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

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.