Predictable Harms, Preventable Failures: FEMHO’s Response to the UK Covid Inquiry’s Module 3 Report
“Healthcare systems faced extraordinary pressure and only just survived – they did so because so many HCWs made enormous sacrifices in putting their work before their own wellbeing and family life.” - Reflections from the Federation of Ethnic Minority Healthcare Organisations (“FEMHO”) as further conclusions are published in the UK Covid Inquiry
“The disparities in Covid-19 mortality rates between ethnic minority and White populations across the UK were, in part, manifestations of longstanding inequalities across society as a whole, which the pandemic exacerbated but did not create. Professor Whitty said that many of the drivers of this disparity were predictable but irremediable in the immediate crisis of a pandemic, as they require many years to address. Until each government addresses these inequalities the same disparities will inevitably be a feature of a future pandemic.”
Key Conclusions of the Module 3 Report:
The Inquiry's report (found online here) delivers a frank and troubling assessment of the capacity of the UK health service to cope during the pandemic response, concluding: “we coped, but only just”. The evidence heard throughout Module 3 confirmed that the disproportionately negative outcomes for ethnic minority groups was entirely foreseeable, and – at least to some extent – preventable had mitigating action been taken. Throughout the report Baroness Hallet highlights the many different areas in which the disproportionate impact and harm was felt, and it reads as a call to action to prevent the same happening again when the next pandemic inevitably strikes.
Below we set out some of the key findings and conclusions contained in the report, and reactions from the Federation of Ethnic Minority Healthcare Organisations (“FEMHO”).
Role of structural racism in the disparate harms suffered by ethnic minority healthcare workers and patients
Disappointingly stopping short of opining directly on the role that structural and/or institutional racism played in the disproportionately high deaths, infection and wider suffering felt by ethnic minority communities, Baroness Hallet’s report instead quotes Dr Habib Naqvi’s answer to that question:
“[I]t would be a combination of structural inequalities, the inequalities and structural racism that we see within society, how that plays out, for example, within the education system or the legal system, or within healthcare, as well as the interpersonal racism that we see on an everyday basis, the trauma, the bullying and harassment, what we call micro and macro aggressions, and how those two interact in terms of institutional racism, how that plays out within policies and processes within organisations, including, of course, our healthcare system.”
Disproportionate redeployment of ethnic minority healthcare workers to high-risk, frontline roles
Inadequacies in data collation mean that there are no concrete statistics on the number of staff who were redeployed during the pandemic, nor their personal characteristics such as ethnicity. The Inquiry says it has therefore been unable to properly draw conclusions about the extent to which there was disproportionate redeployment, nor what the cause for that may have been. Despite this, however, the Inquiry acknowledges the volume of anecdotal evidence raised in its investigation raising concern that ethnic minority staff were redeployed to these high-risk areas in disproportionate numbers and the findings of the NHS Race and Health Observatory undoubtedly “provide a degree of objective support” to FEMHO’s Professor JS Bamrah’s (and others’) evidence supporting this concerning issue.
Failures to provide suitable PPE for the health service workforce
The report is categoric in concluding that the PPE supply was insufficient: “supplies of PPE were particularly constrained at the start of the pandemic, causing healthcare workers sometimes to work in inadequate and unsuitable PPE and put themselves at risk to care for patients. Dangerously low supply levels also caused healthcare workers immense worry and stress.”
The stockpile that existed at the outset of the pandemic was confirmed to have been insufficient in volume and unfit for purpose. The report further highlights the evidence uncovered which demonstrates decision-makers procured less PPE suitable for Black staff, despite the fact that the NHS is the largest employer of ethnic minority staff in the UK who are least likely to be able to achieve a safe fit with standard PPE designed on the face shape of a White male. It concludes that: “Female and ethnic minority healthcare workers generally had less opportunity than their White, male colleagues to find an FFP3 mask that would pass a fit test”, despite their overrepresentation in the NHS workforce. Powered air-purifying respirator (PAPR) hoods, the alternative that ought to be made available when FFP masks do not provide a safe and adequate fit, were also not always provided to staff compounding their lack of protection.
Reflecting on the evidence of health ministers across the UK, Baroness Hallet points out that: “The reliance of health ministers on the fact that none of the four nations entirely ran out of PPE provides cold comfort to the healthcare workers who experienced the fear and anxiety of working without the PPE that made them feel safe, and also to those who were worried that they would not have PPE for their next shift.” She concludes: “there needed to be a broader range of face masks to fit the diversity of face shapes among healthcare workers…had there been better planning, more workers could have been given the appropriate level of PPE protection, in keeping with their role within healthcare – regardless of their sex, ethnicity, disability, size or employment status.”
Inadequacies and gaps in data collation
The failure to collect data on deaths of healthcare workers in the UK meant that decision-makers lacked an important source of information and, also importantly: “risked conveying the impression to healthcare workers that they were expendable and not valued.”
In addition, the significant impact of the wider lack of accurate and disaggregated data inclusive of demographics for patients and staff was highlighted in the report by reference to the QCovid tool. This tool – which took into account ethnicity and other factors – resulted in a major expansion of the shielded patient list when implemented; “especially of people from ethnic minority backgrounds”. Baroness Hallet emphasised that the tool’s value relied on accurate and complete patient data; the benefits of which would only grow with all round better data collation.
Flawed Infection Prevention and Control Guidance
Baroness Hallet is heavily critical of the “flawed” guidance which relied on an incorrect assumption that the virus was spread by contact transmission: “failing properly to consider the extent to which it was also spread by airborne transmission.” Despite the accumulating knowledge of airborne transmission, “insufficient steps” were taken to adapt IPC guidance for healthcare settings, placing healthcare workers and patients at greater risk. So too, there was an insufficient emphasis placed on the importance of ventilation despite knowledge and the relatively low cost of HEPA filter systems where fresh air ventilation is not possible.
Inadequate risk assessments for staff
The Inquiry’s findings reflect evidence heard that although risk assessments were eventually completed for most staff, some felt they were “tokenistic and failed to lead to sustained change or action.”
Limitations of remote communication and consultation
The report acknowledges that the use of remote methods of communication and consultation during the pandemic raised distinct challenges for those who don’t have English as their first language, due to limited availability of phone interpreters, and/or who are digitally excluded due to socioeconomic circumstances. The Inquiry urges decision-makers to ensure that planning for future pandemics takes into account the needs of those with language or communication issues.
Racial bias in medical equipment
The overwhelming evidence as to the ineffectiveness of pulse oximeters, a key tool utilised in the pandemic, on darker skin tones is set out categorically in the report. Baroness Hallet highlights the pre-existing knowledge of this issue, concluding: “Although the Inquiry received no evidence demonstrating a direct link to adverse outcomes for people with darker skin as a result of using pulse oximeters during the Covid-19 pandemic, such events were a real risk” and “caused considerable concern among patients and healthcare workers with darker skin tones, and damaged trust in healthcare systems”.
Vaccination as a Condition of Deployment (VCOD)
The Inquiry notes that, even though the proposed VCOD policy was abandoned, “planning for their implementation caused distress to many healthcare workers and also created tension between some workers and their employers.”
Long Covid
Neither NHS England nor the Department of Health and Social Care collected data about the demographics of those with Long Covid. Current understanding of inequalities in Long Covid is – as a consequence – limited, but the findings note that multiple witnesses have expressed concern about there being a perceived disproportionate impact on ethnic minorities, in particular ethnic minority healthcare workers. Long Covid is also thought to be more common in women, those from lower socio-economic status and with those living with comorbidities.
Importance of support for healthcare workers
The Inquiry emphasises the importance and need for early intervention by healthcare providers to protect and support their staff, particularly in respect of their mental health.
Professor JS Bamrah response to the report on behalf of FEMHO:
“In her Module 3 report released today, while Baroness Hallett has disappointingly not directly attributed the high morbidity and mortality costs of Covid to structural discrimination, it is clear from the substance of her report that she acknowledges that ethnic minorities were disproportionately affected in a number of ways. We expect policy makers and politicians to take serious steps at eliminating those biases, and to ensure that healthcare delivery is equitable across all communities.”
Isabel Gregory of Saunders Law’s response to the report:
“The acknowledgement in the report that the disproportionate harms suffered by ethnic minority patients and healthcare workers during the pandemic were predictable manifestations of longstanding inequalities across society is a significant step forward. The undertone of the evidence heard throughout Module 3 about these harms, however, went further than this; even former Health Secretary Matt Hancock admitted in evidence that the “long-standing issue of racism within the NHS” was a key contributory factor. While it is encouraging to see Baroness Hallet’s acknowledgment, therefore, it is disappointing that her report and recommendations stop short of openly addressing the structural racism that underpins the disparities, nor suggesting specific action to reduce them.
Without clear targeted action – such as the practical suggestions made by FEMHO in their closing submissions – to dismantle entrenched practices and systems that perpetuate these inequalities, meaningful change will be slow and hard to come by. Urgent action is needed to ensure this moment becomes not another missed opportunity, but the turning point and a foundation for the lasting, meaningful change that is so needed.”
About the UK Covid-19 Inquiry
The UK Covid-19 Public Inquiry was established to examine the preparedness, response and handling of the pandemic. The Inquiry has taken a modular approach with ten focused areas of examination. Module 3, focusing on the impact of the pandemic on healthcare services in the UK, concluded its evidence in December 2024.
About FEMHO
The Federation of Ethnic Minority Healthcare Organisations represents the interests of Black, Asian and Minority Ethnic healthcare workers and communities in the UK Covid-19 Inquiry.
Legal Representation
Saunders Law's team is led by Cyrilia Davies Knight and Isabel Gregory, working alongside a counsel team comprising:
- Leslie Thomas KC and Una Morris (Garden Court Chambers)
- Philip Dayle (39 Essex Chambers)
- Elaine Banton (7BR Chambers)
- Ifeanyi Odogwu (Matrix Chambers)
Saunders Law also represents the Covid Airborne Transmission Alliance in Module 3 of the Inquiry.