Leroi Henry Department of Economics The Open University l.w.henry@open.ac.uk

1. Forms of racism and discrimination in career progression in the NHS:Evidence from Ghanaian nurses and midwives Leroi Henry Department of Economics The Open University l.w.henry@open.ac.uk

2. Aims • Explore and conceptualise discriminatory practices in career progression in the NHS • Examine and contextualise how some responses to perceived racism entrench rather than resist marginalisation

3. The REOH Project:Background • Researching Equal Opportunities for Overseas-trained Healthcare professionals • Open University and University of Surrey • Sponsored by European Social Fund • Interviews with over 100 overseas-trained healthcare professionals • Case study of Ghanaian trained healthcare professionals. • Interviews with NHS Trust and clinical managers • Interviews with local and national stakeholders • http://portal.surrey.ac.uk/reoh

4. The REOH Project:Research Team • Dr Helen Allan, EIHMS, University of Surrey • Dr Leroi Henry, Economics, Open University • Dr John Larsen, EIHMS, University of Surrey • Professor Maureen Mackintosh, Economics, Open University • Professor Pam Smith, EIHMS, University of Surrey

5. The REOH Project: Key areas of interest • Accreditation and use of overseas skills and experiences • The factors affecting career progression • Relationships with colleagues and patients • Adaptations to UK work environment • Systems of social, economic and professional support • Influence of relationships with countries of origin on careers

6. Methods • Case study of Ghanaian trained healthcare professionals • Conducted in London and South-east England • Individual semi structured interviews and ethnographic research with the Ghanaian Diaspora. • Informant led interviews focusing on their stated concerns

7. Selection of informants • Participation in previous studies • Contacts with Ghanaian community groups • Activists in Ghanaian and other minority ethnic community and professional associations • Case study visits to workplaces • ‘Snowballing’ through the above routes • Interviewing thirty healthcare professionals at the two largest hospitals in Ghana. • Observation at Diaspora meetings

8. Characteristics of informants • Thirty nurses and midwives • Mostly F and G grade • Most resident in the UK for over 15 years • Mostly joint nationality • Supplemented by more recent migrants and lower grades. • Not representative of Ghanaian nurses in the UK

9. Background: Lack of transparency in promotion in the NHS Henry, L. (2006 forthcoming) Institutionalised disadvantage: Older Ghanaian nurses and midwives reflections on career progression and stagnation in the NHS, Journal of Clinical Nursing Special Issue

10. Background: Lack of transparency in promotion in the NHS • Difficulties adapting to career progression initially attributed to socio-cultural differences • Disadvantage entrenched and institutionalised by a lack of support • In promotion into senior roles informants experienced differential access to training and opportunities to gain experience • Discrimination in the quality of support given to candidates particularly interview preparation and feedback. • Systems of patronage based on meeting subjective criteria rather than meritocratic.

11. Forms of discrimination in career progression within the NHS • Discriminatory acts • Discriminatory omissions • Cultures of discrimination • Marginalising oneself • Narratives of discrimination

12. Marginalising oneself: becoming an agent in discrimination • Response to racism and a form of discrimination • In context of racism nurses balance careers with other commitments and interests • Instrumental attitude towards professional life • Withdraw from career development

13. Alienation leading to withdrawal from career progression • Demoralisation after long periods of career stagnation • Caused by endemic racial or ethnic discrimination • Reinforced by a perception of a lack of support or interest from managers • Avoiding humiliating processes ending in failure

14. Redefining success • Withdrawal accompanied by a redefinition being a successful migrant • Immediate family in the UK • Dual identities: “Living here and there” • Extended family • Property and investments in Ghana • Retirement and or returning to Ghana • Return to migrants’ original aims

15. Being an agent in ones own marginalisation • Trauma and frustration engendered by discrimination are internalised • Victims seek to avoid exposing themselves to further humiliation • Response to racism that reproduces the effects of discrimination through inhibiting career progression

16. Political implications of this analysis • Not blaming these black professionals for their predicament • Understandable response based on their original aims as migrants and current obligations • Does not let the NHS off the hook for the discriminatory practices which provoked these responses • Explains why withdrawal from career progression is common in some overseas trained staff

17. Narratives of discrimination • Perception that ethnicism and racism are endemic not the substance of claims of discrimination • Power lies in the ways that this perception affects responses to situations and relationships in the workplace

18. Narratives of discrimination • Discriminatory practises conceptualised through a collective narrative of discrimination and exclusion • Context: • lack of transparency in career progression • Few black and African nurses in senior positions • Informants understand their relative lack of career success as a result of being Africans • Africans at the bottom of a racial and ethnic hierarchy which largely determines ones status within the NHS

19. Narratives of discrimination as a lens • Narrative can become a lens through which experiences in the workplace are interpreted • Form of racism existing within the mind of the victim which affects responses in the workplace • Most negative experiences are regarded as racism irrespective of alternative explanations • In an environment lacking transparency, racism is easiest explanation for negative experiences

20. Narratives of discrimination • Not questioning the validity of nurses claims of discrimination • Not claiming that racism only exists in the mind

21. Collective narratives of discrimination and marginalisation • Interpretations of shared experiences as discrimination become self sustaining • Little evidence supporting alternative explanations • Expectation of racismdue to history of perceived racism • Demoralised staff become marginalised • Not adopted by all

22. Resisting racism through avoiding racialisation • Discourses of successful black nurses and midwives • Progression built upon not labelling every negative experience and incident as racist • Various interpretations of this discourse

23. Limitations • Current analysis only relates to Ghanaian nurses and midwives attempting promotion above grade F • Some nurses have resisted these processes • Demoralised nurses’ careers can be resurrected

24. Conclusions • Overseas trained nurses experience a range of discriminatory practices that take three guises: • Discriminatory acts • Discriminatory omissions • Cultures of discrimination • Responses to perceived racist or ethnic discrimination can intensify its effects through encouraging individual and possibly collective withdrawal from career progression