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Content ArticleIt is well known that pausing planned hospital care during the pandemic worsened growing waiting lists, and that waits for routine care now stand at record-breaking levels. This research from the Nuffield Trust, supported by the NHS Race and Health Observatory, looks at how the fallout from the pandemic affected people across different ethnic groups, and whether that impact was spread evenly.
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Content ArticleThe investigation and tribunal hearing of Dr Manjula Arora generated significant anger and anxiety among the medical profession. The case raised once again the perception of a regulatory process lacking in fairness; of a system in which the stakes seem much higher if you are a black and minority ethnic doctor. The General Medical Council (GMC) acknowledged that strength of feeling, making clear it would not oppose Dr Arora’s appeal against the sanction and commissioning a review of the case to understand lessons to be learned for future cases.
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Content ArticleRacism is unacceptable and it has no place in health and care. But we know that it exists and that the impact on staff can be devastating. All registered professionals have responsibility under the Nursing and Midwifery Council (NMC) Code to challenge discriminatory behaviour, creating an environment where people are treated as individuals and with dignity and respect. This resource is firmly rooted in our professional Code and it is designed to support nurses, midwives and nursing associates, providing advice on the action you can take if you witness or experience racism. It also supports those in leadership roles to be inclusive leaders. This document provides practical examples of how, as nursing and midwifery professionals, you can recognise, and challenge racial discrimination, harassment, and abuse. It also highlights other useful resources and training materials that will support you to care with confidence. This document is a resource for individuals at all levels. This resource does not replace existing NHS England policies and procedures for speaking up and managing racism. It is a resource to support best practice in line with organisational policies and procedures.
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Content ArticleThis is the transcript of a Westminster Hall debate in the House of Commons on Black Maternal Health Awareness Week 2022, dedicated to raising awareness about disparities in maternal outcomes.
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News ArticlePatients from minority groups are facing longer wait times for potentially life-saving lung cancer treatment compared to their white counterparts, according to a study. Experts warn that disparities can have real consequences – the earlier treatment is initiated, the better the health outcomes for patients. Researchers at the University of Virginia (UVA) Cancer Centre reviewed data from more than 222,700 patients with non-small cell lung cancer across the US. The findings, published in the scientific journal Health Equity, showed that the mean time for radiation initiation was 61.7 days. Broken down by ethnicity, white patients had to wait only 60.9 days, while Black patients had a wait time of 65.9 days, meanwhile for Asian patients, it was 71.9 days. A single-week delay in treatment could lead to a 3.2% and 1.6% increase in the risk of death for patients with stage I and stage II non-small cell lung cancer, respectively. “Our results suggest that non-white lung cancer patients have delayed time to cancer treatment compared with white patients, and this is not limited to a particular type of treatment facility,” said senior researcher Rajesh Balkrishnan, PhD, of UVA Cancer Center and the University of Virginia School of Medicine’s Department of Public Health Sciences. “Collaboration among providers and community stakeholders and organisations is much needed to increase accessibility and patient knowledge of cancer and to overcome existing disparities in timely care for lung cancer patients.” Scientists cite multiple reasons for the racial disparities, including health insurance – non-white patients are more likely to be uninsured, face greater socioeconomic barriers to care and may be perceived by doctors as being at risk for not following through with treatment plans. Read full story Source: The Independent, 26 October 2022
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News ArticleResearchers in the US have found a genetic link between people with African ancestry and the aggressive type of breast cancer. They hope their findings will encourage more black people to get involved in clinical trials in a bid to improve survival rates for people with the disease. Triple negative breast cancer (TNBC) is more common in women under 40 and disproportionately affects black women. A study published in the journal JAMA Oncology found that black women diagnosed with TNBC are 28% more likely to die from it than white women with the same diagnosis. Now a new study has confirmed a definitive genetic link between African ancestry and TNBC. Lisa Newman, of Weill Cornell Medicine, has been part of an international project studying breast cancer in women in different regions of Africa for 20 years. She says representation of women with diverse backgrounds on clinical trials is absolutely critical. "Unfortunately, African-American women are disproportionately under-represented in cancer clinical trials and we see this in the breast cancer clinical trials as well," says Dr Newman. "If you don't have diverse representation, you don't understand how to apply these advances in treatment. "Part of it is because there is some historic mistrust of the healthcare system. "We do continue to see systemic racism in the healthcare delivery system where it has been documented, tragically, that many cancer care providers are less likely to offer clinical trials to their black patients compared with their white patients."
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News Article
'Speaking about the 22 babies I lost is seen as taboo'
Patient Safety Learning posted a news article in News
Imtiaz Fazil has been pregnant 24 times, but she only has two living children. She first fell pregnant in 1999 and, over the subsequent 23 years, has had 17 miscarriages and five babies die before their first birthdays due to a rare genetic condition. The 49-year-old, from Levenshulme in Manchester, told BBC North West Tonight her losses were not easy to talk about, but she was determined to do so, in part because such things remained a taboo subject among South Asian groups. She said she wanted to change that and break down the stigma surrounding baby loss. She said her own family "don't talk to me very much about the things" as they think "I might get hurt [by] bringing up memories". "It's too much sadness; that's why nobody approaches these sort of things," she said. Sarina Kaur Dosanjh and her husband Vik also have the hope of breaking the silence surrounding baby loss. The 29-year-olds, from Walsall in the West Midlands, have set up the Himmat Collective, a charity which offers a virtual space for South Asian women and men to share their experiences. The couple, who have had two miscarriages in the past two years, said the heartache was still not something that people easily speak about. "I think it's hidden," Sarina said. "It's really brushed under the carpet." Read full story Source: BBC News, 13 October 2022 -
News Article
Slow cancer diagnosis twice as likely for ethnic minority patients, survey shows
Patient Safety Learning posted a news article in News
New patient data shows significant regional differences in the effectiveness of primary care in getting cancer sufferers diagnosed – with an even more alarming picture when the data is broken down by ethnicity. A survey of cancer patients asked how many times they had “spoken to a healthcare professional at [their] GP practice about health problems caused by cancer” before they were diagnosed, with a range between one and more than five times. The overall figure for five times or more in England was 7% – but all four cancer alliances in London scored significantly above this. Cancer Research UK said this could reflect the greater concentration of ethnic minority patients in the capital, and the data bore this out. Nationally, 6.6% of white cancer patients had seen five or more primary care staff before getting a diagnosis. This compared to 11.7% for Asian cancer patients and 12.9% for Black cancer patients. Read full story (paywalled) Source: HSJ, 18 October 2022 -
News Article
University of Leicester team finds more stillbirths in deprived areas
Patient Safety Learning posted a news article in News
Research suggests there are higher rates of stillbirth and neonatal death for those living in deprived areas and minority ethnic groups. A report from a team at the University of Leicester shows that while overall stillbirth and neonatal mortality rates have reduced, inequalities persist. MBRRACE-UK, the team that carried out the research, said it had looked at outcomes for specific ethnic groups. The report showed the stillbirth rate in the UK had reduced by 21% over the period 2013 to 2020 to 3.33 per 1,000 total births. Over the same period the neonatal mortality rate has reduced by 17% to 1.53 per 1,000 births. However despite these improvements, the authors found inequalities persisted, with those living in the most deprived areas, minority ethnic groups and twin pregnancies all experiencing higher rates of stillbirth. Elizabeth Draper, professor of perinatal and paediatric epidemiology at the university, said: "In this report we have carried out a deeper dive into the impact of deprivation and ethnicity on stillbirth and neonatal death rates. "For the first time, we report on outcomes for babies of Indian, Pakistani, Bangladeshi, Black Caribbean and Black African, rather than reporting on broader Asian and black ethnic groups, who have diverse backgrounds, culture and experiences. "This additional information will help in the targeting of intervention and support programmes to try to reduce stillbirth and neonatal death." Read full story Source: BBC News, 14 October 2022 -
Content ArticleThere is evidence that certain subgroups of the population have a higher risk of developing dementia than others. Aside from the most important risk factor—age,—other risk factors include ethnicity, sex, learning disability and socio-economic status. This report by the UK Dementia Research Institute (UK DRI) details the impact of scientific research on health inequalities for people affected by dementia. In order to make sure dementia diagnosis and treatments are effective for everyone, we need to understand how and why different groups are affected differently, so that we can target interventions where they are most needed and maximise their benefit. The report was produced by leading dementia scientists from the UK DRI who are taking action to reduce health inequalities through their own research. This includes: Researching “blood biomarkers” to pave the way for a blood test to diagnose Alzheimer’s disease. Ensuring both male and female mice are used equally in animal research so that findings can be applied to the whole population. This is policy across the UK DRI. Broadening understanding of the implications of ethnicity on risk of Alzheimer’s disease through genetic studies. Working to make clinical trials more accessible to all. Pioneering accessible, scalable, and affordable new therapies. Investigating rarer forms of dementia to plug the knowledge gap and support people living with these diseases. Addressing the environmental and lifestyle factors that impact brain health to better understand the link between socio-economic status and dementia risk.
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Content ArticleThis blog by Professor Michael Marmot, Professor of Epidemiology, University College London looks at the ways in which the Covid-19 pandemic both exposed and amplified underlying inequalities in society. He highlights the link between higher Covid mortality rates, race and deprivation that demonstrates the striking health inequalities that exist in the UK. He asks the question, "Can the UK learn the lessons of the pandemic, and build back fairer?"
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Content ArticleThe Government's Race Disparity Unit has published data relating to NHS staff reports of discrimination at work. The charts, tables and commentary on this page cover survey data from 2019, and the data from 2020 is available to download without commentary. 300 NHS organisations took part in the staff survey in 2019, including 229 NHS trusts.
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Content ArticleRAND Corporation and MedStar researchers examined the intersection of patient safety and racism, focusing on patient safety and health equity from clinician leaders' perspectives. An overarching emphasis of the work concerned the impact of racism and other related factors (i.e., bias) on patient safety events and potential interventions or changes (such as creating a culture of speaking up about racism in care) that can help prevent such events.
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Content ArticleInfographic highlighting statistics on ethnic health inequalities in the UK.
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Content ArticleThe NHS Confederation has published a new report, 'The unequal impact of COVID-19: investigating the effect on people with certain protected characteristics', which maps existing research into COVID-19 inequalities onto some of these protected characteristics, showing how the pandemic has interacted with them. The report then showcases four case studies of how different health and care systems have put in place interventions to respond to these inequalities when designing their COVID-19 response. It focuses on a number of key areas including the impact of COVID-19 on: BAME communities people with disabilities older and younger people. The report concludes with a series of recommendations for health and care systems across the UK.
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Content ArticleThis report by NHS Confederation looks at the lived experience of senior black and minority ethnic leaders in the NHS. It is based on the findings of a survey and series of roundtables conducted by the BME Leadership Network in spring 2022, which focused on the challenges BME leaders face in relation to racism and discrimination as they move through their careers. The report highlights that: More than half of surveyed BME NHS leaders considered leaving the health service in the last three years because of their experience of racist treatment while performing their role as an NHS leader. Colleagues, leaders and managers seemed to be a particular source of racist treatment, more so than members of the public. This is concerning, given that the NHS has been prioritising equality, diversity and inclusion activities in recent years. This suggests that more focused efforts are required at every level to reduce the incidence of racist behaviour and to improve awareness among all staff of the impact of this type of discrimination. Only 10 per cent of leaders surveyed were confident that the NHS is delivering its commitment to combat institutional racism and reduce health inequalities. Senior BME staff reported low levels of confidence in their own organisations’ abilities to manage and support a pipeline of diverse talent and in the ability of the system to achieve this at a national level. Only a minority were confident they could rely on the support of colleagues to challenge racial discrimination, and a smaller minority believed they would be supported by NHS England and NHS Improvement if challenging prejudice or discrimination locally. Leaders described how structural and cultural issues within the NHS led to a situation where BME leaders were not present in sufficient numbers to generate a climate of inclusivity and were sometimes siloed in particular types of role. This helped to create a situation where career progression was felt to be unduly challenging and where neither succession planning nor talent development were occurring at sufficient scale to support the next generation of diverse leaders. Some leaders reported policing their own behaviour in the workplace and compromising their values in order to fit in. Being able to represent their own cultures and be themselves at work was a critically important goal for many. The report outlines that it is essential that BME leaders are able to see effective development programmes to support diverse talent, and that they are provided with the right support to feel secure in calling out unacceptable behaviour. It highlights that the NHS needs to do more to tackle cultures of discriminatory behaviour, provide personal support to current and aspiring leaders, and develop succession planning and talent development schemes.
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News Article
Over half of ethnic minority NHS leaders consider quitting due to racism
Patient Safety Learning posted a news article in News
Just over half of senior ethnic minority leaders have considered leaving the NHS due to experiencing workplace racism a survey suggests. The survey was carried out by the NHS Confederation’s BME Leadership Network and its 123 respondents included chief executives, directors and senior managers. Responses were collected from network members online before three roundtables were held with senior ethnic minority leaders to understand their experiences and the challenges they have faced in relation to discrimination. The survey found: 51% of respondents said they had considered leaving the NHS in the past three years because of their experience of racist treatment while working. More than 20% said they had experienced verbal abuse or abusive behaviour targeting racial, national or cultural heritage five times or more in the last three years. 69% had experienced this behaviour from other leaders or managers within their organisation at least once in the same timeframe. 57% had experienced it from leaders or managers in another organisation at least once over the same period. Joan Saddler, NHS Confederation’s director of equality and partnerships, said the NHS was at risk of losing “committed, highly skilled and motivated talent to institutional racism and discrimination”. Read full story (paywalled) Source: HSJ, 17 June 2022 You may also be interested in reading: BMA: Racism in medicine -
Content ArticleThis report from the BME Leadership Network spotlights the findings from a recent survey and engagement on the experience of senior black and minority ethnic leaders in the NHS.
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Content ArticleThe current hospital backlog has had a huge impact on many patients waiting for treatment. But if you are a woman, on a low income or from an ethnic minority background, you are more likely to have a worse experience of waiting for care. Research from Healthwatch has highlighted people were unhappy with the communications they received and the lack of support the NHS gave them to help with things like pain relief or accessing physiotherapy. These concerns were not experienced equally by all, and findings were particularly stark among disabled people, those with long term health conditions, and those on lower incomes. A new poll of 1,000 adults on NHS waiting lists shows that a poorer experience of waiting can be linked to factors such as wealth, disability, level of education, gender or ethnicity.
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News Article
NHS waiting lists: Women, low earners and ethnic minorities worst affected
Patient Safety Learning posted a news article in News
Women, low earners and ethnic minorities are faring worse on NHS waiting lists, according to research. Healthwatch, a patient watchdog, warned there was a risk that those with “more demands on their lives” such as long hours or caring responsibilities could end up at the back of the queue. It urged hospitals to be proactive in managing waiting lists and communicate with patients who might otherwise be left in limbo. The Healthwatch survey found 54% of women had waited more than four months for treatment, compared with 42% of men. They were also more likely to have had treatment delayed or cancelled, and to feel that a delay to treatment had made an impact on their ability to work. Some 54% of people on lower incomes had been waiting more than four months for hospital care, compared with 34% of higher wealth individuals. They reported a greater impact on their mental health and their ability to work. And 57% of respondents from ethnic minorities had faced a delay to or cancellation of hospital treatment, compared with 42 per cent of white British people. Louise Ansari, Healthwatch England’s national director, said the factors could have a “layering effect” that meant people had a much poorer experience, calling for “an additional specific focus on those groups” so that they do not end up “in worse and worse health”. Read full story (paywalled) Source: The Times, 8 June 2022 -
News Article
Messenger at odds with Javid over NHS diversity jobs
Patient Safety Learning posted a news article in News
Sajid Javid’s claim that the number of NHS roles dedicated to promoting equality and diversity should be cut is incorrect and not what the government-commissioned review into NHS management recommended, according to its author. The review by General Sir Gordon Messenger and Leeds Teaching Hospital chair Dame Linda Pollard was published Wednesday. Speaking to the Daily Telegraph on Tuesday evening, the health secretary said: “In my view, there are already too many working in roles focused solely on diversity and inclusion, and at a time when our constituents are facing real pressures around cost of living, we must spend every penny on patients’ priorities. “As this report sets out, it should be the responsibility of everyone to encourage fairness and equality of opportunity which is why we must reduce the number of these roles.” Speaking later to HSJ, Mr Javid was asked if there was any area of NHS management cuts should be made. He said: “I would like to see fewer managers in terms of diversity managers and things, because I think it should actually be done by all management and all leadership, and not contracted out as some kind of tick-box exercise.” However, when HSJ spoke to General Messenger he said: “The report does not recommend the reduction of EDI (equality, diversity and inclusion) professionals. “What it does say though, is that if one successfully inculcates equality, diversity and inclusion to every leadership’s responsibilities then that becomes an accepted, instinctive, understood part of being a leader and a manager at every level then the requirement for dedicated EDI professionals should reduce over time." Read full story (paywalled) Source: HSJ, 8 June 2022 -
News Article
Duty of all NHS staff in England to fight discrimination, review says
Patient Safety Learning posted a news article in News
All the NHS’s 1.5m staff in England should tackle discrimination against disadvantaged groups, not just bosses and specialist diversity teams, a major review has concluded. NHS trusts will need fewer equality, diversity and inclusion (EDI) teams if action against discrimination does become “the responsibility of all”, according to the report. The review of NHS leadership said the health service should adopt a different approach to equality issues in order to overcome the widely recognised disadvantages faced by certain groups of its own staff, which include lower pay and chances of promotion among Black and ethnic minority doctors compared with white medics and low BAME representation in senior managerial ranks. The inquiry, undertaken by Genl Sir Gordon Messenger and Dame Linda Pollard, was commissioned last year by Sajid Javid, the health secretary. The report concluded that: “Most critically, we advocate a step-change in the way the principles of equality, diversity and inclusion are embedded as the personal responsibility of every leader and every member of staff. “Although good practice is by no means rare, there is widespread evidence of considerable inequity in experience and opportunity for those with protected characteristics, of which we would call out race and disability as the most starkly disadvantaged. “The only way to tackle this effectively is to mainstream it as the responsibility of all, to demand from everyone awareness of its realities and to sanction those that don’t meet expectations.” Read full story Source: The Guardian, 8 June 2022 -
Content ArticleIn October 2021 the government announced a review into leadership across health and social care, led by former Vice Chief of the Defence Staff General Sir Gordon Messenger and supported by Dame Linda Pollard, Chair of Leeds Teaching Hospital Trust. The results of the review have now been published and recommendations made.
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News Article
Racial disparity in cancer diagnoses via screening in England
Patient Safety Learning posted a news article in News
Black people are more than a third less likely than white people to be diagnosed with cancer via screening in England, according to the first study of its kind, prompting calls for targeted efforts to improve their levels of uptake. Screening programmes save lives by preventing cancer from occurring or spotting it earlier, when treatment is more likely to be effective. In England, screening for cervical cancer is offered to women aged 25 to 64, breast cancer screening is offered to women aged 50 to 70, and everyone aged 60 to 74 is offered a bowel cancer screening home test kit every two years. The latest research, however, lays bare stark disparities in screening diagnosis rates between different ethnic groups for the first time. The study of more than 240,000 cancer patients over a decade found that 8.61% of patients were diagnosed via screening. Broken down by ethnicity, the figure for white people was 8.27%, almost exactly the same as the national average, but among black people it was 5.11%. The findings suggests that black people are 38% less likely to be diagnosed via screening than white people. Diagnosis via screening in mixed-race patients was much higher at 9.49%, and higher still in Asian patients at 10.09%, almost double the rate for black patients. The results were published in the British Journal of Cancer. Jabeer Butt, the chief executive of the Race Equality Foundation, said the findings should prompt urgent action. “Cancer screening saves lives,” he said. “That’s why it is so important that effective outreach and culturally appropriate interventions are prioritised to reduce health inequalities. “We know that awareness of cancer symptoms is lower among minority ethnic groups, particularly black Africans, with higher reported barriers to seeking help. But we also know from previous research on colorectal cancer interventions that speaking to someone who explains the steps of the screening process ahead of time can lead to improvements in screening uptake in minority patients." Read full story Source: The Guardian, 6 June 2022 -
Content ArticleUK Asian and Black ethnic groups have poorer outcomes for some cancers and are less likely to report a positive care experience than their White counterparts it was found in a study from Martins et al. reported in the British Journal of Cancer. The study investigated ethnic differences in the route to diagnosis (RTD) to identify areas in patients' cancer journeys where inequalities lie and targeted intervention might have optimum impact. Across the 10 cancers studied, most patients were diagnosed via the two-week wait (36.4%), elective GP referral (23.2%), emergency (18.2%), hospital routes (10.3%), and screening (8.61%). Patients of Other ethnic group had the highest proportion of diagnosis via the emergency route, followed by White patients. Asian and Black group were more likely to be GP-referred, with the Black and Mixed groups also more likely to follow the two-week wait route. However, there were notable cancer-specific differences in the RTD by ethnicity. These findings suggest that, where inequalities exist, the adverse cancer outcomes among Asian and Black patients are unlikely to be arising solely from a poorer diagnostic process.
