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Black History Month: regulation has a responsibility to promote equality, diversity and inclusion

Throughout this Black History Month, like many people, I’ve found it sobering to read the articles, stories and documentaries that have been produced to celebrate the contributions of the black community to our history. Doing so has challenged my own ignorance of black history in the community in which I live; a history of inspirational people who have been allowed to be forgotten and of atrocious treatment that has been ignored. We should not need a special month to be aware of this and the fact that we do demonstrates that we need to change as a society.

In healthcare, the black community is strongly represented in the workforce.  For example, 6.1% of NHS England’s employees are black, which is significant given that the community makes up 3.4% of working age population. However, this representation is not evenly split: there is a disproportionately low representation of black people working in senior positions in both hospitals and community services, particularly for doctors and nurses.

In respect of doctors as a whole, over a third are from black and other ethnic minority backgrounds and the GMC has been aware for many years that doctors from such backgrounds are heavily over-represented in fitness to practise proceedings. Black nurses and midwives make up 8.4% of the NMC’s register but are the subject in almost 30% of fitness to practise cases. As part of our scrutiny of regulators’ fitness to practise cases, I have identified cases where I have wondered whether the case would have reached the stage it did if the registrant had been white. But it is difficult to know whether the problem lay with the referrer or the regulator or the fact that the registrant was not adequately represented.

The Covid-19 pandemic adds a further concerning twist. People from the black and other ethnic minority communities are disproportionately affected by the disease. Many of those will be, themselves, the healthcare professionals who care for the patients and vulnerable people and so are at a high risk of contracting Covid. This is in addition to the health inequalities that already exist.

The reasons for these disparities are complex and this blog isn’t the place to analyse them.  However, a culture in which black and other minority communities have been marginalised must play a significant part. Many will blame others: regulators refer, probably with reason, to culture in the educational system, among employers and wider society for discrepancies in attainment and in fitness to practise. I don’t think that it’s helpful to assume that we are perfect or that, somehow, inequality is not our problem. It’s also important to recognise that, while the Black Lives Matter movement rightly focuses on the black community, there are other minority groups facing similar and different challenges. They need to be part of the picture.

So where does the Authority come in? We oversee the performance of the regulators, of whom a substantial number of registrants are black or from other ethnic minorities.

Our remit is to protect the public, which includes everyone, including those who face significant inequality in the healthcare system – a system where people from minority backgrounds are under-represented at a senior level. The public needs healthcare professionals who are competent and diverse. Regulators must be aware of the diverse needs of the community and the impact of the inequalities that we have. This applies both in how they expect their registrants to work with a diverse community, but also how their processes affect people from the different communities, whether as students, registrants or patients. We have a duty to require them to take diversity seriously and to examine how they do it.   

We have come late to this problem. It’s not until this year that we have formally examined regulators’ performance in respect of equality and diversity, though we had identified the issue and consulted on it from 2017. We haven’t looked at diversity as closely as we might have done in respect of our policies and processes.

We need also to make sure that we are doing what we can to promote diversity in the organisation. We’re small, but we must be able to demonstrate that we have a diverse, non-discriminatory and welcoming culture.

That’s why we’ve set up a working group to take action to improve our performance within the Authority. I’m keen that the group looks honestly at ourselves as an organisation to see what we can do about our culture and about the assumptions that we make. Perhaps asking why we are late to this is a relevant question. I want to make sure that our work in overseeing the performance of the regulators is properly informed and stresses fairness and equality, diversity and inclusivity. We’re looking to get expert help to support us, but what will be crucial is that, once the expert leaves us, we’re braver and more expert about diversity and inclusivity and in a position to lead and hold ourselves and regulators properly to account.

The killing of George Floyd and the Black Lives Matter movement have forced us to recognise the racial inequalities that still run deep in society today. Engaging with Black History Month brings greater emphasis to this.  And it needs to be addressed by more than words. By the time it comes around next year, I’d like to be a writing a blog that sets out achievements.

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Please note the views expressed in these blogs are those of the individual bloggers and do not necessarily reflect those of the Professional Standards Authority.