The establishment of a national federation representing health workers from ethnic minorities

ABSTRACT

ContextThe Federation of Ethnic Minority Healthcare Organisations (FEMHO) was established in 2022 in light of the disproportionate inequalities experienced by this group before, during and after the COVID-19 pandemic.The FEMHO is as a multidisciplinary consortium representing Ethic Minority organisations and individuals within the health and social care in the UK. At the time of writing, FEMHO represents over 55,000 individual members, covering various disciplines, specialisms and levels of seniority, spanning across 43 organisations and interest groups. As a self-governed union, FEMHO encourages organisations to collaborate and work collectively to achieve better outcomes through the implementation of improved policies and opinion formers as well regulators and commissioners both locally and nationally.Issue/ChallengeOf the 1.2 million staff employed by NHS, 20.7% belong to Black, Asian and minority ethnic (BAME) background. However, analysis of deaths of NHS Staff during the pandemic showed that 64% of those who died belonged to a BAME background. Such disproportionate impacts were seen when the number of deaths amongst doctors and nurses were further analysed, where 20% of nursing staff identified as BAME yet 64% of nurses who died were BAME and 44% of medical staff identified as BAME and 95% of doctors who died were BAME.Doctors from BAME backgrounds also reportedFeeling less confident that appropriate adjustments had been made to mitigate riskFeeling less confident about PPE provision and feeling safe to report PPE shortagesHigher rates of bullying and harassment during the pandemic periodSuch inequalities are believed to be as a result of a number of structural inequalities that existed well beyond the pandemic. it also hypothesised that several inequalities may persist well beyond the pandemic, such as the disproportionate impact of long-covid of health workers from an ethnic minority, which is currently being investigated by researchers at the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre.In view of these challenges, the FEMHO was established as a method of collaborating and co-ordinating the efforts of grassroots organisations, policy makers, regulators and commissioners to ensure that the lived experiences and potential solutions offered by organisations and individuals within this group can be better heard and acted upon.Assessment of issue and analysis of its causesThe FEMHO was established to promote a more concerted approach for the advocacy for health workers from ethnic minority backgrounds, with the aim of reducing the inequalities experienced by this group. A two pronged approach of galvanising grassroots organisations already working tirelessly to support ethnic minority health workers along with lobbying and collating interests amongst policy makers, commissioners and regulators was utilised.For grassroots organisations, a mixed methodology of targeted invitations and open advertisement of opportunities for membership was utilised. Several mediums were used to spread the word of such opportunities, including social media posts, word of mouth and email.For policy makers and systems leaders, a more targeted approach was adopted to acquire their support. A targeted email campaign was developed to raise awareness of FEMHO's work with the aim of acquiring their official support, particularly in the form of endorsing FEMHO's call for the inclusion of race inequality in the COVID-19 public enquiry.ImpactAt the time of writing, the FEMHO has been successful in galvanising the membership and support of both grassroots organisations and policy makers respectively at a national level.FEMHO now represents over 55,000 individual members, covering various disciplines, specialisms and levels of seniority, spanning across 43 organisations and interest groups.The targeted email campaign saw the achievement of 39 cross party MPs officially supporting FEMHO's call for inclusion of race inequality in the COVID-19 public enquiry.An inaugural meeting was also held within th Houses of Parliament, where grassroot organisation leads as well as MPs were invited to discuss the strategic priorities and direction of the organisation such as the organisations contribution to the COVID-19 public enquiry, to ensure that inequality is truly at the ‘forefront' of issues.Feedback acquired during the inaugural meeting from MPs and front-line workers was incredibly positive, with attendees welcoming this concerted approach to effect change.Challenges faced in this process largely themed around the limited time availability of the several individuals involved with this project. Executive members of the union as well as grassroots member leads largely worked full time in a variety of demanding healthcare professionals, making communication, organisation and prioritisation of voluntary roles such as contribution to FEMHO work difficult at times.InterventionThe intervention, being the development of a national union equipped with the lived experience and expertise of members who are able to effectively advocate for the interests for health workers from ethnic minority backgrounds, has had numerous positive outcomes:A shared space for grassroots organisations to share best practice for support of healthcare workers from ethnic minority backgroundsA concerted voice to contribute to policy change to address the structural inequalities that adversely impact healthcare workers from ethnic minority backgroundsFrom this experience thus far I have learnt that leadership, with regards to solving complex problems, can often be a journey of harnessing the voices, expertise and influence of several individuals and organisations to effect change. Such a journey can come with numerous hurdles from stakeholder mapping to initiatives to promote cross-specialty, cross-seniority, cross-political party discussions. But I have learnt, particularly from the exec leadership team, made up Ade Adeyemi MBE (a Global Health Policy Expert) and Professor JS Bamrah CBE (Chair, British Association of Physicians of Indian Origin), and other notable individuals, that such efforts to galvanise individuals who have seemingly different priorities is often possible when you are able to see beyond this as a leader and define, clarify and communicate where such individuals share interests and focuses in common.Involvement of stakeholders, such as patients, carers or family membersAs mentioned, the main stakeholders that had to be consulted within this process were front-line care workers from ethnic minority backgrounds and any relevant organisations who may work at a grassroots level to support them.Such stakeholders were involved through the establishment of communication channels as well as feedback sessions to ensure that the FEMHO was sufficiently and accurately representing the interests of the group in question.Key MessagesSolving complex problems as a leader requires the ability to create a collaborative environment that often sees the development, nurturing or new relationships at both an individuals and organisation levelLeaders are able to harness human energy through the development and forecast of a vision and mission that is inspiring and compelling, encouraging individuals to sacrifice their time for a matter bigger than themChange that is sustainable and impactful can often be slow, as seen with the policy changes we continue to advocate for as an organisation, but leaders must be patient.Lessons learntAs mentioned, I have learnt that to effect change, one must be patient as a leader. Our policy activities has taken a great deal of time to be heard and seen, and it can often be tempting to grow impatient and quit.Future barriers to our work include the degree to which can promote regular communication and collaboration amongst member organisations who are often time poor, competing with a number of other priorities such as a demanding full time career in healthcare. Other barriers include maintaining political interest from policy makers, commissioners, MPs, many of which may not hold positions for a long-term basis, as a r sult of the political nature of many of their positions.Measurement of improvementWe will measure the effect of our initiative through a series of feedback forms, particularly of member organisations and their members to assess the degree to which front-line care workers from ethnic minority backgrounds feel that progress in being made in the level of advocacy and campaigning on their behalf. Additionally, we will seek to gather feedback on our members perception of ways of working and any suggestions to ensure that all member organisations feel empowered to influence the direction of the federationStrategy for improvementAfter each feedback round, held on a quarterly basis, executive members of the FEMHO will analyse findings and implement changes accordingly where possible