NHS professionals have warned that the UK is racing towards the second wave of coronavirus with ministers concerned that the black, Asian and Minority Ethnic (BAME) community may once again be forced to “shoulder the burden of this pandemic” if a “plan of action” is not in place.
The warning comes after a research study highlighted that nearly 70% of the 1700 doctors surveyed “were likely to quit the NHS” frustrated with the government’s handling of the pandemic. This warning from the Doctor’s Association of UK (DAUK) should be a red flag for the Health Secretary especially after 600 healthcare workers, a majority of them from BAME backgrounds, lost their lives during the first wave of coronavirus.
Concerned about some BAME doctors who are still working in high-risk environments, Dr. Rinesh Parmar, Chair of DAUK has disclosed that “it is still an on-going problem.” Speaking exclusively to Asian Voice, he said, “Institutions have previously failed to complete risk assessments and take actions based on those risk assessments to safeguard our BAME colleagues. Some individuals who are deemed high-risk have not been removed from high-risk environments. Although the government has assured that the published BAME review has been forwarded to the Equalities Minister’s workstream, we have not heard anything from them in terms of how the work would be taken forward. We are heading towards a potential second Covid-19 wave and this is not something that can be put on the back burner. It needs to be addressed now.”
Public Health England (PHE) had submitted a review into why a higher number of BAME medical professionals had died of Covid-19. This review was forwarded to Equalities Minister Kemi Badenoch and consisted of publicly available information. The newsweekly has now learned that to date no investigation has been launched into “systemic and institutional racism that exists within the NHS”. This is particularly worrisome as doctors in the past have reported about being “gagged over airing concerns around PPE shortages.” Many of them were silenced and discouraged to speak about their conditions whether within their trusts, at GP practices, or with local managers. Thus, the DAUK had launched an anonymous App facilitating frontline doctors to report their concerns anonymously and their collective feedback was then taken to the government.
Lack of BAME leadership in Trusts across North of England
The existing racism and Islamophobia are reflected in the leadership of the NHS trusts and hospitals especially across the North of England. Official government figures demonstrate that almost a third (32.2 per cent) of the 277 NHS trusts in England do not have a single BAME professional on its board. These statistics become worse as one analyses Trusts and hospitals across the North of England. At least 13 Trusts have no minority representation in areas including Oldham, Manchester, Derby, Nottingham and Liverpool. All these areas have a substantial BAME population and are now recording a considerable spike in the number of cases. Lack of BAME leadership worries Dr Umesh Prabhu a paediatric consultant and former Director at Wigan & Leigh NHS Trust. For the last 20 years, he has been raising the subject of institutional racism within the NHS in regular discussions with the NHS and the GMC.
Worried that South Asian doctors cannot say “no” to the establishment and stand up for themselves, Dr. Prabhu said, “When I went to Wigan, 40% of medical consultants were from BAME backgrounds. But only two clinical directors were from minority backgrounds. I was shocked at the mist-treatment of some of these doctors and I began appointments of value-based directors from diverse backgrounds including women as they make better leaders especially in their handling of Covid-19.
“We must also understand the anxiety of our doctors. My son is a GP and he is worried. During the first wave of Coronavirus, it was not just junior doctors but even consultant psychiatrists who told me that they were forced to work in Covid-19 wards as opposed to their “white” colleagues. This kind of racism and discrimination worries me even today because South Asians don’t know how to say “no”. But doctors tendering their resignations at such trying times is not a solution either to coronavirus or challenging racism within the NHS.”
Individuals like Dr. Prabhu have tried bringing around these systemic changes with help from institutions such as the British Association of Physicians of Indian Origin (BAPIO). The organisation has been a torchbearer for 40,000 Indian-origin immigrant doctors and nurses presently serving the NHS. The organisation will celebrate its silver jubilee anniversary next year as it continues to help healthcare professionals navigate cultural, social and linguistic barriers in the UK.
BAPIO launches BINA for Indian-origin nurses, undertakes project on ‘differential attainment’
In the wake of the Black Lives Matter movement and health inequalities exposed by coronavirus, the organisation has commenced a major project “differential attainment” considering its influence on the establishment.
Shedding light into what differential attainment means, Dr. Ramesh Mehta, President of BAPIO said, “The career progression of Indian doctors is often hampered because of discrimination and to some degree racism. When Indian doctors take post-graduation exams, it is recorded that their pass rates are much worse than that of their “white counterparts”. We can understand that immigrant doctors may face certain difficulties concerning language.
But this, unfortunately, stands true for the next generation of British born Asian doctors as well. BAPIO flagged up this issue in a judicial review in 2014 and we had lost our case even as the judge stated that we had achieved a moral victory. Six years later and there is still no change. This is just one example but such instances of discrimination or ‘differential attainment’ are rife across the board from leadership positions to receiving excellence awards. More and more people are talking about this but the outcome is still the same.”
But besides supporting doctors, BAPIO is now facilitating Indian-origin nurses as well. About 25,000-30,000 nurses from India are or will be serving the NHS shortly. At the height of the pandemic, many approached the BAPIO for support and guidance. And thus, BAPIO has launched British Indian Nurses Association, a support network for Indian-origin nurses.
BMA advocates for funding to achieve progression of doctors from ethnic minorities
In the meantime, at the British Medical Association’s Annual Representative Meeting, delegates passed a motion calling on the Government to increase funding to tackle ethnic, geographic, and gender equalities and to remove the barriers to progression for those from BAME backgrounds.
BMA council chair Dr Chaand Nagpaul said, “Removing barriers to progression is a crucial part of tackling inequalities which begins with addressing the educational barriers facing BAME school children. This must also be reflected in the workplace with the need for diversity in leadership to build an inclusive culture. As such the BMA believes it is right that all NHS trust and organisation boards should be reflective of the ethnic make-up of the organisation they manage, alongside transparent recruitment and promotion systems across all NHS organisations.”
While some doctors have echoed their concerns around PPE and safety regulations, many are confident that with the assistance of test and trace systems and better stocked PPE, a second wave can be well managed. Speaking to Asian Voice, Rahul Mukherjee, Consultant Physician, University Hospitals Birmingham NHS Foundation Trust said, “The supply of PPE seems to have improved and community infection control measures are slightly better. Institutional racism is a wider issue, and I can’t speak for all Asian doctors but there have been some reasonable measures taken like individual risk assessment and allocation of appropriate duties limiting viral exposure, which is likely to mitigate some risk.”
In its recent survey, the DAUK has noted that 74% of the doctors were frustrated with the lack of real-time pay rise and a decline in their work conditions. 65% of them were wary of the lack of PPE and that the government had repealed promises it had made during the pandemic. Some of those promises including free car-parking for NHS staff were repealed as the charges have now resumed despite a surge in infections. The government in the meantime has insisted that a higher count of deaths of BAME medics can be attributed to a variety of reasons. They include BAME individuals being diagnosed with pre-existing diseases such as Obesity, Type II diabetes contributing to the co-morbidities factor. Other reasons also include living in multi-generational households where other family members may potentially be employed as key frontline staff with more exposure to the virus. Previously, Tory politicians like Craig Whittaker have also blamed ethnic minorities for not following lockdown rules and gathering on festivals such as Eid. But there is no substantial evidence to support such claims.
Discussing the politics of blame game, Dr. Mukherjee said, “Obesity is a major factor but there have been numerous other issues like delays in taking up scientific advice, deliberate lawbreaking being condoned (which has a possible negative effect on public compliance with lockdown regulations) and dubious companies being given contracts for PPE, which has been publicly exposed by groups like EveryDoctor and the Good Law Project. Therefore, it is unlikely that the government will be able to blame obesity and get away.”
Children may suffer mild-illness, elderly should take caution
Dr Ashraf Chohan, Chairman of Conservative Friends of NHS - Director CFOP- Chairman human care has, however, questioned the validity of the survey presented by DAUK. Dismissing the report about the mass resignation of the NHS doctors. Believing that institutional racism cannot be rooted out of the Healthcare system immediately, he said “It needs more awareness and accountability. But the Government is very proactive in my opinion. There has been a new wave of lockdown where cases are
increasing and all businesses are operating with strict rules of distance sanitation and mask. The Government is extending the Furlough scheme.”
Dr. Bharat Pankhania, a senior clinical lecturer, University of Exeter Medical School has also similarly lauded the pro-active approach of the government. Speaking about the balance of reviving the economy versus limiting the case infections, he said, “The case numbers had gone down due to the imposed lockdown but that is not a viable option. The government is faced with a difficult balancing act. I disagree with the government in insisting that people should go back to work and they should continue working from home if they can. This can be especially good for local cafes, and shops.
“But the government is right in re-opening the schools especially as children’s mental well-being is essential. The messaging needs to be more precise. The government should produce an explicit statement that we are re-opening schools. Children can suffer through mild illness but they recover quickly. But they may pass it on to their parents or grandparents and therefore, the older generation must take all precautions required to remain safe.”
Meanwhile, Marsha de Cordova MP, Shadow Women and Equalities Secretary, said, “It is a scandal that BAME communities continue to experience systemic racism daily. Time and again the Government has commissioned reviews on racial inequalities in settings from schools, to the criminal justice system to the workplace and yet done nothing of note with the findings.
The DAUK is also aware of the toll of Covid-19 on the mental health of the medical staff. It is particularly wary of doctors taking their own lives especially when suicide rates are increasing among those doctors under GMC investigations. Thus, the DAUK has been working with a Charity Doctors in Distress in a bid to mitigate the negative impact on the mental health of the doctors.
Rima Sidhpara, is a BACP Accredited Psychotherapist, clinical Director of Rutland House Counselling and Psychotherapy Ltd and Deputy Chair of the executive of the British Association of Counselling and Psychotherapy Private Practice division.
Commenting on the issue of mental health and stress burnout among South Asian doctors she said, “Before Covid-19, doctors were already under strain and at risk of burnout due to high demands from their job. Covid-19 has only made it worse for them to manage their mental health. I am not surprised that many doctors are wishing to resign, having seen some of their colleagues already die from Covid-19. I know some doctors have chosen to live separately from their families to protect their elderly or pregnant wives which will have a huge impact on their well-being. I don’t think that there is enough psychological support for some of our doctors who are at risk of suffering from Post-Traumatic Stress Disorder (PTSD). Doctors are also at higher risk of suicide compared to the general population. Many doctors are reluctant to disclose their mental health problems in their workplace due to the associated stigma and a perceived “failure to cope”.”
(Disclaimer: If you need help with mental well-being, you can contact Doctors-in-Distress at +(44) 1923 606 183)
