Migration, identity and belonging: people of colour and the NHS

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By Steve Gulati, Director of Elizabeth Garrett Anderson Programme
School of Social Policy, University of Birmingham

“The story of the NHS can be viewed through many lenses, those of social history, economic migration and political struggle, and also more personal stories of love, hope, fear and loss.”

The 72nd birthday of the NHS is a time for celebration and reflection. A celebration of the values that inspired its creation, of the countless lives saved or transformed, and a reflection on what the NHS means for us today and for the future. For people of colour, there is also another dimension – the story of the NHS is deeply intertwined with stories of migration, identity and belonging, and being part of British society.

Any discussion of race in the NHS is inevitably conflicted – much to celebrate and lament seemingly in equal measure. The contribution of people of colour, be they immigrants or subsequent generations, is increasingly well documented. Recording, reflecting upon, valuing and celebrating this is important in itself. As the current social movement around Black Lives Matter highlights, it is important to be informed about history and how we came to be where we are now – as Malcolm X asserted “If you give people a thorough understanding of what confronts them and the basic causes that produce it, they’ll create their own programme and when the people create a programme, you get action”. Of course, challenge and change can cause discomfort. Even if unintentionally, too often phrases such as “we are where we are” can be used to close down or discourage a truly reflective analysis of not just how we come to where we are now, but why.

Experiences of people of colour in the NHS

What is the story of people of colour and the NHS? It is a multidimensional – one of sacrifice, hard work in a challenging environment, a story of rewarding careers and public esteem, above all a story of service. In that respect, it is a tale that resonates thousands of times in the NHS. But for us, people of colour, it is also a story of struggle, inequality, wasted talent, sadness; according to Roger Kline, “the NHS is the largest employer of black and minority ethnic people, yet research shows the NHS treat black and minority ethnic staff less favourably in their recruitment, promotion, discipline and career progression”. In some ways, things are improving, with recent data indicating that every NHS Trust in London now has at least one black and minority ethnic (BME) Board member, as well as improvements, albeit from a low base, recorded through the NHS-wide Workforce Race Equality Standard (WRES). On the other hand, as citizens, health inequalities for BAME people remain pervasive, and the impact on BME citizens of the Covid-19 pandemic has highlighted a grim reality.

Looking back at the last 72 years

The story of the NHS can be viewed through many lenses, those of social history, economic migration and political struggle, and also more personal stories of love, hope, fear and loss. It showcases what is best about Britain, but also who and what gets valued, and who and what does not. And this is our present, as well as our past. International recruitment to the NHS continues to this day, with an ever increasing number of races and nationalities contributing to the NHS workforce, so this is about diversity and inclusion in a broader sense, as well as race.

So, we should be rightly proud of 72 years of the NHS, and rightly proud of the contribution to the NHS from the black and minority ethnic workforce. Just as there isn’t ‘one story’ of the NHS, so the experiences of BAME workers are also multi-dimensional. Of course, everybody’s story is important, valuable, unique – but one could argue that to hear the stories of us, people of colour, you hear the story of the NHS, with all its richness. That is indeed something to celebrate.

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