An open letter to public health leaders and psychologists to embed anti-racism in the NHS

​July 2020


As Psychologists for Social Change we strive for a fairer, more just world, embedding this into the health, education, and care-related work that we do. We are deeply concerned about the links between racism and the disproportionate impact the COVID-19 pandemic has had on Black and Asian Ethnic Minority (‘BAME’) communities. We urge you to take timely, evidence-based action to reduce the harmful impact of structural inequalities on the health and lives of your ethnic minority staff and service users.

The rise in global consciousness of the Black Lives Matter movement has accelerated reflections on how centuries of White-privilege and colonialism within the UK continue to impact on communities racialised as ‘non white’. The increased harm from COVID-19  on these communities cannot be divorced from wider racial injustices. The narrative that paints People of Colour as being inherently predisposed to health conditions and suggestions that BAME communities may not be following government guidance masks the impact of socio-structural factors which underpin these inequalities. It is important, but not enough, to call for individual action. Instead, we must seek to radically transform the way power operates within our public services. We must scrutinise the policies, practices, and working cultures that frame our public services and commit to the hard work of transformation. 

We welcome the steps that many healthcare leaders have taken to reflect and foreground racism as an issue of direct relevance to delivering safe and high quality services. It is important that this is an ongoing process and supported by considered action to address the ‘what’, ‘how’ and ‘why’ of challenging structural racism and its entrenchment within our organisations. Anti-racist structures must be therefore be embedded in organisational and service redesigns. We must also recognise each of our professional histories and the ways in which this has perpetuated current structures. This is essential if we are serious about working towards collective and sustainable change as an anti-racist and just society. 

Working together to achieve this
We have set out actions by which healthcare organisations can hold themselves accountable to the changes that are needed within our public services if we are genuinely committed to working towards anti-racism. Some are based on examples of good practice we have seen recently by NHS organisations already beginning to redress these issues. We also call on our colleagues in psychological professions to begin and continue these conversations on structural racism and hold people in power to account, where it is safe to do so.

We urge you to:
  • Work towards implementing the suggested actions below to address structural racism in three key areas: the way public healthcare organisations are run, how we maintain the safety of our BAME staff and how we better meet the needs of those we serve
  • Use and circulate the summary poster of suggested actions
  • Invite and engage in conversations regarding the wider actions this open letter highlights with colleagues in all areas of your services
  • In support of the Build Back Better UK campaign; to pledge your commitment towards structural change with us on social media, using #structuralracism #structuralchange

1. Anti-racism in the way our organisations are run
The ’snowy white peaks’ of the NHS are ever present as White colleagues are still three times more likely to occupy positions of power in the NHS than their BAME counterparts. Where white-privileged perspectives dominate how our services are constructed and delivered, any individual-focused attempts towards anti-racism will be undermined. Instances of both overt racism and more covert racialised microaggressions that both professionals (Bawa et al., 2019) and ‘service-users’ (Sue et al., 2007) experience will continue until we can address racism more broadly (Making the difference: diversity and inclusion in the NHS).

Key actions to address these issues include organisational acknowledgement that racism operates structurally, committing to careful scrutiny of policies, and models of practice and interrogation of hidden biases and assumptions. Proactively facilitating  development of collaborative social structures to promote anti-racism and ally-ship within the organisation and connecting with local groups and movements working towards these objectives. This will be more effective than merely sending individuals to read resources on the topic. It is also key to recognise and acknowledge how ethnicity may intersect with other forms of privilege and oppression, including on the basis of gender, class, faith, sexuality, and disability. Finally, ensuring that there is sufficient representation from marginalised groups at all levels within the organisation is crucial, particularly for leadership positions, and the recruitment process needs to enable this. Though inclusion should be the direct and personal responsibility of the Chair of an organisation, having a properly resourced and workload allocated anti-racism guardian may facilitate implementation of anti-racist action to enable effective change.

2. Anti-racism in maintaining safety of  BAME staff
It is evident there have been a shockingly disproportionate number of deaths related to COVID-19 among BAME staff. Issues include PPE designed to fit the White male body, training in how to use it, and being disproportionately pressured to work on COVID wards. It is clear that adequate and appropriate PPE equipment must be sourced to safeguard the immediate safety of BAME staff. It is also important to acknowledge that 29% of NHS BAME staff experience bullying, harassment, or abuse from other staff and are over twice as likely to receive discrimination at work from a manager than their White staff. These issues need to be taken into consideration when designing and offering meaningful COVID risk assessments to BAME staff. Managers may feel under-skilled in offering such assessments sensitively and should be supported with training. There should be a clear invitation for BAME staff to have a supportive colleague or Union representative present or to support their request for an alternative member of the staff team to conduct the assessment, directly acknowledging the reality that racism will have occurred in the workplace.

To address the toxic effects of racism in our organisations we must listen and respond appropriately to staff from BAME communities without expecting them to educate or problem solve White privilege. BAME networks must be fully resourced and supported. We must also create safe, constructive, and compassionate working environments that are capable of offering reflective spaces for all staff that acknowledge lived experiences of racism. 

3. Anti-racism in meeting the needs of those we serve
Our services are less acceptable, helpful, and accessible to BAME service users. The ways in which White colleagues in the helping professions are socialised and trained negatively impacts their ability to offer anti-racist practices. This results in lower referral rates for ethnic minorities; greater perception of threat; more severe diagnoses; more restrictive and biased practices, such as being detained under the Mental Health Act and disproportionate referrals under counter-extremism policies; longer admissions; and worse care outcomes.
​
To address these issues we must have clear service processes, co-produced with ‘service-users’, where racist practice can be addressed safely and effectively; train staff to discuss and respond appropriately to disclosures of racism; and acknowledge where and how this may intersect with other forms of oppression. This also includes scrutinising working practices and take-for-granted knowledge from a White-privileged perspective and acknowledging how constructs such as ‘racial differences’ maintain structural racism.

We must act now
As COVID-19 and the Black Lives Matter movement has so painfully shown, racism is killing those from BAME communities at a disproportionately higher rate than White communities. We can no longer just stand against racism, we must work together with those in power to call in anti-racist action. We celebrate committed actions already underway to address these concerns, such as the ‘thinking space’ event addressing racism by the Tavistock Clinic and the Faculty of Public Health's event focused on embedding anti-racism into our public health practice. 

We look forward to hearing about the actions you take to address these issues and celebrate the lives you save by addressing #structualchange to end #structuralracism. The time to act is now.


​
Concrete actions we would urge you to rapidly undertake
Individual staff reflections on personal and systemic racism and White Supremacy:
Team reflection and action on racism and Whiteness within medical associate professionals and the impact this has on colleagues from BAME communities:
Actions to support the provision of more anti-racist therapy with clients who are Black, from Ethnic Minorities, and People of Colour:
Actions to support service accessibility, acceptability and delivery for Black clients, Ethnic minorities and People of Colour: