Dr Dele Babalola, Senior Lecturer in Politics and International Relations, discusses the impact of racism in the NHS, from its effects on staff and patients to the need for meaningful institutional change.

The National Health Service has been the subject of attention in the British media in recent years due to the prevalence of racism. According to the most recent NHS staff survey, the majority of workers of ethnic minority background experienced prejudice from patients in the last year, a five-year high. The British public has read stories of patients who feel entitled to call healthcare professionals “dirty foreigners” and “monkeys,” as well as cases where patients refuse treatment from non-white staff. This is what migrant professionals have learned to tolerate, with many accepting such abuse as an inescapable part of their jobs. Immigrants are often blamed for the country’s rising cost of living, housing crisis, and poor employment situation, but refusing treatment from a migrant professional is irrational and deeply disturbing. Such action is not only repugnant, but it also demonstrates a fundamental ignorance of the NHS history.

The historical irony is undeniable and instructive. The NHS was established in 1948 as a direct response to the social and economic devastation of the Second World War, resulting from a rare convergence of political will and public demand. The 1942 Beveridge Report laid the intellectual and moral groundwork, identifying five “Giant Evils” afflicting society – Want, Disease, Ignorance, Squalor, and Idleness – and proposing a comprehensive National Health Service, free at the point of use, as central to their eradication. The NHS was also built on the backs of Commonwealth migrants, a fact usually overlooked in popular narratives. In the 1940s and 1950s, thousands of nurses were actively recruited from the Caribbean to fill vital gaps, and by 1960, the Indian subcontinent accounted for more than 40% of junior doctors. These professionals were not passive participants, but rather active creators of the NHS’s early success. While patients are not wholly to blame for their lack of knowledge of this history, the educational system that fails to teach it must accept responsibility.

The problem, however, extends beyond discrimination from patients to include systemic inequalities experienced by ethnic minority patients themselves. Reports consistently indicate that black women are more than three times as likely as white women to die in pregnancy, childbirth, or the postnatal period – a disparity that has persisted for decades without meaningful intervention. The independent investigation into maternity and neonatal services in England, led by Baroness Valerie Amos, found that racism and discrimination are deeply rooted within the NHS, with black women routinely experiencing being ignored, disbelieved, or subjected to harmful stereotypes about pain tolerance. Similarly, ethnic minority patients consistently report poorer experiences across mental health services, cancer care, and emergency medicine, with Black and Asian communities suffering disproportionately from delayed diagnoses, inadequate pain management, and dismissive clinical attitudes.

The NHS, which is widely regarded as a moral pillar of British identity and the country’s largest employer with over 1.3 million employees, is thus embroiled in a deeply troubling paradox: it was built by migrant labour, but it continues to discriminate against migrant professionals and patients. This contradiction is more than just a regrettable historical footnote; it is a reality that requires immediate response. Racism reverberates across the ethnic minority healthcare workforce, which has served as the foundation of Britain’s most treasured public institution for almost seven decades. The Workforce Race Equality Standard (WRES), a mandatory accountability framework introduced by NHS England in 2015, compels NHS trusts to report yearly on nine specific indicators that compare the experiences of white staff to those of ethnic minority colleagues. The findings consistently show continuing disparities in practically every area of employment. According to the 2024 WRES report, white applicants are still much more likely to be appointed from shortlists than ethnic minority candidates, with 80% of trusts reporting major recruitment gaps. The report also confirms that ethnic minority employees are consistently less likely to believe their organisation provides equal opportunities for career advancement, and they are significantly more likely to face formal disciplinary proceedings and discrimination from co-workers and managers. This highlights a more fundamental structural issue: racism in the NHS is also anchored in professional networks, career pathways, and institutional attitudes that systematically harm ethnic minority professionals.

The conversation about racism has become normalised in clinical and policy circles in ways that were unthinkable even a decade ago. Eminent professionals from ethnic minority backgrounds, speaking from positions of influence, consistently advocate for anti-racist action. Professor Partha Kar, a consultant endocrinologist who previously led the Medical Workforce Race Equality Standard for NHS England and is a nationally recognised advocate for racial equality, and Professor Mala Rao, a distinguished public health physician, are at the forefront of this advocacy. Despite their efforts and the widespread use of anti-racist language in NHS discourse, substantive institutional transformation is noticeably absent. The NHS Race and Health Observatory, which was founded in 2021 to address racial inequities in health and social care, has also pushed for significant policy reforms in pulse oximetry, maternity care, and mental health services, and is now launching workforce-focused programmes. These efforts appear great, but they have yet to result in quantifiable gains for the majority of ethnic minority employees and patients.

To address the NHS’s underlying racism issue, concrete institutional commitments are needed. Without such commitments, the NHS risks becoming an organisation that understands the anti-racist language but does not embrace its real demands. The gap between the rhetoric of equality and the reality of persistent disparities must be bridged not through symbolic gestures but through quantifiable and sustained action. The NHS, which has earned immense popular respect and trust, must now demonstrate that it can apply its core ideals of universalism and fairness to the very people who built it and who continue to sustain it. Anything less would be a betrayal of its history and declared values.

Dr Dele Babalola is a Senior Lecturer in Politics and International Relations at Canterbury Christ Church University. His research focuses on federalism and political economy, particularly ethnicity, democracy and terrorism in Nigeria. He teaches on our undergraduate and postgraduate degrees and welcomes applications from PhD students interested in similar research themes.