What Is Explicit Bias in Health and Social Care?

Explicit bias describes attitudes or beliefs that someone holds and expresses openly. In health and social care, this means conscious thoughts or feelings about certain groups of people, such as those related to race, gender, age, disability, or social class. Staff members often know that they have these views, and these biases can directly shape decision-making and behaviour towards service users.

Explicit bias is different from unconscious bias, which operates outside of awareness. Here, we are focusing on what happens when assumptions, beliefs, or prejudices are clear, deliberate, and expressed through words or actions.

How Does Explicit Bias Develop?

Personal experiences, upbringing, education, and culture all contribute to explicit bias. People may form opinions early in life that stay with them for years. These ideas are then reinforced by stories, traditions, or shared views in a community.

In health and social care, stereotypes can take root in training, media messages, or repeated patterns from colleagues. For example, a care worker might knowingly believe that older people are always frail, or that younger men are prone to violence. These beliefs can then affect the way service users are supported.

People can recognise explicit bias within themselves, and sometimes people will defend their views as normal or justified, rather than seeing them as prejudice.

Where Explicit Bias Shows Up in Health and Social Care

You will find explicit bias in many settings, such as:

• GP surgeries and hospitals
• Care homes
• Community support teams
• Social work offices

At individual or team level, bias can be expressed through:

• Comments and jokes about a person’s race, age, gender, or background
• Putting certain service users at the bottom of a waiting list
• Prescribing different treatments for two people with the same health need
• Using rude language or refusing to listen to service users

These actions may be deliberate or justified by the staff member, but the impact is always harmful and unfair.

Examples in Real Life

Some explicit biases sometimes found in health and social care workplaces include:

• A nurse refusing to treat a patient from a different ethnic background
• A care worker believing people with learning disabilities should not have children and expressing this to clients
• Staff making jokes about someone’s religion or appearance during a handover
• Social workers believing women are always better natural parents, and letting this shape family interventions

How Does Explicit Bias Affect Service Users?

Explicit bias causes harm in practical and emotional ways. People may receive poorer quality care and feel excluded or distrusted. Trust in professionals drops, and health outcomes suffer in the long run.

Impacts felt by service users include:

• Being denied services or treatments given to others
• Feeling unsafe or unwelcome in care settings
• Anxiety, distress, or reduced self-esteem
• Reluctance to seek future support, which means health problems go untreated
• Worse health outcomes compared to others

Some of these impacts are long lasting. For example, groups who are openly discriminated against may avoid using services, which then makes health problems much harder to manage.

Recognising Explicit Bias in Ourselves and Others

Recognising explicit bias is the first step to reducing its impact. This can take courage and self-reflection. Staff members can notice bias by:

• Listening to the language they use about groups of people
• Noticing patterns where certain service users get less attention or respect
• Reflecting on which groups tend to get blamed for problems
• Being open to feedback from colleagues and service users

Training sessions often help staff become more aware of how their words and actions affect others. Peer supervision and discussion can also bring hidden assumptions into the open.

The Difference Between Explicit and Implicit Bias

Both explicit and implicit bias shape health and social care, but they work in different ways.

• Explicit bias means staff are aware of their attitudes and express them deliberately.
• Implicit bias covers the habits, instincts, or feelings that people are not aware of, but which still come out in their actions or decisions.

Often, explicit bias has a clearer link to direct discrimination, like refusing to treat someone or using offensive language.

Tackling Explicit Bias

Managers and organisations have a duty to prevent explicit bias. This is a question of both ethics and law. Steps used to tackle it include:

• Clear policies: Having and enforcing rules against discrimination and prejudice
• Reporting systems: Making it safe and simple for staff and service users to report problems
• Education and training: Offering regular sessions focused on equality, diversity, and how bias affects care
• Supervision and support: Encouraging honest discussion about staff attitudes and experiences
• Strong leadership: Modelling respect, fairness, and zero tolerance for explicit bias

Staff also have a personal role in checking their own beliefs and stopping themselves from acting on prejudices. Sometimes, strong feelings can show up during stress or conflict. It’s important to step back and challenge these.

Legal and Ethical Standards

Legal duties in the UK cover all aspects of equality in health and social care. The Equality Act 2010 makes explicit bias illegal in the workplace, meaning staff cannot refuse services or treat people differently based on personal traits. This covers:

• Age
• Disability
• Gender reassignment
• Marriage and civil partnership
• Pregnancy and maternity
• Race
• Religion or belief
• Sex
• Sexual orientation

Breaking these laws leads to disciplinary action, legal cases, and loss of reputation for staff and organisations.

Respect for equality is written into codes of conduct for every health and social care profession. This means:

• Delivering care without discrimination
• Listening to every service user
• Speaking up when witnessing bias in colleagues

Failing to meet these standards breaks professional codes and can lead to penalties, including losing the right to practise.

Why Health and Social Care Must Tackle Explicit Bias

Every person has the right to fair and compassionate care. Open prejudice or deliberate refusal of services creates lasting harm and widens health inequalities in the UK.

Staff may sometimes excuse explicit bias by saying it is just personal opinion. This is never justified in a public service role. Prejudice leads directly to injustice, and every staff member has a duty to put care, respect, and fairness first.

Some reasons why tackling explicit bias matters include:

• Public confidence in the health and social care system depends on trust and fairness.
• Discrimination reduces quality of life, health, and life expectancy.
• Prejudice against one group can soon affect others.
• Clear standards protect both service users and staff.

Steps Staff Can Take

Every person working in health and social care can keep explicit bias out of their practice. Actions to take include:

• Actively welcoming service users from every background
• Challenging negative talk or stereotypes in the workplace
• Reporting open discrimination through proper channels
• Using neutral and sensitive language at all times
• Reflecting on one’s own views and seeking feedback

In team meetings or training, staff can:

• Raise issues about bias openly
• Support colleagues who challenge prejudice
• Vote for policies that support equality

Sometimes people fear speaking up about bias, perhaps out of worry about conflict. Senior staff have a duty to give support and back team members who stand up for fairness.

Final Thoughts

Explicit bias in health and social care refers to clear, open attitudes or actions that discriminate against certain groups. These can affect every part of the system, causing harm to individuals and to public trust in services. The effects range from unequal treatment to emotional distress and poorer health outcomes.

Tackling explicit bias requires action from individuals, teams, and organisations. Laws, professional codes of practice, and strong leadership all support an environment where respect and equality are at the centre of care. Staff who work with honesty, reflection, and a commitment to fairness make a safer and more caring service for everyone.