We have all watched events unfold in the US following the death of George Floyd and those before him. For many colleagues, awareness of these issues is not new. Indeed, racism is something many have experienced as part of our work within our NHS.

As well as lived experience of disadvantage and inequality, recent data demonstrates the disproportionate impact of coronavirus on our black, Asian and minority ethnic (BAME) colleagues. PHE’s more recent data analysis reaffirms much of what we have learnt since the pandemic started.

Although both of the above factors have combined to create anxiety and distress, they have reinforced the urgent need to improve experiences for BAME communities. We are writing to share what we are doing to ensure that the NHS – a microcosm of our society – heads closer to being not only the world-leading provider of care but also the best place to work for all staff.

We know this is the time for real action rather than words. Since our last update NHS England and NHS Improvement as a leadership organisation has further-increased efforts to address particular issues faced by BAME members of staff which include:

• Sending further clear instructions to employers on their duty to carry out risk assessments, and a recommendation that they should risk-assess staff at potentially greater risk and make appropriate arrangements accordingly, plus information on how we are supporting them to do this.
• Asking employers to further focus educational campaigns around PPE, hand hygiene and social distancing towards agency staff, porters and cleaners who may not benefit from traditional information cascades.
• Sharing best practice of staff being supported through fit testing and infection prevention and control action cards for local adaption and adoption.
• Reinforcing the importance of a safety and learning culture through promoting Freedom to Speak Up Guardians to staff and strengthening their work with our WRES programme.
• Launching the Race and Health Observatory to take action on the underlying causes behind the disproportionate impact on BAME communities

Our work is informed and impacted by actively listening to the immediate concerns of staff and BAME networks. Last week we hosted a meeting of 240 BAME staff network and EDI leads, system leaders and advocates, and were joined by NHS England’s Chair David Prior in a powerful session to enable the role of BAME network representatives as powerful vehicles for change in our organisations and across our systems.

This session identified some concrete steps needed to overcome the barriers to progress we have seen before, for example an expectation of transparent senior sponsorship that enables BAME networks to bring identified issues to the top of the agenda such as support around raising concerns and tackling discrimination within workplaces, backed by external EDI education and support for senior leaders.

This session with BAME network leads and advocates reinforced that it is not the responsibility of any single group to act – to bear the full burden of this huge practical and emotional labour. We know that too many times in the past, speaking out has not led to action or worse, has led to reprisal. We know this has affected your confidence in the very mechanisms designed to respond to your concerns.

We (Nikki and Prerana) have often been told that we can’t have faced any racism or discrimination because we are in the positions we are, which shows how much work there is still to be done to demonstrate solidarity and active allyship in the pursuit for equality. For years it has fallen to people of colour to educate others, but we need our white friends, colleagues and citizens to step into this space with us. This can be done by individuals making their own personal commitment to take time out with widely available resources (examples below); NHS line managers supporting society’s focus on Black Lives Matter and the impact of covid-19 on BAME communities; and team leaders and members engaging in conversations about race, bias and exclusion.

Our CEO Simon Stevens’ statement to staff shared publicly last week identified the COVID-19 pandemic as a fundamental inflection point for the NHS…”because if we’re honest with ourselves, the NHS as an embedded part of society is both part of the problem and part of the solution. More systematic action is needed to tackle the underlying causes of health inequality.”

We repeat our thanks to those of you who continue to show up despite feeling anxious and hurt. To those of you who continue to share your lived experience so authentically. To those of you who continue to have the difficult conversations, often in hostile environments, who have called out behaviours not consistent with our values, and who have championed the rights of others. We support you.

We know that it is our duty (along with leaders across the National Health Service) to provide leadership, reassurance, and protection to our staff. And we will do everything we can to ensure that is the case. We will continue to update you as this work continues to progress.

Links:

• Ethnic minority deaths and Covid-19: What are we to do?, Suzie Bailey, Michael West (The King’s Fund)
• Advice for being an ally, Dr Muna Abdi (BAMEed)
• Let’s not make excuses for prejudice, Partha Kar (BMJ)