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Editorial
24 October 2021
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Black History Month and why it matters

By Professor Mayur Lakhani CBE

FMLM Chair  

Black doctors are making amazing contributions to medicine and patient care, but in my view, this is not recognised or celebrated enough, and as Chair of the Faculty of Medical Leadership and Management, I want to change this. It is clear to me that black doctors face a range of challenges, some of which are specific to them, and I would like to hear more from those doctors working in the UK to better understand their needs.

We will be hearing from a number of you at our forthcoming Leaders in Healthcare conference. I am delighted to announce that tackling racism and building fairer systems to address structural inequalities in healthcare access and outcomes are among the key topics of discussion. I am looking forward to several sessions dedicated to this topic which will explore why diversity in leadership is important and representative of the communities we serve, and the associated performance benefits for teams, organisations, and systems.  

I have an emotional investment in the story of ethnic minority doctors and nurses working in the NHS, being of Indian heritage but born in East Africa and arriving in the UK as a refugee. My story is only one of many extraordinary stories of clinicians from a range of countries, including the Commonwealth, serving generations of patients in the UK.

As a working doctor on the frontline of the pandemic, I saw first-hand how Covid afflicted our BAME communities disproportionately; it was not uncommon to see entire families struck down with the Coronavirus, including those integral to our health and care staff community. It is widely recognised that Covid exacerbated and cruelly exposed pre-existing health inequalities. It reminded me of the spirit of Dame Margaret Whitehead’s definition of inequalities as health differences that are ‘avoidable, unnecessary, and unjust’[1].

But there is a silver lining. The post-Covid world presents us with a brilliant opportunity to do something very different in this sphere. From a crisis there is always an opportunity to learn and plan – and this is a key attribute of leadership. Medical leaders and FMLM have a pivotal role in this.

The case for change

As the professional home for medical leadership in the UK, FMLM supports doctors to become better leaders. We support teams to achieve better patient outcomes. We work to professionalise medical leadership through excellence. Racism is incompatible with medical leadership and our standards make this clear.

The NHS has one of the most diverse workforces in the world with over 40% from ethnic minority groups. But research has consistently shown differential attainment by ethnicity in the medical workforce across all measures of training and career progression.

To get to the heart of the matter, there is wide criticism that ‘talk is not matched by action’. Some barriers still exist, which fall between denial and fear, and result in defensiveness – which is not a helpmate of progress.

What is to be done?

As we define the post-Covid world and the so-called ‘new normal’, there is a unique opportunity to make inroads to the issues of inequality that exist in health and care, and in our workforce. We are at a tipping point especially with the development of integrated care systems in England, the new health and care plans developing in each of the four nations of the UK, and the unprecedented focus on staff wellbeing.

We must talk more about race and accept that there is a problem, both in the workforce and patient care. It is not a subject we have generally been encouraged to discuss, as race in medicine is a toxic, polarising issue. However, when we resort to silence, people suffer. Maintaining priority on this agenda among many competing priorities is a key challenge, but the main priority must be to find a way to make it safe to talk about race; to learn, work together and ultimately support one another to take action.

We need a bigger plan and a new mind-set achieved through deliberate education and training, and professional development dedicated to the elimination of racism within health and care.

There is much to reflect on, and not just because it is Black History Month in the UK.  Historically, migrants have not been treated with the equality we now strive for. Society has not always got it right. This is true in the NHS as well, there are lessons to be learned and some way to go. But we have made progress. More action than talk is needed now.

Despite the serious problems we face and the huge amount of work that needs to be done, I am optimistic about the future. This is a time of opportunity for those who are, and those who aspire to be, medical leaders, to create the best possible futures for all people, both in the workforce and the communities we serve. It is time for us all to become a ‘culturally intelligent’ leader.




[1] Whitehead, M. (1991). The Concepts and Principles of Equity and Health. Health Promotion International, Vol 6, Issue 3, Pages 217-228. Retrieved from https://academic.oup.com/heapro/article-abstract/6/3/217/742216?redirect...

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