Identifying and mitigating the impact of COVID-19 on inequalities experienced by people from BAME backgrounds working in health and social care

黑人、亚洲人和少数族裔(BAME)群体占英格兰和威尔士人口的14%。NHS是BAME员工的最大雇主，至少占劳动力的20%(伦敦为45%)。与其他员工相比，BAME医护人员经历的工作场所种族主义、骚扰和歧视程度更高。歧视、欺凌或虐待对心理健康和职业结果有持久的影响。这类工作经历(更常见的是同事、经理而不是病人)在过去5年里有所增加，特别是在伦敦NHS信托基金。BAME工作人员的工作条件也更差(例如，工资较低，对决策的控制较少，无法抱怨工作条件)。新冠肺炎感染对包括医护人员在内的英国社区的影响不成比例(例如，黑人族群死亡率增加)。因此，BAME NHS工作人员在工作场所内外更多地暴露于与新冠肺炎相关的不利因素，可能会使他们面临的不利工作条件恶化。这些逆境将北京美院的员工置于脆弱的境地(例如，在医院工作的人需要更多地暴露在新冠肺炎病房中；工作场所的压力增加、耻辱、恐惧和对新冠肺炎风险的不确定性给他们自己及其家人带来的风险)。必须解决这些种族不平等问题，以避免BAME工作人员因精神疾病和更糟糕的职业后果而付出的社会、经济和道德代价。这项研究旨在确定国民保健系统工作人员在心理健康和职业结果方面的种族不平等，新冠肺炎是如何加剧这种不平等的，以及不平等是如何产生、维持和抵制的。我们还计划开发种族平等评估工具包，以及旨在改善BAME工作人员经验、留住和相关NHS政策的教育和培训资源。为了达到这些目标，我们将让服务用户和北美院员工代表参与决定调查和访谈的内容，共同领导访谈和开发工具包；收集自新冠肺炎以来北美院员工经历的新的定量(调查)和定性(访谈)数据；开发工具包，以帮助确保北美院的观点在研究和教育中被列为所有NHS员工的优先事项；并开发教育和培训资源，旨在改善北美院员工的工作场所体验、工作保持率和减少北美院员工在COVID19期间和之后面临的不平等。为了做到这一点，我们将把种族模块纳入正在进行的对NHS工作人员的全国纵向研究(NHS Check)，以评估18个月期间按种族划分的健康和工作成果。随着额外的种族模块，国民健康保险检查队列将独特地捕捉到在新冠肺炎期间和之后在精神健康和职业结果方面现有的和正在出现的种族不平等。我们还将采访参与BAME Check研究的BAME工作人员；来自不同种族背景的伦敦医护人员，他们之前曾在新冠肺炎之前接受过采访，作为解决医疗服务中的不平等和歧视经验(DEDS)研究的一部分；以及来自BAME和非BAME小组的NHS经理和全国高级工作人员。数据将通过当前负责为BAME工作人员在工作场所进行可持续转型的倡议(例如，NHS英格兰劳动力种族平等标准)和社区(例如，Black Thrive)，向NHS信托基金、NHS英格兰和公众提供信息。研究结果将用于开发教育和培训材料，通过与心理学家、医学教育以及平等和多样性专业人员的合作，在全国范围内支持BAME NHS工作人员。这些也将在随后通过我们的合作伙伴进行试点，如NHS英格兰劳动力种族公平标准、NHS联合会和皇家护理学院。

Black, Asian and minority ethnic (BAME) groups constitute 14 percent of the population in England and Wales. The NHS is the largest employer of BAME staff, comprising at least 20 percent of the workforce (45 percent in London). BAME healthcare staff, experience greater levels of workplace racism, harassment and discrimination than other staff. Discrimination, and bullying or abuse have persistent effects on mental health and occupational outcomes. Such workplace experiences (more commonly perpetrated by colleagues, managers than patients), have increased over the past five years, particularly in London NHS Trusts. BAME staff also have poorer working conditions (e.g., lower pay, less control in decision making, dis-empowered from complaining about working conditions). COVID-19 infections disproportionately affect BAME UK communities including healthcare workers (e.g., increased mortality among Black ethnic groups). Therefore, adverse working conditions faced by BAME NHS staff may be worsened by greater exposure to COVID-19 related disadvantages, within and outside of the workplace. These adversities place BAME staff in vulnerable positions (e.g. working in role that involve greater exposure to COVID-19 wards; heightened workplace stresses, stigma, fear and uncertainty around COVID-19 risks for themselves and their families). These ethnic inequalities must be addressed to avoid the social, economic, and moral costs of mental ill health and worse occupational outcomes for BAME staff. This study aims to identify ethnic inequalities in mental health and occupational outcomes amongst NHS staff how COVID-19 exacerbates such inequalities, and the processes which inequalities are produced, maintained and resisted. We also aim to develop a Race Equality Assessment toolkit, as well as education and training resources targeted at improving BAME staff experiences, retention and relevant NHS policies. To address these aims we will involve service users and BAME staff representatives in deciding the content of the survey and interviews, co-leading interviews and in developing the toolkit; collect new quantitative (survey) and qualitative (interview) data on BAME staff experiences since COVID-19; develop the toolkit to help ensure BAME perspectives are prioritized in research and education for all NHS staff; and develop education and training resources targeted at improving BAME staff workplace experiences, job retention and reducing inequalities faced by BAME staff during and beyond COVID19. To do this, we will incorporate an ethnicity module into an ongoing national longitudinal study of NHS staff (NHS CHECK) to assess health and work outcomes by ethnicity over an 18-month period. With the additional ethnicity module, the NHS CHECK cohort will uniquely capture existing and emerging ethnic inequalities in mental health and occupational outcomes during and after COVID-19. We will also carry out interviews with BAME staff who take part in the NHS CHECK study; London based healthcare practitioners from difference ethnic backgrounds who have previously been interviewed before COVID-19 as part of the Tackling Inequalities and Discrimination Experiences in health services (TIDES) study; and NHS managers and senior staff nationally from BAME and non BAME groups.Data will inform NHS Trusts, NHS England and the public through current initiatives tasked with making sustainable transformations for BAME staff within the workplace )e.g., NHS England Workforce Race Equality Standard) and communities (e.g., Black Thrive). Findings will be used to develop education and training materials to support BAME NHS staff nationally through collaboration with psychologists, medical educations and equality and diversity professionals. These will also be subsequently piloted prior to scale up through our collaborators, such as NHS England Workforce Race Equity Standard, NHS Confederation and Royal College of Nursing.