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Racism in the NHS - hiding in plain sight for those brave enough to look at it. Our lives Matter

Updated: Feb 27, 2023

Have you been asked to write a reflective account but need clarification on what you might have done wrong?

When you are unsure, it's best to be silent.

When you don't know how to respond, STOP- PAUSE is a good idea.

Avoid sending emails, texts or statements. Just stop talking.

A long tradition of systemic failures has led to healthcare workers (Mainly Black staff) becoming scapegoats for issues beyond their control.

It is worth remembering this;

When the police caution a suspect, it is stated, ''you do not have to say anything, and anything you do say might be given in evidence and used against you''. Why is this mentioned?

In the eyes of the law, innocent until proven guilty. It is not your role to prove it. It is the accuser's task to uncover wrongdoing.

These principles apply equally to healthcare professionals (including Nurses) in clinical practice when accused of wrongdoing. NHS institutions (like the racist Metropolitan Police Service) are built and structured to benefit and protect themselves and the Executive team.

The hierarchy within an NHS trust is usually 96% white at top management and often lacks representation of Black nurses in the higher positions above band 8.

But, as we see in the recent case of Ms A Cox versus the NHS Commissioning Board. Michelle, a highly experienced, caring and professional Black Nurse and a role model to junior Black Nurses strived and worked hard to get a seat at the top table; however, she was still not fully accepted and valued because of her ethnicity. Instead, top senior management treated Michelle appallingly for years while using the institution to maintain personal privileges. Finally, Michelle's complaints of race discrimination and whistleblowing detriment succeeded at an Employment Tribunal.

Black and Brown nurses who reach top management are often ill-treated,

performance-managed out of their job, bullied and harassed, with many forced to resign.

Michelle's case resonates with Black and Brown Nurses and midwives across the UK because we live with bullying behaviours towards us daily. Unfortunately, institutional racism in the NHS is endemic, insidious, and its structure protects the perpetrators, those at the top and leaves its victims, predominantly Black and Brown nurses in lower bands in addition to overseas nurses extremely vulnerable.

The most crucial issue is how Black and Brown healthcare workers routinely become scapegoated for systemic failures beyond their control and how standard NHS operating policies and procedures support this process which disadvantages ethnic minority staff.

The racial hierarchy in NHS hospitals supports an all-white executive board which supports senior management who will not hesitate to refer a Black or Brown Nurse to the regulatory body, the Nursing and Midwifery Council (NMC). Black nurses and midwives are disproportionately represented in the population of referrals to the NMC plus qualifying as a nurse in Africa increases a nurses risk of being referred to the regulator. For many of us, this means our nursing career is over or very costly and burdensome to fight against. Unfortunately, it's a common trend that has repeated itself for decades.

The issues at hand reinforce institutional racism and enables this culture of discrimination to flourish. Racism seriously endangers our patients.

A few years back, a Black Doctor was struck off the GMC register and used as a scapegoat. There were documented failures during the shift, including the department being short-staffed. The doctor tried to seek help from her white consultant, but there was no support. As a result, a patient died through systemic failures within the hospital. A chain of failures included several white senior staff took place; however, this Black Doctor and a foreign Nurse were the only two individuals blamed and punished.

White privilege in the NHS exists but hides in plain sight.

The doctor's reflective account was misrepresented and used against her by the executive team she trusted to support her. This example shows us that as Black workers in the NHS, our lives and careers do not matter.

As nurses and doctors working in healthcare, we are affected when things go wrong, and we are affected by the death of our patients, so if you write a reflective piece, it's usually charged with high emotion. As Black healthcare professionals, we often lack emotional support, including the opportunity to explore potential racial motivations, discrimination and bias openly. The mention of racism or white privilege can result in being labelled, ostracised or victimised. We are (wrongly) judged as strong black people, undeserving and labelled as able to cope with all the shit thrown at us.

Black Nurses are not offered the same level of empathy routinely provided to white nurses when things go wrong.

Being blamed for wrongdoing as a Black nurse leads to self-blame and internalised guilt. As a result, we become vulnerable and unconsciously accept responsibility for failures that are not our fault. Unfortunately, this is our lived experience and is extremely common and very traumatic for Black nurses.

Our work at Equality 4 Black Nurses involved unpicking and demystifying this phenomenon and helping to find justice for these nurses.

We have trained race-based therapists in our team who help our nurses explore and deal with this issue, often connected to untreated childhood racial trauma exacerbated by each racist interaction experienced in our nursing roles.

It is shameful that top senior white nurses and HR departments across the UK are enablers of this trend and fail to speak out.

Gross failures within the NHS happen daily due to poor management. However, when white nurses are involved in incidents, they are offered constructive, supportive training measures and seem immune from sanction or draconian investigations of wrongdoing.

So instead of addressing the root causes when a Black nurse is involved in incidents, it's more manageable and more convenient to blame, project and throw Black and Brown nurses under the bus for things they didn't do.

Our work at E4BN and our case studies demonstrate clear examples of Black nurses who are whistleblowers and then referred to the NMC for trumped-up charges very soon after raising grievances. Many of their concerns uncover legitimate concerns about patient safety, racism and severe misconduct by white Nurses; however, subsequently, they are silenced or subjected to strategically well-planned character assassinations. As a result, some of our Nurses have quit, caved in and attempted suicide because the trauma is overwhelming.

Overseas nurses have increased vulnerability, and many of our cases show evident coercion, with senior managers forcing confessions and guilt-tripping visiting nurses into self-incrimination. Often there are no clear or specific allegations, and managers partake in fishing expeditions to find ways to get rid of these overseas nurses who have come to the UK to help support our failing health service.

Nursing is a vocation; we nurse to help and cure our patients. However, nobody has prepared us for racism within the clinical practice, which has reached epidemic levels. In the eyes of the law, you are innocent until proven guilty, and it is the employer's job to uncover systemic failures and correct them.

The prominent Nursing union representatives also enable and facilitate racism by encouraging nurses to write reflective statements on the assumption of guilt even before an investigation. They rely on the ethos of the nurse needing to "improve". It is worth remembering that no amount of reflection or training will ever support a system that fails its workers who are actively trying to do the best for their patients.

In the case of Michelle Cox, a trade union supported her claim; however, this is a landmark victory because it was unusual and not the norm. Most union representatives deny racism exists and openly say this to the nurses who have called on them for help. This debate and argument are not helpful and traumatise the nurse.

If seeking the help of a union, it's essential to remember that once the reflected piece has been written and signed, it cannot be unwritten or unseen. That reflective account may one day find itself before an NMC fitness-to-practice panel with no knowledge or interest in the circumstances around your experience of coercion, self-internalised racism or the treatment you experienced from the person who has referred you to the NMC.

If you are a Black or Brown Nurse, your written statement, which a traditional union rep has agreed to/approved, will likely be used against you later. Our advice is when you are unsure; it's best to be silent. When you don't know how to respond, STOP- PAUSE and call Equality 4 Black Nurses on 0208 050 2598 to enable us to triage your case and help you to write a factual account of what happened. In the meantime, please avoid sending emails, texts or statements to the organisation or person who is blaming you for wrongdoing. Just stop talking.

We find a trend in how quickly NMC referrals are fast-tracked for interim order hearings when a Black or Brown Nurse is involved. In addition, when the referrer is an established NHS hospital, the NMC will usually instantly believe trumped-up charges without question.

If any of the issues discussed here resonate with you or you are affected by our content, please

Black nurses are suffering mentally and physically from racial trauma, and nobody is listening. Equality 4 Black Nurses is challenging this racism. We demand justice, we demand change and we will not be silenced. If you need our help in any way, please get in touch with us via our website or our social media accounts or phone 0208 050 2598 and we will support you.

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Written by Yasmiin Ibrahim E4BN Member.

As a nurse, I strongly feel that there are times when it's important to keep silent. While communication is an essential part of nursing, there are situations when not saying anything can be just as important as speaking up.

This victory is significant because it highlights the importance of whistleblowing and the protection of Black Healthcare Professionals who speak up against wrongdoing in the workplace. It also serves as a reminder to employers that they have a duty to ensure the safety and well-being of ALL their employees, and to take complaints seriously.


Mwidimi Ndosi
Mwidimi Ndosi
Feb 26, 2023

Thank you for this invaluable insight. I was pleased to read the outcome of Michelle Cox's tribunal, but I thought the magnitude of mental health impact associated with fighting such a case must be unimaginable. Many nurses facing discrimination do not have such skills, knowledge and the mental health resources - which makes the role E4BN plays essential.

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