The NHS, Social Care and Black Lives Matter

This summer’s resurgence of the politics of race and social justice may have a similar effect upon our future as the Covid crisis. The Black Lives Matter international mass protests looked and sounded different from previous protests. In the UK they took place at the same time when, as a nation, we were being confronted with the fact that many more black and minority ethnic (BAME) health and care workers were dying of Covid than their white colleagues. Given the differential mortality from Covid, we were effectively asking BAME staff to walk into greater danger than their white colleagues.

As protests grew, at the same time as differential deaths amongst staff, we were also confronted by the reality that more BAME members of the general public were dying of Covid than were white people.

Neither of these sets of facts are simply statistics. Day after day we saw pictures of children surrounding someone who had, since the photo was taken, died. There were often photo montages of everyone who had died. It was impossible not to see in human terms, what was going on.

The organising slogan of the movement for race and social justice was Black Lives Matter – and every day we saw that a much higher proportion of black lives were being lost to the virus than white ones. And at the same time that we agreed that black lives do matter we saw that when confronted with a virus we had failed to bring that slogan into reality.

The stark facts of these extra black deaths demonstrate a failure of both our society (me included) and the NHS. Since we all thrill to the promise of the equality of the NHS, we need to recognise that we have come up short in making that a reality.

Will we do better with a second wave? Only with very speedy and radical changes to the way in which the NHS and social care works.

Given the nature of the work force and its proximity, I don’t think we are in a position to protect all black and minority health and care staff from front line work in a second wave. There are so many staff in health and social care that will be at greater risk that it will simply not be feasible for all of them to be removed from the front line. But as many BAME staff with underlying health conditions that can be moved out of direct contact should be.

(And the same must be true for other key workers. The number of BAME staff who have died of Covid is truly shocking and if a second wave comes transport regulators need to be aware of their duty to ensure that staff have safe working conditions).

Since black lives do matter, in the little time between now and the second wave we must prepare.

But we also need both medium and long term strategies for greater racial justice both within the NHS and in looking at the way in which it serves BAME members of the public.

It’s been some time now since the scale of internal race inequality in the NHS has been fully described. In 2014 Roger Kline’s apposite description of ‘the snowy white peaks’ of NHS institutions described how white the top of the NHS was six years ago. This week Liverpool University Hospitals NHS foundation Trust admittedthat there are areas “where we need to do better”. This was when they found that of their 35 very senior managers group[1] none of them declared as BAME people.  The phrase need to do better barely encompasses the outrage at this failure to deliver social justice.

Many of us are at fault. Having left in 2019, I was a non-exec director at the Care Quality Commission for those 6 years. I thought we took equality seriously – and in our own organisation I think there were some small advances. But our task was to regulate the health and social care industries and over those six years I don’t think we made enough progress in moving the social justice of race up the agenda.

Looking at the experience of BAME staff in some of the organisations to which the CQC gave the important label ‘outstanding’ there are problems. There are some  organisations called ‘outstanding’ where BAME staff report a significantly worse experience than their white colleagues.  And that over time those experiences have become worse still. Statistically significant differences in the experience of bullying and significant statistical belief that that the trusts do not provide equal opportunities for career progression. Yet the regulator feels it’s OK to tell the world that such organisations are outstanding. What does the granting of that label say to the staff in that organisation? And to the wider world.

Soon the CQC will be launching its consultation for its next 5 years of its strategy. I for one – and hopefully many others – will suggest that its really not possible for us to go on believing organisations can be outstanding if the agreed data on race equality is not just bad but getting worse.

These are the hard yards of social change. There will be many in health and social care that feel it is wrong to prioritise the issue of race equality over other criteria. There are many who will agree. Fine.  In the light of our experience of the call for social justice over the summer – lets have that debate.

Let’s get serious and try and move this issue of social justice forward.

[1] These are reported as staff in executive roles and those earning more than £150,000 per annum quoted in HSJ Am edition 21/07/2020