2020 - a year forever etched in our memories - saw the disproportionate effects of COVID-19 on ethnic minorities and those with disabilities. A string of senseless deaths of black US citizens at hands of the police brought institutionalised racism to the forefront. Never before has the spotlight shone so brightly on health inequalities.
Longstanding issues surrounding equality, diversity and inclusion (EDI) were finally thrown into sharp focus. As a College we had already started to explore how those with different protected characteristics were represented in volunteer roles; last year we published our report, Putting Ladders Down: ways to open up voluntary roles and action plan. The pandemic and racial injustices acted as catalysts to bring forward a second phase of EDI work, including the formation of the EDI Member Reference Group, which aims to support the College’s work in addressing EDI issues across paediatrics.
As a member of this group, I was invited to give my thoughts here on the new reports that set out the College’s next steps on EDI.
We must address barriers to disclosure... language is key
To assess the magnitude of underrepresentation and effects of inequality, and to measure the outcomes of our interventions, we must have accurate and sufficient data. How can we measure progress if we don’t know the full extent of the problem?
We must address barriers to disclosure of protected characteristics, especially from those of underrepresented groups. Language is key. Our new diversity monitoring form, developed with input from this group, conveys sensitivity and greater awareness of EDI to our members.
Other actions we need to take include transparency on how this data will be used, assurances about confidentiality and information on why it is desperately needed.
Working lives of paediatricians
I think there are three major areas where we need to tackle EDI: recruitment, examinations and retention. College examiners should have EDI training, including recognising unconscious bias and disability awareness, which is role-specific, clearly recorded and audited. We need to ensure diversity among those volunteers in decision-making roles - whether recruiting examiners or writing questions for our theory exams – to ensure there is shared cultural experience and that nobody is disadvantaged. We must also promote accessibility through reasonable adjustments for our members with disabilities or long term health conditions.
To prevent a widening gap in differential attainment, the College is working collaboratively with the GMC (General Medical Council) to measure data and improve equal opportunities. We know disparity exists between UK graduates and international medical graduates (IMGs), but does this disparity extend to those with disabilities? These findings highlight an urgent need for greater support for IMGs specifically in their applications for senior posts and the importance of collecting the data to evidence change.
Building on the “Survive and Thrive” campaign, the College created a new voluntary role, Officer for Retention, to look at reasons why doctors are leaving paediatrics and strategies such as promoting less than full time working and career breaks. We particularly need to analyse data on attrition rates – are there disproportionate numbers of paediatricians with some protected characteristics leaving the specialty?
Improving representation among our volunteers
We need diverse perspectives, experiences and knowledge to shape policy
It is our ambition that by 2030 the RCPCH volunteer network will be truly representative of our membership. We need diverse perspectives, experiences and knowledge to shape policy. Currently there is underrepresentation of Black/Black British members in volunteer roles – this needs to change.
To improve representation, we need more inclusive publicity of roles, and to promote accessibility through job-shares and virtual meetings. Enabling observer opportunities and mentoring for prospective volunteers would give greater insight into role responsibilities and help develop key skills required. Fundamentally, we need greater visibility of those from underrepresented backgrounds through media communications, website resources and conference panellists.
The overwhelming impact of COVID-19
The pandemic has compounded pre-existing health inequalities. Children living in deprivation have faced added challenges from school closures. Those with neurodiverse conditions have had limited access to special educational needs support and their families have had added strain with a reduction in respite and support from carers and special schools. Lack of additional support, and reduced socialising with other children has a substantial impact on learning for neurodiverse children and those with and special educational needs, leaving them further behind their peers. Families from ethnic minority backgrounds have also been greatly impacted by COVID-19 through higher morbidity.
The voice of the child and young person through our RCPCH &Us volunteers is integral to identifying areas of need and improving health outcomes.
COVID-19 has also had a detrimental effect on specific groups in our workforce. The College’s study on the impact of COVID-19 on child health services has collected data about child health professionals’ experience, with comments about the effects on those from ethnic minority backgrounds. In June 2020, noting the impact on NHS staff from Black, Asian and minority ethnic communities, the College published a statement of solidarity.
Another important cohort are those with long term health conditions/disabilities who have also experienced high illness burden from COVID-19. Anecdotally, I know many have felt forced into disclosing hidden health conditions in order to adapt their working. To get a more detailed picture we need to know more about this group and how the College can best support impacted members. Have they been able to adapt their current roles to minimise risk? And what impact will shielding have on training progression for trainees at highest risk?
I strongly believe inclusivity in medicine is critical – it improves patient care and contributes to a more equal society. A thriving workforce is essential to best serve the needs of the children and young people we treat.
Through the passion, insights and commitment of our group’s members, we will address EDI issues that resonate throughout paediatrics from our patients and members to our volunteers. We will bring about positive, enduring change.