Last year I wrote a blog for Black History Month. In it, I reflected on the difficulties faced by black and other minority health care practitioners and the role of regulation there. I set out how the Authority was planning to address its role here. So what has happened since?
First, let’s look at the Authority’s work. We commissioned an audit of our work and culture from Derek Hooper. The audit identified a number of areas where the Authority needs to take action. These range from looking at our internal HR processes to much more ambitious but necessary work to look at our internal culture to ensure that it is truly inclusive and welcoming and to establish a vision for the Authority’s work. We need to do more to understand what diversity means for us and what our role is in the health and social care system.
We need help to achieve this, which is why I’m delighted that we’ve appointed Mehrunnisa Lalani to work with us as our EDI adviser. Mehrunnisa was Head of Inclusion at the Solicitors Regulation Authority and works with a number of health care and regulatory organisations. I’m confident that she will help us make sure that our culture fully supports diversity and enables us to develop work to improve the position for minority or marginalised sections in the system.
In the meantime, regulators have continued to do work to address concerns that we’ve raised about their approach to EDI: the General Chiropractic Council and the Health and Care Professions Council have begun initiatives to improve their understanding of the diversity of their registrants. These are welcome.
The General Medical Council also published research about the fairness of part of its fitness to practise process – its internal decision-making about how cases should progress. This showed that decisions were being made in accordance with their guidance. That is very reassuring as far as it goes. However, guidance often involves a range of possible outcomes open to the decision-maker. So it may be that it would be within the guidance for the case examiner either to decide that a warning can be issued or that the matter should be referred to the Medical Practitioners Tribunal Service. The research didn’t address whether there was any difference in the types of the outcomes for different groups. We need to understand more about whether different minority groups are more at risk of decisions at the more serious end of reasonable.
The Nursing and Midwifery Council referred a case to us where a nurse had made seriously racist comments and it was concerned that its recommendation for a suspension had not been sufficient to protect the public. We agreed and have referred the case to the court. We understand that the NMC is looking at its own processes to learn how the original recommendation for a sanction was reached.
For us, the case raised a question that the NMC’s and, indeed, other regulators’ sanctions guidance do not expressly deal with the inherent seriousness of racist behaviour. They quite rightly expect that dishonesty and sexual misconduct should be treated very seriously by the fitness to practise system. Shouldn’t racist behaviour be regarded as being at the same level?
We’re in discussions with the regulators about how we can take work in this area forward and generally to get a full picture of how racism in the healthcare system affects both patients and other registrants.
One of our less known areas of work is that we advise the Privy Council that regulators’ processes appointing their Council members are robust and fair. One of the strong concerns is that these Councils are not very diverse and that, despite efforts to encourage black and minority ethnic candidates, they are not appointed, and are often not well-represented at long-listing stage. It cannot be encouraging if, having taken the trouble to apply, you do not see people from your community progressing beyond that stage.
We all need to do more to address this and we’ve been impressed by Council ‘apprenticeship’ schemes adopted by the NMC and HCPC, where individuals from under-represented groups are able to participate in Council meetings and shadow the Council’s work. We are looking at the idea ourselves because it ought to enable these candidates to gain experience and credibility for competitions in the future. It is, however, essential that this approach actually translates into more successful candidates from these groups.
Black History Month is an important reminder of the contribution black registrants have made to our health care system and that they and patients still suffer serious disadvantage which needs to be addressed. Many events in the last year have shown that there is still a mountain of work to do to address the attitudes and the discrimination they still face. We could have done more in the past. We’re going to address that now.