If I told you that the main reasons as to why the NHS is fragile and fails to create the best health service to everyone in the UK is because white people need to think more about racism, you would have probably raised an eyebrow. Yet, according to Aishnine Benjamin, an Equality, Inclusion and Culture lead at the British Medical Association, this is something which needs discussing. The blog post begins by advising to read Robin Diangelo’s White Fragility, then offering ‘tips’ and links to research in efforts to assist white people in better understanding the racial biases that presumably exist in the NHS. The blog post ends on the authoritative tone, “diversity isn’t a fun to have, it's a must have” suggesting that inclusion and diversity is a vital requirement to improve our national health service. I, however, am not convinced that this makes it accessible to many people from all walks of lives and backgrounds. 

When scrutinised, diversity and inclusion roles in the NHS contain huge annual salaries ranging near to six figure sums which may appear unjustified compared to the salaries of NHS nurses and carers, who are on average paid less than £30,000 annually; especially when you consider nurse and carer roles being more demanding in hours and jobs that need to be undertaken to sustain the NHS. Secondly, when acknowledging the workforce of the NHS, one in five of its workforce is BAME, where 30% of its medical staff is Asian compared to 50% being white.  In other words, despite claims that stressing diversity and inclusion is vital, it would appear hard to grasp their claims in the context of these statistics. As far as I am aware, the solidarity of the workforce is built on the solid principle that universal health care and caring for those who cannot care for themselves is what should be the functional basis of the NHS and not based on the demographic or colour of someone’s skin.

Although, as much as the statistics might challenge the consensus of diversity and inclusion roles in the NHS, it would be wrong to assume that the NHS does have an image problem when it comes to BAME representation. Vaccine hesitancy is high among some enthic minorities- particularly among Pakistani and Bangladeshi groups in the NHS - suggesting there is a growing distrust affecting the NHS’s ability to reach out to certain minority groups. Some of this has been claimed due to underrepresentation of minorities in health and clinical trials, socioeconomic and location problems, and history of unethical health practice in black populations which as sown mistrust in the health service. Although vaccine hesitancy among BAME groups should be concerning (and many efforts have been put in place to make sure vaccine hesitancy is in decline), solutions through the lens of diversity and inclusion should not be the correct way in fixing the image problems the NHS faces simply as it myopically does not factor in various implications resulting in the image problem to begin with. Persisting in this way may fault thinking critically and openly, even by looking into statistics around the NHS without applying reseasoned, contextual understanding. 

For instance, it was reported last year black mothers were statistically  four times more likely to die from health complications during pregnancy or child birth  compared to white women with the report pointing out disparities in socioeconomic and race factors playing part into it. Thereby, it would appear at face value that the health service is drastically failing to provide a substantial service to aid black mothers in desperate times, hence rising maternal mortality rates.  While the figure is true, I feel such statistics are poorly used and do not reveal the full picture. 

When looking at the statistics in absolute terms, it shows that the latest figures on maternal mortality are an incredibly rare occurrence in the UK. In 2016 to 2018, 34 black women died among every 100,000 giving birth, while 15 Asian out of 100,000 and 8 white women out of 100,000 died among giving birth. When contextualising the statistic further, and while every death is of unfortanance, we know that this is not a widespread issue. Due to the small numbers these reports are working with, it is hard to determine or conclude the overall health and predictable likelihood of black mothers (or even any enthic background) dying during or post-child labour. Many of the issues can stem from various health complications prior to pregnancy all the way to socio-economic backgrounds, but nothing is certain as to why this is happening. Prof Marian Knight, the lead author of the MBRRACE-UK report, even stated that while “maternal mortality is uncommon so while there is an unacceptable racial disparity, even for black women the rate is low'' confirming that while there is a disparity, maternal mortality is not on the raise or an epidemic which ethnic minority mothers need to fear. More comprehensive research needs to be done.

Highlighting these aspects into why the NHS may be failing, BAME groups should not be solely solved through the language of diversity and inclusion purported by certain individuals who seek to racialise problems. Although there are no doubt incidences of prejudice and racism that occur within the NHS and should not be discarded to protect its image, this should not extrapolate into a systematic problem which must force doctors and nurses to speak out against the discrimination and bigotry which does not exist on a grand scale in the NHS.  Overall, it will seek to cause more mistrust among groups and create more division than healing problems founded in the health service. Rather, a more humanist and rationalist approach into reaching out to those who are hesitant in entrusting into a health service that can save their lives is crucial. Enabling progress and discussions against a racialised view of the health service could foster solutions to render resolve into dire need of financial support and structural change which may prevent such progression

Instead, wider discussions regarding treatment and wider discussions that affect those who have not been treated correctly in the NHS is needed – and complex questions need to be addressed. But that should not be done solely through the language of diversity and inclusion and emboldening racialised thinking. 

Callum Breese is a columnist for The Equiano Project.

Follow Callum on Twitter: @BreeseCallum