Sometimes two or more events or sets of circumstances come together to create a spark, a spark that spreads to stimulate a reaction that is much wider than each of the individual events or anticipated sum thereof – the so-called perfect storm.
The disproportionate effect of Covid-19 on the lives of those from black, asian and minority ethnic backgrounds (BAME) has shone a light on the increased risks of deprivation and medical co-morbidities in these groups. It has also identified the important role the BAME population plays as public facing key workers which has added to their risk during this pandemic. A black male is more than four times more likely to die from Covid-19 than his white counterpart and the vast majority of British doctors who died from this disease were from BAME backgrounds. This has not gone unnoticed but the reasons for, and actions to be taken to address this, remain undetermined.
The killing of George Floyd with the protests that followed have stimulated not only anger and frustration across the world but also have prompted stories from colleagues of overt and covert racism observed, not only within our society, but also within the NHS – expressing situations where both staff and patients have been affected. Their disturbing experiences of racism here in the UK emphasise what we already know – racial inequalities are evident within the largest organisation in Britain, the NHS.
The awareness of differential attainment, slower career progression and more disciplinary procedures affecting those from BAME backgrounds align with the dearth of numbers to reach senior, leadership positions within healthcare. The Workforce Race Equality Standard (WRES) was mandated in 2015/16 as part of an agreed action to ensure that BAME employees have equal access to career opportunities and receive fair treatment in the NHS workplace. WRES reports have identified some improvements since then, but these are slow and tend to demonstrate a trend rather than significant change. The next phase is to promote a change in the cultural and systematic race inequalities that are evident. In addition, Medical WRES (MWRES) is being added to embed the appropriate indicators and data collection for the medical workforce which were previously lacking.
As we start to recover from the Covid-19 pandemic and recognise both the issues this has highlighted and the opportunities this presents it is a key time to respond and act. The creation of the NHS Race and Health Observatory to identify specific health challenges facing those from BAME backgrounds – aiming to offer policy recommendations to tackle these inequalities for communities, patients and NHS staff is welcome and timely.
From a population perspective, recognition of any potential increase in inequalities regarding access to, or outcomes from, health services deserve particular attention at this time. The Academy has emphasised that health inequalities are given high priority in the Covid aftermath, of which the known effects of race is one. But this is not a new problem, in fact it was exactly a year ago that we drew attention to the racial disparity in the way patients from BAME communities are less likely to report shortcomings in the care they receive.
Regarding the workforce, race should be considered part of staff risk assessment in the light of endemic Covid; and more generally this should be viewed as an opportunity to push for further action to transparently improve equality. This now has policy backing but it is also firmly the responsibility of each staff member to address racism individually and to call out poor behaviours in others.
© 2020 Academy of Medical Royal Colleges.