Erosion of NHS values

Prof. Rajan Madhok says the NHS’s current arrangements for delivering race equality have been found seriously wanting. Best practice needs to be implemented in appointments, education, rewards and discipline

NHS HospitalApril was one of the most eventful months of my professional life in the NHS. We had a judicial review case that the British Association of Physicians of Indian Origin brought against the General Medical Council and the Royal College of GPs and we lost.
The same evening I went to the Royal College of Nursing to hear the research fellow of Middlesex University Business School Roger Kline present his report on the “snowy white peaks of the NHS” survey.
Then a few days later Raj Mattu, an Asian doctor, won his whistle-blowing case and there were the front page headlines about substandard foreign doctors following reports published in The BMJ.
After more than 30 years in the NHS, I was completely demoralised. As someone who had chosen to work in the NHS having graduated from India, and hence an international medical graduate, I have tried to support the system over the years and been a moderate trying to find the “third way” between activism and establishment resistance.
I also changed careers due to lack of progression in my chosen speciality in the 1980s, was made redundant at the peak of my career and was required to sign a compromise agreement in 2012. All because I believed in the NHS, a great health institution.

Prof. Rajan Madhok, Chair of BAPIO
Prof. Rajan Madhok, Chair of BAPIO

Among many other things, what was paradoxical in these recent developments was that Judge Mitting, in his judgement on our judicial review case, made a number of comments that left me puzzled.
He seemed to agree that there was a case to answer but most importantly he said that BAPIO could claim moral success but not legal victory.
I was saddened to note that hardly any senior medical figure came out publicly to robustly defend foreign doctors in the media. The very same foreign doctors who have shored up the NHS in disadvantaged communities and in “Cinderella” specialities, and who have saved the NHS billions in medical education costs, are being openly pilloried and unsupported.
To add insult to injury the health secretary signed a memorandum of understanding, and doctors continue to be recruited from India by Health Education England to staff the emergency departments.
Mr Kline’s report just repeats what has been known for a long time, and indeed similar findings were presented to the first meeting of the then NHS Commissioning Board.
So buyer beware indeed, but it is nonetheless painful and distressing.
The treatment of international medical graduates and BME staff is a manifestation of the erosion of NHS values and this is what hurts us. We are proud to be NHS clinicians, we do not condone bad practice by anyone regardless of race and ethnicity, and we do not compromise on patient safety.
We do not want to defend the NHS just because other systems are worse; we want the NHS to be the best.
The current situation is also a recipe for further polarisation, as increasingly it is not just white on black, but black on black and black on white discrimination, and it will be the opportunists who will succeed, thus creating a vicious cycle promoting mediocrity. We will end up with racial ghettos in the NHS.
However, rage is futile; it is not going to move us forward, said Dr Mattu in his talk at the BAPIO conference on patient safety earlier this year.
His view was endorsed by many other people; large parts of the system are now broken. There are many powerful people in the system who are implicated and the establishment seems to win every time.
Even when the whistle-blower has won, it is at a huge personal cost, and theirs is an almost pyrrhic victory – as demonstrated by not just Dr Mattu’s case, but numerous other cases of whistleblowers (not just BME ones) and silent ones who have seen the perpetrators get away and thrive.
We need to put an end to this, but that won’t happen if we remain in denial, refuse to engage in constructive dialogue and do not address the “barn door” problems.
It is time for healing, for “truth and reconciliation” and for activists and the establishment to come together.
We need to accept that the NHS has not done well in promoting race equality.
We have to develop a list of issues that need addressing urgently, and we need to start implementing best practice in appointments, education and training, rewards and in disciplinary procedures.
Putting race to the bottom of the agenda has brought us to this nadir, and despite rhetoric what remains missing is the means to change this situation.
The current NHS arrangements for delivering race equality have been found seriously wanting and need urgent review and strengthening.

Rajan Madhok is chair of BAPIO and a former council member of the GMC