Identifying and mitigating the impact of COVID-19 on inequalities experienced by people from BAME backgrounds working in health and social care

Lead Research Organisation: King's College London
Department Name: Psychological Medicine

Abstract

Black, Asian and minority ethnic (BAME) groups constitute 14 percent of the population in England and Wales. The NHS is the largest employer of BAME staff, comprising at least 20 percent of the workforce (45 percent in London). BAME healthcare staff, experience greater levels of workplace racism, harassment and discrimination than other staff. Discrimination, and bullying or abuse have persistent effects on mental health and occupational outcomes. Such workplace experiences (more commonly perpetrated by colleagues, managers than patients), have increased over the past five years, particularly in London NHS Trusts. BAME staff also have poorer working conditions (e.g., lower pay, less control in decision making, dis-empowered from complaining about working conditions). COVID-19 infections disproportionately affect BAME UK communities including healthcare workers (e.g., increased mortality among Black ethnic groups). Therefore, adverse working conditions faced by BAME NHS staff may be worsened by greater exposure to COVID-19 related disadvantages, within and outside of the workplace. These adversities place BAME staff in vulnerable positions (e.g. working in role that involve greater exposure to COVID-19 wards; heightened workplace stresses, stigma, fear and uncertainty around COVID-19 risks for themselves and their families). These ethnic inequalities must be addressed to avoid the social, economic, and moral costs of mental ill health and worse occupational outcomes for BAME staff.

This study aims to identify ethnic inequalities in mental health and occupational outcomes amongst NHS staff how COVID-19 exacerbates such inequalities, and the processes which inequalities are produced, maintained and resisted. We also aim to develop a Race Equality Assessment toolkit, as well as education and training resources targeted at improving BAME staff experiences, retention and relevant NHS policies. To address these aims we will involve service users and BAME staff representatives in deciding the content of the survey and interviews, co-leading interviews and in developing the toolkit; collect new quantitative (survey) and qualitative (interview) data on BAME staff experiences since COVID-19; develop the toolkit to help ensure BAME perspectives are prioritized in research and education for all NHS staff; and develop education and training resources targeted at improving BAME staff workplace experiences, job retention and reducing inequalities faced by BAME staff during and beyond COVID19. To do this, we will incorporate an ethnicity module into an ongoing national longitudinal study of NHS staff (NHS CHECK) to assess health and work outcomes by ethnicity over an 18-month period. With the additional ethnicity module, the NHS CHECK cohort will uniquely capture existing and emerging ethnic inequalities in mental health and occupational outcomes during and after COVID-19. We will also carry out interviews with BAME staff who take part in the NHS CHECK study; London based healthcare practitioners from difference ethnic backgrounds who have previously been interviewed before COVID-19 as part of the Tackling Inequalities and Discrimination Experiences in health services (TIDES) study; and NHS managers and senior staff nationally from BAME and non BAME groups.

Data will inform NHS Trusts, NHS England and the public through current initiatives tasked with making sustainable transformations for BAME staff within the workplace )e.g., NHS England Workforce Race Equality Standard) and communities (e.g., Black Thrive). Findings will be used to develop education and training materials to support BAME NHS staff nationally through collaboration with psychologists, medical educations and equality and diversity professionals. These will also be subsequently piloted prior to scale up through our collaborators, such as NHS England Workforce Race Equity Standard, NHS Confederation and Royal College of Nursing.
 
Description Critical Public Health Advisory Board
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description Ethnic inequalities in health care among people with multiple conditions - Advisory Board
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description Guy's and St Thomas' Charity Multiple Long Term Conditions Challenge Fund assessment committee
Geographic Reach National 
Policy Influence Type Membership of a guideline committee
 
Description Health Education England Mental Health Workforce Equalities Subgroup
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description NHS England and NHS Improvement - The Mental Health Equalities Data Quality and Research Subgroup
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description NHS England and NHS Improvement Advancing Mental Health Equalities Taskforce
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description NHS England and NHS Improvement Patient and Carers Race Equalities Framework [PCREF] Steering Group
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description NHS Race and Health Observatory, Co-Chair Academic Reference Group and Board Member
Geographic Reach National 
Policy Influence Type Membership of a guideline committee
Impact The group of national experts generated a infographic which was widely distributed nationally. The infographic highlighted the key recommendations to help leaders maximise vaccine uptake among ethnic minority groups.
URL https://www.nhsconfed.org/networks/nhs-race-and-health-observatory/vaccine-uptake
 
Description The Royal Foundation - Mental Health Research Group
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description Thrive London Advisory Board
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description UK REACH (Research Study into Ethnicity And COVID-19 outcomes in Healthcare workers; Manish Pareek, PI) advisory
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description Welsh Government's Race Equality Plan; contribution to the evidence review for Health and Social Care and Employment and Income policy areas, and ongoing advisory.
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
 
Description Black Thrive 
Organisation Black Thrive
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution Expertise in research methods, peer researcher training, supporting community-based research, data analysis
Collaborator Contribution Participation in programme planning, supporting engagement and impact activities, expertise in community-based research
Impact no outcomes as yet.
Start Year 2020
 
Description Challenge Consultancy 
Organisation Challenge Consultancy
Country United Kingdom 
Sector Private 
PI Contribution Team provides expertise and intellectual input. Also include them in TIDES wider collaborative meetings.
Collaborator Contribution Facilitating workshops for TIDES participants, stakeholder opinion group and advisory group members to help manage microaggressions at work. Conducting qualitative interviews with senior NHS managers and leaders.
Impact n/a
Start Year 2017
 
Description Maudsley Learning 
Organisation Maudsley Learning
Country United Kingdom 
Sector Academic/University 
PI Contribution Team provides expertise and intellectual input. We include them in TIDES collaborator meetings and Virtual Reality advisory meetings.
Collaborator Contribution Maudsley Learning involved in co-production of content, delivery and dissemination of project information; Planning the design, filming, post-production, training and distribution of Virtual Reality elements; TIDES collaborator meetings and Virtual Reality advisory meetings.
Impact n/a
Start Year 2017
 
Description NHS Confederation 
Organisation NHS Confederation
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution Team provides expertise; deliver talks and attends meetings to discuss research findings. Including them in the TIDES wider co-investigator and collaborator meetings. Hatch member of NHS Race and Health Observatory Board and Co-Chair of Academic Reference Group.
Collaborator Contribution • Support accessing NHS leaders for the 'senior leaders and manager' qualitative interviews • Co-producing a collaborative piece of work around engaging senior leaders to progress this work and the reasons why it is important to do so • Contributing to the Race Equality Assessment Toolkit, including supporting commissioned work from external parties, e.g. Wales Centre for Public Policy • Contribution to the TIDES wider co-investigator and collaborator meetings (1.5 hours every 6 weeks - 13 in total, not expected to attend all meetings) • Completing tasks following on from TIDES wider co-investigator and collaborator meetings, for example, commenting on documents, providing video pleas for social media etc. (one hour per meeting (13hrs)) • Involvement in TIDES Advisory Group (Wayne) x 3 2 hour online meetings • Involvement in Stakeholder Group Meetings x 3 2 hour online meetings • Contribution to comms, e.g. disseminating materials to mailing lists, social media etc, making short video appeals for the NHS Check and TIDES study.
Impact The NHS Race and Health Observatory generated an infographic which was widely distributed nationally. The infographic highlighted the key recommendations to help leaders maximise vaccine uptake among ethnic minority groups.
Start Year 2020
 
Description Royal College of Nursing 
Organisation Royal College of Nursing
Country United Kingdom 
Sector Private 
PI Contribution TIDES team provides expertise and intellectual input. Co-produce study content, analysis and dissemination with RCN colleagues.
Collaborator Contribution RCN partners participate in co-production of study content, analysis and dissemination; contribute to advisory group; promote recruitment to survey and identify co-researchers and key collaborators
Impact n/a
Start Year 2020
 
Description BME mental health perspectives - an evidence-based approach CNO Nursing & Midwifery BME Action Plan Steering Group 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Invited to talk at the CNO Nursing & Midwifery BME Action Plan Steering Group, which was held online.
Year(s) Of Engagement Activity 2021
 
Description Call for applicants to get involved in our research - TIDES study 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact We did a social media campaign and connected with our networks and collaborators to reach out to ask individuals to express interest in opportunities to get involved in this ESRC funded project.

We received >200 responses via an web based application form. This is where we recruited for our peer researchers, advisory group, and wider stakeholder opinion group comprising clinical academics, experts by experience, senior leaders and health and social care staff representing geographic areas across England.
Year(s) Of Engagement Activity 2020
URL https://tidesstudy.com/phase-2/
 
Description Challenge Consultancy - Microaggression workshop series 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Collaborator Challenge Consultancy are delivering a workshop series on addressing microaggressions for TIDES participants, advisory and stakeholder opinion groups. Audience 40-26,000.
Year(s) Of Engagement Activity 2020
URL https://tidesstudy.com/microaggressions-workshop/
 
Description Dissemination and engagement to the NHS Check Study and TIDES researcher roles 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Team presented at 10 NHS staff meetings and the Royal College of Nursing BME networks. This was to promote and invite participation in the NHS Check survey and TIDES study.
Year(s) Of Engagement Activity 2020
URL https://tidesstudy.com/phase-2/
 
Description Health Inequalities Research Group Seminar Series 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Postgraduate students
Results and Impact The Health Inequalities Research Group, led by Stephani Hatch holds a bimonthly Seminar Series open to HIRG group members.
Year(s) Of Engagement Activity 2020,2021
 
Description Health Inequalities Research Group Career Development Workshops 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Postgraduate students
Results and Impact We have held 2 workshops one in November 2020 and one in March 2021 - for Early Career Advice and Research opportunities. This will be held quarterly going forward.
Year(s) Of Engagement Activity 2020,2021
 
Description Help us do better - social media campaign 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The team led a successful social media campaign (#HelpUsDoBetter) with the NHS CHECK study and a podcast series on inequalities in healthcare services hosted by medical students.
Year(s) Of Engagement Activity 2020
URL https://twitter.com/tides_study
 
Description How research and innovation are tackling the COVID-19 Pandemic, UKRI Virtual Parliamentary Event 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Invited to speak about the TIDES project and general impact of COVID on 'How research and innovation are tackling the COVID-19 Pandemic' at the UKRI Virtual Parliamentary Event.
Year(s) Of Engagement Activity 2020
 
Description In Conversation with Black Professors in Mental Health, Black & Minority Ethnics in Psychiatry & Psychology Network (BiPP) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Invited to speak and be interviewed for the 'In Conversation with Black Professors in Mental Health' event organised by Black & Minority Ethnics in Psychiatry & Psychology Network (BiPP), and held online.
Year(s) Of Engagement Activity 2020
URL https://www.bippnetwork.org.uk/previous-events
 
Description Maudsley Lectures in Psychoanalysis: Reflections on the Pandemic, South London and Maudsley NHS Trust 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Invited to lead discussion on race at the Maudsley Lectures in Psychoanalysis event. Talk was titled 'Reflections on the Pandemic', and it was organised by South London and Maudsley NHS Trust and held online.
Year(s) Of Engagement Activity 2020
URL https://psychoanalysis.org.uk/civicrm/event/info%3Fid%3D1060%26reset%3D1
 
Description Mental health research is racist, so what are we all going to do about it??Mental Health Question Time - organised by UCL Psychiatry, The Lancet Psychiatry, Black Thrive and The Mental Elf 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Invited to give talk on 'Mental health research is racist, so what are we all going to do about it?' At the Mental Health Question Time, which was held online and organised by UCL Psychiatry, The Lancet Psychiatry, Black Thrive and The Mental Elf.
Year(s) Of Engagement Activity 2020
URL https://www.youtube.com/watch?v=2EkWLGgmUo4
 
Description Overview of evidence on BAME mental health, impact of discrimination, existing gaps and under-utilisation of evidence, opportunities for engagement and to influence, Public Health England Development Day 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Invited to give presentation and discussion at the Public Health England Development Day, talk was titled 'Overview of evidence on BAME mental health, impact of discrimination, existing gaps and under-utilisation of evidence, opportunities for engagement and to influence' The event was held online.
Year(s) Of Engagement Activity 2020
 
Description Peer Researchers - training 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact We recruited 3 peer researchers and provided them with research skills training to support their research activities within the TIDES team.
Year(s) Of Engagement Activity 2020,2021
 
Description Processes and Mechanisms - Race, Racism and Mental Health, The Zinc Academy 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Invited to talk on 'Processes and Mechanisms - Race, Racism and Mental Health' at the The Zinc Academy online event.
Year(s) Of Engagement Activity 2020
URL https://m.facebook.com/ZINCVC/photos/a.1957006657893446/2742331126027658/?type=3&source=57
 
Description Promoting Mental Health & Wellbeing of BAME Staff through COVID & Beyond - CNO - NHS England and NHS Improvement 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Invited to talk at the CNO - NHS England and NHS Improvement event about the impact of the pandemic on Black, Asian and ethnic minority NHS staff.
Year(s) Of Engagement Activity 2021
 
Description TIDES Advisory Group - meeting 1 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Advisory group made up of NHS and Social care staff with an interest/experience in, or on-the-ground experience of action to address Equality, Diversity and Inclusion issues affecting Black, Asian and minority ethnic staff at work, to;

Helping to steer the TIDES study.
Helping us make key decision about the study, such as what questions to ask staff.
Supporting us to increase representation of ethnic minority healthcare staff in our study.
Year(s) Of Engagement Activity 2020
URL https://tidesstudy.com/phase-2/
 
Description TIDES Advisory Group - meeting 2 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Advisory group made up of NHS and Social care staff with an interest/experience in, or on-the-ground experience of action to address Equality, Diversity and Inclusion issues affecting Black, Asian and minority ethnic staff at work, to;

Helping to steer the TIDES study.
Helping us make key decision about the study, such as what questions to ask staff.
Supporting us to increase representation of ethnic minority healthcare staff in our study.
Advise us on the Race Equality Impact Assessment Toolki and training resources to be developed.
Advise us about how to share our findings and to get the resources developed into practice.
Year(s) Of Engagement Activity 2020
URL https://tidesstudy.com/phase-2/
 
Description TIDES Stakeholder Opinion Group - meeting 1 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Stakeholder opinion group involving NHS and Social care workers with an interest/experience in, or on-the-ground experience of action to address Equality, Diversity and Inclusion issues affecting Black, Asian and minority ethnic staff at work?

The meeting was focused on questions for an ethnicity-focused survey and interviews with healthcare professionals.
Year(s) Of Engagement Activity 2020
URL https://tidesstudy.com/phase-2/