Roger Kline, Research Fellow in the Business School and Joint Director of the NHS Workforce Race Equality Standard Implementation team, welcomes a new report into the relationship between ethnicity and disciplinary referrals in the NHS.
At last a good report that shines a light on the disproportionate referrals of black and minority ethnic (BME) nurses and midwives to the Nursing and Midwifery Council (NMC). Elizabeth West and colleagues have done the NHS a favour.
Why is this report so important? One in five of all registered nurses and midwives working in the NHS are from BME backgrounds. Udy Archibong and colleagues reported in 2010 that BME staff in the NHS are twice as likely to enter the disciplinary processes than their white colleagues.
Alongside detailed work by NHS London in 2014, the Royal College of Midwives in 2012 and 2016 indicated that 60.2 per cent of the midwives who were subject to disciplinary proceedings in London were black/black British, however only 32 per cent of midwives in London were black/black British i.e. they were more than three times more likely to be disciplined. They were also more likely to receive higher impact decisions (dismissal and suspension) and less likely to have no further action taken.
Nursing Standard’s survey of 2014 found that although BME nurses make up 19 per cent of the nursing workforce in England they make up 25 per cent of disciplinary cases and they were more likely than white nurses to be reported to the NMC (Spinks, J. Nursing Standard 28(22), 14-15).
The NMC has had such concerns raised for a number of years. Two years ago the NMC finally agreed to take a serious look at the issue. At the time it was strongly argued by the stakeholder group of professional bodies and unions they convened that the primary focus of research should be the pattern of disproportionate referrals by employers rather than (or at least as well as) the internal NMC processes i.e. why BME nurses and midwives were disproportionately entering the ‘Fitness to Practice’ (FtP) process, not just what happened once they were referred.
This is perhaps the most stunning of the finds
The resulting report by Elizabeth West, Shoba Nayar and Taina Taskila of the University of Greenwich is nevertheless a good one and captures some of that concern too. Their report on ‘The Progress and Outcomes of Black and Minority Ethnic (BME) Nurses and Midwives through the Nursing and Midwifery Council’s Fitness to Practise Process’ confirms what previous surveys and anecdotal reporting have found.
In summary, West and her colleagues’ findings include:
All senior nurses should read those findings carefully and reflect on what they mean, not least for BME staff who may have suffered career-ending referral for no good reason.
West’s findings have considerable overlap with those of Archibong et al (2010) on NHS disciplinary processes. That is reflected in their recommendations which include (verbatim):
Apart from the misplaced enthusiasm for diversity training and unconscious bias training, these recommendations are good as is the wider report. The report’s publication is a sign of progress from the NMC. There is, however, a serious risk that the report will gather dust unless the issue of disproportionate referrals by employers is addressed.
The NMC will be judged by whether, finally, and expeditiously, it helps that process
The NMC has statutory duties under section 149 of the Equality Act 2010 which requires it to have due regard to eliminate unlawful discrimination, harassment and victimisation. The NMC Equality and Diversity report for 2015-16, paragraph 23 states: “We will be receiving and taking stock of our research into BME registrants referred to fitness to practise, and the findings are likely to prompt actions from the NMC and potentially, for others. We will also work with other bodies in the health environment to influence change that will lead to fairer and non-discriminatory outcomes for BME nurses and midwives.”
It assures readers that the NMC will:
Tackling disproportionate disciplinary action against BME staff and the disproportionate referrals of BME staff by employers requires an expeditious system-wide initiative as well as a robust look by the NMC at its own systems.
The NMC will be judged by whether, finally, and expeditiously, it helps that process and in particular whether it acts to stop the (now evidenced again) pattern of inappropriate employer referrals of BME registrants.
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