A year ago today, we lost the first of too many healthcare workers to covid as Dr Adil El Tayar and Dr Habib Zaidi passed away. Since their tragic deaths, hundreds of NHS workers have died from covid.

The full extent of the devastation that has been wrought on the NHS workforce by covid is yet to be established. Even the figure of 883 NHS staff covid deaths only records those who died between March 2020 and December 2020 and does not include the many more who have tragically died during the second wave.

We do not yet have data on some other major effects of this pandemic on the NHS workforce, such as the impact of long covid; the toll on mental health of witnessing death on an unprecedented scale; the trauma of treating colleagues and watching them die. This trauma is multiplied in those cases when, only weeks ago, those colleagues were standing shoulder-to-shoulder with us in the pandemic response.

The families of those who have died need to have answers regarding the circumstances, both ethically and legally. An inquiry is needed as soon as possible. However, the need for honesty and openness appears incompatible with recent public pronouncements, such as denials of problems with PPE. These responses seem more concerned with disingenuous denials and spinning of facts rather than a true desire to learn and not repeat mistakes in the future.

Early in the pandemic it was clear that, in the UK, those from BAME communities were at greater risk of dying from covid. Yet a report by Public Health England, published in early June 2020, on the disproportionate effects of covid on black, Asian and minority ethnic people, was criticised for leaving out submissions from third party organisations, which included claims of “structural racism”. The third party submissions were later published, in mid-June 2020, but only after an outcry from opposition parties, the Royal College of Physicians Edinburgh, the Doctors’ Association UK and the Muslim Council of Britain, among others.

One section of the report stated that “…the pandemic exposed and exacerbated longstanding inequalities affecting BAME communities. Action is needed to change the structural and societal environments. There is a legal duty and moral responsibility to reduce inequalities.” The implication of the initial attempts to withhold this information was to summarily dismiss or to attempt to spin potential systemic and structural influences that may predispose mortality.

These actions deeply affected ethnic minority families in mourningas well as the memory of the NHS co-workers who are no longer with us. The government had discarded their sacrifice, despite pressure from groups like the The Doctors’ Association UK making efforts to point out the harm of these actions .

While the government repeated the phrase “follow the science” with a religious zeal, it was striking that they ignored years of evidence with regard to health inequality in the UK. Part of the PHE report showed that the pandemic exposed and exacerbated longstanding inequalities affecting BAME communities. Some of these inequalities arise from the “hostile environment policy” that has been in place over the last decade. Research has shown the deleterious effects of this policy on health, which will have been exacerbated during the pandemic.

Sections of the BAME report stated: “Lack of trust of NHS services and healthcare treatment resulted in their reluctance to seek care in a timely basis and late presentation with disease.” Even before the coronavirus crisis, this was evident and something I had seen personally. It has now been dramatically exacerbated in the era of covid and failure to acknowledge the harmful health impacts and disenfranchisement of the hostile environment is killing people. However, to acknowledge this requires introspection and a willingness to accept responsibility for actions past. Such willingness appears distant at best.

The institutional failure to safeguard the lives of BAME NHS workers has been duplicated in both political and medical sectors. When it became clear that so many of the early healthcare worker deaths were from a BAME background, the response from NHS England was to institute mandatory risk assessments in June 2020. However, the feeling of frontline staff is that these have largely been a paper exercise with no follow through and many BAME workers feeling exploited and at risk.

More recently the strategy has evolved to include heavy spin employed to deny the problems that frontline NHS staff have faced, as demonstrated by health secretary Matt Hancock. An egregious example was his claim that “there was no national shortage of PPE”, which in a demonstration of Nixonian doublespeak seemed to hinge on the definition of “national.”

While undoubtedly a media team congratulated themselves on this insulting view of the past, we remembered cherished colleagues like Dr Peter Tun, who treated covid patients at the Royal Berkshire Hospital in Reading. He pleaded for vital PPE supplies three weeks before dying from the disease last April. Andrew Ekene Nwankwo, a nurse at Broomfield Hospital in Chelmsford, also died of covid after desperately trying to buy his own PPE online.

We are not imagining the mourning of colleagues who had treated covid patients with inadequate PPE. They are not only numbers, but people we miss deeply. This disregard for the experience of shell-shocked NHS staff to save political face is beneath contempt. March 2020 was a month of chaos, with frontline NHS staff screaming at the government that they felt like “cannon fodder” while having to work without PPE.

Politicians and their support structures do not normally have to face fatal consequences of the decisions they have made. However, in this pandemic they have been laid bare as every decision that has been made had a fatal consequence. Every £1billion spent on unusable PPE is money not spent protecting frontline staff. Every £1billion that did not result in a workable Test and Trace programme was money not spent on ensuring lower patient numbers in our overloaded hospitals over the last year. These are very real consequences that must be faced up to. Blame must not be the aim but all those who have been involved must bear responsibility for decisions that led to avoidable deaths. Running from that responsibility disrespects the memory of our colleagues that passed away and the thousands that continue to mourn for their loved ones who have died over the last year.

The time for empty talk and rhetoric is over. The tactic of hiding from the truth is not an option. After the shocking revelations of poor care at Mid Staffordshire Hospital in 2009, Robert Francis QC concluded his inquiry with the words that “there lurks within the system an institutional instinct which, under pressure, will prefer concealment, formulaic responses and avoidance of public criticism” and “an institutional culture which ascribed more weight to positive information about the service than to information capable of implying cause for concern”. Several years later he appears, sadly, to have perfectly described the attitude of the political establishment with regards to deaths from coronavirus, especially those of healthcare workers; once heroes to be applauded, yet now treated as a mere inconvenience.

Their memory deserves more.

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The number of NHS staff reporting being unwell due to work related stress has increased yet again this year. In the NHS staff survey reported today over 40% of staff reported feeling unwell due to work related stress. The number has been steadily rising since 2016.

Worryingly the number of NHS staff who reported personally experiencing discrimination at work in the last 12 months has increased yet again. In particular, staff reporting discrimination at work from patients, relatives or members have the public has increased for the fifth year in a row, a 24% increase compared to 2015. Being from an ethnic minority group was given as the most common reason for discrimination.

Frontline doctors have often given this as a key reason for poor morale in the NHS, however the impact of discrimination is more wide reaching and may have an impact on career progression. It is concerning that only 71.2% of BME staff said their organisation provides equal opportunities for career progression / promotion compared to 86.9% of white respondents. Similar trends were also seen amongst staff with disabilities.

Dr Rinesh Parmar, Chair of The Doctors’ Association UK and an anaesthetic doctor said:

“Whilst there have been many improvements seen in the NHS Staff Survey we are extremely concerned that staff are reporting increasing levels of discrimination, in particular from patients, relatives and members of the public. BAME doctors make up a valued part of our workforce, as do International Medical Graduates, without which the NHS would collapse. Many BME doctors have told us they do not feel welcome in the UK anymore and there is no doubt this a reflection of this government’s hostile environment. We must do more to value BAME staff as well as those who have trained abroad, without whom the NHS would simply cease to function.”

Dr Samantha Batt-Rawden, Co-Founder of DAUK and an intensive care doctor said:

“It is extremely worrying that nearly half of all respondents to the NHS staff survey reported feeling unwell with stress just in the last 12 months. The fact that this number is rising year on year should be red flag to this government, especially at time when the NHS is short of 100,000 frontline staff. Doctors have repeatedly told us they do not feel cared for by their workplaces, and that spiralling workloads are contributing to occupational stress and burnout. Too often ‘wellness’ interventions such as yoga and mindfulness are put forward to try and address this but these programmes will not fix the core issue. What NHS staff need are real improvements to their working conditions if the government has any hope of stemming the haemorrhage of staff out the NHS.”

CONTACT

press@dauk.org

1. The Doctors’ Association UK (DAUK) is a trade association for UK doctors. Run by frontline NHS doctors, DAUK campaigns for patients and the NHS as well as advocating for the medical profession.

2. Results of the NHS staff survey published Tuesday 18th February. The national briefing document can be found here.

3. Last week The Doctors’ Association UK collated over 600 stories from frontline doctors about mistreatment whilst working in the NHS. A selection of these stories were published as the front page story of the Daily Mirror. Further stories can be given on request.

“Aisha Majid asks why ethnic minority doctors are more likely to be investigated by the UK’s medical regulator and what is being done about it

If you’re an ethnic minority doctor working in the NHS you’re twice as likely as a white doctor to be referred by your employer to the General Medical Council (GMC). If you trained outside the UK that figure rises to two and a half times as likely.

These facts are not new. But less is known about the reasons why, says Roger Kline, research fellow at Middlesex University Business School and coauthor of Fair to Refer?, a 2019 report commissioned by the GMC that sought to understand why certain groups of doctors more often fell foul of complaints about their fitness to practise.

“People have known there’s been an issue around disproportionality without understanding what lies behind it,” says Kline. He says that the case of Hadiza Bawa-Garba, who was struck off the medical register after the death of a 6 year old child and then reinstated, was the tipping point for action.

Although it’s not only employers who can refer doctors to the GMC, only referrals by employers show a disproportionate representation of ethnic minorities (see box). Complaints from employers make up only 4.3% of all referrals—but 77% of these result in a GMC investigation, compared with only 9% of complaints from patients.

Dynamics of belonging

The Fair to Refer? report highlighted a pervasive insider-outsider dynamic in the NHS. Doctors perceived as lower status outsiders—such as doctors trained outside the UK—are not given the support they need by bosses and colleagues and are more likely to end up being blamed and facing disciplinary action when things go wrong.

Ethnic minority doctors, whether trained in the UK or overseas, may also feel less confident about raising concerns or challenging an accusation for fear of a backlash. They are also over-represented in roles that can isolate them, such as in locum posts or in small or demanding general practices, leaving them more vulnerable to complaints.

About 40% of doctors working in the NHS in England in 2019 were from ethnic minorities,2 and 38% of the 300 030 doctors working in the UK had trained overseas. A BMA survey carried out the same year found that only 55% of ethnic minority doctors felt included in the workplace, compared with 75% of white doctors.3…

Dr Jenny Vaughan is law and policy lead at the Doctors’ Association UK and led the successful campaign to overturn the conviction of David Sellu, a surgeon who was wrongfully accused of gross negligence manslaughter. She says that the reluctance of some ethnic minority doctors to raise concerns is what makes them particularly vulnerable.

“Minority ethnic doctors feel less confident about reporting concerns, because they feel they are more likely to be blamed because there’s a lot of subconscious bias,” says Vaughan. “Fair to Refer? revealed how toxic working conditions are more likely to lead to a disproportionate referral rate of ethnic minority doctors to fitness to practise processes. The figures [in the report] illustrate how it appears easier to blame ‘outsiders.’”

https://www.bmj.com/content/368/bmj.m338