A few years ago, many people were unfamiliar with the term ‘adultification’, which “is when notions of innocence and vulnerability are not afforded to certain children… by people and institutions who hold power over them” (Davis, 2022).
However, the term now forms part of the safeguarding children vocabulary. This follows the publication of a safeguarding children review into an incident that took place in east London in December 2020 (Gamble and McCallum, 2022).
“The foundation of safeguarding all children, regardless of race, is ensuring that they are protected from harm, listened to and heard”
The review detailed how a criminal justice – as opposed to a safeguarding children – response led to the strip search of a Black 15-year-old girl (‘Child Q’) while on her period in a school by the Metropolitan Police. Two of the findings were that Child Q was not treated as a child but as a deviant adult, and that racism – whether intentional or not – was an influencing factor to the manner in which the girl was treated (Gamble and McCallum, 2022).
This incident sent shock waves across the country, and rightly so. Questions I have been asked relating to the case include: “I thought schools were safe places with safe people who kept all children safe?”
While critical fingers were pointed at the police and teaching staff, the questions I would like to pose to nurses are: Do similar incidents happen in healthcare settings? Are we blind to the injustices and lived experience of Black children? What action would you have taken to ensure that Child Q was safeguarded?
Some may feel that the term ‘institutional racism’ is overused, but we live in a racialised society and the way we respond to and interact with people who do not look like us is influenced by our primary and secondary socialisation.
There are many behaviours by some White colleagues, such as – but not limited to – stereotyping of Black people, unconscious biases, and overt and covert discrimination, which have to be consciously unlearnt. The foundation of safeguarding all children, regardless of race, is ensuring that they are protected from harm, listened to and heard, so that prompt action is taken if there are concerns about their safety and wellbeing.
Often nurses are the first health professional patients build trusting relationships with. Professional nursing guidance places emphasis on dignity, compassion, kindness, respect, recognising diversity and upholding human rights as the cornerstones of good nursing care (Nursing and Midwifery Council, 2018; Royal College of Nursing, 2010).
In addition, since the Child Q case there have been renewed efforts in the NHS at a strategic level that acknowledges that “Race inequality is a blight on our society. The effects of racism can be seen across society, in the NHS and also at NHS Providers” (NHS Providers, nd).
Unfortunately, the experience of Child Q clearly indicates that all children are not equal. The following questions may make you feel uncomfortable, and you may not have reflected on these issues before, but my challenge to all nurses – particularly my White colleagues – is to consider:
Does the race of your patient influence the care you provide? Do you consider the contextual issues that impact on the lived experience of Black children when you assess their needs and consider the risk of harm and action you need to take to keep them safe? Do you think that Black children are more resilient and streetwise, so prompt action is not needed to keep them safe? Are you the child’s advocate – do you see and hear them? What would you do if you saw or heard a fellow nurse using racist language to describe a patient or dismiss their concerns? Will you have the difficult conversation and challenge them, or will fear, or hierarchy, make you stand back in the hope that someone else will deal with the matter?
The formal emerging culture of most NHS organisations is to have or develop anti-racist statements, strategies and action plans. However, I strongly believe that one of the ways to tackle racism is to change the informal culture in healthcare by challenging the behaviours of racist care givers with effective sanctions, such as disciplinary investigation.
The only thing I ask you to do in the face of blatant racism and injustice is to speak out.
Marcia Smikle is head of safeguarding children, Homerton Healthcare NHS Foundation Trust
Davis J (2022) Adultification Bias within Child Protection and Safeguarding. Her Majesty’s Inspectorate of Probation.
Gamble J, McCallum R (2022) Local Child Safeguarding Practice Review: Child Q. City & Hackney Safeguarding Children Partnership.
NHS Providers (nd) NHS Providers Anti-racism statement. nhsproviders.org (accessed 2 May 2023).
Nursing and Midwifery Council (2018) The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates. NMC.
Royal College of Nursing (2010) Principles of Nursing Practice. rcn.org.uk (accessed 2 May 2023).