COVID-19: how can we protect BAME nurses during the crisis?
The pandemic has disproportionately affected BAME people and the NHS has been slow to react
- Black and minority ethnic (BAME) people are more likely to die of COVID-19 than their white counterparts and the pandemic has highlighted workforce inequalities.
- Nurse recruits from overseas report being asked to work on COVID-19 wards without extra training or risk assessment and often feel unable to say no
- What your employer should do to protect BAME staff
Working in the NHS during the COVID-19 pandemic has left Filipino nurse Angelica (not her real name) feeling stressed; she has had anxiety attacks and insomnia.
Angelica says she has been working in COVID-19 areas alongside black and minority ethnic (BAME) colleagues who shouldn’t be there as they have health conditions that put them at higher risk of complications from the disease.
New recruits from overseas are being put on COVID-19 wards without relevant training
She says she has also witnessed high-risk areas being staffed by nurses recently recruited from overseas.
‘I see how Filipino and Indian nurses are being put on these rotas,’ she says. ‘When nurses are newly recruited from overseas they don’t feel able to say no, even if they don’t have the relevant training. Even I don’t feel able to say no. But I don’t know why it is happening when there are more senior British nurses who could go in there. It must be discrimination.’
1 in 5
nurses and midwives in England are from a BAME background
Death rates for BAME staff are considerably higher than for their white counterparts
While figures vary on how many NHS and social care staff have died, it is clear that BAME staff are dying at a higher rate than their white colleagues.
One analysis at the end of April by three clinicians found that of the 106 NHS staff who had died and whose details could be verified, 63% were from a BAME background. The study noted that BAME staff account for about 21% of the NHS workforce.
When it came to the 35 nurses and midwives who were included in the study, 71% were from a BAME background, whereas 20% of the nursing and midwifery workforce is from a BAME background.
From the 19 deaths among doctors and dentists, 94% were BAME, more than double the BAME representation in that sector of the workforce.
Black people almost twice as likely as white people to die from COVID-19
The disparity between white and BAME deaths has not just been seen among NHS staff. An Office for National Statistics report published in early May said people from all minority ethnic groups, apart from those in Chinese and mixed groups, are at greater risk of a coronavirus-related death than the white population in England and Wales.
In particular, black men and women are nearly twice as likely to die from COVID-19 as white people with a similar demographic profile.
The government has announced a rapid review that will look into what puts people at higher risk of serious illness caused by the coronavirus, including ethnic group.
This analysis will include a focus on NHS staff, initially nurses and doctors, to develop a better understanding of how the virus affects the front-line workforce.
Labour party launches own review into the impact of the pandemic on BAME communities
Health and social care secretary Matt Hancock said: ‘Every death from this virus is a tragedy and behind each statistic is a name, a loss and a family that will never be the same again. The more we know about this virus and its impact, the more we will be able to protect lives and limit the spread.’
There were calls in May for a public enquiry into COVID-19 deaths among BAME people and the Labour Party has already announced its own review into the impact of the virus on BAME communities.
But many people in the NHS workforce are asking why more was not done earlier.
Delayed response to the higher risks posed to BAME staff has cost lives
Roger Kline, research fellow at Middlesex University London and a leading expert on NHS workforce and diversity, says that previous research has shown that people from BAME backgrounds suffer disproportionately during influenza pandemics.
He says that this means before COVID-19 reached the UK earlier this year, the government and the NHS should have been considering who was going to be at higher risk.
NHS employers should also have had a risk assessment of staff to see who may be adversely affected.
‘This should have been happening in March and it is only now starting to happen,’ says Mr Kline. ‘People have died who almost certainly shouldn’t have died.’
These could have picked up some of the factors that put people from BAME backgrounds at higher risk, which could then have been mitigated, Mr Kline says.
Risk assessment and protection of BAME staff is vital
Filipino Nurses Association UK officer Francis Fernando, who is deputy head of care of a private care home in London, agrees that the lack of statutory risk assessment that should have been carried out as part of the Management of Health and Safety at Work Act and equality legislation has been a key factor in putting people in danger.
He says that many Filipino staff who have died should have been shielded due to health conditions and not working in the first place.
Moves taken by one Somerset trust, which has placed all BAME staff in the more vulnerable group, are very positive, he says. He urges other trusts to follow this example.
Meanwhile, the Philippines' ambassador to the UK has called for key workers to be 'properly protected'.
By 16 May, the PA news agency had verified the deaths of 173 frontline health and care workers with COVID-19.
Of those, 23 - approximately 13% - were of Filipino heritage.
In a message to PA following the deaths, ambassador Antonio Lagdameo said: 'I urge the NHS to ensure that those heroes who put their lives on the line for all of us are properly protected and equipped as they do their job.'
‘Your well-being is very important’: how one trust is protecting its BAME staff
All BAME staff at a Somerset trust have been placed in the vulnerable and at-risk group.
Senior leaders at the Somerset NHS Foundation Trust said this was to offer BAME staff extra protection to ensure they feel ‘safe and protected’ during the pandemic.
A letter to staff said managers would have conversations with all BAME colleagues as they would with everyone in the vulnerable group.
BAME staff have been given priority fit testing or protective masks
The risk assessment has been updated and BAME staff would be given priority for COVID-19 tests and fit testing for FFP3 masks.
‘We encourage you to feel confident discussing any concerns you may have about COVID-19 and the impact on you and your family with your managers,’ the letter, signed by the trust's chief executive Peter Lewis, states. ‘Your well-being is very important.’
BAME network lead at the trust Sunny Sander-Jackson said BAME colleagues have ‘told me that they have felt very supported during this difficult time and that the letter had a real impact in helping to lift their morale.’
Trusts told to assess risk for BAME staff
At the end of April, NHS England wrote to trusts saying that BAME staff should be risk assessed.
of 106 NHS staff who died of COVID-19 included in an analysis in April 2020 were from a BAME background
Source: Health Service Journal
The letter urged health trusts to make ‘appropriate arrangements’, which could include moving those from BAME backgrounds away from the front line to roles with no direct contact with patients.
NHS Employers published updated guidance to help employers do this, which said managers should be carrying out one-to-one conversations with staff.
Among the risk factors is that BAME people have significantly higher rates of long-term health conditions that could put them at greater risk of becoming seriously unwell from COVID-19.
Prevalence of long-term conditions may contribute to the impact of the virus
The Race Equality Foundation says African Caribbean people have a higher prevalence of high blood pressure, and South Asian people have higher rates of coronary heart disease and are up six times more likely to have type 2 diabetes. Some ethnic groups are more likely to have sickle cell disease, which is one of the conditions identified by the NHS as being at highest risk of mortality relating to COVID-19.
Another potential risk is that BAME staff are disproportionately represented among front-line health and social care staff on lower grades, Mr Kline says. This means they are potentially more likely to be exposed to the virus as they work at the bedside.
‘Far from being a great leveller, this pandemic has highlighted the bleakest detail of inequality’
Wendy Irwin, RCN equalities coordinator
‘The people who are dying are not those making the decisions. BAME people are strongly conscious of that and it is a big issue. It is demoralising, ’ Mr Kline says.
‘There is a steep ethnicity gradient across the NHS with career progression much harder for BAME staff and senior positions generally well out of reach despite some recent limited progress.’
Socioeconomic status has a significant impact on someone’s health. ‘Being poorer is linked with greater likelihood of poor health, overcrowding, poor diet, greater use of public transport, compounded by poorer treatment at work and greater exposure to hands-on work with patients,’ says Mr Kline.
Another risk factor is that BAME staff are less likely to feel they can raise safety concerns, often because they fear the consequences of doing so. This problem was flagged up in the Freedom to Speak Up review, an independent inquiry into creating an open culture in the NHS.
Overseas staff may feel unable to say no to shifts in high-risk areas
Mr Fernando has heard distressing stories from BAME colleagues and the families of those who died, many of whom felt unable to speak out. ‘Filipino nurses are being put on night shifts, reassigned to COVID-19 areas, and even if it was not appropriate for them to go, they don’t feel able to say no.
of 35 nurses and midwives who died of COVID-19 were from a BAME background
Source: Health Service Journal
‘Newly recruited nurses, who are here on work permit visas don’t feel able to say no because they are terrified and anxious that their manager will not sponsor them or extend their visas. They have families they need to send money to in the Philippines, so they feel they have no choice.’
Reports from BAME staff to the RCN, BAME nursing groups, academics and Nursing Standard have also included these worrying inequalities at work.
BAME nurses have reported feeling pressured to work in COVID-19 areas, having poorer access to PPE, being made to work despite having health conditions that make them high risk of infection, and being more likely to be put on night shifts.
BAME staff have had unequal access to protective equipment
In an RCN survey on PPE in April, in response to a question on whether they were being asked to reuse single use PPE, 37% of white staff said they were, compared with 47% of BAME staff.
When it came to feeling pressure to work in a COVID-19 area without adequate PPE, 44% of white staff said they did, compared with 76% of BAME staff.
‘There is a clear difference in lived experience,’ says RCN equalities coordinator Wendy Irwin.
‘Far from being a great leveller, this pandemic has highlighted the bleakest detail of inequality.
‘It is important that everyone gets access to better PPE. It is an awful situation where those who are facing some of the biggest risk are not supported to take those risks safely. It is morally wrong.’
Filipino nurses being forced to work shifts where they feel unsafe
Angelica recently worked a number of night shifts with a newly recruited Filipino nurse who had moved from Dubai. The nurse was upset and told Angelica she was high risk as she had diabetes and shouldn’t have been working night shifts or with COVID-19 patients.
Despite this nurse having had a risk assessment, she was still there. Angelica says she raised the issue and was told the email with the risk assessment results had not arrived to their area and the situation would be sorted.
‘But when I came back on another run of four night shifts, the nurse was still there,’ she says. ‘She was distressed and crying. Those shifts were the most stressful I have done, to be working with the people who are high risk. I tried to protect her as much as I could. It is as though the Filipino nurses are left to survive. After these shifts I had insomnia and anxiety attacks. I woke up all through the night worrying.’
What should employers do to protect BAME staff?
RCN guidance states that its expectation is that employers in all care settings will:
- Carry out comprehensive and continuous equality analysis, including impact assessments on staffing issues relating to COVID-19. This should review the allocation of shifts, access to PPE and fit testing for BAME staff
- Proactively and sensitively identify staff with an elevated risk of experiencing harm as a result of COVID-19
- Carry out regular risk assessments to identify staff with an elevated risk of experiencing harm as a result as a result of COVID-19 and work with occupational health to ensure that those staff can work safely
- Consider redeployment of staff to settings that pose less risk, in cases where the employer recognises or is informed of elevated risk
- Prioritise fit-testing of FFP3 equipment where, following a risk assessment, BAME and other staff with an elevated risk are deemed to be safe to work in areas where they need to wear an FFP3 mask
- Ensure that staff who face an elevated risk because of factors such as ethnicity should also have access to the appropriate PPE for their role and care setting, including redeployment where appropriate
- Include BAME staff in the priority list for testing during the first five days of symptoms
Specialist support for Filipino healthcare staff
A dedicated NHS bereavement and trauma telephone support line has been set up for Filipino staff affected by the COVID-19 pandemic.
NHS England said Tagalog-speaking specialist counsellors and support workers will be on hand to support staff who have experienced bereavement, or who need to discuss anxiety or emotional issues experienced as a result of the pandemic.
The confidential, free helpline is available seven days a week between 7am and 11pm, along with a 24-hour text hotline.
Deputy chief nurse at Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust Edmund Tabay said: ‘We welcome this initiative for Filipino staff whose well-being may have been affected by witnessing traumatic deaths or who just feel overwhelmed by the ongoing pressures they are facing every day, while dealing with this global health emergency.’
No referral is necessary and the helpline is supported by charity Hospice UK.
The helpline number is 0300 303 1115 or text ‘frontline’ to 85258
Erin Dean is a freelance health journalist