Structural inequalities lie behind pandemic impact on BME communities

Joan Saddler

The effects of long-standing health and socio-economic inequalities and institutional racism lie behind the disproportionate impact of COVID-19 on people from black and minority ethnic (BME) backgrounds.

This is the key finding of a new report by the NHS Confederation’s BME Leadership Network, which follows a research study into the underlying factors. It is based on interviews with BME NHS leaders and clinicians, community organisations and service users, and a survey of more than 100 members of the BME Leadership Network. The project was supported by the Health Foundation.

Perspectives from the front line: The disproportionate impact of COVID-19 on BME communities also identifies failure to lift ‘hostile environment’ policies (such as eligibility checks and NHS charges for overseas visitors), lack of translation services, and a culture of bullying affecting BME healthcare workers as contributing factors.

Interviewees said this bullying culture has led BME employees to be less likely to raise concerns or share their experiences, with nearly 9 in 10 survey respondents (88 per cent) saying staff do not speak out because they fear losing their jobs.
Interviewees also agreed that despite the wealth of data collected by national bodies and numerous reviews on the relationship between health, inequalities and BME communities, the NHS and the Government had not taken sufficient action to deal with any of the root causes. More than 9 in 10 survey respondents (92 per cent) called for greater acknowledgement of the role of institutional racism in health services.

Institutional racism has had a negative impact on the accessibility and quality of services available to BME communities, as well experiences of discrimination among BME staff within NHS organisations, the report adds.

This is supported by testimonies in the report from refugee and migrant communities and the community organisations providing support.

Joan Saddler, director of partnerships and equality at the NHS Confederation, who co-authored the report, said: “The COVID-19 pandemic has brought the issue of health inequalities into the foreground in the starkest terms. Now is the time to move beyond platitudes and empty promises. It is absolutely imperative that structural health inequities and institutional racism in the NHS are treated as critical factors in service planning, the COVID-19 response and its aftermath.”

With the country in the grip of a second wave of the pandemic, the report puts forward a set of recommendations, aimed at the government and the NHS, to mitigate the risks to BME communities and to make progress on redressing inequalities. They include:
  • reviewing the potential for hostile environment policies to be a vehicle for promoting institutional racism
  • treating long-term structural health inequities and institutional racism as critical factors in any further research or work on the impact of COVID-19 on BME communities
  • commissioning a review of the availability of translation services
  • acting on the insights of local and national health inequalities data
  • making progress towards NHS People Plan commitments towards transparent, safer staff rostering practices.
The NHS Confederation will continue to work with members to address these issues, including through the NHS Race and Health Observatory, which it hosts.

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