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Covid-19: BAME NHS Staff

Volume 803: debated on Tuesday 19 May 2020


Asked by

To ask Her Majesty’s Government what assessment they have made of the impact of COVID-19 on black, Asian and minority ethnic frontline staff working in NHS hospitals.

The Question was considered in a Virtual Proceeding via video call.

My Lords, the Government are deeply concerned about these groups. That is why we have asked Public Health England to review the evidence. In advance of PHE’s recommendations, NHS England has written to NHS services so that, on a precautionary basis, employers can risk-assess staff at potentially greater risk and make appropriate arrangements accordingly.

I thank the Minister for that Answer. I have been asked by the Labour leader to conduct a review into the effects of Covid-19 on the BAME community. Are the NHS and Government making sure that BAME nurses are properly shielded with adequate PPE? Have they considered taking BAME nurses and staff off the front line, as they are overrepresented in the death toll of the virus?

As I mentioned in my previous Answer, arrangements have been put in place for local trusts to risk-assess all employees, including BAME nurses, and to assess whether they are at a higher risk and, if necessary, to change their rotas and staffing arrangements accordingly. I understand that some trusts have already taken these measures.

My Lords, I pay tribute to my noble friend Lady Lawrence for the leading role she is playing in finding out why BAME communities and health workers are disproportionately bearing the brunt of Covid-19.I understand that the Public Health England review of ethnic minority health records and data is due to report at the end of May. It is looking into how factors such as ethnicity, deprivation, age, gender and obesity can affect the impact of Covid-19. People from ethnic minorities may also be at a higher risk due to the prevalence of co-morbidities such as diabetes, cardiovascular conditions and sickle cell disease. Overall, black people are dying with Covid-19 at almost double the rate of white people. Can the Minister say what the next steps will be after the PHE review and what are the Government’s plans, remits and timescale for the more in-depth analysis and inquiry that is needed to better understand entrenched health inequalities and to respond to the needs of BAME communities and health staff?

The noble Baroness put this very well. We are deeply concerned about genetic differences between groups. This virus is like malaria and other viruses in that it affects different ethnic groups differently. We are concerned about behavioural issues such as diet and environmental issues such as urban versus rural living arrangements. We have already invited health trusts to put in place arrangements to protect our BAME NHS workers. We are also inviting other academic studies, of which there is a large number, to look at the various concerns about how the virus has hit different groups. We will be commissioning a very large amount of medical research into this important area.

I salute my noble friend for her relentless uphill struggle to combat institutional discrimination in our country. No one can ignore the sobering statistics on front-line deaths among members of minority communities. These have raised the deepest fears about the tragic number of deaths. Leaders in the NHS who are responsible for diversity have also said that the Government have been too slow to act to protect NHS front-line staff. What measures are in place to monitor this situation and to assure BAME staff that they can be confident about continuing to provide their services to the NHS in safety?

I completely and utterly reject the suggestion by the noble Baroness that there is institutional racism in the NHS. That is a completely inappropriate slur and I invite the noble Baroness to retract it at a future date.

My Lords, I recognise that this one nation Minister and one nation Government are committed to action, but clearly there is an urgency about this. I realise that we have the Public Health England review, but after that, how soon will the Minister be expecting to take action to ensure that its recommendations are implemented forthwith?

I can reassure my noble friend that action is already being taken. Individual trusts are putting in place trials and arrangements to try out different forms of amelioration, including changing staff rotas and taking vulnerable staff out of the front line wherever possible. We will build on these pilots and trials in order to move as quickly as we can. The causes of the massive difference in the effects of the disease on different ethnic groups are not clear yet, so it is not possible to say for sure which pilots will work. However, we are moving as quickly as we can and we will build on the evidence base in order to put in effective measures.

My Lords, this pandemic must be a wake-up call for us all. The Government’s review is not sufficient. BAME people make up 72% of NHS and social care staff and are 4.2 times more likely to die. Given all these separate initiatives referred to by the Minister, will he meet key leaders from BAME communities to look at establishing a Covid-19 race equality strategy, to find solutions to the current crisis based on the collective experiences of service and sacrifice from these communities?

My Lords, I share the noble Baroness’s tribute to BAME staff in the NHS, who, as she rightly points out, are on the front line and putting themselves at risk. We should all, as a nation, be enormously grateful for their contribution. I also salute those in the NHS moving quickly to address the concerns and evidence that the disease itself is discriminatory. I would be glad to meet representatives, but I want to be clear that the processes in place in the NHS are reasonable, proportionate and will, I believe, deliver the needed results.

Will my noble friend the Minister please ensure that the inquiry carefully and thoroughly investigates all anomalies? While black Afro-Caribbeans have a much higher than death rate than white people, I understand that the rate is even higher for Filipinos and far lower for the Chinese. Will the inquiry also look at why 70% of those dying are men, which is nothing to do with race, and why obesity, diabetes, vitamin D and blood thinners all seem to be factors in this epidemic?

The noble Lord is entirely right. This disease is racist, fatist and sexist. We need to understand why it is discriminatory in all these areas. I reassure the noble Lord that the National Institute for Health Research and UK Research and Innovation have jointly called for research proposals to investigate emerging evidence of an association between ethnicity, behavioural and social factors, and the adverse health outcomes it is generating.

Given the association that there seems to be between a wide range of factors, are these being centrally collated? Are the Government producing guidance on, for example, vitamin D supplementation in the event of deficiency being detected, so that the national results are rapidly rolled out, and those cases where risk is discovered can be managed and supported?

I reassure the noble Baroness that the data is being centrally aggregated. ONS has published figures on ethnicity and the CMO and PHE are both scrutinising them. On their list of issues to consider is the role of vitamin D, where the evidence is interesting but unproven.

To follow further on the data, many medical bodies, and the Science and Technology Committee today, are calling for greater collection of real-time data on infection and deaths by protected characteristics, and for it to be recorded, analysed and shared so that urgent action can be taken to prevent deaths of front-line staff. What assurances can the Minister give that this work is actively under way now?

I reassure the noble Baroness that we have a large amount of data—although we could do with more and better. The collection of death certification data, for instance, has already improved dramatically and we are working hard to ensure that the evidence is there to inform our policy-making.

My Lords, the coronavirus crisis has exposed the fact that the majority of NHS BAME healthcare staff—including Filipino workers, who are often forgotten—hold junior positions and are therefore more likely to find themselves on the front line in the fight against Covid-19; many have lost their lives doing so. After this crisis, what will the Government do to encourage the NHS to develop better career paths and promotion initiatives for its BAME staff?

The noble Baroness is entirely right. We owe a huge debt of gratitude to those BAME staff, whether black Afro-Caribbean or Filipino, who have put their lives at risk on the front line. It is a wake-up call; we should always be thinking about how we can accelerate opportunities for all members of staff. Those who start at the lower ranks should be given whatever opportunities are available to progress to a higher rank. The noble Baroness is entirely right that this puts a spotlight on our commitment to those groups. I completely endorse her point.