Forms of racism and discrimination in career progression in the NHS: Evidence from Ghanaian nurses and midwives Leroi Henry Department of Economics The Open University

Aims Explore and conceptualise discriminatory practices in career progression in the NHS Examine and contextualise how some responses to perceived racism entrench rather than resist marginalisation

The REOH Project: Background Researching Equal Opportunities for Overseas-trained Healthcare professionals Open University and University of Surrey Sponsored by European Social Fund Interviews with over 100 overseas-trained healthcare professionals Case study of Ghanaian trained healthcare professionals. Interviews with NHS Trust and clinical managers Interviews with local and national stakeholders

The REOH Project: Research Team Dr Helen Allan, EIHMS, University of Surrey Dr Leroi Henry, Economics, Open University Dr John Larsen, EIHMS, University of Surrey Professor Maureen Mackintosh, Economics, Open University Professor Pam Smith, EIHMS, University of Surrey

The REOH Project: Key areas of interest Accreditation and use of overseas skills and experiences The factors affecting career progression Relationships with colleagues and patients Adaptations to UK work environment Systems of social, economic and professional support Influence of relationships with countries of origin on careers

Methods Case study of Ghanaian trained healthcare professionals Conducted in London and South-east England Individual semi structured interviews and ethnographic research with the Ghanaian Diaspora. Informant led interviews focusing on their stated concerns

Selection of informants Participation in previous studies Contacts with Ghanaian community groups Activists in Ghanaian and other minority ethnic community and professional associations Case study visits to workplaces ‘Snowballing’ through the above routes Interviewing thirty healthcare professionals at the two largest hospitals in Ghana. Observation at Diaspora meetings

Characteristics of informants Thirty nurses and midwives Mostly F and G grade Most resident in the UK for over 15 years Mostly joint nationality Supplemented by more recent migrants and lower grades. Not representative of Ghanaian nurses in the UK

Background: Lack of transparency in promotion in the NHS Henry, L. (2006 forthcoming) Institutionalised disadvantage: Older Ghanaian nurses and midwives reflections on career progression and stagnation in the NHS, Journal of Clinical Nursing Special Issue

Background: Lack of transparency in promotion in the NHS Difficulties adapting to career progression initially attributed to socio- cultural differences Disadvantage entrenched and institutionalised by a lack of support In promotion into senior roles informants experienced differential access to training and opportunities to gain experience Discrimination in the quality of support given to candidates particularly interview preparation and feedback. Systems of patronage based on meeting subjective criteria rather than meritocratic.

Forms of discrimination in career progression within the NHS Discriminatory acts Discriminatory omissions Cultures of discrimination Marginalising oneself Narratives of discrimination

Marginalising oneself: becoming an agent in discrimination Response to racism and a form of discrimination In context of racism nurses balance careers with other commitments and interests Instrumental attitude towards professional life Withdraw from career development

Alienation leading to withdrawal from career progression Demoralisation after long periods of career stagnation Caused by endemic racial or ethnic discrimination Reinforced by a perception of a lack of support or interest from managers Avoiding humiliating processes ending in failure

Redefining success Withdrawal accompanied by a redefinition being a successful migrant Immediate family in the UK Dual identities: “Living here and there” Extended family Property and investments in Ghana Retirement and or returning to Ghana Return to migrants’ original aims

Being an agent in ones own marginalisation Trauma and frustration engendered by discrimination are internalised Victims seek to avoid exposing themselves to further humiliation Response to racism that reproduces the effects of discrimination through inhibiting career progression

Political implications of this analysis Not blaming these black professionals for their predicament Understandable response based on their original aims as migrants and current obligations Does not let the NHS off the hook for the discriminatory practices which provoked these responses Explains why withdrawal from career progression is common in some overseas trained staff

Narratives of discrimination Perception that ethnicism and racism are endemic not the substance of claims of discrimination Power lies in the ways that this perception affects responses to situations and relationships in the workplace

Narratives of discrimination Discriminatory practises conceptualised through a collective narrative of discrimination and exclusion Context: –lack of transparency in career progression –Few black and African nurses in senior positions Informants understand their relative lack of career success as a result of being Africans Africans at the bottom of a racial and ethnic hierarchy which largely determines ones status within the NHS

Narratives of discrimination as a lens Narrative can become a lens through which experiences in the workplace are interpreted Form of racism existing within the mind of the victim which affects responses in the workplace Most negative experiences are regarded as racism irrespective of alternative explanations In an environment lacking transparency, racism is easiest explanation for negative experiences

Narratives of discrimination Not questioning the validity of nurses claims of discrimination Not claiming that racism only exists in the mind

Collective narratives of discrimination and marginalisation Interpretations of shared experiences as discrimination become self sustaining Little evidence supporting alternative explanations Expectation of racism due to history of perceived racism Demoralised staff become marginalised Not adopted by all

Resisting racism through avoiding racialisation Discourses of successful black nurses and midwives Progression built upon not labelling every negative experience and incident as racist Various interpretations of this discourse

Limitations Current analysis only relates to Ghanaian nurses and midwives attempting promotion above grade F Some nurses have resisted these processes Demoralised nurses’ careers can be resurrected

Conclusions Overseas trained nurses experience a range of discriminatory practices that take three guises: –Discriminatory acts –Discriminatory omissions –Cultures of discrimination Responses to perceived racist or ethnic discrimination can intensify its effects through encouraging individual and possibly collective withdrawal from career progression