Black And Minority Ethnic Population Research Articles

Why continuing education and professional development trainings for Black and Minority Ethnic groups (BAME) is not translating into career progression, economic growths and bridging the employment gap in the national workforce in UK

The research objective of this study is to understand why continuing education and professional development (Lifelong Learning) the UK has not delivered the expected career advancement, economic returns and closing on the employment gap for Black and Minority Ethnic (BAME) population. Nevertheless, much funding has been put into such educational programs to improve the condition of the BAME community for career mobility and economic prospects, they remain prejudiced nevertheless. The purpose of this research will be to establish the causes of these disparities with particular emphasis on the system influences as well as the efficiency of the established CPD programmers. The research method of this study is of mixed nature, while qualitative study is followed by the quantitative one. The data was generated through Q<|reserved_special_token_266|> energy questionnaire survey and interviews conducted with BAME professional participants of CPD programs. Second, secondary data were collected from the governmental and organizational reports on diversity in the workforce and career advancement. in qualitative data were coded and categorized to explore the experiences of BAME people as well as measures of central tendency and dispersion were used on quantitative data in order to understand trends and co-relations. The study reveals several key outcomes: Fixed preconceptions arising out of race, scant opportunity to interact professionally, and lack of BAME personnel in dominant organizational positions ensure that BAME learners cannot advance further in their careers despite enrolling in CPD programmers. It has been established that the CPD programs are not very effective, the BAME candidates complained that the training does not make them earn a better position or get a salary increment like the white counterparts. Further, the study reveals that culture and organizations barriers and gates are among the barriers to complete inclusion and effectiveness of CPD BAME employees in their workplaces. The results have various implications for the policy-makers, educators and employers. Therefore, the current study’s findings are particularly important for policymakers to support more effective and sensitive policy measures to help BAME populations in the workplace. The authors recommend that educational institutions need to carry out changes in the content and the delivery of the CPD programs, such that they are appropriate for the BAME participants. Companies are encouraged to come up with better policies on how best to mainstream employees’ ethnicity, and how the promotion policies can be made fair and inclusive. The Authors therefore argue that while the acquisition of continuing, education and professional development are most important in career advancement, they are not in themselves adequate to either close the employment division or foster economic opportunity for BAME people in the UK. There is, therefore, a need for reforms at the system level to remove the social factors that act as hurdles to the actualization of these learning programs by BAME workers. Based on the study, the following policies, collaborative professional development, and organizational development solutions are proposed.

Black and Minority Ethnic (BAME) Alliance Against COVID-19: One Step Forward.

During the COVID-19 pandemic, the data of Department of Health in United Kingdom (UK) showed an increase mortality and morbidity among the Black and Minority Ethnic (BAME) population. This high mortality can be due to social factors, genetic and immunological factors. Metabolic factors like high prevalence of diabetes, obesity, metabolic syndrome and hypertension were also found to contribute to the increased risk of COVID-19 infection in BAME population. In addition, a large number of BAME population are working in jobs that involve regular and daily contact with public, and this may increase risk of encountering COVID-19 infection. Therefore, future research should address all these factors and generate the correct health policy that will allow us to combat the danger of COVID-19. We recommend the establishment of BAME alliance against COVID-19 in order to improve occupational risks and hazards, adequate income protection, culturally and linguistically appropriate public health communications and decreasing barriers in accessing healthcare. The BAME alliance will initially focus on (i) development of central system to record data about COVID-19 patients from BAME population (ii) involvement of healthcare professionals and researchers from ethnic minorities and (iii) multidisciplinary and inter-institution collaboration; for example, civil engineers and architects need to think about house design and ventilation that decrease risk of COVID-19 especially in BAME populations.

COVID-19 and ethnicity: A novel pathophysiological role for inflammation

IntroductionThere have been recent mounting concerns regarding multiple reports stating a significantly elevated relative-risk of COVID-19 mortality amongst the Black and Minority Ethnic (BAME) population. An urgent national enquiry investigating the possible reasons for this phenomenon has been issued in the UK. Inflammation is at the forefront of COVID-19 research as disease severity appears to correlate with pro-inflammatory cytokine dysregulation. This narrative review aims to shed light on the novel, pathophysiological role of inflammation in contributing towards the increased COVID-19 mortality risk amongst the BAME population. MethodsSearches in PubMed, Medline, Scopus, medRxiv and Google Scholar were performed to identify articles published in English from inception to 18th June 2020. These databases were searched using keywords including: ‘COVID-19’ or ‘Black and Minority Ethnic’ or ‘Inflammation’. A narrative review was synthesized using these included articles. ResultsWe suggest a novel pathophysiological mechanism by which acute inflammation from COVID-19 may augment existing chronic inflammation, in order to potentiate a ‘cytokine storm’ and thus the more severe disease phenotype observed in the BAME population. Obesity, insulin resistance, cardiovascular disease, psychological stress, chronic infections and genetic predispositions are all relevant factors which may be contributing to elevated chronic systemic inflammation amongst the BAME population. ConclusionOverall, this review provides early insights and directions for ongoing research regarding the pathophysiological mechanisms that may explain the severe COVID-19 disease phenotype observed amongst the BAME population. We suggest ‘personalization’ of chronic disease management, which can be used with other interventions, in order to tackle this.

Understanding the friendship networks of older Black and Minority Ethnic people living in the United Kingdom

AbstractOlder Black and Minority Ethnic (BME) people living in the United Kingdom (UK) are vulnerable to the experiences of social isolation and loneliness. Despite this, it is widely assumed that they adhere to traditional family practices and living arrangements that protect them from social isolation and loneliness. Such assumptions are problematic and can reify family networks as the main area of research for older BME people to the detriment of friendship networks which are also crucial. However, few researchers have explored this area. With the older BME population increasing at a faster rate than the older white population, further research is needed. Utilising data from Wave 6 of Understanding Society (N = 7,499, 4.3% of whom self-identified as BME), this study explores the ways in which the friendship networks of older BME people differ compared to older white people using logistic regression analyses. After controlling for potential confounding socio-demographic characteristics, older BME people were more likely to report having fewer close friends and fewer friends who live locally, suggesting that their friendship networks may be restricted in quantity and accessibility. Not only do these findings raise important questions about the varying needs of older minority ethnic people who have been largely overlooked in recent government policy, but they also highlight the continuing challenges of using large-scale surveys to research older BME people in the UK.

The need for service change and community outreach work to support trans-cultural cognitive behaviour therapy with Black and Minority Ethnic communities

AbstractRecently there have been a number of developments in cognitive behaviour therapy (CBT) that have led to cultural adaptations of specific interventions and a greater awareness of how in general CBT might be adapted for Black and Minority Ethnic (BME) service users. These developments, however, involve change at the level of the individual therapist and particular treatment approach, but involve very few considerations of what needs to happen at the levels of teams or services in order to best meet the mental health needs of British South Asian and other BME populations. This paper summarizes the way that services need to understand how minority populations use services and how to involve those populations in developing services in order to ensure their needs are best met.

Size and clustering of ethnic groups and rates of psychiatric admission in England.

There was an eightfold difference in admission rates between ethnic groups for schizophreniform and mania admissions, and a fivefold variation in depression admissions. On average, Black and minority ethnic (BME) groups had higher rates of admission for schizophreniform and mania admissions but not for depression. This increased rate was greatest in the teenage years and early adulthood. Larger ethnic group size was associated with lower admission rates. However, greater clustering was associated with higher admission rates.Clinical implicationsOur findings support the hypothesis that larger ethnic groups have lower rates of admission. This was a between-group comparison rather than within each group. Our findings do not support the hypothesis that more clustered groups have lower rates of admission. In fact, they suggest the opposite: groups with low clustering had lower admission rates. The BME population in the UK is increasing in size and becoming less clustered. Our results suggest that both of these factors should ameliorate the overrepresentation of BME groups among psychiatric in-patients. However, this overrepresentation continues, and our results suggest a possible explanation, namely, changes in the delivery of mental health services, particularly the marked reduction in admissions for depression.Declaration of interestNone.

A formative review of physical activity interventions for minority ethnic populations in England.

Physical activity (PA) levels are lower among some UK Black and minority ethnic (BME) groups than the majority White British population and a variety of tailored interventions have emerged. This study documents the characteristics and logic of local adaptations, a vital first step in evaluating such innovations. An English PA data set was examined to identify and characterize PA programmes focussed on BME populations. Three case studies were conducted, employing documentary analysis and qualitative interviews. Netto et al.'s principles of adapting health promotion interventions for BME populations guided the analysis. Out of 861 PA interventions, 57 focussed on BME populations. These were typically aimed to engage the most inactive groups, improve both health and social outcomes and were largely publically/charitably funded. Tailored approaches matched Netto et al.'s five principles: using community resources for publicity, identifying and addressing barriers, developing sensitive communication strategies, working with values and accommodating cultural identification. Another common principle was identified: building community capacity for sustainability. PA interventions tailored to the needs of BME groups reflect their largely disadvantaged position in society and focus on inactivity. The six principles could be used as a framework for developing, designing and evaluating tailored interventions for BME populations.

Incidence of ANCA-associated vasculitis in a UK mixed ethnicity population.

We aimed to estimate the incidence of ANCA-associated vasculitis in the UK and how this varied by ethnic group. We identified incident cases of ANCA-associated vasculitis between March 2007 and June 2013 in the Nottingham-Derby urban area from medical records using multiple sources. We derived the denominator population from the 2011 census, and we calculated incidence rate ratios using Poisson regression. Overall, we identified 107 cases of ANCA-associated vasculitis, giving an incidence of 23.1 per million person-years (95% CI: 18.9, 27.9). The incidence among the white population was 25.8 per million person-years (95% CI: 21.0, 31.3) and among the black and minority ethnic (BME) population 8.4 per million person-years (95% CI: 3.1, 18.3). After adjustment for age and sex, the difference between ethnic groups was not statistically significant (incidence rate ratio 0.7, 95% CI: 0.3, 1.5, P = 0.3). Overall, the incidence of ANCA-associated vasculitis was similar to other epidemiological studies. Crude incidence rates were lower in the BME than in the white population, but this was partly explained by the older age profile among the white compared with BME population.

Improving patient and project outcomes using interorganisational innovation, collaboration and co-design.

Background Common mental disorders (CMDs) are a leading cause of disability. The Department of Health has launched a large-scale initiative to improve access to evidence-based psychological treatments, such as cognitive behavioural therapy (CBT), through the Improving Access to Psychological Therapy (IAPT) programme. Access to IAPT services by black and minority ethnic (BME) communities is lower than for other groups. Setting The London Borough of Ealing in west London; a diverse borough with areas of high BME population and relatively high deprivation. Aim To compare the outcomes of two linked quality improvement (QI) projects undertaken by Ealing Mental Health and Wellbeing Service (MHWBS), both with the same aim of increasing access to talking therapies for BME communities. Methods Application of QI methodologies supported by the NIHR CLAHRC for northwest London in two different settings in Ealing. One, the 'Southall project', was set within a wider initiative for collaborative improvements and shared learning (the Southall Initiative for Integrated Care) in an ethnically diverse area of Ealing; it was undertaken between April 2010 and September 2011. The second, 'the Ealing project', operated in the two other Ealing localities that did not have the advantage of a broader initiative for collaborative improvements; it was undertaken between April 2011 and September 2012. Results Comparison of the monthly referral rates of BME patients (standardised per 10 000 general practitioner (GP)-registered patients) show that the Southall project was more effective in increasing referrals from BME communities than the Ealing project. Conclusion Broad local participation and ownership in the project design of the Southall project may explain why it was more effective in achieving its aims than the Ealing project which lacked these ownership-creating mechanisms.

The Protection and Rights of Black and Minority Ethnic Women Experiencing Domestic Violence in Northern Ireland

This report examines the support sought by and provided to Black and Minority Ethnic (BME) women, including immigrant women, in the context of domestic violence in Northern Ireland. It was undertaken as a scoping study and forms part of a submission to the UN Committee on the Elimination of Discrimination Against Women (CEDAW).Northern Ireland has experienced an increase in migration, particularly from the European Economic Area with the most recent census showing an increase in the ‘non-national’ population over the past ten years - from 1.8% (2001) to 4.5% (2011). This figure, although increasing, is an under-representation of the proportion of those residing in Northern Ireland who form part of the BME population as it does not include those who hold British or Irish nationality.The findings reveal the challenges faced by BME women such as isolation, language barriers, unfamiliarity with laws and services, and institutional racism. These factors act as barriers in the help-seeking process and increase women’s vulnerability to domestic violence. Some of the most compelling findings are the ways in which immigration law and policy and the benefits system fail to address the needs of immigrant women who experience domestic violence in Northern Ireland. The report highlights the failings in terms of the UK’s human rights obligations and makes a number of recommendations to CEDAW as part of its periodic examination in July 2013. Following its publication, the CEDAW Committee requested the UK government to address, in particular, the report’s findings in relation to the application of the ‘domestic violence’ rule.

Changing Ethnic Segregation and Housing Disadvantage in Dundee

Dundee has a small black and minority ethnic (BME) population, which has been neglected by previous research, as have BME populations in small towns and cities generally. As in other British cities, the residential locations of the main BME groups are distinct from that of the white population. After briefly reviewing the history of settlement in Dundee, this paper examines the extent to which patterns of ethnic segregation have changed between 1991 and 2001. Some moves towards dispersal and suburbanisation are identified but there are important contrasts between different BME groups. The implications of segregation for housing availability are assessed through Census of Population data. The hypothesis is posed that the consequences of segregation for housing disadvantage are greater in small cities such as Dundee.

Ethnic identity, perceptions of disadvantage, and psychosis: Findings from the ÆSOP study

Many studies have shown that rates of psychosis are elevated in the Black and minority ethnic (BME) population in the UK. One important, but relatively less researched explanation of these high rates may be social adversity associated with acculturation processes. Strong identification with an ethnic minority group subjected to social disadvantage may exert adverse effects on individuals from BME groups. Using data from a large epidemiological case–control study of first-episode psychosis, we aimed to investigate whether strong ethnic identification is a factor contributing to the excess of psychosis in BME groups compared with the White British, after adjustment for perceptions of disadvantage. All cases with a first episode of psychosis presenting to specialist mental health services within tightly defined catchment areas in London and Nottingham, UK, and geographically matched community controls were included in the study. Data were collected on socio-demographic and clinical characteristics, perceptions of disadvantage, and identification with one's own ethnic group. Analysis was performed on data from 139 cases and 234 controls. There was evidence that, as levels of ethnic identification increased, the odds of psychosis increased in the BME but not in the White British group, independent of potential confounders. However, the association between strong ethnic identity and psychosis in BME individuals was attenuated and non-significant when controlled for perceived disadvantage. Strong identification with an ethnic minority group may be a potential contributory factor of the high rates of psychosis in the BME population, the effects of which may be explained by perceptions of disadvantage.

Psychoses, ethnicity and socio-economic status

Consistent observation of raised rates of psychoses among Black and minority ethnic (BME) groups may possibly be explained by their lower socio-economic status. To test whether risk for psychoses remained elevated in BME populations compared with the White British, after adjustment for age, gender and current socio-economic status. Population-based study of first-episode DSM-IV psychotic disorders, in individuals aged 18-64 years, in East London over 2 years. All BME groups had elevated rates of a psychotic disorder after adjustment for age, gender and socio-economic status. For schizophrenia, risk was elevated for people of Black Caribbean (incidence rate ratios (IRR)=3.1, 95% CI 2.1-4.5) and Black African (IRR=2.6, 95% CI 1.8-3.8) origin, and for Pakistani (IRR=3.1, 95% CI 1.2-8.1) and Bangladeshi (IRR=2.3, 95% CI 1.1-4.7) women. Mixed White and Black Caribbean (IRR=7.7, 95% CI 3.2-18.8) and White Other (IRR=2.1, 95% CI 1.2-3.8) groups had elevated rates of affective psychoses (and other non-affective psychoses). Elevated rates of psychoses in BME groups could not be explained by socio-economic status, even though current socio-economic status may have overestimated the effect of this confounder given potential misclassification as a result of downward social drift in the prodromal phase of psychosis. Our findings extended to all BME groups and psychotic disorders, though heterogeneity remains.

Count me in even if I am old!

The findings of the 2006 ‘Count Me In’ one-day census of all mental health and learning disability inpatients in England and Wales were recently published by the Healthcare Commission.1 Twenty-one percent of inpatients were from black and minority ethnic (BME) groups, although they account only for 9% of the general population. Admission rates to mental health units, for all the age groups combined, were lower than average in the white British, Indian and Chinese groups, but three or more times higher in the black African, black Caribbean, and white and black Caribbean mixed groups. Moreover, individuals from the latter three BME groups in hospital were between 19% and 39% more likely to be admitted under the Mental Health Act 1983. Rates of referral from general practitioners and community mental health teams were lower and from the criminal justice system higher than average for black African, black Caribbean and other black groups. Patients from the black Caribbean group had the longest duration of admission. Black Caribbean, white and black Caribbean mixed and other black groups were also two to three times more likely to be admitted to learning disability units. There are likely to be a number of reasons for the disparities, including institutional racism.2 Although a third (10,334) of the 32,023 mental health inpatients surveyed were over the age of 65 years, separate analyses were not conducted for this group. This was surprising because the BME population aged 65 years and over has been rapidly increasing over the last two decades,3 presenting new challenges for geriatric psychiatry services. Dementia and depression are the two most prevalent mental illnesses in old age and their prevalence in BME groups is either similar to or higher than that in the indigenous white British group.4,5 However, socio-cultural and cross-cultural aspects of service delivery are poorly researched. There are questions about different pathways to care and secondary care service use. BME elders, in general, are well aware of services provided by primary care and have high registration and consultations rates in general practice.6,7 Despite this, the prevalence of BME elders within old age psychiatry services is generally considered to be very low.7,8 It is unclear whether the high admission rates published in the ‘Count Me In’ census apply to all age groups and whether they are relevant to older people. There is a risk that policy makers, service commissioners, service providers and individual clinicians may erroneously assume that BME elders may be subject to the disparities reported in the ‘Count Me In’ census. If all age groups are treated the same, national, regional and local interventions to correct assumed disparities could worsen the existing inequity in access to old age psychiatry services for BME elders. The combination of being old, belonging to a BME group and having a mental illness is well recognized to disadvantage an individual in society.8 Assumptions about the specific applicability of the findings ascertained from the analysis of all the age groups combined to BME elders may enhance this further. One of the three building blocks of Delivering Race Equality in Mental Health Care (DRE), the Department of Health's plan to improve mental health services in England, is the intelligent use of high-quality information to drive the development of appropriate and responsive services.9 The aim of DRE is to move away from the current ‘one size fits all’ approach to developing psychiatric services;9 this is not only relevant to different BME groups, but to different age groups. There is, therefore, a specific need to analyse the data from the ‘Count Me In’ census for those over the age of 65 years. Given that this census is of all inpatients in mental health and learning disability units and with large numbers, such analysis should unequivocally clarify whether the findings from the analysis of all the age groups combined apply to the elderly. Should it confirm reports from the literature of reduced access to old age psychiatry services for BME elders,7-9 strategies required to correct this are likely to be very different from those suggested for younger age groups.2 Standard one of the National Service Framework for Older People advocates rooting out age-related discrimination in health and social care.10 Specific analysis of 10,334 elderly inpatients for the variable discussed above, as well as others measured in the ‘Count Me In’ census, has the potential to further stimulate a debate and generate activities to achieve this ambition for a highly disadvantaged group of patients. Unless and until the needs of the elderly, particularly those from BME groups, are considered separately from the needs of younger age groups, the elderly will continue to experience discrimination related to age, ethnicity and mental illness. Not only should the elderly be counted in, but the information ascertained should be used to develop equitable services.

Count me in even if I am old!

The findings of the 2006 ‘Count Me In’ one-day census of all mental health and learning disability inpatients in England and Wales were recently published by the Healthcare Commission.1 Twenty-one percent of inpatients were from black and minority ethnic (BME) groups, although they account only for 9% of the general population. Admission rates to mental health units, for all the age groups combined, were lower than average in the white British, Indian and Chinese groups, but three or more times higher in the black African, black Caribbean, and white and black Caribbean mixed groups. Moreover, individuals from the latter three BME groups in hospital were between 19% and 39% more likely to be admitted under the Mental Health Act 1983. Rates of referral from general practitioners and community mental health teams were lower and from the criminal justice system higher than average for black African, black Caribbean and other black groups. Patients from the black Caribbean group had the longest duration of admission. Black Caribbean, white and black Caribbean mixed and other black groups were also two to three times more likely to be admitted to learning disability units. There are likely to be a number of reasons for the disparities, including institutional racism.2 Although a third (10,334) of the 32,023 mental health inpatients surveyed were over the age of 65 years, separate analyses were not conducted for this group. This was surprising because the BME population aged 65 years and over has been rapidly increasing over the last two decades,3 presenting new challenges for geriatric psychiatry services. Dementia and depression are the two most prevalent mental illnesses in old age and their prevalence in BME groups is either similar to or higher than that in the indigenous white British group.4,5 However, socio-cultural and cross-cultural aspects of service delivery are poorly researched. There are questions about different pathways to care and secondary care service use. BME elders, in general, are well aware of services provided by primary care and have high registration and consultations rates in general practice.6,7 Despite this, the prevalence of BME elders within old age psychiatry services is generally considered to be very low.7,8 It is unclear whether the high admission rates published in the ‘Count Me In’ census apply to all age groups and whether they are relevant to older people. There is a risk that policy makers, service commissioners, service providers and individual clinicians may erroneously assume that BME elders may be subject to the disparities reported in the ‘Count Me In’ census. If all age groups are treated the same, national, regional and local interventions to correct assumed disparities could worsen the existing inequity in access to old age psychiatry services for BME elders. The combination of being old, belonging to a BME group and having a mental illness is well recognized to disadvantage an individual in society.8 Assumptions about the specific applicability of the findings ascertained from the analysis of all the age groups combined to BME elders may enhance this further. One of the three building blocks of Delivering Race Equality in Mental Health Care (DRE), the Department of Health's plan to improve mental health services in England, is the intelligent use of high-quality information to drive the development of appropriate and responsive services.9 The aim of DRE is to move away from the current ‘one size fits all’ approach to developing psychiatric services;9 this is not only relevant to different BME groups, but to different age groups. There is, therefore, a specific need to analyse the data from the ‘Count Me In’ census for those over the age of 65 years. Given that this census is of all inpatients in mental health and learning disability units and with large numbers, such analysis should unequivocally clarify whether the findings from the analysis of all the age groups combined apply to the elderly. Should it confirm reports from the literature of reduced access to old age psychiatry services for BME elders,7-9 strategies required to correct this are likely to be very different from those suggested for younger age groups.2 Standard one of the National Service Framework for Older People advocates rooting out age-related discrimination in health and social care.10 Specific analysis of 10,334 elderly inpatients for the variable discussed above, as well as others measured in the ‘Count Me In’ census, has the potential to further stimulate a debate and generate activities to achieve this ambition for a highly disadvantaged group of patients. Unless and until the needs of the elderly, particularly those from BME groups, are considered separately from the needs of younger age groups, the elderly will continue to experience discrimination related to age, ethnicity and mental illness. Not only should the elderly be counted in, but the information ascertained should be used to develop equitable services.

Race Equality and Leisure Policy Discourses in Scottish Local Authorities

ABSTRACT This article presents and discusses the findings of a survey designed to assess two issues. First, it considers the extent to which Scottish local authorities have sought to discover and provide for the specific needs of their black and minority ethnic (BME) populations. Second, it provides preliminary reflections on the impact of political, organisational and legislative change upon the policy and practice of Scottish local authorities in their delivery of services to their BME populations. It raises questions about the potential for improvement in local authority leisure services following the Race Relations (Amendment) Act 2002. The study was carried out in the context of previous research by Horne (1995) and thus sought to assess the extent to which there had been change during the intervening period in the approaches of Scottish local authorities. Results suggest that the environment in which local authority leisure providers operate has changed significantly since 1995. All local authorities now have formalised equal opportunity policies and race equality schemes. Whilst there exist examples of good practice, the degree to which local authorities seek to discover and meet the needs of their BME populations varies considerably. Analysis of the discourses of local authorities suggests that the extent to which the ethos of equality has permeated organisations remains uneven. Scotland, a country of some five million people, is actively seeking a flow of Fresh Talent to flourish alongside native‐born Scots and secure its place as an essential part of the global economy (Scotland is the place to be for opportunities www.scotlandistheplace.com).

No need for segregated approach

Suddenly it appears to be fashionable to sing the BME song. Last week Nursing Standard carried two items (news November 12) to further the black and minority ethnic (BME) cause. Why do we from BME backgrounds need to take a segregated approach? I believe demanding a BME face at the Department of Health or creating an exclusive forum negates the really important aspects related to BME work. Two complex issues need to be addressed: first, how can we strive to serve the healthcare needs of an ever increasing BME population; second, how can we ensure BME nurses - hitherto disadvantaged - get the right opportunities to develop and prosper in the NHS?