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  • Writer's pictureWomenintheNHS

Interview: Minoritised NHS Manager, Divisional Management, Unkown Trust

Publishing anonymously on Twitter about institutional racism in the NHS, and how to move forward

Throughout history the practice of publishing anonymously has been used by people, especially women, who want to be heard but who do not want to reap the often-devastating repercussions of speaking out openly.

History repeats itself, and this NHS Manager has gone on social media to voice her anonymous concerns about institutional racism in the NHS. She goes by the name of “Minoritised NHS Manager” and has an ever-growing following on Twitter.

"Everybody's upset and mortified and thinks I've accused them of racism. But the fact is, we work in a structurally racist system, and we're all in it now."

Inevitably, the question of why she chooses to remain anonymous comes up. She says: “Mainly because I’d lose my job.” She talks about a training course she did, which brought together people from diverse ethnicities, and that the ten people doing the course had all attended multiple NHS interviews for which none had been successful: “The course organiser said, ‘You will need to start writing this down. You need to start sharing this – it needs to be heard.’ But then she followed it up with, ‘But you need to do this anonymously. Because as much as people say that they want to listen, they don’t really want to hear it.’”

Since starting the Twitter account some 18 months ago, this NHS Manager has been sent countless private messages from other NHS employees, of diverse ethnicities, who have recounted similar experiences but who are too scared to publicly comment on Twitter. She says: “I can't remember the last time I heard something I haven't heard before. Everybody's saying the same thing.”

But what exactly are people saying? She explains that they have not yet plumbed the depths of racism in the NHS, towards both staff and patients: “We’re still on the journey of discovering what's going on, and it's really painful for all concerned.

“Everybody's upset and mortified and thinks I've accused them of racism. But the fact is, we work in a structurally racist system, and we're all in it now. To do something differently, we need to be really honest about the need for change and tackle it head on.”

"If we're serious about increasing representation, we need to implement quotas.”

The place to start then is to identify “what racism looks like”. There seems to be confusion amongst many about what the indicators of systemic racism are. An expert in her field, this NHS manager is explicit that it is “not people running around calling each other the “N” word.” Her own experience of moving between trusts, searching for an organisational culture she feels comfortable with, has given her valuable insight into what systemic racism looks like: “When I moved Trust, I saw people in band 2, 3 and 4 roles that they have been in them for years, and who have probably trained many of their supervisors. That to me is a really clear indicator of institutional racism. Part of it is people not being supported to progress, but part of it is actually the low self-esteem of those people. They've been in that position so long they don't believe that can do any better.”

Addressing systemic racism inherent to the recruitment practice in the NHS, this NHS Manager pinpoints the need for better interview training “not just for minoritised people but also training for white people, to address interview technique.” She points out numerous cases where Black women have been seconded for a number of years but then do not get the job at interview stage. It is not “a skills gap” but comes down to people presenting less well during interview. It is important for interviewers to understand cultural traits that are different from their own, particularly regarding differences in body language. “Avoiding eye contact,” she says “is often perceived as a lack of engagement, whereas in some cultures it is actually a mark of respect.” Another cultural difference that can be perceived negatively and as a sign of aggression is candidates “moving their arms around a lot while talking loudly but, in fact, they’re not being aggressive. It’s just how they talk.”

"Be really assertive about your progression and development... Don't be shy about being ambitious."

Equally important in this NHS manager’s opinion is to request a follow-up meeting after an unsuccessful interview to address each question and response, point by point, to ascertain exactly where the candidate has under-performed. It will also encourage recruiting managers to analyse their own responses and to address whether they have acted with bias. To tackle the low self-esteem of people who have been in the same role for many years, she advocates applying for “jobs you have no intention of taking solely for the purpose of getting interview practice.”

Perhaps the most significant change she voices is to implement quotas. Recognising that this is a taboo subject for people, independent of their ethnicity, this NHS manager sees quotas as the only credible solution to ending systemic racism in recruitment. She argues in favour of establishing a point scoring system before conducting interviews, and then appointing the highest scoring minoritised candidate. She admits that: “Ultimately, there will be somebody who scores highest who doesn't get the job. But we must take into consideration that we need representation. If we're serious about increasing representation, we need to implement quotas.”

Ending with practical advice to ethnically diverse people working in the NHS, she advises them to “be really assertive about your progression and development. Speak about your ambition to progress so that everyone in your organisation knows what you’re working towards. Don't be shy about being ambitious.”


Genevieve Shaw, Founder & Editor-in-chief

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