Title: Identifying and mitigating the impact of COVID-19 on inequalities experienced by people from BAME backgrounds working in health and social care
Funder: Economic and Social Research Council

Abstract: 1.To bring together a stakeholder and public and service user involvement and engagement advisory group to co-produce and prioritise content for new survey and interview data collection through a modified Delphi consensus process (series of workshops, feedback and evaluation). 2.To collect new quantitative data on existing and emerging ethnic inequalities in mental health, somatic symptoms and occupational outcomes during and after COVID-19, by developing and incorporating an "ethnicity module" into an existing national longitudinal study of NHS staff (the NHS CHECK study). 3.To collect new rich qualitative data on ethnic inequalities among NHS staff supported by trained peer researchers (BAME healthcare practitioners, Black Thrive community researchers), to capture (a) changes in staff experiences pre- and post-COVID; (b) mechanisms underpinning inequalities, essential for development of interventions/resources for NHS staff; and (c) to provide a human-interest perspective, effective in increasing commitment from policymakers and the public. 4.To engage with key stakeholder and PPIE advisory group members to develop the content of a Race Equality Impact Assessment toolkit for the prioritisation of BAME perspectives in research and training for all NHS staff. This toolkit will highlight within and between BAME group differences, including at the intersection of other identities (e.g., migration status) to best tailor approaches, and improve resources and interventions. 5.To develop Virtual Reality (VR) scenarios informed by our data collection and advisory group. These will form a key part of training and education intervention resources for NHS staff and managers from all ethnic backgrounds. Enabling managers and staff to 'walk in the shoes of' BAME staff in occupational roles most affected by racism, discrimination and other workplace adversity is a more engaging, empathic and experiential approach than any existing training and education resource. We will pilot, rapidly evaluate and refine the VR training and education materials in collaboration with partner networks within 18-months, preparing the groundwork for wide distribution and evaluation of refined VR materials to educators and NHS Trusts through our partners. 6. To optimise the utility of the research by making anonymised data derived from this study publicly available via the UK Data Archive. 7.To increase public awareness of BAME NHS staff experiences by coproducing and publicly disseminating three podcasts from the perspectives of BAME health and social care workers and managers during COVID-19. We will disseminate findings, raise awareness of and encourage uptake of the Race Equality Impact Assessment Toolkit through our partner networks.

Lay abstract: Black, Asian and minority ethnic (BAME) groups constitute 14 percent of the population in England and Wales. The NHS is the largest employer of BAME staff, comprising at least 20 percent of the workforce (45 percent in London). BAME healthcare staff, experience greater levels of workplace racism, harassment and discrimination than other staff. Discrimination, and bullying or abuse have persistent effects on mental health and occupational outcomes. Such workplace experiences (more commonly perpetrated by colleagues, managers than patients), have increased over the past five years, particularly in London NHS Trusts. BAME staff also have poorer working conditions (e.g., lower pay, less control in decision making, dis-empowered from complaining about working conditions). COVID-19 infections disproportionately affect BAME UK communities including healthcare workers (e.g., increased mortality among Black ethnic groups). Therefore, adverse working conditions faced by BAME NHS staff may be worsened by greater exposure to COVID-19 related disadvantages, within and outside of the workplace. These adversities place BAME staff in vulnerable positions (e.g. working in role that involve greater exposure to COVID-19 wards; heightened workplace stresses, stigma, fear and uncertainty around COVID-19 risks for themselves and their families). These ethnic inequalities must be addressed to avoid the social, economic, and moral costs of mental ill health and worse occupational outcomes for BAME staff. This study aims to identify ethnic inequalities in mental health and occupational outcomes amongst NHS staff how COVID-19 exacerbates such inequalities, and the processes which inequalities are produced, maintained and resisted. We also aim to develop a Race Equality Assessment toolkit, as well as education and training resources targeted at improving BAME staff experiences, retention and relevant NHS policies. To address these aims we will involve service users and BAME staff representatives in deciding the content of the survey and interviews, co-leading interviews and in developing the toolkit; collect new quantitative (survey) and qualitative (interview) data on BAME staff experiences since COVID-19; develop the toolkit to help ensure BAME perspectives are prioritized in research and education for all NHS staff; and develop education and training resources targeted at improving BAME staff workplace experiences, job retention and reducing inequalities faced by BAME staff during and beyond COVID19. To do this, we will incorporate an ethnicity module into an ongoing national longitudinal study of NHS staff (NHS CHECK) to assess health and work outcomes by ethnicity over an 18-month period. With the additional ethnicity module, the NHS CHECK cohort will uniquely capture existing and emerging ethnic inequalities in mental health and occupational outcomes during and after COVID-19. We will also carry out interviews with BAME staff who take part in the NHS CHECK study; London based healthcare practitioners from difference ethnic backgrounds who have previously been interviewed before COVID-19 as part of the Tackling Inequalities and Discrimination Experiences in health services (TIDES) study; and NHS managers and senior staff nationally from BAME and non BAME groups. Data will inform NHS Trusts, NHS England and the public through current initiatives tasked with making sustainable transformations for BAME staff within the workplace )e.g., NHS England Workforce Race Equality Standard) and communities (e.g., Black Thrive). Findings will be used to develop education and training materials to support BAME NHS staff nationally through collaboration with psychologists, medical educations and equality and diversity professionals. These will also be subsequently piloted prior to scale up through our collaborators, such as NHS England Workforce Race Equity Standard, NHS Confederation and Royal College of Nursing.

Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS;2.5 RESEARCH DESIGN AND METHODOLOGIES (AETIOLOGY)
Health categories: MENTAL HEALTH;GENERIC HEALTH RELEVANCE;INFECTION