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    Black, Asian and Minority Ethnic (BAME) deaths

    Three of the four NHS workers reported to have died from Covid-19 in Oxfordshire to date were from a BAME background.[1] The first ten doctors to die of Covid-19 infection were BAME, many of them born outside the UK. This situation among health workers[2] reflects the pattern for deaths in the general population – the ONS has just found that Black people in the UK are four times more likely to die from Covid-19 than White people[3] –  as well as for deaths among people working in the NHS (including outsourced workers) and, probably, care workers.[4]

    Health and economic inequality sustained by structural racism, and exacerbated by austerity and privatisation of the welfare state, is the cause. The Covid-19 pandemic has highlighted the extreme racial and class inequalities in the UK.[5]  Michael Marmot’s recent Ten-Year Review of inequalities highlights straightened circumstances and poor life chances, and moves away from focusing on the behaviour of individuals. Marmot and the UN Special Rapporteur on Racism remind us of the austerity context within which the current pandemic is taking place, with the UN Rapporteur stating that ‘austerity measures in the United Kingdom are reinforcing racial subordination.’[6]

    NHS England and Public Health England and their leaders must be held to account.[7] The current inquiry to be led by the very bodies being investigated is not adequate. We must hold the Government to account for running down the public sector and undermining the NHS and its capacity to deal with pandemic, for its response to the pandemic, and for exploiting the situation to further privatise the NHS.[8]

    An effective enquiry into Black, Asian and minority ethnic deaths must be based on serious analysis of the interlinked socioeconomic and structural factors that may be involved and an understanding that racism adversely affects health even when these factors are accounted for.

    The socioeconomic effects of racism include:

    Longstanding structural discrimination in employment:

    • Low paid, insecure work with an overrepresentation of BAME workers in health and social care and allocation to higher risk roles.[9]
    • The effects of racism persist amongst medics – and, though less research has been done on this, presumably amongst all workers in the health and care sectors – with the evidence that BAME doctors are much less likely to make complaints around safety due to a fear of recrimination.[10]
    • Frontline, ‘key worker’ roles which do not permit working from home, with relative poor access to limited PPE.
    • The gig economy, and in jobs in domestic work, cleaning, childcare, small retail and family businesses. The economic packages allow many in these groups to fall between the gaps and make shielding for high risk workers and their families impossible.
    • Poorly protected outsourced jobs often with low union membership: the true impact of the policy of privatisation of public services and utilities needs to be investigated. This investigation must cover employment and NHS trust practices, policies and guidelines around the health and safety of all workers on their sites, not just those in their direct employment.
    • The lack of clarity about what constitutes a ‘vulnerable’ worker who should be shielding further increases the risk of pressure on less favoured groups in the population.

    Structural discrimination in housing and access to healthcare with:

    • Relative overcrowding in housing compared with White households.
    • A high proportion of BAME communities in densely populated urban areas of deprivation with (per person) under resourced health and social care facilities and higher levels of air pollution.

    Factors relating to migration include:

    • Whether a person was born outside the UK: 53 of 64 BAME Covid-19 deaths among NHS staff in one study were of people born outside the UK.[11]
    • Immigration status: some overseas workers fear losing their jobs and may feel driven to accepting additional risks.

    Some continue to propose various biological explanations for the prevalence of BAME Covid-19 deaths. Such evidence must be robustly scrutinised and not allowed to distract the focus on the overwhelming socioeconomic causes and the urgent need to address structural racism.

    Action

    Urgent tasks

    The most urgent task is to reduce all deaths from COVID-19 through adequate provision of  personal protective equipment (PPE), workplace practices that minimise risk, and physical distancing. Workers have the right not to work in unsafe conditions and employers have the duty to ensure safe conditions. A working, effective system to trace infection routes must be part of any loosening of lockdown. Local public health teams must be restored to deliver this.[12] All the evidence so far points to the fact that centralised privatised solutions have failed us.

    Research

    A programme of research is urgent to clarify the main factors and provide the basis for new policy. Ethnicity must form part of data collected by health and care services.[13]

    Health and Safety Executive guidelines and definitions in analysing workplace deaths, and procedures for investigating workplace deaths, need to be strengthened to keep workers safe and protected. Currently NHS trusts are left to assess themselves – a clear conflict of interest.

    Beyond immediate tasks

    The government’s hypocrisy must be challenged. Boris Johnson’s government has promised to ‘level up’ areas where health has deteriorated. Oxfordshire County Council leader and chair of the Local Government Association’s community wellbeing board, Ian Hudspeth, called the Marmot report a wake-up call: ‘Councils want to work with government on closing this gap… . Sustainable, long-term investment in councils’ public health services is also needed.’[14] Just one week later, on 4 March, a majority of MPs voted not to call on the Government to end austerity, invest in public health, and implement the recommendations of the Marmot review.[15] Opposition parties must be unrelenting in denouncing this hypocrisy now.

    The Runnymede Trust’s proposal[16] to introduce the socioeconomic duty, making class an ‘equality ground’ should be supported. This would return to the situation before 2010 when Theresa May scrapped the legal requirement designed to make public bodies try to reduce inequalities caused by class disadvantage (the socioeconomic duty).[17] [18]

    Migrant workers are the lifeblood of our NHS, our care system and our society. The hostile environment must end now. That means granting indefinite leave to remain to all NHS and care workers and their families, and abolishing a) ‘no recourse to public funds’ barriers to health and other services, b) charging migrants for NHS treatment, c) charging migrants a health surcharge on top of their income tax, and shutting detention centres.

    Action is necessary to end health inequalities. The Marmot Review’s recommendations must be implemented with race as a ‘social determinant of health’ as put forward by the Runnymede Trust. Inadequate public health expenditure and ‘shrinking the state’ disproportionately affect poorer people including our BAME communities. More ‘austerity’ to ‘pay for’ the pandemic is not an option as austerity widens the health inequalities that lead to disproportionate BAME Covid-19 deaths.

    This briefing gives rise to a number of issues to be taken forward in national and local investigations which we will be pressing Trusts and Local Authorities to undertake.

    Oxfordshire Socialist Health Association Committee

    May 2020

    [1] Oscar King and Elbert Rico, porters, and Philomina Cherian, nurse, at the John Radcliffe Hospital, Oxford, and Margaret Tapley at Witney Community Hospital.

    [2] https://www.hsj.co.uk/exclusive-deaths-of-nhs-staff-from-covid-19-analysed/7027471.article

    [3] https://www.theguardian.com/world/2020/may/07/black-people-four-times-more-likely-to-die-from-covid-19-ons-finds

    [4] ‘Death rate among black and Asian Brits is more than 2.5 TIMES higher than that of the white population, reveals stark analysis by Institute of Fiscal Studies’, Daily Mail, 1.5.20:

    https://www.dailymail.co.uk/news/article-8276097/Clear-disparity-ethnic-groups-Covid-19-deaths-IFS-study.html;

    Office of national Statistics: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsinvolvingcovid19bylocalareasanddeprivation/deathsoccurringbetween1marchand17april

    [5] https://morningstaronline.co.uk/article/coronavirus-highlighting-extreme-racial-and-class-inequalities-–-let’s-vow-end-them

    [6] https://hjt-training.co.uk/un-special-rapporteur-criticises-hostile-environment-policy/

    [7] http://www.irr.org.uk/news/institutional-racism-in-the-nhs-intensifies-in-times-of-crisis/

    [8] https://www.theguardian.com/business/2020/may/04/uk-government-using-crisis-to-transfer-nhs-duties-to-private-sector

    [9] https://metro.co.uk/2020/04/21/nhs-puts-pressure-ethnic-minority-staff-work-coronavirus-wards-12589058/

    [10] https://www.theguardian.com/society/2020/apr/10/uk-coronavirus-deaths-bame-doctors-bma.

    The February issue of the British Medical Journal was devoted to the subject of racism in medicine:  https://www.bmj.com/racism-in-medicine

    [11] https://www.hsj.co.uk/exclusive-deaths-of-nhs-staff-from-covid-19-analysed/7027471.article

    [12] https://www.theguardian.com/world/2020/apr/26/to-tackle-this-virus-local-public-health-teams-need-to-take-back-control

    [13] ‘Ethnicity and COVID-19: an urgent public health research priority’, Lancet: https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2930922-3

    [14] https://www.theguardian.com/society/2020/feb/24/austerity-blamed-for-life-expectancy-stalling-for-first-time-in-century

    [15] https://www.theyworkforyou.com/debates/?id=2020-03-04d.903.0

    [16] https://www.runnymedetrust.org/uploads/publications/We%20Are%20Ghosts.pdf

    [17] https://www.runnymedetrust.org/uploads/publications/We%20Are%20Ghosts.pdf

    [18] https://www.theguardian.com/society/2010/nov/17/theresa-may-scraps-legal-requirement-inequality

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    From Mark Ladbrooke, of Oxford SHA branch, and formerly chair of Oxford University Hospitals Foundation Trust (OUHT) Joint Union Committee

    Oscar King, Jr. and Elbert Rico, porters at John Radcliffe Hospital, Oxford, and union activists, died two weeks ago of suspected Covid-19.

    Both of them are married to members of the nursing team at the hospital and Twilight, Oscar’s wife, was admitted to hospital, while their 10-year old daughter is being cared for. Oscar and Rico came from the Philippines and had worked at the hospital since they arrived.
    The Filipino community is extremely important to the NHS – after workers from the UK itself and India they make up the largest proportion of the workforce.

    Patients may not notice the porters as much as they notice doctors and nurses, but their role is just as vital, since they take everyone where they need to go, and move equipment and machinery to where it is required. The Labour Movement has supported junior doctors and nurses in dispute with management (backed by government) at various times – but porters, domestics and catering staff are frequently outsourced and are at the end of the queue.

    As long ago as 1982 the Thatcher government brought in competitive tendering for NHS services such as catering, cleaning, portering and estates maintenance. Oxford University Hospitals Foundation NHS Trust (OUHT), of which the Radcliffe is part, signed up to a Private Finance Initiative (PFI) deal, under which management of the porters, domestics and catering staff was transferred to a private company as the hospital was expanded. PFI was dreamed up when Norman Lamont was Tory Chancellor, but took off under the New Labour Government of Tony Blair after 1997.

    A Unison strike in Dudley in 2000 was the seventh against transfer to the private sector, as part of increasing resistance to PFI. The striking workers won important concessions around secondment, nevertheless management was still transferred to Carillion (which went bust in Jan 2018). The John Radcliffe workers threatened strike action in 2015 around pay cuts.
    Industrial action continues to be taken against PFI and its impact on working conditions, most recently this year in Lewisham (because the outsourcing firm failed to pay cleaners, porters and catering staff the wages that had been agreed) and Paddington. In the latter case, porters, caterers and cleaning staff at St Mary’s, with the support of some of the other staff, including doctors, became employees once again of the NHS.

    We, in the Joint Union Committee and local SHA branch knew Oscar, in particular, as a “brilliant rank and file union leader”. The SHA branch is well connected to the workplace and local unions. They help provide the leadership of the branch. The Chair of the SHA branch, Cllr Nadine Bely-Summers, a nurse, who also represents Oxford City Council on the local Health Overview and Scrutiny Committee (HOSC), demanded answers from Bruno Holtof, chief executive of the OUHT, about the deaths of the two porters:


    – How many staff on site are managed by outsourcing companies or agencies?
    – What personal protective equipment (PPE) was provided by the trust to staff managed by outsourcing companies or agencies?
    – What personal Protective Equipment (PPE) was provided by the trust to staff managed by Bouygues and other outsourcers eg G4S? When was this provided?
    – Are staff being put under pressure to return to work while reporting sick?
    – How are the frontline outsourced staff who are vulnerable being treated?
    – Is the Trust legally liable for Health and Safety breaches on its premises including those by outsourcing companies and agencies?

    In response to her demands the Director of Public Health has promised to investigate further.
    BAME Labour activists working with Oxford City’s Labour Council have raised concerns that this may be part of a worrying national picture of an especially high death toll among black and Asian workers, as reported on various TV channels and in several daily newspapers in the last week.

    The local city council has written to the Chief Executive of the NHS Trust asking for an explanation.
    Nadine said “We must seek assurances from all NHS Trusts that there is day-to-day monitoring carried out to make sure there is not a disproportionate impact of the rates of infection and death on ethnic minority workers, and that adequate PPE are being provided at all times to all staff groups”.

    Stop Press!

    The Chief Executive of the Trust has written back to the council saying, among other things:
    We note, however in the case of reporting incidents in relation to Covid-19, that the HSE have indicated that “[in] a work situation, it will be very difficult, if not impossible, for employers to establish whether or not any infection in an individual was contracted as a result of their work. Therefore, diagnosed cases of Covid 19 are not reportable under RIDDOR ( Reporting of Injuries, Diseases and Dangerous Occurrences Regulations )  unless a very clear work related link is established.”

    We are unable to comment in detail on specific individual cases but are able to note that there is not currently evidence to support such a link in relation to these two staff members. However we can confirm that reporting and investigation will take place in line with HSE guidance where a diagnosis of Covid-19 is directly attributed to an occupational exposure.

    Oxford and District Labour Party Executive has asked Anneliese Dodds (Labour Oxford East) to raise this issue in parliament. She reports that Labour is planning to raise such issues on workers’ memorial day.

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