The Fire This Time
Written By Maha Khan
It feels as though there has been a sudden shift in the political landscape in this country. In the wake of the Tommy Robinson Rally in September 2025 and the Conservative-to-Reform allegiance switching between voters and MPs alike, the atmosphere of intolerance has only grown.Yet this racist shift has been brewing for centuries. Racism has plagued Britain for much of its history, which has had irreparable ramifications on our healthcare system, NHS staff and patients. In 1963, James Baldwin warned in his book The Fire Next Time that if America failed to confront the truth of its racial injustice, ‘the fire next time’ would consume it. Sixty years later, on the other side of the pond, England faces a seemingly quieter but equally corrosive fire; one burning through its hospitals, institutions, and its self-belief as a fair and tolerant nation.
The National Health Service was famously built on the promise of equality, yet for many people of colour, that promise remains unfulfilled. Ethnically diverse populations have worse patient outcomes and struggle more in workplace environments. In the corridors of a system meant to protect all that it serves, discrimination persists. As Brits, we certainly prefer to speak of ourselves as tolerant and post-racial, ‘not like the Americans’. And yet, just one look at England’s healthcare system will reveal that it is riddled with inequality. Institutions inherit the moral failures of the societies that built them. Where racism is woven into the nation’s history, it is also woven into the NHS. Britain must recognise that the fire this time is not a sudden blaze, but a long and slow burn. Worse patient outcomes, delayed diagnoses and an unequal workforce are just some of the major issues that can be identified.
Maternal outcomes and delayed diagnoses
Living in a world full of oppression is ironically both a unifying and isolating experience. The day-to-day trials of a person of colour in Britain are varied and individual. In relation to healthcare, understanding that equal access does not guarantee equal outcomes is a bleak reality. An essential example is maternal outcomes. Black women in the UK are three- to four-times more likely to die during pregnancy or childbirth than White women, with Asian women facing roughly twice the risk. These disparities have been documented for years, including in reports by MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK); yet despite this acknowledgement, they still remain under-researched.
These failures aren’t addressed in medical education beyond a few scattered lectures, and harmful narratives about particular ethnic groups are still perpetuated through stereotypical and racist case studies. Delayed diagnoses, inadequate pain management, structural biases and socioeconomic barriers are just some of the many factors that influence unequal health outcomes. A pertinent example is delayed diagnosis of neurodiverse conditions such as autism and ADHD in young black children, where they receive diagnoses later in life as compared to their white counterparts after being dismissed as having ‘behavioural problems’. The reasons for these inequalities are presented as complex and difficult to pin down. This gives rise to a laziness that turns into ignorance, where it is easier to turn a blind eye than to address the problem at hand.
How orientalism affects outcomes
Orientalism and the old fascination/hatred towards ‘the Orient’ carried the British
through much of the last 500 years, and can be cited as one of the roots of structural inequalities in healthcare in Britain today. The idea that foreign cultures needed to be altered or destroyed, and for Western philosophies and ideals to be disseminated through ‘oriental’ nations, was the guiding force for the British Empire. A signifier of Western attitudes towards ‘oriental’ behaviours negatively affecting its own people is the way Black males’ mental health is dealt with in Britain.
Black men in England are four times more likely to be detained under the Mental Health Act and more likely to be diagnosed with severe mental illness, such as schizophrenia. Black men are more likely to experience poverty, policing, exclusion from education and employment discrimination, all of which increase psychological distress. Evidence shows that diagnostic and risk-assessment biases lead clinicians to interpret Black men as more dangerous and more severely ill. These structural, institutional and interpersonal forms of racism combine to make higher diagnosis and detention rates not coincidental but predictable outcomes of the current system. The state of Black males’ mental health is linked to deep-rooted mistrust and racism in psychiatric diagnosis as well as the ever-infallible pattern of our government’s approach of crisis-driven intervention rather than early support. A 2024 US study indicated Black patients reported high levels of race-based mistrust and skepticism toward healthcare workers, influenced by personal and systemic discrimination experiences. With continuous budget cuts from community care and the use of police and detention at the forefront of mental health crisis management, Black males with a context of fear of criminalisation are known to feel particularly vulnerable. Looking at these figures, they certainly carry the ember of our American counterparts.
Workforce diversity
The NHS is one of the most diverse workforces in the country — yet, paradoxically, it is also one of the spaces where racial disparities are most stark. Ethnic minority staff make up over 28% of the NHS workforce, but they hold only around 10% of senior leadership roles. A 2014 BMJ article by Roger Kleine references the ‘snowy white peaks’ of the NHS, referring to the fact that the higher the pay band or position of power, the less representation of the global majority.
The NHS Workforce Race Equality Standard (WRES) has repeatedly shown that not only do minority staff report higher levels of bullying and harassment, but they are also less likely to believe their organisation would take racism seriously. Ethnic minority staff often face racial abuse from patients and colleagues alike, and rather than attempt to tackle this problem at the root, the NHS culture tells them to learn how to shoulder it. I was asked in an interview for medical school (once the interviewer identified my race and religious beliefs) how I would deal with the inevitable discrimination I would face as a doctor. This is just one example of how the culture of the NHS expects resilience instead of reform, opting for silence over the wellbeing and fair treatment of its patients and staff.
England often sees racism as an American problem and the NHS sees itself as inherently fair. These narratives form what Baldwin would call a ‘dangerous innocence’, the comfort of believing in one’s virtue while ignoring one’s failures. In the guise of acceptance and equality, the NHS appears to have colour-blindness. By not confronting its inequalities and misguidedly addressing them in a way that only perpetuates stereotypes, there is a massive failure at play. The NHS is one of the greatest achievements of modern Britain; but it is far from perfection. Health inequalities among people of colour and discrimination against ethnic minority staff is not inevitable and should not be treated as such. In the 2024 NHS Workforce Race Equality Standard data analysis and report for NHS trusts, it was highlighted that 25% of staff from different ethnic backgrounds reported experiencing harassment, bullying or abuse from their collogues. At 80% of NHS trusts, white applicants were significantly more likely than ethnic minority applicants to be appointed a role from shortlisting. These are certainly alarming figures, even more so when you think about those incidents which go unreported, of which there are many on a day-to-day basis. These injustices persist because they are tolerated by the institutions that are supposed to support those who exist within them. Baldwin wrote to force America to look itself in the mirror. Today it is pertinent to ask Britain to do the same. The question is whether we will face it before the fire consumes us whole.
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