The NHS response to BME staff’s covid deaths was late and lopsided

Twice as many health and social care workers have died from covid-19 in the last three months as died on average (142 deaths) across all UK employment in each of the last five years. Despite a wave of risk assessments and other activity, too many NHS trusts are not yet addressing the key issue.

Initial employer covid-19 staff safety concerns focused on PPE shortages and on departments such as ICU that were self-evidently high risk. But early data suggested a problem. None of the first 119 NHS staff deaths from covid-19 analysed were amongst staff in ICU.

Researchers concluded it was likely this was because these staff were rigorous about personal protective equipment use. They also found the vast majority of staff who died had patient-facing jobs and were actively working during the pandemic. They concluded that it was likely that “many of the episodes of infection will have occurred during the course of work”. 

Other data confirmed whilst long-term health conditions might worsen the impact of infection for healthcare staff, the initial cause for many, if not most, was “occupational exposure”. Thus, Public Health England researchers estimated that 89 per cent of covid-19 infections among healthcare workers may have been caught in hospital. 

In response to rising staff deaths and infection, NHS employers emphasised individual staff risk assessments using the PHE “vulnerable” and “shielded” criteria, and then the more sophisticated Faculty of Occupational Medicine Risk Reduction Framework.

There were two problems with this emphasis: it was late and it was lop-sided.

It was late because by early March employers should have implemented statutory risk assessment duties arising from Section 1 (2) Health and Safety at Work etc Act 1974), Regulation 3 (1) of the Management of Health and Safety at Work Regulations 1999; and Regulation 4 (1) of the Personal Protective Equipment at Work Regulations 1992 and Equality Impact Assessments. These would have identified the risks and classes of individuals who might be at greater risk, and how to mitigate those risks. They would, for example, have picked up potential problems with the PPE fitting or the higher risks BAME staff faced.

Higher risk

It was lopsided because local risk assessment processes overwhelmingly focused on risks from long-term health conditions and understandably stressed PPE and social distancing challenges.

But what these risk assessments overwhelmingly did not do was tackle a key cause of the dangerous occupational exposure, the (predictably) racialised patterns of staff treatment. A mixture of anecdotal evidence and survey data shone a light on the greater risks to BME staff and what should have been done.

The best trusts ensure that health risk assessments and workforce treatment risks assessments complement each other and are underpinned by relentless scrutiny by the board

Surveys by the BMA (April) and RCN (May) found that BME doctors and nurses had much poorer access to appropriate and sufficient PPE than white doctors and nurses. Why did trusts and the NHS nationally not act on soft intelligence? Why wasn’t this monitored and stopped?

BME staff are disproportionately represented among lower-graded frontline staff who might generally be at greater risk. There was widespread anecdotal evidence (and some trust data) that BME staff were being disproportionately redeployed on to wards with greater covid-19 risks. Why were staff concerns not heard and acted on?

Agency staff and contractors include larger numbers of BME staff who reported poorer experiences with PPE and how they were deployed – and were more likely to be concerned about income loss if prevented from working. Why was this not heard and acted on with income guarantees for self-isolation? Who was doing what risk assessments for these staff?

• We know from the 2015 Francis Speak Up report that BME staff are more reluctant to raise concerns either because they do not believe they are listened to or because they fear the consequences of doing so. Why were trusts not being proactive and seeking out concerns rather than waiting?
• Why were cramped communal, non-clinical areas with poor social distancing not identified as problematic?
• Lower paid staff are more likely to use public transport with further risk of infection. Were steps taken to mitigate this?

Such risks may not be easily noticed by leadership teams, who are infrequently diverse, rarely inclusive, and do not put themselves in the shoes of those on the front line.

Crucially, the failure to address the adverse patterns of workforce treatment, notably towards BME staff, has been a key source of increased risk for some groups of staff. The risks listed above are rooted in deep-seated patterns of discrimination that face BME staff in particular.

The best trusts ensure that health risk assessments and workforce treatment risk assessments complement each other and are underpinned by relentless scrutiny by the board. Some trusts (eg Chelsea and Westminster) and some regions (eg South East Region) see this as a corporate risk and staff safety is underpinned by accountability, rather than being just an equality issue.

If Black Lives Really Matter we need practical steps on covid-19 and a fundamental reassessment of how one-fifth of our NHS staff are treated. The risks from covid-19 are a good place to start.