Covid-19: BAME Communities

Caroline Nokes Excerpts

Thursday 18th June 2020 Commons Chamber

[Caroline Nokes (Romsey and Southampton North) (Con)]

I congratulate the hon. Member for Brent Central (Dawn Butler) on having secured this important and timely debate. She picked up on several themes that I will probably echo, but she also spoke about voices, focusing on Marcus Rashford and Raheem Sterling—people who have used their voices effectively. In my speech, I will concentrate on the voices of BAME workers in our health service.

At the very start of the pandemic, we had a debate in this Chamber about the emergency covid legislation. I vividly remember receiving a briefing from the Equalities and Human Rights Commission that spoke about how the pandemic might affect different groups of people differently. It is interesting to read and review that briefing with 2020 hindsight. When it spoke of BAME communities, it mentioned their employment opportunities, including the likelihood that young BAME people in particular would be working in unsecure employment in the gig economy and on zero-hours contracts. What it did not speak about was their health.

I think that the death toll has shocked us all. But it is not only the death toll, is it? As the hon. Member for Brent Central highlighted, BAME people are more likely to be hospitalised. If hospitalised, they are more likely to end up in intensive care units. And if in intensive care units, they will be there for longer. As we have learnt over the course of the pandemic, all those things have a significant impact on people’s wellbeing going forward because the longer that someone is in ICU, the longer it will take them to recover and to return to their home, their family and their employment.

At the start of the pandemic, the Women and Equalities Committee launched an inquiry into the unequal impact of covid. That has now split into three separate inquiries looking specifically at: the impact on disabled people and their access to services; the gendered impact of covid; and—the inquiry that we have launched within the last couple of weeks and on which we have already taken significant evidence—the impact on our BAME community. As I said to Committee members last week before we had the first evidence session, “If there is one thing you can rely on from the Women and Equalities Committee, it is that our inquiry will come up with recommendations for the Government to act.”

Yesterday we heard from Dr Chaand Nagpaul and Professor Kamlesh Khunti. I do not wish overly to paraphrase their evidence, but I only have six minutes so I really will have to. They both reiterated what can be found in the NHS England and NHS Improvement briefing on the disproportionate impact of covid—that BAME staff are over-represented in the lower grades of the NHS hierarchy, that there is not enough diversity in management structures, and that, as a direct result, BAME staff are worried to speak up when they do not have the right PPE. Those staff are not having their voices heard—or, worse, they are too scared to use their voices. That is Britain in 2020: BAME staff in the NHS are scared to speak up. We have to make sure immediately that channels are open for people to be able to do so, whether they work in the NHS or in other frontline roles such as bus drivers, retail workers and nursery assistants—the people without whom, to be blunt, our country would have ground to a halt over the course of the last 12 weeks.

The Committee heard from Professor Sir Michael Marmot, who did a review back in 2010. He refreshed his review in February this year—hard up against the start of the crisis.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

The right hon. Lady makes a valid point about the NHS, in which there is not a great record on whistleblowing but at least many of those workers would be in regular jobs. Does she agree that there is a disproportionate number of black, Asian and minority ethnic people in insecure employment, for whom raising an issue could mean losing their jobs? They should not have to make that choice.

[Caroline Nokes]

The hon. Lady is absolutely right. That is why I specifically raised those who are working in transport and the gig economy, who do not have those routes. In the NHS they should at least be there; in some sectors, they do not exist in the first place.

We heard from the hon. Member for Brent Central some uncomfortable truths—issues that may be difficult for us to hear—but we cannot just listen and review; we must act. When I rather proudly told one of my constituents, as Chair of the Women and Equalities Committee, that we had launched an inquiry, her instant response was not great: it was, “Not another inquiry. Not another review. Please, can you come up with some action?” She was right.

The race disparity unit in the Cabinet Office was set up specifically to obtain data, but it needs to do more than just get data. It needs to be able to look at datasets and understand them—of course it does; we have to know where the structural inequalities lie—but it is of no use to accurately record a growing deficit, or perhaps a shrinking deficit. We have to have actions. We need policy levers to effect change, so that the young Caribbean boy in the constituency of the hon. Member for Brent Central has the same educational opportunities as the white girl in mine; so that the job opportunities and chances of progression in work—and that is absolutely key: it is about not just getting a job but getting a good job getting, a better job—are available whatever someone’s ethnicity; and so that someone’s ability to speak out when they do not have the right PPE is the same regardless of their gender, ethnicity, religion, age, sexuality or disability.

I cannot stand here and predict the outcome of my Committee’s inquiry—it would be wrong to do so—but I can predict that we will expect delivery from Ministers, not warm words, not more reviews and not more commitments to get better data. We want action and improvement.

Covid-19 is of course a novel virus and we have been forced to learn about it at pace, but it has highlighted health inequalities that are real and current: if someone lives in overcrowded, poor-quality housing, they are more likely to be negatively impacted; if someone is in frontline, public-facing work, they are more likely to be negatively impacted; if someone’s English is poor or they have learning difficulties, they will not be able to receive the important public health messages that they need; and if someone lives in multigenerational families, they are more likely to be negatively impacted, as are those whose work is insecure. Of course, a person may well have no choice but to carry on working at the height of a pandemic to feed their family. No one can be a careworker, a retail worker or a transport worker from the safety of their own home.

We have not had a public health crisis like this since the Spanish flu 100 years ago, and I do not know whether our generation will see another, but we cannot lurch to another crisis without having worked out how to risk-assess our frontline workers; without having established culturally intelligent ways to disseminate information; and without having empowered people in the workplace to voice their concerns and enabled the routes to redress.

I know that the Minister and her colleagues across Government will work hard on this issue. We heard last week from my hon. Friend the Minister for Equalities about the importance of the work that the race disparity unit is doing, but I urge the Minister present to come forward with what is actually going to happen, because that is what our BAME communities up and down the country wish to hear.

--- Later in debate ---

[Ms Nusrat Ghani (Wealden) (Con)]

It is a pleasure to follow the passionate speech of the hon. Member for Slough (Mr Dhesi). I first want to thank all NHS workers, who have done a tremendous job during this covid period. My speech will not be so friendly, so I want to start by thanking the Minister, who has been tremendous in supporting me in Wealden, where we have a particularly large care home system—I have a lot of older constituents. Regardless of the day of the week and the time of day, she has been incredibly responsive. Unfortunately, the rest of my speech will not be so flattering, so I will just crack on.

Like so many people in this country, I have lost loved ones to covid. I also have loved ones working on the frontline dealing with covid. We had the experience and network to highlight quite early on that we saw a pattern forming, but we were met with, “We don’t have the data”—it is 2020, and we do not have the data. I understand the argument that this is an unusual situation, and that we did not have the statistics to deal with this particular pandemic, but we do have data about how viruses spread. We also understand the long-standing institutional biases of NHS England and Public Health England, which have failed in their leadership, are unaccountable, and hide behind the catch-all, “We just don’t have the data.” It is shameful.

[Caroline Nokes]

Does my hon. Friend agree that we did not actually need data, given that we could open up the pages of any newspaper and see the photographs?

[Ms Ghani]

I agree with my right hon. Friend. That goes back to my earlier point: Public Health England needs far more functioning leadership.

Public Health England’s report says:

“It is clear from discussions with stakeholders the pandemic exposed and exacerbated longstanding inequalities affecting BAME communities in the UK.”

That is nothing new. Moreover, it confirms to me the wilful blindness of Public Health England and NHS England in addressing racial inequalities and their inability to put in place measures to address workplace risk and make sure that so many BAME staff were not exposed. In the time it took for Public Health England to review the disproportionate number of BAME deaths, another 17 doctors passed away. Sixteen of those were BAME.

What else do we know? We know that there is a significantly higher proportion of BAME healthcare workers in England across our health system; without BAME workers, there would not be a health system. We know that BAME workers are in lower-paid jobs and that they cannot work remotely. We know that BAME workers tend to work in high-risk areas, and that the families they go home to are high-risk individuals. It was a high-risk strategy, yet Public Health England and NHS England continued to expose high-risk staff to high-risk shifts.

We know that 94% of doctors who died were of a BAME background. In the biggest survey of its kind, ITV News asked the UK’s BAME healthcare community why they thought more of their BAME colleagues were dying than their white counterparts, and 50% felt that discriminatory behaviour played a role in the high death toll. One respondent described the treatment as “very unfair”, adding that “all BAME nurses” have been

“allocated to red wards and my white colleagues”

are “constantly in green wards.” Perhaps more worryingly, ITV found that 53% of BAME respondents said that they felt they could not comfortably raise concerns about deployment, so they risked their health as against their employment.

To me, that suggests that the problem is related not to covid but to long-standing institutional inequalities. I want to hear from the Minister a resolute commitment to hold Public Health England and NHS England to account, and to ensure that the recommendations are acted on, reviewed and assessed by the real workers on the frontline who are most at risk—by that I mean BAME workers—and that all the data, good and bad, is shared in good time. I hope that the Minister understands that I have very little confidence in particular in Public Health England.

As we champion our frontline key workers, we also need to give them confidence that we have their backs. Like all public workers, they want to do their jobs, but many are concerned that if there is a second wave of covid they will be risking their lives or their families’. The BAME community has already been severely hit. I am not sure that it could take a second wave. For BAME health workers to die at such a rate frankly amounts to negligence on the part of NHS England and Public Health England, but perhaps it is not that surprising. Their leadership boasts 46 individuals; yet only four of them are from BAME backgrounds.

The country was united in tackling covid, but Public Health England and NHS England let down BAME health workers. They have time to put the record straight. Either we are in this together or we are not. I hope that the Minister can confirm that the Department is committed to ensuring that Public Health England and NHS England will treat, manage and support all their staff equally, so that we do not see a second wave of disproportionate BAME health worker deaths.