Video report by ITV News Health Correspondent Emily Morgan
Black, Asian and minority ethnic (BAME) medics and healthcare workers say "systemic discrimination" on the frontline of the coronavirus outbreak may be a factor in the disproportionate number of their colleagues who have died after contracting the virus.
In the biggest survey of its kind, ITV News asked the UK's BAME healthcare community - respondents were of different ethnicity and roles in the NHS - why they thought more of their BAME colleagues are dying than their white counterparts.
The government has not published an official breakdown of NHS deaths by ethnicity, but ITV News' analysis found that the number of BAME NHS staff who died in England, was seven times higher than white workers.
From the more than 2,000 respondents to our survey, comments revealed BAME NHS staff feel fearful in the most at-risk frontline roles, while others are feeling unfairly deployed, and at an increased risk of infection, with many feeling unheard, and some driven to quit their profession.
Perhaps most shocking, 50 per cent of respondents felt discriminatory behaviour has played a role in the high death toll - with one in five claiming they have experienced it personally. 50 per cent also said health was a contributing factor.
One of the most revealing parts of the survey was the stark insight into the experiences of BAME workers in the NHS gained from more than 4,000 comments.
These included accounts of racism.
These are some of the comments made by BAME medics and healthcare workers who responded to the survey:
Indeed, the British Medical Association (BMA) Chair, Dr Chaand Nagpaul, told ITV News just "the status of being a BAME doctor puts you at risk".
Reacting to our survey, he said: "This is a real concern, and it's about a culture in the NHS that has existed for a while, and it needed to be addressed.
"The Covid pandemic - when you consider all the challenges that come with that pandemic - has brought to the fore these problems and they manifest in the inequities that have surfaced."
What was the most common cause respondents identified as the reason for the disproportionate number of deaths?
The most common reason given in the survey for the potential cause of these figures was the deployment of BAME staff to frontline roles, with higher potential for exposure to the virus.
Whilst this may be due, in part, to minority ethnic groups often being over-represented at lower levels of the NHS - many respondents told ITV News they believed unfair or discriminatory decisions were also at play.
One respondent described treatment as "very unfair" adding: "All BAME nurses [have been] allocated to red wards and my white colleagues [are] constantly in green wards."
Another said: "Only BAME doctors from the department have been put forward for deployment."
This was a concern echoed by other respondents, a British consultant cardiologist of Pakistani origin made the analogy: "Many of the white doctors are in management positions leaving more BAME on the coal face."
One respondent - working in A&E - said colleagues, "particularly" non-BAME staff, "literally avoid going to covid areas pushing me and my junior colleagues there even when we have patients, we [are] already seeing".
Of those surveyed who had been redeployed to meet the needs of the coronavirus outbreak, more than half said they did not feel comfortable raising their concerns about the move.
It's something the BMA has raised, Dr Nagpaul told ITV News: "Our own BMA survey's of the past have shown bullying and harassment of doctors and ethnic minority doctors to be much greater than white doctors".
A consultant pediatrician told the ITV News survey this all boiled down to "systemic discrimination at the frontline" of the fight against coronavirus.
That feeling was reflected in some of the responses to the survey. A British respiratory consultant of Asian origin said:
"Suggestions from BAME group are not taken by hospital management. The concerns or comments are ignored. Not a single BAME member was included in [the] Covid response team."
While a female senior clinical fellow registrar described her experience: "The staff who spoke up have been reported to medical director and received emails from them that they would be subjected to investigation."
The issue is something independent think tank The King's Fund has raised before:
"Minority ethnic group staff are systematically over-represented at lower levels of the NHS grade hierarchy and under-represented in senior pay bands".
Feeling underrepresented in "different places" of the medical profession is something Anu Agboola, a deputy sister at a mental health hospital, says makes it hard to speak out.
She told ITV News "it’s difficult to get your voice heard" or be understood on the impacts of coronavirus on minority communities because of a lack of representation of these forces in senior roles across NHS departments.
How has the experience differed for BAME NHS workers from overseas?
For BAME NHS workers from overseas, the fear of losing their jobs is coupled with the fear of losing their home due to visa regulations around employment.
One respondent told ITV News: "A lot of BAME [people] don't have the support of an immediate family because they live alone in UK whilst their family are back in their home country.
"I believe this adds to the stress especially now it's pandemic a lot of BAME have not been able to go back to their home country to be with loved ones."
ITV News spoke to one nurse, Via Salisanal, whose best friend Ken Lambatan, also a nurse, died after contracting Covid-19.
Having watched her friend, and others, die from the virus - she is fearful she too could contract it.
Ms Salisanal said: "I can't help but worry, if I get it, will I end up like them."
The nurse - from the Philippines - said BAME staff are living in "fear" of losing their jobs and of "being judged" if they do speak out.
The alternative, she says, is to stay working in the healthcare profession, despite concerns about the higher risk roles BAME staff are being deployed to.
How have issues around PPE impacted BAME medics and healthcare workers?
Issues of supply and the quality of personal protective equipment have been recurring during the Covid-19 outbreak.
The reported lack of proper PPE impacts medics of all race and ethnicity, but nearly three quarters of those who responded to our survey said a lack of adequate protection may well have been a factor in the disproportionate number of deaths among BAME medics.
Multiple respondents told ITV News they were told by superiors not to "panic" after they raised concerns around PPE early in the outbreak.
"I initially spoke up about lack of PPE for pharmacy staff and lack of systems in the organisation to protect staff from exposure and was told by a senior colleague to not speak about this and to stop spreading fear and panic, I felt uneasy speaking about the issue in front of seniors again," said one individual.
Another medic said: "I have had a few precarious discussions with managers early in the crisis who were telling us to stop panicking and not to “waste” PPE because we wanted to protect ourselves."
Though PPE guidance to medical staff has changed during the outbreak, one health worker responded to the survey that they had been "actively forbidden" from wearing masks in the two weeks prior to lockdown.
The individual said: "We were [...] threatened with being sacked If we spoke up about not being allowed to wear PPE."
What is the reality for BAME medics and healthcare workers during the pandemic?
Behind each of the statistics to have come out of the ITV News survey, is a personal experience and the 4,000 comments provided by respondents gives a rare insight into the experiences of BAME medics able to speak out about the outbreak through an anonymous platform.
Of those surveyed, 85 per cent said they are more scared as a result of disproportionate deaths of BAME medics.
One worker described their work as "absolute hell" and said they were "extremely fearful" adding: "I want to treat corona patients at the cost of putting my own life at risk."
Another respondent said BAME medics have been going to work "knowing they are on the firing line".
The individual pointed to the disproportionate number of BAME deaths in the general population:
"We have been so scared. News of death everywhere. Thus, of people we know. Death is painful to everyone but as BAME personal death has hit us hard while doing a job we love. Some of us have an entire family of frontline workers [sic]."
Deputy sister Anu Agboola said being BAME made the fear of judgement "in every other situation" far worse.
Reflecting on their experiences since the outbreak began, 90 per cent of respondents pointed to the government - calling for more to be done to protect BAME medics.
Downing Street has announced a formal review will take place into why people from black and minority ethnic backgrounds appear to be disproportionately affected.
Matt Hancock, the Health Secretary for England, told ITV News he is "very concerned" about the numbers of "people from a BAME background" contracting Covid-19 and dying from the virus.
Asked about the ITV News survey findings on the issue of racism and discriminatory behaviour, Mr Hancock said it's something he is "determined to stamp out".
"Of course people should have the confidence to be able to say when they don’t feel safe.
"I fully acknowledge that there is a higher prevalence amongst people of BAME backgrounds and it’s something that we're doing work on."
Mr Hancock added: "It's something I’m really worried about."
In a statement, an NHS England spokesperson said: "This is a new virus, and while we await the findings of the Public Health England investigations into the impact of Covid-19 on people from BME backgrounds, the NHS has already asked every trust to take the precautionary measures of risk-assessing staff at potentially greater risk and making appropriate staffing.
It added: "Ensuring that we protect all NHS staff will always remain an absolute top priority and if any colleague is concerned, they should raise this within their trust and be listened to."
Indeed, the formal review is something the heads of medical organisations have called for, Chair of the BMA Dr Nagpaul told ITV News a "proper investigation" is needed.
He said 94 per cent of doctors who have died after contracting Covid-19 are from a BAME background
"That proportion is far greater than the proportion of BAME doctors in the workforce."
But will a review, or an investigation, go far enough?
One survey recipient said: "I strongly feel that the lost lives of the BAME NHS staff will be brushed off without much changes or protection [it] reflects the current state of affairs within the system."
The ITV News survey was created after discussions with BAME medics.
The survey was distributed directly, officially through large medical organisations, like the GMC, and to leading British BAME medical groups including: APPS, BAPIO, MDA, BIMA, SDDA,SDU, Melanin Medics, BSMA, NMA, GMA, GDDA, RCN, NNCAUK and BIDA.
Responses were gathered across a seven day period from when the survey was released on May 2