Discussing Diversity: Being the first black NIA fellow – a source of comfort or concern?

Sami Nur, Director of Strategic Development and Partnership at Feebris and Digital Health Specialist, shares his reflections on navigating his roles in the NHS and health tech as a black person. Feebris is a DigitalHealth.London Accelerator company and Sami was selected as an NHS Innovation Accelerator (NIA) Fellow in 2021.

Just six months into joining Feebris as Director of Strategic Development and Partnerships, I was delighted to hear we had been selected to join the NHS Innovation Accelerator (NIA) for the 2021 programme. Personally too, I was profoundly moved to learn that I was the first black Fellow to enrol on the NIA Fellowship. I was proud, of course, and humbled by the sheer number of young black men and women who reached out to me with words of congratulations or to seek advice on how they too could pave a career in digital health. Yet I was more than a little surprised. How could the NIA, now in its sixth year of supporting brilliant, enterprising and forward-thinking start-ups and individuals, not once have had a black Fellow pass through its doors?

Don’t get me wrong. This isn’t a slight at the NIA – I am immensely grateful for the mentorship and guidance Feebris and I stand to receive from the accelerator – nor is this a unique example of underrepresentation. It’s been show that individuals from Black, Asian and ethnic minority (BAME) communities are less likely to identify themselves as innovators, less likely to have the financial security to develop an innovation and more likely to face barriers which prevent them from innovating than non-BAME individuals [1]. Clearly the number of BAME innovators who get to the stage where they are ready to apply to an accelerator is going to be far less than their white counterparts.

As a short aside, let me just say that the term BAME is not how I like to be categorised. However, as of today there isn’t yet an alternative that is widely accepted, so I will use it here out of necessity. I’m not a fan of lumping a wide range of humans with unique and often conflicting experiences under one label – but this is another discussion. 

That said, the realisation that I was the first black Fellow has served as something of a wake-up call for me, and it highlights a problem that continues to be endemic within the NHS.

I imagine my experience of working in positions of leadership and management within healthcare mirrors those of other black and minority ethnic individuals. Serving as a primary care commissioner for a diverse and multicultural primary care trust in West London, now over a decade ago, it became quickly apparent to me that the diverse frontline workforce (from regions as disparate as South East Asia, Eastern Europe, and a multitude of African states, including my own country of birth, Somalia), were the bedrock on which our health and social care sector sat.

Yet as I climbed through the ranks, standing shoulder-to-shoulder with non-clinical managers and other executives, it was clear that our NHS leadership was not as representative as its frontline staff suggests it would be. On more than one occasion, I would be the only non-white person in the meeting room, with other members quick to assume I was the secretary. Other times, they’d politely enquire if I wouldn’t mind ever so much fetching them a cup of tea whilst they waited. For a meeting. With me.

The lack of representation of black leaders in senior roles across healthcare, both within the NHS but also in the private digital health space, make the possibility of taking on such a role harder to imagine. The UK government has reported that only 5.1% of small and medium enterprise (SME) employers were led by ethnic minorities [2]. NHS staff is over three quarters (77.9%) white [3], and there has yet to be a non-white Chief Executive of NHS England.

So, before one can talk about solutions to the problem of underrepresentation and other biases within healthcare, it’s important to acknowledge the problem. And to acknowledge the problem, we must first define it. At its broadest level, this may be something as simple as saying ‘there aren’t enough black candidates applying for senior positions in healthcare’. From there, we can look into the reasons why this is the case.

Part of the challenge is that underrepresentation is not always (although most certainly is sometimes) borne out of the malice that fuels ‘everyday’ racism. A lack of opportunities at the highest level in the workplace does not share its roots with the urine throwing, tyre slashing, or slew of other racially mediated vitriol that I and other individuals from minority backgrounds have been subject to at one point or other in our personal lives. On the contrary, the factors precluding black people from climbing up in the workplace are perhaps more a function of the status quo. In some ways, this casual insouciance is even more difficult to challenge or confront.

Even so, confront and challenge it we must.

People often talk about addressing the ‘root cause’ in issues such as these. It’s well known that BAME individuals, for a variety of reasons (such as personal circumstances and household income, geography, social mobility, and the quality of school attended), are less likely to attain the standard of grades at GCSE and A-level needed to secure a place at university. In turn, the absence of a university degree or other higher education qualification will cause even the most well-intentioned of employer to look elsewhere.

The absence of minorities at the highest level is not for a lack of ability, talent or skill, but rather due to the lack of means and opportunities provided to them. In an only slightly tongue-in-cheek example, I’d like to borrow from the 1993 cult classic movie ‘Cool Runnings’. Who knows how many other bobsleigh teams are out there, determined to prove their worth at the Winter Olympics?

However, it’s encouraging to see that, slowly, the tides are changing. The work of prestigious academic institutions such as Oxbridge in their outreach programmes to identify bright young minds from traditionally undersubscribed and poorly performing areas is cause for encouragement. Similarly, the efforts of many medical schools in their widening participation programmes has also seen record numbers of medical students from disadvantaged backgrounds.

In my current role at Feebris, one can’t help but feel that, engrained within the organisational fabric, there is a reverence for equitable, affordable, and accessible healthcare. Healthcare that is delivered in manner that challenges racial and gender biases, to ensure technology stands to benefit as large a section of the population as possible.

Though it’s encouraging that we’re beginning to lay the pipeline for more equitable recruitment for future generations, simply stating the fact is of little intrinsic value in the short term. As one of a handful of BAME NIA fellows, I’ve been active in seeking out opportunities to mentor others; to drop the ladder within arms’ reach rather than to pull it up behind me. It’s immensely rewarding to speak to the vast numbers of confident and passionate young people from minority backgrounds, full of fire in their bellies and itching for the opportunity to prove their mettle.

Fundamentally, promoting diversity in the workplace mustn’t come from a place of pity of altruism. I’m the first to say that I wouldn’t want a job, just because I am black. No, diversity is important for a plethora of reasons, including because it helps the bottom line. Research has consistently shown that a diverse workforce leads to better outcomes and productivity, maybe because the breadth of lived experiences amongst the workforce helps to grow the business. Once we recognise that a diverse organisation – or accelerator – is a more successful one, we can work backwards to reverse engineer how we promote this diversity.

Finally, I want to speak to the importance of visibility and role-modelling. So many young people are put off from applying to positions of power because a quick scour of the company website reveals there are very few others ‘like them’. An increasingly diverse workforce can help create a cadre of role models, whose mentorship young people can benefit immensely from. In turn, this can set up a virtuous cycle of representativeness and diversity where people of diverse backgrounds feel they belong and can bring their authentic selves to be productive in their roles.

Feebris is a mobile-based software platform, powered by AI, that helps users (clinical or non-clinical) to detect and triage deterioration. It enables proactive healthcare, where health assessments can be conducted in a community setting and communicated to other teams in the healthcare system. It is designed to act as an early warning system, shifting risk away from hospital facilities and making earlier interventions possible.

Feebris is currently one of 20 digital health companies on the DigitalHealth.London Accelerator programme.

The DigitalHealth.London Accelerator is a collaborative programme funded by London’s three Academic Health Science Networks – UCL Partners, Imperial College Health Partners, and the Health Innovation Network, MedCity, CW+ and receives match funding from the European Regional Development Fund.

DigitalHealth.London is delighted to publish blogs by the NHS staff and digital health companies we support through our programmes, as well as sector thought-leaders, experts and academics. Any opinions expressed within blogs published on our website are those of the author and not necessarily held by DigitalHealth.London. For more information, or if you would like to write a blog for our website, please email info@digitalHealth.london.

[1] Supporting Innovation and Diversity in Innovation, Innovate UK, 2020, https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/902986/InnovateUK_Supporting_Diversity_and_Inclusion_in_innovation_WEBVERSION.pdf

[2] https://www.ethnicity-facts-figures.service.gov.uk/workforce-and-business/business/leadership-of-small-and-medium-enterprises/latest

[3] https://www.ethnicity-facts-figures.service.gov.uk/workforce-and-business/workforce-diversity/nhs-workforce/latest