By Barnie Choudhury
SENIOR south Asian doctors have accused the government of failing to protect the most vulnerable frontline health workers.
Their comments came during an end-of-year virtual roundtable on the government’s handling of the pandemic.
Board members of the British Medical Association (BMA), the doctors’ union, told Eastern Eye, that they and some of their south Asian colleagues had yet to be vaccinated for the virus.
“I really think that it would be a dereliction of duty if doctors and other healthcare workers who are at highest risk are left delayed in not receiving the protection they need through being vaccinated,” said the BMA chair, Dr Chaand Nagpaul.
“What I and others are doing is putting real pressure on those system leaders in our local areas and government that they have to prioritise the doctors who are most at risk of this virus and other health care workers.”
According to government data, the Covid virus disproportionately affects black, Asian, and minority ethnic (BAME) groups.
Dr Farah Jameel, a north London GP and member of the BMA’s general practitioners committee, described the government’s approach as “shambolic”.
“I have not seen enough studies which suggest what is it about being BAME that makes me more at risk of developing a significant illness when I do contract Covid and being at a higher risk of things like mortality.
“They (the government) acknowledge that BAME individuals are at a higher risk, but then they do not acknowledge or explain why they haven’t put us at that front of the queue. And I think I’d want to be asking questions about that.”
Chair of the BMA staff, associate specialist and specialty doctors committee, Dr Amit Kochhar, said lessons from earlier lockdowns had not been learned.
He had not been vaccinated when he spoke to Eastern Eye, despite being in a high-risk group.
“I don’t know why there is a failure to recognise that these groups, and it needs looking at, because we have been through so much,” said the ear, nose and throat (ENT) surgeon from Lancashire. “I personally knew five of the first 10 doctors who died, and to speak to their families was heart breaking. It is not only a loss of an NHS worker, it is a loss to the whole NHS and a loss to that family forever.”
South Asian doctors felt undervalued by the government, according to the panellists.
“You also know that some of us have beards. One of the consultants who died in the Midlands was a Sikh doctor. You can’t have PPE (personal protective equipment) that doesn’t fit the beard appropriately, so you need other measures,” Dr Kochhar said.
“These have to be arranged if you value that doctor’s life and that doctor’s contribution, and sometimes it does feel as though we were not valued. When the vaccines prioritisation list is being drawn up, where are the BAME doctors? Where are the BAME staff? They haven’t been prioritised as yet, not to my knowledge.”
Throughout 2020, the BMA chair wrote to the government pointing out that health workers were dying unnecessarily because of a lack of protection.
More needed to done to protect the most vulnerable groups, Dr Kochhar said.
In the past month, Dr Nagpaul wrote to the head of the NHS, Sir Simon Stevens, asking him to look into the arrangements.
The first letter was sent just before Christmas (December 21), followed by a second letter on December 29, reinforcing the message that 90 per cent of doctors who died were BAME.
He blamed the lack of a “systematic approach” in dealing with the pandemic for GPs and hospitals forced to do “their own work to try and protect their most vulnerable healthcare workers”.
That is still happening today, Dr Nagpaul said, when it comes to vaccinating patients in his own surgery. He told Eastern Eye that 40 per cent were BAME and most of these were south Asian.
“We had 1,000 vaccines for over 80s, and there are 10,000 over 80s in our population. We prioritised the first 1,000 to those who were over 80 and were from a BAME status and who had other medical conditions, such as diabetes.
“So, in fact we prioritised from a commitment we had to our community to protect those who are the most vulnerable and those have been largely BAME patients.”
What annoyed south Asian doctors was the government’s inconsistent messaging in recognising that BAME people were disproportionately more likely to not only contract Covid, but also die from it.
They point to the contradiction between two government reports.
The Public Health England review in June said that racism and inequality could have been increased risk factors for BAME communities. Yet in October, the race disparity unit’s quarterly report did not once mention racism as a factor.
Later, during a briefing, a government adviser ruled out structural racism being a feature.
“I find it extraordinary that the government can, at a stroke, ignore that the recommendations from an esteemed body of specialists who looked at this, which said there was structural racism, and to just ignore it and say that now suddenly it doesn’t exist; well, of course, it exists,” said the BMA chair.
“There are clear structural aspects of our health service that have resulted in unequal treatment, unequal experience for some of our healthcare workers, who are from a BAME background – the evidence is clear cut.
“So, I don’t quite understand how the government can ignore the recommendations and simply talk about another report from the race disparity unit in October.”
Another concern for south Asian doctors is a culture of fear among BAME health workers in the NHS.
According to the BMA, survey after survey reveals the lack of confidence to complain about systemic unfairness.
“BAME doctors have reported between two to three times as much as their white counterparts feeling under pressure to see patients without protection.
“They have reported to us feeling less able to raise concerns in their workplace to go to their managers to say, ‘I feel worried about whatever it might be during the Covid pandemic’.
“What they’ve told us is they’re much more concerned that if they do speak out, they may have repercussions, including issues around career progression. That is not a health service, any of us want to be part of where they may actually suffer disadvantage by speaking up because of their skin colour. That all needs to end.”
Dr Nagpaul said he wants the government in 2021 to demonstrate they “have their backs”.
“It really should not have taken 90 per cent of doctors who have died coming from a BAME background to show the government just what the BAME healthcare workforce does for the nation.
“But now that tragically that has happened. In the coming year this is what the government must make sure it delivers on, which is showing proper valuing of its workforce, in particular, those who’ve come from all around the world, including those who also were born here, who are from a BAME background.”
The government accepted that BAME groups were disproportionately affected.
Its prioritisation guidance states, “Good vaccine coverage in BAME groups will be the most important factor within a vaccine programme in reducing inequalities for this group.
“Prioritisation of persons with underlying health conditions will also provide for greater vaccination of BAME communities who are disproportionately affected by such health conditions.”
A government spokesperson said, “All health and social care staff have been prioritised for the Covid-19 vaccine since the start of the programme, along with those of older age.
“Throughout the pandemic, we have prioritised protecting the most vulnerable in our society and have invested more than £4 million into research into Covid-19 and ethnic disparities so that we can go further.
“We are supporting the NHS and have committed £3 billion to maintain surge capacity and safe discharges over winter, on top of a record cash funding boost of £33.9 billion extra a year by 2023-24.”
‘Failure of leadership’
Both the Greater Manchester mayor, Andy Burham, and his London colleague, Sadiq Khan, have accused the government of a failure to understand the way the virus impacts south Asian and black communities.
Speaking exclusively to Eastern Eye, Burnham said the race disparity unit quarterly report in October report lacked credibility. “These may be things that people don’t want to face up to, but they have to face up to them,” he said. “Hard questions have to be asked. Why has Covid-19 hit some communities so much harder than others?
“One reason around (is) people’s professions. But there’s another; in terms of the quality of housing, overcrowded housing, poorly regulated housing in the private rented sector.
“These are the issues, and it’s because we have an unequal society where there isn’t fairness in terms of access to opportunity that many people are trapped in jobs that don’t support them to have good health and housing, which equally doesn’t promote good health.”
Khan said his team had given the evidence of more south Asians being disproportionately affected by the virus. He told Eastern Eye that “without a doubt” this was a failure of leadership. “Anybody who’s examined the data from Public Health England, and also the data that councils have produced, and we’ve produced, can’t but conclude there is structural institutional racism still in 2020 across the United Kingdom,” Khan said.
“For the government to be in denial about this is frankly shocking, and it beggars belief. What I’d say to the government generally, is look at the data speak to the experts and recognise there are big problems, structural problems, that still exist in our country, I’m the first person to accept and be proud of the progress we’ve made. We’re not the same country we were 10, 20, 30, 40 years ago, but there are still challenges.