“Can I see a doctor qualified in Britain?” inquired the woman.
“I qualified from Oxford,” I assured her.
“I mean a British doctor,” she persisted.
“I was born in Hull, east Yorkshire,” I replied.
Her expression showed she was not satisfied, despite my assurances.
“You mean a white doctor?” I asked.
She nodded sheepishly.
“I am afraid it is just myself and the registrar in clinic today. He’s originally south Indian and has a longer surname than mine. Do you want to be seen for your heart problem today?”
The woman sat down and the consultation proceeded. This conversation in a London hospital in 2016 is one of very few such encounters in the 21 years since I started medical school, but it made me question whether racism was still an issue in the NHS.
When my father joined the NHS in the early 1970s, a totally different world greeted him: signs in pubs said “Dogs and Indians not allowed” and bananas were thrown at black footballers during matches. On hospital wards, his generation faced open taunts from patients and senior colleagues. He and his “coloured” friends were advised, often by senior fellows of the Royal College of Physicians, to pursue jobs in undersubscribed specialties in underserved areas because they would “never be considered, even for interview” in more popular specialties in London or the home counties. In parts of the country where locally trained medics were less willing to work (such as rural Wales or east Yorkshire), the proportion of foreign doctors grew as a result. Regardless, the promises of a better life for their families and better training meant immigration continued to increase.
In common with many migrants from all over the world, my father’s experiences led him to raise us with a “you must try harder than the local guys to succeed” philosophy. I never really believed this view was applicable to modern, multicultural Britain. Other than a couple of insults traded on the rugby field while growing up, I faced remarkably little racism. The same is true of my clinical career, but the government-commissioned report The “snowy white peaks” of the NHS implies that institutional racism is not a historical phenomenon.
The tragic death of six-year-old Jack Adcock in 2011 led to the recent manslaughter conviction of Hadiza Bawa-Garba, a UK graduate and junior doctor, and her removal from the General Medical Council register. As one consultant paediatrician has reflected: “It appears that a team of inexperienced medical and nursing staff were thrown together, reliant upon each other through the exhausting 13-hour shift, but who had not worked together in some cases, without any team introductions, adequate handover or consistent IT support.”
Concern inside and outside of the profession has focused on the injustice of scapegoating an individual for system failures. Suggestions by the British Association of Physicians of Indian Originthat Bawa-Garba’s headscarf and skin colour influenced the outcome have been met by accusations of “playing the race card” in mainstream and social media. However, migrant doctors are, on average, treated differently to their caucasian peers, from medical school to postgraduate training, and professional examinations to disciplinary proceedings.
Donald Trump’s criticisms of the NHS were said to have been inspired by Farage, who spoke of the demise of the “international health service”. It has always been international – but because of the overseas staff on which it has relied since its inception. During a trip to Kerala in January, I saw newspaper advertisements encouraging Indian doctors and nurses to apply for jobs in the UK, from paediatrics to general practice. As EU doctors and British-trained doctors leave, or threaten to leave, in increasing numbers, the gaps need to be filled from somewhere. Recruitment and retention challenges will persist and worsen if the government makes immigration difficult and there is a failure to treat all staff without discrimination. The NHS needs the brightest and the best doctors, nurses and scientists, regardless of their country of birth or their country of training.