Six months ago Aisha Okafor (not her real name), in her 30s, was ready to quit her job as a nurse and leave the NHS.
“I got to the point where I thought [nursing] wasn’t for me anymore, where I forgot what I was doing here – which was to care and look after the service users. I was starting to lose that motivation,” she says.
The reason? Okafor, an employee of South London and Maudsley NHS trust (Slam), says she was tired of being ignored, criticised and treated with contempt by colleagues because of the colour of her skin.
There have been many obstacles in her career so far, she says. But there is one that stands out. On her first day of a secondment, she believes the ward manager blanked her and later dismissed her in front of everybody when she tried to introduce herself in a meeting. Okafor said the ward manager avoided her and would sit with two white colleagues at lunch, with no physical space for her to join them. There was one other black nurse and Okafor suspects the pair were kept separate, working different shifts.
She remembers: “The ward manager said she found me intimidating and told me I needed to think about how I approach things – there were no examples. It was more about that person and how they weren’t comfortable with diversity. That experience really upset me.”
Racism and unconscious bias is a problem in the NHS. There are 1.4 million people who work in the health service. Twenty percent of staff are from black and minority ethnic (BME) backgrounds. Forty percent of hospital doctors are from BME backgrounds and 20% of nurses and midwives, rising to 50% in London. Yet across 234 NHS trusts in England there are only five BME chief executives, 37 medical directors and seven directors of nursing.
What’s more, BME staff are more likely to experience discrimination and bullying in the workplace than their white colleagues, and are disproportionately involved in disciplinary proceedings.
Catherine Gamble, head of nursing education, practice and research at South West London and St George’s NHS trust (SWLSTG), had seen this play out in her career and decided to do something about it. She says: “I’m not from a BME background but I felt deeply uncomfortable that our service users were perhaps not getting the service they should expect. My hypothesis is if you have more diversity in senior management roles, you’re more likely to have inclusive patient care and an understanding of the issues of the community we serve.”
Although the trust saw leadership and professional development as a priority, having a separate programme for BME staff was not. Gamble put in a bid to the Burdett trust for nursing and won a grant of £176,000: the money allowed her to set up a steering group involving the local university, which would provide teaching and supervision, patients, carers, and senior representatives from the Royal College of Nursing and others. The programme was spearheaded by people from minority ethnic backgrounds and there were focus groups with staff to find out what they needed.
The resulting Burdett BME nurse development programme, which offers six full-day sessions over six months, is now on its second round. On the first day participants have an hour to express their frustrations and explain why they are there, before they are told their experiences are the norm and that people in high positions have been through the same.
Judith Francois, a senior lecturer with a particular focus on leadership and management at Kingston University and who helps run the programme, says: “This is part of the journey. This is where we are in 2019 – [it’s been] 70 years since Windrush and we’re still fighting for directors of nursing. What we’re saying is, this is how you survive and succeed in this environment.”
The programme features games based on exploring management theory, and exercises where participants are encouraged to think about themselves and what they bring to their job. They also receive one-to-one coaching and must come up with a project they can implement in their jobs.
All this had an impact on the first cohort. Within six months, half of the attendees showed a desire to progress in their careers by applying for new roles. All 18 people who submitted applications were shortlisted, and 14 of them were successful. One of them was Simon Arday, 30, who is approaching the end of his Darzi fellowship, which he would never have applied for had it not been for the programme. “For me one of the biggest parts has been about finding my voice. I know how much this programme enabled me to do that,” he says.
The first programme made such a positive impact that SWLSTG decided to team up with Slam to fund a second round. The scheme is part of a wider programme at Slam to help BME staff and explore why there aren’t many in senior positions. Beverley Murphy, director of nursing, explains: “It’s really impactful to hear our BME staff talk about the weathering impact of working in public organisations including our own and how they feel overlooked and that they don’t have the same opportunities … It’s shameful, absolutely shameful.”
This time the funding for the programme amounts to around half the original amount provided by the Burdett trust. Gamble explains: “Since 2010, continuing professional development money has been cut, in some cases up to 30-40% for nurses’ development. The fact that the directors of nursing [at the two trusts] have funded this is a demonstration that they see the value of it.”
Its future is far from certain, but for now it’s still having a huge impact. Okafor, who was initially sceptical about the programme but has now decided to stay in the NHS, says : “This course has helped me … I’m confident now.” She’s set herself the goal of applying for a more senior role within six months, and her ultimate dream is to have a job that would allow her to work in improving diversity. “I think it’s time we call things what they are,” she adds. “If we think there’s institutionalised racism, let’s call it what it is.”
