How The NHS Failed It’s Black & Brown Workers
Duriuring the height of the pandemic in Wales, it was revealed that workers from black, asian and minority ethnic communities are most vulnerable to Covid-19. At that time, F Clarke spoke to South asian NHS workers about how they were being overexposed to the virus, the strain on their mental well-being and the role played by structural racism.
She later interviewed the chair of race council Cymru and delved into key statistics on the impact of corona-virus on these groups of workers. The result is a powerful report that reveals the shocking way so many have been treated.
Photography Copyrights – ©Tom Davies
When Lola speaks to me one Sunday morning in June, she’s nervous. She’s speaking quietly so she doesn’t wake her family, and more importantly, so they don’t hear the details of our conversation. As she pads down the stairs, I hear her house alarm go off in the background – she’s the first up. Lola is a nurse in a major South Wales hospital. Throughout the pandemic she’s seen countless Filipino faces appear on the news: faces of healthcare workers who died fighting Covid-19, just like she has been doing.
“There’s a lot of Filipinos who are in ITU, some have survived and some haven’t survived,” she says simply. “That’s why our community’s really scared. We are scared, but there’s nothing we can do.”
One of the key messages communicated during the Covid-19 pandemic – by governments and the media alike – has been the idea of shared experience, fueled by campaigns of collectivism and solidarity: that “we’re all in this together.”
While we are all at risk of coronavirus, some of us are more at risk than others. At the height of the pandemic in April, the Intensive Care National Audit and Research Centre (ICNARC) found that 34% of critically ill coronavirus patients in England, Wales and Northern Ireland at the time were from Black or minority ethnic backgrounds.
A report by Public Health England (PHE) back in June – the release of which was delayed, with PHE denying it was to do with global anger over the murder of Black man George Floyd – found that when age and sex were excluded, people of Bangladeshi ethnicity were at twice the risk of death than people of white British ethnicity.
Moreover, it found that people of Chinese, Indian, Pakistani, Caribbean, ‘other Asian’ and ‘other Black’ ethnicity had between a 10% and 50% higher risk of death from Covid-19 when compared to white British people.
While many like to say the virus “doesn’t discriminate”, statistics suggest otherwise.
Despite this heightened risk, Lola had little choice but to be redeployed to Covid wards throughout the pandemic. When she pointed out that some staff members like herself were being redeployed more than her white counterpart, she was told by managers “[that] everybody has to take their part.”
But there is undoubtedly a feeling that healthcare workers have to ‘step up’ and get on with the job, particularly at the height of the pandemic back in June, when thousands gathered on their doorsteps weekly to ‘clap for the NHS’, displaying rainbows in their windows as a sign of solidarity.
“We always put on a brave face when we come to work,” Lola admits.
She describes at one point being the only Filipino left on her ward – where there are usually five or six – because the other Filipinos “were infected at that time”.
When asked how it felt to be put at risk again and again, Lola tentatively replies: “It just made us feel really like, you know, like we are being thrown under the bus really.”
During the early stages of the pandemic, this website reported that many NHS workers had inadequate protection while working in hospitals, yet several months later it seemed the situation had barely evolved.
Dev is an Indian nurse working primarily with elderly patients, who are also more vulnerable to the virus.
During the first months of the pandemic, his ward was classed as “amber”, meaning it was at medium risk. He describes wearing a disposable mask for half of his shift – and taking it with him on his break due to his department being short-stocked on disposable facemasks.
He also explains that they didn’t have visors until mid-May, and that at the time of our interview in June, he’d been using the same one for several weeks – bringing it home and wiping it down each time.
“Everyone [is] doing it,” he tells me frankly. “If anyone denies it, I disagree with that…I’ll be honest…yesterday, we didn’t have [alcohol] wipes,” he adds.
“We used the bleach tablets, but I don’t know how [good] they are…We have gloves. We are lucky to have gloves and aprons…we manage, but i’m just saying it’s not adequate.”
Speaking to Lola, the situation seemed similar on her ward, despite countless promises from health ministers to improve the situation. “They [management] just printed this policy, put it on the wall, if you’ve read it, okay, if you haven’t read it, nobody really cared,” says Lola.
She goes on to outline how a bank nurse, rather than a manager, had to explain to staff members the correct PPE they needed to be wearing:
“… she said, ‘no, no, no, this is what you need to do’ – and that was an NA – assistant nurse, who told us the policy of the other ward [where] she used to work. And she said, ‘yeah, this is what you need to wear.’”
As well as relying on PPE advice through word-of-mouth, Lola also describes the difficulty in dealing with inpatients, with no real indication of who has Covid-19 and who hasn’t: “[Patients] get admitted to the department. They get swabbed from A&E, and so they stay in the department until they are sure if the tests are positive,” she explains.
“If they’ve tested positive, they move to the Covid ward. And if they are negative, they get moved to their specific speciality. So really, we should have treated everybody in that department as positive because we weren’t sure if they’re positive or not.”
Not only was there confusion around what PPE to wear in the first place, but getting hold of it was an issue in itself, adds Lola: “There was a PPE storeroom on the other floor where we have to go and collect them – but a lot of times it was shut, and you have to email them and it was just begging and borrowing really, sometimes we go into another department just to get the stuff that we need.”
Lola describes the Infection Control team in her hospital as “unsupportive.”
At one point, she recalls asking for help with how to swab potential infected patients after herself and others on the ward were assigned to swabbing patients coming in and out of the department.
“Nobody trained us how to do it, or what protection we needed, nobody explained it to us,” she says with frustration.
“So some Filipino staff who were staffing the department… have been infected from those patient[s] because Infection Control refused to provide them the things that they needed or even assist them in how to do the swab properly. And yeah, there was no protection [for] them. And… yeah, they fell ill.”
The UK as a whole has one of the highest numbers of foreign-born nurses in the EU, with an estimated 40,000 Filipino staff employed throughout the NHS, many of whom make up the Welsh NHS workforce.
The Filipino UK Nurses Association spoke out previously about how Filipino health workers needed “additional protection” after a major study concluded South Asian people were 20% more likely to die with Covid-19 after being admitted to hospital in the UK. Moreover, in late June, the BBC reported that in Wales, seven of the 16 health workers who had died with coronavirus at this point were originally from the Philippines.
These workers underpin the NHS and keep it going, yet when Lola tried to protect herself early on in the pandemic, simply by wearing a mask, she was met with hostility from management, who actually confronted her: “One shouted at me and said ‘why are you wearing that mask?’” Lola recalls. “I said ‘well I have to.’”
When Lola asked why the mask was an issue, she was told it was causing “hysteria”: “I just said ‘what hysteria?’ I’m not creating hysteria. I know my other colleagues don’t wear masks… but I’m only doing this for my protection.”
Months later and it seems ironic that masks are now mandatory in indoor public spaces in Wales, with Welsh Government making this part of coronavirus restrictions back in September, a point at which 1,597 people had died from the virus in Wales.
Lola says she felt humiliated and spoken down to in front of colleagues, but this didn’t stop her: “I didn’t stop wearing it,” she says with conviction. “I still carried on wearing it because I didn’t feel safe and they couldn’t stop me basically. They [tried] to reprimand me every time they see me – but no – I still carry on.”
The risks of Covid-19 to Black, Asian and minority ethnic communities has been roughly segregated into health and socio-economic factors, with the latter only brought to the fore some months into the pandemic.
In terms of health risks, comorbidities are thought to play a role, with hypertension and diabetes particularly high amongst the Black population, and issues such as high blood pressure increasing with age at a higher rate amongst South Asians compared to Europeans.
In April, Judge Ray Singh, chair of Race Council Cymru, wrote to the First Minister, the Deputy Minister and Chief Whip, and the Chief Medical Officer on behalf of the trustees of the organisation, expressing serious concerns about the disproportionate impact of Covid-19 on Black, Asian and minority ethnic communities. As a result, the Welsh Government soon set up the BAME Covid-19 advisory group, inviting Judge Singh to be the chair, and the first meeting was held on the 29th April.
Soon after, the group designed and rolled out a risk assessment tool specifically designed for Black, Asian and ethnic minority members of staff across health and social care, and has since been extended to other sectors such as education. The form takes into account factors such as age, gender, and existing health conditions, and if an individual’s risk of contracting the virus is indicated as high, they can then discuss this with their line manager.
When I spoke to Judge Singh via Zoom in June, he was optimistic about the risk assessment:
“Wales will see the best results from this risk assessment tool if everyone uses it,” he says. “When a person can understand how their personal risk factors add up, they have a chance to mitigate some of those risks.”
However, the success of this risk assessment relies on it being widely rolled-out across Welsh NHS and social services – and then on people taking the time to fill it out, and managers taking further action to protect anyone who is considered high risk.
Worryingly, Dev had only heard of the risk assessment the day I initially spoke to him on the phone, around mid-June. “I’ll be honest with you, she [my manager] told me yesterday…and you called me in the evening,” he says.
“That’s bad isn’t it…? The workforce…the agency workforce, most of the nurses, they’re from London…and they’re from African ethnic background. So I don’t know whether their agency told them. They’re hiring accommodation…and working five or six days a week…”
He pauses momentarily: “Do they know they’re more vulnerable? I don’t know…” he sighs.
Lola found herself in a different situation: she was aware of the risk assessment but hadn’t been given one by her line manager. Overhearing several white staff members discussing the form, she decided to take matters into her own hands.
“I said, ‘Oh, can I have a read?’” she explains.
“And I looked at it and it looks like it is for BAME – the recent risk assessment, but it was given to the white staff [member] who works in my department, although her management is a different management.”
Concerned about a Filipino colleague with underlying health complications, Lola photocopied the form and gave her a copy: “I said, ‘have a read, fill it up yourself because our manager should be giving you this form.’”
One point Lola stresses is that the quality of management varies in different departments, after hearing rumours from colleagues in other areas of the hospital:
“My colleague told me that her husband works in orthopaedics, and the manager in orthopaedics [is] actually very, very good…[they] would never redeploy staff to the ward if they have high blood pressure, ” she explains. “So it is a manager’s decision… Some departments have done really [well] to protect the staff. Other departments just don’t do anything…”
This is worrying because the success of strategies such as a risk assessment relies on managers adhering to their duty of care for their staff across all areas of the NHS and social care. It also rests on staff being aware of the form, understanding it fully, having the time to fill it out, and having the confidence to raise concerns with managers.
It should also be noted that the information regarding higher rates of specific health conditions among certain ethnic groups is not new. According to the British Heart Foundation, experts have known for 50 years that the risk of Coronary Heart Disease (CHD) is up to 50 per cent higher in first-generation South Asians than in the white European population in the UK, and of course, people with health vulnerabilities and underlying conditions were identified as being particularly vulnerable to Covid-19.
If this is the case, why was more not done at the beginning of the pandemic to protect these communities? For example, asking them to shield along with the elderly and other vulnerable people, and ensuring certain health workers and other essential workers from BAME communities aren’t working on the frontlines.
Shouldn’t more have been done at the beginning, I ask Judge Singh?
“Certainly,” he replies, without hesitation.
“Although the First Minister took steps when we [Race Council Cymru] wrote very swiftly, this should have been addressed before…In the face of the crisis, what has been clear is that these underlying problems have been there for a long time, and could have been addressed. And had they been addressed, I’m sure there would have been a saving of loss of lives as a result.”
However, the reasons for high rates of infection among Black, Asian and ethnic minority communities cannot be connected to health alone. As the Black Lives Matter protests saw issues of structural racism brought to the fore in the US, Europe, and here in Wales, many point to the less explicit factors which make certain communities more vulnerable to Covid-19.
As Judge Singh puts it, the “entrenched inequalities” faced by Black, Asian and minority ethnic people in Wales and beyond are “well documented”, but Covid-19 simply brought them “into sharper focus.”
In Wales, a report led by Professor Emmanuel Ogbonna, vice chair of Race Council Cymru, found “structural and systemic racism” to be among the risk factors leading to disproportionate coronavirus deaths among Black, Asian and minority ethnic groups in Wales. Professor Ogbonna underlined the point that it was not a person’s ethnic background in itself that automatically made them more vulnerable to Covid-19, but rather the types of jobs they do that put them more at risk and make them less likely to complain about issues such as inadequate PPE.
In our conversation, Lola again mentions her Filipino colleague with health implications, who had still been working on Covid wards regardless: “[When] she was redeployed in the ward… I said, ‘Why don’t you contact the GP to do something about it?’ Because I said to her, ‘our manager’s not going to do anything about it…you already told her and she hasn’t done nothing about it,’” Lola recalls.
She explains that her colleague hadn’t been working in the department long at the time, and was therefore nervous to bring up any issues: “she is quite reluctant to – you know – say anything,” Lola sighs.
Professor Ogbonna’s report also raised other factors, such as communication of healthcare information (and how effective this is), overcrowded housing, income and employment insecurity, and the financial burden of the asylum process.
The discussions opened up by Black Lives Matter demonstrations have also underlined the intersection where race and class meet. The Joseph Rowntree Foundation estimates that the UK poverty rate is twice as high for Black and minority ethnic groups as it is for their white counterparts. It identifies higher rates of unemployment and economic inactivity, and a higher likelihood of low pay, as some of the driving factors. These communities are also more likely to live in overcrowded accommodation, which right now is especially dangerous due to a higher chance of contracting the virus, particularly if people are going out to work and returning to shared households.
According to UK government statistics, 30% of Bangladeshi households were overcrowded between 2014-2017, which compares to just 2% of White British households.
One point made by Lola was that the staff from Black or ethnic minority backgrounds in her workplace were repeatedly picked to do particular tasks or be redeployed to Covid wards because they were often more open to working longer and harder hours than the white British staff.
“My [Filipino] colleagues, they have families, they would like to supplement their salary by working extra work on a weekend or on those days off,” she explains.
The effect all this has had on Black, Asian and ethnic minority workers has been picked up by unions who have thousands of members in health. In April, Unison paid tribute to Donna Campbell, a Black cancer nurse who died after contracting Covid 19 at work. Following the tragic news, the union’s secretary, Tanya Palmer, wrote to Mark Drakeford angrily demanding urgent action over PPE. “This is killing our people,” she wrote.
The Trade Union Congress in Wales has also set up a survey and a helpline for all minority workers, with General Secretary Shavanah Taj saying that “More often than not, BME workers are left feeling ostracised, vulnerable, exploited, work zero hours, on precarious contracts faced with bad bosses, unfair and dangerous work practices with no recourse to public funds.”
During my conversation with Judge Singh, we discuss the Black Lives Matter movement, and he says that it’s essential we recognise the “structural disadvantage” for Black people and ethnic minorities within our “own communities” in Wales, not just in terms of police brutality in the US.
“At the worst of it, it is straightforward racism,” he remarks. “But there is [a] disadvantage for people from those communities that is less overt than that. It isn’t racism in that deliberate sense, but it’s embedded in the way that institutions operate.”
He refers specifically to Butetown and the former Tiger Bay, an area of Cardiff where over a third of the population identifies as Black, Asian or minority ethnic.
“If you go to former Tiger Bay, in that area…the youngsters [are] all unemployed, majority have been to school, been to colleges. No jobs,” Judge Singh says.
“And they described the wall separating them [and] Welsh Parliament as the Berlin wall – and that is the perception. I’ve told Jane Hutt that – and you need to break that barrier.”
The conversation that has recently opened up around the role of structural racism in the pandemic has drawn attention to the lack of diversity within decision-making. For Judge Singh, the first ethnic minority judge on the Welsh bench, he’s witnessed this first-hand:
“When I first got involved with the national advisory group for the Welsh Assembly…walking there, the only time you saw Brown faces were at about six and seven [o’clock]… a busload of them coming in, and then nine o’clock they’re leaving – they were the cleaners,” he explains.
“I said to the Secretary of State then, I’m very impressed with your multi-cultural workforce, but I don’t see any of them in the corridors when I’m working from nine to four. It’s only at five o’clock they arrive…”
The issues involving Covid-19 and its disproportionate impacts on the most marginalised in society goes far beyond risk assessments and deep into structural racism. Exposure to Covid-19 and how well-protected people are relies on access to healthcare, understanding the information distributed by the government – which has been laced with confusion throughout – and having the privilege of a safe home and outdoor space to isolate in, which not everybody has.
It is also a question of who is risking their lives day-in and day-out to keep the country going amid the pandemic, as whilst we are encouraged to work from home, having a job which can be done from home – and having the space and equipment to do so – is not an option for everyone.
Yet there are also issues on the surface of this pandemic which required an urgent government response to prevent countless lives being lost.
“We knew what was happening in China,” Judge Singh says frankly.
“It became apparent that it’s not going to be contained in China… and we look at New Zealand, we look at Australia and the South Pacific countries – they locked down immediately, and as a result thousands of lives have been saved. They’re now ready to move out of it. We are not anyway near it.”
When Judge Singh told me this back in June, Wales was of course still in lockdown. Since this interview we’ve come out of lockdown, had several local lockdowns, and have recently come out of a two-week “firebreak” lockdown in Wales, with a further lockdown likely again after the Christmas period.
If Welsh Government hadn’t gone along with a “herd immunity” strategy during the first few weeks of the virus emerging in Wales, we could be in a very different position now. For NHS workers though, the reality they’ve faced is that they’ve lost colleagues and friends who should have been protected, who should have had the basic right to adequate PPE, to informed, clear advice and guidelines from their management and government.
Dev tells me how several of his colleagues became infected with Covid-19. One of them survived, while others were not so lucky. “I had a colleague, we used to work in the care home…he was working in intensive care in the hospital…he contracted [covid] and he died – he’s only 41, he’s from [the] Philippines…he has two kids.”
For Dev, the statistics on the TV are real people: people he knows, cares for, and works with. “We know the people who died…[it] is shocking,” he says sadly.
As we publish this article, we are already in the midst of a second wave of the pandemic, with deaths in Wales exceeding 3,000 this week. Whilst many people await family reunions and large gatherings, for Lola and her colleagues, things may never go back to normal.
“[The] experience in the Covid ward actually caused a lot of psychological issues with us,” she says. “I feel… I don’t feel the same,” she admits, breaking down.
“Only recently they have arranged psychologists in the department… but none of us feel comfortable to speak to them anyway.”
Why not? I ask hesitantly, aware that I will never truly understand.
“I don’t think they would do anything different,” she replies. “I don’t think they would ever do anything different. It’s just a structure of the system… it is always going to be like this. We can’t do anything about it.”
Many NHS workers are left with the emotional baggage, trauma and grief of tending to coronavirus patients, colleagues, and loved ones, day-in and day-out. Yet many, like Lola and Dev, also face the daily battle of racism – implicit and explicit – itself a separate “pandemic”, as described by the attorney of George Floyd’s family.
It was the global Black Lives Matter movement sparked by Floyd’s brutal murder at the hands of a white police officer which brought the issue of racism to the fore, but the situation faced by the workers I spoke to are born out of a system that’s been centuries in the making. These workers are all too aware how hard it will be to change that.
Yet when two nurses involved in recent protests for an NHS pay rise spoke to Voice about what had inspired them to organise, they cited Black Lives Matter. The pain and anger which has been building among health workers in the pandemic may yet express itself in strikes and protests. If that happens though, it shouldn’t simply be seen as a fight over pay, but also one about the shocking treatment of Black and Brown workers.
