The recent briefing from the Health Services Safety Investigations Body (HSSIB) and the NHS Race and Health Observatory should make all of us pause and reflect. Its message is simple yet uncomfortably true: bias and discrimination are not separate from patient safety. They are patient safety issues.
For many women and families from racially minoritised communities, inequity is not an abstract concept. It is experienced in moments of vulnerability; when concerns are dismissed, when symptoms are minimised, when communication breaks down, or when families feel excluded from investigations after harm has occurred.
In maternity and women’s healthcare, we already know the consequences of unequal care. Persistent disparities in maternal outcomes for Black and Asian women have been repeatedly highlighted in national reports and inquiries. Yet despite growing awareness, many patients and healthcare professionals still describe experiences where racism, bias, or cultural misunderstanding are either overlooked or considered too difficult to address openly.
The briefing highlighted several recurring themes: the impact of bias and discrimination on patient safety investigations, inconsistent consideration of racism within reviews, tokenistic family involvement, gaps in ethnicity data collection, and organisational cultures that can sometimes prioritise process compliance over meaningful learning. It also reinforced the importance of culturally competent investigation teams, psychological safety for staff raising concerns, and leadership accountability in addressing inequity.
It recognises that patient safety investigations themselves can be affected by bias and discrimination, and that this bias influences how harm is understood, investigated, and learned from.
This matters a lot.
If investigations fail to fully consider the role of inequity, then opportunities for learning are lost. More importantly, trust is lost. Families who already feel unheard may feel retraumatised by processes that appear defensive, impersonal, or lacking cultural understanding.
The briefing highlights several important recommendations, including embedding explicit consideration of racism within investigation standards, improving family involvement, strengthening leadership accountability for equity, and ensuring better use of data to identify inequalities.
It is time we understand that these are not “optional extras” but are fundamental to equitable safer care. Language also matters. Terms like “hard to reach” communities can unintentionally shift responsibility onto patients and families rather than organisations. Often, communities are not hard to reach; healthcare systems have simply not been designed inclusively enough.
As healthcare professionals, many of us entered medicine to advocate for patients and reduce harm. But improving safety requires honesty about the systems we work within. Structural inequities do not disappear simply because intentions are good. We must be willing to ask difficult questions. Yet speaking up is not always easy. Creation of environments where staff feel able to raise concerns, reflect honestly, and contribute to learning is equally important.
Reassuringly, through my own involvement in RCOG committee work, I have seen a genuine commitment to ensuring that diverse perspectives are represented in discussions and decision-making. Conversations about inequalities in women's health, workforce inclusion, cultural competence, and representation are increasingly embedded within college work. While there is always more to do, this visibility matters because it helps create important space for more open, honest, constructive conversations, reflection, and meaningful change across our profession.
For those of us working in women’s health, the challenge is no longer recognising disparities. We know these exist and we have acknowledged them, time and again. The challenge now is having the courage and commitment to ensure that equity is reflected not only in what we say, but in how we investigate, learn, lead, and care.
Author bio:
Dr Erum A Khan is a Consultant Obstetrician and Gynaecologist with specialist interests in high-risk pregnancy, intrapartum care, maternity governance, patient safety, and the medicolegal aspects of maternity care. Alongside her clinical practice, she contributes to national maternity safety and quality improvement initiatives through her work with NHS Resolution, NHS England, and the RCOG. She is passionate about improving outcomes for women through evidence-based care, multidisciplinary collaboration, and continuous learning.
Suggested further reading:
- HSSIB and NHS Race & Health Observatory briefing: Bias and Discrimination in Patient Safety Investigations
- NHS Race & Health Observatory resources on maternal and neonatal equity
- RCOG resources on reducing inequalities in women’s healthcare
- RCOG Race Equity In the Workforce eLearning resource
The RCOG Race Equity program provides practical tools, eLearning modules, and strategic guidance to address racism and promote inclusivity in obstetrics and gynaecology. This programme was developed in recognition that a diverse, inclusive and well-supported workforce is essential to equitable care and ensuring patients feel safe, heart and respected. RCOG offers a free eLearning package hosted on RCOG Learning, with six interactive modules that support O&G professionals to reflect, learn and embed inclusive practices in their everyday work. The modules blend real-world scenarios, interactive learning and guided reflection and discussion tools. The package is designed to empower every member of staff, at every level, to be a part of meaningful change, not just in conversation, but also through action.
Key areas covered:- Psychological Safety at Work: Creating safe spaces where staff feel heard and able to speak up.
- Anti-Racist Leadership: Understanding language and behaviours, setting clear policies, and holding leaders accountable.
- Equitable Teams: Promoting fair recruitment, mentorship, and clear escalation routes.
- Empowerment and Support: Building skills in self-advocacy, negotiation, and conflict resolution.
- Challenging Bias: Recognizing and addressing stereotypes and assumptions in clinical practice.