An analysis of media reports published in the Health Services Journal in April showed that 95% of the Doctors who have died from Covid-19 were from BAME backgrounds. Currently 44% of NHS doctors are identified as being BAME. To date, the NHS has not enacted a uniform, timely approach to protecting this vulnerable group of staff. Such action is urgently needed.
The Office of National Statistics has published the data showing that being Black, Asian or Ethnic Minority in the UK is a serious risk factor for Covid disease. In comparison to White ethnicities, the risk of death is reported as:
7.3 x in Black ‘other’ groups (i.e. not Caribbean or African)
4.3 x in Black Africans
3 x in Bangladeshis
2.5 x in Black Caribbeans
2.8 x in Pakistani
1.5 x in Indians
Risk assessments for BAME staff have been produced by various organisations, based on guidance from Public Health England published on 12th May. It has not yet been clarified however who should be performing the risk assessments, whether or not it is mandatory and any timescale for completion. There is reported significant national variability between organisations.
The PHE report discusses risk factors including age, sex and disabilities and makes suggestions for protection of staff such as provision of adequate PPE and redeployment for example. However, it is unclear how risk should actually be stratified in order to realistically protect staff and how the information should be actioned if suggested options are not achievable.
Many BAME staff report that they have not yet had any risk assessment. Furthermore, in some instances, staff members have been identified as high risk, but suggested options to ensure their safety have not been supported on an organisational level. Concerns have been expressed therefore that some risk assessments are being performed without plans for provision of action to protect staff identified as being high risk.
We know that BAME doctors are more likely to be investigated by the GMC than their white counterparts, are less likely to feel they have been using offered PPE and are more likely to report having been bullied at work. Therefore, as a marginalised group, individuals may be less likely to speak up to request their own risk assessment unless it is made mandatory with a timescale.
The risk assessment loophole
All risk assessment frameworks published to date are reliant on staff being aware of pre-existing health conditions. However, many of the identified risk factors such as Chronic Kidney Disease, Hypertension and Type 2 Diabetes are indolent and sometimes only picked up incidentally during screening for other reasons.
A proportion of staff therefore will therefore be incorrectly identified as being safe to continue in unmodified patient-facing roles unless such risk factors are actively screened for.
I suggest therefore that all BAME staff be offered the option of what could be termed, an ‘NHS BAME Staff Medical,’ which could either be commissioned in General Practice and / or Occupational Health. This would be optional, but senior leaders should empower and enable all staff to request such a consultation. Priority should be given to those who also have other known factors that put them at higher risk of death from Covid-19 but who do not meet the current criteria for shielding.
BAME staff should be unconditionally supported to step back from the front line if they so wish, particularly when one considers the ONS data, that people who are of Black African or ‘other’ ethnicities have four to seven times higher risk for serious Covid infection compared to White ethnicities, at least whilst awaiting a BAME staff medical. We must also consider ways in which these staff can be protected given that their ethnicity alone significantly elevates their risk.
If health conditions are revealed, risk assessment should be updated and workplace environment or duties modified appropriately to ensure staff safety and wellbeing. The individual can also consider any treatments or lifestyle actions, with the support of their employer, to control identified conditions and also reduce their risk of developing more serious disease in the event of contracting Covid-19.
This suggestion is supported by the Health and Safety Work Act 1974 that requires all staff, all processes and all workspaces to be risk assessed and those risk assessments to be regularly reviewed.
‘NHS BAME Staff Medical’
Current evidence for risk factors for serious Covid disease guide the following suggestions for measurements that could be included in this assessment:
- Blood pressure
- BMI
- Urea and Electrolytes
- HbA1c / glucose
- Liver Function Tests
- Non fasting lipids
- For menstruating women: Full Blood Count and Ferritin given that they may have Iron Deficiency Anaemia affecting oxygenation
- Lifestyle questions and relevant analysis such as Qrisk3
Audit would of course help guide whether this proposal would indeed be effective.
Final thoughts
Safety of staff at work should continue to remain of paramount importance. The findings of the HSJ analysis stressed the importance of staff having access to the appropriate level of single-use Personal Protective Equipment.
The concerns raised in the Black Lives Matters protests have stemmed in part from weeks of public dissatisfaction that the UK Government has failed to announce any measures for protecting its BAME communities. As an organisation, the NHS can lead the way in showing that it does take the health of a large proportion of its workforce seriously (44% of NHS doctors are identified as being BAME).
BAME staff risk assessments should therefore be clarified and simplified for usage. There should be a clear timescale for completion with a clear plan for realistic options for protecting staff and both organisational responsibility and accountability for completion. We should also be mindful that not all staff will know without blood tests and other measurements of health whether they have conditions which are considered risk factors and appropriate leave should be offered if this is something that they wish to explore. NHS leaders have a responsibility to empower and enable such staff to access the proposed ‘NHS BAME Staff Medical’.
Dr Sonali Dutta-Knight
Dr Sonali Dutta-Knight (MBBS BMedSci DFSRH) is a GP in Newcastle-upon-Tyne. She has taken an interest in the BAME Covid issue and is administrator of the Facebook Group ‘Health Professionals BAME Forum’ and is an active member of the BAME Primary Care Leaders Network. Follow her on twitter @TheBAMEGP or read her blog https://medium.com/the-bame-gp .
Declaration of interests
I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.