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Your experience matters: why storytelling is essential for fighting injustices within health and care

Farhana Nargis 04 June 2020

Farhana Nargis looks at issues of race inequality in health and care, arguing that it is essential for minority voices to be heard.

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Every healthcare worker has a story, and each story has the potential to empower, transform, and change the lives of others.

Around the world, triggered by protests in the US against the appalling death in police custody of George Floyd, people are demanding an end to the injustices faced by black and minority ethnic communities. Strikingly, what had been perceived by many to be largely an American issue, has spilled over into many other countries where there is a similar sense of racial injustice. It comes at a time when we at the Point of Care Foundation have been considering how our work must better reflect the rich ethnic diversity of society and the health and care system.

In the UK, the Covid-19 crisis has laid bare the disparity between white people and those from Black and Minority Ethnic (BAME) communities. This week’s figures from Public Health England show that people from BAME communities are much more likely to die of Covid-19 than their white counterparts. For some ethnic groups the chance of dying from Covid-19 are 50% higher than for white people. For people from the Bangladeshi community it is twice as high.

In a health and care context, this disparity is particularly astonishing because people from BAME communities make a disproportionate contribution to the health and care system. In the UK, 13.8% of the population are from BAME backgrounds; within the NHS workforce, non-white people account for 20.8% of the workforce

Related to this, in recent weeks we have seen two examples of injustices felt by migrant workers in the health system:  last month the government announced a death-in-service scheme which granted indefinite leave to remain to the families of immigrant health workers who died of Covid-19. Unfortunately this privilege was not extended to people in lower-paid roles. This led Hassan Akkad, a Syrian-born NHS hospital cleaner, to post a short film on social media. In it he argued passionately against the unequal treatment of workers who perform vital roles. “The nurses and the ward hosts and the cleaners and the porters are the spine of the hospital,” he proudly exclaimed. 

His video went viral, triggering a wave of support from health workers and the general public. A hasty U-turn on the policy followed. 

In a second policy reversal, the government abandoned the migrant NHS surcharge for migrant workers in the NHS. This is a fee, added to visa costs, to pay towards any potential use of the NHS by a worker while in the country. Amid widespread public outrage that migrant workers within the NHS were required to pay extra for a service they were themselves providing, this policy was also dropped. 

The message we draw from these issues of race disparity and policy injustices, is that stories from migrants and BAME people within the health system are important. Everyone’s experiences matter and by sharing them we can help others to understand these experiences. Mr Akkad’s video forced a government to change its mind about a policy. But whoever you are, sharing stories with colleagues within your organisation can make a big difference. 

At the Point of Care Foundation, we seek to improve the quality of care and we recognise that, in large part, this is achieved by supporting the wellbeing of people working in health and care – of all ethnic groups. 

Schwartz Rounds and Team Time are our vehicle for enabling storytelling within health and care organisations. We know that by providing a space for sharing stories, they build understanding and empathy across organisations, crossing divides between staff groups and hierarchies to find common humanity. We often describe the effect of ‘seeing the person behind the profession’ through Schwartz Rounds, but it would be as valid to see the person behind the skin colour, background, country or culture. Schwartz Rounds give everyone an equal opportunity to contribute, to reflect and to be human – with the tears, laughter and sorrow that involves. 

Faciltators running Schwartz Rounds at East Sussex Healthcare NHS Trust wrote a beautiful piece on inclusion in their entry for ‘most powerful Round’ in this year’s Schwartz Community Awards. They wrote: “We knew that the theme of experiences of Inclusion needed to be heard and tackled sensitively but honestly. It is an important, topical subject. A recurring theme of the importance of respect for others became clear as a thread running through the discussion. A takeaway message was the need for sustained dialogue and education all around this area, to counteract pockets of ignorance.” 

Attendees’ feedback on the session showed that it had made a big difference to their understanding of colleagues’ experiences. One wrote: “Very informative about what people encounter on a day-to-day basis. Didn’t realise there were so many struggles on a daily basis”

All of this matters because ensuring that there is a space for everyone working in health and care, regardless of origin or race, to reflect and share experiences, is one small contribution we can make to greater equality and justice. But it also matters because it impacts on the quality of care we provide to patients. Jeremy Dawson’s analysis of links between staff experience and patient satisfaction, published in 2018, stated that “the extent to which an organization values its minority staff is a good barometer of how well patients are likely to feel cared for.”

As we continue to endure the challenges that Covid-19 has placed on us, there is, understandably, an urge to return to ‘normality’, and to break free of the crippling sense of uncertainty so many of us feel. But do we really want to go back to what we thought ‘normal’ was, where the rights of disadvantaged groups were left unfulfilled? Sharing the burden of the underrepresented, in healthcare as in society, should be everyone’s responsibility. 

I hope we can use the Covid-19 crisis to make long lasting changes for generations to come. Because everyone has a story, we must give a platform and voice to all who work in healthcare, now and always.