Learning lessons from the pandemic: the next steps

How data and evidence can lead to fairer outcomes for healthcare workers

In many ways, organisations and systems are primitive by nature. The outbreak of the COVID-19 pandemic caused a shift from working in a state of 'normality' to working in an emerging emergency. In these situations, fundamental principles, such as equity and inclusion, are often disregarded. The occurrence of these patterns is as predictable as any ‘fight or flight’ reflex reaction. The pandemic was no exception.

Humans and animals have reflexes to help protect them from danger. In a similar way, organisations geared up and responded to the pandemic by focusing on evolving priorities and predictions. They concentrated on what they knew and relied on as fact.

In typical circumstances, human behaviour is often based upon an individual’s own perception of the situation they are involved in, as captured by the notion of personal context. If something does not relate, it’s less likely to be seen as important. And it’s less likely to be acted upon in a meaningful way.

That is one of the reasons why diversity in representation and in thought is critical in organisational (and other) contexts. Being inclusive is a far better response to tackling danger than an approach set within restricted comfort zones.

The hardest hit by the pandemic

In my previous blog, I focused on how COVID-19 amplified the pattern of poorer workplace experiences, in particular, for Black, Asian and ethnic minority staff.

Among some of those hit hard by the pandemic are lower paid ethnic minority staff. It is in the lower pay grades where we find the majority of ethnic minority workers within the NHS. The diversity of the NHS workforce is its positive backstory. But at the same time, the lack of representation at senior and leadership levels is front and centre of its imperfection.

That is why I welcomed the Commission’s inquiry into the impact of the pandemic on these workers and called for greater accountability.

The importance of quality data

We must turn data into insight and that insight into practical action for sustainable change. But for that to happen we need good quality data – data that can focus on specific ethnic minority groups and parts of the workforce, such as those working in the NHS as agency or Bank staff. This will help us to better understand and tackle the ‘causes of the causes’ of the flaws in our healthcare system.

One area that would benefit from such a focused approach is inequalities in pay and the ethnicity pay gap across the NHS. We should not be shying away from tackling such fundamental matters because of a fear that it may lead to a decrease in workforce morale. We must consider the impact on staff and patients of not tackling this issue head-on. We cannot sugar-coat the clear evidence that a supported workforce, where everyone feels valued, leads to better patient outcomes.

We know that in the NHS: ‘what doesn’t get measured, doesn’t get done’. So, to tackle this critical matter we need robust data and clear insight into the scale of the challenge. We also need a pay gap review that is independent. People must be confident that the approach, conclusions and recommendations are transparent and objective.

The pandemic has also demonstrated that the lack of good quality ethnicity data is reducing our understanding of ethnic inequalities in health. It is also reducing the ability to identify effective responses as we head into recovery and reform.

So what needs to happen next?

The first step to any change is the acknowledgement that there is a problem or issue to resolve. While some people may talk about how the concept of diversity threatens traditional values, others are addressing new, progressive approaches to inclusivity. This includes methods that are data-driven and evidence-based and lead to better outcomes for everyone.

Living and working in a diverse society, it is important that every member of staff in healthcare understand the relationship between race, health and inequality. They all have a key role in ensuring fair healthcare and in safeguarding working environments that are inclusive.

At the NHS Race and Health Observatory we are beginning to drive policy change through clear evidence for patients, communities and the healthcare workforce. This work is just beginning, but the tide is slowly starting to turn.