A BREAKDOWN OF The “snowy white peaks” of the NHS: a survey of discrimination ingovernance and leadership and the potential impact on patient care inLondon and England.Available from Middlesex University’s RESEARCH REPOSITORY


Following a segment on BBC Women's Hour on the 'Snowy White Peaks' article and the issue of racial imbalance within NHS services and patient care. The Equality Act 2010  and subsequent Public Sector Equality Duty encouraged unlawful discrimination, advancement of equality of opportunity between those with a protective characteristic and whose who do not and the fostering of good relations between the two. Public authorities are required to analyse the effects of the organisation's functions on all protected groups and maintain a record of usable information to monitor the situation. 

However, the 2010 study on disciplinary processes comissioned by NHS Employers found that only one-fifth of all NHS Trusts published recent disciplinary data with further considerable gaps fund in published information on workforce ethnicity data. 

In recent years, the NHS has demonstrated a serial unwillingness to confront the scale and depth of race discrimination and the potential impact on service comissioning and delivery. 

The executive teams of NHS England and the three main regulatory are entirely white British. With the exception of NHS England, the non-executive members are entirely white. The patterns of Board membership reflect a hierarchy in which BME staff are disproportionately employed in low numbers and in junior grades. The restructuring the NHS undertook in 2013 provided no evidence that it enabled the organisation to increase the number of senior posts held by BME staff. Only 5% of senior managers, eccluding chief executives, are from BME backgrounds. 

The relative abscence of women, and especially those of black and minority representation at Board level, is not a phenomenon exclusive to the NHS or public sector. Race for Opportunity showed in its 2009 report 'Race to the Top' that "our British black, Asian and BAME workers are simply not gaining the share of management or senior level jobs that their population would justify." (Race to the Top (2008).

The barriers to professional progression for BME staff in the NHS are well documented with the pivotal barrier being stereotyping and the preconceptions of others. Yvonne Coghill who lead the Breaking Through programme agreed that: 

"Years of strategies, ideas and initiatives have not been effective in resolving the problem of underrepresentation. Most initiatives have focused on supporting leaders from BME backgrounds to "fit in" and be more like the leaders already in positions of seniority."

What Coghill suggests is not only to accept the need to increase representation in leadership but to make a radical change in leadership style to create a coherent strategy, monitor their workforce and analyse deficiencies. Despite the significant record of BME leaders within the NHS, nervousness is the abiding emotion when exploring why, in former chief executive Sir Nigel Crisp's redolent phrase, the service's upper echelons are dominated by "snowy peaks". Integrated care sustems have a should lead the development of governance and human resources functions that facilitate diverse leadership in line with commitments to the NHS People Plan. 

In the circumstances we face today, the coronavirus pandemic has had a significant part to play in contributing to the disproportionate services granted to BME communities within the healthcare sector. But why is this the case? Failure to life 'hostile environment' policies such as eligibility checks and charges for overseas visitors were seen as a contributing factor with the effect felt the strongest among migrant and refugee communities with little access to translation services and communications strategies to enable clear channels of communication between patient and service provider. 

Within the workforce, BME health and care professionals were reported to be more likely to take on high-risk roles due to feat oc contracts being terminated or shifts reduced particularily if they were agency staff or had a vulnerable immigration status. Referring to the statistics, in May 2020, an Office for National Statistics study explored whether the risk of dying from Covid-19 is greater among the black and other ethnic minority groups than among the white ethnic population It showed that after controlling for age along, in Britain's black communities, women were 4.3 times and man 4.2 times more likely to have a Covid-19 related death than white women and men. (source: NHS Confederation)

From the 'Snowy White Peaks' article to the NHS 'Perspectives from the Front Line' report overwhelming research points to two main factors deemed to lie behind the disproportionate impact of Covid-19 on BME communities: long-established inequalities and institutional racism. 

Read the reports here: 



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