Thank You For Inviting Me. Thanks to GMC! Always Nice to be Amongst Friends
My Background Dr P Umesh Prabhu FRCPCH Consultant Paediatrician Lead Clinician 1992-1998 Medical Director 1998-2003 NPSA Board Member 2001-2003 NCAS Adviser Overseas Doctors Mentor Clinical Adviser to the HCC Member DOH, BMA, NCAS Equity & Diversity Group
Personal View And Not A View Of Any Organisation
Our NHS I am very proud of our NHS I have always been very passionate about it NHS is one of the best asset that we have in our country.
Our NHS Vast majority of care is of very high quality. NHS is about Good Doctors Trying to Do A Good Job.
Back Ground I have been very fortunate. Have met lots of very nice people from various backgrounds. UK is one of the fairest countries in the world. UK is one of the fairest societies in the world I am proud to be British and Britishness.
In Fact Whenever I have expressed my concerns, it is my ‘White’ Colleagues who have taken them seriously and done something about them. Many BME friends tried to discourage me!
The leadership shown by the GMC My role in the NCAS My discussion with Healthcare Ombudsman My recent experience with the DOH. My own Trust Chief Executive. Just Some Examples
Other Hand Nothing changes so why bother. My bum is not on fire – so why bother? You are doing a good job Umesh – Carry on. Please do let me know if I can do anything. There is no racism – Go home – BMA, College, and MDU.
Doctors Role In The Society Being doctor gives us lot of privilege Ours is the most trusted and respected profession. Doctor patient relationship is based on trust and mutual respect.
Who Do the Public Trust? Doctors 89% Teachers 86% Clergy 78% Police 63% Man on the street 52% Journalists 18% Politicians 17% MORI May 2005 (After Shipman)
Patient safety and their well being should be at the heart of our duty as doctors. Our conduct, behaviour should be above board all the time. We should always maintain the patient and public confidence in our profession. Doctors Role In The Society
Due to ‘Poor’ Professional Regulation. • Shipman • Rodney Ledward • Richard Neale • Alder Hey Pathology • Bristol Cardiac Babies • Kerr and Haslam • Clifford Ayiling • Many More
Doctors, NHS, Patient Safety and Medical Errors Let me now put these in context
Patient Safety - UK • 1 in 10 Patients suffer an adverse event due to medical error. • 900,000 adverse events per year. • 20,000 deaths each year due to medical errors in UK • 50,000 Patients may be harmed due to medical errors each year.
Doctors with Problems • At any given time 6% Doctors have problem with their clinical performance. • 1 in 16 doctors drink excessively or take drugs in the UK • 5% doctors behaviour is so disruptive that it puts patients at risk
Professional Regulation • To some extent self-regulation has failed • Many patients harmed. • Untold misery to our patients. • By those whom they trusted! • We need to refine professional regulation.
But it is equally important that doctors are treated fairly, equally and action taken are fair and proportionate.
Black and Minority Ethnic Doctors (BME) Statistics 220,000 Doctors registered with the GMC 155,000 work in the NHS 60,000 (40%) 0f BME doctors 35,000 Overseas qualified.
BME Doctors Significant Medical Workforce Contribute tremendously to the NHS Most single handed, inner city GPs Deal with the most deprived population of the society. We are like ‘Carling Black Label’
Consultants in less popular specialities 70% of SAS doctors But only 22% of Consultants 80% of non-training posts are taken up by BME doctors. Less Clinical Excellence Awards BME Doctors
Evidence • 5 Published Evidence • GMC Data • NCAS Data • Manslaughter Data • National Audit Office Data • Deanery Data on RITA D and RIAT E
GMC and Doctors • Doctors referred by patients • There is no difference in the ethnicity • I find this very interesting and encouraging. • Doctors referred by Institutions • Significant difference • Disproportionately more BME doctors are referred. • Question is why?
Doctor Manslaughter Charges • Since 1972 • 25 Cases involving manslaughter charges • 30 Doctors charged with manslaughter • 22 Ethnic minority (70% Ethnic Minority) • 8 Europeans • 6 times more likely! • I now know off 4 BME doctors who have been suspended because they may be charged with manslaughter. • In my opinion these are genuine human errors and there were systems failures.
NCAS Adviser One of the best jobs I have done One of the best Institutions I have worked for. I am amazed at the Quality Assurance systems which are in place. I am amazed at the length to which NCAS goes to make sure that doctors are treated fairly and correctly. It is an advisory body and not a regulator. I am very proud of NCAS
National Audit Office (NAO)Report • NHS used to spend £46 Million on suspended doctors • Longest suspension – 12 years • NAO report concluded • BME doctors are three times more likely to be suspended for long term • BME doctors are less likely to be reinstated even when they win the case.
IMG and Trainees • RITA D and RITA E and IMGs • 3 times more likely to get RITA D and RITA E • Even local graduates from EM tend to get more often RITA D and E.
Reasons • 1. Discrimination (Institutional Racism) • 2. System Failures • 3. Something about IMGs themselves
Sex and Private Practice Most do it Most enjoy it No one talks about it No one feels they had enough. Racism Most of us know it exists I don’t think anyone enjoys it. No one wants to talk about it. Racism, Sex and Private Practice. It Makes Us Uncomfortable
Most ‘White colleagues’ really find it hard to believe that there is discrimination or racism. They genuinely believe ‘Discrimination’ is not a big problem. Most Ethnic Minority doctors believe that discrimination and ‘Racism’ is a big problem. Some blame racism for everything! Racism/Discrimination.
If it is only bad people who are prejudiced, that would not have such a strong effect. Most people would not wish to imitate them—and so, such prejudices would not have much effect—except in exceptional times. It is the prejudices of good people that are so dangerous. Vikram Seth. A suitable boy. London: Phoenix, 1993.
Discrimination • I don’t like the word ‘Institutional Racism’ • Institutions are not racists • Most ‘White Colleagues’ get upset and rightly so.
Discrimination Exists Because: • 1. Poor leadership in the organisations. • 2. Most Organisations have one or two individuals who do not want to see any changes. • 3. Some of so called ‘Our Own’ (BME) collude with the system or don’t challenge the system.
Discrimination Exists Because: • 4. NHS Tokenism • 5. BME doctors inability to stand up for their rights. • Our apathy • Our inability to unite • Our inability to stand up for our rights. • 6. Experts and NHS Leaders tend to be ‘White’ and most doctors facing discipline tend to be overseas qualified BME!
Examples – None of them are NCAS Cases. • Consultant saw a private patient during NHS time. • Consultant rang off sick and did private work. • Consultant found guilty of plagiarism • SpR forged signature of 4 consultants
Examples – None of them are NCAS Cases. • SHO downloaded pornographic material. • Registrar downloaded pornographic material • SHO took down the phone number of a patient and rang and went to her house. • Registrar hit a patient in A&E
Examples – None of them are NCAS Cases. • Consultant raised concerns about patient safety regarding two of his White colleagues • He was suspended for bullying • His concerns have not even been investigated. • Consultant accused of bullying – Dismissed • Consultant accused of bullying – Not even investigated
My Personal View • Most of the time discrimination is not wilful or malicious. • But it is about trying to protect our own. • Less weight is given when it is ‘One of us’. • BME doctors are less well supported, guided. • Investigated more thoroughly and dealt formally.
2. Systems Failure - UK • Poor induction • Poor Resource • Inner city, single handed GPs • Career Barriers for overseas doctors • More often isolated • More often - Bullied and harassed • Obstruction at every level • Poor representation at senior levels
2. Systems Failure - Overseas • Overseas training is different. • ALS, PALS, NLS – Not taught • More of a theoretical training • Struggles to deal with emergencies. • NHS • Different culture and different environment • Patient and Colleagues expectation is different. • Relationship is different. • Not trained in ‘softer skills’ of being a good doctor. • Doesn’t know the duties of a doctor.
3. Poor Softer Skills • Poor Communication • Working in isolation – Poor Team Working • Poor integration • Poor Leadership skills • Poor Organisational skills • Not keeping up with skills • Poor interpersonal skills • Poor reflection on patient safety, quality • Poor in seeking help • Fatalistic attitude • Cultural Differences