Redeployment Experiences of Healthcare Workers in the UK during COVID-19: data from the nationwide UK-REACH study
Authors: Lal Zainab Zuzer , Martin Christopher A. , Gogoi Mayuri , Qureshi Irtiza , Bryant Luke , Papineni Padmasayee , Lagrata Susie , Nellums Laura B , Al-Oraibi Amani , Chaloner Jonathon , Woolf Katherine , Pareek Manish 
Published: March 2024

Background

Increasing demands of COVID-19 on the healthcare system necessitated redeployment of HCWs outside their routine specialties. Previous studies, highlighting ethnic and occupational inequalities in redeployment, are limited by small cohorts with limited ethnic diversity.

Aims

To assess how ethnicity, migration status, and occupation are associated with HCWs’ redeployment experiences during COVID-19 in a nationwide ethnically diverse sample.

Methods

We conducted a cross-sectional analysis using data from the nationwide United Kingdom Research Study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH) cohort study. We used logistic regression to examine associations of ethnicity, migration status, and occupation with redeployment experiences of HCWs, including provision of training and supervision, patient contact during redeployment and interaction with COVID-19 patients.

Results

Of the 10,889 HCWs included, 20.4% reported being redeployed during the first UK national lockdown in March 2020. Those in nursing roles (Odds Ratio (OR) 1.22, 95% Confidence Interval (CI) 1.04 – 1.42, p=0.009) (compared to medical roles) had higher likelihood of being redeployed as did migrants compared to those born in the UK (OR 1.26, 95% CI 1.06 - 1.49, p=0.01) (in a subcohort of HCWs on the agenda for change (AfC) pay scales). Asian HCWs were less likely to report receiving training (OR 0.66, 95% CI 0.50 – 0.88, p=0.005) and Black HCWs (OR 2.02, 95% CI 1.14 – 3.57, p=0.02) were more likely to report receiving supervision, compared to White colleagues. Finally, redeployed Black (OR 1.33, 95% CI 1.07 – 1.66, p=0.009) and Asian HCWs (OR 1.30, 95% CI 1.14 – 1.48, p<0.001) were more likely to report face-to-face interaction with COVID-19 patients than White HCWs.

Conclusions

Our findings highlight disparities in HCWs’ redeployment experiences by ethnicity, migration, and job role which are potentially related to structural inequities in healthcare. For future emergencies, redeployment should be contingent upon risk assessments, accompanied by training and supervision tailored to individual HCWs’ experience and skillset.

What is already known on this topic:

Ethnic minority healthcare workers (HCWs) were at an elevated risk of infection during COVID-19 due to occupational and socio-demographic factors. The strain on healthcare systems during the pandemic resulted in acute staffing shortages, prompting redeployment of HCWs to areas outside their professional training. However, recent research suggests inconsistent implementation of redeployment across ethnic groups, revealing structural disparities within the healthcare system.

What this study adds:

Our study, the largest of its kind, found no ethnic differences in the process of redeployment itself, but disparities emerged in the experiences of redeployment. Asian HCWs reported less likelihood of receiving training, while Black HCWs reported more likelihood of receiving supervision compared to their White counterparts. Ethnic minority HCWs were also more likely to report interaction with COVID-19 patients than their White colleagues. While there were no ethnic differences in the process of redeployment, occupational and migration differences reveal that those in nursing and midwifery roles (in comparison to medical roles), as well as migrant HCWs on the AfC payscale (in comparison to those born in the UK), were more likely to report being redeployed.

How this study might affect research, practice or policy:

This UK-wide study highlights inconsistencies in the redeployment process, training, supervision, and patient interactions based on occupation, ethnicity and migration status. Further investigation, incorporating qualitative and human resources data, is crucial to understand the complexities and address potential structural discrimination within the NHS. For future practice, redeployment should align with risk assessments and include training and supervision tailored to HCWs’ experience and skillset.

Teaser text

This study explores how ethnicity, migration status, and occupation were associated with healthcare workers’ (HCWs) redeployment experiences during COVID-19. After adjustment of covariates, we found that nursing roles and migration to the UK increase redeployment likelihood. Asian HCWs reported lesser training and Black HCWs reported more supervision, compared to White colleagues. Redeployed Black and Asian HCWs were more likely to report interaction with COVID-19 patients. Findings highlight disparities in HCWs’ redeployment experiences in an ethnically diverse sample.