Since February 2024, Liverpool Women’s Hospital has delivered anti-racism training to 80% of all staff
Liverpool Women’s Hospital(Image: Julian Hamilton/Daily Mirror)
Liverpool Women’s Hospital has committed to prioritising anti-racist policies following the death of a pregnant Black African woman last year. A damning Maternity and Newborn Safety Investigation report, published in February 2024, found “ethnicity and health inequalities impacted on the care provided” to the woman, who died in March 2023.
The pregnant 31-year-old had been taken to the hospital in severe pain, and a scan found her baby had died. After her condition became critical, she was rushed to the Royal Liverpool Hospital where she died of acute intestinal ischaemia – sudden loss of blood flow to the small intestine.
A coroner determined the cause of death was a “natural cause”. But the MSNI report said the woman’s care suggested “an unconscious cultural bias” at the hospital which “delayed the timing of diagnosis and response to her clinical deterioration”.
Since then, hospital bosses say the organisation has continued work on its anti-racism training, which is provided to staff with the aim of reducing healthcare inequalities affecting women from racially marginalised groups. Recognising racism as a public health issue, the hospital has pledged to “develop staff to be aware of their biases and the impact that racism has on patient outcomes and staff experiences – giving them the tools to address their biases in their clinical practice”.
It has also pledged to create a more diverse workforce, with more Black and ethnic minority staff in leading roles. In an interview with the ECHO, Rachel London, deputy director of workforce at Liverpool Women’s NHS Foundation Trust, said: “What was very concerning to us from the report was the implication there was an aspect of racism in the staff’s decision making in the way they provided care, and I think that’s something we were already aware of. If you asked us three years ago if Liverpool has a problem with racism, we wouldn’t have been aware.
“But there’s been a number of pieces of feedback from patients which made us realise that, although every organisation does equality and diversity training, there needed to be an actively anti-racist approach, and to make that our primary focus.
“It’s not something that turns around overnight. We’ve done a lot of work with our staff; we’ve got some very challenging face-to-face training, making it relevant to our clinical staff, giving examples were we might have observed racism in the organisation and the impact that has.
“People tend to take the view that they have not said or done anything racist, but there is the whole bystander culture of allowing comments to be made. That training has been quite difficult for the staff, but it has started to send ripples through the organisation and we’re really seeing an impact.
“It’s a very nuanced subject, because the vast majority of people do not go to work as a midwife with the aim of giving poorer care. But because racism is very built-in, biases might cause someone to spend more time with a patient who is a white woman from Liverpool rather than someone who needs a translator. Naturally that person then may feel they’re not getting the level of support they need. There’s a number of complex things.
“What we wanted to do was to take the decision to call out there is racism in Liverpool Women’s Hospital, like there is in every organisation – but we want to do something about it. Through that, people are talking about it.”
The hospital has its own anti-racism hub, where both patients and staff are invited to share their experiences and concerns. It has also set up meetings at 27 different community centres, such as the Liverpool Arabic Centre, Mary Seacole House and Refugee Women Connect, with the aim of building trust and relationships with Merseyside’s Black and ethnic minority communities.
Rachel said: “What’s interesting is we didn’t have staff or patients coming to us in the past with their experiences of racism, but now they are coming to the anti-racism hub. It’s a strategy with some risk because we have opened ourselves up to criticism. But what we have seen is patient groups really opening us up to the community.
“We’ve got, this year, a number of improvement priorities, and anti-racism has been one of them. We made a decision as a board that this is to have the same importance as cancer care. Although is has been challenging, we feel it is the right approach in giving better outcomes for patients from diverse communities.”
Following the MSNI report in February, Liverpool Women’s Hospital has delivered anti-racism training to 80% of all staff, with further training being given to managers about supporting staff. It also started the “Call It Out, Stamp it Out Campaign” aimed at reducing the “bystander culture” of casual racism.
The hospital has also partnered with the Anthony Walker Foundation, the racism and hate crime charity, for independent guidance.
Liverpool Women’s Hospital’s equality, diversity and anti-racism lead, Lisa Shoko, said: “Right at the beginning of this journey to becoming an anti-racist organisation, we started looking at what does race actually mean. Sometimes you take for granted that people have an understanding of race and racism.
“Our version of creating accountability is through educating people. It’s important to take people through the steps of understanding race is a social construct and the impacts of racism, whether interpersonal or systemic.
“The greatest impacts in healthcare will be around maternity and mental health. With use focusing on maternity care, those statistics will fall to us. A lot of the work we did started with foundational learning, and now we’re starting to do process mapping – which is understanding the patient journey. These issues are not specific to Liverpool Women’s Hospital, but they are to do with understanding Black and brown bodies and the conditions they are most susceptible to, and how we can be proactive in shifting the dial when it comes to statistics.”
Such statistics include government findings that, in 2022/23, the maternal mortality for Black women was 3.7 times higher than for white women. Significant disparities also existed for women of Asian and mixed ethnicity, who were 1.8 times more likely to die than white women.
These inequalities have proven to be long-lasting and systemic, as all government reports since 2000 have shown greater risks for mothers from ethnic minority backgrounds. Between 2000 and 2002, Black African women were almost seven times more likely to die than their white counterparts.
Black women as a group have consistently remained at highest risk, and women living in the most deprived areas continue to have the highest maternal mortality rates overall.
Lisa said: “These statistics are quite difficult to mitigate, so we are doing everything within our power to shift that dial. There is some responsibility for us as an organisation to see where there are opportunities to reduce those health inequalities.
“We are very optimistic about the way things are going. This is a culture change programme, so benefits will take a while to shop. But with the relationships we have been building, some people have already said to us they feel the leadership competency is growing, seeing people from the global majority have been successful in leadership roles.
“Racism is societal, its systemic, so we never underestimate what we have taken on. What we do accept is the values of our organisation, which is committed to anti-racism. We can’t fix the issue of racism in a societal context, but it is within our power to provide learning and training to change health outcomes. We’re not doing this work alone. We have other partners and organisations supporting us. We’re not taking that we know it all.”