Review

A dose of reality

ETHNICITY, EQUALITY OF OPPORTUNITY AND THE BRITISH NATIONAL HEALTH SERVICE
Paul Iganski and David Mason
Ashgate Publications, 2002, £39.95

This is a shameful story — told without passion or excitement, but with a great deal of detailed evidence — of the complete failure of the NHS to tackle the well-documented problems of institutionalised racism and discrimination in the recruitment of staff over the last 20 years. It does not attempt to investigate issues relating to patients or the delivery of services.

For me, it is a bit too detached and lacking in political perspective, but the authors have done a thorough job, focusing particularly on recruitment to nursing schools. They demonstrate clearly how a large and complex organisation has completely failed to monitor the recruitment process. Complacent managers have undeniably done nothing effective in most organisations to institute an equal opportunities policy.

Despite a number of investigations by the Commission for Racial Equality, there has been little action from the centre save exhortation. Until there is a coherent national system of monitoring recruitment it is difficult to envisage much change.

Most of the data on which the book is based goes back to 1996 and more recent studies seem to indicate that little has changed since. There is enough material here for generations of black applicants to bring actions for racial discrimination against schools of nursing and I hope they do. This is not a tale of deliberate exclusion but of thoughtless stereotyping, confusion about law and policy and lack of effective guidance. All the organisations surveyed had a formal commitment to equality of opportunity, but they seemed to have been left to find out what this was supposed to mean for themselves.

Politicians and managers find it easier to avoid the contentious issues associated with race. The census categories, on which almost all analysis is based, exemplify the woolly thinking that discourages clear analysis and effective action. The notion of ethnicity overlaps a number of different categories — race, nationality, culture and colour — and it might be easier if they were unpicked.

If we want to know what colour people’s skin is because we think that this relates to some social or political issue, it would be more straightforward to ask them about that directly. Perhaps for the next census a colour swatch could be provided, instead of asking people to decide themselves if they wanted to be described as black.

The problem we should be doing something about is racial discrimination, and from that point of view it does not matter what colour people see themselves as. What matters is what colour those discriminating against them think they are, as the Sikhs who were attacked for being Muslims last September discovered.

Certainly, the present fudge will become increasingly incomprehensible over the next 10 years. Being British, being Welsh, and being black are not alternatives. They are quite different characteristics.