Racism in medicine - are things getting better?

Five years on since The BMJ’s special issue on racism in medicine, and a global pandemic, the landscape is very different, but has racism in the NHS and UK medicine got better or worse?

In 2020, a BMJ investigation found that UK medical schools were failing to deal with complaints of racism. Another round of requests to the UK’s 46 medical schools has now found that eight in 10 (34 of 41 that responded) are collecting data on complaints about racism, up from half in 2020. And the number of complaints logged has risen to at least 138 in five years, compared with just 11 between 2010-20.

Some 83% of medical schools also said they had adopted the British Medical Association (BMA) charter and guidance for students to prevent and effectively deal with racial harassment. 

It’s hard to say whether this rise is significant as there’s no comparable data about racial incidents reported among ethnic minority undergraduates generally, writes Gareth Iacobucci, Assistant News Editor at The BMJ. But the number of 138 seems small, especially as almost half (49%) of the UK’s 50,000 or so medical undergraduate students are from ethnic minority backgrounds. 

Even still, it is a sign of progress, said Olamide Oguntimehin, a resident doctor working in Kent. “While the increase in complaints may seem concerning at first glance, it could also indicate that people feel more confident to report it because they trust or hope that there'll be action taken or support provided as a result," she said.

Ria Bansal, the BMA medical students committee co-deputy chair for student welfare, and a fourth year at University of Nottingham, also told The BMJ that since 2020, she felt racial harassment and racism had become less of a “taboo topic,” and that grassroots activism from ethnic minority students and doctors was holding medical schools more accountable. 

But Lois Haruna-Cooper, associate professor at UCL Medical School, said that despite efforts to support students who wish to make complaints, underreporting is definitely still an issue, particularly on clinical placements. 

The latest figures support this, showing that while most schools have published protocols for dealing with students’ complaints about racism or harassment within university grounds, these typically do not cover students working on placements in hospitals or GP practices. 

Haruna-Cooper said she has mixed feelings on how much improvement there has been in tackling racism and racial harassment, and added that success won’t come from medical schools taking action in isolation.

In an accompanying debate article, Mala Rao, Director of the Ethnicity and Health Unit at Imperial College London, says there are many shoots of hope.

For example, she points to initiatives that are transforming workforce experience, opportunity and performance for specialist, associate specialist, and specialty (SAS) doctors and locally employed doctors - most of whom are international medical graduates, and a landmark move to make inclusion a key condition for National Institute for Health and Care Research (NIHR) funding for health research.  

What’s more, there’s been a modest increase in ethnic minority representation in medical leaders on the NHS Board, in NHS Trusts, and at some medical royal colleges.

Changes to clinical practice that have previously undermined diagnoses and care of ethnic minority people are also evident, she writes, while the then NHS CEO Simon Stevens' empathetic leadership in announcing his support for the launch of the NHS Race and Health Observatory (RHO) in 2020 “inspired an upsurge of activism and leadership at the front line of healthcare.”

She acknowledges that true equity across ethnic groups will take many years to achieve, but says “the NHS landscape has changed beyond recognition, and action to root out racism and discrimination is stronger than ever.”

But Victor Adebowale, Chair of the NHS Confederation, argues that five years on, there has been change - but not enough.

He acknowledges the work of the RHO, but says “failures to tackle racism in medicine, healthcare, and the NHS are still too prevalent for me to say that we’re making anything like enough progress.”

He points out that the NHS and healthcare don’t exist in a vacuum and warns that recent events in the US - and indeed the mood in Europe - risk reversing the small gains made in healthcare and in society in general, with many pushing back on equity, diversity, and inclusion (EDI) programmes and a rise in general “anti-woke” sentiment. 

He also highlights a persistent lack of accountability from those at the top ... “with the resulting racial inequity and inequality ranging from cancer outcomes to mental healthcare.”

While he can see small signs of improvement, he says “the needle isn't moving quickly enough, and it may start going backwards as leaders respond to the prevailing societal and political winds.”

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