Atlantic Slavery and the Royal Infirmary of Edinburgh

In 2023, the NHS Lothian Board agreed to take action after research revealed the Royal Infirmary of Edinburgh has historical links to slavery.

As a healthcare provider and employer NHS Lothian has a duty to stop racism, inequality and discrimination. In 2021, NHS Lothian Charity funded a project to look into the links the Royal Infirmary of Edinburgh had with Atlantic slavery and the legacies of this today.

The ‘legacies’ of slavery can mean many things. The actions taken in Scotland by enslavers or those with financial ties to Atlantic slavery helped to create many key features of life today e.g. corporations, roads, schools, universities and hospitals. The most immediate legacies were for enslaved people and their descendants. Atlantic slavery was central to the underdevelopment of both Africa and the Caribbean and established and sustained racist ideas about Black people which still influence the world we live in today, including inequalities in health.

Public acknowledgement and apology

Speaking at the NHS Lothian Equality and Diversity Conference on 28 February 2024, NHS Lothian Chairman, Professor John Connaghan CBE, said:

“Since the founding of the Royal Infirmary of Edinburgh in 1729 and as Scotland’s oldest voluntary hospital the Royal has a long and distinguished history due in the main to the dedicated staff who have built its reputation over the years.

“However, as an institution dedicated to the care of individuals and with core values of compassion, honesty and integrity NHS Lothian needs to face up to and apologise for the fact that in the early days of this great hospital, wealth to support its activities was drawn from the practice of slavery that we now know was a crime against humanity.

“As we near our third century we recognise and apologise for these historical acts and the impact on all the people who have suffered because of them.

“The knowledge and understanding we have gained from examining the history of the Royal in more depth has reinforced our determination to ensure NHS Lothian is an organisation where all people feel welcome, as staff, patients and visitors and where we strive to achieve equal access to healthcare for all.”

Chair of the Edinburgh Slavery and Colonialism Legacy Review Implementation Group, Irene Mosota, said:

“We welcome the fact that NHS Lothian have committed to anti-racism as an organisation. Alongside the research into the Royal Infirmary of Edinburgh’s historical links with slavery and colonialism this represents a positive step in the right direction. I hope these measures will ensure that NHS Lothian is an organisation where all patients and colleagues are respected, accepted and supported.

“It’s right that as a city we are examining and working through our historical links with slavery and colonialism and what this means in the modern day. We will not shy away from this work.

“I’d encourage other organisations in Edinburgh and beyond to follow NHS Lothian’s example and commit to anti-racism as a central aim.”

Watch this short video for some reflections given during the conference from Professor John Connaghan, Irene Mosota, Calum Campbell (NHS Lothian Chief Executive) and Professor Sir Geoff Palmer (Chancellor of Heriot-Watt University).

Watch the video

Official Report

An official report was published in February 2024.

Slavery, the Royal Infirmary of Edinburgh and the legacies that remain today

Read the report

Research Project

The research confirmed that some people who donated money to the hospital in the eighteenth and nineteenth centuries were enslavers or benefitted financially from enslavement.

The research also showed that the hospital made money from renting out an estate, and the enslaved people who lived there, in Jamaica called Red Hill Pen. The estate was left to the hospital in the will of a Scottish surgeon in 1750 and the hospital owned and rented out this estate and the enslaved people (and, after the abolition of slavery, ‘apprentice’ labourers) for over 143 years.

The hospital received what would be equivalent to around £39 million from these donations and the income from Red Hill Pen and used the money to pay for doctors, fund a new hospital building and buy medicines.

We recorded the findings in a public research report – Uncovering Origins of Hospital Philanthropy: Report on Slavery and the Royal Infirmary of Edinburgh (PDF).

The recorded names of the enslaved people of African descent on Red Hill Pen.

Public Conversations

We ran ‘conversation events’ with nearly 200 people to help us understand the research and how it relates to life today. Six themes emerged from these events – acknowledgment and apology, commemoration, education, further research, reform and partnerships.

We recorded the results in a public consultation report (PDF).

Learning from Others

We commissioned expert advice and learned from other organisations taking steps to acknowledge their connections with slavery including the City of Edinburgh Council, Museums and Galleries Scotland and University of Glasgow.

Recommendations and Actions

The NHS Lothian Board agreed to seven recommendations to understand and acknowledge this part of its past and take action to stop modern day racism and discrimination and contribute towards improvements in health and work outcomes for the people we serve and employ.

• Publicly acknowledge and apologise
We will issue a public apology and acknowledgement that the history of the Royal Infirmary of Edinburgh and the wider history of Atlantic slavery explains much about racism and why Scotland looks how it does today.

• Establish an Implementation Group and Chair
We will establish a group to advise on and steer the delivery of the recommendations. The group will include representatives from NHS Lothian Board, the BME staff network and the local community.

• Tackle racial inequalities in employment and health
We will ensure we have a diverse and inclusive workforce with staff who challenge racism. We will learn from experts, including people with lived experience to understand the impact of discrimination and other factors on racial health inequalities and take action.

• Commission commemorative works and review current arts and culture activities
We will install a commemorative plaque at the Royal Infirmary of Edinburgh, respecting the people who suffered the horrors of Atlantic slavery. We will review our artwork and, if there is a link to slavery, we will add information about this. We will commission new artwork to represent people who fought against Atlantic slavery and that represents our diverse communities.

• Educate people about our history and legacies of slavery
The hospital’s connections with slavery will be included in training for all NHS Lothian staff and shared with local groups. This will empower staff to develop an understanding of their own values, beliefs, and cultures and those of other staff and patients. It will help staff understand and challenge racism.

• Partner with Jamaica and West African countries
We will explore how to work in partnership with health centres, hospitals and centres for medical research in Jamaica and West Africa for the benefit of people living there and in Scotland. We will follow the Scottish Code of Practice for International Recruitment of Health and Social Care Personnel and respect the need to protect the healthcare systems of lower income countries.

• Undertake further research
We will do more research into the connections between other NHS Lothian hospitals and slavery and into the lives of the enslaved women on Red Hill Pen. We will explore partnerships to allow further research on medicine, slavery and colonialism, and the impact of British medicine on enslavement.

Timeline

Slavery and the colonial period that followed it has established and sustained racist ideas about Black people which still influence the world we live in today. The timeline below charts the history of the Royal Infirmary of Edinburgh alongside some key dates relating to the racial inequalities we see today, in all aspects of life, including health.

1655
1661
1726
1729
1736
1749
1807
1833
1834
1869
1879
1892
1948
1962
1989
1999
2001
2003
2010
2015
2019
June 2020
September 2020
September 2020
2021
December 2022

Jamaica becomes an English colony.

Barbados passes an influential ‘slave code’. It defines enslaved people as chattel property, describes Africans as ‘heathenish and brutish’, and sanctions extreme violence against enslaved people by enslavers.

University of Edinburgh Medical School is established.

Royal College of Physicians appeal for funds from donors for ‘Hospital for the poor’. The Royal Infirmary of Edinburgh is founded.

King George II grants the Hospital a Royal Charter, naming it as the Royal Infirmary of Edinburgh. It moves to new building, funded by donors.

The hospital is left a 420 acre estate in Jamaica called Red Hill Pen. This includes the land and the slaves living on it.

Passage of the Act for the Abolition of the Slave Trade, making trafficking in enslaved Africans illegal in British ships.

Passage of the Abolition of Slavery Act. The Act comes into effect in 1834, although many colonised people continue to be exploited as apprenticed labourers until 1838.

The hospital receives compensation for the loss of labour of the enslaved people they owned on Red Hill Pen.

Joseph Lister (known as the ‘father of modern surgery’ and invented antiseptic surgery) appointed as Head of Surgery at the Royal Infirmary.

The Royal Infirmary moves to a new location in Lauriston Place, funded by Council and donors.

The Royal Infirmary sells Red Hill Pen.

The Royal Infirmary becomes part of our National Health Service. The hospital is funded and run by the newly formed NHS.

Jamaica achieves independence from the United Kingdom.

Lothian Black Forum leads the campaign to recognise the murder of Axmed Abuukar Sheekh as racially motivated. Axmed Abuukar Sheekh was a Somalian student who was killed by white Scottish fascists on Edinburgh’s cowgate in January 1989.

Sir William Macpherson labels the Metropolitan Police as ‘institutionally racist’ in his report setting out the findings of the public inquiry into the investigation of the murder of Stephen Lawrence.

The Race Equality Duty comes into force, introducing a positive duty on public bodies to eliminate unlawful race discrimination, promote race equality and good relations between people of different racial groups.

The new Royal Infirmary opens at Little France, funded by the NHS.

The Equality Act 2010 comes into force, harmonising and strengthening equality law in Britain. It includes the public sector equality duty, which requires public bodies, and those carrying out public functions, to have due regard to the need to eliminate unlawful discrimination, promote equality of opportunity and foster good relations when they are carrying out their work.

Sheku Bayoh, a 31-year-old Black man born in Sierra Leone, dies after being restrained by police officers in Kirkcaldy, Scotland. A public inquiry into his death was announced in 2019, with terms of reference published in 2020 and evidential hearings beginning in May 2022. The inquiry includes establishing the extent to which the events leading up to and following Mr Bayoh’s death were affected by his actual or perceived race.

NHS Lothian BME Staff Network is established to provide BME staff with a safe and confidential and supportive space, peer support, and to raise awareness of BME issues and increase the visibility of BME staff.

Public demonstrations in support of the Black Lives Matter movement occur across the world, including in Edinburgh, after the murder of George Floyd.

Growing evidence emerges of the disproportionate impact of COVID-19 on ethnically diverse communities. The Scottish Government responds by establishing an Expert Reference Group to make recommendations on data, evidence and systemic health and socio-economic inequalities facing minority ethnic communities.

NHS Lothian establishes an Independent Advisory Group to inform its work examining the history, legacy and impact of historical ties Atlantic slavery.

8.3 per cent of Edinburgh’s population identifies as a non-white ethnic group. Around 5.9 per cent of the NHS Lothian workforce identifies as being from a BME background.

NHS Lothian publishes the research report, Uncovering Origins of Hospital Philanthropy: Report on Slavery and the Royal Infirmary of Edinburgh.

FAQs

NHS Lothian and NHS Lothian Charity are joint descendants of the legacies of donations and endowments connected to the Royal Infirmary of Edinburgh and the enslavement of people of African descent.

Whilst slavery and colonialism may seem like something that happened a long time ago, and not within our lifetime, the legacy of colonial attitudes, structures and practices continue to have a negative impact on health today, and contribute to ongoing inequality in health outcomes.

As the official charity of NHS Lothian, we work in strategic partnership to take actions that contribute to a healthcare system that tackles inequality, discrimination and racism, and improves health outcomes for all our communities.

This work supports our charitable objective of ‘the advancement of health’, helping to shape a positive future for all by removing the health inequalities that persist today.

The reparations outlined in the recommendations do benefit patients, and those who care for them.

The recommendations seek to address the legacy of slavery and its impact on our diverse communities today. Working in strategic partnership with NHS Lothian, we will support projects that tackle racial inequality and racism and contribute to a health and care system where everyone in Lothian lives longer, healthier lives.

Not all reparations are claims for single, one-off payments. Reparations may also cover other forms of social justice such as, programmes of positive action, cultural projects, and public apologies.

No. Donations that have been given for specific purposes are restricted to those purposes. The Charity has a number of funding streams to support the wide range of projects that help us achieve all of our strategic aims, including tackling health inequality.

Slavery and colonialism established and sustained racist ideas about Black people which still influence the world we live in today, manifested in Britain by the racial discrimination and inequalities we see in all aspects of life, including health.

This project in no way detracts from the work that NHS Lothian continues to do to provide care and support for all of its patients and the wider community. If NHS Lothian is meet its goal that everyone in Lothian has longer and healthier lives because of the care and treatment provided, then it must understand the inequalities that persist in the communities it serves.

Everyone should be treated with dignity and respect and valued for who they are and what they do. There is no room for racism and prejudice in NHS Lothian, there is too much important work to do.

In 2020, the NHS Lothian Equality and Human Rights Team became aware of information about the potential historical links between NHS Lothian and Atlantic slavery. This was at the same time as evidence was emerging showing that people from Black and Minority Ethnic (BME) backgrounds were being disproportionately affected by COVID-19 and the global profile of the Black Lives Matter movement was bringing broader race equality issues into sharper focus in the UK, along with the shocking murder of George Floyd.

How does this history affect us today?

The slavery period and the early history of the Royal Infirmary of Edinburgh may seem like a long time ago, but they are closer than we think. The Royal Infirmary, for example, only sold its Jamaican property in 1893 – possibly around the time your grandparents or great-grandparents were born.

The ‘legacy’ of slavery can mean many things. The actions taken in Britain by enslavers or those with financial ties to slavery created vast material legacies (e.g. corporations, roads, schools, universities and hospitals). Many developments that we think of as key features of modern British history were connected to slavery-associated money. This has continued to impact British society long after the abolition of slavery.

The legacy of colonial attitudes, structures and practices continue to have a negative impact on health today, and contribute to ongoing inequality in health outcomes.

Yes. Like elsewhere in Britain, across Scotland slavery-associated wealth was embedded into the country’s economy and landscape. University College London’s Legacies of British Slavery Database, and the Slave Voyages Consortium’s Trans-Atlantic Slave Trade Database, amongst other sources, help us to understand the scale of Britain’s connections to slavery.

Many other organisations are investigating their connections to slavery. Some examples include:

Glossary

Abolition: In this context, the legal prohibition of slave-trade and -ownership. An abolitionist was someone who campaigned for abolition.
Anti-racist: Taking action to oppose racism and promote racial equality
BME: BME stands for Black and Minority Ethnic Communities and is the designation agreed and used by the Independent Advisory Group for this project
Chattel Slavery: A specific type of servitude that legally defined and treated African people as sub-human and moveable property who could be purchased, sold, loaned, mortgaged, used as collateral, and inherited.
Colonialism: A practice where a powerful country directly controls a less powerful country or territory (the “colony”) and uses the colony’s resources to increase their own power and wealth. Colonisers impose elements of their culture, including religion, language, economics, and other cultural practices, on those they rule. Colonialism is an expression of power that relies on oppression, extraction of resources and silencing other ways of being and knowing.
Enslaver: Someone who enslaved another human being: this term is preferred rather than slave owner, slave holder, slave master/mistress, as it affirms that slavery was forced upon people.
Enslaved person: A more humane way of describing someone who was legally owned by another person. What in the past has historically been called ‘a slave’.
Indentured labourer: A person who is contracted to work for a specific number of years without the option of terminating the contract. This system of bonded labour was revived in the British Empire in the period of the abolition of slavery. Indentured labourers were recruited to work on sugar, cotton and tea plantations, and rail construction projects in British and other European colonies in the Caribbean, Africa and South East Asia.
West Indies: A term used during the era of European colonisation that referred to colonies in the Caribbean.