This is a blog post by Prof Joy Warmington, brap CEO.
Six months ago, Roger Kline and I published Too Hot to Handle, an investigation into racism in the NHS. The report was based on feedback from over 1,300 NHS staff. It explored what happens when allegations of racism are raised and some of the reasons organisations don’t respond to them appropriately.
Six months on, what have we learnt? What could we have done differently? Here are six things lessons from the Too Hot to Handle aftermath.
1. Unsurprisingly… the problem is worse than we thought
Since publication of the report Roger and I have been inundated with texts, calls, and emails from people telling us about their experiences. Lots of equality leads have also spoken to us about things happening in their trusts – inappropriate behaviour, unfair scrutiny, denied opportunities. Latest Staff Survey figures suggest about 16% of BME staff have experienced discrimination at work from colleagues. I’d guess the real figure is much higher.
2. We may have underestimated barriers to speaking up
Too Hot to Handle identified barriers that prevent people from speaking up about their experiences. Given the number of people who have subsequently contacted us – and not their Guardians, union, HR colleagues, etc – we perhaps should have explored this more.
3. Reactions have been mixed
We’ve had some great responses from organisations including the RCN, National Guardians Office, etc, However, despite making ourselves available to some of the most senior decision makers in the NHS, we are still to hear from them. Perhaps the topic is too hot to handle?
4. We need to get better at communicating anti-racism
What made Too hot to Handle different? We were clear we were going to analyse people’s experiences through an anti-racist lens and suggest anti-racist responses. Perhaps half of this approach has landed. Many trusts have committed to being anti-racist; some have put an anti-racist statement up on their websites. But often this activity occurs without organisations understanding what anti-racism actually is. Anti-racism is not about addressing the symptoms of racism: it means deploying different thinking and actions that move away from transactional approaches. Many trusts can’t show up as anti-racist because they don’t understand what anti-racist practice is. We did outline what some new approaches could look like in the report, but we think leaders need support to be clearer that anti-racism requires them to show up differently in the spaces they occupy.
5. The cycle is continuing
Einstein once said the definition of madness is doing the same thing over and over again and expecting different results. When it comes to culture change, this could also be a motto for the NHS. One of the things we highlighted in Too Hot to Handle is that the system routinely reports on the challenges it has with regards to race, but does little to actually change. Since its publication, there have been other reports highlighting the persistence of unprofessional behaviours in the healthcare ecosystem. The National Guardian’s Office, for example, recently reported that nearly 40% of cases it handles involve inappropriate behaviours. Similarly, a recent report into the NMC found a culture that permits racism and discrimination. Despite these glaring revelations, the system shows little sign of learning from its mistakes. Occasionally, leaders may offer expressions of regret when confronted with these issues, but substantive change and genuine accountability are notably absent. And so the pattern continues.
6. Many equity leads are eager for new thinking
Connected with the above, we have heard from lots of equality leads and others who say they feel isolated, marginalised by their trust, and unable to ‘sell’ the importance of this agenda in the face of other pressures in the NHS. It seems a lot of people are eager to hear about new approaches – they want to learn how to do more on this agenda, something different that makes a real impact. People are tired of the same old same old.
There are other lessons we’re mulling over too. Every day brings with it a new conversation and fresh insight into how the NHS needs to change.
Based on feedback from NHS staff and our experience of supporting trusts, we have developed a new programme for ED+I leaders. It’s called Equity Unpacked, and we’re very proud of it. It has cutting edge content and responds to the challenges we’ve seen in Too Hot to Handle. It includes insights around system disruption, embodied leadership, and articulating the importance of ED+I.
For more info see: www.brap.org.uk/post/equity-unpacked
In the meantime, if you need support please let us know. Unfortunately, the Too Hot to Handle story isn’t over.
In case you missed it, you can watch this seminar in which Joy and Roger discuss the findings of Too Hot to Handle.
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