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RCEM survey finds one in five BAME EM clinicians have not been risk-assessed by their Trust

21 January 2021

new report from the Royal College of Emergency Medicine confirms significant racialised patterns of occupational risk for staff working in Emergency Departments during the first wave of the pandemic.

Based on the findings of RCEM’s December 2020 survey of 780 EM clinicians, the report found:

  • Nearly 3 in 10 of all survey respondents and nearly 1 in 5 of BAME respondents disclosed that they had not been risk-assessed by their Trust or Board. Two key themes arose amongst respondents when explaining their dissatisfaction with risk assessments: the inadequacy of the risk assessments and the lack of consideration of ethnicity.
  • A slightly higher proportion of BAME respondents revealed that they had not received any PPE training.
  • Almost half of BAME respondents reported they failed fit testing either ‘very often’, ‘often’, or ‘sometimes’, compared to just over one third of white respondents.

Dr Hodon Abdi, co-chair RCEM’s EDI Committee, said: “Risk assessments for staff from Black, Asian, and minority ethnic (BAME) backgrounds have clearly been inadequate, threatening their safety. These staff were more likely to lack access to adequate PPE while being in contact with suspected or confirmed covid cases.

“While these issues appear to have improved slightly over the course of the pandemic, it is imperative that policies around risk assessments and access to appropriate PPE must be monitored closely by senior leadership and rigorously scrutinised by Trust Boards.

“It is widely known that there is a disproportionate risk of mortality amongst BAME staff, and there is growing evidence that throughout this pandemic ethnic minority staff did not feel like they could speak out about their concerns to management about staying safe at work.

“These are systemic issues, and we are asking senior leaders to take a proactive approach to tackling racialised patterns of occupational risk within Trusts.”

As well as providing recommendations for NHS England and its devolved equivalents, the report calls for Trusts to:

  1. Monitor risk and act quickly on any concerns raised by staff members.
  2. Ensure all staff, including agency staff, working in Emergency Departments are risk assessed through a face-to-face review.
  3. Report ethnic breakdown of number of staff risk assessments completed, and percentages of total risk assessments completed of the whole Trust in your Board Assurance Framework.
  4. NHS Trust Boards should rigorously scrutinise their Trust’s policies around occupational risk and ensure adequate processes are in place to support ethnic minority staff.

Dr David Chung, co-chair of the EDI committee, said:
“Risk assessments have been an issue throughout the pandemic, so while the results of the survey are somewhat unsurprising, what is surprising is the lack of significant action since we first ran the survey.

“The evidence is clear. Staff from ethnic minority groups are at a disproportionate risk of mortality from covid. Ethnicity and/or race must be recognised and included as independent risk factors for all staff.

“This is a systemic issue. NHS management, trust boards and regulators must all take action to make sure all staff working in an Emergency Department are protected. That includes fit testing, PPE training, ensuring staff can raise concerns, providing adequate risk-assessments, providing information on PPE and ensuring ethnic minority staff are supported.

“This is even more urgent now with the new transmissible variants coursing through the community. It is essential that the PPE guidelines are revisited to ensure they are adequate to keep all staff safe, that includes recognising the disproportionate risk and vulnerability of staff from a minority ethnic background and ensuring they are protected.

“A person’s race or ethnicity should not increase their occupational risk, but this is still sadly the reality, and this must change. We must look at forward planning, starting with the vaccine roll-out; we cannot allow the same disparities to occur.”


Notes to Editor
The first survey was administered in May 2020 and collected a total of 1,167 responses from Emergency Medicine clinicians across the UK. The survey included general questions about Covid-19, testing, PPE, how clinicians felt their Emergency Department was set up, and mental health. The second survey was administered in December 2020 and examined risk assessments and PPE in more detail. A total of 780 members and fellows of the College responded to the second survey.

The surveys were conducted online and rolled out through a series of emails sent to members and fellows. To boost the sample size, we employed a snowball sampling technique whereby we asked members to inform their networks about the survey. As both surveys contain self-selected samples, we have been cautious not to make generalisations about the results. However, we believe this does not downplay the importance of the findings of these surveys – there are clearly disparities in occupational risk faced by ethnic minorities in the NHS – and this is well evidenced in the supplementary research provided in this paper.

The Equity, Diversity and Inclusion Committee has been formed to tackle inequalities and discrimination in Emergency Medicine. Dr Hodon Abdi and Dr David Chung have been officially appointed as Co-Chairs.

Dr Hodon Abdi is a Specialist Trainee at Queen Elizabeth Hospital Birmingham.

Dr David Chung is an Emergency Medicine Consultant at University Hospital Crosshouse, NHS Ayrshire and Arran. Dr Chung previously served as Vice President of RCEM Scotland.

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