Race & Equality Senedd Cross-Party Group Meeting Minutes

July 6, 2023

Anti-racist Wales Action Plan and Health Inequalities with Muslim Doctors Cymru

Present: John Griffiths MS, Selima Bahadur (Eyst), Abyd Quinn-Aziz (Cardiff University), Aderinola Omole (Eyst), Andrew Bettridge (Senedd Support), Deborah Stauber (Gypsy Travellers Wales), Ryland Doyle (Senedd Support), Gareth Lynn Montes (WRC), Gethin Rhys (Churches Together in Wales), Judge Ray Singh (Race Council Cymru), Riaz Hassan (Welsh Government), Chantelle Haughton (Cardiff Met University), Jessica Bowen (Thinkedi), Joanne Maksymiuk-King (Race Council Cymru), Ifeoluwa Ishola (Race Council Cymru), Leila Usmani (Eyst), Dr Sibani Roy, Simon Lu (Tai Pawb), Marian Gwyn (Race Council Cymru), Farzana Mohammed (Muslim Doctors Cymru), Kasim Ramzan (Muslim Doctors Cymru), Dr Robert Moore (Liverpool University), Owen Jones (Senedd Support), Norma Glass, Zephyr (Cymru Hong Kongers), Wanjiku Mbugua-Ngotho (Bawso)

Apologies: Peredur Owen Griffiths MS, Llyr Gruffydd MS

Griffiths, John (Aelod o’r Senedd | Member of the Senedd)  
John opens the meeting and welcomes all.

There will be two presentations at today’s CPG Meeting:

· Riaz Hassan, Head of the Anti-racist Wales Action Plan (ArWAP) Implementation Team working for Welsh Government

· Farzana and Kasim at Muslim Doctors Cymru - related to anti racism and racial inequalities as they apply to health.

Hassan, Riaz (ESJWL - Communities & Tackling Poverty - Communities) 

Riaz explains the background to the ArWAP, including the killing of George Floyd in America, the resurgence of Black Lives Matter, more deaths among Black Asian minority ethnic communities during COVID 19, etc. This led to The First Minister commissioning an advisory group where they were looking at the impact of COVID-19 on people from Black, Asian minority ethnic communities, a rapid evidence review by WCPP and deep dive sessions involving minority ethnic communities.

There was direct interaction between policymakers at Welsh Government, the people who undertook the evidence review & consultation and people from Black, Asian minority ethnic communities. The goals and actions for the action plan were co-produced using individuals with lived experiences related to housing, health, social care, education, etc. After the first draft of the action plan, shared it for more feedback and 300 people were involved in this consultation which contributed to the action plan which was published in June last year.

The vision is to be anti-racist; we need to work collectively to make meaningful difference to the lives of minority ethnic. We need to be transparent; we need to be open, we need to be taking a rights based approach and lived experience needs to be part and parcel of not just the decision making process but when we are delivering the goals and actions of the of the plan.

The focus of the current goals and actions is just for the first two years, which is basically when we wanted to check our own base and then see the kind of challenges which we will be coming across.

Riaz explains the governance structure:

· Internal Welsh Government Challenge Group - policies officials with accountability responsibilities for goals/actions meeting monthly.

· External Accountability Group, 7 independent race experts recruited, with expertise in different areas such as housing, employment, local government, etc. The remit of the External Accountability Group is to hold Welsh Government to account.

Currently working to establish the regional forums across Wales, reaching out to people from Black Asian Minority Ethnic Communities. Internally, anti-racism related training being delivered to staff.

Riaz continue to give an update on different areas of the Action Plan:

· Education – all Universities members of Race Equality Charter. Given funds from Welsh Government. Incentive of £5000 for every new minority ethnic background teacher. Also, new curriculum mentioned.

· Culture, Heritage and Sports - the Minister allocated 1.6 million of funding, including for accelerating their anti-racism work.

· Health – Diverse Cymru funded to audit the old Wales NHS workforce policies through anti-racism lens. Within Health another key focus will be on experiences of Black Asian Minority Ethnic neonatal experiences.

· Homes and Places - offering paid work placements to long term unemployment individuals and Black Asian minority ethnic communities and individuals – currently at pilot stage. Revising regulatory standards for housing associations to include setting and delivering the equality commitments, specifically how to tackle hate crime. Diversifying Boards and being more representative.

Crime and Justice -  working closely with criminal justice partners who have developed their own Anti-racist Action Plan.

For last year’s launch we focussed on 11 areas of policies. Currently we are working on other policies area and those other policies including environment climate change in rural affairs, with goals and actions being developed. Also, later this year Welsh Government will be starting work on the goals and actions for the third and fourth years – for June 2024 onwards.

Riaz ends presenting and John Thanks Riaz for the presentation

Question and Answer session

Abyd Quinn-Aziz 

It's really good to see the progress. I didn't get a sense of how we will measure achievement, so you talked about the criminal justice dashboard, are there similar things across all the sectors that show not that they're using the plan, but the difference that it's making?

Hassan, Riaz (ESJWL - Communities & Tackling Poverty - Communities) 
So, it's two things we are doing. The accountabilities for the various Policy Officials within the Welsh Government, that is happening internally where we measure every single action. The second thing is happening on two levels, we will be publishing our annual report around September or October time which we will take to our External Accountability Group. We are also working with our Race Disparity Unit.

We want to measure not just the work which is taking place internally within the Welsh Government, (that is kind of the easy part), but also measure of our impact across the wider public sectors. We are currently developing a framework for us to measure the impact across the wider public sectors and once we establish that framework, we will be sharing it with the wider public sector for us to measure the impact. Hopefully, that will give us some kind of indication of where we are with regards to the implementation of the goals and actions within the plan.

Griffiths, John (Aelod o’r Senedd | Member of the Senedd) 

Do you have a reasonable amount of baseline information then, in terms of where we start from, to measure against in terms of progress?

Hassan, Riaz (ESJWL - Communities & Tackling Poverty - Communities)   3
Some of the data we have and we'll be measuring against those data. So for example, the data which we were looking at in the social care sectors, there was no data for the last 20 years. So social care colleagues within the Welsh Government, have agreement with all the local authority areas and hope by the end of this year all local authorities will be in a position to share with us data which is the breakdown on ethnicity. So that is something which is currently taking place.

But then there are other areas where we didn't have the data, but that data is currently being collated. As an example, related to board representation.

FooSeng (Chinese in Wales Association)
Is there any plans or policies in place for the BNO holders coming from Hong Kong - we invite them or we allow them to come in and then there are no jobs for them, so are there plans for them? And then what about housing - is that all this being planned? They have language barriers, so they need to call the GP for an appointment, but they couldn't so they struggle. Are there any plans on how to tackle all this?

Hassan, Riaz (ESJWL - Communities & Tackling Poverty - Communities)  
For the BNO, the Strategic Migration Partnership have some dedicated resources and they are very closely working with the BNO. When I was doing my previous role as the Community Cohesion Coordinator, one of my colleagues was working on that program, so that specific work is already add taking place.

Robert Moore
We've had some of these discussions before, but the anti-racist action plan involved a very radical step change in the development of an equal opportunities policy.
Now we're talking about how we're going to measure the success of the Anti-racist Wales Action Plan. I think we're left with a lot of measures which are actually inherited from the equal opportunities tradition, which is only looking at the symptoms of racism. What measures are you planning to discover the extent to which racism as such in Wales has been taken down because I don't think the traditional equal opportunities measures are adequate for that?

Hassan, Riaz (ESJWL - Communities & Tackling Poverty - Communities) 
That is one of the implementation gaps. It’s a massive issue in terms of understanding. When anti-racism is mentioned, people still think in terms of diversity inclusion equal opportunities, etc. We need to see things from a completely different perspective. We need to be proactively identifying those structures, systems, which don’t allow us to tackle the disparities.

Mentioned recent issues about not being able to share data due to the GDPR.

We had a discussion with the Permanent Secretary and some of the leadership within the Welsh Government to tackle those issues; that we shouldn't be hiding behind  the legislation/our policies which mean we will not be able to do the work which is needed.

I mentioned there is a Race Disparity Unit currently undertaking this work, identifying the framework, how to measure the impact. We are not going to measure the progress itself, but it's a measure of the impact of the work.

So, I don't have a clear answer at this stage, but once we have that framework hopefully.

Wanjiku Mbugua 
I work for BAWSO. My question is very operational, Riaz, it's about the community engagement - How are you carrying out the engagement taking place? Are you using the same people that are known within the Black and Minority Ethnic communities, the same people that we talked to? Are we looking to reach out to people that we don't know about?

Wanjiku gave some examples of people who may be new to communities that need to be looked out for in the engagement work.

Zephyr Li
From your presentation, I see all the data collected is around July of 2021. The Hong Kong BNO programs started at the January of 2021, so at the time of data collection the Hong Kongers hadn’t really come to UK yet. So in these 2 and a half years, more and more people come here and they are facing different challenges and difficulties, even hate crime. Just wondering how can the local government gather the information or the latest situation of this kind of this group of people. How can we add on our situation into the action plan?

Hassan, Riaz (ESJWL - Communities & Tackling Poverty - Communities) 
So if I take the last question first. When you mentioned the Hong Kong program, it sits with my colleagues in other policy areas, the nation of sanctuary and the Wales Strategic Migration Partnership. They have very specific dedicated resources. I’m not being involved since I have been in this role, but when I was a Community Cohesion Coordinator, I used to attend those meeting and the regular basis. I don’t have the full answer but I know the structure is there.

Wanjiku, you asked if we were aware when we co-produced the action plan that we didn't go through the gatekeepers, those specific 1 or 2 or few organisations. There is a huge section of Black Asian minority ethnic communities where they were not previously involved. So when I've mentioned the regional forum, it is the main engagement tools for us, we will be trying to engage not just the established community, but all the kind of the new communities to closely work with us when we are co-producing the actions and goals for June 2024 onwards.

Glamorgan House FDC   Judge Ray Singh
You need not answer this question now. I’m very anxious that there is to be timeline outcome and sanction - those 3 headings - ought to be included. What we want to achieve? By when? and if not achieved, why not? and what are the sanctions?
Otherwise it will become another document which will be quite shiny on the shelf but of little use. So, it's a big question you may want to take it back.

Riaz Hassan:
We have the timelines, and then who are the key leads and partners who will be responsible/accountable for each of those goals and actions.

But it's a really, really good point in terms of the failure. If there are failures, we are unable to deliver towards those commitments, then what would happen?

I mentioned the External Accountability Group, some members are in this meeting and they are fully, fully aware. Hopefully once we publish the annual report that is the time we will be asking all our officials about the responsibilities they had to deliver certain goals and actions within a specific time timeline.

Griffiths, John (Aelod o’r Senedd | Member of the Senedd)  

Thanked Riaz and welcomed Kasim and Farzana from Muslim Doctors Cymru

Kasim Ramzan (Risca - Wellspring Medical Centre)  
I’m Doctor Kasim Ramzan, GP partner in Wellspring Medical Centre in Risca, Caerphilly and I'm also a part of the Rapid Diagnostic Cancer clinic in the Grange Hospital. I’m one of the founding members of Muslim Doctors Cymru.

Farzana Mohammed  

I’m Farzana and I'm a Pharmacist by background and the Pharmacy Lead for Muslim Doctors Cymru. I've worked in the hospital sector, general practice and also in the EDI field looking at health inequalities as well from a pharmacy perspective.

A lot of the work that we've done and engagement with the communities has been done in our own time. Workforce data statistics show that they're inequalities and representation in senior leadership positions. Although our background is from South Asian heritage, our work is inclusive to all. We do our utmost level best to include all faith groups and we go out of our way to include everyone from different backgrounds and we are open to all. What I don't want you to do is to take away from us that we are only working with the Muslim communities as that is not the case.

We have to ensure equitable access to care and such as availability of services, experience of care which is monitored by patient satisfaction and outcomes because we want better population health for everyone who interacts with the healthcare system, and that includes equalities groups - anyone with a protected characteristic, anyone with refugee status, anyone who is rough sleeping, Gypsy Roma Travellers and people living in the most deprived areas. As the data shows, there's a gap in life expectancy within these groups, so the wider determinants of health, such as the education you receive, such as the quality of housing that you have and the ability to buy the food that we are told that you need 5 times a day, all of that impacts on your experience. And then how often you engage with the healthcare system.

Kasim Ramzan (Risca - Wellspring Medical Centre) 

Dr Kasim gives the background of how Muslim Doctors Cymru were established.
Th Pandemic hit and I don't think anyone here or within the health sector really realized that it was going to impact us in the way it did. I'm just a GP, I've got no special qualifications other than being a GP. After work coming home and having messages from the community related to misinformation that was spreading. And it was weird that this was a community that would have no issue contacting me in the middle of the night for any medical advice because I've grown up in this community and we've gone to the same we've gone to weddings, funerals, pray together, eat and fast together.  Suddenly I'm answering these questions and there's a bit of hesitancy from the community. So, there's a bit of distrust, and every time we'd answer one question like Medusas head, another five questions or videos or something would pop up, felt almost drowned.

With regards to COVID, we've done multiple language webinars, so we've done it in not only in English, in Urdu, Bangla, Kurdish, Arabic and Somali.

Farzana Mohammed  

Discussed the UK wide Panoramic study and contributing by being trusted faces who could connect with the ethnic minority groups, engaging in different languages, videos in community languages, etc.

Kasim Ramzan (Risca - Wellspring Medical Centre)  
One of the learnings that we took was that if we looked at just the Muslim community, a mosque is a trusted space for the community. It's not necessarily only a place for prayer, there's lots of things that take place in mosques - funerals, weddings and gatherings. Once the pandemic lockdown eased we saw we could use the mosque and the imams had a really important role because there could be a lot of religious or cultural taboos and myths that permeated through the community, as we saw in the pandemic. We’ve been able to branch out of the pandemic work.
So we looked at mental health, both male and female mental health and we’ve been doing community health fairs where we offer blood pressure/BMI/heart rhythm irregularity screening and blood sugar testing.

During the Ramadan months, one of the big issues with the long days of fasting is the impact of that can have on people's health, especially if they are on medication or diabetic. We've offered a webinars on a healthy Ramadan.

So the aim that I'm working on in Newport is to go into the Pakistani dominant mosques and have hepatitis C screening, we identified 6 mosques, but while we're also doing that to be opportunistic, so we're also going to be bringing in TB information, diabetes information, doing those blood pressure/BMI checks and also bringing in other organizations who want to come in.

Dr Kasim Ramzan continued to discuss Do Not Resuscitate orders, palliative care medicine, being terminally ill being quite poorly understood.

Farzana presented in relation to stem cell donors and the struggles that ethnic minorities face when finding stem cell donors.

Expertise are there, cure can be achieved but the only thing missing is me and you.

This is why our team has decided to start this campaign to raise awareness with consultations, especially in the ethnic minority communities.

Kasim Ramzan (Risca - Wellspring Medical Centre)  
These (ethnic minority) communities were seen not as victims of COVID, but were vilified that they were not following the rules or they were stupid to think that 5G or chips were in vaccines and things. That was not what was causing the vaccine hesitancy seen in these communities. It was the constant disinformation that they were receiving via social media, and that's something really important to know.

Yes, money was spent on reporting. And what did it show? It did not show that a lot of the ethnic minority communities were in front facing jobs, that did not have the luxury of sitting in or being able to work from home.

Dr Kasim explains the benefits of Watsapp when reaching out to communities..
Don't always assume people can read and write in their own mother native language, especially if you are creating literature that could sometimes just be a direct Google Translate or copy and paste. We're taught as doctors to use layman language when we are explaining anything to people in English, but if you're suddenly using medical terminology that's in another language, you're not using layman language.

This work is done on weekends, evenings, lunch breaks, annual leave.
This morning I've had to take annual leave to take part in this meeting.  We are coming to these meetings, and various organizations do reach out every day for advice and help, and there's an expectation to do this work without funding.

In 2021 there was an article in The Independent by the Black and ethnic minority health care professional consortium, which is made of 50+ ethnic minority healthcare organizations, including the Jewish Medical Association, the Muslim Doctors Association, the Commonwealth Nurses, Diaspora UK, British Islamic Medicine, Medical Association. These are big organizations. We are still fledgling and what they said was that there is a cultural taxation that staff of Colour take on being the ethnic representations on issues that are not compensated for these tasks.

I’ve known John for quite a number of years now, feel quite uncomfortable just by me putting this in. I felt nervous and scared. There's also a fear amongst us that we don't want to lose the support. We don't want to lose the work that we're doing, so we don't ask for funding. We don't ask for payment. We don’t ask for anything. I mentioned it once in the Hepatitis Project which is a massive project and they said we will have to get back to you and I felt embarrassed about even asking. Why not integrate us into your strategies?

But you know, I could be doing this Monday to Friday and I could give a lot more.
I could do a lot better, more efficient work, but at the moment it’s trying to respond to emails in a lunch break or on the weekend. Or saying can we please do this clinic on a Sunday because I can't do it Monday to Friday because I've got to do my normal work? We have done this for 3 years without money, I don’t want it to seem like it is all about money. We'll continue to do as much as we can, but there are going to be times where we have to say no which so far we haven’t.

Griffiths, John (Aelod o’r Senedd | Member of the Senedd) 
OK, thank you very much, Kasim and Farzana. It's been absolutely brilliant to work with you and Muslim Doctors Cymru. I'm sure we'll do so into the future as your activities grow and develop and make a very significant contribution to the overall effort to deal with health inequalities and discrimination and prejudice.

Moore, Robert  
I just like to endorse that point that was made about hard working people being expected to do things free. It happens again and again and again, and it's sometimes extremely hard to achieve proper representation on committees and so on.
If people have to take time out of their work and lose pay in order to do it, so it seems to me that that minorities of all sorts are often required or expected to subsidise, both the public at large and the statutory sector, and that really does need to be looked at very carefully.

Griffiths, John (Aelod o’r Senedd | Member of the Senedd)  
Thank you very much for that, Robert and I'm sure you're right because I know that, as Kasim said, and I know that general approach of Muslim doctors Cymru are very, very generous with their time and their efforts and their work. But it is a question of sustainability, isn't it? And how any developments can be sustained for the future, and it does need to be more organisational in that way.

John thanks the attendees and closes the meeting.