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Consultant at the Royal Surrey NHS Foundation Trust, has been awarded government funding for a ‘first of its kind’ study into the link between the Black, Asian and minority ethnic community and an increased risk of Covid-19.
Case studies
- Diverse representation in decision-making – a community approach to protection from COVID-19: Frimley Healthcare System
- Diverse representation in decision-making – an organisational approach to protection from COVID-19: Surrey and Sussex Healthcare NHS Trust (SASH)
- Diverse representation in decision-making – a whole system approach and response plan: Sussex Health and Care Partnership ICB
1. Diverse representation in decision-making – a community approach to protection from COVID-19: Frimely Healthcare System
Background
Increased rates of COVID-19 are impacting communities with high numbers of BAME residents. 54% of Slough’s population fall within this category and 27% do not speak English as a first language.
Other factors that make this community vulnerable include high deprivation, high population density neighbourhoods and multigenerational, larger households.
Aim and approach
An inclusive partnership has been created in the area to pilot a multi-agency approach which can identify and promote effective interventions. This is supporting individuals and communities to:
- protect themselves and their families by taking preventative steps
- benefit from GP and community services that are easy to access
- reduce their morbidity and mortality risk
- tackle health inequalities.
The partnership brings together Frimley Health and Care ICB, Slough Borough Council and Public Health and community, faith and voluntary sectors. The pilot has five areas of work:
- Improving information – development of a risk profile, enhanced ethnicity recording and sharing of NHSE/I data and BME health impact assessments.
- Community awareness and engagement – social marketing, multilingual communications, and engagement with faith and cultural leaders to help build community resilience.
- Prevention and harm reduction, including frailty detection and management and mental ill health prevention.
- Clinical management
- Enhanced community swabbing for hard to reach symptomatic patients.
- Preventive GP practice outreach work by proactively managing patients in the community for blood pressure, diabetes and weight management.
- Proactive remote pulse oximetry home monitoring for patients with suspected COVID/positive COVID.
- Workforce – undertaking risk assessments with health and care staff and volunteers and understanding and capturing staff experiences.
Case example:
“I have approximately 5,000 patients of which 90% are from a BAME background. When COVID started in our area, I recognised that many of my patients lived in large, multigenerational households and this could potentially impact the spread of infection within a single household. To protect both the patients, staff and wider community, KMC decided to review any suspected COVID patients in their own homes. Home visits are carried out with full PPE and has enabled the GP practice to keep COVID-free.
Furthermore, by visiting the patient at home, I could assess the other family members and discuss the importance of self-isolation within the household. All COVID-positive patients were coded on our system and as we knew who lived with them, an alert was placed on other members within the household in case another family member became ill. Therefore, proactively identifying potential patients in advance to our clinicians.
A local voluntary sector council collaboration – One Slough – has also been a great source of help with communicating to families and supporting vulnerable members within the community. They have helped with providing food, medical supplies and will be part of our wider support in accessing these hard to reach communities.
It has been an emotional period where our practice has lost patients and a staff member. Our own families are at risk too, but I know our patients appreciate the care we are taking, and as each day passes, we are learning how to help the next patient. We are now embarking on a proactive approach, introducing preventative measures, as identified above, and are beginning to look at evidence and understand the virus and its effect on our BAME community.”
Dr Priya Kumar
Kumar Medical Centre, Slough
GP and Primary Care Lead for Slough
2. Diverse representation in decision-making – an organisational approach to protection from COVID-19: Surrey and Sussex Healthcare NHS Trust (SASH)
Background
To help reduce transmission of COVID-19, trust leaders wanted to ensure all 5,000 staff, including those in support service roles, felt safe.
It was committed to ensuring all colleagues understood the emerging evidence that COVID-19 was having a disproportionate impact on black, Asian and minority ethnic (BAME) communities and what the Trust could do proactively to protect them.
SASH established a BAME staff network in 2018 to listen to their BAME colleagues and offer advice and guidance to trust leaders. This Network has been integral to the approach described below.
Approach taken by SASH
- Early risk assessment of vulnerable staff. This included talking to all staff with higher risk factors and offering the opportunity to work in a lower risk area or from home. This early intervention has helped to minimise COVID-19 sickness absence and mortality rates and offers an example of good practice as described in the South East regional risk assessment tool.
- Hosting socially distanced peer to peer drop-in sessions for BAME staff to discuss concerns and talk to experts face to face, including members of the BAME staff network, clinicians, senior leaders, infection control, workforce, wellbeing, communications and chaplaincy teams. This has reassured staff.
- Feedback is collated from the drop-in sessions and is being used to keep all staff updated and involved, ensuring a high level of ongoing support for BAME staff in particular.
- Offering tailored support and communications channels to different communities and for staff who do not speak English as a first language, including:
- a dedicated WhatsApp group to keep those informed of support on offer.
- a dedicated App for staff to access individual peer to peer support.
- new COVID action cards for staff specifically for facilities teams, porters and housekeepers, with step by step infographics to help them understand proper application and removal of PPE and working in COVID-19 areas.
Staff say that they clearly understand how to keep themselves and their colleagues safe at work and were enthusiastic about having the opportunity to talk to the media recently about the positive work the trust has been doing.
“I was really scared I was going die. What is going to happen?”
Randolph, Paediatric Nurse
“I’m happier now I know that I’m following the guidelines and I’m well supported and have the PPE.”
Priscilla, Clinical Support Nurse
3. Diverse representation in decision-making – a whole system approach and response plan: Sussex Health and Care Partnership ICB
Background
The Sussex BAME Covid-19 Response Programme has set out a framework for action across Sussex, which draws on work already being carried out by partner organisations in the system to mitigate the risk to the BAME workforce and local community; and the additional support put in place to save lives through measures to protect staff via health and social risk assessments, testing at scale, provision of PPE and monitoring data.
The plan also includes a strategy for full engagement with BAME staff and BAME communities and stakeholders in Sussex.
The programme will act as a single focal point for coordinating the Sussex response and will coordinate, track and report on all actions being undertaken by health and care partners in Sussex. The system programme is being led by one of a BAME executive: Executive Managing Director at Brighton and Hove Integrated Care Board, alongside the ICB SRO as co-lead.
Framework of the Plan
The Sussex BAME Covid-19 Response Plan is underpinned by three key domains:
- Safeguarding our Workforce
The first includes both the health and social care workforce across Sussex and covers:
- Training and compliance on appropriate use of PPE, guidance on re-fit tests, support of use of PPE
- Staff testing
- Risk assessment
- Prehospital care (e.g. telephone follow up of staff who are ill)
- Recovery (e.g. review of the quality, access and cultural appropriateness of the current Health & Wellbeing and Mental Health offer for BAME communities)
- Safeguarding our Population (clinical)
We need to mitigate risk in the community and ensure our BAME communities with long term conditions (e.g. diabetes, hypertension, CVD) are reviewed. A Locally Commissioned Service has been put together to use the relationship that already exists with General Practice to help us do that more quickly.
- Engagement and Communication
A key element here is to bring together and work effectively with our BAME workforce and resident population. It includes engaging and establishing conversations with existing BAME, faith and other staff networks; improving COVID-19 meaningful communication amongst BAME community groups; ensuring culturally appropriate awareness and support in the workplace for BAME staff; increasing BAME representation in communications and on the media.
In addition to the three key domains, a governance structure has been created to sustain the action plan in the long term.
Key achievements to date
A key achievement regarding all the actions and plans that have been delivered is the very short timeframe in which all the activities below have happened.
- Safeguarding staff
- Sussex BAME staff engagement event, Friday 5th June – over 300 people participated.
- Primary care communication on guidance and standard operating procedures issued to general practice.
- All partners in the SHCP are developing appropriate risk assessments for staff.
- Meetings with senior public health researchers at Brighton Medical School have taken place to discuss collaborative work to support this programme. The University has funding for research to support domiciliary care and care homes.
- Safeguarding our community
- Medical Leads: Chief Medical Officer, CCIO, SIRO, Sussex Integrated Care Board; Deputy Medical Director – Sussex Community Foundation Trust, have been
- A COVID-19 Emergency Locally Commissioned Service (LCS) has been compiled and signed off, which will offer extended health services to local BAME
- The Director of Public Health for East Sussex has been appointed the Public Health Lead for the population workstream.
- Working groups have been set up with Sussex Departments of Public Health to agree a strategic approach to collating data in Sussex to support this programme.
- Communication and engagement
- A Sussex BAME health and care staff engagement event took place in early June 2020, with over 300 people attending.
- Creating partner events with the Voluntary and Community Sector (VCS) to engage with health and care workers in the Third Sector, working with BAME network leads.
- External communications and engagement plans have been developed to support the workforce and population workstreams.
- A key stakeholder engagement advisory group has been established and the first meeting has taken place.
- VCS partnerships have been commissioned to undertake targeted engagement in key hard to reach localities.
- Establishing groups and links with local linguists and community leaders to support the programme.