This series of articles will appear weekly and present my recommended Seven Survival Steps for black and ethnic minority staff working in the NHS, but may be a useful read to anyone with an interest in the NHS. The articles are excerpts from a forthcoming handbook, and provide highlights.
Survival Step 1 looked at Lining Up Your Defence and covered recommendations of the basics to have in place from at the outset of starting your NHS career.
Survival Step 2 - Write a new script committing to higher levels of engagement
Survival Step 2 is about developing a new mindset and telling a new narrative about the type of contribution black and ethnic minority staff can make to a modern NHS.
When the NHS started in 1948, it required a huge workforce to run the new hospitals, providing many new and diverse roles. Overseas workers from many different countries, encouraged by direct recruitment campaigns in their own countries by the British Government, rose to the challenge. In the UK, this development was greeted with a mixed reaction, for although the creation of an NHS free at the point of use was welcomed, the presence of foreign people in the UK, in increasing numbers, was not as welcome in wider society.
One of the main reasons for British mass overseas recruitment was that it was a source of cheap labour. This was a workforce that would be grateful for jobs, at the relative low pay and poor working standards and conditions. Britain also assumed the presence of a an inherited 'colonial mentality' where these workers saw it as natural that they, BME workers, should be working for white people, under whatever conditions that were set.
Hard work, in poor conditions, for low pay, was part of the deal between BME workers in the NHS and their hospitals and employers. It was a hidden clause, in an unwritten contract. This is what can be called the 'implicit inequality clause'.
Whilst many will argue that poor conditions was the experience of all NHS workers, which is true, this implicit inequality clause led to the concentration of BME workers in the less popular fields of healthcare such as mental health, learning disability, care of the elderly and night shift work. They also performed the most menial, lowest paid, and least prestigious jobs in the NHS such as cleaning and portering. BME workers were there to donate their labour for a wage, and that was as far as the deal went. The cream of the jobs, those in the most desirable and prestigious areas would go to white workers, and BME workers would play a servicing role, and serving role.
A good example of this was the two tiered nurse training which saw most black nurses placed on the lower level training programme (State Enrolled Nurse), from which it was not possible to be promoted, and white nurses placed on the more prestigious and advanced State Registered Nurse programme from which they could achieve the highest levels of seniority in nursing profession. Once courses came in to allow nurses to convert from the SEN qualification to SRN, black nurses struggled to get onto the courses. But while the structural racism in that scenario has gone, but its tentacles still reach into today's nursing profession.
BME NHS staff today face a bigger challenge which is to confront these attitudes and expectations in themselves. Too many BME NHS staff bolster and reinforce these attitudes and expectations of themselves. For example, each time a BME NHS worker declines to apply for a senior position because they feel they will not be successful, and that a white NHS worker is more likely to get it, they are bolstering expectations and self-expectations.
Self-belief and a sense of equal entitlement is a must for success for BME staff in the NHS.
The step that BME workers are recommended to take at Survival Step 2 is to commit to a higher level of engagement at an early stage in their NHS career, whatever their role or job. This means moving away from the self-belief that doing a job is solely about doing hard labour, no more, no less. There's nothing wrong with hard graft, but why leave it at that?
For example, if you are a hospital cleaner, take an interest in NHS Cleaning Standards, join in hospital wide cleaning audits, patient experience projects on hospital cleanliness and patient safety initiatives. Read about cleaning, write about cleaning Get prepared because, even though cleaning is critical to patient care and safety, you might want to do more than the actual mopping one day. From my observations, most hospital cleaners are black and ethnic minority, with the cleaning and Facilities Manager or Supervisors, and Directors of Estates and Facilities are mostly white.
Write a new narrative and engage at a higher level.
If you work in the caring professions, or are a technician or scientist the same tenet applies to you. Do the hard labour bit really well, but at the same time, commit to a higher level of engagement.
To commit to engage at a higher level, these are the steps you are recommended to do for yourself:
a) Government and politics - find out about the Government, the Opposition and their policies for the NHS. Learn about local politics - who's in charge locally and what are their policies, who are the local councillors, the MPs, their interests, and how do they engage with your organisation?
b) Read The Five Year Forward View - this is the agreed national plan for the NHS until 2020. You must talk about this at every interview you go to, whatever job and whatever level you work at in the NHS.
c) Become familiar with the NHS Workforce Race Equality Standard - new standards for race equality introduced into the NHS in 2015
d) Read the Health Services Journal regularly - ask your NHS librarian for online access
e) Participate in Social Media, just reading content as a minimum - Twitter, and Facebook are key for networking, and for fast sharing of news, information, debates and discussion
f) Websites to follow: Care Quality Commission, NHS Trust Development Authority, Monitor, and NHS England.
g) Read the quality national and local papers.
Every great dream begins with a dreamer. Always remember, you have within you the strength, the patience, and the passion to reach for the stars to change the world.