Racism and the NHS.The White Mans Ice Is Always Colder.

Lee Jasper NoWREStil Equal Campaign Launch Speech

Bradford Health Forum 2^nd April 2016

 Thank you Bradford Health Forum for inviting me to speak. I am going to address the situation as relates to black people our health and the National Health Service. But let me first pay tribute to the work the Health Forum is doing right here in Bradford.

Our communities are not in good shape, the gap between rich and poor has widened under two successive governments bent on slashing services and privatising the health service we all depend upon.

Community organisations have borne the full brunt of those cuts and there has been a decimation of Black voluntary sector organisations across the country. But, you are still here still standing strong and I celebrate that fact and thank you for inviting me here to share my thoughts with you.

The need for organisations like BHF is greater now than at any time in the past 3 decades.

Poverty, discrimination and the obvious often tragic knock-on effects on the health of our people, means we desperately need groups that act as conduits for disseminating information and signposting services to our communities. Please, continue to do the great work that you are doing here.

I am going to talk a little bit about some of the health challenges facing our communities, then go on to talk about the work we are doing to make alliances with our sisters and brothers in the NHS who are catching hell in an organization, that is supposed to be providing for our health needs. They are vital to making the health service sensitive to our needs and our well-being is inextricably linked to theirs.

Let me start by picking up on some of the conditions that affect our communities and for which we need targeted NHS resources:

§  Type 2 diabetes is 3.5 times more prevalent in South Asians than Europeans. However, a Diabetes UK survey of South Asian members found that only 16% of those responding had attended a course to help manage their diabetes.

§  In the UK, men of Black African and Black Caribbean descent are three times more likely to develop prostate cancer than white men of the same age.

§  Men are more likely to be overweight than women however, among Pakistani, Bangladeshi and Black African people, women are less likely to be of normal/healthy weight than men.

 Race for Health highlights the following inequalities:

•          Some 35% of African Caribbean men smoke, compared with 39% of white Irish men,   44% of Bangladeshi men and 27% of the general population.
•       Young black men are six times more likely than young white men to be sectioned for compulsory treatment under the Mental Health Act.
•       Young Asian women are more than twice as likely to commit suicide as young white     women.
•       The prevalence of stroke among African Caribbean and South Asian men is 40% to 70% higher than for the general population.
•       Differential infant mortality rates also remain a scandal that highlights that racism and its effects even affect the unborn.

      According to a new study, conducted in the United States[1] found that black teens who experience racial discrimination in adolescence are more likely to develop stress-related health issues that could put them at risk for chronic diseases later in life. Specifically, researchers found that they were more likely to have higher levels of blood pressure, a higher body mass index, and higher levels of stress-related hormones once they turned 20.

The psychological toll that racism takes on adults has also been well-documented[2], and racisms now linked to high blood pressure. Just the fear of racism alone, can trigger stress, the silent killer, which means that many black people who live within a racist society defined  are constantly under increased biological stressors.

In relation to Mental Health and black people, I would describe the current situation as a crisis. Black Mental Health UK's submission to Home Affairs Parliamentary Committee in 2013 cited the following:

"People who use mental health services account for 50% of those who lose their lives in police custody, and it is in the area of mental health and policing that many of the most serious causes for complaints against the police occur.

Detention rates under the Mental Health Act continue to be highest for people from the UK’s African Caribbean communities, even though there isn’t a high prevalence of mental illness amongst this group. "

They added..

'Black people are currently 50% more likely to referred to mental health services via the     police than their white counterparts.

The high profile, deaths in police custody, cases of Kingsley Burell-Brown, Sean Rigg, Olaseni Lewis, Colin Holt, Mikey Powell and Roger Sylvester is further evidence that failures in policing of mental health services users, which is impacting people from Briton’s black communities in greatest numbers.

The unsatisfactory way in which a long line of complaints involving high profile police deaths in custody of people from this community has been dealt with over the years has shattered faith in the belief that the IPCC is an independent body with the ability to investigate complaints made against the police without bias.

Mental health service users also account for 61% of all deaths of those detained by the state, but currently there is no independent body established for investigating these fatalities.”

The Guardian [3]newspaper in 2014 reported,

“Black men in Britain are 17 times more likely than white counterparts to be diagnosed with a psychotic illness.  While only 26% of Lambeth’s population is black, nearly 70% of the borough’s residents in secure psychiatric settings are of African or Caribbean heritage.”

Stop and search and policing are huge health issues.

• Racial profiling is not only a danger to a person's legal rights, which guarantee equal protection under the law. It is also a danger to their health.
• A growing literature shows discrimination raises the risk of many emotional and physical problems. Discrimination has been shown to increase the risk of stress, depression, the common cold, hypertension, cardiovascular disease, breast cancer, and mortality.
• Recently, two journals -- The American Journal of Public Health and The Du Bois Review: Social Science Research on Race -- dedicated entire issues to the subject.
• These collections push us to consider how discrimination becomes what social epidemiologist Nancy Krieger, one of the field's leaders, terms "embodied inequality."
• Anecdotally, ambulance services are all also cause for concerns. Telephone assessments by white NHS 101 responders can often downplay the seriousness of black patient conditions. Responses to times to violent injury are often delayed as ambulance crew and the police are often intimidated when attending known black neighbourhoods.
• London Ambulance Service has the largest number of staff and patient complaints about racism than any other part of the NHS.
• The ongoing failure to integrate the NHS with the criminal justice system has denied the adoption of a fully intergrated, public health approach tackling violence that has also exacerbated rates of teenage homicide, domestic violence, mental ill-health has contributed enormously to the epidemic of violence that plagues areas defined by high rates of poverty, school exclusions and long-term unemployment.
• Sarah Reed is our most recent and tragic example failure in this regard. 
• The failure to adopt a public health approach focussing on the prevention of violence and the silo culture of Government has failed communities. Violence is on the rise and the NHS has to step up the plate and in partnerships with communities champion public health as a priority, 

The Local Situation In Bradford.

•      South Asian 5 year old children have significantly higher levels of dental disease than their white peers living in areas of similar socio-economic status.

•      A Health Needs Assessment of local African and African-Caribbean people carried out in 2002 recommended that there is a particular need for culturally appropriate services in respect of hypertension, stroke, diabetes, mental illness and obesity.

•      Focus group work carried out with local Black and Minority Ethnic (BME) women from 2009 until 2011 showed that many have had poor experiences of using local maternity services.

These are just some of the headlines that show that there is a real need for work to be done to deliver healthcare attuned to the needs of our communities.

Despite the rhetoric of austerity, we have to keep up the fight for adequate resources to address these conditions and call for more community based healthcare practitioners who are sensitive to the needs of BME communities.

Alarmingly, national patient surveys show lower levels of satisfaction amongst BME patients with NHS services. 

Simon Stevens the current NHS CEO say “We know that care is far more likely to meet the needs of all the patients, we’re here to serve when NHS leadership is drawn from diverse communities across the country, and when all our frontline staff are themselves free from discrimination.”

He has set new mandatory standards to help NHS organisations achieve these important goals.” But while enormous efforts are going into describing the problems face by BME people in the NHS, not much is being done to change the culture of racism and discrimination that is their everyday experience under his Mr. Stevens’ leadership.

Race in the NHS, is a policy twilight zone,  - someone shines a light on a problem only for it to literally disappear into a wormhole and pop up again in another part of the space-time continuum. 

Look around at the advisory bodies, tasks forces and committees established to deliver a better experience for BME staff and patients - You will find them led by lack-lustre people with scant understanding of the problems we face. 

And there is a fetish for appointing white men with a history of running organisations completely bereft of diversity - because a track-record of failure is the perfect qualification for ensuring more failure.

Many, although not all black appointments are not much better and proves it is not enough to be black, you have to be competent. commited and in a position of power. If you have been black in charge of breaking BME people into leadership positions for years and have nothing to show for it, it’s perfectly legitimate for us to ask "are you doing you doing your job”  or "do we need to adopt a radically different approach?"

Either way, a change has got to come, if the legacy of all decades of sacrifice that black staff and patients, have sweated into this organisation, will have been for nought. 

Here is my take on how race equality is typically tackled in the NHS.

Someone highlights a problem of discrimination. 

The NHS leadership reacts by appointing the usual suspects - and because they are far removed from the daily experience of BME staff, they have to do a fact find -  typically 6 months. The good thing about consultation is that you get to meet lots of NHS Trust leaders who can line you up for your next job and you get to chow-down on ethnic food. Of course by the time you get shown around a hospital, the management has already sent the Black rebels to another location for the day, so you never have to have your stomach upset, by hearing about the reality of racist behaviour.

By month 7 it’s time to take a breather and write an interim report while you digest. You can’t trust your own views, so you round up some ‘experts’ and ‘stakeholders’ to tell you what they told your predecessors - because nothing has changed in 60 years. 

Finally, you’re ready to publish the report; but oops it’s Christmas, or as you like to call it ‘the holidays’ – time to relax - after all BME nurses get fired unfairly all year round – no hurry! By the time the report comes out everybody's forgotten about the issue and the guilty parties have all either left or been promoted. If fault is attributed, its a consequence of arrant behaviour, a lone renegade, a systems error, a misunderstanding. And so the institution having refused to take racism seriously fails to capture the learning such incident can offer for institutional learning and development of best practice. It would be funny if it were not true. 

Hands up,  if you've ever witnessed or experienced an institution, that when confronted with a serious allegation of racism has swiftly and fairly investigated, treated the matter seriously, assumed responsibility, apologised and compensated the victim? 

Now hands up, those who've experienced or witnessed the complete opposite? Denial, defensiveness, anger, hostility, accusation and victimisation? The reality is the culture of an institution can eat policy for breakfast. That culture is established and maintained by the corporate centre and the Chief Executive, they set the tone and in delivering real progress leadership has to start at the top. 

As Policy Director or Equalities in former Mayor of London I was able to deliver real progress on these issues, by ensuring that equalities were mainstream into the corporate heart the organisation. What does that mean? 

Total integration of equalities into the performance and supervisory framework of all staff, linked to incremental pay awards.

Equalities became of central to our corporate governance framework. Departments and to set out and equality action plan, all departments reported monthly progress with reviews at six months and end of year assessment . All equality targets and to be met and in each budgetary cycle, departments could only submit their budgets to the mayor if they'd been clear by me. 

Each department was subject to and equality star chamber that signed off departmental budgets as being robust capable delivering our quality objectives. The progress we made was spectacular and you can evidene that by reading the Greater London Authority Equalities reports from 2000 – 2008. In that priod we became the most diverse public sector organization in the UK. Over 75% of the top 5% earners across the GLA group were black. 

The number of black police officers increased by 100% a remarkable achievement given the history of relations between black communities and the Metropolitan police service. It shows what can be achieved when there is unwavering political leadership to delivering equality.

You see the critical difference at the Mayor's office was, Ken Livingstone was totally committed to do whatever it took to achieve the equality objectives we set. Leadership is the key to delivering quality.

So the obvious solution here is to make NHS Trust leaders accountable for making progress in reducing racist incidents and increasing diversity at the top. Fail to deliver - they lose their jobs. But that message would be considered rude and too harsh for delicate NHS leaders - so what to do? Thankfully some bright spark always comes up with a bells and whistles solution, which is much nicer than burdening busy Trust CEO’s with sorting out racism. Cue the bright spark with a gift for snazzy sounding acronyms “let’s call it the WRES”.

Five years down the line a new NHS CEO takes the stage and makes the customary pledge to change things for the better – he gets a standing ovation from the assembled sycophants and off we go on the merry-go-round. Meanwhile in a hospital far-far away sits a highly trained Indian doctor wondering why a minor clinical mistake is about to end his career, as his Filipino nurse chokes back tears, because her ward manager has picked on her for the fifth time today.

Let’s turn to this Workforce Race Equality Standard – They say WRES (Rest) – but we say No WRES(Rest) til Equal.  This was built on the work done by Roger Kline then a Researcher Fellow at Middlesex University. He has since been appointed Director Workforce Race Equality and shares this top spot on a snowy peak of his own making with Yvonne Coghill. Roger did good work in throwing light on NHS discrimination, but we have to wonder if it is true that ‘the white man’s ice is always colder’. 

I say that, as it seems to me, with all due respect, that Roger’s work mirrors exactly what was done by the South East Coast BME Network four years before he picked up his pen to write the ‘Snowy Peaks’ Report. Even the phrase ‘snowy peaks’ is borrowed from Trevor Phillips, co-architect of a 10 Point Race Action Plan developed in a partnership with Sir Nigel Crisp previous NHS CEO.  That turned out to be an Inaction Plan.

As a result of the sterling campaigning work done by the sister and brothers in the NHS BME Network, December 2009 saw the Equal Opportunities Commission issue compliance notices to three NHS Trusts,

• Frimley Park Hospital NHS Foundation Trust,
• Kent and Medway NHS
• Social Care Partnership Trust,
• and NHS Surrey,
• issuing a warning that they needed to take steps to address race equality or face legal action for failing to comply with the Race Relations Amendment Act.  Notices were issued against them because these Trusts had failed to put in place compliant Race Equality Schemes that set out how they will meet the Act's Race Equality Duty.

What has happened in these Trusts since; has there been proper due diligence done on their progress? We are issuing notice to them - you are on our radar and there will be No Rest until BAME staff report tangible change.

Where are those heroic BME Network leaders now and why are they not given a place at the NHS England table?

We say to them join us and fight for that place as of right. Rumour has it that NHS England is making strides to set up a its own National BAME Network - let us give notice today that we are launching our NoWREStilEqual campaign, a community led network here in Bradford today and we will stand in opposition to any attempts to silence the legitimate and authentic voices representing the views of BAME stakeholders. Real, sustained, radical change will only take place if two objective conditions are present. 

1. Strong leadership from the top

2. External, well organised pressure and public accountability. 

In relation to health we need to assume full responsibility for improving the life chances of our children. Its that simple. If we are united then the job of reform becomes that much easier. Social movement like the newly emerging Blaksox demonstrate a 21st century approach to community development and empowerment. Born out of the tragic teenage orders we've seen in London of late, this is a radical, unique and completely self funded initiative. 

The Blaksox mantra is simple, its time to realise our assets and organise independently, funded by our own resources, we will do for self and hold agencies to account by educating, forming ands mobilising people through dedicated leadership programmes that provides an ethical framework for leadership. 

The focus is on young people and the key question facing the Windush baby generation is " What will be our legacy to our children?" 

Back to the NHS. Roger Kline says  “It’s time to stop bullying in the NHS – for the sake of patients” and links the discrimination BAME staff face with poor patient care.

This is not just blindingly obvious it was already evidenced in Lord Darzi’s [4] report which concluded there was a “pervasive culture of fear in the NHS and certain elements of the Department for Health”.

None of this stopped Cardiologist Dr Raj Mattu [5] being bullied in Walsgrave hospital Coventry and subjected to a 12-year “witch-hunt” after daring to raise concerns over overcrowding and fears for patient safety in 2001.

Nor did it prevent the racist sacking of Elliot Browne [6]the first and only black man to hold the position of divisional director for clinical scientific services with a Manchester Trust. Those two cases alone cost you and I, the taxpayers over £2.5m in compensation and heaven knows how much in legal fees. 

These cases are the tip of an iceberg that runs deep below its snowy peaks, dragging into the mire the finest, most dedicated BAME professionals in the land. That’s why there can be NoWREStilEqual.

We have to ask Simon Stevens, Roger Kline and their colleagues what is different this time?  

Can it really be possible that, despite 60 years of evidence to the contrary, the WRES is going to deliver a marked improvement in the discrimination endemic in the NHS?

How can it succeed where, Positively Diverse, Race Impact Assessments, Equality Delivery System 1 and EDS2 and a shed load of other initiatives have failed?

The signs are already bad for the WRES, because most Trusts in the country have failed to produce WRES reports showing the level of discrimination way past the July 2015 deadline.

Instead of taking them to task NHS England has extended the deadline for these reports to be submitted, by a whole year.

It is time to abandon these plodding mechanistic approaches and mandate NHS leaders to change the system that leads to snowy peaks or step off the mountain. 

We say no WRES ‘til Equal.

In Launching the NoWREStilEqual Campaign right today in Bradford we are making a demand for real change and an end to racism in the NHS. Our demands are:

1.    Measurable annual Race Equality Targets set for each NHS Trust, with the specific aims of eliminating race discrimination within a decade. We’d like some equality before we Windrush babies die please.

2.    Positive and Direct action taken to eliminate the under-representation of BAME staff at paybands 8 and above within 5 years

3.    The gap closed between the experiences of White British and BAME staff by 50% within 5 years and eliminated within 10 years (e.g. recruitment, selection, harassment, grievances, disciplinaries, dismissals etc.)

4.    NHS England to remove from the contracts of CEO’s and Chair’s any protection from punitive action in the case of failure to deliver on Race Equality Targets.

5.    Failure of an NHS Trust to deliver measurable improvements on hard Race Equality Targets for 2 consecutive years to result in the summary dismissal of its Chair and Chief Executive Officer.

In pursuit of these campaign goals we are taking the step of bringing together a national alliance of BME led organisations to form a Black & Minority Health Alliance and we hope that Bradford Health Forum will be amongst the first organisations to join in that alliance.

---

[1] Effects of Perceived Racism, Cultural Mistrust and Trust in Providers on satisfaction with Care. Ramona Benkert, PhD, RN; Rosalind M. Peters, PhD, RN; Rodney Clark, PhD; and Kathryn Keves-Foster, MSN, RN

[2] Racism and Psychological and Emotional Injury: Recognizing and Assessing Race-Based Traumatic Stress

[3] http://www.theguardian.com/healthcare-network/2014/oct/28/tackle-mental-health-inequality-black-people

[4] http://news.bbc.co.uk/1/hi/health/7480910.stm

[5] http://www.independent.co.uk/news/uk/home-news/whistleblowing-cardiologist-raj-mattu-wins-unfair-dismissal-case-9269510.html

[6] http://www.theguardian.com/society/2012/jan/09/nhs-manager-race-discrimination-case