You will need to provide some examples of hot topics you can apply during your medical school interviews. Here you will learn everything you need to know about issues related to BAME staffing in the NHS. This includes ethical implications and some example medicine interview questions and model answers for you to look at. Combine your reading here with medicine interview tutoring to boost your answers and delivery.
Summary of Issues Related to BAME Staffing in the NHS
Asian and Black staff in the NHS are overrepresented compared with the general working-age population as a whole, however, they are disproportionately likely to be in lower-grade roles - other BAME groups are underrepresented more generally
Whilst BAME people on a whole are more likely to be doctors in the UK than white people, amongst doctors white and Asian people are more likely to be senior doctors, with all other ethnic groups more likely to be junior
BAME staff are disproportionately more likely to face discrimination, and less likely to receive adequate support when compared with white staff members
COVID-19 disproportionately adversely affected BAME NHS staff, who died at a higher rate than their white counterparts
The NHS is currently undertaking various measures to attempt to address some of the issues faced by BAME staff in the NHS
👉🏻 Read more: MMI Medicine Interview Tips Guide
What do I Need to Know About BAME Staff in the NHS for Medical School Interviews?
What proportion of NHS staff are from BAME backgrounds?
The following table summarises levels of BAME staffing in the NHS, per UK government data:
| Percentage of NHS Staff | Percentage of Doctors | Percentage of Working-Age Population |
Asian (exc Chinese) | 10.0 | 29.7 | 7.2 |
Black | 6.1 | 4.6 | 3.4 |
Chinese | 0.6 | 2.5 | 0.9 |
Mixed | 1.7 | 3.2 | 1.8 |
White | 79.2 | 55.6 | 85.6 |
Other | 2.3 | 4.3 | 1.1 |
Amongst doctors, the figures of senior vs junior doctors are:
| Percentage of senior doctors | Percentage of junior doctors | Percentage of doctors overall |
Asian (exc Chinese) | 31.0 | 28.7 | 29.7 |
Black | 3.5 | 6.2 | 4.6 |
Chinese | 1.9 | 3.4 | 2.5 |
Mixed | 2.4 | 4.1 | 3.2 |
White | 57.0 | 53.0 | 55.6 |
Other | 4.2 | 4.6 | 4.3 |
👉🏻 Read more: NHS Questions at the Medicine Interview
What kinds of inequalities do NHS workers from BAME backgrounds face?
As has already been shown, doctors from most ethnic minority backgrounds are disproportionately less likely to be senior-grade doctors. However, doctors from all ethnic backgrounds face inequality in various forms across the NHS. The King’s Fund published an article featuring BAME staff sharing their stories which is well worth reading.
Some key points from this article, and other sources, include:
Board inequalities: NHS board members are disproportionately likely to be white, which influences the decision-making that affects all clinicians and patients.
Fair to Refer: BAME doctors were found to receive less effective, timely and honest feedback due to hard conversations being avoided where the manager is of a different ethnic background from the doctor.
Culture of blame: BAME doctors can be more likely to be blamed when things go wrong due to being seen as outsiders. For instance, Dr Bawa-Garba faced significant blame for a tragic outcome that resulted from mistakes being made by various individuals and the NHS trust, and race is suggested as being likely to have played a role in this.
Blatant discrimination is also, unfortunately, a significant issue for NHS staff from BAME backgrounds. Rates of reported discrimination are increasing - whilst some suggest that this is due to staff feeling more comfortable discussing this, others believe that rising racism within the NHS is the underlying cause. Note that actual rates of discrimination are likely to be higher than reported, and the following figures are from 2019:
29.8% of BAME staff reported bullying, harassment, or abuse from patients, relatives, or the public.
4.8% of BAME staff reported bullying, harassment, or abuse from colleagues
15.3% of BAME staff reported bullying, harassment, or abuse from a manager, team leader, or other colleagues
The disparity between the last two figures indicates that it is likely that non-clinical team leaders are more likely to engage in discriminatory behaviour than clinicians, though clinicians also do so at too high of a level.
What is being done to improve conditions and levels of BAME staff in the NHS?
The NHS is committed to working towards improving the underlying present in its staffing system. Some of the key action being taken includes but is not limited to:
COVID-19 guidance: COVID-19 guidance has been published that includes measures that should be taken to protect staff from BAME groups, and considers ethnicity as part of the risk assessment
Research: Over £4M was invested by UK Research and Innovation and the National Institute into research on the links between COVID-19 and ethnicity in the NHS
Health and wellbeing offer: A bespoke health and wellbeing package for BAME NHS workers was created that sought to address specific issues faced.
Networks: The NHS is facilitating and working with networks of BAME staff to better understand and address the issues that they face
Widening participation: Widening participation measures aim to increase ethnic representation at all levels of the NHS.
Time: Today’s junior doctors are tomorrow’s senior doctors - strides that are made to increase the number of junior doctors from underrepresented ethnic groups will help to increase the number of senior doctors from those groups once they fully qualify.
Multiple strategies and targets are necessary to help to resolve the various issues faced by BAME NHS workers.
👉🏻 Read more: Common NHS Hot Topics
Key Ethical and Social Issues Related to the BAME Staffing in the NHS
What are the benefits of a more ethnically diverse NHS workforce?
There are a variety of advantages that come from having an NHS workforce with fair ethnic representation at all levels. These include (but are not limited to):
Higher quality staff: The best quality staff possible will be ethnically representative of the broader workforce, and improving diversity ensures that the best possible staff are being recruited.
More diverse knowledge pool: People from BAME backgrounds may face different health issues, or health access issues, than white people. A more diverse knowledge pool of people with lived experiences of these issues can better tackle them.
Improved financial management: Studies have shown that, due to better quality staffing, financial management of ethnically diverse boards is better.
Better patient experience: When patients have their needs catered to as described above, they are likely to have better outcomes in the NHS.
Great public satisfaction: When the public feels more represented by the NHS, their trust in the NHS increases.
👉🏻 Read more: Answering Medicine Ethics Questions
How did COVID-19 impact BAME staff in the NHS?
BAME staff are disproportionately more likely to fall ill with and die from COVID-19. The racial inequality here amongst NHS staff is even higher than it is among the population more generally. Underlying genetic and physiological factors are not sufficient to explain the full extent of the gap.
Various factors have been suggested for this, and the NHS is continuing to investigate this problem and trying to address the underlying issues. Some of the suggested factors include:
PPE: It is possible that there was lower PPE access in areas with more BAME doctors
Frontline discrimination: It is possible that doctors from BAME backgrounds were more likely to be placed in dangerous, frontline roles and less likely to be protected
Underlying issues: Underlying factors such as the number of hours worked may also have been contributing factors to this particular inequality
Top tips for Medicine Interview Questions on BAME Staffing in the NHS
You could get questions about any of the above topics, or diversity in the NHS more generally, in your medical school interviews. Some top tips to consider are:
Acknowledge the various reasons why increased ethnic diversity in the NHS is so important.
Recognise the complex, various forms of discrimination faced by NHS staff - it’s not just about the numbers of who works where.
Consider intersectionality - discrimination is also faced by staff on the grounds of gender, disability, religion, sexuality, and other characteristics, and these interact with each other and race in complex manners.
You should weave your understanding of this issue into other questions where it is relevant, as it will often impact other things that you are discussing.
👉🏻 Read more: MMI Medicine Interview Tips Guide
Example Medicine Interview Questions and Answers on BAME Staff in the NHS
Q: What can the NHS do to improve conditions for BAME staff?
A: BAME staff in the NHS face various different forms of discrimination and challenges, to a disproportionate extent when compared with their white colleagues. Addressing these requires a complex combination of different strategies, but I think that there are a few key steps that need to be taken.
First, it’s important to improve diversity at high levels in the NHS - such as on boards and management teams. This can be done by encouraging more BAME people to apply and looking at how BAME people’s applications are considered to limit the effect of discrimination at this stage. Management training programs are another important consideration that may really help here. Quotas are also something that I think could be considered, where appropriate.
Second, I think that measures need to be taken to address the active discrimination faced by NHS staff - from their managers, colleagues, and patients. It’s important to have proper diversity training for all NHS staff and to screen them at interviews with questions just like this one. There must also be appropriate sanctions for NHS staff who engage in racist behaviour, including of course termination.
Third, more needs to be done to look into the significant inequalities during the COVID-19 pandemic where BAME NHS staff were far more likely to become sick and die. This laid bare some ugly systemic issues within the NHS, and it’s only by fully understanding them that we can begin addressing them. Similarly, I think that engagement with networks of BAME staff would also be helpful.
Of course, these measures are only a starting point and must be part of a larger strategy - but I do think that they are an important strategy to addressing racial inequality in the NHS.
👉🏼 Read More: Medicine Interview Questions Guide 2023
Practice Medical Interview Questions on BAME NHS Staff & Racism
What inequalities do you think BAME NHS staff face?
What do you think are the biggest sources of discrimination against BAME NHS staff?
Why were BAME NHS staff disproportionately likely to die from COVID-19 during the pandemic?
To what extent do you think that the NHS workforce is ethnically representative of the wider UK? What about doctors specifically?
What is the NHS currently doing to improve conditions for BAME staff?
What are the benefits of a more ethnically diverse NHS workforce?
How can we increase the presence of BAME NHS staff on boards and in management roles?
What is the impact of ethnic diversity in the NHS on public perceptions of it?
Do you think that the NHS is a fair employer for BAME staff?
What role do you think widening participation measures should play in medical school admissions?
👉🏻 Read more: 280 Common Medicine Interview Questions
Conclusion
Overall, BAME staffing in the NHS questions can provide a valuable opportunity to reflect on the ethical challenges that can arise in medicine and to demonstrate your ability to think critically about these issues.
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