By ITV News Content Producer Alex Binley
With Black History Month upon us - October recognises the contributions and achievements made by black people to the UK and its history - and the NHS once again at the forefront of the fight against Covid, ITV News spoke to black doctors and a dentist of their experiences of racism while working in the health service and what they want to see change.
Those who spoke to ITV News told of a patient’s parents saying they “don’t want that person” treating their child, feeling that they have to work much harder than their white counterparts, and a need for more diversity in the upper echelons of the NHS.
"Because of my various professional portfolios, I know what racism is… I have seen examples of racism on staff members,” says Professor Rotimi Jaiyesimi of his more than 30 years in the NHS.
While the consultant obstetrician and gynaecologist says the racism he has experienced is not as overt as when he began his career in the health service in 1989, for example, he doesn't hears slurs such as "p***" or "go home" anymore, he feels it is still pervasive.
He recalls visiting a hospital in the early 1990s in search of a senior registrar and being told: "'You’re a good doctor, but there’s something about you that you can’t change’ and he [the consultant] pointed to my skin."
He recalls another interview in 1993 for a consultant post and being told: "You do know this is a white area?".
He recalls other incidences, including patients' notes stating: "No black doctor”, or being told by a patient: "I didn't come to see a black doctor."
Nowadays, Prof Jaiyesimi says, there is less "in-your-face racism" but there is still a "marginalisation" of black staff in the NHS.
Black doctors are "on the edge and treated differently," he says, "you're treated worse for minor mistakes" which white doctors often only get a "slap on the wrist for".
Part of the problem, he believes, is a lack of black healthcare professional representation higher up in the NHS.
“There is a glass ceiling for the black community and you’re not invited to the table and part of it…
“If you look at the boards of NHS institutions you’ll see the representation is not there.”
A 2019 report from the NHS Confederation found that just eight percent of chairs and non-executive directors of NHS trusts are not white.
At the time of the last census in 2011, 13% of the UK population, or 8.1 million people, identified as Black, Asian or Minority Ethnic.
However, he believes this lack of minority ethnic staff in leadership roles is representative of society in general.
As a black person he says, “if you walk in to a shop, people clutch their bags and security follow you down the aisles”.
“It's due to conscious and unconscious bias within society,” he says, and the portrayal of black people in the media, for example, "on TV black people are associated with gun violence and drugs".
While Prof Jaiyesimi has seen the situation improve during his more than three-decades in the NHS and the UK, he still believes there is some way to go.
“Things are getting better…
"People and the regulators for healthcare professionals are talking about it [racism]…
“By and large there is progress, but there is a large scope for improvement in the NHS...
“We need to re-educate ourselves as humans," he continues.
“I hope that things will change, that human beings will be treated equally… we are all the same.”
"The colour of the internal organs is the same colour irrespective of race.
"You can receive a blood transfusion or an organ donation from anyone of other races for as long as the [blood] typing matches,” he states.
"Life has no colour and we must eradicate racism in society."
A patient’s parents didn’t want me treating their child
“It’s difficult to quantify the scenarios, there have been so many over the years,” says Dr Sam Botchey.
While the sports and exercise medicine trainee says “the most overt” racism he has experienced has been from patients, recalling treating a 17-year-old whose parents said they “didn’t want that person” treating their child, “it’s most difficult when other staff members don’t say anything, they acquiesce or go along with it”.
Racism from staff members is “not as overt” as what he receives from patients, the 32-year-old says, “but the main issue is a lack of realisation of unconscious bias”.
Dr Botchey - who also does A&E shifts - says that when he is in charge of a team, he is often the last person to be acknowledged by a consultant: “It’s less likely I’m viewed as being in a senior role, people don’t expect it,” he says.
He adds he deals with incidences such as this every day.
“We need to promote awareness of bias in medicine,” he says, but adds it’s part of a “generic unconscious bias against all black people in society…
“Medicine is no different.”
Only by accepting this unconscious bias can we “move forward”, he says.
“Some people reading this will become defensive and deny this [unconscious bias] and deny lived experiences and say they don’t see themselves as racist.”
He says he has brought up issues before and been accused of “having a chip on my shoulder”.
Dr Botchey cites a 2016 paper published in the BMJ (British Medical Journal) which found that doctors from black and minority ethnic backgrounds are less likely to pass their specialty exams, as evidence of bias.
The research focused on the academic year 2014-15 and found that the average pass rate for UK white doctors was 75%, while for black and minority ethnic doctors it was 63%.
“The difference between the two groups remains statistically significant,” the GMC said.
While the data from the GMC is broken down in to white and ethnic minority groupings, Dr Botchey is keen to stress that the experiences of all ethnic minority doctors are not uniform - that in his view, black people are less likely to be viewed as doctors than “people of Asian, Indian or Chinese heritage”.
However, he is keen to stress that “this doesn’t take away from the way things are for them.
“One problem doesn’t take away from another’s.”
Likewise he says, the experiences of black doctors are not uniform; some have been born and raised in the UK, while others have emigrated to work in the NHS.
“I have different views to black doctors who weren’t brought up here, I can’t speak for them,” he says.
‘There’s a system-wide inequality for ethnic minorities’
Dr Abdullah Zubairu believes the Black Lives Matter (BLM) movement has affected change.
He admits he was “initially quite sceptical” and was worried the message released by his hospital trust in response to the movement was “just words on a page”, however, he does believe BLM has enabled people to “discuss race at work".
“It can be hard to discuss race but people asked me about it and gave their own examples”.
While the 25-year-old says he has “not experienced anything overtly racist” and says the consultants he works with are “diverse”, he believes there is “system-wide inequality for ethnic minorities” within the NHS.
He cites a BMJ report which shows a pay gap of 4.9% between white consultants and their Bame counterparts which amounts to an average of £4,644 per year.
The report, by John Appleby, Chief Economist at the Nuffield Trust, found that the pay gap is “small for most doctor grades, but larger amongst consultants”.
It’s not just financially that ethnic minority doctors suffer, Dr Zubairu believes they are “dealt with and punished” more harshly than their white counterparts and mistakes are escalated more quickly.
He also cites coronavirus death statistics which show ethnic minority doctors and medical staff are at a higher risk of death.
While 44% of medical staff in the UK are from ethnic minorities, 95% of doctors who died after testing positive for Covid-19 in March and April 2020 were from ethnic minorities, according to research published in the Health Services Journal.
All of this he says points to “racial inequality” and a “system-wide” problem.
However, lumping all non-white doctors together under the “BAME” label, is part of the problem, he believes.
“It almost softens the statistics for black doctors and means interventions aren’t targeted.”
Instead, he believes data should be collected “by ethnic group” in order to be able to pinpoint where the issues are and what needs to change, as he believes there “is a disparity within different ethnicities” in medicine.
“Doctors of Indian-origin are well-established in the UK” and there are groups set up for them, he explains pointing to niche groups such as the British Association of Indian Anaesthetists.
He feels the situation is different for black doctors; there are “less niche groups and support is not so readily available as there is not such a great proportion” of black doctors, he says.
Like others, he believes a “top-down” approach and seeing a “greater penetration of black doctors on top boards and in management positions”, would help increase equality within medicine.
“It needs to be more diverse otherwise they can’t understand the plight of doctors,” the 25-year-old says.
‘As a Black doctor you need to be more careful and keep your head down’
After graduating, a doctor who wishes to remain anonymous said his first jobs were in Boston Lincolnshire and Nottingham University Hospitals where he claims there was “institutional racism” from “staff and colleagues”.
“Just because you’re not white, people think you aren’t up to the standard,” he says.
His name, he says, led to people asking where he had studied, assuming he was not British.
At the start of your career, “you’re excited to be a doctor”, he says, but “you’re also vulnerable in those first years, you’re babies, you don’t know what’s happening.”
He says the whole point of the Foundation Years 1 and 2 roles is to learn and progress, but he felt there was “scapegoating”, with mistakes made by black doctors escalated more quickly.
“As a black doctor you need to be more careful and keep your head down," he says.
He believes that because he is black, colleagues were more likely to form negative opinions of him; “I’m confident, but people often think I’m arrogant”.
He says he felt his colleagues were “waiting for me to snap, to call me aggressive” and that as a black doctor when “you defend yourself, people think you’re defensive”.
As a result, he did not want to raise his head above the parapet and says he “wouldn’t put myself forward for things which could progress my career”.
As a black doctor “you have to be better, sharper, more organised and make less mistakes”, while “white counterparts are given the benefit of the doubt.”
“You need to be really good to stay out of risk. During the learning stage this is hard.”
He cites a GMC report which states that ethnic minority doctors have more than double the rate (1.1% compared to 0.5%) of being referred by an employer over fitness to practice concerns compared to white doctors.
He says he has learnt strategies to try and minimise negative repercussions for himself, for example, cc’ing in others when sending emails “to make sure you’re covered”.
Black doctors who are not from the UK often face a more hostile situation due to the fact they have an accent which contributes towards a more “negative bias” against them, he says, but he believes the situation is harder for black British doctors who are facing discrimination and a lack of inclusion from their home which can be “hard to accept”.
The doctor believes the hostile environment black doctors can face is due to the “subconscious bias” which exists in general society as well as in medicine.
He believes sessions on tackling this should be made available to all in the medical profession in order that discrimination can be “tackled head on” to help others “understand”.
Racism “needs to be tackled to make a difference”, he says.
While he believes more should be done to raise awareness within medicine, he harbours fears over the general population’s views and biases.
“Patients are always going to be the same and can’t be changed,” he says.
‘I was called a n*****’
It’s not just doctors who face racism, a dentist who works in London and wishes to remain anonymous told ITV News she has had suffered “many incidences" of racism.
“Whilst at university I was called a n***** when I was a student.
“This happened when I was on clinic with a senior member of staff.
“The patient who was in the dental chair, who was about to have a dental extraction was obviously very offended by my skin colour and my presence in the room so, he called me a n***** to my face.
“And he didn’t just do it once, he said it twice.
“The way in which the situation was handled by the university was so poor and I was told by senior staff, after the matter was expedited, that we would have to make allowances as the individual responsible for such language was an ‘older gentleman’.
“So, in other words, because the man responsible referring to me as a n***** was older and had a perceived mindset, I should accept that this behaviour is acceptable from those who are within that age bracket.
“To say this hurt is an understatement.
“I didn’t feel supported by my alma mater in this issue at all, even after they told me that they had put a ‘note‘ on the patient’s file so that if he went to any healthcare institution within the trust, any healthcare professional would be able to see his past history/record pertaining to this.
“In addition to this I’ve been asked by patients and staff if I trained and qualified in the UK, I’ve been told several times that I speak really good English (just an FYI I was born and raised in the UK and English is my first language - so what would one expect?)
“And I’ve even been mistaken for the cleaner by patients when I’ve been in my uniform with full PPE about to do a clinical assessment for a patient and have introduced myself as the dentist…
“Some may say it is not a big deal, but for a patient to vocalise such beliefs tells me that they only think black people can be nothing more than domestics.
“Ideologies like this are rooted in racism.
“I am no one’s domestic.
“I didn’t work hard in school and university to go to work to be abused and be viewed as less by patients or staff.
“Yet this is the unfortunate reality I’ve had to endure at times.
“I would like to say that these incidents have been far and few between but I cannot deny that they have happened.
“More awareness is needed to be raised on this issue.
“I hope that you can begin to understand how many people who work in the NHS have suffered due to racism.”
In a statement to ITV News, Lincolnshire University Hospitals NHS Trust (ULHT) which covers Boston, Martin Rayson Director of People and Organisational Development said: “We cannot comment on individual cases, however, we absolutely do not tolerate any racism at ULHT.
“We have a robust inclusion strategy in place and work hard with our staff networks, who represent staff with different protected characteristics, including our BAME network, to ensure that our Trust values are upheld and felt by everyone working in the organisation or using our services.
“A range of support is available for any staff who feels they need it including specialist training and induction.
"We have clear mechanisms in place for staff to raise any issues they have about their experience whilst working in the Trust.”
Nottingham University Hospitals NHS Trust has been contacted by ITV News for a response.
In a statement to ITV News, NHS England said: “It is unacceptable for anyone to be treated unfairly because of their race or any other protected characteristic, and the NHS Workforce Race Equality Standard was introduced to ensure BAME staff receive the same opportunities as their white colleagues in the NHS.
“The NHS belongs to us all, and as part of the People Plan, NHS employers are committed to increasing black, Asian and minority ethnic representation across their leadership teams as well as eliminating discrimination and inequality.”
Chief Executive of the GMC Charlie Massey told ITV News: “Recent events have served as an important reminder of the differing experiences black, Asian and minority ethnic doctors face throughout their careers and the need for the system to work together to foster a truly inclusive NHS.
“Our 2019 research to understand the professional barriers these doctors face is now more relevant than ever.
“It is essential that the complex factors which can disadvantage doctors and lead to poorer outcomes throughout their careers are identified and addressed early, which is why we continue to build evidence around how to tackle them at all levels of the profession. It is clear discrimination still exists in medicine and everyone in the NHS now has a responsibility to strive to make real change.”