Equality, Diversity & Inclusion
Indranil Chakravorty MBE
In 2023, there were nearly 265,000 NHS staff (19% of 1.5 million) who reported a non-British nationality. If one were to add ones who have acquired British nationality the numbers are considerably larger. The majority are from Asia, European Union and African countries. Yet, the experience of internationally qualified staff in the NHS is far from ideal. There is established differential treatment and attainment in every aspect of their recruitment, retention, promotion, non-mandatory training, support and disciplinary actions. It is now acknowledged that the NHS, not unlike other parts of British society and other major organisations, has a problem with deeply ingrained institutional bias. Although there are some allies who are keen to bring equality and justice back into British life, they are a vanishingly small minority.
This scenario was played out brutally during the COVID-19 pandemic which demonstrated for the first time, the harsh reality of societal inequalities and its outcomes supported by large data, and in a democratised format for all to comprehend. It was not new knowledge to data scientists, public health professionals and some in top leadership, but the data once presented to the general public – was difficult to live by. The Rt Hon Boris Johnson promised in 2022, that he would allow a full and free inquiry of the government’s handling of the pandemic. The COVID inquiry is listening to evidence from all walks of life and the most prominent ones in the last few weeks was the experience of hospital staff presented by Witness Statement of Dr Kevin Fong, National Clinical Adviser in Emergency Preparedness Resilience and Response (EPRR), and differential experience of international healthcare staff presented by JS Bamrah.
Kevin Fong described, ‘The disparity between data, ..and insight, was exacerbated by the use of teleconferencing tools.’ He, ‘had the best data from the units under the least pressure and the worst data from those under greatest stress.’
He also believed that, ‘a shift away from the usual command and control structures, towards a more permissive style of management, was viewed positively by frontline operational teams.’
The trauma experienced by staff was palpable, “There was so much death, it was unlike anything they had seen before. Staff didn’t have time to process or accept the losses, because as soon as one patient had passed away they had to get the bed cleared and ready for the next patient, who sometimes also did not survive.”
Sadly, such responsive and emotionally intelligent leadership experience was not the experience of colleagues from Black and ethnic minority backgrounds and for international staff. As a representative of the Federation of Ethnic Minority Healthcare Organisations Dr JS Bamrah highlighted how decades of socio-economic and health inequalities were leading to poorer outcomes for patients from BAME backgrounds. For BAME healthcare staff, he highlighted the experience of discrimination in ‘fit testing’, access to personal protective equipment and allocation to high risk areas. He quoted a nurse, “when we were being allocated in greater numbers to high risk areas we were asking in the back of our minds: “why us, why not them?” But what follows is that more of us died because there were more of us on the frontline. This isn’t just in Wales, it is all over the world. When new Filipinos come to the UK, they are asked to be on the frontlines, especially in A&E. We find it difficult to turn this down. They were put there, first to be deployed in these areas, but many are afraid of the situation and they can’t turn it down. They felt very scared. Not only in pandemics, but generally, we find it hard to stand up for ourselves and cannot turn down.”
“As a human being you adapt. You feel overwhelmed, but you adapt. You want to give your best, we had to do this, we were the people at the coal face, what else are you going to do? You can’t go back, you have to work. This type of disaster brings you together or tears you apart. I was proud of the team and the way we rose to the challenge…”
In 2020, the Bapio Institute for Health Research was conceived and established with a purpose of tackling inequalities in healthcare both for professionals and patients from minority backgrounds. BIHR started with a National Lottery funded project supporting ethnic minority patients with their communication needs with patient advocates working remotely with digital devices. Its mission has involved working on areas of differential attainment, or treatment of staff (Dignity at Work project, University of Glasgow), supporting international medical graduates and locally employed doctors, looking at inequalities in the legal and ethical framework for registration (University of Leeds), and understanding the enablers of racism in the NHS (University of Hertfordshire).
Unfortunately, reacting to the severe restriction in funding under the previous government, NHS has decided to cull its investment in equality and diversity champions, expecting that this would be ‘business as usual’ under ‘empathic leadership’ it has fostered. It almost culled the support provided to healthcare professionals through the NHS Practitioner Health, which was restored for another year, after major protests from staff. Health professionals have high levels of mental health problems driven by high workload, stress, experience of death and human suffering, shift work, lack of sleep and many other factors. For international staff there are additional challenges of isolation from family, socio-cultural isolation and experience of discrimination and bias in their work as well as day-to-day life.
This is where an organisation such as BAPIO and its partners from FEMHO are crucial to lend a voice, a platform for expression and provide the cultural intelligence that is essential if the NHS and by proxy the larger British society is to change for the better. If we have learnt a lesson from the COVID-19 pandemic, where Britain had one of the highest mortality rates amongst developed health economies, is that a fair and just society (as well as institutions) is a strength for providing the resilience that is needed to survive future pandemics.
Thinking of our contribution to the new BAPIO Foundation charity – there are 2 mantras we can take away from the BAPIO Bristol conference; (1) we get the most happiness from engaging in activities which either cost nothing or are voluntary, and (2) that if we think we are doing enough, we can certainly do more. Charles Dickens in the ‘Bleak House, “There were two classes of charitable people: one, the people who did a little and made a great deal of noise; the other, the people who did a great deal and made no noise at all.” If we all commit to being a little more like that “other” class of people, we could one day create a more just society.