Commission on Race and Ethnic Disparities Report -continued

As you know there has been endless number of reports and statements about the Commission on Race and Ethnic Disparities Report.

However, only yesterday the Chair of the Commission, Dr. Tony Sewell informed the Telegraph’s Planet Normal podcast that:

“I am not going to entertain this idea of me feeling anything-I’m used to this and am fairly thick skinned”. He also added “When people are desperate to silence you and discredit you, you must be saying something that’s true”. 

His comments are truly shocking!

It is noteworthy that Boris Johnson has made no major statement in relation to the uproar other than the report makes a number of interesting findings, not all of which will be accepted by the government. He is clearly doing what he always does and that is to say very little whilst there is uproar and wait until such time that people are exhausted as a result of the venting and then do what he always intended to do-implement the report anyway!. The report clearly reflects his views that we portray ourselves as victims and it needs to stop.

To state the obvious the damage is huge and we will need to give much consideration to what we do next to mount an effective challenge. Below we outline some of the comments within the report that we will give particular attention from a health perspective in deciding the best way forward notably:

General comments

  • The Commission has seen no evidence that the UK is institutionally racist.
  • The system in Britain is no longer deliberately rigged against ethnic minorities. Although disparities exist and are varied very few of them are directly related to racism
  • For some the historic experience of racism still haunts the present and there was a reluctance to acknowledge that the UK had become open and fairer and the report  speaks to a new period described as an era of ‘participation’
  • Some ethnic minorities have been able to ‘participate’ better than others, which further reinforces the fact that the disparities observed is not due to the racism
  • The overall picture suggests that racism and discrimination are not widespread in the health system as sometimes claimed, as Black groups are more or less equal in their satisfaction to White groups.
  • Whilst there are still some snowy white peaks at the very top of the public and private sector some of that snow is melting.
  • 40% of NHS consultants are from ethnic minorities.
  • The NHS is a success story with significant over-representation of ethnic minorities in high status professional roles, but also a less happy story, with a consistently negative experience reported by many of its ethnic minority staff at lower levels,
  • There is survey evidence of dwindling White prejudice.
  • There is no evidence to support the term ‘White privilege” and hence it should be replaced with the term “affinity bias” to explain the psychological comfort that can be derived from looking like the majority of people around you.
  • Organisations should stop using the acronym BAME to describe minorities.
  • The use of ‘unconscious bias’ training should be phased out in the workplace.

 

Health Inequalities

  • Life expectancy reflects the key determinants of health (socio-economic, education, income, housing, employment) over the whole life course and so is the best measure of overall health.
  • For many key health outcomes, including life expectancy, overall mortality, and many of the leading causes of mortality in the UK ethnic minority groups have better outcomes than the White population. Furthermore, this evidence clearly suggests that ethnicity is not the major driver of health inequalities in the UK but deprivation, geography, and differential exposure to key risk factors.
  • In contrast to the narrative of other reports there is no overwhelming evidence of racism in the treatment and diagnosis of mental health conditions.
  • The Commission does not believe that the evidence it reviewed offers support to claims of discrimination within psychiatry.
  • Although maternal mortality is four times higher for black women when compared with White women the low numbers involved should be highlighted in fairness to expectant mothers everywhere. In 2016-2018 in the UK 34 Black women died among every 100,000 giving birth, 15 Asian women died among every 100,000 giving birth and 8 White women died among every 100,000 giving birth.
  • The increased risk of dying from COVID-19 is due mainly to increase risk of exposure to infection rather than race.
  • Focus should be shifted to improve outcomes for all and not center on specific ethnic groups alone.

 

Racism

  • Society has ‘defined racism down’ to encompass attitudes and behaviours that would not have been considered racist in the past.
  • Institutional, structural, and systemic racism are being used interchangeably and need to be properly defined and as such they propose the following to distinguish between different forms of racial disparity and racism:
  1. Explained racial disparities:this term should be used when there are persistent ethnic differential outcomes that can demonstrably be shown to be as a result of other factors such as geography, class or sex.
  2. Unexplained racial disparities: persistent differential outcomes for ethnic groups with no conclusive evidence about the causes. This applies to situation where a disparate outcome is identified, but there is no evidence as to what is causing it.
  3. Institutional racism:applicable to an institution that is racist or discriminatory processes, policies, attitudes, or behaviors in a single institution.

They also state in the report that institutional racism should only be used to apply to when deep-seated racism can be proven on a systemic level.

  1. Systemic racism: this applies to interconnected organisations, or wider society, which exhibit racist or discriminatory processes, policies, attitudes of behaviours
  2. Structural racism:to describe a legacy of historic racist or discriminatory processes, policies, attitudes or behaviours that continue to shape organisations and societies today.

 

Recommendations

The report makes 24 recommendations of which:

Recommendation 2-states there should be a review of the CQC inspection process to consider the disparities in the experiences progression and disciplinary action taken against minority staff. It is recommended that the review is chaired by an expert of the health care system and CQC internal processes and that they should work closely with the WRES team and the disciplinary bodies of the medical professions.

The report also states that the Commission accepts that the work of WRES is important to monitor fairness in the NHS, but suggest that further detail is required. This includes disaggregating within the BME category, as well as looking at opportunities in more detail, most notably in terms of disparity within staff groups.

In addition, it quoted a paramedic as stating “the CQC has made it clear they ignore race issues”.

Recommendation 8 considers how to advance fairness in the workplace by the use of sponsorship to ensure wider exposure of BME individuals to their peers, managers and other decision makers. Training and routine skills support for all employees to replace the use of unconscious bias training.

Recommendation 10 concerns improving understanding of the ethnicity pay gap in NHS England.

Recommendation 11 supports the establishment of an Office for Health Disparities to target health disparities in the UK. It is proposed that the Office should be an independent body to work alongside the NHS as part of or in place of the redesigned Public Health England, to improve health life expectancy and reduce inequalities.

To also push for the inclusion of known health disparities including those impacting BMEs in clinical care guidelines and for work to be undertaken with NICE to ensure all guidance includes information on disparities as standard.

Maternal mortality given the disproportionate deaths among BME women should be one of the highest priorities for the new Office for Health Disparities.

Recommendation 23 calls for the use of data in a responsible and informed way by the publication of a set of ethnicity data standards

Recommendation 24 – use of the acronym BAME should stop and the focus should be on specific ethnic groups instead.

 

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