21 Jun 2022

The study was carried out by researchers from ARC South London’s maternity and perinatal mental health theme based at King’s College London. The study findings – based on interviews with 53 maternity and children’s healthcare professionals were published in eClinicalMedicine. The study findings suggest that micro-aggressions between so-called ‘in-groups’ and ‘out-groups’, were prevalent, defined not just by ethnicity, but by other social determinants, especially where staff were trained (i.e., in or outside the UK)

These findings represent progress within the NHS race debate, on which we can build, through conversations which promote openness to less familiar debates around discrimination, whether related to individuals or ways of working.”

Professor Laura Magee

Senior author, professor Laura Magee, King's College London

Staff who contributed to the study described working conditions in 2020 and 2021, at a time when the UK was: gripped by the Covid-19 pandemic, in the wake of Brexit, and reckoning with the issues raised by the Black Lives Matter movement. Staff described difficult working environments and burn-out, challenges which existed pre-pandemic, but were exacerbated by it.

Respondents were particularly concerned about staff members who were not from the UK and were unable to return home overseas to see family members or attend funerals of loved ones who died from COVID-19, due to Government-mandated travel restrictions.

Respondents often spoke of the pressure to keep the service running, in strained circumstances, whilst also describing an expectation that they were personally responsible for their own psychological safety and wellbeing. They also shared how clinically vulnerable staff and people of Black, Asian, and Minority Ethnic heritages often accepted that responsibility and risk (such as working clinically despite increased personal risk of more severe COVID-19 symptomatology) to not further burden their colleagues or service delivery.

Importantly, there was a clear message that positive change is desired by staff, but at a more rapid pace than the NHS is used to delivering, meaning change often lags behind the call for action.

Suggestions cited by staff included collective action across the NHS, with greater attention to diversity in management, and engagement with acts of cultural humility (e.g., accepting and understanding concerns raised on the basis of factors beyond race and skin colour).

Researchers added to suggestions the need for a timely process for grievance in which all staff have confidence, as micro-aggressions have no place in the clinical care of mothers and babies.

We must acknowledge that structural discrimination exists within the NHS, but seemingly in a different form from that of the past. Not listening to concerns made by staff is not only bad for morale, but can increase incidences of micro-aggressions between colleagues, which can be damaging to patient safety.

Sergio Silverio

Lead author, Sergio A. Silverio, research associate, King's College London

Crucially, the researchers conclude, it is important for all aspects of the NHS to prioritise health equity amongst staff and patients and move past the rhetoric of simple equality in healthcare.

Read the full article: On race and ethnicity during a global pandemic: An ‘imperfect mosaic’ of maternal and child health services in ethnically-diverse South London, United Kingdom

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