Ethnic inequalities among NHS staff in England - workplace experiences during the COVID-19 pandemic (preprint)

ObjectivesTo determine how workplace experiences of NHS staff varied by ethnic group during the COVID-19 pandemic and examine how these experiences are associated with mental and physical health at the time of the study. MethodsAn online Inequalities Survey was conducted by the TIDES study (Tackling Inequalities and Discrimination Experiences in health Services) in collaboration with NHS CHECK. This Inequalities Survey collected measures relating to workplace experiences (such as personal protective equipment (PPE), risk assessments, redeployments, and discrimination) as well as mental health, and physical health from NHS staff working in the 18 trusts participating with the NHS CHECK study between February and October 2021 (N=4622). ResultsRegression analysis revealed that staff from Black and Mixed/Other ethnic groups had greater odds of experiencing workplace harassment (adjusted odds ratio (AOR) = 2.43 [1.56-3.78] and 2.38 [1.12-5.07], respectively) and discrimination (AOR = 4.36 [2.73-6.96], and 3.94 [1.67-9.33], respectively) compared to White British staff. Staff from black ethnic groups also had greater odds than White British staff of reporting PPE unavailability (AOR = 2.16 [1.16-4.00]). Such workplace experiences were associated with negative physical and mental health outcomes, though this association varied by ethnicity. Conversely, understanding employment rights around redeployment, being informed about, and having the ability to inform redeployment decisions were associated with lower odds of poor health outcomes. ConclusionsStructural changes to the way staff from ethnically minoritised groups are supported, and how their complaints are addressed by leaders within the NHS are urgently required to address racism and inequalities in the NHS. Policy implicationsMaintaining transparency and implementing effective mechanisms for addressing poor working conditions, harassment, and discrimination is crucial in the NHS. This can be achieved through appointing a designated staff member, establishing a tracking system, and training HR managers in identifying and handling reports of racial discrimination. Incorporating diversity and inclusion considerations into professional development activities and providing staff with opportunities to actively participate in decision-making can also benefit their health. The NHS Workforce Race Equality Standard may need to broaden its scope to assess race equality effectively.

Mental health of healthcare workers in England during the COVID-19 pandemic: a longitudinal cohort study (preprint)

Objective To examine variations in impact of the COVID-19 pandemic on the mental health of all types of healthcare workers (HCWs) in England over the first 17 months of the pandemic. Method We undertook a prospective cohort study of 22,501 HCWs from 18 English acute and mental health NHS Trusts, collecting online survey data on common mental disorders (CMDs), depression, anxiety, alcohol use, and PTSD, from April 2020 to August 2021. We analysed these data cross-sectionally by time period (corresponding to periods the NHS was under most pressure), and longitudinally. Data were weighted to better represent Trust population demographics. Results The proportion of those with probable CMDs was greater during periods when the NHS was under most pressure (measured by average monthly deaths). For example, 55% (95%CI 53%, 58%) of participants reported symptoms of CMDs in April-June 2020 versus 47% (95%CI 46%, 48%) July-October 2020. Contrary to expectation, there were no major differences between professional groups (i.e. clinical and non-clinical staff). Younger, female, lower paid staff, who felt poorly supported by colleagues/managers, and who experienced potentially morally injurious events were most at risk of negative mental health outcomes. Conclusion Among HCWs, the prevalence of probable CMDs increased during periods of escalating pressure on the NHS, suggesting staff support should be increased at such points in the future, and staff should be better prepared for such situations via training. All staff, regardless of role, experienced poorer mental health during these periods, suggesting that support should be provided for all staff groups.