The Race Equality Foundation, the organisation I head, has a strong track record of recruiting staff that reflect the communities we serve. Often our staff are grappling with the same issues in their own lives that the Foundation is addressing in promoting racial equality. The Covid-19 pandemic has demonstrated this in ways that none of us could have imagined.
Just as we had published a briefing warning of the greater risk black, Asian and minority ethnic (BAME) communities faced, we got news that a relative of a member of staff had passed away in hospital after testing positive. Just over a week later, we heard that a long-term collaborator of ours who had been working for us as recently as December 2019 had also passed away. She left behind a sister for whom she was the main carer.
In the midst of all this terrible news we found ourselves with four members of staff off sick with Covid-19 symptoms, with only one testing positive. The bad news did not stop there. At the beginning of May we received news that a colleague in the US had passed away too after testing positive. Shockingly for us, he was in his early 30s. As I was giving thanks that two of my own family, both frontline hospital doctors, were on the road to recovery, I got news that my uncle had passed away after spending nearly four weeks on a ventilator.
I found myself having a conversation many others have had, where my cousins told me “you cannot attend the funeral.”
At times it has felt that the Foundation was living the pandemic in microcosm: the majority of our staff are from black, Asian and minority ethnic communities, the very communities disproportionally impacted by Covid-19. In a recent analysis we published with the New Policy Institute, we showed that while there was some variation between communities and between men and women, black, Asian and minority ethnic communities were at greater risk of being infected by Covid-19 (56 per cent higher for working-age and 69 percent higher for people age 65 plus) and that they were are also at greater risk of dying once infected (12 per cent higher for working age and 19 per cent higher for people age 65 plus). This disproportionality persisted even when deprivation was taken into account.
The disproportionate impact, while distressing, was predictable. The dawn of a new decade saw a series of warnings about the persistence of racial inequalities and the haphazard response to them. The coroner, in reporting on the death of Errol Graham, noted that “the safety net that should surround vulnerable people like Errol in our society had holes in it”. Graham, an African Caribbean man with long-term mental health problems, was found dead in June 2019 by bailiffs who had entered his flat to evict him. When he was found, Graham weighed 30kg and there was virtually no food in his flat.
Unfortunately, the Graham case fits a pattern of discrimination and disadvantage documented by the Race Equality Foundation and the government-commissioned review into the Mental Health Act. At the same time, Michael Marmot, revisiting his review of health inequalities, pointed to the worsening of inequalities over the past 10 years across a range of measures from income to housing to exclusion from school, concluding that “these outcomes, on the whole, are even worse for minority ethnic population groups and people with disabilities.”
These reports were published almost a year after the NHS Long Term Plan had recognised the threat posed by health inequalities to the nation and to the health care system. The Plan committed the NHS to address health inequalities, including the multi-morbidity experienced by black and minority ethnic communities, including tackling equality issues for BAME staff working in the NHS. What improvements have taken place are difficult to identify, with evidence showing that initiatives such as the Workforce Race Equality Standard have had little impact. The most recent NHS Staff Survey reported another rise in BAME staff saying that they had been bullied or harassed by other staff.
Despite the evidence, the initial response of healthcare and government was bereft of any recognition that the Covid-19 pandemic was occurring in the context of persistent and rising health inequalities. There was certainly no recognition that black and minority ethnic communities were at particular or at greater risk at the start.
The development of NHS Volunteer Responders was just one example, with no recording of ethnicity of the people volunteering and, as importantly, no recording of community language skills combined with no way for referrers to note that those needing support required a responder with community language skills. Worryingly, the approach to the healthcare workforce was equally problematic, with risk assessments not carried out, ill-fitting PPE or worse, lack of PPE, and slow response to the mounting evidence of a disproportionate numbers of deaths of black, Asian and minority ethnic staff.
As we approach a second wave of infections, it is important to record that while the disproportionate impact has been predictable, this does not mean it was inevitable. So, we called for the factors that might dissuade people to self-isolate to be addressed urgently. Key was protecting people whose income would be jeopardised and ensuring that these people were actually able to isolate. The paltry announcement of support for those who will lose income if they self-isolate – statutory sick pay of £95.85 a week – is a clear indication that we are still not willing to take the steps that will protect those at disproportionate risk. Combining this with the punitive fines that have been announced will only intensive inequality.
Jabeer Butt is the chief executive of the Race Equality Foundation