What Is Implicit Bias in Health and Social Care?

Implicit bias refers to automatic attitudes or stereotypes that affect our understanding, actions, and decisions unconsciously. In health and social care, this means thoughts or assumptions about people that happen in the background, without the staff member realising. These biases often go against our declared beliefs and values, yet they still influence the way care is delivered.

Unlike explicit bias, implicit bias is subtle and unintentional. It can be much harder to spot. Someone may strongly believe in providing fair and equal care, but hidden biases can shape behaviour and decisions in small but important ways.

How Does Implicit Bias Form?

Implicit biases start early in life. Family, friends, education, media, and wider culture all play a role. Over time, the brain learns to make automatic connections, such as linking certain jobs with a gender, or associating illness with a particular group. These patterns develop without us choosing them consciously.

The brain uses shortcuts to make quick judgements, especially under stress or when time is limited. This helps us cope with daily life, but it can also lead to unfair treatment in health and social care settings.

Where Implicit Bias Shows Up in Health and Social Care

Implicit bias can slip into every stage of the care process. No-one is immune; it affects health professionals, social workers, care assistants, and support staff alike.

It shows up in:

• First impressions during assessments or appointments
• The language used to describe service users’ symptoms or needs
• Decisions about whose concerns to take seriously
• Choices about which treatments or support options to offer
• Everyday interactions: tone of voice, eye contact, body language

Common examples include:

• Assuming a woman is exaggerating pain and offering less effective pain relief
• Treating people with strong accents as less credible
• Assuming people from deprived backgrounds are less motivated to manage their health
• Not noticing the special needs of disabled service users if disabilities are hidden

Much of the time, staff do not realise this is happening.

How Does Implicit Bias Affect Service Users?

Even when bias is unintentional, the effects can be far-reaching. Unfair treatment, missed diagnoses, poor communication, and lack of trust can all result from implicit bias. Service users may feel invisible, misunderstood, or undervalued, which harms health outcomes and wellbeing.

Impacts often include:

• Delayed or incorrect diagnosis because symptoms are not taken seriously
• Unequal access to treatment or medication
• Less time and patience given to some service users
• Service users feeling unwelcome or judged
• Trust in health and social care professionals reduced
• Reduced willingness to seek help in the future

Over time, patterns of implicit bias can help create and reinforce health inequalities across groups in society.

Recognising Implicit Bias in Ourselves and Others

Explicit bias is easy to spot, but implicit bias is much more difficult. People are often blind to their own hidden beliefs. Recognising it means accepting that everyone has biases of some kind.

Tips for identifying implicit bias:

• Reflect on gut reactions to different people
• Notice who gets more patience, sympathy, or time during busy shifts
• Pay attention to which service users are remembered or forgotten after a long day
• Look at patterns: do certain groups get offered different services or outcomes?
• Be open to feedback from colleagues and service users, even when it feels uncomfortable

Simple tools and exercises can help uncover these hidden biases. For example, the Implicit Association Test (IAT) is used in training to show how quickly people link certain groups with positive or negative concepts.

The Difference Between Implicit and Explicit Bias

Both types of bias affect health and social care but work in different ways:

• Explicit bias is deliberate and conscious. Staff know about these feelings and may even admit to them.
• Implicit bias is automatic and happens without conscious control. Staff may act on these biases without any idea they exist.

Both cause harm, but implicit bias can be more difficult to address because it’s often invisible even to the person affected.

Why Implicit Bias Matters in Health and Social Care

Staff often intend to treat everyone fairly. Implicit bias can quietly undermine these values, leading to systematic disadvantage and worse health for some groups.

Addressing implicit bias means recognising that “good intentions” are not enough. It requires constant reflection and challenge. Even everyday small actions, like listening and responding differently to service users, can cause inequalities to spread.

If left unexamined, implicit bias can contribute to:

• Poorer care for minority groups
• Lower job satisfaction for staff who feel uncomfortable about unfair treatment
• Legal and ethical risks for organisations

Steps to Reduce Implicit Bias

Taking practical steps can help reduce the effects of implicit bias at all levels in health and social care.

Individuals:

• Commit to ongoing self-reflection
• Attend training on unconscious bias and equality
• Ask for honest feedback from staff and service users
• Challenge gut reactions and slow down decisions during assessments
• Use language that reflects respect and avoids stereotypes

Teams and Organisations:

• Build explicit checks into decision making, such as double-checking care plans for fairness
• Monitor data for patterns in access, referrals, and outcomes
• Hold regular discussions about unconscious attitudes and how they influence work
• Create safe spaces for staff to talk openly about their experiences

Formal training sessions, mentoring, and inclusive policies all help raise awareness and gradually change habits.

Legal and Ethical Framework

Implicit bias breaches the same legal and ethical standards as explicit bias, even though it tends to be hidden. The Equality Act 2010 and codes of conduct for health and social care require equality in all parts of service delivery.

Organisations that ignore the impact of implicit bias risk complaints, investigations, and reputation damage. Care workers, nurses, doctors, and social workers are expected to:

• Treat every service user with respect, regardless of background
• Provide equal access to advice, care, and support
• Address and discuss their own biases and blind spots
• Support colleagues to do the same

Not tackling implicit bias can be seen as a failure to meet professional standards.

The Role of Leaders and Managers

Leadership has a strong influence on the way implicit bias is handled. Managers set the tone by:

• Leading discussions about hidden bias
• Modelling respectful behaviour at all times
• Supporting staff to speak out about concerns
• Taking action when patterns suggest bias in care or decisions

They can also support innovation, such as using data, feedback, and service user stories to highlight where inequality exists.

Some practices that help tackle implicit bias:

• Regular training and updates for all staff
• Anonymous complaint procedures
• Seeking feedback from minority, marginalised, or less heard groups
• Reviewing policies to remove unintentional discrimination

Final Thoughts

Fair, person-centred care is at the heart of all good health and social care. Implicit bias chips away at this principle, making it harder for people from all backgrounds to get the support they need. Tackling implicit bias is not “political correctness”—it is about safe, high-quality practice and ethical responsibility.

Staff who reflect on their own habits and keep learning create a better, kinder, more trusted service for everyone.