A bad case of chronic prejudice

Despite previous attempts to address the problem, racism persists in British medicine, reports Gina Agarwal

As we approach 2000, Britain can be said to be a truly multi-cultural society. At present, about 5.5 per cent of Britain’s population is not indigenous.¹ For a long time, the NHS has been a major employer of ethnic minorities; approximately 23 per cent of NHS staff are from an ethnic minority.² While we all know that racism exists, in the NHS it can, potentially, be more serious than in other contexts. The issue is often ignored or glossed over and given a ‘minority’ status.

A recent BBC2 programme on ethnic issues (East) focused on racism in the NHS. It highlighted areas of discrimination that had long been suspected by many people and, indeed, had been researched and the findings published. In 1992 a study was carried out by Drs Sam Everington and Aneez Esmail. Identical CVs with either Anglo-Saxon or Asian sounding names were sent for consideration for prospective junior hospital posts. Significantly more CVs of Anglo-Saxon sounding applicants were offered interviews. The researchers concluded that in selection procedures for interviews, panels were deliberately discriminating against candidates with Asian sounding names.

As disturbing is the way the researchers were harassed after hospitals realised their discrimination had been exposed. Although all the personnel departments were politely informed that the candidates who had been offered interviews would not be attending, they discovered that bogus candidates had applied. The Fraud Squad was contacted and both doctors were arrested and questioned. In trying to establish whether there was a lack of fairness, the doctors inadvertently became wrong-doers themselves.

The study was published in the BMJ, which is a widely read and highly regarded academic journal.³ As a result, the NHS Executive decided to implement racial monitoring as a standard procedure for all NHS trusts recruiting new employees. Five years later, in spring 1997, the research was repeated. The results were extremely disappointing: only 5, out of the 50 NHS trusts sampled, were operating any equal opportunities monitoring. Discrimination on the basis of names still existed, and of 100 interviews offered to doctors of Anglo-Saxon origin, 70 only were offered to applicants from an ethnic minority.

It is idealistic to hope that racism will cease in Britain. It is not idealistic to expect fair treatment in a country where you have been born, educated and lived all your life. This is how many young doctors will see the situation. One in five medical students is from an ethnic minority background. As members of the NHS and the medical profession, we cannot allow unfair recruitment practice. If we do, it will ultimately be reflected in the quality of care we give our patients.

In a multi-cultural society, the distribution of doctors from ethnic minorities should be representative. At present, about a quarter of GPs are from an ethnic minority. This may be due to the influx of doctors from the Indian subcontinent and the Caribbean who filled the NHS doctor shortage in the 1960s. Although not specifically trained for general practice, many opted for this career. In the light of Everington and Esmail’s research, it is not hard to see why: if you are consistently refused hospital posts, then moving up the career ladder of hospital medicine becomes impossible.

The situation has improved dramatically since the 1960s, but it can be improved still further. We owe it to medical students, and patients, to improve the system. Eight years ago, certain London medical schools were exposed as having unfair admission policies also based on names, not merit. There have been claims of unfair treatment by the GMC of foreign doctors undergoing complaints procedures.

Now that some significant academic research exists, isn’t it time the issue was formally addressed? I would like to see racism being given a wider platform for discussion and more research opportunities. Working parties need to be set up to implement change and monitor progress. And then perhaps, when the next batch of research is conducted at the beginning of the millennium, we may begin to see that the issue is at last being tackled.