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The sinister parallels between the NHS and the airline industry

Parallels are often drawn between the airline industry and the NHS, but there appears to be another rather sad comparison between the two.

Recently, a surgeon colleague and his family were deboarded from a flight. This occurred after he got up to settle his one-year-old daughter, with the plane still attached to the gate, because he objected to the crew’s rude behaviour.

This colleague strongly believes that there is no reason for this extreme high-handed action, which nearly branded his family as criminals, other than the different skin colour and that this colleague wears a turban.

Such extreme incidents are rare, though the scale of the problem is much bigger. The differential behaviour ranges from being ‘randomly’ selected for security checks, to being served differently, from being asked to wait unnecessarily for boarding under flimsy pretexts, to being spoken to rudely or threatened to be deboarded or reported under the pretence of safety. These appear not that uncommon, and I personally have been at the receiving end of them too, including being randomly selected for security checks.

One airline changed its policy after it emerged that a BME doctor’s offer to assist in a medical situation was turned down by the crew. Images of a doctor being dragged from an overbooked flight in 2017 stand testimony, too.

The problem is so widespread that the National Association for the Advancement of Colored People, the oldest and largest non-partisan body of civil rights in the United States, accused the airline industry of racism. It pointed out ‘a corporate culture of racial insensitivity and possible racial bias’ within the largest American airline.

Such incidents are likely to be the tip of an iceberg and aren’t uncommon within the UK, either. Rather, there are so many anecdotal experiences, from what I have heard, just from the BME medical community itself.

A very closed environment, little or no answerability from the authorities to the public, and the pretence of safety or security essentially leaves anyone helpless and unable to challenge decisions. It would seem that the ‘zero tolerance’ policy that exists to protect the staff and for overall safety is often used and potentially abused.

The world is hardly confined and defined by boundaries anymore… these industries continue to let so many subsets of people down

Though the concept of professionalism is shared between healthcare and the aviation industry, it would seem that attributes of the inherent biases and prejudices are also commonalities.

It’s clear that racism is rife across society, with its tumultuous political narrative, the rise of far-right ideology and a significant increase in reports of racist behaviour.

In the NHS, we often talk about discrimination and institutional racism in the context of ’snowy white peaks’, i.e. a lack of non-white representation in leadership positions in the NHS. A recent report suggested that out of the 76 positions within STPs and ICSs, only one has a lead with a BME background. This is about 1% representation, when the BME represents about 30% of the doctors alone.

The data suggest that disparity in performance starts right at the university level, resulting in an attainment gap during the graduate years and at the time of recruitment, and continues through membership examinations. This means huge disadvantage to BME doctors during their careers.

Moreover, BME doctors are less likely to be offered GP training places, while BME international graduates are almost 15 times more likely to fail the CSA on their first attempt, and BME UK graduates are 3.5 times likelier to fail than their white colleagues. The scenario is so appalling that the differences are also seen in form of a pay gap based on ethnicity, where the median basic pay for white consultants is 4.9% higher than for BME consultants, despite the same work being conducted.

Additionally, Pulse previously pointed out that BME GP partners are over-represented within practices rated as inadequate by the CQC. After decades of being aware of the fact that BME doctors are not only more likely to be reported to the GMC, but also to be investigated and to receive sanctions including erasure, it’s just now instituted yet another review.

I fear this will become nothing more than a tick-box exercise, and that future generations will have the same debate. The fact remains that a male international medical graduate is likelier to fail multiple times in membership examinations, work in deprived areas and have suboptimal career progression, whilst a white male UK graduate is more than likely to be the leader of your CCG or trust, and thrive in the process. It’s often felt, and in fact vocalised, that BME graduates have to perform at a much higher level to attain the same achievements as white counterparts.

All in all, it appears that the striking similarities in the treatment of the BME community, be it the NHS or the airline industry, are tellingly shocking. If there is anything to learn, the message is indeed very simple. We have to unlearn a lot of our prejudices and start afresh, with the whole of humanity recognised as one race.

Specifically, the NHS and the airline industry, and more generally, wider society, must be more open and fairer to all. The world is hardly confined and defined by boundaries anymore. There really is a need to learn from each-other, concerning the two industries and why they continue to let so many subsets of people down.

The very least we can do is to stand up against racism. As American author and activist Angela Davis once said, ‘In a racist society, it is not enough to be non-racist. We must be anti-racist’.

Dr Kamal Sidhu is a GP and trainer in Durham, vice chair of County Durham and Darlington LMC and chair of South Durham Health CIC. He writes in a personal capacity.