“I’m tired of you calling me names. I know I’m black. I was born black. And I like being black. So tell me something I don’t know.”
These words, uttered 50 years ago as a young nurse facing regular racist abuse from patients on a London hospital ward, were a turning point in Alison Williams’ life and career.
Williams came to the UK in 1969 from the post-war English culture of the Caribbean – where children of all races learned English literature, grammar and history by rote – only to be attacked in the “home country”.
She is now among those who, having dedicated their lives to the NHS, fear the UK still does not properly value the huge contribution made to UK healthcare by black, ethnic minority and foreign-born or trained staff – decades after the Windrush Generation nurses stopped serving in its early years.
Among these professionals was Delores James, who was born as a British citizen in St Kitts and Nevis and moved to Cardiff when she was 10 in 1964. She was “pushed” into working in the NHS, after her mother, who was a midwife – and 12 other relatives also worked in the health service.
James, 71, who used to work as a nurse and midwife, said: “The stories I hear seem as if things are worse than they were when I was in the NHS.” “I’m not saying there hasn’t been racism, but it seems to be much more prevalent.”
The number of foreign nurses and midwives coming to the UK is collapsing, with rising racism and changes to immigration rules blamed for the decline. In an interview with The Guardian, the president of the Academy of Medical Royal Colleges, Janet Dixon, said the NHS was at risk because foreign health professionals increasingly viewed the UK as a “racist and unwelcoming” country.
Between April and September, 6,321 overseas nurses and midwives joined the register of those licensed to work in the UK, compared to 12,534 who did so in the same period in 2024. In October, the Royal College of Nursing revealed that the number of nurses reporting racist incidents at work had risen by 55% over three years.
Meanwhile, doctors trained abroad are leaving the UK in record numbers, with 4,880 doctors qualified in another country leaving the UK during 2024, a 26% increase on the 3,869 doctors who did so the previous year, according to the General Medical Council.
“More than 50 years have passed and no one has learned any lessons,” said Williams, the writer who came to the UK in 1969 and spent 40 years in the NHS as a nurse, midwife, manager and clinical leader. “No one saw fit to congratulate or thank the multiracial people who came – in our generation – to ‘rebuild the country’, that’s how we were presented.”
“I came at a time of brain drain when a lot of English people went to Canada, America and Australia. When I entered the hospital, and in my class, there were 30 girls training. One was English, four were Irish and the rest were West Indians and West Africans – of the West Indians, there were 14 girls from Trinidad alone.”
“The training and social life were amazing, but there was a lot of racism from the patients. They would slap you, hit you or push you away. I was called the N-word. I was told I was bad. It was very annoying.”
A year later, Williams told her mother that she “couldn’t take it any longer” and that she felt as if she was “walking on glass.”
But her mother told her: “You have a dream. You’ve wanted to be a nurse since you were little. Racism is their problem. You just have to continue your career and find a way to deal with it.”
“It actually led me to take this big stand on the wing,” said Williams, who commemorated the moment in the title of her autobiography, Tell me something I don’t knowHe said. “I don’t know where that came from… It was the most empowering statement I’ve ever made – from that moment on, [racism] It just never bothered me.”
Williams moved into the profession of midwifery, where there was much less racism, and where she found that “bringing life into the world was such a privilege.”
She said: “Every now and then, you would get a woman who said she didn’t want to have a black midwife. But the managers were very strict. They would say ‘they’re all we have and they’re the best – either you have a black midwife or you pack up and go somewhere else.'”
Decades later, not all black, ethnic minority or foreign-born or trained paramedics feel they can rely on their colleagues for support.
Latest NHS Benchmark Report on Race Equality in the Workforce It was revealed that black or minority ethnic women (15.6%) were more likely to be discriminated against than other staff in the past 12 months, and 51% of NHS trusts reported that BME staff were 1.25 times more likely than white staff to be involved in formal disciplinary processes. In 80% of NHS trusts, white applicants were significantly more likely than black and white applicants to be shortlisted.
Alison Hewitt is the second generation of her family to devote her working life to the NHS. Her aunt was a Windrush nurse and her mother was a pediatric nurse — but Hewitt broke the traditional mold of radiology training 35 years ago, when black radiographers were rare.
“I think a lot of nurses at Windrush kept their mouths shut. Whereas nowadays, you’re constantly fighting HR,” she said.
But despite discrimination and disparities, 28.6% of staff in NHS trusts are black or ethnic minorities and around 20% are non-UK nationals.
“There are at least 27 countries represented where I work,” Hewitt said. “If black staff, Asian staff and foreign-born staff go home, the NHS will collapse within hours. We have always been brought in to do the difficult work.”
However, Hewitt believes that if there is anything driving staff turnover in the NHS, it is “economic improvement” – and Williams agrees.
“Where do you go in the world where there is no racism?” Williams said. “It’s a global, international problem. But what you might find [outside the UK] Is it that the wages are better or there is something else to compensate for it.
Saada Maida, a 41-year-old gynecologist from Leamington Spa who came to the UK as a refugee from Syria, said NHS staff from all backgrounds shared the common challenge of dealing with patients with diverse needs in a system that was “systematically underfunded”, but she stressed that he felt welcomed – and felt that “the UK is one of the least racist countries”.
He added: “The common denominator among these people leaving is feeling that they are somehow not valued in the NHS – if you get a contract in the Gulf, we know it is systematically riddled with inequality, more so than in the UK, but the pay is better. I think for all doctors or healthcare professionals who leave the NHS, I think the motivation, whether they admit it or not, is largely financial.”
Having seen so many of her family members dedicate their lives to the NHS, James is concerned that the service she has known will be lost due to cuts and privatization, as well as the pressures facing her “fantastic” staff.
“It makes me feel so sad,” James added. “Here we go back to the 1950s, when people were invited to come to Britain to work and rebuild, and when they arrived, they faced these hostilities.”