Women from black and minority ethnic (BME) backgrounds working in registered nursing and midwifery roles in the NHS are facing ‘especially high’ rates of discrimination and bullying from their colleagues, new data has shown.
NHS England’s latest annual report into race equality across the health service about career progression or promotion, as well as discrimination and harassment, bullying and abuse faced by staff from minority ethnic backgrounds, has been published this week.
And in chapter’s dedicated to the nursing workforce specifically, it was suggested that nurses and nursing assistants from BME backgrounds, and white nurses and nursing assistants recruited internationally, ‘tend to have poorer experiences of working in the NHS’.
The NHS Workforce Race Equality Standard (WRES) for 2023 saw some progress, with the number of black and minority ethnic staff working at senior positions in the NHS now higher than ‘at any point in history’.
Minority ethnic representation at very senior management pay bands has increased by 62% since 2018 – from 201 to 325 people in 2023.
However, BME representation was ‘highest’ at Agenda for Change (AfC) band 5, the base grade for registered nurses.
‘BME representation above AfC band 5 falls dramatically to 23.0% at AfC band 6 and 17.8% at AfC band 7, pay bands that include charge nurses and nurse managers,’ the WRES report added.
In terms of career progression, at 76% of NHS trusts, white applicants were ‘significantly more likely than BME applicants to be appointed from shortlisting’ – up from 71% last year.
And just 39% of staff from a black background felt their trust provided ‘equal opportunities for career progression or promotion’.
The data set also draws on findings from 2022’s NHS staff survey results, sparking fresh concerns about discrimination and abuse faced by colleagues from minority ethnic backgrounds.
In 2022, women from black and minority ethnic backgrounds (28%) were ‘most likely’ to have experienced harassment, bullying or abuse from other staff over a year period.
This was a trend the report said has been evident ‘since at least 2015’ and that was ‘especially evident’ for black and minority ethnic women in registered nursing and midwifery roles (31%), general management (30.5%) and medical and dental (33%).
In addition, women from BME backgrounds (17%) were also the ‘most likely’ to experience discrimination at work from colleagues in 2022. Rates were also high for men from Black and minority ethnic backgrounds (14%).
The report flagged that levels of discrimination from other staff were ‘especially high’ for women from BME backgrounds in registered nursing and midwifery (19%) and general management (20%).
Women from BME backgrounds (31%) were also the ‘most likely’ to have faced harassment, bullying or abuse from patients, their relatives or the general public.
‘However, amongst registered nurses, White men (43.0%) and BME men (42.9%) were more likely to experience harassment, bullying or abuse from patients, their relatives or the general public than their female colleagues; with a similar trend apparent amongst nursing and healthcare assistants for white men (49.8%) and BME men (43.5%),’ the report added.
‘Poorer experiences’
The report also explored specific experiences of internationally and domestically recruited nurses, midwives and nursing assistants, based on ethnicity – also drawing on the NHS staff survey from 2022.
‘Black British nurses, midwives, and nursing assistants and those from “other” backgrounds were most likely to suffer discrimination from staff,’ the report said.
‘Levels were also high for nurses, midwives, and nursing assistants from all BME backgrounds and from “other” white backgrounds.’
In addition, Black British nurses, midwives, and nursing assistants were ‘least likely to feel that their organisation provides equal opportunities for career progression or promotion’.
‘Levels were also low for nurses, midwives, and nursing assistants from all BME backgrounds and from “other” white backgrounds,’ the report said.
It added: ‘In summary, amongst nurses, midwives, and nursing assistants, the largest part of the NHS workforce, BME staff and staff from “other” white backgrounds have poorer experiences of working for the NHS than their white British colleagues.
‘This inequality is most marked for black staff who feel the least equality of opportunity and are most likely to be victims of discrimination.’
Professor Pat Cullen, RCN general secretary and chief executive, said: ‘Discrimination in the NHS is systemic – and it’s clear the health service still has a long way to go in overcoming the prejudices that both patients and staff face.
‘It’s promising to see some progress – including an increase in the number of black, Asian and minority ethnic staff at senior manager level – but it is not nearly fast enough, and the NHS can ill afford to waste more time moving at this glacial pace.’
Pointing to concerns around career progression or promotion, she added it was ‘clear that much more needs to be done’.
‘The NHS must urgently hasten the pace of change,’ said Professor Cullen.
‘The RCN is determined to end race discrimination against our members and we are urging the NHS to commit to implementing properly supported anti-racist strategies.
‘It must now seek to disrupt these seemingly entrenched patterns of inequality and embed robust and racially-just processes and cultures that enable every member of staff to thrive.’
The NHS Workforce Disability Equality Standard
The publication of the WRES comes alongside that of the NHS Workforce Disability Equality Standard (WDES) report which found only 35% of staff with a disability reported that they ‘felt valued for their contribution’.
Overall, data included within the report showed 5% of staff (70,866) declared a disability on the electronic staff record as of 31 March 2023 – an increase of 20% from the previous year.
A third (33%) of staff with a disability reported having experienced bullying, harassment or abuse from patients, according to the dataset. In comparison, 26% of staff who were not disabled reported experiences of bullying, harassment or abuse from patients, service users or the public.
Meanwhile, 16.1% of staff with a disability – compared to 9.2% of non-disabled staff – reported facing harassment, bullying or abuse from managers.
And one in four (25%) of staff with a disability had experienced harassment, bullying or abuse from colleagues – compared with 16.5% of non-disabled staff.
Other findings suggested the relative likelihood of a job applicant with a disability being appointed through shortlisting had improved from 1.18 in 2019 to 0.99 in 2022.
According to NHS England, ‘this suggests disabled and non-disabled applicants are equally likely to be recruited to the NHS’.
Just over half (52%) of staff with a disability believed they had equal opportunities for career progression or promotion – up around 1% from 2022.
And around three-quarters (73%) of staff with a disability felt their employer had made ‘adequate adjustments to enable them to carry out their work’.
Professor Cullen from the RCN added: ‘A third of disabled staff reported having experienced bullying or abuse from patients, service users or the public.
‘This is notably higher than for non-disabled staff and that difference has remained steady over the last five years. It’s simply not good enough.’
Also responding to the two reports, Dr Navina Evans, NHS England chief workforce officer, said: ‘There are some positive improvements in this year’s WRES and WDES data, including a higher number of people in senior positions in the NHS being filled by people of ethnic minority backgrounds and disabled colleagues.
‘But we know there is more to do, and with the NHS workforce more diverse than at any point in its history progress is particularly critical.’
She pointed to the NHS’ Equality, Diversity and Inclusion improvement plan which she said ‘sets out targeted actions to address prejudice and discrimination in the workplace, including making sure every NHS board and chief executive has a measurable objective to improve the experience of staff’.
Health and social care secretary Victoria Atkins added: ‘I want to see the NHS recruit and retain brilliant people from all backgrounds.
‘It is important that the NHS at all levels represents the people it cares for, and I welcome progress in appointing more black and minority ethnic staff to senior positions and better representation of disabled people in the NHS workforce.’
