black working lives matter

A few weeks ago I did something I have been avoiding for about 20 years. I talked about racism at work.  As part of the frontline education we’re starting at the Tavistock Clinic, a group of practitioners of the psychoanalytic persuasion have been meeting and having conversations about the juicy stuff of whistleblowing, bullying, fear and loathing in the NHS. A kind of Anti-Action for Happiness.   In an interview about bullying in the NHS with the divine Angela Eden and Elsie Gayle - Elsie, a black midwife who walked away from the NHS because of bullying said without a trace of bitterness “Even talking to David Nicholson (the then head of NHS England) couldn't protect me from the consequences of being a black woman”.   To have these kinds of conversations with other human beings means you have to pretty much be in love with each other - which as would luck would have it is the case with Coreene Archer from the Tavistock Institute for Human Relations and Roger Kline a bloke behind the new NHS Workforce Race Equalities Standard.   Despite the blinding evidence, very few of us have the balls to say that the NHS is, in fact, institutionally racist. Roger’s research has let the cat out of the bag - that despite 41% of NHS workers in London being from a BME background and a lot of equalities work over the years- the proportion of London NHS Trust Board members from a BME background is 8%- white staff in London are three times more likely to become senior managers than BME staff.- 25% of BME staff consistently report they are discriminated against at work   The NHS’s own workforce surveys show that BME staff who are more likely to be bullied at work and subject to disciplinary processes.   The moment has come when we have to ask, do black working lives matter in the NHS?  Very much if you’re a patient in the NHS. The discrimination against BME staff is not just an employment relations problem, its a clinical one. The treatment of BME staff is a good indicator of the quality of patient care. Research, much of it being churned out by the Kings Fund and Michael West’s research team, shows that when BME staff are treated unfairly this is reflected in poor patient care. This is linked to our experience that a lack of diversity in teams reduces innovation and learning and that when staff don’t represent their local communities they struggle to provide genuinely patient centred care.   Earlier this year, the Workforce Race Equality Standard was announced to tackle equal access to career opportunities and fair treatment in the workplace for BME staff. It provides a measurement for workforce equality and a requirement for NHS trusts and employers to deliver results - neutrally named the Equality Delivery System or EDS2. These measurements will be used by health regulators to measure equality in the NHS.  Potentially this sounds a bit dull - but having standards, measurements and tracking data is extraordinarily necessary given the reality that nobody wants to talk about racism. The NHS has until now relied heavily on not collecting data, not publishing it and therefore not having to acknowledge the problem in the first place. Data is good.   Not only that because data drives inquiry. In every other aspect of NHS life – disease, patient safety, improving care - we use data to identify problems and make changes. If workforce race discrimination adversely impacts patient care surely data on racism should be treated the same way. This is what the Standard is starting to do.  But once the data comes out we are still left with the enormous difficulties NHS staff are going to have in trying to tackle racism at work. The data doesn't express the deep and difficult emotions that are inherent in experiences of discrimination. Bluntly, racism is underpinned by a hatred for other people and the rage at being on the receiving end of it.   When I was setting up the Surviving Work Library I did hundreds of anonymous interviews about how people survive work - including the question “How to get angry without losing your job?”. Being of an angry persuasion I thought I was playing to my strengths but I hit a wall of denial - powerful, smart and senior black women from health and trade unions, vibrating with righteous anger claiming “I don't do anger”.  So I asked Coreene a question that’s been bugging me for some time. Given the levels of discrimination in the NHS why don’t black women get angry at work?  This was the answer. When you’re black, particularly a black woman, even a slight inflection of the voice can be felt as the tipping point for a race war that has been brewing for hundreds of years. And who needs to take on centuries of white guilt by raising their concerns at work?  When the issues at work get this tough we need to wheel in the big psychological guns.  Psychoanalytic ideas are really helpful in thinking about racism. A much discussed idea developed by Fakhry Davids relates to the Internal Racist - the part of all of us that hates difference in others.   This is the primitive stuff of babies coming out of the womb to a world of strange smells and even stranger bodies, a raging hunger and not a clue how to survive in this big old diverse world.  Racism is a primitive reaction to a world of people that are not like me and who I can’t control, often provoked by a scarcity of resources. Within this psychoanalytic model, we start with the basic belief that we all have an internal drive to hate difference in others.  We also see the job of growing up as an attempt to reach a position where the world is not black and white. Away from a perspective where people like me are good and people who aren’t like me are bad, towards a more depressive and often depressing position that we are all a mixture of love and hate, and none of us are in much of a position to cast the first stone.  This might sound too abstract, so let me tell you a story about the emotional experience of trying to face up to racism at work.In an attempt to, psychically speaking, grow up this summer I went on a Group Relations Conference on race and class at the Tavistock Clinic. This involves all manner of human torture - like experiential groups and open discussions about violence and racism. Anyone can say anything, at all, to anyone.  Gulp.  Despite this, it turned out to be probably the most profound learning experience of my life. So, at the risk of taking one for the team, I’m going to tell you what I learned.  On day three I found myself crying in a toilet having been beaten up by the big girls. In a particularly intense experiential group, I had been accused of being racist during a discussion about black leadership in the NHS. My contribution to the debate was to raise the thorny issue of the growth of Islamaphobia at work, unfortunately formulated as “Why is it OK for a black woman to say they hate white muslim women wearing the headscarf to work?”.  People, I was tired.  This led to something of a brutalisation and being accused by the group of being a racist. My response to having my PC credentials challenged was to shout, all red faced and sweaty “I spent three months of my life running truth and reconciliation meetings with workers in the conflict diamond mines of Congo! How racist can I be exactly?”.  I had, it appears, turned into Travis Bickle in Taxi Driver. You lookin’ at me?  In these kinds of settings, once the niceties and veneer of civilisation has been chipped away, our internal racists become exposed. Faced with our own and other people’s prejudices we are all, it appears, offended.When we encounter differences in others, particularly if we don’t like them or are working in a workplace in conflict, the psychic process can go as follows:

• something gets challenged - a belief, a comfort zone, a value, a denial
• feel really irritated
• get angry
• get hateful
• then experience paranoid guilt that the other person is going to retaliateget defensive and possibly a bit hostile

   In most cases our egos cant handle this decline into primitive feelings and we deal with this by withdrawing from other people. This dilutes the strength of our ugly feelings but it also allows us to keep our views unchallenged and our superiority intact.   Retreating from diverse groups is sad but probably not terminal if you are actually a taxi driver. But if you work in health and social care dealing with different people is the nature of the job and very much your duty of care. Whether they’re patients or colleagues, you don’t get to walk away from them just because you don’t like them.   Working with people who are not exactly like us and are in pain and distress means that being offended by others is an occupational hazard. The issue is not whether we will be offended, rather what we do with the offence. If we nurture it and leave it unchallenged it can turn to a hatred and a righteousness and workplaces where some people are believed to be inherently better than others.   Equalities data and standards are crucially important in maintaining the battle lines between offence and hatred - but we can only do this, really do this, if we are prepared to know our internal battle with difference, and keep the internal racist in its primitive place.