Disproportionality in NHS Disciplinary Proceedings

Abstract

NHS England is the largest employer of black, Asian and minority ethnic (BAME) staff with people from these minorities comprising 14% of the NHS workforce (Archibong and Darr, 2010;Likupe and Archibong, 2013). While it is important that the NHS has the power to apply disciplinary procedures, ensuring that staff behave in a professional and appropriate manner, the evidence to date indicates that disciplinary procedures are disproportionately applied to BAME staff (Likupe et al, 2014;Seston et al, 2015; Royal College of Midwives, 2016;West et al, 2017). Staff from BAME backgrounds face discrimination during NHS recruitment processes (Kline, 2013), promotion (Esmail et al, 2007), representation during disciplinary procedures (NHS England, 2017, 2019 and bullying within the workplace (Kline and Prabhu, 2015). In addition, as evidenced by a UK report on the failings on patient safety and quality of care, there is a disparity in the treatment of BAME staff who report patient safety incidents compared to their non-BAME colleagues (Francis, 2013).

The do’s, don’ts and don’t knows of redressing differential attainment related to race/ethnicity in medical schools

“…Conversely, if dominant professional norms are rejected in this process of PIF, this could have an impact on attainment and progression through medical education and training. Direct evidence is lacking, but in many countries doctors from minority groups tend to receive disproportionately more sanctions or warnings than those identifying as from the dominant group [ 160 , 161 ]. Retrospective and prospective studies which examine patterns of performance and explore underlying reasons for differential attainment are needed.…”

Cultural competence as a technology of whiteness: race and responsibilisation in Scottish health and social care

“…Sehmi’s doctoral dissertation on the over-representation of BAME employees in the disciplinary process in a National Health Service Trust (2015) shows that BAME staff whose attitudes and behaviours did not conform to accepted norms were those most likely to be involved in disciplinaries, even where this non-conformity did not reflect a breach in performance standards. In this extract of an interview with an adult nurse in NHS England, Archibong et al (2019, p. 4) highlight problems of “misreading”:…”

“…Often, cultural competence training is promoted precisely as a means to ensure management awareness and sensitivity about racial bias. It is argued by Sehmi (2015) and Archibong et al (2019), for example, that a key factor in the inequality of punishment for poor practice is a lack of cultural competence at management level. However, as argued above, cultural competence only serves to reiterate essentialised cultural difference.…”

If I was minister of health I would prioritise addressing all health inequalities

“…Proposal 2: Addressing discrimination and systematic racism in healthcare Black, Asian and minority ethnic staff are more likely to be harassed by managers and subjected to disciplinary procedures by their Trusts, Royal Colleges and regulators. 11 In a survey with more than 2000 Black, Asian and minority ethnic health professionals, 50% felt discriminatory behaviour has played a role in the high death toll seen in COVID-19, with 20% claiming they have experienced it personally. 12 As Health Minister, I would give full consideration to the extent to which such fears prevented Black, Asian and minority ethnic clinicians from challenging managers over personal protective equipment or any disproportionate allocation to COVID-19 wards.…”