Caribbean nurses have secured a promise from health leaders in England that they will use their positions of power to address racism in the NHS and improve the experiences of overseas staff.
The Caribbean Nurses and Midwives Association UK (CNMA) hosted some of the most senior people in nursing and the health service more widely, at a conference today held at London South Bank University.
“I want to reiterate there is no place for racism in the NHS”
Chief nursing officer (CNO) for England, Dame Ruth May; Nursing and Midwifery Council (NMC) chief executive and registrar Andrea Sutcliffe; Royal College of Nursing (RCN) president Sheila Sobrany, and director of the NHS Race and Health Observatory, Dr Habib Naqvi, all joined the event.
It comes just over a month before the 75th anniversary of the arrival of the HMT Empire Windrush, which began the mass recruitment of Caribbean people into the British nursing profession when the NHS was founded just a few weeks after.
The event, titled Sustaining a global workforce now and beyond, heard how, 75 years on, another major recruitment drive of overseas nursing is taking place including from the Caribbean.
According to Dame Ruth, NHS England’s annual overseas recruitment was between 5-6,000 in 2019 and now that had increased to around 20,000 per year.
However, CNMA president Paulette Lewis, who was chairing the event, said the new influx of overseas nurses had not been matched with an equal improvement to the experience of Black NHS staff.
Dame Ruth reiterated comments she has previously made about the need for the NHS to become not just non-racist, but an overtly anti-racist organisation.
She explained that while progress had been made, with glass ceilings being “shattered”, there was still a long way to go.
“It’s not just all about international recruitment,” she said. “It’s about how we support nurses who are here.”
Dame Ruth referred to her upcoming CNO strategy, which will include consultation on how to tackle racism in the health service, particularly that aimed towards nurses.
She pointed to the recent case of Michelle Cox, a Black nurse who won a landmark employment tribunal against the NHS which ruled she had been the victim of repeated institutional racism.
She continued: “We let down Michelle Cox, we let her down. But she is not the only case.
“Just this morning I was supporting five nurses, from the global majority, and I want to reiterate there is no place for racism in the NHS.
“But we need to go further and to be more about ant-racism. We must make those steps.”
Ms Sutcliffe, who leads the regulator of the profession, described a “worrying backdrop” of intolerance from some sections of the public towards marginalised groups.
She said: “We need to recognise that and acknowledge there is a problem. So, what can the NMC do about this? We can start with improving our regulation.”
Ms Sutcliffe said the NMC was aware that employers “disproportionately” refer Black nurses and midwives to fitness to practise (FtP) procedures.
“We’re feeding that back to employers,” she said. “And trying to make sure that doesn’t happen is very important.
“But we also have to look at ourselves, and how we make our decisions on which cases to take forward.”
The NMC was also working to reduce its long backlog of FtP cases, noted Ms Sutcllife.
“It’s not going down as fast as I’d like, and because of the disproportionate referrals it is affecting people from the global majority more than White counterparts,” she said.
It had also been using cultural competence training and was bringing anti-racism to its way of working.
Ms Sutcliffe further said that she wanted the NMC to be a “role model” for the rest of the health service.
RCN president Ms Sobrany agreed that more needed to be done to support newly arrived nurses, some of whom were having “horrendous experiences” both within and outside the workplace.
She highlighted that internationally educated nurses formed almost half of the workforce.
If they “downed tools”, she said, the health service “wouldn’t function very well, it’d come to a grinding halt”.
“Some nurses are having horrendous experiences of being placed with racist people. Two nurses, recently, were placed in accommodation with a particularly horrible individual who set fire to the flat by blowing up the oven.
“That causes trauma. Those types of experiences are happening and we can’t ignore them.”
Meanwhile, Dr Naqvi said “urgency” was now needed in addressing inequalities facing both staff and patients.
He said: “To be proud of our NHS is to not be blind of its problems.
“We know diversity is not a precursor to inclusion. Higher up the Agenda for Change bands you go, the less likely you are to see people who look like us.”
He added: “We have deep-seated inequalities in health for our communities. For example, it can’t be right that Black women are two-four times more likely to die at childbirth.
“There is a level of urgency needed to focus on this agenda. Our healthcare system should be well-equipped to deal with this.”
“That causes trauma. Those types of experiences are happening and we can’t ignore them”
Dr Naqvi also acknowledged, like Dame Ruth, that this was “not a new problem” and that past responses had been “somewhat fragmented and confused”.
Marsha Jones, committee member of CNMA, asked the panel to promise they would use their “positional power” to do something concrete to tackle incivility, racism and the struggles of international nurses.
Ms Jones said: “You have heard all our issues today. My request transcends that.
“Can you use your positional power to acknowledge the issue, and include it in a national patient strategy plan?”
Dame Ruth said she would, and pointed once again to the Michelle Cox case as a point of learning for NHS England.
Also responding, NMC chief Ms Sutcliffe said: “I completely agree that incivility and racism has an impact on patient safety.
“No, it’ll impact on you and people you care for. The one thing we can do from the NMC in terms of setting that strategy is through the review of our code happening in 2025.
“I absolutely recognise my positional power, White privilege and ability to speak up. You have my personal commitment that we will act.”
The panellists also discussed the topic of ethical international recruitment, and described a two-way street of improving the conditions of those who come here, while also ensuring countries are not exploited and drained of qualified nurses.
Professor Laura Serrant, a nursing leader and academic who has held roles at NHS England and Health Education England, spoke after the panel session.
Professor Serrant said Black nurses were “sick and tired of being sick and tired”.
She agreed that Dame Ruth and the other leaders should step up but added: “We need to realise that while we are from small islands, together we are a majority.
“We can’t overly rely on other people to do what needs doing.”