On my daily commute into work last year, still half asleep, several news stories made me double-check that the free paper I’d picked up was from this century; a double-spread on the Spice Girls, England winning a penalty shoot-out, and the news that senior NHS doctors from black, Asian, and minority ethnic backgrounds (BAME) earn less than their white counterparts.
The latter, based on official NHS figures, was reported in The British Medical Journal (BMJ) only last September 2018. White consultants, the most senior members of frontline staff, earn on average an extra £4,664 a year than their BAME counterparts. Another study followed from NHS Digital suggesting the gap was closer to £10,000.
In my sweaty tube carriage I quickly dismissed this uncomfortable truth, thinking: ‘My beloved NHS doesn’t see colour; it’s probably botched numbers, or the fact that white consultants tend to be older and experience is linked with remuneration or maybe white doctors are just better negotiators of pay or BAME consultants don’t ask for the more lucrative opportunities or responsibilities?’, and sought escapism in an article about a slice of toast that looked like Boris Johnson.
Then, just before Christmas of last year I met my racism.
As a trainee psychiatrist I attended a ‘Group Relations Conference’ at the famous Tavistock Institute; an immersive experience with one hundred strangers forced together in a room for five days, to form a society. In this largely unstructured learning laboratory, members were free to reflect aloud on the conscious and unconscious dynamics which played out. Like ‘Lord Of The Flies’ but with coffee breaks. The purpose, the brainchild of psychoanalyst Wilfred Bion, devised in the aftermath of WWII, was to examine why humans behave oddly in groups.
With no guidance from the conference directors, our first task was to silently form ‘small groups’. Despite our make-shift community being a near 50:50 mix of white:BAME members, I was mortified to discover I’d drifted into a predominantly white group. Was I a monster?
Next, leaders were appointed for each of the 10 ’small groups’ and a meeting arranged between them. The rest of us observed silently from outside the inner circle. Every elected leader was white.
I now realise that as a straight, white male I experience the world in a certain way. My career’s gone smoothly, I don’t get interrogated at customs or followed around by security guards in shops. I’m shielded from the lived realities of many people of colour by my privilege. The Queen thinks the whole world smells of fresh paint. Frustration at the blind spots seen in the majority prompted Reni Eddo-Lodge’s ‘Why I’m No Longer Talking To White People About Race’.
The conference held a mirror up to our murkier natures. Under stress, I learnt about the people I more naturally gravitate towards, based on occupation, gender, class and ethnicity, my legs moving faster than my brain can. They tend to be people most like me.
I’m not alone. Psychologists have suggested that prejudice begins once children start to notice difference. My partner’s sister describes the uncensored things her 4-year-old innocently says on buses; “why do I have brown skin?”, “they only have one arm” and “look mummy, he’s pregnant just like you!”. Studies have shown children have a preference for playing with children based on shared similarities, and that in later life this can manifest as discrimination with recruiters favouring candidates from their own tribe.
The ‘small group’ leaders meeting felt analogous with the structural racism seen in the upper echelons of power in this country, from CEO boardrooms to Premier League football management. Figures recently emerged of the BAME pay gap within the television industry. It seems wishful to think white-heavy, senior NHS management (of which BAME members make up only 7% despite representing 25% of the NHS workforce), would be any different.
Clearly the figures need interrogating further and I don’t pretend to have the
answers to a complex problem so embedded within society’s fabric. For example, in education it has been suggested that another contributor to the stark attainment gap between white and BAME students is differing attitudes towards entitlement and sense of privilege. Whatever the reason, it’s our responsibility to narrow the gulf.
But a New Year is an optimistic time for pledging changes towards a better us; stop smoking, go for that jog, don’t eat a whole packet of Jaffa Cakes at once etc. The NHS is not perfect; improving racial equality should be one of its New Year’s resolutions.
A crucial early step in the model of change is acknowledging we have a problem. The doctor’s union, the British Medical Association (BMA), was quick to condemn “unacceptable barriers and discrimination” implicit in the BMJ’s findings, adding “it cannot be right that in 21st-century Britain there are such wide gaps in pay between white and BAME doctors”.
Then health minister Stephen Barclay promised to “outline plans to tackle inequalities at senior levels” and, encouragingly, the recently released NHS 10-year plan pledged an extra £1m for the Workforce Race Equality Standard to improve the experience of BAME staff. More than this, compulsory ‘Group Relations’ experiences for senior NHS management and mandating fairer BAME representation at the top would seem logical.
But awareness is only the beginning. A relative of mine was recently diagnosed with type II diabetes. Despite plenty of lifestyle advice over the festive break, I’d still bump into him at the fridge, scoffing mince pies or pouring double-cream directly into his mouth. Diagnosis counts for nothing in the face of apathy.
There’s a tired joke that strangers like to tell me on discovering I’m a shrink: “How many psychiatrists does it take to change a lightbulb?’. The punchline is: “One, but they have to want to change”. And of course here the NHS is no different.
Dr Benji Waterstones is an NHS General Adult Psychiatrist