If BAME nurses are more likely to lack PPE than their white British colleagues, why – and what are the wider implications?
A new report from the Royal College of Nursing (RCN) finds that black and minority ethnic (BAME) nurses are more likely to lack Personal Protective Equipment (PPE) than their white British colleagues. Drawing on a survey of its members carried out in the second week of May, the report’s top line is that over a third of respondents had felt pressure to care for individuals with possible or confirmed Covid-19 without adequate protection. Among BAME respondents, more than half had been in that position.
This pattern – a problem affecting a sizeable minority of all nurses and affecting a still larger proportion of BAME nurses – runs through the report. The reason for this focus is that the main issues raised by the RCN’s members are “a lack of availability and training in general, and a disproportionate impact on staff from a BAME background”.
The graph below, contained in the report and redrawn here, presents the basic point. Asked of nursing staff working in non-high-risk environments, it shows that around 25% of BAME nurses said they did not have enough PPE to use, compared with 9% of white British nurses. This is a ratio of more than 2 to 1. Almost another quarter (both BAME and white British) said that while they did have enough PPE for now, they feared they might not on their next shift.
Responses to the question: do you have enough of the following standard personal protective equipment (PPE) items for the duration of your shift?
The question-mark hanging over any survey is whether its results reflect the situation of the whole group – in this case, the nursing profession – to which the respondents belong. The number of respondents here is large enough (several thousand overall) but this alone doesn’t make it representative, especially when what we are seeing might be distorted by a London effect.
A London effect is always possible when it comes to Covid and ethnicity. On the one hand, London was hit earlier and has been hit far harder than anywhere else. On the other, the ethnic mix of the capital’s population is completely different from the rest of the country, with the BAME share being almost the same as the white British share. Differences in country-wide statistics like the RCN’s between white British and BAME may therefore reflect something about London more than something about BAME.
While the RCN survey cannot just be taken at face value, it is strong enough to put two questions on the table which must now be answered. The first is how far differences in access to PPE lie behind the higher rate of BAME deaths, both among health workers and the general population. The second is what lies behind the difference in access to PPE between white British and BAME nurses.
If the answer turns out to be that there isn’t actually any difference in access, then – subject to the obvious point that nobody should lack the PPE they need – very well. But the RCN survey means that this subject must now be examined. It is to be hoped that Public Health England’s enquiry into why the BAME population has been hit so much harder by Covid will look into this matter.
Going back to the graph, the more than 2 to 1 ratio between BAME and white British nurses lacking access to PPE is a similar order of magnitude to the difference in the BAME and white death rates – around double – both for staff and (once age and geography are taken into account) the population as a whole. Lack of access to PPE doesn’t just affect the nurses and other health workers who don’t have it but their patients, their colleagues, their households and the wider communities within which they move, including public transport and local shops.If there is to be a statistical explanation of the higher death rate among BAME groups, explanatory factors with a similar range of variation are likely to play a big part. Poverty rates by ethnic group are another potential factor which fits this bill. Although it can only be treated as suggestive not definitive, the evidence contained in the RCN report makes it one of the most important to have been published so far. Its findings should be investigated without delay while its questions should be asked of workers in other industries whose jobs put them in close proximity either to customers and clients – or to fellow workers.
 Source: redrawn, with permission, using the data and titles shown on the graph on pg.6 of the RCN report.