As a black and minority ethnic (BME) nurse consultant, I inevitably come in to contact with various members of the BME community in Lewisham. When considering the question being asked by the British Medical Association (BMA) ‘Are we doing enough to protect our BME workforce?’, sadly my answer is: ‘Not enough!’ My view is that this question cannot be answered in isolation without considering the systemic deep-rooted barriers that affect the BME community in institutions generally.
This encompasses numerous inequalities and unequal starting blocks that confront BME people—even before many are aware of their surroundings—and this continues from childhood to adulthood. The slogan of ‘Black Lives Matter’ addresses current discriminatory practices, but it has to be more than a catchphrase. This awareness that ‘Black Lives Matter’ must go beyond reflecting on the inequalities that BME people have experienced in perpetuity in today's society.
With regards to the national COVID-19 pandemic, developments have shown that enough was not done to protect some of our NHS workforce. Sadly, this resulted in a disproportionate rate of deaths from COVID-19 in our NHS BME community. The endless discussion on lack of personal protective equipment (PPE) becomes disheartening. We now know this has a higher impact on the risk for the BME community.
A greater voice for BME staff
The statistics tell a very stark story and the writing is evidently on the wall. The BME community needs to be allowed to have a greater voice in processes and procedures not only in relation to PPE but also recruitment, risk assessment, management, logistics—in fact a full representation of the community the NHS serves; equal positions; equal access to equipment; listening to requests and demands; and acting on them with evidence to assure the BME community—and other members of the NHS workforce—that the NHS is an equal opportunity employer.
There is still no reliable recommendation from the Government for COVID-19 risk assessment for NHS staff, so primary care employers are having to develop their own policies for assessing staff risk themselves.
Why is there still an issue with this? We are all aware of the Workforce Race Equality Standard (WRES) data, which has been around for the last 5 years (WRES 2020). This tool has the ability to identify and predict how racism occurs in the NHS. It has enabled some improvements over the years but not enough.
The BME community needs to have a greater voice in how to provide health care, at every level, if the NHS is truly to be an equal opportunity employer
Career development inequalities
There are still a substantial number of BME nurses who seem unable to develop their career above band 5; and a lack of nurses in the higher bands 8b–9. Why are we not supporting effective career development practices among BME nurses? Why are we not providing the frontline BME workforce with more protective equipment? Why we not demonstrating how valuable BME nurses are to the NHS? Is it a clear fact that black lives matter less? If we are to embracing the fact that Black Lives Matter beyond the motto, the NHS needs to upgrade BME health professionals to role model positions. When we do not see ourselves in higher roles, breaking through discriminatory barriers, it feels lonely. You get a sense of belonging when you see people like yourself—whatever your race, gender or sexuality—being able to attain society's goals. We know we do not live in an ideal world, and realistically BME staff are favoured less in career progression to higher bands and are subjected to more disciplinary action (NHS England, 2019). Now, there are concerns from BME staff that they are seen as high-risk for employment due to COVID-19 risk assessment, so this is another potential block to the progression of their careers.
If such a large proportion of deaths of frontline staff (nurses, doctors, porters, phlebotomists, and health care assistants) had been white workers would there have been more concern? There has been some suggestion that vitamin D levels and their effects on the ACE receptors in the lung may be related to the increased COVID-19 deaths in BME people, although this is still unclear (Martineau 2017). However, there is a strong and disquieting suggestion that the stress of conforming and unspoken racial pressures could be a reason for the increase in the numbers of deaths for BME staff (PHE 2020).
Getting uncomfortable and facing facts
The COVID-19 pandemic has compounded BME people's disadvantaged working conditions and many are stressed as they keep quiet in fear of speaking out about the risk factors presented by their jobs. The dichotomy of this is vast and will take time; it means getting uncomfortable and facing some facts. For too long BME staff have kept quiet, worried that they will be seen as aggressive or troublemakers if they give voice to their concerns, so problems are never really taken forward to management.
‘The NHS needs to upgrade BME health professionals to role model positions. When we do not see ourselves in higher roles, breaking through discriminatory barriers, it feels lonely.’
Black Lives Matter
It is difficult to witness the untimely deaths of black people in the USA. This has stirred up so much pain, which goes in line with the injustice that exists in every part of society. The Black Lives Matter movement has given a sense of urgency to the need to confront race issues, inequality and social justice across the globe, as well as here in the UK. These issues should have been addressed years ago.
It is urgent that we build a deeper awareness that promotes empathy and understanding in the working environment and the difficulties that BME staff face. To make a difference there needs to be a coming together to work in unity, to have difficult conversations, to acknowledge white privilege, to examine history and to see colour for what it is.
Observable racism is a manifestation of the good intentions of people who feel they are progressive and educated, which means they are not typical racists who are abusive. It sits on the surface of consciousness because such people do not believe they are influenced by racism, saying things such as ‘I have a friend who is black’ or ‘I don't see colour’. It is important to face up to this objectively and to challenge yourself. This will mean becoming comfortable with being uncomfortable, but the end goal is that people will be able to face their prejudices and discriminations which are felt in the work environment. So, I ask again, ‘are we doing enough to protect our BME colleagues?’ Clearly not. We need to address our own bias and the systemic racial issues which have caused social and professional injustices in the NHS. It is here that change happens.