Working in fear: survey reveals impact of COVID crisis on Scotland's black and minority ethnic workers
News emerged last month that black people are up to four times more likely to die of COVID-19 than white people.
Now, a survey by Unison Scotland, seen by Holyrood, reveals how all this has left many of Scotland’s black and ethnic minority (BAME) health and care workers feeling panicked and vulnerable.
It paints a picture of workers who feel less empowered than many of their white counterparts and less able to voice their worries.
With a second wave predicted, black workers and Unison stress that policy changes must be made now.
The survey, completed in May, draws on responses from 2,000 Unison Scotland members, predominantly health and social care workers, one tenth of whom were BAME workers.
It finds that black workers are more fearful of infection than other workers, more concerned about access to PPE, more worried about onward infection to family, less likely to get sick pay, more anxious about struggling to pay bills as a result of COVID infection and more fearful of losing their job.
In spite of higher anxiety about infection, black workers are less likely to raise a safety issue at work with their employers (two thirds of all workers have done so, compared to only half of black workers) and less likely to escalate it to senior management. Unison suggests that “this difference suggests something deters black workers from speaking out about those fears”. Another finding is that BAME workers are more likely to fear reprisals after making complaints.
And black staff are less likely to seek union support over safety concerns, which Peter Hunter, head of organising for Unison Scotland, describes as “a worrying revelation that demands a swift and sustained response”.
Black workers are more likely to be employed in the private sector, particularly in residential care, than by the NHS or councils, and are typically overrepresented in what Unison describes as “lower paid, insecure roles”.
More than a quarter (27.5 per cent) said they would lose money if they were off sick, compared to 21.2 per cent across the survey as a whole.
Black workers are less likely to get full pay while absent with illness than the population as a whole and nine per cent report the loss of all pay when on sick leave, compared to 3.3 per cent for all workers.
Importantly, the survey found that black workers had daily contact with “noticeably higher numbers of service users” than staff as a whole. Forty eight per cent of black workers reported contact with 10 or more service users per day, compared to 37 per cent of all workers. Thirty three per cent reported daily contact with 15 or more service users per day, compared to 25 per cent of workers as a whole.
The report says: “This perhaps speaks to the occupational and sectoral segregation of black workers into roles where patient/service user contact is more intense. It is possible that frequency of patient contact is one dimension of the heightened risk of infection that black workers appear to face.”
Research continues on the extent to which BAME people might be at heightened risk of contracting the infection, but feeling at higher risk has had a profound impact on some staff. “It has been overwhelming and appalling to hear colleagues crying over the phone,” says Rakiya Suleiman, a senior nurse with 30 years’ experience on the NHS front line, who is chair of Unison’s Black Members Committee in Scotland.
Hunter, who wrote the report, says: “People have a visceral fear for their safety. Their commitment to their jobs and their patients overrides their fear but they come to online meetings about this with fear such as I’ve never encountered before.”
A Public Health England report published earlier this month highlights several ways in which the risk of COVID might be heightened in BAME people, including historic racism or poor experiences at work which could make people less likely to voice safety concerns, being in higher risk occupations and prevalence of underlying health conditions (often linked to socio-economic factors).
The Scottish Government has encouraged risk assessments and has issued guidance that employers should “ensure line managers have sensitive, supportive conversations with all BAME staff, that also consider their psychological wellbeing and personal views/concerns about risk”.
Unison says this is “definitely part of the solution” but stresses that both the UK and Scottish governments must go further. Hunter says: “We’re talking about something that is deeply embedded and to a great extent institutional. It’s a big ask during a pandemic to expect that a sensitive conversation is going to overcome all of that.”
The report warns that “fear and silence linked to discrimination create the perfect conditions for spreading infection”.
The union has made more than 15 individual recommendations for tackling the problem.
“We need to hear their voice,” says Suleiman. “COVID is not going away, and black and minority ethnic workers are worried about a second wave: why are we waiting, in Scotland, for more to be done?”
The problem reflects the “invidious way in which racial discrimination seeps into many different layers of the relationships between workers and work”, says Hunter.
He continues: “I think the disparate impact [of COVID on black workers] will come as a surprise to managers. I don’t think we’re talking about intentional racism, but an unintentional unobserved impact on black workers.”
One black nurse who works at a city hospital, and prefers not to be named, says that when the pandemic started she was scared she would fall ill, due to having an underlying health problem.
“We weren’t given the right PPE in our unit in the beginning,” she says.
She saw other nurses being transferred out of situations where they could be at higher risk but was never given the option herself.
She fell ill with COVID on annual leave and was told to cover the first week of illness with the holiday. “Immediately after my annual leave my managers said, come back to work. I said ‘I’m still not well, I can’t breathe properly’ and they said, ‘go on sick leave for that, for one week’.
“But for the third week I was off I haven’t yet been paid. My boss actually wrote ‘unknown cause of illness’. So they didn’t pay me – that was in spite of having tested COVID positive. I am hoping to be paid for that week this month.
“While I was off, I was getting scared that I would lose my job. So I went back and I had 15 patients with COVID to look after. I called occupational health and asked to go to another ward.
“After that, I was taken out of the unit, but only after I complained.”
Tina Makedenge, a staff nurse in an elderly care ward in Edinburgh and a Unison representative, was worried about a lack of PPE at the beginning of the outbreak. She says there were a lot of guidelines every week, highlighting the type of PPE people needed for different specialisms, such as intensive care.
She spoke to her own managers about her concerns that she and her colleagues should have better PPE on their ward and they were sympathetic but said they were supposed to follow the guidelines.
“After I went to my manager and to infection control, they supplied gowns. But by that time, a lot of staff had caught the disease.
“I was fighting for my colleagues and my family too – I didn’t want to bring this to my family or other patients.
“Most BAME colleagues were very worried. Some people started panicking. Most black people feel they can’t phone and say they can’t come into work.
“A lot of people don’t have the courage to speak to their managers. And some members were saying their managers were not sympathetic at all. Some BAME people were going to work with underlying conditions because the risk was not explained to them well.”
She says: “We are worried about the second wave. Risk assessments of BAME staff are urgently needed. We have no time to lose.”
In Wales, risk assessments for BAME workers are being performed under the auspices of health boards. Suleiman says: “We have nothing in place like that here, up until this time. Why has it taken so long?”
Unison Scotland has developed a tool their branches can use to do risk assessments, which is included in the report.
The union’s raft of recommendations include calls for the Scottish Government to commit to “a series of urgent interventions under a rolling COVID-19 Race Equality Action Plan”, the directions of which should be mandatory; the creation of a group of black safety representatives; and the creation of an online portal for black workers to report specific concerns.
Unison says the need for better data in Scotland on black workers’ experience has been “cruelly exposed” and calls for better evidence on infections, deaths and safety reports.
Hunter stresses the need for mandatory sick pay at 100 per cent for those workers who are symptomatic or thought to have the virus. “To do otherwise is actually to assist the virus in reaching the maximum possible audience.”
The Scottish Government welcomed the report. A spokesperson said the government hoped to engage further with Unison on it, adding: “On 21 May we published interim national guidance on risk assessments for minority ethnic health and social care staff, which is kept under review. We are also engaging with minority ethnic staff to ensure their voices are heard.
“In addition, we are working with a range of bodies – including employers, trade unions and regulators – to develop sectoral guidance to ensure workplaces are safe to return to. Our guidance advises a risk-based approach which should take into account the impact of individual health circumstances and protected characteristics, including race, as part of the risk assessment process.”
On June 9, the Scottish Government announced that an expert group of officials and academics would examine the impact of COVID-19 on ethnic minority communities.
The Race Equality Action Plan published in December 2017 set out more than 120 actions to be taken over the course of the current parliament to secure better outcomes for minority ethnic communities in Scotland, including efforts that start to address the “employment gap” and ensure BAME people have “equal, fair and proportionate access to employment and representation at all levels, grades and occupation types”.