In April I voiced my concerns regarding the disproportionate deaths amongst BAME communities, secondary to Covid-19. Two months on, and I have continued to see the death toll rise. Approximately 60 per cent of healthcare worker deaths and over 90 per cent of all doctors dying are BAME individuals.
I, like many British-born doctors from an ethnic minority background, whilst sadly unsurprised have witnessed very little in the way of an adequate response. The government’s momentum towards instigating an inquiry was, like much of its approach to the pandemic so far, sluggish and sloppy. For one thing, why did it take so long before an inquiry was launched from when the initial figures were released? Why was a controversial decision made to appoint Trevor Phillips to the taskforce? This hardly inspired confidence, not to mention conducting the inquiry behind closed doors as well as delaying publication due to ‘worries’ around ‘current global events’, which has added fuel to the fire.
The report itself has not actually told us anything we didn’t already know. It is a mere regurgitation of statistical analyses with no conclusive plan to address the disproportionate deaths. The limitations in the research presented are significant. Inadequate data recording on patients with Covid-19 including ethnicity was highlighted as a challenge prior to the inquiry, and described as a ‘scandal’ by the Chair of the Council of the British Medical Association (BMA). How many patients were excluded from the final results because of gaps in the data?
Moreover, anyone who has every worked in the NHS will be all too aware that IT systems are not uniform or inter-linked across trusts, and many haven’t even made the transition to electronic documentation systems. I accept that CHESS (Covid-19 hospitalisation in England surveillance systems) has provided an element of consistency, but disparities and input of patient details between units have been acknowledged as shortcomings, not to mention the research being incapable of capturing the effect of key factors such as co-morbidities, obesity and occupation.
To obtain the high quality comprehensive data we need would have required close collaboration and co-ordination at a national and local level in the NHS and within communities, necessitating the mobilisation of additional staff, dedicated resources and training. This hasn’t happened, and whilst a colossal task is not impossible (a chunk of Rishi Sunak’s ‘unlimited funding’ here would not have gone amiss), this is a prime example of poor planning. Conversations revolving around the relationship between ethnicity and risk from Covid-19 have at the best of times been simplistic, lumping all ethnic minority groups into one homogenous pool under the umbrella ‘BAME’. As someone who is very accustomed to ticking the ‘other’, ‘please specify’ ethnicity on equality and diversity forms, I can’t help but question the categorisation of ethnicity. The options we have to choose from have often been cited as a muddle conflating ethnicity, race, country of origin, skin colour, and social constructs.
How useful is this really in pinpointing underlying reasons for higher death rates in certain populations? How much weight can we really place on the inquiry results stating that those of Bangladeshi origin are at the highest risk of all? There was an opportunity here to develop more robust, insightful tools with longer-term benefit which was squandered. This leaves the impression that the inquiry served as a snapshot appeasement, rather than the beginnings of a prospective study committed to uncovering solutions.
What stands out as hugely disappointing is the absence of scrutiny on the increased mortality rate amidst BAME healthcare workers. The reasons cited as causes for disproportionate deaths such as living in urban areas, overcrowded households, deprivation, being born abroad with subsequent language barriers etc., cannot be extrapolated to medical healthcare workers. Blatant disregard to examine this further despite escalating alarm and heeds from medical bodies adds to an already mounting case of negligence.
What is equally worrying is that there hasn’t been any tangible, real-time impact within NHS environments. I have observed profound variations in responses, if any response at all. I have no doubt that underlying causes are likely to be multi-factorial and complex, but that does not justify being idol. Why is it that I see one hospital trust aiming to remove all BAME staff from frontline positions, yet I have many colleagues elsewhere in high-risk settings who still haven’t so much as undergone a risk assessment? Not to mention my colleagues without adequate PPE who are still hesitant to speak up, and those that have been accused of ‘victimhood’?
A few weeks ago I talked about inequalities within NHS culture that may possibly play a role in the disproportionate deaths amongst healthcare workers. A recent study by the BMA did indeed highlight that 64 per cent of BAME doctors have felt pressured to work in settings without sufficient PPE, in contrast to 33 per cent of those who identified as white. This reiterates previous BMA and GMC research showing that BAMEdoctors are much less likely to raise safety issues for fear of recriminations.
But what support has been offered as a consequence? What open dialogue have we had with staff? HR sending out a batch of emails addressed: ‘Dear BAME colleague …’ doesn’t cut the mustard. For the few trusts that have acted and taken initiative independently, whilst welcomed, this is an issue in itself reflective of a lack of communication and leadership from the highest level. But is it also reflective of issues within the infrastructure of the NHS? Whilst ethnic minorities may constitute over 40 per cent of medical staff, they comprise less than 8 per cent of senior managerial roles. With that in mind, is it any wonder that there has been such a poor reaction overall? This is all the more unsettling when confronted with the fact that there are just as many unanswered questions now as there were eight weeks ago, and no strategy towards a resolution.
As lockdown measures ease, the sense of impotency, low morale and fury amongst many of my BAME colleagues rises. We collectively need to persist with demands for a representative public inquiry. We need to demand accountability and consistent, widespread guidance with rapid movement towards interventions in the workplace with targeted studies examining inequalities within clinical and managerial environments. For though Matt Hancock ‘values the contribution’ we make, this government has failed BAME healthcare workers and I fear it will continue to do so if service provision remains a priority over safety.
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