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A new Covid-19 assessment tool that has been introduced in Wales does not identify black, Asian and minority ethnic nurses as at sufficiently high risk, according to the Royal College of Nursing.
The RCN warned that it also failed to always identify nursing staff with diabetes as at higher enough risk from infection with coronavirus, including those with the condition from a BAME background.
“The tool does not always identify those workers from BAME backgrounds or with type 1 diabetes as being at a very high risk”
The All-Wales Covid-19 Workforce Risk Assessment Tool was introduced last week by the Welsh Government to help identify health and care staff who might be at greater risk from coronavirus.
Its development forms part of wider work by an expert advisory group, which was tasked by ministers to “accelerate work on a risk assessment tool for the health and social care workforce”.
The self-assessment tool uses a two-step process involving a scoring matrix that allocates points for individual risk factors and a second part that takes into account the setting that staff work in.
For example, points are given by the tool for different ages, genders and ethnicities, as well as health factors linked like obesity, family history and existing conditions.
Staff can then hold a “supportive and structured conversation” with their line manager to discuss their level of risk and put in place actions to ensure they are “protected as far as possible”.
“These may include additional protection, changing working practices or working from home,” said the Welsh Government.
The creation of the assessment tool follows emerging evidence on different risk factors for infection with coronavirus and the subsequent severity of Covid-19, including death.
Studies have indicated that older age, male gender, diabetes and being from a BAME background are all important risk factors for infection and severity of Covid-19.
The advisory group that designed the risk assessment tool is also carrying out an “urgent investigation” to understand the reasons why BAME communities are at higher risk from Covid-19.
This work is linked to a wider review being carried out by Public Health England and NHS England, the findings of which are expected to be published imminently.
Launching the tool, Welsh first minister Mark Drakeford said: “The emerging evidence suggests people from BAME backgrounds are being disproportionately affected by the coronavirus pandemic.
“This is of significant concern, particularly as people from these communities make such a significant contribution to our NHS and care services.
“I want to thank the advisory group for their work on this risk assessment. It has been developed in a short space of time and will be made available throughout the NHS and social care.
“Its use will be monitored and reviewed so we can continue to learn and take all measures to protect those who are working so hard to support and care for others,” said Mr Drakeford in a statement.
RCN Wales, while welcoming the idea behind the tool, criticised its reliance on a scoring matrix and called for a more “holistic” approach that more strongly recognised BAME background and diabetes.
Nicky Hughes, associate director of nursing (employment relations) at RCN Wales, said: “It’s really important that our hard-working healthcare staff are fully protected.
“The All-Wales Covid-19 Workforce Risk Assessment Tool, designed for employers to work through with their staff, is an excellent idea,” she said.
“RCN Wales asked for this tool to help support and protect nurses and health care support workers who may come into contact with the virus.
“However, the tool does not always identify those workers from BAME backgrounds and/or with type 1 diabetes as being at a very high risk due to the scoring matrix.
“We would advocate that a holistic assessment is made and that the scoring is one element of that,” warned Ms Hughes.
“The two-stage risk assessment will be monitored and reviewed as the evidence base builds”
She added: “We need the Welsh Government to work with us and the British Medical Association to make sure we get this right, but also to continue to review it frequently to ensure it reflects current evidence and the experiences of those staff using it”.
In response to the concerns raised by the RCN, a Welsh Government spokesperson said: “Safeguarding our health and social care workforce is our key priority.
“We launched a national risk assessment tool, developed by the expert advisory group set up by the first minister to look at the reasons why people from BAME communities are being disproportionately affected by coronavirus.
“The two-stage risk assessment will be monitored and reviewed as the evidence base builds,” said the spokesperson.
“We would like to work with RCN Wales to discuss how the tool works in practice, to enable it to make an informed judgement about its use.”