic London boroughs—Tower Hamlets, Newham and Waltham Forest. But the trust’s Inclusion Matters—equalities report 2016 also reveals institutional racism.

The report admits that “underrepresentation of women and BME colleagues beyond pay band 7” is a major issue. Pay band 7 represents senior physicians who are paid more than £40,000 a year.

A black worker at one of the hospitals in the trust told Socialist Worker, “I love my job.

“But I know as that I will find it harder to move up the scale. Look around at the managers. They are mostly white.”

Among the higher pay brackets the proportion of whites only falls below 50 percent among doctors and junior doctors. That’s because the NHS has relied on Asian doctors for much of its history due to labour shortages.


The situation is likely to be worse as the figures don’t take into account outsourced workers, many of whom are migrants and black (see below). There has been some movement from the lowest paid brackets, but being promoted into the high bands is still a problem.

The top pay bracket is “not reflected at all within black, Chinese or mixed staff and has a 0.4 percent representation of Asian staff”.

A Unison member at one of the hospitals in Barts Trust says, “If you’re black you will, on average, be paid less, be less likely to be in a high grade, find it harder to reach a top post and be more likely to be disciplined.

“That’s a structural problem and it’s a management problem.”

And in the 2015 national staff survey 56.5 percent of respondents reported that Homerton hospital “does not act fairly with regard to career progression/promotion”.

But there is one area where BME health workers are overrepresented—disciplinary procedures. Out of 142 disciplinary cases in 2016, 59 percent were against BME workers compared to 18 percent against white workers.

The report suggests “career development programmes” and other measures to remedy the inequalities.

But the figures reflect wider racism within society—and it will take a fight by black and white workers to push it back.

We can win against outsourcing healthcare bosses

Equality figures for Barts Health NHS Trust in east London do not include outsourced workers.

They are often at the sharp end of discrimination.

But at Barts low paid, mainly migrant workers fought against multinational giant Serco in east London earlier this year.

The Barts report noted that “BME colleagues” are “more likely to report experiencing discrimination from managers and other colleagues”.

Majorie, a domestic worker at the Royal London Hospital, spoke to Socialist Worker at the time of the Serco dispute. “They are making money off us, off our suffering,” she said.


“They don’t treat us with any respect—we’re not people to them.

“We’re the ones that clean the shit and they treat us like shit—we deserve to be paid properly.”

Many workers were left frustrated by the final deal and they could have won more with proper backing from the Unite union’s national leadership.

But they showed it was possible for unions to organise low paid, migrant and black workers to fight against poverty pay.

Building on that example can help challenge discrimination in the NHS.

But it will take a national fight by the health unions against racism,low pay and oversoucing to overturn inequality for black workers.

Women paid less than men

Pay discrimination against women also runs through the health service. At the Homerton some 78 percent of workers are female and 22 percent are male.

But 92 percent of women workers earn between £16,000 and £45,000, compared to 79 percent of male workers.

“Women are more likely to be represented in the lowest paid groups,” the report notes.

And if women are able to reach the top of the pay scale, these differences only increase sharply.

As the report said, “It is interesting to note that in a mostly female workforce, men are better represented in senior posts.

“From £46,000 onwards the proportion of women in the higher pay bands decreases whilst male representation increases to significantly higher levels.”

Pay band 9—the highest one—is made up of just three men. This is also a reflection of wider problem of pay discrimination in Britain.

The gender pay gap fell to its lowest figure in January 2017.But it currently is still 9 percent, meaning women on average earn £100 a week less.

A Unison member at one of the Barts Trust hospitals says “Unions can’t ignore this.

“Part of fighting for pay and conditions is to recognise and confront this.”

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