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Racism and racial inequality continues to plague the NHS – with negative outcomes for individual staff, but also for organisations and patients.

To get to grips with this issue, and how to tackle it, Dr Paula Redmond speaks to Owen Chinembiri. Owen is Senior Implementation Lead at the NHS Race & Health Observatory – but is chatting today in a personal capacity.

As you might imagine racism and examples of racism are discussed in this episode.

Here are the links/resources Owen mentions:

• Links between NHS staff experience and patient satisfaction
• Glass cliff
• NHS staff survey
• Latest WRES report
• Diversity wins: How inclusion matters
• Changing The Way People Saw Black Rugby Players

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Transcript

[music]

Dr. Paula Redmond: Hi, I’m Dr. Paula Redmond, a clinical psychologist, and you’re listening to the When Work Hurts Podcast. On this show, I want to explore the stories behind the statistics of the mental health crisis facing healthcare professionals today and to provide hope for a way out through compassion, connection, and creativity. Join me as I talk to inspiring clinicians and thought leaders in health care about their unique insights and learn how we can support ourselves and each other when work hurts.

[music]

Paula: Facing racism is, unfortunately, a very live and present issue for many NHS staff today. To understand more about this, I spoke with Owen Chinembiri, who is a trained occupational therapist originally from Zimbabwe and now based at the NHS Race and Health Observatory. Just as the head’s up, we obviously do talk about racism and some of the upsetting impacts of this throughout the episode. I started by asking Owen about his current role.

Owen Chinembiri: I lead on everything digital health and data-related in the Race and Health Observatory. I’ll tell you just a little bit about the Race and Health Observatory. I think it’s important to mention at this point that I’m here on a personal capacity, I’m not representing the Race and Health Observatory. Everything I’m going to be saying is what Owen thinks, not what the Race and Health Observatory thinks.

In February 2020, the British Medical Journal published a special edition that was called Racism in Medicine. In it, it looked at ethnic inequalities in the NHS from a workforce perspective and from a patient outcomes perspective. The key thing to note at that point, that was before COVID had become the pandemic that we know it to be today and that George Floyd hadn’t been killed yet, at that point, there was enough evidence to have a recommendation that the NHS needed to have an independent body that focused on tackling ethnic health inequalities. The Race and Health Observatory was born. Then, my role in various focusing, as I said, on digital health and data.

Paula: Is racism a problem in the NHS?

Owen: Well, I think the way I’ll answer your question is, what is racism, which I know will sound a cop-out. In preparation for this, I was reading a document by Pearn Kandola. [unintelligible 00:02:45] what people define as racism is the blatant, the obvious getting called names. That’s what people see as racism. However, the modern racism is a little bit more subtle than that, it’s a little bit more innocuous. There is research that was done, which asked people from an ethnic minority background to say, “What do you perceive as racism at work?”

Some of the answers were people reported that being ignored because of your color, being overly criticized and managed more than what would happen to someone from a different ethnicity, assumptions being made about your role or your job. I’ll give you an example on that. I remember one colleague, who is a doctor, when he was walking around and someone immediately assumed that he was a nurse. Then it was obvious why, and they said, “Look, I’m dressed as a doctor, what would make you think that I’m a nurse?”

Those are some of the things that people define as racism, insensitive race-related jokes and banter, people not recognizing your face, being passed over for promotion, missing out on training opportunities, and one of the big ones is patients refusing to be seen by staff from an ethnic minority background. With those things in perspective, does racism exist in the NHS? Yes, it does because all those things happen. We might not have people walking around the NHS calling people the N-word or something like that, but that doesn’t mean there isn’t racism in the NHS. It exists in more subtle ways which people from an ethnic minority background know.

One point I’ll make is, these issues have been known for a long time. I think when we were preparing for this podcast, we had a discussion about it and I told you that the oldest paper that I’ve read was written in 1992. It was called Racism in Nursing. What it found is that when they talked to Black nurses and midwives, they found– this is a quotation from the paper, “They all told the same story of continued job rejections, difficulties being accepted for post-basic training, and poor promotion prospects.” This was in 1992. That is still happening to this day.

Paula: We know this has been around for a long time and that beginning of 2020, there was a recognition that something needed to be done about this. You’ve given a lot of examples that are difficult to hear. I’m wondering about your reflections on the last couple of years and what we’ve learned through COVID and Black Lives Matter movement, what your thoughts are on how that shaped things?

Owen: Yes. What I’d say is, one thing we know is when COVID started, quite early on, it became apparent that NHS staff from an ethnic minority background have been disproportionately affected. When you look at the data now, you can see that in particular, nurses from a Filipino background and doctors from an Asian backgrounds died in much higher rates than all other ethnicities.

Early on, when, I think, the first three doctors who died were all of an Asian background, we could clearly see what was going to happen because there was evidence that when things go wrong in the NHS, people from an ethnic minority background get to be affected significantly more. What that told me is, even though we knew it, we could feel it, I think more could have been done. We should have anticipated it. We have got enough information to tell us that we could have done something.

As COVID went on and the data became more apparent that people from an ethnic minority background, not just in the NHS, but in general, were getting affected more, people almost shocked by some of the data that was coming out. It showed me that there seems to be a lack of awareness of some of the ethnic inequalities that exist. For people like me, as I said, we knew it was going to happen, but when the data started coming out, there was almost a shock, like, “Oh, why is this happening?” People almost didn’t understand.

Then compounded by the death of George Floyd, there was almost a mass awakening, there was almost a global epiphany that, “Oh, guess what? We’ve got ethnic health, wealth inequalities.” As I already mentioned, these have existed for more than 40 years. For me, that has been my lesson over the past two years, that these inequalities exist, but for some reason, either people willfully or unintentionally are not aware of them. There is something that needs to be done.

Paula: Reflecting on what you were saying about what happened in COVID, and we know that staff who were from minority ethnic backgrounds were dying in greater proportions than white staff, and I remember reading about it at the time. I think that there was narratives around linking that to health inequalities, that people from minority ethnic backgrounds had more health complications and therefore were at greater risk of death from COVID.

I guess what I’ve learned more recently and in particular the video you shared with me, which was really striking of narratives of healthcare staff during that time, the evidence of people being treated very differently, of being placed at greater risk, of not being given access to appropriate PPE, which is a much more uncomfortable explanation.

Owen: Yes. If you look at the latest NHS staff survey, data, of which I’ll put a link in, there are questions which specifically look at COVID. I’ve got data for last year. I haven’t looked at the data for this year, the most recently published data. What we know is that according to that staff survey, people from an ethnic minority background, they were more likely to work on COVID wards and they were more likely to be redeployed to work on COVID wards.

Whether that’s what directly resulted in the disproportionately being represented, I cannot say for sure, but what we do know is that that’s what people say were happening, that if you’re from an ethnic minority background, you’re more likely to end up working on a COVID ward and you’re more likely to be redeployed on a COVID ward.

I think the impact that this has, if we talk about not just COVID, but racism in general, if you look at it at a personal level, people start feeling disillusioned, people are unhappy, people get depressed, lack of confidence, sometimes anger, and people don’t believe in the system anymore. That can have serious challenges for the system. If you look at things such as staff retention, sickness, and then the financial cost associated with that.

That’s how racism impacts people at a personal level. People go to work and they’re doing a good job and they’re feeling that, “Oh, I’m putting all this effort with the system, but the system does not value me and the system is not working for me.” It’s not a good feeling to have [unintelligible 00:11:17]

Paula: I guess there’s also something about the makeup, potentially, of staff in services, particularly when we get to more senior levels not being representative of the wider staff group. I guess if you’re not able to see yourself or someone like yourself working in senior positions, I’m imagining that that can create a real sense of disillusionment and disengagement from the process of career progression.

Owen: We know that if you look at the Workforce Race Equality Standard data, that people from an ethnic minority background are significantly underrepresented in senior appointments. We know that they’re less likely to be appointed to a role if they get shortlisted. We know that they’re more likely to be disciplined and we know that they’re significantly less likely to believe that the organization provides equal opportunities.

For me, there’s three problems with that. One is the personal one, at a personal level, so you know that I’m doing the right thing, for some reason, I’m just not getting promoted. At times you get examples of people who talk about being [unintelligible 00:12:39] Is that the term? [unintelligible 00:12:41] by people who either qualified after them, and then after a few years, they get promoted and start managing them, and like, “Oh, wait a minute, this person was a student a few years ago and now they’re managing me.” That happens a lot and it can be very, very demoralizing.

Then the other problem is, we know that there are benefits to having a diverse leadership. McKinsey has done a lot of work on this. What they found is– I think their most recent paper is called Diversity Wins. Once again, I’ll send you the link to it. They looked at more than a thousand companies across 12 countries in the initial research. I think the later researches looked at even more companies.

The companies that were in the top quarter for gender diversity were 20% more likely to overperform. If you’re in the top quarter– This is really important. This is not just having one or two talking women on the board, this is like bringing the top quarter for gender diversity are 20% more likely to overperform. Then the companies that were in the top quarter for ethnic diversity were 33% more likely to overperform. What this means is there are clear benefits to having diversity in leadership. By not having a lot of people from an ethnic minority background in leadership positions, we are missing out on that benefit.

Then the third issue that I always talk about is one of blind spots. I’ll give you one non-related example then I’ll come back to one NHS-related example. There’s work that was done looking at the financial crash in 2009. One of the things they found is that because of the homogeneity of the leadership in banks at that time, the massive blind spots at what was happening on the ground, so they could not see what was coming. If the leadership may be more diverse and they were having conversations with people outside their bubble, they might have been able to see some of those challenges earlier.

Then when it comes to the NHS, I remember visiting one trust in London. At that time, we met the staff network for staff from ethnic minority background. When we were talking to them about what their fears were, one of the things that they brought out is that they lived in an area which had quite, at the time, high rates of stabbings of Black children. Where parents were there, were saying, “Look, I’m really worried that if I’m at work, if my phone rings after 3:00, my heart skips a bit because I’m thinking, oh, maybe somethings happening to my son,” that type of thing. This is something they were genuinely worried about.

When we met the senior leadership team of that organization, they were all white and most of them except one commuted into the area. They didn’t live there. They were not even aware of these challenges that their members of staff were worried about because it was not part of who they were, the massive blind spot as to something that was really, really affecting their workforce. That was one of the challenges of having a senior leadership team that not a representative of the workforce or the community that unintentionally you can have these blind spots.

Paula: We’ve touched on different areas of identity and diversity there, but I wonder about people who have multiple minority identities, if we’re thinking about intersectionality, what your observations are around that.

Owen: I think, once again, the latest data from the race report covers intersectionality. The data is very clear that Black women in particular have got the worst experience in the NHS. They’re less likely to be represented in senior positions, they report the highest rates of bullying and harassment from patients and from colleagues, and they’re least likely to believe in equal opportunities.

I know that some of the data actually is people from a gypsy background. If you take away people from a gypsy background and if you look at ethnic minorities, Black women are the ones who’ve got the worst experience. I think someone causes a multiplying effect that for every projected characteristics you have, it means you’re way, way more likely to have the least positive experience in the NHS.

Then also, something that I always talk about is there something called the glass cliff. The glass cliff, it’s a research-pegged phenomenon, which shows that people, either women or people from an ethnic minority background or women from an ethnic minority background as well, tend to be disproportionately represented in the most challenging leadership positions. As a result, they tend to be overly scrutinized and they do not get recognized for the work that they do.

As you know, we live in a world where people look at CV and say, “Oh, look, this person used to work at this very challenged organization.” They wouldn’t want to work with [unintelligible 00:18:30] this organization and they used to have really poor care. As a result, I think the glass cliff talks about it becomes a rigged leadership test as it were that people from an ethnic minority background, women end up working in very challenged positions, which makes it even more likely for them to succeed, or maybe the way that their is shown is slightly different. Therefore, this compounds even the challenge they have of trying to progress.

To summarize, yes, the more protected characteristic someone has, the more difficult it is going to be for you. I think one of the things we need to start doing is having those nuanced discussions in a way that everyone understands that, “Look, if you’re an ethnic minority woman, if you’re someone who’s disabled and you’re a woman, if you’re disabled and you’re from an ethnic minority background, it means that the challenges you face actually multiplied.

Paula: Clearly, racism is bad for staff and we’ve heard how it’s also bad for services and organizations as a whole. Is there any data around the impact on patient and patient care?

Owen: Actually, there is. When Robert Francis was looking at some of the failures of Mid Staffordshire, they were looking at whistleblowing and the freedom to speak up what they did there. What they discovered is that ethnic minority staff were more likely to be victimized if they spoke up about poor care, they were less likely to be praised if they spoke up about poor care. As a result, they’re almost half as likely to speak up about poor care because they were afraid that they’ll be victimized or they wouldn’t be praised. That’s not something you want. You want to be able to know that everyone working in the NHS feels empowered to speak up and to whistle-blow when they see poor care.

There’s also work that was done by [unintelligible 00:20:46] Professor West, where they were looking at staff survey and patient survey results and trying to see what the correlations were. What they found is that things such as high work pressure for staff, perceptions of equal treatment, and discrimination for staff were all very damaging to patient satisfaction.

As already discussed, two of the areas where ethnic minority staff were the worst experienced is equal opportunities and discrimination. In that paper, I think the summary, one of the things that they concluded was that the way an organization treats its ethnic minority staff is almost a barometer. Actually, they described it as a good barometer of how well patients are likely to feel cared for in that organization.

Organizations with high levels of discrimination, the ethnic minority staff, when you talk to patients in their organization, they don’t feel as cared for compared to other organizations. Then the last point I make around this is, we talked about one of the ways that people perceive racism in the NHS is patients refusing to be treated by someone from an ethnic minority background. What this can do is that patients might actually miss out on being seen by the best clinician. It could be on that day, the most senior, most experienced, most knowledgeable clinician could be someone from an ethnic minority background.

If patients, for racist reasons, feel they don’t want to be seen by someone from an ethnic minority background, they might be missing out on being treated by the best person. These are some of the impacts that racism can have on patient care.

Paula: Bad for, obviously, the individual staff members affected, bad for organizations, and bad for patients. Assuming we can all agree that we don’t want an NHS that tolerates racism, and hearing the data, it’s very clear, very stark. Why do you think it is that it’s so persistent, so pervasive, so difficult to tackle effectively?

Owen: Professor Williams from Harvard, who’s probably known as the world leader in ethnic health inequalities, talks about the three barriers to tackling health inequality, which are political will, empathy gap, and resources. If you look at each one of those different– Political will is just about the leadership in an organization, accepting that this is a significant problem that needs to be dealt with. This will mean leading from the front or making sure that everyone in the organization recognizes the ethnic inequalities [unintelligible 00:23:56] for patients or for staff as a problem that everyone has to be involved in but has not always been the case. I think in some cases, it continues to be a challenge. I think there are still people in senior positions who do not believe that there’s ethnic inequalities in the NHS. There are people who genuinely believe that racism isn’t there anymore. I think we’ve touched on it, that their definition of racism maybe does not capture the modern way that racism presents itself. Political will has been a big challenge.

Then the other issue is the empathy gap. One of the challenges around the empathy gap at times relates to the example I gave about if you’ve got leaders who are not representative of their workforce. If the challenges that other people are going through are not a part of your reality, you won’t have the empathy. Therefore, you won’t feel like it’s something that you need to tackle. The political will and empathy gap, they go. If the leaders or if anyone does not feel this is a problem, then it’s going to result in problem. number three, they’re not going to put in the right resources to type of a problem.

One of the most successful programs in tackling ethnic inequalities– Was it a university in America? I’ll look for the name and then I’ll send you the link to the study. They dedicated 1% of their budget to say, “Look, we’re going to tackle inequality in our university.” They made sure that everyone at every level was aware of their challenges and that they had a part to play.

If we look at what happens in the NHS, most organizations will have someone who’s called an equality and diversity manager. Sometimes it’s the head of equalities. They tend to be mostly around agenda for [unintelligible 00:26:16]. They’re like middle managers, but they’re not the most senior people in the NHS. Then each organization will have one person looking, not just at workforce inequalities, but at patient inequalities as well. There’s just not enough resources. That has been one of the biggest challenges, that there has not been enough resources that have been made available to tackle this problem.

What the death of George Floyd and COVID have done is, actually, there has now been a lot of investment in the area of inequalities in general, and ethnic inequalities specifically. What I hope is that that investment is going to stay, but we’re already starting to see that some of that investment was for a limited period of time. Some of that investment was tied to COVID, and as you overcome COVID, some of that investment is being pulled. For us to really, really make a big difference in this, we need the investment and the resources to be there. Investment has been done.

Then another challenge as to why things haven’t changed is the constantly changing of initiatives. There’s a lot of acronyms I can just be telling about, oh, there was something called EDS2, then EDS1, then you had the WRES, then you got this. The NHS is constantly changing the initiatives around tackling inequalities, and ethnic inequalities specifically. The problem is– I’ll quote what one of the most senior HR managers in the NHS said. He said, “If this was easy, we’d have tackled it a long time ago.”

This is not something that’s going to be tackled in three, four years, but what the NHS does is specifically around inequalities, probably more than anything else. After three years, they’ll level look and say, “This is not working, let’s try something else.” Then try something else. It means you now have to set up new systems re-orientate everyone, get the buy-in. Once that thing is starting to just develop a bit of momentum, people look and say, “Oh, look, it’s four years, it doesn’t work. Let’s move on something else.” That’s been one big body as well.

Then aligned to that is just the high turnover rate you get for people working in inequalities in general, and ethnic inequalities specifically, because it’s a tough job to do, people get burnt out really quickly and then people move on and go do something else. As with every job and every walk in life, when someone new comes in, they want to put their stamp on, it as it were. When you get someone new, they start changing things again.

When new people come in with new ideas, they need almost like everything that’s been done before almost gets forgotten then they start again. It’s almost like starting from zero. That’s one of the reasons as well why things haven’t changed as quickly as they should have or they should be.

Paula: I was thinking, as you were talking, Owen, about how, given the context of the NHS in terms of the load that people are carrying generally, the stretched resources, the emotional demands of the work, that there’s a lot of exhaustion around, and I think there’s a danger sometimes with this work being siloed into a particular little part, everyone has to do some mandatory training and that’s almost it, or maybe a bi-monthly committee meeting, and that’s really hard to sustain. There’s real culture change when people are stretched and I guess we end up seeing not always the good sides of organizations and systems and people when things are hard.

Owen: There’s an overly used phrase in the NHS, which is the golden thread that runs through everything. My view is, if equalities, and including ethnic equalities, was the golden thread that ran through everything, that would definitely lessen the load on equality and diversity managers. The example I always give is budget management. In the NHS, regardless of what role you do or how senior you are, if you’ve got budget responsibilities, you’re expected to work within the budget. If you don’t know how to budget, you have to go and learn, but you’ll be told that, “Look, you’re going to deliver this service for £100,000,” or whatever it is and that’s it, and you have to be able to manage that budget.

I almost feel that inequalities have to be treated in the same way, that everyone has to be told that, “Look, as part and parcel of your role, you want everyone working with you, under you to have the same positive experience regardless of their background. We want every patient that you treat, regardless of their gender, ethnicity, sexual orientation, to have the same positive experience.” For me, if we get to that point where that is the default position, that people see equality as part and parcel of their everyday job, we’ll start to see the improvements that we want to see.

Paula: Owen, have you got any examples for us of initiatives that you’ve come across that have been effective in producing change?

Owen: Yes. I’ll give you two examples. One is, there’s an organization called North East London Foundation Trust. When I was working for the NHS England Workforce Race Equality Standard team, I used to be the lead analyst there. That organization went through three years of continuous improvement, when you look at their workforce data. This is looking at the levels of discrimination, looking at belief in equal opportunities, and looking at career progression. For those three years, you had people from an ethnic minority backgrounds getting promoted and feeling better about working in the organization.

Then the question becomes, what did they do? The first thing that they did is they came up with their strategy, which I think is still available online. I think it was their 2020 strategy at that time, they’ve since updated it. That strategy was signed off at every level in the organization. They made sure that every team in the organization was aware of that strategy and then they signed up to say, “Yes, you know what? As a team, we sign up to this strategy.” This wasn’t just something which the equality and diversity managers do, this was something which the whole organization was doing.

The other thing that they did as well is that, in that strategy, every board member had to sign up to it as well. This wasn’t just something which is going to be done by the chief people officer, but every board member was aware that, “Look, I have a role to play in this as well.”

Then, importantly, the organization, I think touches on about what I said before, they just didn’t start off and stopped, they were actually working on this for a long period of time before they started seeing those three years of year-on-year improvement, which I think is really, really, really important for people to understand that this wasn’t a one year, two years, “Well, let’s try it.” No, no. They actually went for like two, three years before they started seeing those year-on-year improvements.

Then, most importantly for their organization at the time, their CEO was a gentleman called John Brouder. What John Brouder used to do is, in the NHS, when you’ve got new members of staff starting, you have this induction. It’s a day where you go and you’re told about the organization’s strategy, you do information governance, training and everything else.

John as a CEO would go to that induction, and then he would tell people clearly that, “Look, for this organization, we’re here to provide excellent clinical care. One of our key priorities is tackling ethnic inequalities. You make clear that as you walk into this organization, I don’t care what job you’re doing, those two things are really important and you’re going to play a part in it.” It sets the tone for someone getting into the organization so you already know that, “Look, I’m coming to an organization where ethnic inequalities are not tolerated.” That’s probably, I think, one of the most successful organizations initiatives around tackling ethnic inequalities in the NHS that I’ve come across.

Paula: You’ve described how the strategy is really embedded from top to bottom and, as you said, setting the tone of a cultural message of priority. I’m curious about whether there are particular strategic measures within the strategy that were particularly helpful or important or whether you think just setting the tone and the embedding of it was key.

Owen: One of the things that they did was, because it was embedded everywhere, the governance behind it as well. One of the things they did around recruitment was having a diverse interview panel. You will find, but I think now it’s the talking thing every organization says they do. They are looking at, “Well, we’ll just get someone with a bit of melanin on the interview panel then everything’s okay. Let’s just get a woman on the interview panel then everything’s okay,” but what they did is they said, “Look–” They put governance in place.

One was, the people who were supposed to be on the interview panel were trained to say, “This is what a fair interview looks like.” Your role there is beyond just representing people from an ethnic minority background, your role is there in part as an adviser and as– I don’t use the word referee, but as someone who understands how a fair process looks like. That person was also given the authority to say, “If you feel or you see something in that interview that doesn’t feel right, you escalate it.” That’s extra governance.

I’ve got examples of this happening in other organizations of it, “Oh, come on, let’s just get an Owen on the panel,” and then you get there and it’s quite clear that the scoring doesn’t work or there’s a preferred candidate, but in that organization, they had the governance to say, “This is not just about it doing it, this is about making sure that we do it and we do it right.” It’s not only having the strategy, it’s having the governance in place as well and implementing it fully.

Paula: Was there a second example, Owen, of–

Owen: Yes. The second example I’m going to give is, I won’t name the organization, but I’ll tell you what happened. They were recruiting a new team and then we were called to come and say, “Oh, look, can you check whether this is a fair process or not.” The first thing we asked for is the demographics of the people who had been shortlisted, and it was quite apparent that for one of the role, they’d only listed men, for some of the roles, there was no one from an ethnic minority background at all.

Generally, it was quite clear that with the shortlisting that had been done, they were not going to get the outcomes that they wanted. What then happened is, they went back and said, “Okay, this is not going to work.” They stopped the interview process then and there, which is really important. It’s about showing that leadership, that as soon as people could see that they were not going to get the outcomes that they want, they were brave enough to say, “We’re going to stop things.” Whereas normally people just say, “Okay, no, let’s do it and then do it as lessons learned later.”

They then changed the interview process completely. Instead of shortlisting, they went for something called longlisting. What that does is it removes some of the biases that happen at shortlisting, and they also went for something called [unintelligible 00:39:42] recruitment, where you don’t interview for one job at a time, you interview for multiple jobs at the same time. Then they also had a diverse interview panel. Each interview panel had to be diverse. Then they also did something called blind auditioning. The way blind auditioning works is– Let’s say, it’s you and me, Paula, we’re interviewing for the producer of a podcast, and all we get is, we’re just told that the person you’re going to interview has got the qualifications for the job. You don’t know their name, you know nothing about them. The first time, the only interaction you have with that person is when they walk into the room. You don’t have any preconceived ideas.

By making those changes in the recruitment process, what happened is that in that organization, they ended up appointing– I think more than 60% of the people appointed into senior positions were female and I think about 40% were people from an ethnic minority background. By showing good leadership, strong leadership, changing the processes, getting the right things in place, they’re able to achieve what they want to do.

Paula: I’ve read recently in the BMJ were looking into the inequalities for referrals around complaints to the GMC, the General Medical Council, and there was a known disparity in that more people from Black and minority ethnic groups were going through to complaints level than white doctors. They changed the process so that those applications were anonymous. The impact of that was that the racial disparities disappeared. Something as, I guess, straightforward as anonymizing those applications was able to remove the bias inherent in the process.

Owen: Yes. I think it’s something which happens all the time, and it’s not just around ethnicity as well. Obviously, you’ve got the usual examples where people send the same CV with different names and you get different outcomes. Then you got examples of when people used to audition to be in an orchestra, but when people would hear the footsteps, this person is wearing heels, immediately they would score them differently, but when they started having people walking in barefoot, they saw that, actually, the number of women who started it getting in were much higher because you had no idea. We know that they are inherent biases.

What I would say is, what needs to be done is exactly what is done in this case, where you anonymize it and you always look at the outcomes, say, “What can we do to get the outcome that we want? Where in our process are there most likely to be bias?” In most cases, you get the bias where people are able to distinguish between people of different characteristics.

I remember in 2010, ’11, the NHS runs its graduate management scheme. At that time, people from an ethnic minority background were significantly underrepresented. What they did is they worked with a company that understood some of the biases. What they did is they said, “Remove photos and names from all applications.” They started having more online tests for some of the things, to say, “You just get in there and then you enter your responses. You’ve just got a number, you are candidate one, candidate two.”

By making those changes and removing any points where people would be able to identify who you are, your characteristics, you actually saw that for the next cohort, the proportion of people from an ethnic minority background was representative of the applications. It’s something that I very much support, that if you review all your processes, identify where the inequalities are, where you might be swayed one way or the other by someone’s characteristics and try to resolve that.

Paula: What feels challenging about that is owning and accepting an innate bias, that as a white person, if I’m on a panel, whatever my conscious mind might want to convince me of, I’m likely to favor someone with a white-sounding name. That’s not a nice thing to have to accept about myself. I’m wondering if that is part of the barrier too, that in order to make these changes, we have to name it, that we do hold biases, and that’s part of the problem.

Owen: I think one of the things we do not have conversations enough about is exactly that, to say, “Look, we all have biases and we know that people from certain backgrounds are disproportionately affected by those biases.” Part and parcel of what we need to do to tackle the inequalities is to have more of those conversations to get people to understand that this is not about someone accusing you of being a racist or so, this is about saying, “Look, there’s something in our systems that results in people from an ethnic minority background having worse experiences and less opportunities,” and then trying to identify with those challenges and working together to tackle them.

Part of that conversation is about acknowledging that there are biases in our systems, be it at an individual or at a systematic level, there are biases that are inherent in how we do things, and it’s about how do we work through them in a way that benefits everyone. Part of it is, like you said, accepting that, “Look, we all have biases.” As long as you know what those biases are, how they affect us and mitigate against them.

Paula: What would you say to people listening to us about what we might be able to do on an individual level to tackle this?

Owen: There are three things I would say people need to do. The first thing is to look at the data for your organization, if it exists at all. Whether you’re a psychologist, like yourself, whether you’re an occupational therapist, whether you’re a nurse, just look at the data and say, in your organization, what’s the career progression like? Where do people sit in leadership? Is it representative of the workforce? Is it representative of your patient groups?

If you’re not collecting that data yet, then challenge people to say, “Oh, look, we need to start collecting the data and analyzing it that way.” Take a look at– Just going to say a psychologist because you’re here with me, look at your patient group, are there any patients who either have got a higher dropout rate by ethnicity? How is the proportion of patients who we refer on to something else?” Just look at the data and see what it tells you.

That alone is the first thing you need to do, look at the data for your organization for workforce and for patients, or if you don’t work in healthcare, for your clients, because this could be a business opportunity for a business that caters only to people of certain ethnicities. There’s a whole group of other ethnicities who you might be missing out on. Then the second thing is to have conversations in your organization about ethnic inequalities. When I’m doing presentations, there’s a video I normally play, which is of the South African rugby team, the Springboks. I’m a big rugby fan. Of course, Springboks. I apologize to my–

Paula: No apologies needed, Owen. I’m with you. [laughs]

Owen: Apologies to our English listeners here. What it is, once again, we’ll put in the link to the video below, so you can jump to about eight minutes. One of the things that Rassie did we need to cover the Springboks is that, at the time, there was a push to have more diversity in South African rugby. There was always the pushback that you’re lowering the standard, you aren’t just about tokenism. He doubled done. He did it. He actually said, “You know what? Actually, no. I want the team to be representative of the nation.” Instead of pushing back, I will just say, “They’re going to do it.”

Within the team itself, he realized that people didn’t understand the issues around race. In the same team, you have someone like Mapimpi, who came from some of the worst deprivation ever. Then you’ve got other players who came from significant wealth and they’re playing in the same team and they didn’t understand what that is.

What he did is, at the start, he made them sit in a room, depending on where you’re from, for hours to talk about the issues to say, “You need to understand where everyone is coming from, you need to have the conversations about ethnic inequalities, you need to understand why people are clamoring to have more Black players, to have more players who look like them in the Springboks.” By doing that, it actually brought the team closer because they now understood each other together, they were now able to work together with purpose. Against all odds, they went on to win the World Cup in 2019.

Then the last thing I’d say is go out and read books. There are a lot of books that are available there on issues around ethnic inequalities. I’ve read quite a few. What I’ve discovered is the most well-known books, without naming them, are not the ones I enjoyed the most. I’m someone who’s got a data background research evidence. The one that I enjoyed the most was one called Diversify by June Sarpong dream support because it’s actually like research-based. She actually did research, lots of data, lot of articles saying, “This is what this says.” For me, that’s the one that resonated with me the most.

There are other ones which people tell of a personal story to say, “This is what I went through.” It’s not research-evidenced, it’s just someone telling, “This is what I went through.” There are other people who find that more appealing. What I’ll say is, go look for a book around– There are so many of them. Look for one that will resonate with you and then just read it.

Then the last one is support those who are trying to make a difference. As mentioned before, the jobs look more glamorous on Twitter than they do in real life. They’re very challenging jobs. If you’ve got someone in your team, in your organization, who’s doing something on tackling inequalities or specifically ethnic inequalities, when you see them, just give them a pat on the back and ask them, “How can I help?” and find a way to work with them to make a positive difference.

Paula: If I could ask you what sustains you? What nurtures you? What keeps you going in doing the hard work that you do?

Owen: One of the things is I run a lot. I exercise. I call it my mental exorcism. At the end of a hard day or something, if I want to clear my mind, I go for run. The other really important thing, which I’ll say to everyone listening on the podcast is have a good network, have someone that you can talk to. I’m blessed to have some friends and some role models and people I look up to, people like my Boss Habib, Yvonne Coghill.

I’m part of a group of Zimbabweans. We call ourselves a progressive minds. We catch up every fortnight just to have a chat just to, we call it debrief and to learn, “Look, this is what’s happened.” That’s really, really important. That’s what sustains me, knowing that I’ve got all these people out there.

Also importantly, I know that some of the work I’m doing is making a difference, maybe not at the national system level, but on the odd occasion, someone will call you and say, “Oh, look, you know what, Owen? Because of this work that you did, this is how I personally benefited from it. Thank you.” That’s always makes it so much worthwhile to say, “Okay, maybe we haven’t got rid of all the inequalities in NHS, but I managed to get rid of the inequalities for that one person, and that one person’s life is much better.” It always makes such a big difference.

Paula: Thank you for listening. If you enjoy this episode and you’d like to help support the podcast, please do share it with others, post about it on social media, or leave a rating and review. I’d love to connect with you, so do come and find me on LinkedIn or Twitter. You can also sign up to my mailing list to keep up to date with future episodes and get useful psychology advice and tips straight to inbox. All the links are in the show notes. Thanks again, and until next time, take good care.

[00:54:08] [END OF AUDIO]