Vital that BAME groups are part of health action plans, says academic

By Professor Iqbal Singh OBE

THE CRED [Commission on Race and Ethnic Dispar­ities] report has three spe­cific recommendations aimed at health.

It is important that these specific recommendations are implemented and re­sourced properly to be able to make a meaningful con­tribution to addressing health inequalities.

Covid-19 has highlighted the hugely disproportionate impact on BAME health­care and social care staff and communities and ac­centuated many of the structural and health ine­qualities. Over 20 per cent of NHS staff are of BAME origin, as are more than 44 per cent of the doctors in the health service.

The Appointments Com­mission had taken positive steps to increase the repre­sentation of BAME doctors and communities in NHS boards, but over the last 10 years, the percentage of NHS board chairs from BAME backgrounds has re­mained between six and nine per cent.

This lack of visibility and involvement in decision making is reflected in indi­vidual trusts and at higher levels in the NHS and DH and other regulatory and health organisations.

In terms of the three spe­cific action points, recom­mendation 2 deals with re­viewing the Care Quality Commission’s (CQC) in­spection process. The CQC as a regulator has the po­tential to influence and help deliver change by holding the trusts accountable.

Sir Simon Stevens, the chief executive of the NHS, launched the Workforce Race Equality Standards (WRES) that all trusts have to pub­lish and they are assessed on their WRES data. There are nine indicators which form part of WRES data. For some years now, the WRES data takes account of CQC inspections and forms part of the well-led domain as­sessment. This is a reflection of the capability of the lead­ership of individual trusts. Organisations with a poor WRES rating should not be graded as good or out­standing but a maximum of ‘requires improvement’.

The second action point (recommendation 10) asks for strategic review of the differences in the pay gap in terms of ethnicity in the medical profession. It will be important that this re­view addresses issues around workplace culture, structural barriers, filters and barriers to progression and involvement in deci­sion making and promoting diversity in leadership.

The third (recommenda­tion 11) is to establish a new office of health dispari­ties in the UK. The high lev­els of CVD [cardio-vascular disease] and diabetes in the Asian community; hyper­tension and mental illness in the black population and certain haemoglobinopa­thies is evidence-based and known for many years. To address these disparities and improve outcomes the unit will need a system of targeted interventions and effective and meaningful public health messaging which has the confidence of the local communities it aims to reach.

For these recommenda­tions to be successful it is important that the imple­mentation is led by senior BAME doctors and leaders who have knowledge of healthcare and medical regulation. Success will only be achieved with the sup­port of and working with stakeholders and BAME professional organisations and doctors. It is therefore critical that those leading on implementing these rec­ommendations have the confidence of BAME profes­sionals and communities.

Professor Iqbal Singh OBE FRCP is chair of CESOP and a member of the Health Honours Committee.