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- HSJ-‘Distressing’ rise in maternal death as progress stalls
An article in the HSJ, by Emily Townsend with the above title and published on 13 January 2026 reads as follows:
>Rate of maternal deaths up 20 per cent compared to 2009-11
>Rise means previous government’s ambition to halve rates by 2025 has failed
>Inquiry chair warns data “so distressing” and reflects “stalled progress”
More women are dying during pregnancy or shortly after giving birth compared to over a decade ago – despite a pledge by the last government to halve maternal mortality rates, new data shows.
The research by MBBRACE-UK suggests the national rate of maternal deaths is now 20 per cent higher than it was in 2009-11.
It found there were 252 maternal deaths between 2022 and 2024, with most women dying due to blood clots and heart disease, while around a third died by suicide.
The investigation, led by Oxford Population Health’s national perinatal epidemiology unit, examined the deaths of women between January 2022 and December 2024 during pregnancy or within six weeks after their pregnancy had ended.
It found the rate of direct maternal deaths, due to conditions occurring as a result of pregnancy, such as blood clots, bleeding and pre-eclampsia, increased by 52 per cent, while indirect deaths caused by pre-existing conditions were largely unchanged.
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Inequalities remained, with black women dying at a rate three times higher than those from a white ethnic background.
The deterioration in performance comes despite a pledge by the last Conservative government in 2017 to halve the rates of maternal deaths by 2025.
Data ‘distressing but not unexpected’
Donna Ockenden, who is currently leading the Nottingham University Hospitals Foundation Trust maternity review, said: “It is so distressing to read of the issues outlined in the latest MBRRACE report… but unfortunately it is not unexpected.
“We have known about the inequalities within maternity care provision in excess of a decade, yet the same issues still persist despite stated ambitions to reduce harm.
“Nowhere near enough has been done to fix the chronic problems, and sadly, it appears that progress has stalled. Suicide has been known to be a leading cause of death for years. This highlights once again that maternity services are not ‘an island’ and that families deserve better support before, during, and after the birth of their baby.”
MBRRACE-UK programme lead Marian Knight heads up the team that carried out the research.
She said: “These latest data highlight the need for a renewed focus on maternal mortality and the critical actions required to ensure safe and equitable maternity care for all women in the UK.
“While the change in the overall maternal mortality rate between 2021-23 and 2022-24 is not significantly different, a 20 per cent increase in maternal deaths over a 15-year period is very concerning, especially as pressures on maternity services have not eased.”
New care bundle launched
Last week, NHS England launched a maternal care bundle, which sets out best practice standards across five areas of clinical care for implementation by NHS providers and commissioners.
It aims to reduce maternal mortality and morbidity and reduce inequalities. All trusts providing maternity services and integrated care boards must meet the new standards by March 2027.
NHSE’s chief midwifery officer Kate Brintworth said: “These figures are deeply saddening and highlight how much more work is needed to prevent more deaths and address the unacceptable inequalities that persist for families across the country.
“That is why this week we have set out new best practice standards across maternity services, including to ensure earlier and more consistent assessment for blood clots, and improved identification and care for perinatal mental health concerns. Alongside this, the NHS is continuing to strengthen maternity care through specialist treatment centres.”
The Department of Health and Social Care said: “Every maternal death is a tragedy, and our hearts go out to all families affected. This government is taking urgent action to tackle the maternity crisis we inherited…
“We are also investing over £130m to make maternity and neonatal units safer, rolling out a programme to reduce avoidable brain injuries, and backing Martha’s Rule so families are always heard when they raise concerns.
“It is unacceptable that some women face far greater risks than others simply because of their ethnicity or where they live, and addressing these inequalities is a priority.”
- The Mental Health Act 2025
The Mental Health Act 2025 gained Royal Assent on 18 December 2025 although it will take 8 to 10 years to be fully implemented in England and Wales. A consultation on the Code of Practice is expected to start in early 2026. There will also be a consultation on a potential new category of ‘authorised person’ and a review into community treatment orders.
NHS Providers and NHS Confederation in partnership with Mills and Reeve have published a briefing about the new Act which provides a good overview of the updates made to The Mental Health Act 1983 and reads:
Overview
On Thursday 18 December 2026 the Mental Health Act 2025 received Royal Assent. It is not yet fully “in force”.
The Act follows many years of work by different governments to update the Mental Health Act 1983 to better reflect the modern understanding of mental illness. The Mental Health Act 1983 was last amended in 2007 – nearly 20 years ago.
In 2018, the Independent Review of the Mental Health Act was published. Two of the main drivers of the review were to reduce detention rates and stark disparities of the use of the Act on some ethnic minority groups. The review’s final report identified four key principles that should be used as a ‘basis for all actions taken under the act’. These principles form the foundation of the 2025 Mental Health Act:
- choice and autonomy
- least restriction
- therapeutic benefit
- the person as an individual.
The updated Act will not be fully implemented immediately, but in stages over approximately a decade, subject to Spending Review decisions. This will give services time to train and recruit staff and to develop new services. There will be a formal consultation on the existing Code of Practice, which we expect to begin in early 2026 with an updated Code of Practice published within around 12 months.
The first phase of significant reforms should begin in 2028, however, the scope of this phase has not been fully defined. Changes that do not require significant workforce expansion are expected to be implemented in phase one.
Key aspects of the reforms
- Discharge: A new form of conditional discharge will be in place. This change was in response to the decision of the Supreme Court in November 2018. This is likely to only apply to a small number of patients and will begin in February 2026.
- A new time limit of 28 days will be set to transfer prisoners who need mental health treatment to a mental health hospital. This is expected to come in between 18 and 24 months post Royal Assent.
- Definitions: Four new definitions feature in the Act for “autism”, “learning disability”, “psychiatric disorder” and “Appropriate Medical Treatment”.
- Detention: The bar for detention will be higher: under both section 2 and section 3 there must be evidence that ‘serious harm may be caused to the health or safety of the patient or of another person’. However, we await the Code of Practice for a definition of “serious harm”. Under section 3 a patient must be suffering from a “psychiatric disorder”, there must be a clear therapeutic benefit from the treatment and detention must be necessary.
- Community treatment orders (CTOs): will also have these stricter criteria and require the input of the community clinician. The government has committed to a review of CTOs; however, timelines and how the review of CTOs will impact on these changes is currently unclear.
- Nearest relative: provisions will be updated to provide for a nominated person (“NP”). Patients will be able to choose their NP, with safeguards in place. The NP will be able to exercise some additional rights compared to the current nearest relative role, such as the right to object to a patient being placed on a CTO or the right to be consulted about renewals.
- Consultation: Before discharging a patient, the responsible clinician (RC) must consult a person who has been professionally concerned with the patient’s medical treatment and who belongs to a profession other than that to which the RC belongs.
- Treatment: part IV of the Act is changing, with new provisions around making treatment decisions, the introduction of a “compelling reason” being required to give treatment without consent and amended provisions around electroconvulsive therapy (ECT).
- Care and treatment plans: which set out how current and future needs arising from or related to the patient’s mental illness when an individual is detained, will become a statutory requirement.
- Learning disabilities and autism: Integrated care boards (ICBs) and local authorities will need to seek to ensure the needs of people with learning disabilities and autistic people can be met without having to detain them, by increasing community provision for these groups. ICBs are already expected to maintain a dynamic risk register of people with learning disabilities and autism; however, the updated MHA will make this a statutory duty.
- Advance choice documents (“ACDs”): NHS England and ICBs will have a statutory duty to ‘make arrangements’ to provide information and support that allows people to create ACDs. Clinicians will have a duty to “have regard” to ACDs so a reason will need to be given if a decision not to follow the ACD is made.
- Independent mental health advocates (IMHAs): Informal patients will have access to IMHAs, but will need to opt in. Patients detained under the Act will automatically have access to IMHAs, unless they choose to opt-out.
- Section 3:
- changes to renewals, frequency of tribunals and changes to second opinion appointed doctor (SOAD) roles.
- The initial period of section 3 detention for treatment will be three months followed by renewals of three months, followed by six months and then a year.
- People with a learning disability and autistic people without a co-occurring mental health issue will no longer be detained under section 3. However, this will only be enacted when the government is confident sufficient community services are in place.
- Police and prison cells will no longer be able to be used as a place of safety for adults experiencing a mental health crisis. In 2023/24 police cells were only used as a place of safety for around 1%of the total number of those detained, and they are already outlawed for children and young people.
Analysis
Updating the Mental Health Act was long overdue. However, success will be dependent on the wider infrastructure to support it.
Changes for people with learning disabilities and autistic people
Detention: There is agreement from the mental health and learning disabilities sector that people with a learning disability and autistic people should not be detained any longer than necessary, unless they have a co-occurring mental illness.
Community provision: However, meeting the needs of these groups within the community will require a significant increase in community provision. During the pre-legislative stages and the passage of the Bill, the NHS Confederation and NHS Providers consistently raised this as a concern, and Lord Adebowale, chair of the NHS Confederation, tabled an amendment calling for a costed plan to build up capacity. Without a funded plan to build up this provision, there is a risk that the proposed changes to the legislation will never be enacted, and people will continue to be inappropriately detained.
The government will only enact this change once it is confident there is sufficient community provision in place. However, the level of provision that is needed for the government to enact this change is not currently clear. If the change is enacted before a safe level of provision is in place, there is the risk of people with a learning disability and autistic people being held in criminal justice facilities, being at risk of homeless and presenting disproportionately in urgent and emergency pathways within the NHS. Members would also welcome clarity on how the government envisages local registers being resourced, supported and monitored.
Timeframes: More widely there are concerns from members that 28 days is not long enough for a thorough assessment to identify co-occurring mental disorder, due to the complexity that patients present with.
Staff: High vacancy rates across the sector also impact on staff capacity and that will need to be addressed.
Mental Capacity Act: The government has committed to monitoring the use of the Mental Capacity Act (MCA) as there are risks that this will be used as an alternative and has fewer safeguards for patients.
The lack of clarity around the interface between the MHA and the MCA has been a broader, longstanding cause for concern for the system. There have been significant delays in implementing liberty protection safeguards (LPS), however, we are now expecting a consultation on LPS. Trust leaders have stressed the importance of the codes of practice for each Act providing clear guidance to assist in practitioners’ decision-making regarding which legal framework would be most appropriate.
ICBs and local authorities will be responsible for ensuring there is community provision available. The significant cuts and reorganisation of ICBs also presents a risk to long-term planning which will be required.
Reducing racial disparities
PCREF: Reducing racial disparities in the use of the Act was a key driver of the reforms. While it is not included in the legislation, the patient and carer race equalities framework (PCREF), the anti-racism framework for mental health providers, is the key vehicle to reducing the racial disparities that exist within the application of the MHA and in wider services. All mental health providers must implement PCREF as part of the NHS Standard Contract. There are concerns that the understanding of the framework, as well as the lack of resources available, are hampering its implementation and this is a missed opportunity to address one of the more important issues with the MHA.
Part III: There is also the risk that excluding Part III from elements of the reforms, which relate to patients involved in criminal proceedings, will increase racial disparities related to detentions. This is because black people are significantly more likely to access mental health support through the criminal justice system and are over-represented in secure mental health care settings.
Community treatment orders
Use: The racial disparities in the use of CTOs are incredibly stark – with black people being eight times more likely to be detained under a CTO than white people. There has been much debate about whether CTOs should be removed; however, there was consensus among NHS Confederation and NHS Providers members that, while acknowledging the disparity concerning CTO use, they can result in the least restrictive option.
Review: The government has now committed to ‘reviewing’ CTOs. The details and timescales on this are not currently clear. Trusts largely welcomed revising the criteria for the use of CTOs and enhancing the professional oversight required. It will be important for the government to monitor the effects of any changes to CTOs, including the impact of increasing evidence requirements, section 17 leave and readmission rates.
Advance choice documents
Duty: Making advance choice documents (ACDs) – which allow patients to set out ahead-of-time choices about their care if they become severely unwell – statutory was recommended by both the independent review and the pre-legislative scrutiny committee, due to the evidence that they can reduce racial disparities in the level of detentions. The legislation puts a duty on ICBs and local authorities to allow and support people to create them, and to provide a reason if clinicians decide not to follow an ACD. There is disappointment from some in the sector that there is no statutory duty to complete an ACD. It will be important to support ICBs and local authorities to effectively and equitably provide this support.
Issues: Guidance on how providers approach ACDs that were created by different trusts, how to digitally hold and connect records, and clarity on language within ACDs to ensure it is consistent (with the MCA and National Institute for Health and Care Excellence guidelines) will provide stronger safeguards for patients.
28-day time limit for prison transfers
Trust leaders have highlighted successful delivery of the time limit depends on bed and transport capacity, as well as hospital location. We would welcome the government clarifying how it intends to support services to achieve the 28-day transfer from prisons to hospitals, how services’ ability will be independently assessed before the 28-day limit is commenced, and how the government will monitor and report on delivery and impact.
Tribunals
The increased opportunities for patients to challenge their detentions are likely to increase the number of tribunal hearings and could require an additional 33% expansion of the inpatient responsible clinician workforce. Given the 10-15% national consultant psychiatrist vacancy rate, this will be very challenging. The legal aid budget would also need to increase.
Consultation of expansion of definition of authorised persons
The Department of Health and Social Care has committed to a consultation in response to an amendment tabled in the House of Lords, but removed by government, to introduce a new category of “authorised person” who can carry out detentions under sections 135 and 136, which sought to enable health and care professionals to do so and potentially reducing the involvement of police. While in certain circumstances there are benefits to removing the current requirement for police to remain with a patient from the first contact until they are in a place of safety, there are significant concerns around the ability of health and care staff to carry out detentions. This includes the impact on therapeutic relationships between health and care staff and patients, and workforce capacity.
Implementation
Baroness Merron, the minister responsible for mental health, described drafting and consulting on the Code of Practice as being the “first priority” after Royal Assent. However, this is likely to take at least a year. Updating the Code of Practice will translate the legislation into practice. The new criteria for detention, that ‘serious harm may be caused’ needs to be defined, otherwise there risks inconsistency on how the definition is interpreted, and the bar for detention may not be adjusted. The devil will very much be in the detail.
The Mental Health Act 1983 is a detailed and technical piece of legislation, and the reforms will have implications for the whole health and care system. However, the Act is only the legal framework in which the system for people with severe mental illness sits, and success of the reforms, will be dependent on the wider infrastructure to support it.
Successful implementation will depend on ensuring that the workforce and resources required to deliver the reforms in practice are in place.
Capital funding to improve the safety and therapeutic environments of inpatient wards, and capacity of community services, are also needed.
Detaining fewer people will help reduce demand for expensive inpatient services. However, to detain fewer people, clinicians must be confident that community services are resourced and robust enough to support the level of need of patients.
Detentions also often impact negatively on patient outcomes, increasing the need for, and therefore cost of, mental health support in the longer-term. Additional resources, such as supported housing, is vital to ensure people have access to step-down care, and more NHS and voluntary, community and social enterprise (VCSE) provision to support people from entering a mental health crisis is required.
The 2024 impact assessment estimates? £5.5 billion of monetised benefits due to fewer detentions, the cost of the reforms to be £5.3 billion for the areas of housing, health and social care and £313 million for costs to the justice system. The 2025 three-year Spending Review committed no additional funding to support the implementation of the reforms. Without appropriate resourcing, there is a significant risk that many of the elements will not be successfully implemented.
The NHS Confederation has led efforts to bring about long-awaited changes to the legislation. This includes:
- Persuading the government to commit – on record – to laying an annual written ministerial statement setting out details of the work that has been done over the preceding 12 months to implement this legislation and plans for how we will implement future reforms. Baroness Merron referred directly to the NHS Confederation’s chair Lord Adebowale’s amendment on this matter when announcing this.
- Securing support from several members of the House of Lords and the House of Commons for the amendments we drafted and led on.
- Briefing selected MPs and Lords ahead of parliamentary stages and securing mentions for the NHS Confederation in debates on the bill.
- Building a reputation with the government, MPs and members of the House of Lords as a key mental health stakeholder, which has led to subsequent engagement on behalf of NHS Confederation members.
NHS Providers has also played an active role over the years to keep members informed and influence reform of the act on their behalf. This included:
- Responding to the white paper consultationand joint committee’s calls for written and oral
- Regularly voicing supportfor legislative reform, and the wider actions required to deliver ambitions in practice, in the media.
- Briefing parliamentarians in advance of the bill’s second and third readings, and producing member briefings on the white paperand the draft Bill.
- Organising meetings between DHSC and members, and meeting with DHSC and stakeholders, to discuss the bill’s development and implementation at key points….
- HSJ-Major flaws discovered in trust training programme
An article in the HSJ by Caitlin Tilley with the above title and published on 8 January 2026 reads as follows:
>KMPG reviewed UHB’s international training fellowship programme
>Trust to axe the scheme after critical findings
>Concerns include fair pay, employment rights, failure to pay tax, governance of payments, and trainees remaining in the UK
An external review has uncovered multiple problems with fairness, finance and governance in a major trust’s scheme for taking on hundreds of overseas medical trainees.
University Hospitals Birmingham commissioned KPMG to conduct an independent review into its long-standing international training fellowship programmes a year ago, after concerns that it might be being abused as a way to secure cheap medical labour from overseas.
The report is dated July 2025 but was only released today to HSJ via freedom of information request. It advises the trust to reassess and reconsider the programme, and HSJ was told it is now due to be axed.
The programme involves the trust – one of the biggest in England – taking on hundreds of people who are training as doctors oversees as “international training fellows”, on two-year placements.
The auditors uncovered serious issues which they said presented “several financial and reputational risks” to the trust:
- Concerns about fair pay and employment: There was no reference in the UHB’s agreements that the doctors should have UK employment rights, including to a minimum wage, sick pay, and maximum working hours;
- The international fellows are required to work 37 on-call shifts every three months — compared to just nine for domestic trainees;
- The scheme appears to break tax rules, with no employment tax or national insurance currently paid by ITFs as part of the programme, even though the HMRC states that it should be;
- An “unusual arrangement” for funding the scheme, whereby money which is meant to support the trainees as a “stipend” is paid by UHB to a small UK company, with no oversight or agreements about how much is passed to trainees; and
- A large proportion of the ITFs do not return to their home country after their placement, which “contravenes” the purpose of the initiative “in supporting the healthcare systems in lower income counties”.
KPMG’s report cited complaints from applicants in Pakistan that short-listed candidates were based on “personal references and favouritism”. Unlike at other trusts, UHB’s medical recruitment team has “little involvement” in the ITF programme, which is instead run by the medical consultants who oversee the scheme, the report said.
It also raised concerns about overseas travel by trust staff. It says overseas trips are not unreasonable, but “it is important that this is undertaken in line with trust policy, and the spirit of achieving value for money”.
The trust’s MOU with the College of Physicians and Surgeons Pakistan, which is the main route for ITFs joining the trust, says the colleage will bear the cost of flights of UHB consultants for exchange visits. But KPMG found all flights to Pakistan had in fact been paid for by the trust.
The trust has spent £233,000 since 2017 on travel to Pakistan, China, Ethiopia, Jamaica and the UK, with £123,000 spend on travel in Pakistan, including £9,000 on hotels.
The report said: “We are aware that trust staff have travelled to Pakistan, separately from conducting interviews, for educational conferences, and our review has not found declarations of such trips.”
A staff travel policy is in the process of being drafted, the review said.
The programme operates through the national NHS Medical Training Initiative. This is an England-wide Academy of Medical Royal Colleges scheme, under which doctors from countries with a “fragile healthcare system”, such as Pakistan, Saudi Arabia and India, can come to train and gain experience in the NHS.
They are expected to return to work in their home countries afterwards, bringing back benefits from their NHS experience.
Some fellows are sponsored, for example, by their home country, while others are employed directly by an NHS trust.
HSJ revealed the review was due to be carried out in January, after internal reviews had uncovered “pay parity” issues, and following “concerns raised by clinical and non-clinical colleagues”.
A BMJ investigation into MTI schemes in 2023 said University Hospitals Birmingham – along with the Dudley Group FT and Walsall Healthcare Trust – had a specific agreement with the College of Physicians and Surgeons Pakistan, under which doctors on the scheme were paid less than doctors employed by the trust.
The magazine reported evidence the trainees were being paid substantially less than trainees on domestic training programmes working at a similar level.
- HSJ-Trust must pay £500,000 to director it victimised
An article in the HSJ, by Annabelle Collins with the above title and published on 24 December 2025 reads as follows:
>Trust must pay former senior director £450,000
>Comes after dismissal six years ago following flawed internal investigation
An employment tribunal has increased the compensation a trust must pay its former research director to total almost £500,000.
In 2019, Professor Tanweer Ahmed was sacked from United Lincolnshire Hospitals Trust, where he worked as director of research innovation and director of the Lincoln Clinical Research Facility, following allegations he had bullied staff in his team.
The tribunal found the trust’s investigation into Professor Ahmed was “one-sided”, while disciplinary action taken against him and his dismissal were influenced by suspicions he would “play the race card”.
Professor Ahmed, whose background is in clinical research and innovation, was sacked for gross misconduct, but a colleague who worked with him described the allegations as “laughable”. The tribunal upheld Professor Ahmed’s claims of race discrimination, victimisation, and unfair dismissal, but his claim of harassment did not succeed.
The ruling was first made in July 2022. But it was not until March this year that a payment was agreed by consent between the claimant and ULHT. This said the trust must pay him a basic award of £11,287, alongside £163,834 in salary loss, £80,410 in pension loss and £500 for loss of statutory rights.
However, in later reserved remedy judgments – published earlier this month – the tribunal decided after further representations that the earlier payment agreement had been flawed, and must be “set aside”.
The latest remedy judgment, dated October, says ULHT must in fact pay Professor Ahmed £449,548, which includes an “injury to feeling” payment of £36,000.
In response to the tribunal’s decision, Karen Dunderdale, chief executive of Lincolnshire Community and Hospitals Group (that United Lincolnshire sits within), said: “We accept the tribunal’s finding, at the initial liability hearing, that mistakes were made in how we approached the investigation into the bullying complaints raised against Professor Ahmed. We have apologised to Professor Ahmed for the failings in our internal process.
“These issues date back to 2018, and we believe the organisation has moved forward significantly in the seven years since these matters were first raised.”
Ms Dunderdale said the trust is “committed to creating a culture where discrimination and unfair treatment are addressed swiftly and effectively”.
She added: “Regarding the remedy award, we reassure our staff, patients, and the public that this will not negatively impact patient care or services.”
- The Guardian-‘The NHS would collapse within hours’: BME staff say Britain fails to appreciate their roles.
Long-serving workers say they faced racism as they helped build health service-but it ‘seems things have got worse’
An article in The Guardian, by Chris Osuh and Geneva Abdul with the above title and published on 26 December 2025 reads as follows:
“I am fed up of being called names. I know I am Black. I was born Black. And I love being Black. So tell me something I don’t know.”
Those words, uttered 50 years ago as a young nurse facing regular racial abuse from patients on a London hospital ward, were a turning point in Allyson Williams’s life and career.
Williams had come to the UK in 1969 from the anglophile culture of the postwar Caribbean – where children of all ethnicities learned English literature, grammar and history by heart – only to be attacked in “the mother country”.
She is now among those who, having dedicated their lives to the NHS, fear the UK still does not properly appreciate the outsize contribution made to UK healthcare by Black, ethnic minority and overseas-born or trained staff – decades after Windrush generation nurses held up the service in its earliest years.
Those professionals included Deloris James, who was born a British citizen in St Kitts and Nevis and moved to Cardiff as 10-year-old in 1964. She was “pushed” into a career in the NHS, following after her mother who was a midwife – 12 other relatives also worked in the health service.
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“The stories I hear, it seems as if things have got worse than when I was in the NHS,” said James, 71, who worked as a nurse and midwife. “I’m not saying there wasn’t racism, but it seems so much more prevalent.”
The number of overseas nurses and midwives coming to the UK is collapsing, with rising racism and changes to immigration rules blamed for the fall. In an interview with the Guardian, the chair of the Academy of Medical Royal Colleges, Jeanette Dickson, said the NHS was being put at risk because foreign health professionals increasingly saw the UK as an “unwelcoming, racist” country.
Between April and September, 6,321 nurses and midwives from abroad joined the register of those licensed to practise in the UK, compared with 12,534 who did so in the same period in 2024. In October, the Royal College of Nursing revealed the number of reports by nurses of racist incidents at work had risen by 55% over three years.
Meanwhile, overseas-trained doctors are leaving the UK in record numbers, with 4,880 doctors who qualified in another country leaving the UK during 2024, a rise of 26% on the 3,869 who did so the year before, according to the General Medical Council.
Williams, a writer who came to the UK in 1969 and spent 40 years in the NHS as a nurse, midwife, manager and clinical leader, said: “It’s been over 50 years and nobody has learned any lessons. Nobody has seen fit to congratulate or to thank the multi-ethnic people who have come – in our generation to ‘rebuild the country’, that was how it was put to us.
“I came at a time of brain drain when so many English people had gone to Canada and America and Australia. When I got into the hospital, and in my class, there were 30 girls who were training. One was English, four Irish and the rest were West Indians and west African – of the West Indians, there were 14 of us from Trinidad alone.
“The training and the social life was amazing, but there was a lot of racism from the patients. They would slap you or hit you or push you away. I was called the ‘N’ word. I was told I was nasty. It was quite disturbing.”
After a year, Williams told her mother “she couldn’t take it any more”, that she felt as if she was “walking on glass”.
But her mother told her: “You have a dream. You have wanted to be a nurse since you were small. The racism is their problem. You just get on with your career and find a way to deal with them.”
“It actually led me to make that big stand on the ward,” Williams, who celebrated the moment in the title of her autobiography, Tell Me Something I Don’t Know, said. “I don’t know where it came from … it was the most empowering statement I’ve ever made – from that point on, [racism] just never bothered me.”
Williams would move on to midwifery, where there was much less racism and where she found “bringing life into the world was such a privilege”.
She said: “Every now and then you would get a woman saying she doesn’t want to have a Black midwife. But the managers then were very strict. They would say ‘they’re all we have and they’re the best – you either have a Black midwife or you pack up and you go somewhere else’.”
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Decades on, and not every Black, ethnic minority, or overseas-born or trained medic feels they can rely on colleagues for support.
The NHS’s most recent workforce race equality standard report revealed Black or minority ethnic (BME) women (15.6%) were most likely to have experienced discrimination from other staff in the last 12 months, and 51% of NHS trusts reported BME staff were over 1.25 times more likely than white staff to enter formal disciplinary processes. At 80% of NHS trusts, white applicants were significantly more likely than BME applicants to be appointed from shortlisting.
Alison Hewitt is the second generation of her family to devote her working life to the NHS. Her aunt was a Windrush generation nurse and her mother was a children’s nurse – but Hewitt broke the mould to train in radiography 35 years ago, when Black radiographers were a rarity.
She said: “I think a lot of the Windrush nurses kept their mouth shut. Whereas nowadays, you’re constantly battling HR.”
But despite the discrimination and disparities, 28.6% of staff in NHS trusts are Black or minority ethnic and about 20% non-UK nationals.
“There’s at least 27 countries represented where I work,” Hewitt said. “If the Black staff, the Asian staff and the foreign-born staff all went home, the NHS would collapse within hours. We’ve always been brought in to do the difficult work.”
Nonetheless, Hewitt believes that if anything is driving turnover of staff in the NHS, it is “economic betterment” – and Williams agrees.
“Where do you go in the world where there is no racism?” Williams said. “It’s a global, international problem. But what you might find [outside the UK] is that the wages are better or there’s something else to compensate for it.”
Saada Maida, a 41-year-old gynaecologist from Leamington Spa who came to the UK as a refugee from Syria, said NHS staff of all backgrounds shared the common challenge of coping with patients with diverse needs in a “systematically underfunded” system, but stressed he had been made to feel welcome – and felt “the UK is one of the least racist nations”.
He added: “The common denominator between these people leaving is feeling somehow that they’re not appreciated in the NHS – if you take a contract in the Gulf, we know it’s systematically full of inequalities, more so than the UK, but the pay is better. I think all doctors or healthcare professionals leaving the NHS, I think the incentive, whether they admit it or not, is to a great extent financial.”
Having seen so many members of her family devote their lives to the NHS, James worries that the service she knew will be lost to cuts and privatisation, as well as the pressures facing its “wonderful” staff.
“It makes me feel very sad,” James added. “Here we are again, back to the 50s, when people were invited to come to Britain to work and rebuild and, when they do arrive, then they face these hostilities.”