Racism and misogyny persist in digital health

Two weeks ago, the Guardian reported that in 2019, Frank Hester, chief executive of the Phoenix Partnership, and the conservative party’s biggest donor, said that: “It’s like trying not to be racist but you see Diane Abbott on TV, and you just want to hate all black women because she’s there, and I don’t hate all black women at all, but I think she should be shot.”1 Subsequent reports have shown that Hester made further derogatory remarks about Indian and Malaysian people and what he called “Asian corners.” 2 The reported comments are indicative of a wider problem of racism and discrimination in the NHS and digital health that must be challenged.

The Phoenix Partnership is a healthcare technology firm that has won more than £400m of NHS and prison contracts.1 The company’s clinical systems are used in more than 7800 NHS organisations in over 25 different settings including GP practices and the prison service.3 The stakes are particularly high in light of the recent budget that announced £3.4bn of new investment in NHS digitisation and modernising IT systems, doubling investment in digital transformation. According to the Guardian’s reports, the comments were made five years ago, but have only just come to light, which raises questions as to why no one in the NHS or digital health sector expressed concerns or acted sooner.

The informatics and digital health sectors are known for lacking diversity in their leadership.456 The lack of diversity and representation on boards and in organisations can contribute to a culture where people are scared to speak up and challenge unacceptable behaviour because they are intimidated by hostile and threatening environments, culture, and leaders.7 These cultures enable and perpetuate discriminatory attitudes like those reportedly expressed by Hester.

Many organisations have spoken out in response to the revelations in the news, but some have remained notably silent. The Shuri Network,8 which I founded and chair, a national network which champions diversity and inclusion in digital health and empowers women from minority ethnic groups in informatics, was one of the first NHS organisations to call for action. In a joint statement,9 the Shuri Network and Digital Health highlighted that we have a “joint responsibility, at all levels of the NHS—national leaders to those working within healthcare settings—to speak out and challenge views that have no place in our industry.” Jon Hoeksma, the chief executive of Digital Health has said that the organisation will no longer be working with the Phoenix Partnership while Frank Hester is at the helm. This shows how other organisations could take anti-racist action when dealing with discrimination.

The BMA has called for Frank Hester to resign as chief executive officer given his comments. The BMA’s general practice committee, which represents all UK GPs, voted for an emergency motion urging Hester to stand down from the company with immediate effect, and calling on UK health boards to “apply their own processes vigilantly when contracting external stakeholders whose views and values may not align with the wider professional NHS workforce.”1011 The committee advised GP practices to consider Hester’s comments before signing new contracts with the Phoenix Partnership but stopped short of calling for practices to cancel their contracts with the organisation. Last week Amanda Pritchard, the chief executive of NHS England said the alleged language used by Hester was “racist, sexist and violent” and were a “long way from our NHS values.”12

The NHS relies on its workforce—of which 77% identify as female and more than one in four belong to ethnic minority groups. Those responsible for awarding NHS contracts should know that it is unacceptable for people expressing racist and misogynistic views to hold multi-million pound NHS contracts. We must consider what levers are there within NHS contracting and commercial processes to hold suppliers and contractors to account.

The digital health community is being urged to sign an open letter condemning racism and discrimination and pledging commitment to develop an “‘equity charter’” for the industry which incorporates standards of behaviour to hold ourselves and each other to.

As a woman from a minority ethnic group in digital health, I would like the NHS and tech industry to take positive action towards cultural change and send a clear message to the 1.7 million people who work in the NHS that racism and misogyny will not be tolerated. I would like to see organisations that represent informatics professionals and digital health leaders using their influence to challenge these attitudes in the technology sector and step up to raise the standards of professionalism, ethics, and behaviour within the industry.

Going forward, this will be a true test of allyship, the courage to speak up, and not turning a blind eye to unacceptable and dangerous behaviour. It is time to stop making excuses for inaction and work with the Shuri Network, Digital Health, and other organisations to build a representative and inclusive digital leadership and culture.