That University Hospitals Bristol and Weston (UHBW) NHS Foundation Trust has faced issues with racial discrimination is no secret.

In its three years of existence, the trust, which runs the Bristol Royal Infirmary (BRI) and Weston General Hospital, has been subject to two inspections by the Care Quality Commission (CQC) that highlighted the issue in 2021 and 2022.

After an internal report from June 2023 found a third of staff did not feel safe whistleblowing on racism, then-chief executive Eugine Yafele pledged to get a grip on the situation. But six months later, has anything changed?

When I met my manager and said I was from Nigeria she said, ‘Oh, Nigerians are very smart – even when they commit crime.’ I didn’t find it funny. She would always make demeaning jokes about me.

The Cable has been investigating claims of institutional racism at the trust, after 10 whistleblowers came forward to share their stories, including seven who have now left as a result.

Bullying, facing racial slurs, being passed over for promotion and blamed for mistakes – these are just some of the experiences sources have told the Cable they’ve faced in recent years. All names have been changed to protect their identities.

Institutional racism is notoriously difficult to prove. Sources say their complaints were often met with a lack of action from management – and even gaslighting. Add to this isolation and strenuous working hours, and it’s no surprise many say they suffered serious mental health problems as a result.

The trust said it was “saddened” some colleagues had experienced “unacceptable” discrimination, while maintaining the organisation is “on the right path” thanks to a series of new initiatives. But sources we’ve spoken to say these are inadequate, and fail to understand the nature of the problem.

Meanwhile regulatory body the CQC has promised to investigate the issue and hold the trust accountable. But six months on, sources are giving up hope the CQC will make good on its promise.

‘I’m here because the NHS needs me!’

In 2021, Femi was working in a teaching hospital in Nigeria when recruiters for UHBW came to deliver a persuasive pitch. “They tell you how great the trust is, how nice the city is,” he recalls. “They organise and pay for your flight, the visa, all your examinations, the first three months of accommodation,” he continues. “They want you so badly!”

Excited and curious about life in the UK, Femi and a cohort of 15 others arrived to work at Weston General hospital in 2021, with high hopes. He began working as a nurse in an intensive care unit – but before long, things took a turn for the worse.

One patient said, ‘What are you doing in this uniform? You don’t even look like a nurse – get away from here.

“‘Go back home!’ ‘You look like a monkey’ ‘Don’t touch me’ – these were the kind of things patients would say to me,” he tells me. “I would just smile, and walk away. But I would think to myself: I’m here because the NHS needs me!”

Many of the sources we have spoken to say that when they faced incidents of racism such as this, they received little support from their white colleagues.

But racism wasn’t just coming from patients. Femi says he experienced a repeated pattern of discrimination from his white colleagues: “If you make a mistake, it’s always blown out of proportion,” he says. “There is always an element of racism in everything.”

After eight tough months, he left Weston General to work at the Bristol Royal Infirmary (BRI). “In my exit interview I told the HR woman everything I’d been through – and she cried,” Femi remembers. “She told me it’s not the first time she’s heard this.” He says at least five other overseas staff on his ward alone left due to racism.

“I’ve had times where I have thought to just go back home where I have my sanity,” Femi says. “Nowadays I keep my head down, I don’t talk much. When I finish my shift I just leave.”

For now, he remains at the BRI, but Femi says he is keen to go back to Nigeria in a few years.

Femi’s story is just one – but as well as highlighting discrimination, it speaks to the wider staffing crisis in the NHS. This investigation began in June 2023 against a backdrop of industrial action by health workers, and a government plan to tackle chronic issues around recruitment and retention.

Picket line cries made clear that NHS workers were burned out, fed up and leaving in droves. At present, the shortfall totals 100,000 NHS staff, including around 10,000 doctors and 47,000 nurses.

In response, the NHS announced its Long Term Workforce Plan, with overseas recruitment key to filling the vacancies. A costly recruitment drive is now in full swing, with India, the Philippines and Ghana sourcing the highest number of recruits.

But unless racism is tackled, these efforts will be in vain. As one former nurse with the trust told me: “The biggest group of people that they’re losing right now because of discrimination are our nurses from overseas and our Black colleagues. So they ought to care about this from a business point of view, even if not from a human point of view.”

Of course, people coming to the UK to work for the NHS is nothing new. To mark the 75th anniversary of the health service last July, local artist Hasan Kamil painted a stunning mural just opposite the BRI and UHBW headquarters.

The mural paid tribute to the “achievements and the commitment of NHS staff”. It featured three figures representing the past, present and future of the NHS. In the middle stands a Black woman – a hospital consultant, representing the present. In the background is the ship HMT Empire Windrush, which brought West Indians to the UK. The Caribbeans had been expressly invited to help rebuild war-torn Britain, and huge numbers went to staff the newly founded NHS. Similarly, the 1960s and 70s brought waves of South Asian migrants, many of whom also joined.

The contribution of global majority staff – often in the face of overt racism and discrimination – has then been critical to the NHS’s formation and survival. And combating the problem is critical to the survival of the NHS. Once again, the NHS looked to overseas staff to make up the shortfall. But these efforts, and expense, will be undermined if people leave because of racism.

‘Racism is a difficult thing to prove’

“The racism at individual and institutional level is affecting the well-being and careers of racially minoritised staff,” a tip-off sent by former UHBW worker Simone read. But how do we prove that?

“Gone are the days of obvious racist remarks – it’s more subtle behaviour now,” says Dr Mishra, a consultant at Weston General Hospital. “Racism is a difficult thing to prove, but there is a definite difference in how whites and non-whites are treated.”

According to Anu, who works at the BRI, there is a lack of understanding of the issue among senior management in the trust: “If a Black person was assaulted, they’d get upset – because that’s visible. But if say, a Black person isn’t given a fair chance to do their job, that doesn’t matter because that’s subtle.

“But they don’t realise that that kind of embedded inequality really affects the person,” Anu adds. It makes you question your validity as a human being.”

Another source, Kamala, started working as a nurse at Weston General in 2012, and at the time was the only Black person on her ward. When she applied to the training course required for her job, she was refused twice by her manager. “She told me she thought it was because of my English,” Kamala says. “But I spoke the language fluently.”

Eventually Kamala paid for the course herself at the University of the West of England (UWE), but she says she was not provided the support she needed, for instance being assigned a mentor. “When I was a student, I really felt like I was being watched more than anyone else,” she says. Despite completing the course well, Kamala says her manager did not sign her off, causing her to fail.

She redid the practical element but, Kamala says, her manager would not sign off her work until the very last week. “Every time you want to do something, it’s 10 times harder,” Kamala reflects.

Darius, a former specialist at Weston General, reported a similar situation. Arriving in the UK from Nigeria, Darius was confused to learn that he was not qualified to do certain roles in the UK – despite having long studied and practised them back home.

Nevertheless, determined to thrive, Darius applied for the competitive training courses he needed. “It took my manager two years to sign me off on training – another young colleague came up and it took her four months,” Darius says.

Meanwhile Eli, a Black student nurse, was studying to get an extra qualification at Weston General in 2021. He says his manager on the ward repeatedly found faults with him, and refused to sign off on his work.

In documents shown to the Cable, a fellow white student nurse wrote to the manager saying she believed Eli was being held back unfairly, having completed all the same training as she had. In December, the matter was escalated to HR, but they said it was the university’s responsibility not theirs, and no one was held accountable.

Passed up for promotions

Being held back from promotion was a common concern from the staff we spoke to. Darius was mocked by his manager for applying for a new position. “She laughed at me,” he says, which particularly stung given he had done this role for many years in Nigeria.

He reported his manager’s reaction. “Later that same day, she came and told me that I’m not qualified and would not offer me the job.”

I worked there for years – they never knew how to pronounce my name so would call me little un and flower. There were a few Black nurses in the ward, and the management would always get the names confused.

In her 10 years as a nurse in Bristol, Kamala has never had a promotion – despite applying many times. “There was a Band 6 [senior] role, and me and my Filipino colleague went for it. But then we saw managers were helping one of the white Band 5s to apply, she got it and they closed the position early.”

Ex-Weston General nurse Roshini has seen it too: “In my team, I saw a white Band 5 promoted after a year, when there was an Indian guy on the team who had been working much longer!’

Anu thinks nepotism as well as racism is to blame, where hiring managers give their friends the inside scoop on upcoming job opportunities. “Nepotism is rife in the NHS,” she says. “It’s embedded in the organisation, people don’t even bother to report it because it’s just a given.”

‘The assistants were told to supervise us’

It’s not news that the NHS is understaffed, but hearing the details is still grim. Roshini worked as a nurse in the gastrointestinal ward at Weston General. “The staff shortage was horrible,” she recalls, adding she and her colleagues had to do everything from serve food to administer medication.

“The healthcare assistants were mostly white and didn’t support us,” adds Roshini. “They were so rude and had such a bad attitude with us. We used to tell the manager and they didn’t take any action.”

Many sources also allege that their white colleagues would not accept their seniority. Darius recalls: “They won’t join you in the work, they won’t support you, they won’t even do their own jobs of assisting you well – but they will start picking on you, and challenging you! Eventually we realised that the assistants, instead of supporting us, were told to supervise us!”

“Me and my other Black colleagues got tired of this, and ended up ignoring them and doing everything ourselves,” he continues. “Then they’d go and tell our managers that we were not allowing them to do their jobs.”

In his three years at Weston General, and after feeling bullied by his manager, Darius felt his mental health deteriorate: “My self-confidence went down and I ended up making mistakes that I wouldn’t usually make. I was getting depressed at the time. It’s the first time I have ever gone to a GP to ask for help. I was signed off work for a week.”

Faith, a nurse from Zimbabwe at Weston General, says she once faced a night in 2022 with 28 patients in her ward, and only one agency worker to help her. She had to do multiple blood transfusions, and one of the patients started to crash. Despite her multiple pleas to the Matron for help, she says no extra staff were sent.

By the morning, the patient had died. Roshini recalls: “The next day she was asked to write so many explanations, and she was blamed – why was this not signed and that not signed…?”

‘We are on the right path’

In response to the allegations we heard from almost a dozen current and former staff, a spokesperson for UHBW said: “We are saddened and disappointed that some of our colleagues have experienced discrimination working for us. It is unacceptable. As a Trust we are dedicated to creating a safe and inclusive environment for all. We are, of course, anti-racist. We are against all forms of discrimination.”

“We know we still have work to do but we believe that we are on the right path,” the spokesperson added, pointing to initiatives such as its talent management programme, listening events and mutual respect toolkits as steps in the right direction. But our sources say these measures are still falling short of delivering real change.

The trust’s Bridges Talent Management programme, which is “designed to empower ethnic minority colleagues to progress to higher band roles”, includes reverse mentoring – where a senior leader is mentored by a younger or more junior colleague – practical support with developing skills such as application writing, and interview practice.

But Anu, who underwent the programme in 2023, describes it as being “horrendously weak”.

“Nothing in there about what it would be like to be a Black person being a leader in a trust which is predominantly white,” she says. “When some of us tried to talk about a kind of racism, that was shut down.”

She adds that the approach taken by the trust does not tackle its problem at their roots. “It sits on the premise that Black people have a skills deficit, that’s why they’re being passed over for promotion,” she says. “How many white staff are told that at the start? What about the practical barriers we face?”

“It’s a tick-box exercise,” Anu continues. “Unfairness exists because of structural inequality – it’s not because Black people don’t know how to do PowerPoint presentations.”

Nor was hers the only complaint. Other staff we spoke to said they found the course patronising, and discriminated against them even further.

‘What about accountability?’

The trust points to listening events as one of the ways in which they were tackling racial discrimination. “Senior Leadership Team has been meeting with colleagues from minority ethnic backgrounds to learn more about their experience of working at UHBW,” the spokesperson said.

On 15 August 2022, a meeting was organised between UHBW leaders and staff from Bristol and Weston to share their experiences of racism, hoping it would bring about organisational change.

According to sources, the director of nursing said she saw everyone the same and doesn’t see people’s colour. She shed a tear and said she wasn’t proud of the organisation. “It’s crocodile tears,” former nurse Ruth tells Cable, adding that nothing concrete ever came of those meetings, and since, of the dozen or so attendees, all have now left the trust.

Anu says there was a lack of accountability because the chief executive, Eugine Yafele, never attended. “In my view he’s been incredibly silent around challenging discrimination, specifically racism. It appears to not be his priority.”

Some were hopeful when a Black CEO was appointed – but then found him inactive. One source said that Yafele promised to look into their case personally, but this never happened.

A lack of will to tackle racism?

From the perspective of the people we spoke to, the failure of UHBW to take appropriate action to combat its racial discrimination problems comes from a lack of will, and a lack of understanding. How can the trust solve a problem it does not understand?

“There isn’t a desire to really think about how race is structurally embedded in the way that things operate,” says Anu.

Ruth recalls asking colleagues in HR what training they’d had about racism and discrimination. “They said it’s often not actual racism or bullying being brought forward,” she says. “Sometimes it’s just a firm, but fair management style. They just said they all had training as HR advisors and about poor behaviours.”

On another occasion, Ruth says she confronted a senior manager about the lack of lived experience of racism in the HR team. To Ruth, the manager’s reply was telling.

“She said she did have lived experience of racism, because she visited the Black community in St Paul’s in the 80s, when her father was a community police officer,” Ruth says. “She touched their hair, and their skin because she was curious as a child and enjoyed their food – that’s her interpretation of lived experience of racism!”

Simone also says how frustrating it was for racism to be renamed as ‘supporting behaviours’.

Indeed, in the trust’s response to our question on calling out racism it mentioned the ‘It Stops with Me’ campaign empowering staff to challenge poor behaviour.

UHBW also pointed to its ‘Respecting Everyone’ framework to manage and reduce conflict in the workplace, with 12 staff members becoming fully accredited mediators. But staff said mediation is often not an attractive recourse to victims of racism. “I’m not going to sit in a room with somebody who finds me abhorrent because of my skin colour!” Anu says.

The failure to call out racism specifically, instead of generic discrimination, is also a key underlying issue, sources say. In the trust’s statement for this story, its said: “We are of course anti-racist.”

But Ruth cites other trusts and public bodies that have taken a stronger public stance. She says that when she questioned senior managers about why they didn’t commit to an anti-racism pledge, they said other groups might object.

Regulators renege

Frustrated by the lack of action at UHBW, some staff wrote to the CQC to ask them to investigate the issue in August 2023. In emails shown to the Cable however, despite monthly promises to investigate the issue, it appears this has not been done. The CQC did not respond to our request for comment.

Anu says she has since given up hope. “Everybody appreciates that they’re busy and that they’re a regulatory body. But if you are not in a position to investigate, don’t ask people to share their stories.”

She adds: “How else are people supposed to challenge inequality, when even the regulatory body is not interested?”