‘What starts off as a germ, a little tiny piece of behaviour, or maybe a big aggressive piece of behaviour, left unchecked, it spreads… like a virus.’

The Royal College of Nursing (RCN)’s North West Regional Director, Estephanie Dunn, recently attended the launch of the findings of a study titled Nursing Narratives which delves into the structural inequalities that disproportionately affect Black, Asian and minority ethnic (BAME) NHS staff. The study sheds light on the ‘disturbing’ and ‘upsetting’ realities of how BAME nurses have been treated during the pandemic, making it crystal clear that something has to be done.

The team behind the study is calling upon the NHS to ‘implement a Zero tolerance to racism policy and practice’ to ultimately ‘build a more compassionate NHS with respect and equity for Black and Brown workers.’ Their new accompanying documentary, Exposed, sees BAME nurses speaking openly about the traumatic nature of their roles during the pandemic.

Covid risk inequalities

In the early days of the pandemic, the numbers weren’t very transparent in terms of the number of staff who were dying. Felicia Kwaku (one of the nurses featured in the documentary) made her own list of 200 staff that had died. She counted over 70 nurses and, barring 3, they were all BAME. Esther Akinpelu also noticed a clear pattern in terms of seniority – none of these deaths were in upper management, it was the lower paying roles that were hit hardest.

Figures released as early as April 2020 showed a startling reality:

21% of all staff are BAME – 63% of healthcare workers who died were BAME.
20% of nursing staff are BAME – 64% of nurses who died were BAME.
44% of medical staff are BAME – 95% of doctors who died were BAME.

The BAME nurses who spoke in the documentary were acutely aware of the risk they were facing. Some felt like they were being sent to their deaths every time they were asked to work in the covid ward.

NHS England advised that employers should risk-assess all staff: ‘Ethnicity should be considered in combination with other risk factors, including age, gender, and co-morbidities. The assessment should consider whether adjustments to work or redeployment might be appropriate.’

However, some nurses who had been risk assessed and identified as having vulnerabilities were still asked to work on the front line and have unfortunately since passed away. Nurses in the documentary felt they couldn’t raise their concerns around their increased risk as they would just be accused of ‘playing the race card’ and being a bad team player.

PPE inequalities

Neomi Bennett was allocated to a covid ward and not given protection. She asked for a filtered N95 mask (as opposed to the now very familiar blue surgical ones) and was told she couldn’t have it because ‘it would scare people.’ Multiple nurses in the documentary reported being told to reuse their PPE – including masks – on multiple occasions. Neomi Bennett also reported one instance where she was given less access to PPE than her white counterparts; at first, she thought this might have been because she was an agency nurse, but it soon became apparent this was not the case.

June Green and Benash Naimeen recounted their difficulties with finding masks that fit. Masks are designed with typical white noses in mind, so often don’t fit different shaped noses. This left many BAME nurses with PPE that didn’t offer proper protection as it was loose, falling off, or slipping down. Asian women, for example, have been found to pass fit tests for N95 masks only 60% of the time compared to 90% of white colleagues.

Nurses with afro hair also couldn’t find head protection that was suitable and had to improvise protection – Neomi Bennett used yellow clinical bags to cover her hair. This act feels almost symbolic of how little care was given to this community and the extent to which BAME nurses were left to fend for themselves.

Racism in the NHS

While the racism in the sector wasn’t immediately apparent when these BAME nurses were in their early studies, the reality made itself known during placements. One nurse reported a patient refusing to be treated by her because she was black, but the most hurtful part of the interaction was that none of her new colleagues stood up for her. A recent NHS report highlighted the shocking reality that many BAME staff experience discrimination from managers at work.

This poor treatment and lack of support from colleagues take a considerable toll on staff. Felicia Kwaku commented she ‘had staff at the point of self-harm because of the degree of bullying and harassment.’ Another nurse, June Green, perceptively noted the bleak reality that ‘because they care less for you, you become careless with your own health.’

‘Research indicates there is a link between harmful cultures and the safety of patients, and the well-being of staff, so resolving these issues can’t wait,’ noted RCN’s North West Regional Director, Estephanie Dunn. ‘Staff of all ethnic backgrounds have worked flat out during this pandemic and I am extremely saddened to continuously hear about the mistreatment and prejudice these professionals are facing.’

Progress?

While some employers have admittedly made progress in addressing race inequality, ‘the latest performance by NHS trusts against the WRES indicators shows that BAME workers have worse outcomes than their white colleagues in relation to career progression, disciplinary action and other measures.’ In fact, ‘White nurses are almost twice as likely, in some cases, to get promoted compared with their Black and Asian counterparts.’

The facts and figures about racism and discrimination within the NHS – especially during the pandemic – have been laid bare for many months. It is hoped that this documentary centred around the personal realities of this will expose the true individual cost of continued inaction. If decision-makers can see what these numbers look like in real human terms, perhaps an NHS with zero tolerance for racism and discrimination will become a reality.

Our NHS relies entirely on its people, and their stories must be heard.