Black History Month

Ben Coleman Excerpts

Thursday 23rd October 2025 Commons Chamber

[Ben Coleman (Chelsea and Fulham) (Lab)]

My remarks will be influenced by my membership of the Health and Social Care Committee, and by the fact that I am the vice-chair of the all-party parliamentary group on black health. Also, like my hon. Friend the Member for Leyton and Wanstead (Mr Bailey), I have the pleasure of being a trade envoy: for Morocco and francophone west Africa. We share a great interest in that continent.

I will focus my remarks on health. When we talk about health and black people, very often we talk about the huge improvement in recognition of one outstanding person: Mary Seacole, who is now just talked about as a nurse who did wonderful things in the Crimea. She has reached the august stage of not just being referred to as “the black Florence Nightingale”; she is now referred to in her own right, but it took an immensely long time for that to happen.

The hon. Members for East Grinstead and Uckfield (Mims Davies) and for Aberdeen North (Kirsty Blackman) referred to the contribution made by the Windrush generation. The history of the national health service and of our country’s black community are intertwined. The people who came on Windrush and other boats, and the successors to them, are now retired and are served by the national health service, but the people who came after them are still the bedrock of the national health service. They provide the majority of the care that we all expect to receive, but we know that their contribution has not always been well rewarded.

There is still a huge issue today regarding how well the national health service serves people of colour—how well it serves black people. That was brought home to me quite starkly by one of the most challenging things that has confronted any of us in our recent history: the covid pandemic. As a cabinet member for health and social care in a London council at the time, I would see the vaccination figures every week among people of different socioeconomic backgrounds. Consistently, people from an African-Caribbean background would be the least likely to be vaccinated; they would be the most reluctant.

A lot of people were saying things like, “Oh, this is just because they are prey to misinformation or have irrational fears. All we need to do is put them in front of people of religion, or footballers, and it will change everyone’s mind.” I found that slightly odd, so I talked a lot to people to try to understand why it was happening. I should say that I went to a London comprehensive school with people who were black, white and from all sorts of backgrounds. I have always been aware of racism, but I thought that things had got a lot better. From talking to black people about covid and their feelings about the NHS, I realised that things were really not as good as I had liked to pretend to myself.

The situation was not driven by a need to educate people or make them aware; the problem was that there was a lack of trust in the NHS, and it did not come from nowhere. If people consistently get less good access to care, less good treatment and less good outcomes, it is not surprising that when they are told, “Trust us, we’re the NHS,” they say, “Well, you haven’t always obviously had my best interests at heart, so forgive me a certain amount of reluctance to do so.”

We have a very serious problem in our country of people getting less good healthcare simply because their skin colour is different, which is completely absurd—it sounds very childish of me to put it in that way, as it is so ridiculous—and what I saw during that time on the council made me think, “How do we address it? How do we create the trust that we need everybody in this country to have equally in the NHS?” Our Select Committee is trying to grapple with those questions in different ways. The hon. Member for Chelmsford (Marie Goldman) mentioned the issue of black maternal health. She is right that maternal health services are a huge problem.

The Health and Social Care Committee recently undertook an inquiry into how to improve black maternal health services. I will talk a little bit about it, because I think what we came out with provides a bit of a road map for transforming the NHS’s treatment of black people across the board, and for improving services across the board. We started by confronting the shocking fact that a black woman is 2.3 times more likely than a white woman to die during pregnancy or childbirth, or in the post-natal period. As a slight aside, the figure used to be even worse; it used to be almost five times. It has only got better because everything has got worse for white people as well. There is a huge problem in maternity services in this country generally, but the disparity still remains: black women are 2.3 times more likely to die than white women—in 2025, in one of the richest countries in the world.

We heard repeatedly that the disparity was not the result of social factors, biology or other things; it was simply racism—it was not direct, not overt, not thought through, but racism was one of the core drivers of the disparity. The statistic that black women are 2.3 times more likely to die than white women is not just a statistic, because behind every number is a woman who did not come home to her family; a child left to grow up without their mother; and a partner, parent or a friend left devastated by a death that was preventable.

We were encouraged to be optimistic, so I want to be optimistic against that stark background. I think things can improve if we want them to improve. The Committee made a number of recommendations on maternity care. They are specific, but as I say, I think they have some universal applications. I will share them, and suggest how each can apply to the NHS more broadly to tackle racism, so that everyone gets equal care, no matter who they are.

First, we heard some really strange things. For example, we heard evidence about black women being told by both black and white doctors, “Oh well, you’re black. You can cope with more pain, can’t you?” It is incredible that people are still having that said to them. Other problems include symptoms not necessarily being identified —things like skin rashes and pre-eclampsia discolouration —because doctors and nurses are not properly trained to understand the differences in skin colours, and how to recognise these problems in black people as opposed to white people.

The Committee simply thinks that it would be useful if we had mandatory anti-racism training. That is not training against being racist; it is training in cultural competency, understanding differences—they could be colour differences or cultural differences—and respecting all patients, not just some. Surely it is the job and the fundamental duty of anyone in public service to be there for everybody, not just some people. We would like the training to be not just mandatory but informed by lived experiences, not by assumptions. At the time some people said to me, “Let’s just get people in front of churchmen and churchwomen and then they’ll take the covid vaccine.” It must not be those sorts of assumptions; we must actually listen to people and understand their lived experiences in order to tackle unconscious bias and racist assumptions.

The good news is that there is a model for this that works. Last night I was at a really interesting presentation by the Caribbean & African Health Network on something called the black health improvement programme. It was commissioned by the Greater Manchester Health and Social Care Partnership to address the health inequalities that were exposed by the covid pandemic, and it is now operating in Greater Manchester and Enfield. It offers GPs culturally appropriate education and training, informed directly by talking to the community. It covers institutional racism, health inequalities and lived experiences, and it is grounded in reality. We need to look at that and learn from it. We must scale up such programmes for use across the whole NHS.

[Marie Goldman]

The hon. Member speaks very powerfully and knowledgeably, in particular about maternity services. I note with interest the maternity services review being kicked off by the Government at the moment. Does the hon. Member agree that many of the changes he is suggesting could be implemented right now and that we do not need to wait for the outcome of that review before we get started?

[Ben Coleman]

The hon. Member makes a very good point. I will run through a few more proposals from the maternity report, but they will not surprise Members; they are not radical or new. What would really be radical and new would be if one of these reports— I think I have read at least six reports about black people getting less good treatment from the NHS—had their recommendations implemented. That would be radical. We on the Health and Social Care Committee are looking forward to the Government’s response to the report and are hoping to see the recommendations implemented. If they are implemented for maternity care, we hope that they can be applied more broadly.

The maternity services development fund has sadly been slashed from £95 million to £2 million. The money has been given to integrated care boards to parcel out, but they are all facing 50% admin cuts, so maternity services will have to compete with every other local priority. We need dedicated ringfenced budgets, and we need budgets for areas where there are specific racial health inequalities, such as conditions that affect some people more than others because they are black. I am thinking of fibroids, for instance, and sickle cell awareness, which I will come to in a minute.

I turn to another thing that is essential in the NHS. The Health and Social Care Committee was glad to have the new chair of the NHS, Dr Penny Dash, in front of us being interviewed before her appointment. She said that one thing that is really important to her is data, data, data—and I agree. However, the extraordinary thing is that ethnicity data collection in the NHS is not very good. But it is not impossible to do. There was some work done on assessing disparities in maternal morbidity outcomes. It was almost complete in March 2023 under the previous Government, but when the Committee asked Ministers in June 2025 how it was going, we were told that it was good news and that it was still being developed and was expected within less than three years. That means it will have taken potentially six years to complete something that was meant to be almost finished. This is very slow and unacceptable progress.

[Kirsty Blackman]

I was pleased to hear the hon. Member highlight some good practice. As a parent, you get slightly obsessive about your children’s health and tend to google what is going on with them. The NHS website—nhs.uk—has improved monumentally over the years. For instance, when it comes to rashes it says, “Rashes will present differently on black and brown skin,” and it shows pictures of how that might look. I am glad that the hon. Member highlighted good practice. Does he think it is possible to lift and shift the good practice we see, such as on the NHS UK website and with the Greater Manchester example he mentioned, and do that across the board?

[Ben Coleman]

Absolutely. I think the hon. Member and I are advocating the same thing. I have to say—quick plug here—that the NHS app is quite good. If anyone does not have it, I would sign up and get it. If people do not get it and give feedback, we cannot make it any better. I am quite impressed by the app. I was shocked to see how many times I have been to the doctors in recent years, but all the information is there.

One way to achieve what the hon. Member for Aberdeen North and I want to achieve is by collecting better data on what is going on. We need mandatory data collection. We need to look at deaths, near misses and complications. We need to report disparities and take action when they are revealed. We also need people to be accountable for taking action. We could look at a whole range of areas to see the disparities and differences that exist in treatment and outcomes between black and white people. We could look at cancer diagnosis timing and survival and mental health, sectioning and treatment, which is a huge issue. We could look at pain management, analgesic prescribing, referral rates to specialists, treatment escalation decisions, patient satisfaction and how we measure that, and complaint patterns. We need data on all these areas so that we can address the issues and take action.

Then we need to look at the workforce. The Government are coming out with a workforce plan later this year, which is hugely needed. There is a shortage in the work- force in some parts of the NHS, in particular maternity services, but the workforce issue is not just about numbers. It is about having staff who understand and respect patients, and this comes back to the cultural issues. It is difficult enough for women being patronised as a patient, but it is even more difficult for black women.

[Peter Prinsley]

Sadly, my experience as a consultant in a rural part of England is that, shockingly, some patients are still reluctant to see black doctors and nurses. Although my hon. Friend is talking about the experience of patients, I think we also must consider the attitudes of patients towards our staff and the way in which staff are treated by some patients.

[Ben Coleman]

My hon. Friend makes a strong point, and I could not agree more. There is some data out there. Hospital trusts collect data each year on how their staff are feeling about a whole range of things. I looked at my local hospital trust’s data and one question it asks is: “Do you feel that you have suffered more discrimination this year from patients and from colleagues and managers?” I have not looked for a couple of years, but sadly the last time I looked it was getting slowly worse.

This is definitely an issue. If people are foolish enough to think that somebody’s skin colour is going to affect their ability to do their job properly, it makes it more difficult for staff to provide care to the whole population. Black NHS staff need to have safe working environments. They encounter racism, and they should not. It is interesting that you talk about doctors—

[Madam Deputy Speaker (Caroline Nokes)]

Order. The hon. Member means “he” not “you”.

[Ben Coleman]

I am most grateful for the correction, Madam Deputy Speaker. It is interesting that my hon. Friend talks about doctors, because honestly there are not that many people in leadership positions in the NHS who are black, and that is another issue that needs to be addressed.

I have used the word “racism”—as we all have—in a way that is perhaps not easy to do everywhere. I have to say, when I first started becoming aware of the huge differences there are in how people are likely to experience health services depending on whether they are black or white, I did not feel at all comfortable using the word “racism”. Sometimes when people say “structural racism” when talking about racism, people will say, “I am not a racist!” but that is not what is being talked about, so it is very difficult to enter this conversation.

I remember when I was on the council I was once on a big Zoom call with 150 people to discuss the inequalities work we were doing. A black woman talked a lot about micro-aggressions, and I asked her, “When you are talking about micro-aggressions, aren’t you talking about racism?” She answered, “Yes, yes. But you can say that. I can’t.” So I think it is incumbent on people like me—a white middle-class gentleman of a certain age—to be allies, as many hon. Friends and hon. Members here are being, and to stand up and talk about these things and name them for what they are.

We can effect change. We can do the radical thing of implementing the change that is needed, but to do that we need to have leadership that wants to actually effect the change. We have found, sadly, that black women facing poor outcomes is shaped by systemic failings in leadership and accountability as well as in training and data collection. We need senior leaders to be held accountable for racial health inequalities. That means that they need to be aware of them, which means they need the data. We need Care Quality Commission inspections to specifically assess equity in care delivery. Trust boards should be specifically responsible for monitoring and addressing disparities, and performance metrics should include equity indicators. That all sounds terribly onerous, but it is not. It can become part of the normal way of doing things; it just has to be introduced at some point. As I said, these are not radical suggestions, but to do them would be radical.

Indeed, the really radical thing to do—this came out of the Committee—is just to listen properly to the women needing maternity services. I saw a terrible programme during covid where a woman was talking about her daughter, who was 20 and had gone to see her doctor. She was talking about being in immense pain. The doctor said, “Well, black women have differently shaped cervixes, so that is probably why.” She died in childbirth. That sort of thing happens all the time; we just do not talk about it all the time. It has to stop. We need to listen to black patients.

Black patients talking to us said, “I had pain. I reported pain and I reported symptoms—I just wasn’t believed.” Their concerns were dismissed. That pattern appears not just in maternal health services but right across healthcare.

[Mr Calvin Bailey]

My hon. Friend is making a powerful speech. It is important to highlight the simple things like listening to people, but we must also get over our inherent reluctance to speak about health inequities when we are speaking to each other. Prostate cancer, for example affects one in four black men, whereas it impacts one in eight white men, partly because we do not discuss the fact that it is more prevalent in black men and we need to conduct diagnosis much earlier. Does he agree that if you are a black man or you have a history of prostate cancer in your family, you should go and get a prostate prostate-specific antigen test as early as possible—as early as 45? I will not make reference to my own age or the fact that I have had a test myself.

[Ben Coleman]

I am grateful to my hon. Friend—my youthful friend—for that comment. I could not agree more. When I became aware of this problem back when I was a councillor, we instituted a programme to build trust within the black and minority ethnic community in the NHS. As a result, we had hundreds of conversations in the community with people from the NHS and with people of colour. One black gentleman, who I think was a little older than 45—he was probably not far from my own age—went and had a prostate test as a result, and it was found that he had prostate cancer. If he had not had the test, who knows what the situation would be these days. I therefore fully support my hon. Friend’s call for everybody to have prostate cancer tests. I have had one myself, and fortunately, like him, I think things are all right.

When we get feedback from patients, we need formal mechanisms for registering that—it should not be done in the typical ad hoc, amateur way—and we need to co-produce the changes with the people we are actually meant to be there for. Also, when people complain about discriminatory treatment, we need to consider that seriously, and the NHS needs to respond in a much more open-hearted, open-handed and open-minded way than I am told it often does. The Committee did the inquiry and came up with specific recommendations that affect black maternal health, but I think they spread right across the piece of black people not getting as good healthcare as they should, and as white people do.

I end on a specific example of something quite close to my heart because of friends: sickle cell disease. As we are talking about black history, I would like to pay tribute to Dame Elizabeth Anionwu, a wonderful woman and the UK’s first sickle cell nurse. She has done so much to educate me and other people and improve services in this country.

People may not know much about sickle cell if they are not black. It causes intense pain and organ damage. Crudely, cells get shaped like sickles, and it can cause strokes; it can even cause early death. It is often overlooked, mainly because it affects black and minority ethnic people.

Imperial College healthcare NHS trust is currently running a wonderful programme that serves my constituents in Chelsea and Fulham. It is one of only seven centres in the country piloting what is called a renal haematology triage unit, which is one of those sexy NHS titles, but it just means if a person suddenly get a crisis and needs to be seen swiftly, they do not have to wait for hours and hours in accident and emergency; they can get swift pain relief. That is vital for making sure that the problem does not get seriously dangerous seriously quickly. I went to visit it and talked to patients and staff. It is a terrific centre that has made a huge difference to people’s lives, as they are able to go to work and look after their children more easily. It is inspirational—but, sadly, it is a pilot. In the normal world, we do a pilot, we see if it works and, if it does, we try to find the funding long term. Often, in the NHS it means, “We have got a bit of money left over. What can we do?” or it means, “Let’s do a project for a few years and call it a pilot.” We need to keep the funding for those seven projects across the country, which are offering urgent, swift pain relief for people with sickle cell, after April. That is one thing that I am working on at the moment. We have to show everybody that they matter equally. We have to build trust.

So let us build trust, let us acknowledge the harm that has been done and let us do the work on training, comprehensive data and workforce issues. Let us name racism and tackle it head on. Let us listen to black patients and ensure that services for conditions such as sickle cell are as important to everybody as they are to just a few. We cannot change history—we can recognise it, as my hon. Friend the Member for Clapham and Brixton Hill (Bell Ribeiro-Addy), who has just left the Chamber, said—but we can change the future. We have the evidence and the recommendations. We know what needs to be done. I have not said anything new or anything that will have shocked the House. The only thing that is shocking is that there is often so little willpower to make the obvious and necessary changes that are needed. I will keep fighting for that to happen, and I hope that everyone in the Chamber will fight alongside me.