Collecting feathers in the health service

I am a senior practitioner. I am passionate about my work and about the NHS, which is why I have much to say on racism within the organisation. Racism is a threat to any organisation. The police force was the first state body to be publicly exposed as having “institutional racism.” The NHS faces the same allegation. An accusation of racism leads to denial or the accuser being accused of playing the “race card.” It seems that consciously or not some people are blind to racism, at least that which is real for the visible minority.

When I proposed changing my name to give me a better chance of securing an interview to study medicine in the 1980s, I was considered naive; a London medical school proved me not so naive some years later. At my graduation ball the professor of surgery gave me some advice: “Even with your surgery medal you will have to work harder, be smarter, try and join the right clubs and it will still take you longer—if you are lucky.” Fortunately I was not interested in a surgical career. I did come across racism in my career path though. While I was in surgery as a houseman, the consultant surgeon said: “You're from Africa. Do you think black people are genetically incapable of running nations?” Except for the rhythmic noises of the gas machine, the theatre was still. Everyone awaited my answer. My immediate thought was of the consultant being a potential referee, so I took a white feather; I suggested that his query was perhaps a little more complex than just genetics. Covert racism is more interesting. By definition it is subtle, yet more visible to the visible minority and invisible to others.

I was clear about my career and how to go about achieving it. I chose to sidestep racist language, behaviour, and views from colleagues. I could have treated them as potential barriers; I could even have taken a formal, perhaps legal, route. Sidestepping was safest for me, but in doing so I failed to deal with the issues and left exposed others that followed. I kept collecting feathers. Yet pull the race card and whatever the outcome, the complainant is damaged—career, livelihood. So people just keep collecting feathers.

Despite my European education, indistinguishable English, and confidence, each of my career choices included a wider assessment of the potential for racism. Consider the international medical graduate with an Asian education, accented English, and unquestioning respect for seniors and institutions, grateful for the opportunities in an economically rich system. It is no surprise that the graduate from Bangalore feels more able to access support and direction from senior colleagues also from Bangalore. I chose deliberately to keep away from race issues. I was determined to stand out and be “the doctor” not “the Asian doctor.”

As a trainee I presumed that prejudicial recruitment practice was likely wherever I applied for work. For every application I visited the unit, not to inform myself but to inform potential employers of my abilities over and above a foreign sounding name. Ironically I am now involved in recruitment. I am in a position to implement good recruitment practice, bringing transparency, questioning assumptions, and being critical about supposedly historical practices. If a colleague genuinely believes that applicants with parents in medicine make better doctors, what other prejudices exist? I work on the assumption that most people I encounter and work with are fair, but I know that it takes few to corrupt an institution and to damage its employees and reputation.

Institutional racism has always been, and always will be, in the NHS. The McPherson report attempted a definition of institutional racism: “the collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture or ethnic origin which can be seen or detected in processes; attitudes and behaviour which amount to discrimination through unwitting prejudice, ignorance, thoughtlessness and racist stereotyping which disadvantages minority ethnic people.”

Just as people resent the accusation of being racist because they are unable to see it in themselves, organisations resent accusations of institutional racism. Exposure of such racism lies in building transparent systems rooted robustly enough to fight off the few invisible professionals who are hardwired to damage otherwise forward thinking institutions.

Covert racism is more insidious, more difficult to frame legally, and more damaging than overt racism. When a senior, white, colleague commented in 2005 that a national award bestowed to a colleague from the visible minorities was more to do with achieving ethnic balance, it shows we still have a long way to go.

We have not yet travelled far enough for me to reveal my name, so pass me another white feather. You may know me, but do you know yourself?

Consciously or not some people are blind to racism