Working as a student nurse in east London in the Eighties, Donna Kinnair, then in her twenties, got an early lesson in the relationship between race, racism and health.
Conditions specific to certain ethnic groups in the local population were little understood by her fellow healthcare professionals. “I had very little information, very little data, on things that were affecting some of the populations, things like thalassaemia, things like sickle cell anaemia,” she told me in a recent video call from her apricot-coloured living room.
Both of these inherited blood disorders most commonly affect people from black, Asian and minority ethnic communities.
Kinnair, now 59, and head of Royal College of Nursing (RCN) after decades on the front line and in senior leadership positions, did her own research. Having learned “about the pain that happens when capillaries and vessels get blocked”, she understood how people coming into A&E in a sickle cell crisis were being misdiagnosed.
“There was a pervading view at that time by people who hadn’t experienced this that these were people seeking drugs. You know, pethidine,” Kinnair said. (Pethidine is an opioid pain killer, sometimes used recreationally.)
“That went on for quite a long time. When I think back and reflect on myself, it would have been easy to subscribe to that view,” she said, adding that, if more people in healthcare or in senior positions were familiar with the disease, or had suffered from it themselves, it might have been understood sooner.
Racism – and not only the systemic kind – is something she has dealt with throughout her career. During our interview, she described how an A&E patient once told her: “I don’t want you touching me with your black hands.”
The ward sister “was having none of it”, Kinnair recalled, describing how she came in and told the man that Kinnair – a very junior nurse at the time – was qualified to care for him. This experience helped her later when, as a director of nursing, people refused treatment from nurses, or were openly racist to them.
Sometimes it’s not “just an individual issue… sometimes it’s a societal issue, but there is still that responsibility as a leader to be very, very clear that we are here to give care, we are not here to participate in racist banter”.
Things have improved since she first trained in 1983. “Well, seriously yeah,” she laughed. “The hospital I trained in, there weren’t many black nurses especially that were doing the registered general nurse [training].”
Her sister was in the year above her, also studying to be a nurse. “It was just interesting that they used to always mix us up.”
Kinnair’s impressive career has taken her from her student nursing days in east London to working with HIV and intensive care patients, to a line of senior leadership roles and now the top job in the world’s largest nursing union. Along the way, the mother-of-three from Hackney, London, completed a masters in medical law and ethics, which led to a specialisation in child protection.
Kinnair was awarded a damehood for her role in the inquiry into the death of eight-year-old Victoria Climbié, who was neglected, tortured and abused by her great-aunt and her boyfriend. Medics and social workers infamously failed to see warning signs and to intervene.
One of the defining issues of the Covid-19 pandemic has been the stark racial disparity in infections and deaths caused by the virus. Government data shows that the coronavirus has disproportionately affected Bame people overall.
Last week, the government published its first quarterly report on addressing these disparities. Equalities minister Kemi Badenoch’s recommendations included ensuring ethnicity is recorded on the death certificate, and improving the communication of public health messages to different ethnic groups. Spotlight understands that, while the RCN did welcome the recommendations, the union wanted to see more support for front-line health and social care staff ahead of a winter crisis and second wave. The RCN has in the past called for a government race equality strategy across the public sector, a spokesperson for the union said.
Does a lack of diversity in healthcare leadership contribute to such racial disparities? “It would be remiss of me to say it doesn’t,” replied Kinnair, one of few black women in positions of leadership in healthcare, a sector where a high proportion of workers are Bame. Around 20 per cent of NHS staff are from a non-white ethnic minority background. That figure is as high as 38 per cent for registered nurses working in social care, according to Skills for Care.
“What you see sometimes is that some of the diseases that only affect a particular group aren’t as explored or pushed to the forefront as we see with some other conditions, so I do think that much depends on the leadership,” said Kinnair.
She believes that leadership should reflect the communities it serves. “It’s so important when we want to investigate the outcomes in terms of maternity issues or cardiac issues or any of those things that affect certain communities, and whether that’s because they are socially disadvantaged, whether it’s because it’s intersectionality, whether it’s because of ethnicity, we certainly need the data to help us understand that.”
The government “have tried” to prioritise the issue of racial disparity in Covid-19 outcomes, she said, citing the Public Health England (PHE) review commissioned in April, which preceded Badenoch’s recent progress report.
“One of the things with Covid is that there was no shying away from it – if you look at the first ten doctors and nurses who died we knew it was disproportionately impacting black and ethnic minority people,” she says.
Much has changed in nursing since Kinnair started out, but one issue that remains problematic is pay (or lack of it). In August, the RCN launched a campaign demanding a 12.5 per cent pay increase for nurses. In a speech to RCN members in October, Kinnair slammed “gendered notions” of nursing and the “hollow clapping of politicians”.
“Before they get any ideas this winter, I have something simple to say to Boris Johnson. We don’t want claps, or medals or pin badges – this time, just pay us fairly for the tough job we do,” she said in the speech.
According to a recent survey of 42,000 RCN members, 35 per cent are thinking of leaving the profession this year – up from 27 per cent at the end of 2019 – with more than half (61 per cent) of those citing pay as a factor. Nearly three-quarters (73 per cent) said improved pay would make them feel more valued.
If there is one good effect of the crisis for nurses, Kinnair said, it’s that the general public finally seems to appreciate them. “For the first time in my entire career no one is asking me what a nurse does… people have seen for themselves that we have been there, supporting patients through their illnesses.”
The pandemic has highlighted the vulnerability of frontline healthcare staff, the role of nurses, and the NHS’ staff retention problem. In fact, Kinnair pointed out, with many nurses coming from abroad and from the very ethnic minorities seemingly vulnerable to Covid-19, there is a responsibility to protect them.
The NHS had a shortage of 50,000 nurses when the pandemic started. The government brought in student and recently retired nurses to boost the ranks, though the difference this made to overall staff numbers was small. The registered nurse vacancy figure for the NHS in England going into the pandemic was just under 38,736, according to RCN figures. The current vacancy figure is 37,821, a reduction of 2 per cent.
Kinnair herself went back to clinical care, going into the Nightingale Hospital intensive care unit, “using skills… that I used many years ago”.
This connection to the frontline was something that helped her work out early on in the pandemic that shortage of personal protective equipment (PPE) was a major problem. One nurse “rang me and told me that they were using black bags because nobody had thought to order [PPE] for them”.
“I wanted nurses to be able to talk to me directly, and they did. There was not a nurse I don’t think across this country… that didn’t email me or didn’t talk to me personally about some of the things that they were experiencing in the community,” she recalls of those early months.
As we head into winter and a second wave, she is less concerned about PPE, “partly because the nurses on the ground are not telling me as they were on a weekly, daily basis that there is a huge absence of PPE”, but also because the RCN has sought reassurances from government, PHE and the NHS “right across the UK”.
“When nurses tell me that there isn’t [any PPE], I will be battling again,” she said.
[See also: Where did the UK go wrong on coronavirus?]
She is concerned, of course, about the coming winter, the pressure on hospital and healthcare staff from the flu season and a second wave, but she is diplomatic about whether government failures have exacerbated the crisis.
“I suppose I’ve dodged that a bit,” she said, after avoiding answering a question about whether the NHS had survived the pandemic despite the government’s lack of strategy. “But I just worry about people thinking that Matt Hancock rides in on his shining horse. That doesn’t happen.”
What is key for Kinnair is whether the government has been listening when healthcare professionals have raised concerns about PPE shortages, or a lack of testing for NHS staff.
So, has the government listened?
“On several occasions I did contact the government directly, and on several occasions, when I was worried about nurses having to go in without adequate protection, I was not going to hold back in speaking truth to power… I think they definitely heard my voice.”
This piece was corrected on 26 October to reflect that the government, rather than the RCN, recruited student and recently retired nurses to boost the nursing ranks during the pandemic.