Covid-19: BAME Communities

Meg Hillier 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.

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[Meg Hillier]

I take the hon. Lady’s comments in good part, and she is right to highlight the rise of people of all backgrounds in government. However, it still disturbs me and many—most—of my constituents that the Prime Minister under whom she serves has described people as “piccaninnies” with “watermelon smiles”. That is completely against the tone of this debate so far. Does she agree with the Prime Minister, or does she call him out, as we do?

[Felicity Buchan]

I would agree with the hon. Lady that language is incredibly important in these sensitive times, and it is not language I personally would have used.

I want to talk about levelling up. We talk a lot about levelling up, and normally it is exclusively in the context of the north versus the south, but clearly there are huge disparities in our inner cities. We have already heard that our cities have been worse affected by covid, often due to overcrowding and deprivation. I therefore urge my hon. Friend the Minister to ensure that, when we focus on levelling up, we focus on our cities just as much as our regions. I also want to talk about prevention and screening, which are critical, not necessarily in the context of coronavirus but in the context of mitigating health inequalities. Only if we have proper prevention and screening can we extend people’s lives. I am glad that the NHS has a diabetes prevention programme, for instance; clearly, that has a comorbidity with coronavirus.

In summary, I thank the hon. Member for Brent Central (Dawn Butler) for securing the debate, and I urge the Minister, on behalf of my constituents, to proceed with pace with this review and to ensure that its recommendations are implemented with a sense of urgency.

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[Stephen Timms (East Ham) (Lab)]

I agree with my hon. Friend the Member for Liverpool, Riverside (Kim Johnson) and congratulate my hon. Friend the Member for Brent Central (Dawn Butler) on securing this debate on how she opened it.

I want to focus on one point. The Public Health England review says:

“People of BAME groups are also more likely than people of white British ethnicity to be born abroad, which means they may face additional barriers in accessing services”.

I want to highlight one barrier in particular, and that is the “no recourse to public funds” restrictions on leave to remain, which has already been touched on this debate. We are talking about families who have leave to remain in the UK, who are law-abiding and hard-working, often with children born in the UK and who may well be British nationals and have British passports. Typically, they are on a 10-year route to securing indefinite leave to remain, and in the meantime they have to apply four times, getting two and a half years to remain each time. Throughout that 10-year period, when they are working here, typically very hard, doing exactly the kinds of jobs we have been talking about, they have no recourse to public funds.

That is a formidable barrier that those people face. It is exactly the kind of barrier that the Public Health England report refers to. I asked the Prime Minister yesterday about this, and I asked him about it at the Liaison Committee three weeks ago. His answer then was that hard-working families in that position should have help of one kind or another. I absolutely agree. Unfortunately, he did not say that when I asked him about it yesterday, but it is what he said to me at the Liaison Committee, and he was right on that occasion. The problem is that those families are not getting that help.

It comes as a shock to a lot of people to learn that the parents of children who have been born in the UK and might well be British nationals cannot claim child benefit for them, because no recourse to public funds excludes that. The families cannot apply for universal credit either, or access the safety net that so many people have had to depend on during this crisis—2 million additional people have been claiming universal credit since the beginning of the crisis. That safety net is not there for people with no recourse to public funds. That has created a very serious problem of destitution, a huge increase in food bank demand in many parts of the country and, in my area, the return of something I never thought we would see again: soup kitchens, where people are handing out free cooked food just to keep others alive.

[Meg Hillier]

My right hon. Friend raises a very important point, and a very pertinent point in our London constituencies particularly. No recourse to public funds means no housing benefit, and it is impossible pretty much to rent privately on a low wage, or even quite a good wage, in my constituency. Does he agree that that underlines how this policy is now out of date?

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

I speak today not just for my constituents, but to represent my right hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott), which may surprise most people, because in her 33 years in this place, I think everyone would agree that she has never needed anyone to speak for her. She has been perfectly capable, able and talented at speaking up on inequality repeatedly in her 33 years, and she was the first ever black woman to be elected to this place. Sadly, the Government’s refusal to allow remote participation means that she is unable to attend today because she is shielding, but she wanted me to speak for our borough together, because of the concerns we both share about the number of deaths from covid-19 of black, Asian and minority ethnic people. I am proud to stand with her. She has spoken up for the marginalised for many years, and I am proud to have her as a neighbouring MP and a friend.

My right hon. Friend highlights that black deaths from covid-19 have been particularly traumatising  for the black, Asian and minority ethnic communities, who are very likely to know someone who has died. We have heard that very firmly in the Chamber today. I also want to highlight the very important work of Councillor Carole Williams, a cabinet member on Hackney Council, who highlighted this inequality at an early stage. She was ahead of the curve of many people in this Chamber today, and of the Government. It is because we live and work in the community, and understand its needs and its trauma, that we really wanted to raise these points today.

Hackney is the 22nd most deprived local authority district in England and the third most densely populated. Our housing overcrowding is severe, as I have often mentioned in this House. When we break that down in terms of ethnicity, over 70% of people on our housing waiting lists are from ethnic minority backgrounds. These are inequalities that we are all weary of raising. As my hon. Friend the Member for Brent Central (Dawn Butler), who has done a great job in securing the debate today, highlighted, it is a pattern that we recognise and are weary of having to highlight again and again and again. I echo the points raised by my hon. Friend the Member for Slough (Mr Dhesi) and my right hon. Friend the Member for Tottenham (Mr Lammy) about the need for action now. We know a lot of these problems. We have raised them repeatedly. We need to see action.

Hackney has the third-highest death rate per 100,000 people, at 183, of all local authority areas. With 40% of our population from BAME backgrounds, it is not surprising that we have had 175 deaths from covid-19, but 70% of those deaths were of people born outside the UK and 60% of the deaths were of people employed in routine and manual occupations. As my right hon. Friend the Member for Hackney, North and Stoke Newington highlighted when we were discussing this matter today, we also know that it is not just a matter of underlying health conditions. Black people are disproportionately employed, as other colleagues have highlighted, in sectors exposed to covid: transport, social care and the NHS. They are more likely to be agency staff or in roles with zero-hour contracts, so feel less empowered to insist on proper PPE. This goes very much to workplace rights as well and the ability to call out something when it is wrong. If you call it out and lose your job, it is of course harder to do that.

[Mr Dhesi]

Does my hon. Friend not agree that with more than 200 recommendations from previous reviews already gathering dust, the reason why so many of us are pointing out, again and again, that we need action and not more reviews and investigations is that we have not even implemented a single recommendation from the previous reviews?

[Meg Hillier]

I agree with my hon. Friend. My right hon. Friend the Member for Hackney North and Stoke Newington is calling for a public inquiry into black deaths from covid. I support her in that, but, as my hon. Friend highlights, it must not be an excuse to kick this issue down the road. We need action now for the people at the frontline who are still affected by this. If we have the second peak that we all fear is coming, they need to be protected. If people are moved out of frontline jobs to be shielded and protected because of their greater risk of death, they must not see detriment to their career path. We need action now. We need workplace plans to support people. It is a tragic and visible reminder of the inequalities we see.

Black, Asian and minority ethnic households are nearly five times more likely to be overcrowded than white households. I have repeatedly raised in this place the tragedy of families who are living in double households, with one family in the living room and one in the bedroom. My right hon. Friend the Member for East Ham (Stephen Timms) highlighted how no recourse to public funds also feeds into that, and 43.9%—so nearly 44%—of London NHS staff are from black, Asian and minority ethnic backgrounds. A staggering 67% of adult social care staff in our capital are from black, Asian and minority ethnic backgrounds.

One interesting and important point is how we communicate public health messages. Sometimes one size does not fit all. If you live in an overcrowded household and are told to self-isolate, it is a different challenge than if you live in a home with spare bedrooms, studies, extra living rooms, large gardens and big kitchens. People need advice about how to manage the public health situation in their own domestic situation and their own workplace. The digital divide is a big concern in my constituency when it comes to getting that message across, with 11% of Hackney residents having no access to the internet.

This is near Shoreditch. Shoreditch is part of my constituency—part of the borough that my right hon. Friend the Member for Hackney North and Stoke Newington and I represent together—yet just over one in 10 residents have no access to the internet and 20% say they are not confident using the internet.

This has been a thoughtful, measured debate, and I do not doubt that every Member here, and many others who would have liked to have spoken, means every word they say about action now. The Under-Secretary of State for Health and Social Care, the hon. Member for Bury St Edmunds (Jo Churchill), is a reasonable and thoughtful woman and I look forward to her response, but I must repeat that the Prime Minister under whom she serves has repeatedly used racist language. Where is the word “piccaninnies” from? I am not going to give a history lesson, but look it up. It is not acceptable for a Prime Minister of this country to have only in recent times described people in those pejorative terms, using the phrase “piccaninnies” with “watermelon smiles” and talking about women in burqas with “letterbox” slits.

That does not set the tone or give me confidence that the Government will act. I believe that there are good people in the Government. There are good people in the Prime Minister’s party, but he needs to shape up. Just as Marcus Rashford educated him about the poverty and hunger of children on free school meals, my right hon. Friend the Member for Hackney North and Stoke Newington and I stand ready, with our constituents and with colleagues across the House, to educate the Prime Minister about how badly wrong he is getting the messaging on this. He needs to act now.

[Several hon. Members rose—]