COVID-19 has in some ways proved to be a great leveller for the world’s nations, with the virus indifferent to the race, gender, sexuality, disability or social class of those it infects.

It has, however, served to highlight many of the inequalities that exist both within societies and, indeed, within the NHS itself.

Acknowledging and finding ways to address these inequalities was the subject of a frank panel discussion at this year’s BMA annual representative meeting.

‘What has become very clear since the beginning of the pandemic,’ said King’s College Hospital sexual health and HIV consultant Michael Brady, ‘[is that] where inequalities already exist, COVID-19 has both highlighted and exacerbated these inequalities.’

The first national adviser for LGBT health, Dr Brady said COVID had increased staff workloads and dramatically changed ways of working, something that has had a negative impact on the mental health and wellbeing of many health service staff.

‘We know from the NHS staff survey that lesbian, gay and bisexual staff report worse experiences when compared to their heterosexual colleagues, are more than twice as likely to report bullying, harassment or discrimination in their workplace,’ he said.

‘For LGBT staff who are already starting from a point of discrimination, harassment or poor mental health and wellbeing, that impact can only be greater.’

Data and monitoring

Dr Brady said that implementing two particularly important measures could make the difference in improving the experiences of both LGBT patients and staff in the health service, including better data collection and monitoring.

‘We do not consistently and robustly collect data on sexual orientation and gender identity in the same way that we collect information on other demographic characteristics – either for staff or patients. Until we do that we won’t fully understand the inequalities, nor will we be able to address them,’ he said.

‘The staff survey tells us that the NHS is still not an inclusive place for all to work, so we need to do more to ensure that all LGBT staff feel safe, welcomed and included and able to bring their true selves to work.’

‘When we’re thinking about the services we deliver and how we redesign and reopen them, we need to be sure that they are inclusive of and recognise the needs of all LGBT patients.’

The NHS is still not an inclusive place for all to work

Michael Brady, sexual health and HIV consultant

The knowledge that the pandemic has disproportionately affected certain groups was shared by Cardiff University medical student Olamidé Dada.

Ms Dada, who founded the African and Caribbean medical students advocacy group Melanin Medics, spoke of the world in 2020 having been gripped by two pandemics – that of COVID-19, but also the long-standing pandemic of systemic racism.

‘Going back six months ago, when COVID-19 began impacting our communities and society, we observed that ethnic minority individuals were more at risk than other ethnicities, with black patients being four times more likely to die with COVID-19 than white patients,’ she told the session.

‘With the first 10 doctors to die from COVID-19 being from ethnic minority backgrounds, this was something that was more than a coincidence, and I do question whether we were too slow to act and whether more could have been done to protect these individuals.’

Systemic racism

Ms Dada highlighted the killing of George Floyd, the African-American man who on 25 May died whilst being restrained by police, as a moment of immense grief and outrage, but also a turning point in demonstrating the need for global conversations about the corrosive impact of systemic racism.

‘Looking to the future I am hopeful, but I am not naïve, and I know that we cannot afford to be complacent. Although we have been taking steps in the right direction, more still needs to be done,’ she said.

‘We have seen medical students rise to the occasion and say, this is what we need from our medical schools and education in order to make sure we’re able to treat the diverse patient group that we serve in this country.’

She added that the challenges posed by racial inequalities could not be seen as solely the problem of one group, but of everyone in the health service. ‘Anything that affects the NHS, anything that affects the way we care for patients or treat our colleagues, requires our attention. Intentions do not change outcomes, our actions do.’

‘Disabled people are forgotten’

A call to action was one shared by neurology registrar Helen Grote, who spoke about how disabled patients and medical professionals had frequently been forgotten or ignored during the pandemic.

Herself deaf, Dr Grote has helped lead a campaign for the introduction of clear face masks in the NHS, something that she said was straightforward yet so important to improving the experiences of those with hearing loss.

‘Time and time again, disabled people are forgotten, and the pandemic has only served to widen pre-existing health inequalities,’ she said. ‘We have seen, for example, how government policy has been produced with no equality impact whatsoever, leading to discrimination, isolation and exclusion of disabled people.’

One in seven people in the UK have hearing loss and many deaf people rely on lip-reading, which she said had become all but impossible with the introduction of masks.

‘This has made the isolation felt by deaf people during the pandemic so much worse. Many deaf patients have reported being afraid to go into hospital or to seek medical attention, because of the communication difficulties involved,’ she said.

Government policy has been produced with no equality impact whatsoever, leading to discrimination, isolation and exclusion of disabled people

Helen Grote, neurology registrar

‘There are also a number of deaf doctors, nurses and allied health professionals who, despite years of training, have found the introduction of masks and subsequent communication difficulties make it impossible for them to do their job. A number of these individuals have been redeployed to non-patient facing roles, which is a terrible waste of talent, education and training.’

Dr Grote said COVID-19 had revealed the desperate need for far greater deaf awareness in the health service, adding that it was incumbent upon the NHS to do everything necessary to meet the needs of disabled patients and staff.

‘Hospitals and GP surgeries need to ensure deaf patients and staff have access to communication in a way that they can understand – whether that’s through the provision of clear masks, screens, access to loop systems, sign language or written communication.’

‘As healthcare professionals, we need to ask disabled people what they need to access healthcare or continue in their job. We need to use our voice to advocate for patients and colleagues with disabilities and we need to, as far as possible, ensure that those structural barriers are eliminated.’

Religious inequality

London GP and vice chair of NHS religion equality advisory group Mark Pickering raised the issue of religious inequality, highlighting it as one of the often under-discussed inequalities that exists within the health service.

Dr Pickering said discrimination relating to faith was also an issue that frequently intersected with ethnic and cultural inequalities, pointing to the conflict that had occurred during the pandemic around incompatibilities of PPE with certain aspects of religious identity.

‘We’ve seen, for instance, with issues about PPE for Sikhs or Jews or Muslim [staff],’ he said. ‘And we’ve read in The Doctor magazine about the “bare below the elbows” policy and how that negatively impacted female Muslim staff, and how there was very little consultation before that was brought in.’

Resources available

Panel member Professor Farah Bhatti, a cardiac surgeon and chair of the Women in Surgery forum at the Royal College of Surgeons of England, said she fully recognised the struggles that many doctors faced in being able to perform their job while still not having to compromise their religious beliefs and expressions of faith.

She said there were resources available, such as disposable sleeves for those who did not want to be bare below the elbow, and that religious clothing, such as the hijab, were perfectly acceptable within clinical environments provided that they were clean.

She added, however, that it was vital that misconceptions around such issues concerning religious faith were challenged through ensuring all staff were better educated and informed.

‘It is an important topic but I think there are solutions available. It is a matter of educating those who may challenge those people. Anybody facing these difficulties should be flagged up so they can be approached.’