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Sickness in the service

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Issue 1755

Racism in NHS

Sickness in the service

By Theresa Bennett

THE NHS is institutionally racist and the medical profession runs “a white man’s register” with “jobs for the boys”. These are some of the findings of a study by the King’s Fund, Racism in Medicine.

As waiting times for hospital treatment have spiralled, this study reveals that the talents of health workers are being wasted because of racism within the NHS. The report exposes the institutional racism at the heart of the NHS. One of the main problems of the NHS is that enormous power is concentrated in the hands of consultants from upper middle class families.

The report shows that they can hold some of the nastiest prejudices. Consultants have the authority to decide who is shortlisted for jobs, and the make-up of interview panels. They evaluate the performance of junior doctors, and their role is to provide both formal and informal guidance on career progression.

A survey found 81 percent of consultants were critical of Asian doctors. Because of this prejudice Asian doctors find it harder to progress up the career ladder. This discrimination is prevalent throughout the health service. A survey of British doctors found that 60 percent of them felt that “the general level of competence is lower among Asians”.

Only a fifth of all doctors recognise that these views are based on racial bias. “Overseas doctors” (those with primary medical qualifications from outside Britain or the European Economic Area) suffer systematic discrimination in the NHS.

A third of doctors are from ethnic minorities. Asian doctors made up half of these doctors in the NHS in 1999. The report shows that non-white doctors are stuck in the lowest grades in the NHS. They are consigned to working on temporary contracts for years. Racism means black and Asian doctors are denied access to training, their choice of medical specialism, promotion and the prestigious consultant posts. White doctors dominate the high status positions in the health service and the most prestigious areas of medical specialism like surgery.

Ethnic minority staff are disproportionately stuck in the most stressful and low status areas of medicine like psychiatry, geriatrics, and accident and emergency. Discrimination in employment is not just confined to overseas doctors. Temporary doctors are judged to be “of lower quality than permanent staff” within the profession.

Ethnic minority applicants find it harder to get accepted into medical schools. The survey finds that “bullying and intimidation are experienced during medical training”, which falls heaviest upon black and Asian doctors. Institutional racism means that black and Asian people are not offered jobs they are qualified for.

Esmail, an Asian man, and Everington, his white colleague, hit the headlines in the 1990s. They applied for jobs using exactly the same qualifications, and found that Esmail’s applications were much more likely to be rejected. The NHS does not address the racism that is experienced by people from ethnic minority backgrounds in the way it cares for these people. Too often “special projects” aimed at ethnic minorities do not get mainstream funding and are the first to go when cuts are announced.

Around 60,000 patients experience a problem understanding a discussion about their health in English. Despite this, interpretation services are not provided to meet their needs.

Racism in Medicine makes detailed recommendations to tackle racism by adopting positive action to undermine it and abolishing the prohibitive exam fees for refugee doctors.

While the recommendations are all positive, the survey fails to explain why racism is rife within the NHS. It is crucial to make the link between racism within the NHS and its key role in justifying the scarcity of resources. The immense power of the consultants and the racism in the NHS has to be challenged.

Underfunding of the NHS is not raised within the report. Decent pay and conditions for all NHS workers are the most important way to transform the service provided and abolish the areas of medicine which are currently ghettoised.

The divisions created by racism amongst the workforce are important to sustain the long term underfunding of the NHS. Most importantly, Tony Blair plans more privatisation of NHS services and clinical provision. Private firms of profiteers running the NHS will perpetuate the inequalities.

The fight against racism has to be linked to the fight against underfunding and privatisation.

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