We are living in unprecedented times in the midst of a pandemic that has changed the world around us.
None of us were ever trained or expected to practise medicine in such an environment.
Many of us have lost friends and colleagues in the last couple of months owing to COVID-19. More than 90 per cent of all doctors and consultant colleagues who have tragically lost their lives in the UK up till now have been BAME (black, Asian or minority ethnic), leaving little doubt about the disproportionate effect of COVID-19 on these groups.
All doctors want to do the best they can for their patients, we become doctors to serve humanity. Doctors maybe expected to accept a degree of risk in providing treatment in a pandemic, but they should not be expected to give the ultimate sacrifice of their lives.
The BMA has taken a lead in highlighting the issue of increased BAME deaths owing to COVID-19 nationally. BMA council chair Chaand Nagpaul, BMA consultants committee chair Dr Rob Harwood and BMA staff, associate specialists and specialty doctors committee co-chair Amit Kochhar and many others have worked tirelessly championing this issue.
Their efforts have no doubt influenced the decision of the NHS England to ask Public Health England to start a national inquiry on understanding why healthcare workers from BAME background are being disproportionately affected by COVID-19. I should not forget the work done by organisations such as BAPIO (British Association of Physicians of Indian Origin), BIDA (British International Doctors Association) and APPNE (Association of Pakistani Physicians of Northern Europe) in the background championing this cause.
It was hoped that there would have been a national guidance by now on how employing organisations can protect their BAME staff by taking practical steps to mitigate what increasing evidence shows an increased risk of them being more severely affected by COVID-19 infection.
We do not know why this increased risk exists and poses questions such as: is it because of underlying co-morbidities? Cultural factors? Workplace factors (such as hesitancy to raise concerns, workplace bullying and harassment)? Is it because of an underlying predisposition? The Office for National Statistics data seems to confirm there is an increased risk for BAME staff even when correcting for socioeconomic factors and underlying health conditions. It is likely all these factors may play a part in this increased risk to BAME colleagues. The fact is that we just don’t know why this is so.
The question is that is it right for our employing organisations to wait for the result of the inquiry or for the result of other studies so that we know exactly what is causing these disproportionate deaths in BAME colleagues before practical steps are taken to protect them.
I would like to ask the NHS organisations who are taking this view: do we ever wait for a complete understanding of a disease before we start helping the affected patients with at least symptomatic treatment? Of course not.
We know for a fact that BAME colleagues in the NHS are disproportionately being affected by COVID-19 infection and are losing their lives. Practical steps need to be taken now to mitigate the risk as we cannot simply sit idly by while we wait for a full understanding of the cause.
An article from the HSJ noted that, currently, of those doctors who have died from COVID-19, approximately 94 per cent were BAME.
All employers have a legal and ethical responsibility to protect their staff and ensure a safe working environment for them.
There is understandable anxiety and frustration among BAME colleagues that this issue is not being dealt with the importance and urgency it deserves in many NHS organisations around the country.
So what can we do?
I am fortunate to work in a trust (Northern Lincolnshire and Goole NHS Foundation Trust) which has taken the increased risk to BAME doctors seriously and have worked collaboratively with the local negotiating committee and staff committees to take practical steps to mitigate this increased risk. We have developed an ‘options decisions tool’ which gives a guideline how to reassign staff from high-risk areas and provides other practical steps to protect vulnerable staff.
If your employer has not taken practical steps to mitigate the increased risk which COVID-19 infection poses to BAME and other vulnerable staff groups then I would urge you to speak to your local negotiating committee and raise it with your trust executives. Only this week, the BMA has written to all NHS trust chief executives urging them to introduce a risk-scoring tool to evaluate staff who are at an increased risk of death from COVID-19 infection and take steps to protect them.
There is some evidence that doctors are sometimes reluctant to acknowledge their personal ill health. If you feel in any way that you belong to the ‘at-risk’ group, please ask for a personal risk-assessment.
It is known that some BAME colleagues are hesitant to raise concerns, find it difficult to say ‘no’. BMA surveys have shown that BAME doctors are more likely to experience workplace bullying and harassment. Please do not be shy to raise legitimate concerns.
Every doctor has the right to appropriate PPE (personal protective equipment) and no one should be pressurised to work with inadequate protection. Despite this, a recent BMA survey showed that 64 per cent of BAME doctors have felt pressurised to work with inadequate PPE. Remember you have a right to say ‘no’ and the BMA has guidance for colleagues who find themselves in the rather unfortunate situation of being pressurised to work with inadequate PPE.
Let us all do whatever we can to support each other, help our colleagues to stay safe, and always remember that the BMA is here to help all of us.
Sakkaf Ahmed Aftab is a consultant ophthalmologist in Lincolnshire and a member of the BMA consultants committee