Black History Month provides an opportunity to reflect on how black and, indeed, other people from minoritised communities are treated by the health and social care system and the regulators. The Windrush Generation provided huge support to the NHS, and it is unacceptable that the system seems to discriminate against them providing yet another challenge to Black lives.
The BMJ recently reported on a survey of Black peoples’ experience of life here. Among the findings, 65% of respondents said that they had experienced discrimination from doctors or other healthcare staff in respect of their medical care. This rose to 75% for black people aged between 18 and 34. Maternity care and diagnosis of special needs cause particular problems. Patients also said that they were simply not understood. Moreover, the King’s Fund and many others have found poorer health outcomes for members of ethnic minority communities in the UK.
We’ve noted this ourselves in our Safer care for all chapter ‘ No more excuses’ where we talk about inequality affecting patients and service users and that affecting registrants. There, we also identified the problems faced by practitioners in the system. These have been noted by the General Medical Council (GMC) for some originally arising out of the over-representation of BAME practitioners in fitness to practise proceedings. The GMC’s Fair to Refer report identified a range of cultural issues, particularly with employers, which lead to overseas and BAME doctors receiving poorer training, less targeted feedback, fewer opportunities to learn and working in environments which do not provide support for them to develop. Those environments may be more likely to apportion blame and use those doctors as scapegoats, leading to increased reports to the GMC.
It would be surprising if these problems were unique to the GMC. Indeed, the GMC has done a huge amount of work to understand and address the problems generally. We’re looking to see how our performance reviews of the regulators can encourage improvements.
When we introduced our original Equality, Diversity and Inclusion (EDI) Standard, we focused it on the regulator having an understanding of the make-up of its registrants and patients and looking at its own processes to ensure that they did not impose inappropriate barriers. We were aware that this was a relatively low bar, but recognised that the regulators we oversee were at very different levels of achievement in this area. After three years we’re now looking at the Standard again.
There’ve been some achievements in those three years. The bulk of regulators now at least have data about their registrants on which they can base assessments of the impacts of their process and their decisions and we’ve seen greater use of impact assessments and some very strong efforts among regulators’ staff to encourage diversity. But more is needed.
We’re now in a very different place and have a much greater understanding of the issues. We’re still in the middle of a review exercise of the new standards, but we’re already clear that we need to widen it so that our performance reviews encourage regulators to go beyond their own processes and target the right things. We need to look at:
- How regulators ensure that practitioners are equipped to deal with the diverse needs of patients from different backgrounds and needs – it’s not acceptable, for example, that they don’t understand about how different skin colours can impact on a patient’s presentation.
- How regulators make it clear that racism is unacceptable.
- How regulators work with employers and training bodies to address the cultural issues that can exist – not just those that lead to fitness to practise referrals but also that affect career progression.
- How regulators are approaching their public sector equality duty.
- And, of course, also ensure that regulators continue the work to keep their processes fair and open to all.
We are also currently consulting on strengthening our approach to Equality, Diversity and Inclusion with Accredited Registers and plan to introduce an EDI standard to the Standards for Accreditation. The deadline for responding is 17 January 2023 and you can find out more here.
It’s good that we’re now able to go further and be more ambitious.
Neither we, nor the regulators and accredited registers, can solve all the problems faced by Black patients and professionals. There are huge environmental problems. But we can influence and take steps to address part of that environment, so that we can show that Black lives do, indeed, matter.
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