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News Article
UK nursing regulator’s new chief resigns after four days following racism row
Patient Safety Learning posted a news article in News
The UK nursing regulator’s new interim chief executive has stepped down just four days into the job after facing widespread staff backlash over her links to a high-profile race discrimination case. Multiple staff working at the Nursing and Midwifery Council (NMC) raised concerns to its directors over the appointment of interim CEO Dawn Broderick, who was head of HR at another trust when it was found to have discriminated against a Black employee. The Independent can now reveal Ms Broderick resigned from the NMC on Monday evening. It is the latest in a succession of controversies to hit the nursing regulator, following reports uncovered by The Independent last year. These include allegations from whistleblowers that racism within the NMC was allowing complaints against nurses to go unchecked. Staff have come forward to The Independent, warning they do not have confidence the NMC’s board will take the issue of racism seriously. Read full story Source: The Independent, 2 July 2024 -
News Article
Midwives call women in labour ‘Asian princesses’ amid ‘hostile’ environment fears
Patient Safety Learning posted a news article in News
The NHS Race and Health Observatory has raised fundamental concerns about racism towards maternity patients after several cases have come to light in recent months, including midwives branding patients as “Asian princesses”. The watchdog’s intervention follows regulators identifying patterns of racist and discriminatory behaviour at the maternity departments of two large hospital trusts and a smaller general hospital in the last six months. The observatory’s CEO Habib Naqvi told HSJ he was “deeply concerned” by the seriousness of the issues raised. He added that “discriminatory behaviours and ways of working… [can] lead to hostile and unsupportive learning environments… impact patient care and safety, and also seriously undermine the NHS’s goal of attracting and retaining its workforce”. Examples given included the term “Asian princess” being used by midwives in reference to brown-skinned women requesting pain relief during labour. The students also described a “disregard” from some midwives towards black and brown-skinned women, particularly where English was not their first language. It was also reported when Asian women verbalised their pain during labour, some midwives responded with “Oh, they are all like this”, while additional derogatory comments were made towards asylum seekers, that “they are playing the system”, the NHSE team’s report said. Read full story (paywalled) Source: HSJ, 28 June 2024 -
Content ArticleIn this article, Ashley Milne-Tyte looks at how older people are treated by healthcare professionals and the impact that negative views can have on their care and treatment. She highlights examples of older people being marginalised by healthcare professionals, who sometimes shout at their patients or speak to family members rather than addressing their older patient directly. Emphasising the harm that this can cause, she cites research that shows that medical bias towards older people can accelerate cognitive decline, increase anxiety and depression and shorten lifespans by up to seven-and-a-half years.
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Content ArticleSelf-advocacy is an individual's ability to communicate their own needs and is an important skill for patients. However, medical self-advocacy can be challenging, especially when there is a power imbalance between people in positions of authority and patients, who are often in a more vulnerable position. This power imbalance can be even more difficult to navigate for children and young people. In this personal account, Hannah Eaton describes her experiences as a disabled young person attempting to get support for diagnoses relating to chronic illness and neurodivergence. She aims to highlight the difficulties faced by children and young people accessing healthcare. She also makes some suggestions to improve how much children are able to take part in their own healthcare care and the healthcare system as a whole.
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Content ArticleThe doctor-patient relationship should be immune from bias, but growing evidence challenges doctors’ objectivity. In this study in Science, the authors analysed vast data from US military emergency departments, where active-duty doctors and patients have military ranks and some patients outrank their assigned doctor. The study found that patients who outranked their doctors enjoyed more clinician effort and better health outcomes because more resources were inequitably invested in their care. The results also showed that White physicians consistently put less effort into caring for Black patients. The authors suggest that power-driven variation in behaviour can harm the most vulnerable populations in health care settings.
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Content ArticleAccording to the United Nations Convention on the Rights of the Child, all children have the right to the highest attainable standard of health “without discrimination of any kind”. The UK has committed to upholding this right—but not all children in the UK are equally protected. Racism is a known risk factor for health in children, ranging from preterm birth and low birthweight, to major depression and asthma, and childhood is a vital period that can shape health throughout the life course. The authors of this Lancet article report on a roundtable discussion convened by Race & Health and the Race Equality Foundation in October 2023. The discussion focused on racism in the UK health system, with the aims of identifying key areas of exposure to racism in the UK health system for children, and the main barriers to uprooting racist structures and practices in the health system. The roundtable recommended the following immediate actions: Adopt a human rights-based approach that upholds children's rights to the highest attainable standard of health without discrimination and abolish policies that undermine these rights for minoritised children. Incorporate anti-racist health and research practice into the health system's functioning and commissioning, including by increasing engagement during decision making, and co-creation of processes, policies, and procedures with minoritised communities to foster greater trust. Integrate anti-racist training within health-care curricula to ensure that the next generation of health workers have the information and skills to recognise and combat racism in the health system. Embed professional accountability to uphold anti-racist principles and practice into the health system, including by embedding anti-racism within the annual appraisal process as a professional requirement. Ensure that data and evidence collected and valued by the health system incorporate the voices and inputs of communities, delivering epistemic justice. End structural discrimination in institutions and systems that shape children's interactions with the health system, including social care systems, and separate policing and prison systems from health care. Uphold equality, diversity, and inclusion commitments and funding and allocate funding to dismantle racism and white supremacy in the UK health system. Co-create anti-racist and anti-oppressive services with minoritised communities, providing a viable alternative to oppressive systems and structures.
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Content ArticleThis Lancet study examines the discrepancy between occurrence of Long Covid as perceived and reported by participants in longitudinal population-based studies and evidence of Long Covid recorded in their EHRs. The authors argue that this discrepancy might reflect substantial unmet clinical need, particularly amongst patients of non-White ethnicity. This is in keeping with reports from individuals with Long Covid of difficulties accessing healthcare, and poor recognition of and response to their illness when they do.
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News Article
NHS whistleblowers: We lost jobs after reporting patient deaths
Patient-Safety-Learning posted a news article in News
More than 50 NHS whistleblowers claim to have lost their jobs—with some driven to the brink of suicide—after standing up to protect patients’ lives as bosses bury their concerns. The group of doctors and nurses said that they had been targeted after raising concerns about more than 170 patient deaths and nearly 700 cases of poor care. One consultant said that it was the “biggest scandal within our country” and claimed the true number of avoidable deaths was “astronomical”. Instead of addressing the problems, the whistleblowers claim that NHS bosses are spending millions of pounds of taxpayers’ money on hiring law firms and private investigators to investigate them instead. Last year Rob Behrens, the health ombudsman, warned The Times Health Commission that patient safety was at risk due to “toxic” and hierarchical behaviour among NHS doctors. Professor Phil Banfield, the chairman of the council of the British Medical Association, which represents doctors, wrote in The Daily Telegraph that whistleblowing “is not welcomed by NHS management… NHS trusts and senior managers are more concerned with protecting personal and organisational reputations than they are with protecting patients.” In one case, the NHS spent more than £4 million on legal action against a single whistleblower, which included £3.2 million in compensation. Among the clinicians interviewed, 40 said that their employer took “no positive action” to address patient safety concerns; 36 said that patients remained at risk at their place of work; 19 said that NHS trusts covered up the problems, and ten said that their employers had denied there was a problem. Whistleblowers’ representatives are urging the government to require independent medical assessments for claims and to ban the suspension or exclusion of doctors for speaking out about patient safety. Dr Naru Narayanan, president of the hospital doctors’ union, has called for an independent national whistleblowing body outside of the NHS to register protected disclosures and protect individuals against recriminations. The Times Health Commission recommended that a no-blame compensation scheme should be introduced for medical errors, with settlements determined according to need. Backed by Jeremy Hunt, the chancellor, the scheme would help end the deadly cycle of NHS scandals and cover-ups and ensure families receive timely support. Read full story (paywalled) Source: The Times, 15 May 2024 -
Content ArticleThis systematic review aimed to find out the prevalence of sexual harassment, bullying, abuse, workplace discrimination and other forms of harassment among medical students, residents, fellows and attending physicians in obstetrics and gynaecology. It found that many of these behaviours were frequent among respondents of the ten studies used in the review. The findings suggest that there is high prevalence of harassment in obstetrics and gynaecology despite the field being female-dominant for the last decade.
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News ArticleBlack people have the highest rate of sexually transmitted infections in Britain and officials are not doing enough to address the issue, sexual health experts have warned. Black Britons have “disproportionally high rates” of various STI diagnoses compared to white Britons, with those of Black Caribbean heritage specifically having the highest rates for chlamydia, gonorrhoea, herpes and trichomoniasis. Experts have told The Independent that healthcare providers are failing to address these disparities in STIs. They have called for more research to fully understand the complicated reasons why STIs are higher among people of Black ethnicity. Research conducted through the Health Protection Research Unit (HPRU) found that there were no clinical or behavioural factors explaining the disproportionately high rates of STI diagnoses among Black people. But higher rates of poverty and poor health literacy among marginalised communities are all linked with higher STI rates, according to a 2016 study, which found that behavioural and contextual factors are likely to be contributing. Moreover, experiences of racism among Black people can fuel a reluctance to engage with sexual health services and test frequently, according to HIV activist Susan Cole-Haley. She told The Independent: “I very much believe that it is linked to socioeconomic disadvantage and racism, often in healthcare settings, which can be a significant barrier for people accessing testing, for instance, and feeling comfortable engaging with care.” Read full story Source: The Independent, 19 February 2023
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Content Article
A growing number of patients with eating disorders are reporting having treatment withdrawn by services, often without notice and without their consent. We spoke to eating disorder campaigner Hope Virgo about how pressures on services, enduring stigma around eating disorders and dangerous new narratives are leading to the practice of treatment withdrawal. Hope explains how this is affecting vulnerable patients and highlights that as the number of people developing eating disorders increases, the risks to patient safety will only get worse. -
Content ArticleDisordered eating can affect anyone, but it can be confusing to understand and recognise it in our own personal experiences. This guide, published by East London NHS Foundation Trust, is a snapshot of how adults in East London have navigated those experiences of uncertainty while seeking support for disordered eating. For many of the contributors, preconceptions about what an eating disorder is (or isn’t) have previously acted as a barrier to seeking or receiving support. It also contains advice on how to seek support for disordered eating.
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Content ArticleThis report from the BME Leadership Network comprises examples of anti-racist initiatives from BME Leadership Network members, to help advance equality within the workforce and for service users.
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Content ArticleThis research letter in JAMA Internal Medicine describes a multicentre retrospective cohort study that investigated associations between stigmatising language, errors in the diagnostic process and demographics for hospitalised patients. The study found that stigmatising language in patient documentation was associated with diagnostic error and multiple diagnostic process errors. The prevalence of stigmatising language was higher in documentation relating to Black patients and patients with housing instability. The authors argue that this may be indicative of clinician biases that interfere with data gathering, communication and clinical reasoning. They call for further research to explore the mechanisms behind this and to understand how clinician use of stigmatising language can be reduced.
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News ArticleA secret report has warned that the NHS is failing to protect trainee paramedics from widespread sexual harassment and racism at work, The Independent has revealed. A confidential NHS England report uncovered by The Independent has found that “extremely alarming” conduct and undermining behaviour are rife in ambulance trusts across the country, with trainees subjected to derogatory comments about their age, ethnicity and appearance in front of patients. There is a “worrying acceptance” that this is “part of the job”, with students hesitant to raise complaints about sexual behaviour by male colleagues in case it gives them a reputation as “annoying snowflakes”, the report says. The revelations come after a recent NHS staff survey revealed that thousands of ambulance staff had reported unwanted sexual behaviour from colleagues and patients last year. One healthcare leader described the findings as “harrowing”, warning that much more needs to be done to protect junior staff. The national report, which is understood to have gone through several edited versions and is marked commercially sensitive, was not due to be released until The Independent obtained the document through a freedom of information request. It found an “undercurrent” of bullying in some areas, with examples of students leaving their jobs as a result of inappropriate behaviour. Trainees reported feeling undervalued and unwanted while on the job, with one apparently told: “Your concerns don’t matter – we have to meet patient demands.” Ambulance handover delays have also led to student paramedics having less experience and training on the job, prompting fears that newly qualified paramedics do not have sufficient levels of experience in life-critical situations. Read full story Source: The Independent, 19 March 2024
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Content ArticleOlder people’s mental health has long been overlooked and poor mental health is often dismissed by health professionals as an ‘inevitable’ part of getting older. And despite NHS Talking Therapies having higher than average recovery rates among the over-65s, this service is less likely to be offered to older people. Commissioned by Age UK, this briefing from the Centre for Mental Health summarises evidence about the mental health of older people in England. It finds that ageist attitudes underpin a system that discriminates against older people, while fatalistic assumptions about what people can expect for their mental health in later life undermine the provision of effective support to promote wellbeing, prevent mental ill health and treat mental health difficulties. The briefing finds that while older people may possess many protective factors for good mental health, they face numerous risk factors, including poorer physical health, reduced mobility and, for some, poverty and racism. Tackling the risk factors and boosting protective factors can increase wellbeing in later life and either prevent or stop the escalation of mental health problems.
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Content ArticleThis report describes the findings of a study that collected stories of the working lives of Black and Brown healthcare staff during the Covid-19 pandemic. The study asked them to reflect on their experiences and highlight the changes they would like to see. It highlights a number of issues around victimisation, access to PPE, speaking up and risk assessments. The authors argue that the report confirms previous studies that identify the entrenched nature of racism in healthcare systems and highlights how systemic cultures of racism contributed to the disproportionate impact of Covid-19 on health and care workers from minority ethnic backgrounds.
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News Article
'Ethnic bias' delayed care before Liverpool woman's death
Patient Safety Learning posted a news article in News
"Cultural and ethnic bias" delayed diagnosing and treating a pregnant black woman before her death in hospital, an investigation found. The probe was launched when the 31-year-old Liverpool Women's Hospital patient died on 16 March, 2023. Investigators from the national body the Maternity and Newborn Safety Investigations (MSNI) were called in after the woman died. A report prepared for the hospital's board said that the MSNI had concluded that "ethnicity and health inequalities impacted on the care provided to the patient, suggesting that an unconscious cultural bias delayed the timing of diagnosis and response to her clinical deterioration". "This was evident in discussions with staff involved in the direct care of the patient". The hospital's response to the report also said: "The approach presented by some staff, and information gathered from staff interviews, gives the impression that cultural bias and stereotyping may sometimes go unchallenged and be perceived as culturally acceptable within the Trust." Liverpool Riverside Labour MP Kim Johnson said it was "deeply troubling" that "the colour of a mother's skin still has a significant impact on her own and her baby's health outcomes". Read full story Source: BBC News, 16 February 2024 -
News ArticleDeeply ingrained medical misogyny and racial biases are routinely putting people in need of treatment at risk, the government’s patient safety commissioner in England has warned. Dr Henrietta Hughes was appointed in 2022 in response to a series of scandals in women’s health. She outlined a “huge landscape” of biases in need of levelling, citing examples ranging from neonatal assessment tools and pulse oximeters that work less well for darker skin tones to heart valves, mesh implants and replacement hip joints that were not designed with female patients in mind. Hughes said: “I don’t see this as blaming individual healthcare professionals – doctors and nurses – for getting it wrong. It’s pervasive in the systems we have – the training, the experience, the resources. “Anatomy books are very narrow in their focus. Even the resuscitation models are of pale males – we don’t have female resuscitation models, we don’t have them in darker skin tones. This is deeply ingrained in the way that we assess and listen to patients.” She described the realisation that pulse oximeters, used to measure blood oxygen levels, work less well for darker skin tones as a “real shock to the system” when the problem was highlighted during the pandemic. More recently, the NHS Race and Health Observatory highlighted concerns about neonatal assessments. Bilirubinometers, widely used to assess jaundice in newborn babies, are less reliable for darker skin tones and some guidelines for the assessment of cyanosis (caused by a shortage of blood oxygen) refer to “pink”, “blue” or “pale” skin, without reference to skin changes in minority ethnic babies. The Apgar score, a quick test given to newborns that was rolled out in the 1950s, traditionally includes checking whether a baby is “pink all over”. “Even the names of those conditions – jaundice and cyanosis – suggest a colour. The Apgar score includes P for pink all over,” said Hughes. “There are systemic biases in that if you have a darker skin tone those conditions may not be so apparent.” Read full story Source: The Guardian, 4 February 2024
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Content ArticleSickness absence in the English NHS in 2022 was 5.6% – higher than the 4.3% rate three years earlier pre-covid, and totalling some 27 million days sickness absence. Moreover, 54.5% of staff reported they had gone into work in the previous three months despite not feeling well enough to perform their duties. This is a challenge for staff, managers, employers and occupational health services. Sickness absence measured and reported accurately can help identify trends that may assist with both understanding individual causes and preventing or mitigating sickness absence patterns by addressing their root causes. The NHS, along with many other public sector organisations, however, relies on a system of sickness absence measurement called the “Bradford Factor” which some suggest is counterproductive, without research underpinning and needs to be replaced. The Bradford Factor is a system which creates individual level, “trigger points” at which line managers consider investigation which may lead to disciplinary action to supposedly prompt improved attendance and referral to occupational health. The NHS’s over reliance on the Bradford Factor is potentially discriminatory and highlights the urgent need for a shift in how the service manages sickness absence, writes Roger Klein in this HSJ article.
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Content Article
Left-handedness—A handicap for training in surgery? (2010)
Patient-Safety-Learning posted an article in Surgery
Left-handedness was historically considered a disability and a social stigma, and teachers would make efforts to suppress it in their students. Little data are available on the impact of left-handedness on surgical training and this report aimed to review available data on this subject. The review revealed 19 studies on the subject of left-handedness and surgical training. Key findings include: Left-handedness produced anxiety in residents and their trainers. There was a lack of mentoring on laterality. Surgical instruments, both conventional and laparoscopic, are not adapted to left-handed use and require ambilaterality training from the resident. There is significant pressure to change hand laterality during training. Left-handedness might present an advantage in operations involving situs inversus or left lower limb operations. -
Content ArticleThis open letter penned by four senior female NHS doctors outlines the issues caused by ongoing misogyny in the medical profession in Wales. They call for real change to ensure that the trainees and medical students of the future do not experience the same harassment, inappropriate comments and bullying from senior colleagues that each of them can recall during their careers. "The four of us have risen to senior leadership positions in our respective specialties. We work in cancer, general practice, psychiatry and HIV medicine. And every single one of us can think of experiences from our own career that at the time we ignored, brushed off, pretended not to hear or not to see–but we saw, we heard, and we still remember."
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Content ArticlePeople with diabetes often encounter stigma in the form of negative social judgments, stereotypes and prejudice, which can adversely affect emotional, mental and physical health, self-care, access to healthcare and social and professional opportunities. On average, four in five adults with diabetes experience diabetes stigma and one in five experience discrimination due to diabetes in healthcare, education, and employment. Diabetes stigma and discrimination are harmful, unacceptable, unethical, and counterproductive. Collective leadership is needed to proactively challenge, and bring an end to, diabetes stigma and discrimination. To help achieve this, an international multidisciplinary expert panel conducted rapid reviews and participated in a three-round Delphi survey process. The group achieved consensus on 25 statements of evidence and 24 statements of recommendations. The consensus is that diabetes stigma is driven primarily by blame, perceptions of burden or sickness, invisibility and fear or disgust.
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Content ArticleAn estimated 2.1 million people are living with Long Covid in the UK alone. The Conversation recently asked 888 people in the UK with Long Covid about their experiences of stigma, and 95% of them said they had experienced stigma related to their condition. On top of the physical symptoms, people living with Long Covid may have to contend with discrimination and prejudice within their communities, workplaces and even health services. Long Covid is a relatively new medical condition, and has been subject to lots of misinformation and minimisation of its legitimacy as a physical illness. To date, there have been no estimates as to how common stigma around long COVID is, which has limited our ability to tackle the problem. Being aware of numerous anecdotes of the discrimination Long Covid patients face, The Conversation decided to look into the extent of this problem and designed a questionnaire together with people who had lived experience of the illness. The questions aimed to estimate how commonly people with Long Covid experience stigma across three domains. “Enacted stigma” means being treated unfairly due to their long COVID, “internalised stigma” is where people feel embarrassed or ashamed of their illness, and “anticipated stigma” is a person’s expectation that they will be treated poorly because of their condition.
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Content ArticleUnconscious bias, which is deeply ingrained and often hard to recognise, impacts decisions in ways we may not realise. Implicit bias, shaped by repeated exposure to real-world interactions, also plays a significant role in this phenomenon. As such, in healthcare, intuitive decision-making can be a double-edged sword. It can help during emergencies but can also lead to discrimination and biases, especially in complex situations. In addition, hidden and automatic biases, which are further strengthened by unquestioned repeated practices, have a significant impact on daily healthcare interactions. Historically, gynaecology occupied a marginalised position within the realm of surgical care, often relegated to the status of a ‘Cinderella service’. This perception stemmed from societal attitudes and gender biases, which influenced how gynaecological surgeries were viewed in comparison with other surgical specialties. Gynaecology, being predominantly focused on women's reproductive health, was sometimes considered less prestigious or less prioritised than other surgical fields such as orthopaedic surgery or general surgery.
