Warning: Invalid argument supplied for foreach() in /home/nclexion/public_html/wp-content/themes/jnews/class/ContentTag.php on line 47
Institutional racism and bullying at work have meant that nurses from black, Asian and minority ethnic (BAME) backgrounds are “afraid to speak up” about issues that put them at a higher risk of Covid-19, such as inadequate personal protective equipment (PPE), a review has found.
The report released today by Public Health England (PHE) is a follow up to an inquiry it held into the disparities in the risks and outcomes of Covid-19, the findings of which were published earlier this month.
This initial research had revealed that more than 10,000 nurses, midwives and nursing associated had contracted Covid-19 since the start of the pandemic, with rates of infection highest in Asian staff.
However, at the time, the British Medical Association among others questioned why a 69-page section of the report containing recommendations was not included in the original publication.
Today’s report – Beyond the data: Understanding the impact of Covid-19 on BAME groups – outlines observations and concerns of 4,000 stakeholders and puts forward seven points of action to help reduce health inequalities faced by BAME groups in the UK.
Within the report, concerns were raised by stakeholders regarding the “increased risk of exposure to Covid-19 among BAME staff in NHS and social care settings”, and about the high mortality rates of people from these groups.
For example, some said they had experienced first-hand or had been told by colleagues about racism, bullying and harassment at work which meant BAME staff were “reluctant to speak up about issues (such as PPE shortages), which placed them at higher risk”.
“Historic racism and poorer experiences of healthcare or at work may mean that individuals in BAME groups are less likely to seek care when needed or as NHS staff are less likely to speak up when they have concerns about PPE or risk,” the report noted.
Meanwhile, others said BAME frontline workers across health and social care were “sometimes given substandard quality or inadequate PPE given the nature of their roles and the risk of exposure”.
“Numerous examples were given of staff not able to access appropriate PPE to protect themselves adequately in line with national guidance and being afraid to speak up about this,” the report noted.
One stakeholder even said that “requests for risk assessments or additional PPE by BAME workers are more likely to be refused” and added that in some cases “those requests are less likely to be made because of fear of adverse treatment”.
In April, NHS leaders sent out a letter to organisations outlining a series of measures to protect BAME staff in the pandemic including carrying out risk assessments.
However, as part of the report, it recommended that work on the development of “culturally competent” occupational risk assessment tools needed to be accelerated – especially for key workers such as those in health and social care.
Concerns raised in the report come after Carol Cooper, head of equality, diversity and human rights at Birmingham Community Healthcare NHS Trust, told Nursing Times that BAME nurses and healthcare assistants felt they were being picked to work on coronavirus wards more so than their white colleagues.
At the time, Ms Cooper said the outbreak had placed a stark lens on the inequalities faced by BAME nurses and this was echoed today in the PHE report which said the pandemic had “exposed and exacerbated” this issue.
Stakeholders spoken to for the report – including more than 4,000 people with a broad range of interests in BAME group issues – “pointed to racism and discrimination experienced by communities and more specifically by BAME key workers as a root cause affecting health, and exposure risk and disease progression risk”.
“For many BAME groups lack of trust of NHS services and health care treatment resulted in their reluctance to seek care on a timely basis, and late presentation with disease,” the report added.
It stressed that “strategies to create healthy and supportive workplaces (within and outside the health service) that have zero tolerance for discrimination and empower BAME staff to raise concerns about occupational risk and safety are essential”.
Equally as important was work with local communities to “rebuild trust and reduce fear of using health services in the aftermath of Covid-19”, the report noted.
Another observation reported by stakeholders in the report was around emerging evidence which showed poorer outcomes of Covid-19 for people with mental illness.
The PHE document said this issue was “especially compounded for BAME communities for whom problematic access to primary mental healthcare and mental health promotion have been well described”.
“There were concerns that the importance of mental ill health as a risk factor for Covid-19 was not adequately acknowledged and therefore poorly managed, with many missed opportunities for early intervention and support,” it added.
Overall, those involved in the report felt that the disproportionate impact Covid-19 had on BAME groups “presented an opportunity to create fast but sustainable change and mitigate further impact”.
Drawing on findings from stakeholders, PHE listed seven recommendations to be introduced to help better protect people from BAME groups and reduce inequalities.
- Mandate ethnicity data collection and recording across the NHS and social care, including mandatory collection of ethnicity data at death certification
- More research to better understand the social, cultural, structural, economic, religious, and commercial determinants of Covid-19 in BAME communities, and to develop programmes to reduce risk and improve health outcomes
- Improve access, experiences and outcomes of NHS, local government and integrated care system commissioned services for BAME communities
- Accelerate the development of culturally competent occupational risk assessment tools that can be employed in a variety of occupational settings and used to reduce the risk of employee exposure to and acquisition of Covid-19, especially for key workers working with a large cross section of the general public or in contact with those infected with Covid-19
- Fund, develop and implement culturally competent Covid-19 education and prevention campaigns, working in partnership with local BAME and faith communities
- Accelerate efforts to target culturally competent health promotion and disease prevention programmes for non-communicable diseases promoting healthy weight, physical activity, smoking cessation, mental wellbeing and effective management of chronic conditions including diabetes, hypertension and asthma
- Ensure Covid-19 recovery strategies actively reduce inequalities caused by the wider determinants of health to create long term sustainable change
Commenting on the second report from PHE, Unison general secretary Dave Prentis urged the government to “act now” and stressed that “words and promises to do something in the future won’t cut it any longer”.
“More thorough risk assessments, targeted testing and moving vulnerable workers out of reach of the virus are paramount,” he said.
“People will also want to see exactly how structural and institutional racism in all areas of employment, housing, education and every other aspect of life in the UK are to be eradicated.”
Meanwhile, Dr Jennifer Dixon, chief executive at the Health Foundation, welcomed the report and its recommendation of “a properly funded strategy to tackle the wider circumstances in which people live”.
“However, the report makes no specific recommendation on tackling entrenched discrimination and racism,” said Dr Dixon.
“Black and minority ethnic communities speak loudly in this report and say discrimination is among the fundamental causes of ill health. They should be listened to.”
Susan Masters, director of nursing, policy and practice at the Royal College of Nursing, warned: “If UK governments had acted on the advice of previous reviews and reports, BAME nursing staff across the UK would have been better protected going into this pandemic.
“We’ve been calling on employers in all health care settings to take swift and comprehensive action to support and protect BAME staff through targeted risk assessments. These new recommendations show clearly why they must take place to avoid needless loss of life.”
She also called for a cross-governmental strategy and costed action plan to tackle the systemic issues that had resulted in racial health inequalities.
“Much research has already been undertaken in this area, and what the government must do now is act,” added Ms Masters.