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Health
Can racism in the National Health Service be cured?Top Black nurses must target race injustice in health system
As she came off her shift on the general medical ward, Diane, a nurse of Caribbean heritage, targeted the twin perils of being Black in the National Health Service. There's "overt racism" - like being called a 'black bitch' when you give some one an injection". And, there's "polite racism". That's when a patient says, "Listen dearie, it is nothing personal but I'd rather you didn't touch me," she told the Independent newspaper. Senior nursing staff fare no better. "One morning, some years ago, I entered my office to find excrement had been placed among my files," recalls hospital administrator, Carol Baxter, now professor of nursing at Middlesex University. Then there is the subtle day-to-day racial discrimination that "occurs by default, when the ways things are done do not take into account the needs of Black and ethnic minority people," she says in her article "Take it personally" in the Nursing Times January 2002, Vol.98 No. 3. This condition is common across the National Health Service. It affects not only Black nurses of African Caribbean descent, the largest nonwhite group, but also those of Chinese, Indian, Pakistani and Bangladeshi backgrounds. NHS 2001 figures show that Blacks made up 3.4 per cent and Asians under one per cent of all (316,180) nursing, midwifery and health visitors.
Black
nurses: service and struggle Later advances have borne their own hazards and stress. In post-war Britain, young, robust Black women were recruited to build up the National Health Service inaugurated in 1948. Filling the jobs white women would not do, Black women worked long hours as nurses, midwives and public health workers, and as cleaners, cooks and orderlies. They supplied the cost-effective cheap labour that government officials considered necessary to run the hospitals and public health care services. Senior nurse Cherry Byfield recalls those days. "There was an atmosphere of high anxiety among black nurses in the hospital. They felt exploited and that prejudice from other staff was being directed at them, " she told her interviewer Jacqueline Harriott, author of Black Women in Britain. These forebodings were more than justified. In 1989 an Afro-Caribbean nurse observed: "Promotion for Black nurses is only ever available in low status disciplines such as mental health nursing. It is very rare that you find a Black nurse running or even staffing on surgical wards. This seems reserved for whites." Political
controversy As the row neared boiling point it threatened to derail prime minister Tony Blair's plans to inject private finance into modernising the ailing health service. Unexpectedly, Black nurses were thrust into the midst of one of the most acrimonious, politicised health controversies in recent times. Reports
and initiatives Health Department officials called for a two-step process to curb racist offences against staff. Persistent offenders would be warned, and their access to health services withdrawn, if necessary. The Commission for Racial Equality (CRE), a government sponsored watchdog, would have powers to monitor the success of these initiatives. Major professional and trade union bodies announced campaigns "to wipe out racism". The Royal College of Nursing (RCN), the voice of nearly one-third of a million nurses, health care assistants, and nursing students, called for an "equality audit" to monitor race progress . Bob Abberly, head of the health for public service union, Unison, vowed to wipe out racial discrimination in the health system. Doctor's leaders welcomed the government's decision to clamp down on racism in the health service, said Dr Simon Fradd, chairman of the Doctors Patient Partnership, established by the British Medical Association and the Department of Health. The Institute of Health Services Management pledged its support. Limitations
to change Many Black nurses point to growing evidence of a racist career structure. A disproportionate number of Black health workers are passed over for training and promotion by NHS managers, according to a government report on racism in the NHS, Racism in Medicine 2000. "The vast majority of Black staff in the NHS are clustered in the lower grades and the quality of their working life is significantly worse than their white counterparts," says Bob Abberly, head of Unison. "They are more likely to face job segregation, poor promotion chances and racial harassment from patients and colleagues", he told a BBC News report, "Nurses tackle racism". Others say that health authorities are failing to carry out their equal opportunity responsibilities. According to a Unison survey, half the 440 employers surveyed said the ethnic mix of their workforce does not reflect their local community - and only 11% have set targets to recruit more black and ethnic minority staff. Keith Sonnet, deputy general secretary of Unison, says: "This survey shows that translating policy into practice has not been as successful as it could have been." Commissioner Shushila Patel of the CRE came to similar findings in her study of English NHS hospital trusts. At the core of these limitations to change is one potent fact: the decades-old reality of racism, says Dr. Jane Richards, chair of the British Medical Association's working party on racial equality. "Racism affects all parts of the NHS - doctors, managers, nurses" (and) some of it comes from patients," she said in the BBC News article "NHS 'is institutionally racist'. Institutional
racism That Black nurses face unfair practices in nursing and medical institutions is one aspect of institutional racism, says Raj Bhopal, professor of public sciences, community health sciences, University of Edinburgh. He supports his views in several learned papers: "Is research into ethnicity and health racist, unsound, or important science?" and "The spectre of racism in health and health care: lessons from history and the USA, published in the renowned British Medical Journal.
The health service race equality record was also battered by a report on racism in medicine by the prestigious health think tank, the King's Fund. Another report by consultants Lemos & Crane called the NHS "a hostile place" for black and Asian staff, according to the Nursing Times. Alarmingly, allocation of performance pay in the NHS is 'riddled with racism' according to a survey carried out by health union MSF and the Community Practitioners & Health Visitors Association. Black health visitors and community nurses were found to be only a third as likely as white staff to receive performance related pay awards worth up to £1,300 a year. Furthermore, of the 1,210 health visitors and community nurses surveyed only 5% of black staff were awarded performance pay rises as compared to 14% of their white and Asian colleagues. These conditions make the NHS unattractive to second and third generation Afro-Britons. Potential recruits are put off entering. Lack of career progression leads to frustration. And, Black youth spurn jobs in nursing because of institutionalised racism, delegates to Unison's health conference in Harrogate were told. The
way forward The forthright Black nurse, Petronella Mwasandube, says that despite being awarded an OBE for services to ethnic minority staff and patients in the Queen's New Year's Honours list she is still not free of racism in the NHS. She is doubtful that official pledges to increase the number of black and ethnic minority nurses will ever be met. Interviewed in the Nursing Times, the RCN journal, she described the 7% target for 2004 as "very, very ambitious". Ms Mwasandube, who is the deputy director of nursing at Heatherwood and Wexham Park hospitals, Berkshire, said: "Things are still very tough and negative out there. The NHS needs to get away from the numerous directives we have had and move into action. We need to increase the visibility of black managers and give them more support". Mary Clarke, based in east London and one of the country's few black directors of nursing, added: "The 7% target won't be reached unless nurses have been groomed or that process starts now. I would not want to see nurses put in posts just because targets need to be achieved and not because they can do those jobs. That would be soul-destroying." Respected Black women academics are making their contributions too. They include Carol Baxter, professor of nursing at Middlesex University and Mel Chevannes, head of the Leicester De Montfort University nursing faculty. Professor Baxter is an advocate for Black community health improvement and member of the NHS consumer involvement in research committee. She believes that "All nurses have a part to play in helping their organisations move towards equality. Individuals have to be prepared to change themselves and to take responsibility for their level of commitment". Fellow academic, professor Chevannes is a skilled researcher on health and Black issues. She leads a formidable research team at the Mary Seacole Research Centre, dedicated to the Crimean War heroine, and is responsible for pioneering health studies on Black families and communities. She has published widely on equality and diversity issues in professional journals.
Dr Beverly Malone, the new general secretary of the 327,000-member Royal College of Nursing, holds the most prestigious administrative office in Britain's nursing circles. She is therefore in a powerful position to make a difference for Black nurses. Dr Malone, an African American, brings to her new job formidable campaigning and lobbying skills from a stint as Assistant Health Secretary for the Clinton administration. The clinical nurse and psychologist led the biggest US nurse's organisation (as president of the 2.6m American Nurses Association from 1996 to 2000) and was cited by Ebony, a popular Black magazine, as one of the 100 most influential African Americans. Heading what is now the 6th largest union in the UK, Dr Malone has raised issues of diversity within the RCN and its members council. There can be no underestimation of the task before her in shepherding this classic, quaint British institution - of well-intentioned, largely female, white and middle class members - into modern multiracial society. We share a common interest in gaining more investment in the NHS and nurses' pay, says Malone. But "Diversity is our strength and the rainbow of colours found among patients should be reflected in nurses," she says. Government needs to be more supportive of equality goals and initiatives to stamp out racism and bullying within the NHS, she declared in a profile article "Voice for nurses" published in the Nursing Standard. "Through our Working Well initiative, we are aiming for equality of working conditions for all staff. It includes confronting racism, bullying and other forms of harassment. It's about removing barriers to effective working - and improved patient care," she wrote in the Bulletin of the Runnymede Trust, a rights organisation. Challenging
race injustice; building healthy communities Moreover, the new generation of Black nursing leaders and health activists have outlined the first steps toward sorting out racial injustice. These include challenging perpetrators of institutional and individual racism, by means of the law and the powers of the Race Relations acts. But, this is patently not enough. Talk of diversity and "a health service of many talents" means little if no cure is found for racism in, and by, the NHS. Leading Black nurses must tackle ethnic health inequalities more directly and resolutely. They are in a key position to urge health administrators to reach out to people who feel excluded from mainstream health services and to raise awareness of their needs (see below). To do this effectively a number of issues must be addressed and formulated in an action plan to deliver full equality within the decade. Failure to do so will be likely to reinforce doubts about the ability of Black nursing leaders to work on behalf of Black and ethnic minorities. The Black presence in the NHS is dwindling, say demographers. Statistics show that 10% of NHS nurses over 50 were from black and ethnic minorities but less than 1% of those under 25 were from these groups. It is said that nearly one third of Black nurses are due to retire over the next 10 years, and there are few new Black recruits to take their place. This pattern must be reversed. Youth's apparent lack of interest should not go unexplored and unchallenged. Ominously, failure to develop the sentiment and skills for public service, community health work and voluntary caring activities, especially in disadvantaged areas, is a blow to the well-being of Black communities. A reduced presence in the public sector means a setback for Black empowerment.
Strategies for equal opportunity must be buttressed with progressive employment policies and pay scales. The NHS director of human resources must be urged to ensure Black involvement in the proposed £5m government-sponsored recruitment drive for new staff. In the process of these actions, it will become obvious that love of equality is a collective sentiment. Hence, the formation of a national Black nurses organisation is essential. What could it hope to accomplish? It would be devoted to professional achievement, mutual aid and affordable health care for Black communities and other ethnic groups. (In America, the National Black Nurses Association represents 150,000 African American nurses in a similar endeavour). The organisation would actively promote youth recruitment, professional development and career opportunities. Building up consumer knowledge and understanding of health issues would be another aim. Promoting the economic development of nurses through entrepreneurial and business activities would be encouraged as part of the uplift of Black communities. Pressing Government to appoint a senior Black nurse to promote the interests of Black and ethnic minority nurses in the NHS would be an innovative addition to the organisation's strategy and action plans. Strengthened by these shared purposes, Black nursing leaders could seek a place in all circles where the reform of NHS policies and structures is discussed and decided. Forging alliances with friendly groups seeking beneficial change in the health industry can help assure success. By these means, Black nurses and their leaders can join the ranks of the progressive social movements of the 21st century and revitalise their own heritage from preceding generations. Ultimately, the odious epithet "black bitch" will truly become a thing of the past.
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