Last year, we talked to black NHS managers from around the country about the Black Lives Matter movement, racism in the UK and tackling inequality in the NHS. After a tumultuous year, how do they feel now? And what progress do they think we’ve made?

“They were so excited to join in the atmosphere and everything,” says Zoeta Manning (pictured right), describing how her son travelled to London with friends for July’s Euro 2020 final. “But when the three black guys missed the penalties, I rang him and he said, ‘Mum, they’re attacking black people for no reason!’ I waited, worrying for hours, until he got back to Birmingham about three in the morning. Then I had to go to work the next day like nothing had happened.”

The following week, NHSX, where Zoeta works as a senior programme lead, held a support session for staff affected by the violence and racist abuse that followed the final. “People shared their experiences or just went to listen,” she explains. “Seeing these racist events makes people anxious and stressed. It can give them depression because they’re constantly worrying about it. Each time my sons go out I have to worry because they’re black boys.”

The experience of Euro 2020 encapsulates the mixed feelings of many black Britons towards everything that’s happened since the Black Lives Matter movement came to prominence last year following the murder of George Floyd. 

“We all have shares in the England national team,” says Richard Stubbs, chief executive of Yorkshire and Humber Academic Health Science Network (pictured below). “For some, like me, there’s a sense of pride in that. That, in the absence of leadership from mainstream politicians, Southgate and the players stepped into the vacuum with a national badge on their chests.” 

But for others, the idea of an inclusive England team is anathema, he says. “The second that first penalty was missed, my mind wasn’t on the football anymore; I knew the reaction would be an attack on our black players. When you’re successful, people are colourblind, yet the moment that you fail racism rears its head. Ten minutes earlier, those people were literally chanting your name – the fragility of their support is really unsettling.

“The section of society who were already racist have been galvanised, and the majority feel like they’re somehow an oppressed minority,” Richard continues. “So you get All Lives Matter, White Lives Matter and people flying banners over football grounds. But you can’t just keep saying it’s a certain section of society. At some point you have to say that is society.” 

Karen Bonner, chief nurse at Buckinghamshire Healthcare NHS Trust, says that while there is more willingness to have open conversations about race, “there’s a sense that people are thinking ‘enough already, let’s move on’, without understanding that this isn’t going to get fixed overnight. I also wonder whether people really understand their individual responsibility to deal with this.”

One big change she has noticed is the increased visibility of black people in the media – on the news, and in TV shows and adverts. “When I watch TV now, I do see more people people of colour,” Karen says. “And you’re starting to see more real black families in regular situations, which can only be good because a lot of negative stereotypes come from only seeing black people in particular circumstances.” 

Karen was particularly struck by Channel 4’s ‘Black to Front’ event on 10 September, when all its programmes were fronted by black broadcasters for 24 hours. “I remember watching it, thinking how a white person might feel seeing just black people – and how that’s our lived experience every day,” she says. “Since I was a kid, up until recently, I didn’t see anyone who looks like me on TV.”    

For many, the report published in April 2021 by the Prime Minister’s Commission on Race and Ethnic Disparities, which dismissed the existence of institutional racism in Britain, epitomised how many mainstream politicians want to brush the issue of race equality back under the carpet.

“I thought that was a prime example of politicians trying to draw a line underneath the issue and move on to other policy areas,”  says Richard. “The report and its methodology has certainly been rubbished by some politicians and parts of the public sector, but that doesn’t mean it hasn’t mean successful [in playing down the significance of the issue].” 

“It was outrageous,” adds Manning. “The report concluded – I actually wrote it down – that racism is either a product of the imagination of people of African descent or of discrete individual incidents. Just hearing that from the government sent a damaging message to black people. We’re thinking there’s actually going to be a change and then they say it’s all in our imagination.”

​All four managers voiced frustration that there are still few signs of meaningful change in the NHS or society at large. “There’s been some progress but I think it needs to be faster and harder,” says Patricia Miller, chief executive of Dorset County Hospital (pictured left). “BAME communities will be looking to see if the current conversations and actions are making a difference to their everyday lives – in terms of education, the criminal justice system, whether they’re treated fairly in employment, whether they get the same health outcomes.” 

Despite some improvements to recruitment processes and senior leaders being more willing “to recognise that they’re in a privileged position”, equality activity in the NHS often doesn’t go much beyond monitoring, says Zoeta.  “We’ve updated our policies and procedures, we’ve got refresher training on unconscious bias and inclusiveness, but we’ve still got under‑representation at senior levels. I work in Birmingham and it’s horrific, it’s shocking.” 

Patricia welcomes signs that NHS is moving away from the “deficit model”, which tries to tackle discrimination by encouraging black staff to improve their skills and capabilities. “We’re spending a lot more time developing leaders who understand black people’s lived experiences and what actions they can take to change organisational culture,” she explains. “I think there’s a recognition that, whilst we are the recipients of racism, this is not a black problem. It’s actually about the way the world views whiteness as being superior, and that’s what’s got to change.”

While there are more “white allies” prepared to have such “uncomfortable” conversations, “there’s still far too much resistance, because it’s really hard talking about a system that you benefit from and that other people feel oppressed by,” she adds. 

On a positive note, Richard Stubbs points to the new anti-racism movement launched by  West Yorkshire and Harrogate ICS as an example of “real leadership” on the issue. The movement brings together NHS organisations with other public services and private companies to tackle institutionalised racism and health and social inequality across the ICS footprint.

“They haven’t done it because of an edict but because they know it’s the right thing to do for their staff and their population. And they’re putting a lot of resources into it. When you get leadership like that, it genuinely feels for the first time like other people have got your back,” he says.

Miller says the development of new job descriptions for chairs and chief executives will help to provide “an accountability framework… to make sure that the skills and behaviours required lead to the right cultural change within organisations.” But that accountability needs to be extended to organisation and ICS level, she adds. “I wouldn’t expect organisations to be rated as outstanding unless they’re on that journey to becoming an inclusive organisation, or they’ve already achieved it.”

But the problem of racial justice “doesn’t just sit with the National Health Service, it sits across multiple places in society, and we need that wider commitment,” says Karen Bonner (pictured right). “We’re starting to see more positive images and responses, so let’s not back down on this, let’s keep it going.”

And Richard argues that keeping up the momentum of the Black Lives Matter campaign is symbolically important too. “It’s more important for the England players to be taking the knee now, in 2021, than it was last year,” he says. ”If it had just happened in the immediate aftermath of George Floyd’s murder, people would have forgotten it by now. But to carry on doing it, I think that’s the most important part of the gesture for me.”