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We’ve got ourselves into one of those subjects where the moment people stop listening to each other… debate becomes useless.
The dreadful circumstances surrounding the death of Henry Nowak has reignited a familiar argument…
…when institutions appear to make poor decisions, are they; acting out of racial prejudice, unconscious bias, fear of appearing prejudiced, poor training, group think or simple incompetence?
The answer is often much more complicated.
Most public services operate under intense scrutiny around race and discrimination.
That scrutiny is justified.
The Macpherson Report fundamentally changed the way public institutions think about race. The concept of ‘institutional racism’ entered the lexicon of life.
Since, organisations have invested enormous effort into preventing discriminatory behaviour, and…
… a well researched paradox has emerged.
Staff become so concerned about avoiding accusations of prejudice that they can become hesitant, over-cautious, or distort their decision-making.
They stop asking straightforward questions for fear of how they might be interpreted. That is not racism, but…
…neither is it good decision-making.
NHS maternity services have repeatedly reported poorer outcomes for some ethnic minority women. Reviews continue to shown differences in maternal mortality, stillbirth rates and access.
The danger is; the debate divides into two camps…
One side says the explanation is racism. The other says racism has nothing to do with it.
Reality is more nuanced.
Almost 1 in 3 nurses, midwives and health visitors combined, are from minority, ethnic backgrounds.
The allegation that maternity services are racist doesn’t do justice to the issue being more complicated.
The major maternity reviews all point to…
- poor listening,
- communication failures,
- staffing shortages,
- inadequate escalation,
- organisational culture,
- deprivation
- social factors,
- and in some cases stereotyping or bias.
The uncomfortable truth is that maternity services sometimes fail women of all backgrounds
The word ‘racism’ carries enormous moral weight. If every disparity is automatically described as racism, people stop engaging honestly.
Equally, if every suggestion of racial disadvantage is dismissed as ‘playing the race card’, genuine problems are ignored.
Neither approach helps.
The more useful question is; what exactly happened and why?
Not; who can we blame?
However, the 'what' requires evidence.
Many organisations focus on intentions. What matters is outcomes.
A Trust can run hundreds of diversity workshops and still have poor maternity outcomes, at three o'clock in the morning in a birthing unit.
A police force can produce thousands of pages of equality policies but officers arriving at a rowdy and confusing crime scene can still make bad operational decisions.
Culture is not written in policies. Culture comes from the environment in which the activity takes place.
The answer might be in something we have in abundance. Data... used it to understand variation and foretell it.
If maternity outcomes differ between groups, the first question should be; ‘What does the data tell us?’
Not… ‘what narrative do we already believe?’
There’s a phenomenon called; the Single-Cause Fallacy. Complex systems rarely fail for a single reason, yet...
... we have a strong preference for simple explanations…
… racism… funding…. management… technology... resources.
The reality is usually several interacting causes.
Good data tells us whether problems arise; from access, deprivation, staffing, communication, geography or bias.
Without data, everyone retreats into ideology, and…
… the discussion becomes relevant to both policing and healthcare…
...it’s about trust.
If minority communities do not trust institutions, they’re less likely to engage.
If staff feel they’ll be accused of prejudice whenever something goes wrong, they become defensive and risk-averse.
Both sides lose trust simultaneously, and that’s the most dangerous outcome.
Five principles seem applicable to both policing and the NHS.
1. Follow evidence, not assumptions.
Every incident should be examined on its own facts.
2. Focus on outcomes.
Measure what happens, not merely what policies exist.
3. Improve cultural competence without ideological rigidity.
Understanding communities is different from stereotyping them.
4. Use data relentlessly.
Identify where disparities exist and investigate why.
5. Rebuild trust through transparency.
Explain decisions openly. Admit mistakes quickly.
The lesson from maternity services may be that inequalities are real, but the causes are rarely simple.
The lesson from policing may be that fear of appearing prejudiced can sometimes distort judgement just as surely as prejudice itself.
The goal should not be to prove racism exists everywhere, nor to prove it exists nowhere.
The goal is to create institutions that are;
- fair enough,
- confident enough and
- transparent enough...
... to treat every individual as an individual…
… and that is one of the hardest management tasks in public service.
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