By Barnie Choudhury
PUBLIC HEALTH ENGLAND (PHE) did not speak formally to key experts and organisations for its review into why a disproportionate number of Asian and black people are dying from Covid-19, reliable sources have told Eastern Eye.
On Tuesday (2), PHE published findings of its review into the disproportionate number of deaths from coronavirus among black, Asian and minority ethnic (BAME) communities, after missing its May 31 deadline.
“Death rates from Covid-19 were higher for black and Asian ethnic groups when compared to white ethnic groups,” the PHE report said.
That was in line with similar conclusions from previous reports looking at the high mortality rates among minorities.
There were no recommendations on how to mitigate the risk for BAME people who contract the virus, even as influential doctors’ leaders have repeatedly called for a risk assessment for frontline
Health secretary Matt Hancock defended the review at the Downing Street briefing on Tuesday, hours after announcing that equalities minister Kemi Badenoch would lead a second review into the matter.
“A link to occupation is part of the conundrum,” Hancock said, as the PHE’s John Newton said it was “a complicated picture”.
Addressing the Commons on Tuesday, the health secretary said, “The PHE ethnicity analysis did not adjust for factors such as comorbidities and obesity, so there is much more work to do to understand the key drivers of these disparities, the relationship between the risk factors and what we can do to close the gap.
“I’m determined that we continue to develop our understanding and shape our response. And I’m pleased to announce that the equalities minister [Kemi Bedenoch] will be leading on this work and taking it forward, working with [Public Health England] and others to further understand the impact,” Hancock said.
He refused to be drawn into a timeline to publish findings of the second inquiry.
Eastern Eye understands that the British Medical Association (BMA), arguably the most influential doctor’s union, had to ‘chase’ PHE to have input into the review.
In the end, said one source, the BMA’s policy team sent a letter last week listing doctors’ concerns.
“It’s beyond belief that the BMA have to beg to be involved in such a vital piece of work, and you have to question what PHE have been doing for the past six weeks,” said one parliamentarian.
“If we can build the Nightingale hospital in eight weeks, it isn’t beyond the wit of man to produce a report with relevant policy recommendations worth implementing within six.”
The BMA’s chair, Dr Chaand Nagpaul, described the review’s findings as a “missed opportunity”. He said, “The BMA first called for a review at the beginning of April in order to understand why there were such disproportionate deaths and serious illnesses in BAME healthcare workers and in the community, and so that action could be taken protect them.
“Two months later, this report is a missed opportunity. It is a statistical analysis, which while important, gets us no closer towards taking action that avoids harm to BAME communities. More specifically, the report fails to mention the staggering higher proportion of BAME healthcare workers who have tragically died from Covid-19 – with more than 90 per cent of doctors being from BAME backgrounds.”
Eastern Eye has been told that PHE held one virtual meeting before the review was announced. On the call were the BMA, health experts and other groups concerned about the lack of understanding or action over BAME deaths. They were told that the NHS would carry out the review, but that was changed later to one being led by PHE.
One doctor told Eastern Eye, “The whole process has been opaque. First, we were told it would be Simon Stevens (NHS chief executive), then it was a government review, then it was PHE. No one knows who has been doing what. We doctors have a lot to say because of our own experiences and issues affecting us, but we haven’t had any input.”
The delayed 89-page report, published on Tuesday, has one small section concentrating on ethnicity.
But it has no recommendations on how to deal with the disproportionate nature of the pandemic when it comes to minority communities, something experts say is vital for review documents.
PHE concludes that black males were four times more likely and Asian males three times more likely to die from Covid-19. The report also states that “diabetes was mentioned on 21 per cent of death certificates where Covid-19 was also mentioned”.
But Eastern Eye understands that one of the country’s foremost experts, Kamlesh Khunti, professor of primary care diabetes and vascular medicine at the University of Leicester and Leicester General Infirmary, was not consulted.
Speaking to Eastern Eye, the shadow health and social care secretary, Labour’s Jon Ashworth, said he was surprised that this did not happen.
“That is staggering,” said Ashworth. “I would have thought this report of such importance should be drawing expertise in the wider medical world, not least of all because we have leading clinicians from BAME communities who understand these issues which would hugely benefit Public Health England.
“Given the prevalence of diabetes in the Asian communities, and wider black minority communities as well, I would have thought that PHE should be using experts like Professor Khunti and other expertise that is out there.
“So that is extremely disappointing, and we’ll be asking questions of ministers why that’s happened.”
Eastern Eye has also learned that the BMA had concerns about the way the NHS collects data and how it interprets it. It is not clear whether the PHE review team addressed this issue.
Another expert, who spoke on the condition of anonymity, claimed the whole process had been politicised. They said the report was delayed because the PHE was ‘scared off’ by campaigners who did not want former equality chief, Trevor Phillips, to be part of the review panel.
“The decision to delay is nothing but political,” the expert said. “You have to ask why, if you were offered state-of-the-art data crunching technology that no one else has, you wouldn’t bite their hand off?”
They were also angry with BAME groups and politicians who had campaigned to remove Phillips from the review process.
“What they did was to delay and politicise the entire process. That meant Public Health England did not have the best tools.
In playing politics they have harmed lives and caused more deaths. But they’ll never be called out for doing that.”
Phillips was not available for comment.
But in a previous interview with Eastern Eye, the former equality chief did call for an investigation into the structural racism which exists in the NHS.
One parliamentarian told Eastern Eye, “At first glance, the report is hardly mind-blowing is it? It looks as if PHE fudged it, putting ethnicity into a wider report.
“You have to really question their usefulness and whether they have a future.”
In a statement, PHE said, “The current review has been undertaken by PHE scientists alone. Webber Philips is one of a number of stakeholders who offered assistance for contributing to further research on the relationship between Covid-19 and BAME communities. This may be considered in future after publication of the PHE review.