1. SUNDAY ClaS:
In the wake of ITV's TONIGHT Diversity Deficit special on 11th December 2014
(https://www.itv.com/itvplayer/tonight/series-16/episode-10-the-diversity-deficit-tonight),
it was not surprising to see that, as usual, MEDICINE and ...the other SCIENCES were
completely omitted. READ ON for the Unanswered letter sent a year ago (and again 6
months later) to the Health Select Committee. There will never be equality in healthcare
provision if inequality persists in senior scientific appointments:
23rd November 2013
Dear Mr. Dorrell,
Re: Inequality within the Medical Profession
I am writing primarily to you and to my MP... in despair of the state of consultant
appointments and its negative effect on patient care in Britain today. My own... experiences
took me on a personal search for answers.
‘The Creation and Evolution of Medical Inequalities within the Profession’ essay
(http://www.ganfyd.org/index.php?title=Talk%3AThe_Creation_and_Evolution_of_Medical
_Inequality_within_the_Profession) presents a theory to contextualise the enormity of the
challenge...New consultants are groomed (in what) to expect in their prospective job search.
... Women, ethnic minorities and locums are universally poorly treated within the medical
establishment. The annual Equality and Diversity Statistics, which are freely available on
Trust websites, make for truly appalling reading... In addition, most locums, no matter how
long they have been within a department or how conscientiously or skilfully they do their
jobs and more, are simply not seen as equal to permanent consultants. That employment
status can be held against them due to the belief that it makes you somehow ‘less’ –
compounded if you are an ethnic female...
...Anecdotal stories (exist) of female and ethnic doctors repeatedly passed over and excluded
– driven away from the more desirable posts, locums poorly treated (including contract
limitations to avoid accruing employee rights) and even refused references for permanent
positions, women sexually harassed and threatened against pregnancy... and none of it to do
with fitness to practice! There are other extremes - departments, certainly in anaesthesia,
where the entire workforce is of a single ethnicity...
There are many campaigns attempting to redress individual issues such as misogyny and

2. racism. I believe employment status is just as stigmatised and propose each disparate issue
be tackled as one – as inequalities within the medical profession.
It is right that the governing bodies of the land act to protect the good health of its nation.
But, doctors are nationals too and there is not much recourse for justice in the face of unfair
treatment. And it is rife.
I believe the Health Committee is the body with the authority to oversee an independent
evaluation and revision of consultant appointments procedures in order to allow the
profession to truly practice Good Medicine:
1. Excerpt: HM Government Business, Innovation and Skills Committee Women in the
Workplace: First Report of Session 2013–14, Volume I, Introduction, p. 7, 20th June 2013
(http://www.publications.parliament.uk/pa/cm201314/cmselect/cmbis/342/342.pdf):
- ‘...We received written evidence that included anecdotal experience of [...] some shocking
examples of inequality at work, in both private and public organisations, including the
fields of education, the law, the construction industry and the NHS. Much of the
confidential written evidence highlighted such inequality, and we were struck by the fact
that so many women did not want their names published.’
Medicine as part of the NHS is mentioned under the STEM subjects (science, technology,
engineering, mathematics), but is never given the attention it deserves. And the problem is a
big one! Outside of general practice, women still occupy the minority of senior and very
senior hospital roles, despite representing 50+% of medical school admissions for over 20
years!
2. Excerpt: The GMC ‘Good Medical Practice Guidance’, Domain 3, Communication
(http://www.gmc-uk.
org/guidance/good_medical_practice/communication_partnership_teamwork.asp) states
that:
- You must work collaboratively with colleagues, respecting their skills and contributions
(para 35).
- You must treat colleagues fairly and with respect (para 36).
- You must be aware of how your behaviour may influence others within and outside the
team (para 37).
- You must be honest and objective when writing references, and when appraising or
assessing the performance of colleagues, including locums and students. References must
include all information relevant to your colleagues’ competence, performance and conduct

3. (para 41).
There is, however, no remedy via the GMC for one doctor to complain against another. They
must use the hospital grievance procedure which is not stacked in their favour.
3. The BMA organised the ‘Breaking Down Barriers: Supporting Ethnic Minority Doctors’
meeting in May 2013 9http://bma.org.uk/practical-support-at-work/doctors-well-being/
dealing-with-discrimination/breaking-down-barriers) and produced the
‘Memorandum of Understanding’ document, committed to:
- Monitoring the representativeness of its committee structure, identifying potential
barriers to engaging with the BMA, and removing any unfairness or disadvantage
- Actively promoting the support it provides to BME doctors. The BMA is supported in this
task by the signatories;
- British International Doctors Association (www.bidaonline.co.uk)
- Medical Association of Nigerians Across Great Britain (www.mansag.org)
- NHS Employers (relating to England only) (www.nhsemployers.org)
- Progressive Muslims Forum (UK) (www.pmfuk.com). The GMC and The British
Association of Physicians of Indian Origin attended the meeting, but are not signatories.
4. The BMA also published 'A Celebration of BME Doctors' to mark Black History Month
(October) in the NHS’ 60th year (2008, http://www.em-online.
com/news/article.asp?id=37142 - now missing!) It recognised ‘their achievements
over the past 60 years’, outlining the challenges and barriers that BME doctors experienced
in the past and continue to face today. It did not even mention black British (Caribbean)
doctors... – apparently a vanishingly rare minority within a minority! Some awareness
continues with articles such as;
http://www.crer.org.uk/crerblog/entry/lets-celebrate-nhs-65-but-remember-the-challenge-
of-racism-still-exists
5. Excerpt: H M Government published ‘Opening Doors, Breaking Barriers: A Strategy for
Social Mobility’ in April 2011 (https://www.gov.uk/government/publications/opening-doors-
breaking-barriers-a-strategy-for-social-mobility-update-on-progress-since-april-
2011). The Chair was the Rt. Hon. Nick Clegg, MP, and the document highlights the failing
of ‘the professions’ to address inequalities:
- ‘...Success should be based on what you do, not who you know. A large number of the
professions remain dominated by a small section of society...’ p7
- ‘...There are also vast differences in terms of access to professional jobs. Those from less

4. well-off backgrounds are less likely to enter the professions or to reach high levels within
them if they do...’ p19
- ‘...Improving social mobility depends on increasing fair access to jobs, particularly in the
professions...’ p56
- ‘...we also need to ensure that access to the top jobs in the professions is genuinely open to
all...’ p64.
6. The Bridge Group published ‘Social Mobility Through Higher Education, Bridging the
Gaps: Current issues and Focus for 2011-12’ in May 2011
(http://www.thebridgegroup.org.uk/wp-content/uploads/2013/07/BridgingGaps.pdf),
stating;
- ‘Professional regulators and representative bodies should encourage their constituents to
monitor applications and recruitment by socio-economic factors and large firms should do
the same. In practical terms, this process would augment the current equality and diversity
monitoring. The monitoring and reporting of transparent data about application and
recruitment from the professions would have multiple advantages. It would give us a
clearer picture of how recruitment is socially patterned, and to look for variance within,
and between, different professional areas. The current approach to promoting fairer access
to the professions is too homogenised, partly because not enough is known about
recruitment patterns by individual professions.’ p28-29
It also referred to Mr. Alan Milburn’s ‘Panel on Fair Access to the Professions, Unleashing
Aspiration: The final report of the Panel on Fair Access to the Professions’ (2009).
7. There is an on-going campaign to increase organ donation amongst Black, Asian and
Minority Ethnic communities
(http://www.organdonation.nhs.uk/how_to_become_a_donor/black_and_other_minority_et
hnic_communities/)
- ‘66% of Black, Asian and some Ethnic Minority (BAME) communities living in the UK
refuse to give permission for their loved ones organs to be donated compared to 43% of the
rest of the population.’
Religious objection is heavily quoted as a cause, as is short-comings in education. However,
there are not many ethnic doctors associated with the UK and Ireland’s organ donation
programmes and ethnic communities tend to place more trust in an organisation which
appears inclusive! ‘More Recruitment from Ethnic Minority Groups Would Improve NHS's
Service, Report Says’, Seye Amibola (Race for Health), BMJ 28 June 2007;
334:1339(http://www.bmj.com/content/334/7608/1339.1)

5. (Ethnic females) do not comply with the picture or expectations generated by the ethnic and
gender statistics. With one glance, before (saying) a word, (an ethnic female's) non-compliance
is somehow translated to indicate unpredictability or a cause for wariness.
(Their) ambitions are simply a (natural) result of (their)education and experience, for which
it would be taken were (they) a white male.
The ease with which discrimination is practiced is astounding. ISC Medical is the trading
name of Medical Interview Skills Consulting Ltd, (www.medical-interviews.co.uk). They
claim to be ‘... the largest provider of recruitment solutions in the UK for candidates
applying to consultant posts and have trained over 16,000 candidates for consultant
interviews.’ (Perpetuation of the) medical doxa ensuring the continuation of the physician’s
hexis through maintenance of the habitus becomes astounding clear with it's reading... -
‘telling it like it is’, where they openly state that job descriptions and person specifications
can either be sloppily assembled or tailor-made. They promote pre-shortlisting and pre-interview
visits and ‘trials by sherry’ to give the candidate an advantage. What is surely
more obvious is that here is the opportunity to practice discrimination, giving prospective
employers more time to make pre-judgments, to collude, to the point where the day-of-interview
‘voting’ or ‘marking’ system, whilst serving as the official record of the interview
outcome, cannot be considered unbiased. A candidate can enter an interview consisting of a
panel instructed not to appoint; where you are pre-judged on visits to each member of the
panel who chooses to allow you access. Conversely, one can enter an interview a danger to
the public and be awarded the job...
The true scandal, and one of the inspirations for this document, is that inequality has been
highlighted numerous times before, but never really addressed. Compare the two headlines
from the last decade alone;
2003, 16th October: ‘NHS Aims to Increase Number of Ethnic Minority Staff in
Management’, Zosia Kmietowicz, British Medical Journal, 2003;327:889
(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1140358/)
2012, 26th September: ‘Ethnic Doctors Far Less Likely to Reach Senior Posts in NHS, The
Independent, Charlie Cooper. (http://www.independent.co.uk/life-style/health-and-families/
health-news/ethnic-doctors-far-less-likely-to-reach-senior-posts-in-nhs-
8842397.html).
Nothing has changed!

6. In the current economic climate, I would argue that things may have deteriorated.
I am writing to appeal to you... to truly promote a multi-racial, inclusive profession, to act
on these shocking statistics to safeguard the health of the UK public... Alternatively, visit a
Trust website and take a good long look at the statistics... shameful example(s) of hospitals
in areas of London where staff ethnicity does not reflect either the local population, or its
trainee doctors. Watch the numbers change as the hospital site becomes more prestigious
i.e. district general vs central teaching hospital site. This is not merely an academic exercise.
I would wish for someone to re-shape medical consultant appointments into a transparent,
honourable process, where your ‘face’ and its ‘fit’ is NOT a defining characteristic. The
health service is not the personal dominion of the incumbent physicians and it should not
be treated as such.
After all, Robert Francis QC chaired the Mid Staffordshire NHS Foundation Trust Public
Inquiry (HC 947). The Executive Summary Letter to the Secretary of State (p. 4) published
on 6 February 2013
(https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/279124/09
47.pdf), identified warning signs which were thought to be red flags to a failing
organisation. Those that are relevant to this issue are;
- A culture focused on doing the system’s business – not that of the patients;
- An institutional culture which ascribed more weight to positive information about the
service than to information capable of implying cause for concern;
- Standards and methods of measuring compliance which did not focus on the effect of a
service on patients;
- Too great a degree of tolerance of poor standards and of risk to patients;
- A failure of communication between the many agencies to share their knowledge of
concerns;
- Assumptions that monitoring, performance management or intervention was the
responsibility of someone else;
- A failure to tackle challenges to the building up of a positive culture, in nursing in
particular but also within the medical profession;
- A failure to appreciate until recently the risk of disruptive loss of corporate memory and
focus resulting from repeated, multi-level reorganisation.
Francis made many recommendations, the most relevant to this issue being;
- Foster a common culture shared by all in the service of putting the patient first;

7. - Develop a set of fundamental standards, easily understood and accepted by patients, the
public and healthcare staff, the breach of which should not be tolerated;
- Provide professionally endorsed and evidence-based means of compliance with these
fundamental standards which can be understood and adopted by the staff who have to
provide the service;
- Ensure openness, transparency and candour throughout the system about matters of
concern;
- Ensure that the relentless focus of the healthcare regulator is on policing compliance with
these standards;
• Make all those who provide care for patients – individuals and organisations – properly
accountable for what they do and to ensure that the public is protected from those not fit to
provide such a service;
- Provide for a proper degree of accountability for senior managers and leaders to place all
with responsibility for protecting the interests of patients on a level playing field;
- Enhance the recruitment, education, training and support of all the key contributors to the
provision of healthcare, but in particular those in nursing and leadership positions, to
integrate the essential shared values of the common culture into everything they do;
- Develop and share ever improving means of measuring and understanding the
performance of individual professionals, teams, units and provider organisations for the
patients, the public, and all other stakeholders in the system.
This as a call-to-action, imploring the Health Select Committee and all addressees to seize
this opportunity to come together and address, in earnest, the inequalities that persist within
the UK medical profession pursuant to Section 26 of the Inquiries Act 2005, to take this
opportunity to expand and support equal opportunities legislation, to champion a cause to
ensure the British people receive the best medical treatment administered by the best people
for the job.
Yours sincerely,