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

在英格兰和威尔士，黑人、亚洲人和少数民族（BAME）占人口的14%。NHS是BAME员工的最大雇主，至少占劳动力的20%（伦敦为45%）。BAME医疗保健工作人员比其他工作人员经历更大程度的工作场所种族主义，骚扰和歧视。歧视、欺凌或虐待对心理健康和职业结果有持续的影响。这种工作场所的经历（更常见的是同事、经理而不是病人）在过去五年中有所增加，特别是在伦敦国民保健服务信托机构。黑人、亚裔和少数族裔工作人员的工作条件也较差（例如，工资较低，对决策的控制较少，无权抱怨工作条件）。COVID-19感染不成比例地影响BAME英国社区，包括医护人员（例如，黑人族群的死亡率上升）。因此，BAME NHS员工面临的不利工作条件可能会因工作场所内外更多地暴露于COVID-19相关不利因素而恶化。这些逆境使BAME员工处于弱势地位（例如，工作角色涉及更多地接触COVID-19病房;工作场所压力增加，对自己和家人的污名化，恐惧和对COVID-19风险的不确定性）。这些种族不平等必须得到解决，以避免社会，经济和精神疾病的道德成本和BAME工作人员更糟糕的职业结果。这项研究旨在确定NHS工作人员在心理健康和职业结果方面的种族不平等，以及COVID-19如何加剧这种不平等，以及不平等产生，维持和抵制的过程。我们还旨在开发一个种族平等评估工具包，以及教育和培训资源，旨在改善BAME工作人员的经验，保留和相关的NHS政策。为了实现这些目标，我们将让服务用户和BAME工作人员代表参与决定调查和访谈的内容，共同领导访谈并开发工具包;收集新的定量（调查）和定性数据，（访谈）自COVID-19以来BAME工作人员经验的数据;开发工具包，以帮助确保BAME观点在所有NHS工作人员的研究和教育中得到优先考虑;并开发教育和培训资源，旨在改善BAME员工的工作场所体验，保留工作并减少BAME员工在COVID 19期间和之后面临的不平等。为此，我们将把一个种族模块纳入正在进行的全国国民保健服务工作人员（NHS）纵向研究，以评估18个月内种族的健康和工作成果。有了额外的种族模块，NHS的种族不平等队列将独特地捕捉COVID-19期间和之后在心理健康和职业结果方面现有和新出现的种族不平等。我们还将对参加NHS研究的BAME工作人员进行访谈;来自不同种族背景的伦敦医疗保健从业者，他们在COVID-19之前接受过采访，作为解决卫生服务中的不平等和歧视经历（TIDES）研究的一部分;以及全国范围内来自BAME和非BAME群体的NHS管理人员和高级工作人员。数据将通知NHS信托，英国国民保健服务和公众通过目前的倡议，任务是使工作场所内的BAME工作人员的可持续转型），例如，NHS英格兰劳动力种族平等标准）和社区（例如，Black Thrive）。调查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。这些也将随后试点之前，通过我们的合作者，如英国国民保健服务劳动力种族公平标准，国民保健服务联合会和护理皇家学院扩大。

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.