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An open letter to the Health Secretary

An open letter to Wes Streeting, who was appointed Secretary of State for Health and Social Care on 5 July 2024. From Michelle Cox, Roger Kline, and Prof Joy Warmington (brap CEO).


Dear Secretary of State

Congratulations on your appointment.

Six months ago, we published Too Hot to Handle, an investigation into racism in the NHS [1]. Over 1,300 people responded, outlining their experience of racial discrimination in the health service.

Their feedback overwhelmingly demonstrated that the NHS is not addressing racism effectively. In fact, our analysis of tribunal cases indicates it actually expends a lot of energy defending and burying allegations of racism as a reactive measure. In doing so, many organisations have created environments where it is unsafe to speak out about racism, and this means many staff must endure their experiences of racial discrimination over a prolonged period.

There is still a paralyzing reluctance within organisations to talk about race. Some minimize racism when it occurs, others demand evidence it exists, others still simply ignore the issue, hoping the person experiencing it will stay quiet or move on.

This is simply unacceptable.

The importance of tackling racism in healthcare is self-evident. In an NHS workforce where 25% of staff are now of Black or minoritised ethnic (BME) backgrounds and a significant and growing proportion of the population served by healthcare organisations are too, this is not remotely a marginal issue.

You are no doubt aware of the links between bullying and patient safety. Bullying and incivility are a common feature in almost every independent review of systemic patient harm from Bristol to Francis to Ockenden. Tackling (raced-based) bullying and harassment will enhance cooperation within teams, increase communication between colleagues, and, as a result, promote patient safety within trusts.

So, while we don’t underestimate the scale of the challenges facing you in your new role, we would impress upon you the importance of creating an NHS free from race discrimination. There are several things NHS organisations can do to realise this goal:

  • become more comfortable with staff speaking out about racism and ensure concerns are acted on without retaliation. We noted earlier this year you pledged to ban NHS managers who try to silence and victimise whistleblowers [2]. This level of commitment to, and solidarity for, those who speak out about racism is what is required to ensure staff are able to voice their concerns

  • develop their capacity to talk about race (and, in particular, covert, everyday racism)

  • set standards of behaviour that challenge ‘everyday’ racism

  • get better at acting on the early warning signs of racism by tackling racism more informally and being proactive when evidence would suggest there might be a problem

  • impart the skills that all staff need to get closer to genuine anti-racist practice

We urge you to make explicit recommendations about this issue. It has, for far too long, been the subject of avoidance and denial.

We would, of course, be happy to meet with you to discuss the lessons we have learnt working with NHS trusts, and the actions and ideas we believe can make a real difference to patient care, staff wellbeing, and the promotion of a fairer NHS.

You have a monumental job ahead of you. But you also have the opportunity to create a more equitable and inclusive NHS. We hope you seize this opportunity.

Congratulations once again on your new appointment.

Yours sincerely

Michelle Cox

Race Equality Consultant, Queens Nurse, and Fellow of the Royal College of Nursing


Roger Kline

Research Fellow at Middlesex University Business School


Joy Warmington MBE

CEO of brap and Visiting Professor at Middlesex University Business School. Joy has held various non-executive positions within the NHS


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