9. Submissions on Behalf of the Federation of Ethnic Minority Healthcare Organisations by Mr Odogwu

Mr Odogwu: Thank you, my Lady. I represent the Federation of Ethnic Minority Healthcare Organisations and will use the shorthand of FEMHO in my oral submissions.

As you will be aware, FEMHO is a large consortium of black, Asian and minority ethnic healthcare workers. Our members were on the frontline and behind the scenes throughout the pandemic, working tirelessly under brutal pressures and conditions across the UK to support the public health services.

A striking feature of the Covid-19 pandemic was the disproportionate impact on healthcare workers. Many of our members lost their own lives, colleagues, friends, family and loved ones whilst suffering from physical and mental burn-out because of the conditions they were required to work in.

According, my Lady, FEMHO provides the Inquiry with a unique and pivotal voice on the impact of the pandemic on healthcare systems and staff.

Your Ladyship will have received our written submissions and I don’t propose to repeat the same in my oral submissions.

My submissions today will focus on four main topics: first, scope; second, the Rule 9 requests and disclosure; third, expert and impact witnesses; and fourthly, public hearings.

Dealing firstly with scope.

The Inquiry had previously indicated that a revised list of issues would be provided in the spring of 2024. It is now being suggested that a second draft will be made ready for the end of May. Any further delay in the provision of the revised list of issues is likely to be counterproductive, given the tight timeframes we are already under. It is also unnecessary.

We say respectfully there are obvious omissions from the provisional list of issues that ought to be immediately addressed. FEMHO stands firmly behind its submissions made at previous preliminary hearings that the examination of race inequality, both in terms of impact and root causes, should be explicit in the list of issues.

We know your Ladyship has demonstrated already in this Inquiry a recognition of the importance of the issue of discrimination and inequality. It is therefore surprising to my clients that there has been no direct response from the Inquiry to those submissions.

The list of issues as presently drafted make no reference to – specifically to the issue of race inequality, and this can be contrasted with the specific references to inequalities in relation to other vulnerable groups, for example those relating to age and disability.

A comprehensive investigation into the impacts of Covid-19 on the healthcare system must include a thorough consideration of race inequality. It is important that this is officially acknowledged in the list of issues. In order to assist your Inquiry, we submit the revised list of issues should include the following five issues:

1. Whether and if so how structural inequalities influenced the capacity of the healthcare systems and workers.

2. Socioeconomic factors such as the impact of poverty, discrimination and social exclusion.

3. Specific challenges faced by ethnic minority healthcare workers including inadequate access to PPE and occupational health support, and increased exposure to the virus due to high risk clinical roles.

4. The impact of government policies and decisions or lack of them on black and minority ethnic people in the healthcare system.

5. Engagement and consultation and inclusion with black, Asian and minority ethnic communities and healthcare workers in the development of policies or interventions.

We echo calls made by other core participants for greater clarity on the remit of healthcare within Module 3. We urge the Inquiry not to narrow its focus purely on hospitals, and instead take an expansive view that encompasses primary and community care services.

Finally, in respect to scope, we support the submissions made by the Long Covid groups. FEMHO’s membership includes a cohort suffering from Long Covid after occupational exposure, some of whom have had profoundly negative consequences and experiences in obtaining support and adjustment from their employers.

We share the view that the scope of Module 3 should include an examination of how healthcare staff who developed Long Covid as a result of their occupational exposure have or have not been supported.

The second issue is Rule 9 requests and disclosure.

FEMHO welcomes the Rule 9 requests to the spotlight hospitals and notes what was said this morning. We have, though, three observations about the gathering of evidence on what was happening on the ground during the pandemic.

First, a point that has been advanced by other core participants, we consider that the Inquiry would benefit from carrying out a similar exercise in gathering information from a range of primary care services and not just hospitals. We note CTI’s observations that evidence already gathered means this isn’t necessary. We would suggest the spotlight approach that we encourage you to adopt would ensure the Inquiry hears from a range of people, including GP surgeries, mental health facilities, ambulance trusts and other frontline community healthcare centres.

Second, we are concerned that the Rule 9 requests have been sent to the chief medical officers or equivalent roles, and we therefore echo the other submissions made by core participants in this regard.

We do note Ms Carey’s submission this morning that requests specifically ask that the statement be provided by an appropriate person or individual. It is imperative that the spotlight hospitals take an open and transparent approach to their responses, and defensive corporate statements from members boards responsible for particular hospitals would undermine the integrity of this approach.

The Inquiry should ensure evidence is obtained from a full range of personnel in the hospital and primary care settings, including frontline workers. The responses should reflect the experiences of healthcare workers across the different levels and areas within the individual hospitals and be candid in acknowledging any issues and negative experiences that were encountered.

Third, whilst we are grateful to the Inquiry in sharing the summary of topics that were covered in the spotlight hospital requests, we are concerned about the absence of specific references to evidence regarding the impact of treatment on vulnerable groups, and in particular black and Asian, minority ethnic healthcare workers.

In our submission, the Rule 9 requests ought to include topics specifically addressing racial inequalities, including but not limited to whether appropriate and effective risk assessments were carried out in the deployment of black, Asian and minority ethnic healthcare workers, the extent of any diversity within the leadership, disproportionality in decisions regarding re-deployment of staff into red zones or other high clerical(sic) risk areas, and, finally, whether concerns regarding PPE access and suitability were raised and appropriately addressed.

In relation to the wider disclosure process, whilst acknowledging the constraints caused by delays in material provider provision to the Inquiry team, we remain concerned as to the progress with onward disclosure of material to the core participants.

We have our full submissions set out at paragraphs 3.1 to 3.3 in our written submissions and note what was said earlier. We simply stand behind those submissions and echo calls from other core participants on this point.

Thirdly, my Lady, expert and impact evidence.

The Inquiry’s commitment to placing possible inequalities at the forefront of this investigation is of particular importance to FEMHO in this module, as this is where we say the impact of inequality cuts the sharpest.

In line with that commitment, expert evidence on racial inequality on all aspects of healthcare and disproportionate outcomes should be obtained for Module 3. This should look at both patients and staff. We fully endorse and support the submissions made on behalf of the Bereaved Families for Justice group, that there is a need for further healthcare-specific evidence in this regard.

FEMHO implores the Inquiry to go further than merely examining impact, but to investigate the root causes of the underlying inequalities within the healthcare system. It can achieve this by adopting what we say is a three-pronged approach.

First, the Inquiry should instruct its existing experts to produce addendum reports and, where necessary, instruct further experts to address the Module 3 specific matters in relation to discrimination and race inequality. We certainly do encourage the use of the existing expert evidence prepared for the purposes of other modules. However, it is inadequate, in our submission, to examine the Module 3 specific issues by merely adducing those reports.

We respectfully do not agree with Counsel to the Inquiry’s submission this morning that the background and context of those existing reports provides sufficient evidence in of itself to this module. They do not address the institutional or systemic issues within the healthcare setting which it is imperative that this module investigates.

Second, FEMHO urges the Inquiry to prioritise calling a proportionate number of witnesses who are from diverse backgrounds, disciplines and locations across the UK and who can speak to a range of systemic issues relevant to Module 3. FEMHO has many such witnesses who can provide this evidence. Our position is that the experience of FEMHO members speaks directly to the issues of health inequality as workers and users of the healthcare system. Their voice should not be limited to the Every Story Matters reports.

We are grateful for and encouraged by the requests for short summaries of impact evidence from a number of our members. We look forward to engaging with the Inquiry and endeavour to assist in this regard. To assist this process, my Lady, Saunders Law, those instructing me, have sent a letter to the Inquiry team requesting that consideration is given to providing some protection to those individuals who are coming forward, such as anonymity. We are aligned with Ms Sen Gupta KC’s submissions just now in this regard.

As your Ladyship will appreciate, many of our junior members and those in lower band and support roles have legitimate concerns about negative consequences and negative repercussions of speaking out.

Third, we invite the Inquiry to request evidence from the researchers on the UK-REACH project, which is a study focused on the experiences of minority ethnic healthcare workers during the pandemic. We are grateful for Ms Carey’s confirmation that the Inquiry are actively considering requests from core participants for further Rule 9 requests to be made to individuals or bodies. In our submission, it would greatly benefit Module 3 if witness evidence is obtained from UK-REACH, as well as the study reports, which we are happy to provide the Inquiry.

We also urge the Inquiry to revisit its consideration of adult mental health services within Module 3. Again, we welcome Ms Carey’s confirmation this morning that the mental health of healthcare workers is being examined. Individuals’ experiencing mental health problems died disproportionately during the pandemic and the data indicates that black, Asian and minority ethnic healthcare workers were overly represented within that cohort. Its impact on the healthcare system and its obvious impact on patients in accessing appropriate care should be examined, and we therefore endorse and support the submissions on behalf of Mind.

Finally, my Lady, in regards to public hearings, FEMHO shares the genuine concerns advanced on behalf of other core participants regarding the limited duration afforded to evidential hearings for Module 3. Given the breadth of the scope and the issues to be investigated, we are of course keen that progress is made expeditiously but we respectfully invite the Inquiry to allocate more days to Module 3 for it to be meaningful and effective.

We also support submissions on behalf of the Bereaved Families for Justice group that a further preliminary hearing is likely to be necessary in preparation for the substantive hearings.

Finally, we would also echo the concerns about timetabling and limited time windows before the public hearings are due to commence. We would urge the Inquiry to adopt a pragmatic and sensible timetabling approach, namely prioritising early disclosure, particularly witness statements, allowing more time for EPs by starting this process earlier, aligning timetables with school holidays, and avoiding deadlines during and immediately after August.

My Lady, those are our submissions, unless there are any questions.

Lady Hallett: No, very grateful to you, thank you very much, Mr Odogwu.

Right, who is next? Mr Simblet. Oh, there you are.