The past weeks have revealed and brought to prominence the vast disparities that impact Black, Asian and minority ethnic (BAME) communities within healthcare. Over the pond, systematic racism has been deemed a public health crisis, while the light has also shone alarmingly bright in exposing racism and inequality in various parts of our health care system in the UK.

Research from Inclusive Boards found that just 8.5% of senior leaders in the industry were Black, Asian and Minority Ethnic (BAME), and nearly 75% of boards had no ethnic minority representation. According to the Shuri Network, a support network for BAME women in digital health roles, out of around 500 senior digital positions in the NHS in England, there were less than ten BAME women in CIO, CCIO or equivalent roles in 2019, despite over 75% of the NHS workforce being female and 20% identifying as BAME.

Digital health tech brands have been quick to publically condemn racism during protests last month and have emphatically put in place internal diversity and inclusion boards and officers to combat issues such as unconscious bias and lack of diversity, with the aim to stimulate understanding and action around Black Lives Matter.

Around this time, in an open letter seen by HealthCare IT News last month, CEO of NHSX, Matthew Gould, invited colleagues to sit remotely with him and other senior leadership team members, to talk about experiences and issues of racism and exclusion in the NHSX and how to tackle them. Meanwhile, In more recent news, Oxford University offered its tech services for free to help find reasons why the BAME community is at greater risk from coronavirus.

Exposure has been one side of the solution, however, practical steps and action to take in light of these findings is paramount in the deconstruction of the inequalities that impact the health care and health tech environment.

Tokenisms and platitudes – action is needed now

With mounting criticism that the NHS and NHSX have infamously had a problem with diversity within its board steering groups, it is clear that there is still much work to be done, particularly as the NHS is one of the largest healthcare systems in the world, with such a vastly diverse patient demographic.

Healthcare IT News spoke to former NHSX director of digital development, and the fourth most influential BAME tech leader 2019, Professor Sam Shah, on his thoughts on the current state of things and how he believes inclusivity can improve. 

“I think the only way we can really tackle this is by putting something down on a policy and or legislative footing.

“From a policy point of view, I think we actually need to make it into policy what the NHS is going to do about it. No more working groups, no more platitudes, put it down for what it’s actually going to do. Make a mandate commitment. A timescale for when it’s going to achieve it and the actions it’s going to perform and how it is going to change the makeup of boards, committees and groups that are in decision making positions across the health system and start at the very top. Outlaw this whole thing about friends and family scheme. Literally have an independent appointments panel for senior leaders in the same way that we would for non-exec directors,” Shah pointed out.

Shah will be a keynote speaker at the HIMSS & Health 2.0 European Digital Event (7-11 September 2020) on the topics of climate change, health crisis and social determinants of health.

On leadership appointment, Shah adds: “I’d like to see some sort of entity in a form or otherwise that supports independent appointments in the NHS or at the very least has independent advisors that can sit on appointments panels start to finish to ensure that the process is fair.”

A safe mediation space was also highlighted as a key move to improving communication and speaking up on the issue. On this topic, Shah said: “It would be useful to have another entity that almost acts as independent conciliation, arbitration, mediation, more than ACAS, which you can go to as a sounding board that can help. Not a trade union function more about trying to improve what’s there in the workplace to help all parties involved when there’s a problem. Unfortunately, the people that can see it can’t raise it because they will feel like they will be victimised raising it. There needs to be an independent way of dealing with it."

BAME data representation

An area that has received coverage for its failure to BAME communities is the lack of representation in COVID-19 data analysis and storage. In June, it was highlighted that the data protection impact assessment (DPIA) run by Palantir on the NHS COVID-19 data store would not be broken down by ethnicity, despite BAME people disproportionately affected by the virus. 

The Shuri Network, has previously warned the analysis of BAME data cannot be passed between departments as a “hot potato too difficult to confront” and has called for a stronger focus from leaders to address these inequalities in data.

What is currently being done in digital health?  

Conversely, on the patient end, other initiatives such as Tower Hamlets Good Things Foundation works with the NHS and other partners to bring digital health inclusion to communities who are most excluded. One of the projects is the Digital Health Lab, which assists BAME groups with the tools and information to access a GP or online services and to co-design ways to reduce exclusion.

Since its launch in 2019, the Shuri Network has worked to create spaces that give women of colour a platform to share experiences and propel forward the advancement and contributions of BME women in digital innovation. The network has recently launched the Shuri Fellowship which will provide future leaders shadowing opportunities to enhance their career. They have also partnered up with the Faculty of Informatics (FCI) to supply Shuri FCI bursaries for 15 members to cover the cost of their FCI membership, as well as with Hunter Healthcare, a national recruitment agency to deliver practical career advice.

Healthcare IT News spoke to Dr Shera Chok, co-founder of the Shuri Network about the work the network is currently doing: “The COVID-19 crisis and Black Lives Matter have really shone a spotlight on the inequalities in our workforce in terms of health outcomes as well and it also shone a light on digital-first services. It’s really helped the network because we are well placed to help increase inclusion, diversity, digital skills, build confidence amongst BME women and improve patient safety as a result."

The network did a patient survey in April to ask their members what support they would want most. Chok explained: “They told us they wanted to hear the stories of successful leaders and role models who are BAME, from different levels from across all spectrums, not just director level because sometimes just hearing about directors when you’re a band 4, is just too far away. We’re doing this with the Health Foundation and NHS England.

"They also want practical career advice for how to get shortlisted, how to improve visibility as a BAME woman, what to do to improve chances at interviews, as well as, what trends are emerging with digital roles and jobs, what recruiters are looking for and how to meet that person spec. 

"Thirdly, they want specific technical topics. What’s happening in AI? What are the latest digital developments in primary care or mental health or interoperability? So we're also covering specialist topics. 

"Lastly, they want exposure, secondments, shadowing and mentoring opportunities. The chance to get an insight into different roles and what it’s like being a CIO or CCIO, to build connections and to understand what a job actually means."

Actions to take both personally and professionally

Healthcare IT News has participated in a number of diversity and inclusion health care tech discussions and has picked up on a number of pertinent practical recommendations that have included:

• finding an ally in your colleagues;
• education through forums and focus groups;
•  un-normalising silence and creating an environment where it’s welcome to address and report bullying;
• greater access to assertiveness courses;
• more BAME leaders in executive roles;
• distinguishing the difference in needs between BAME groups;
• including diverse patients representations in panels; and
• removing tick box culture.

Shah explained: “The most important thing is to talk to other people, find allies, seek advice and support and when the moment is right, raise the issue or do something. It may not be immediate, it may take some time but don’t give up on it. Pick the right moment so you remain as safe as possible in the job that you’re doing. Because unfortunately the way the system is constructed for those who speak out they will not work again if the system doesn’t want them to.”

Chok adds: “You need to build that support network around you. You need to build your own personal board of directors, people that you can trust. Your family, your friends, your other colleagues, the Shuri Network can help connect you with other women. I myself have found it really helpful personally to talk to other BAME people.

"Another piece of advice would be to take risks. We don’t realise that we’ve got the skills and many of the skills are transferable so if you’re good at managing people, if you’re good at managing change and influencing - that will take you a long way in tech because it’s the same principles."

The real challenge for the health tech industry, however, will be transitioning these findings and awareness toward policies and practices that will last for years to come. While there is still much to be determined about how exactly these initiatives will impact the health and technology space in the long run, it has unquestioningly propelled conversations about the pressing need for diversity and inclusion within the most essential health care institutions in the UK. 

More information about HIMSS & Health 2.0 European Digital Event (7-11 September 2020) can be found here.