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Too Hot to Handle?

Updated: Mar 4

Our latest report shows the health service is still falling short in tackling race discrimination. The report argues there is a culture of avoidance, defensiveness, and minimization of racism within NHS trusts.

'Too Hot to Handle?' brings together key learning from:

  • a number of significant tribunal cases; and

  • survey responses from over 1,300 NHS staff

to explore how healthcare organisations respond to allegations of racism.


In this post you can explore:


The survey

Between May and July 2023, an online survey was sent to NHS staff. An amazing 1,327 people responded.

Survey findings showed:

  • UK trained staff are much more likely than internationally trained staff to raise concerns. 71.0% of UK trained staff have highlighted race discrimination as an issue, compared with 53.1% of internationally trained staff

  • the most common reason for not raising a concern of race discrimination was not believing anything would change (75.7%). 63.5% of people who didn’t raise their concerns were worried about being seen as a troublemaker

  • of those staff who have raised concerns, only 5.4% said they were taken seriously and that their problem was dealt with satisfactorily

  • the most common outcome to a race discrimination concern was nothing happening (the outcome in 42.7% of cases). In one in five (19.1%) instances, claims of race discrimination were treated the same as any other workplace dispute and referred to mediation. In 5.0% of cases, the individual raising the concern were themselves disciplined

  • 41.8% of respondents left their jobs as a result of their treatment

Survey findings also show racially minoritised staff face common responses when raising concerns about race equality.

These include:

  • denial: in many of the cases outlined above, staff were subjected to ‘poor behaviours’ but neither managers nor subsequent investigations felt they could name the race discrimination that lay behind these behaviours

  • reluctance or refusal to acknowledge race as an issue: connected with the above, employers tend to resist acknowledging poor treatment as race discrimination often, it seems, because of the stigma attached

  • minimising of harm: organisations go to great lengths to downplay the impact of racist behaviours

  • a lack of empathy: racially minoritised staff do not always receive compassion and understanding when raising concerns. Indeed, it is more common they are met with frustration, defensiveness, and exasperation


What can be done?

The report offers a number of thoughts about what organisations can do if they are serious about responding more effectively to both overt and covert forms of racism. Among the report's recommendations, the authors suggest:

Developing an appetite for 'race talk'

Being able to talk about ‘race’ and in particular covert racism (‘everyday racism’) helps people get past the belief that racism is an unusual occurrence. It works the muscle of understanding, lessens the fear of discussing it, and helps create conditions where racism is spotted, believed, and referred to more routinely.

Setting standards of behaviour that challenge everyday racism

There is an opportunity for behavioural standards to establish expectations of behaviours with regards to ‘race’ and the consequences of breaching them. Depending on the nature of the behaviour, interventions should be improvement-focused, taking for example, the form of coaching for individuals so they understand more about the impact of their behaviours or the use of nudge theory as a means of improving performance and recognising how non-inclusive behaviours are experienced.

Being more comfortable with staff speaking out

Employers, despite ongoing evidence to the contrary, must recognise organisations are experienced very differently depending an individual’s role, position, and identity. The result of this is that staff hesitate to make allegations of racial discrimination because there is good evidence that they won’t be believed, and raising a complaint will make things worse or will be a waste of their time.

Commissioning the right kind of support

Employers need to think about commissioning ‘development’ and not ‘training’ (and be clear about the distinction and about what they have commissioned). Common flaws with training opportunities are: they are often not lengthy enough; they are not engaging; and they do not support staff to gain a more critical understanding of race and racism. Organisations should be prepared for staff to feel disrupted as a consequence of any development. In the report we outline what features effective anti-racist development should have.

See the full report for our complete recommendations.


Who we are

The report is a collaboration between Prof Joy Warmington, brap CEO and Middlesex University Visiting Professor of Education, and Roger Kline, Research Fellow in the University’s Business School.

Professor Warmington said:

Our report shows that the NHS is not addressing racism effectively, and that many organisations respond by challenging or ignoring allegations of racism rather than taking them seriously.
Racially minoritised staff are still anxious about raising concerns, worried about the consequences if they do, and see little or no action if they do raise concerns.

Mr Kline said:

Our report found that some Black and minoritised ethnic staff still face serious challenges in raising complaints of racism and this has an impact on staff morale, progression and recruitment, and potentially on patient care if staff feel under-valued and badly treated.
In the NHS, where a quarter of staff have BME heritage and a significant proportion of patients do too, this is not a marginal issue and nor is it a new one.


Responses to the report

A number of organisations in the health sector have responded to 'Too Hot to Handle?'.

  • The RCN is a membership organisation of over half a million registered nurses, midwives, health care assistants and nursing students. Read their response.

  • NHS Providers is the membership organisation for the NHS hospital, mental health, community and ambulance services that treat patients and service users in the NHS. Read their response.

  • The National Guardians Office leads, trains and supports a network of Freedom to Speak Up Guardians. Read their response.

  • The Royal College of Psychiatrists is the professional medical body responsible for supporting psychiatrists throughout their careers in the UK. Read their response.

  • West Yorkshire Health and Care Partnership is an integrated care system, working in partnership with NHS organisations, councils, Healthwatch, hospices, and other community organisations to improve the health and wellbeing of local people. Read their response.

Coverage of 'Too Hot to Handle?' in the media:

  • 'Trusts risk ‘Obama effect’ after diversifying boards', Health Sector Journal. Link

  • 'Report investigates racism in the NHS', Health Business. Link

  • 'Racism: Too Hot To Handle', BMJ Leader. Link

  • 'NEWS: NHS leaders urged to address racism', Practice Business. Link

  • 'Racism remains part of NHS culture, researchers warn', Nursing Times. Link

  • 'NHS racism: staff fear troublemaker label for raising concerns', Nursing Standard. Link

  • NHS organisations must “get a grip” on racism, says report', The British Medical Journal. Link


Leadership webinar

This webinar, hosted by Middlesex University Business School, features Joy Warmington and Roger Kline talking about the lessons of 'Too Hot to Handle?'.

The webinar, held on 1 February 2024, was attended by over 300 people. It was hosted by Dr Mary Hartog, Director Organisation and Leadership Practice, Middlesex University Business School. The webinar is part of a series aimed at introducing participants to themes explored in the University's new Doctor of Business Administration DBA. See here for more information.


Download the report
Too hot to handle brapKline
Download PDF • 3.73MB


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