Our study, the largest of its kind, analyses data from a diverse sample of over 10,000 HCWs in the UK and sheds light on variations in redeployment experiences. We identified inconsistencies in the redeployment process, training, supervision, patient contact, and interaction with COVID-19 patients based on occupation, ethnicity, and migration status. Whilst we found no differences in likelihood of redeployment by ethnicity in the cohort overall, our results suggest migrant HCWs on AfC pay bands were more likely to be redeployed than those born in the UK. We found that in comparison to White HCWs, those from an Asian background were less likely to report receiving training during redeployment, while Black HCWs were more likely to receive supervision. Further, redeployed ethnic minority and migrant HCWs, were more likely to report contact with COVID-19 patients compared to those from a White ethnic background and born in the UK respectively.

As per existing literature [18,25] our findings indicate that occupation played a crucial role in the likelihood of being redeployed. Compared to those in medical roles, HCWs in nursing, midwifery, and allied health professional roles were more likely to report redeployment, while those in pharmacy, healthcare scientist, ambulance, dental, optical, and administrative roles were less likely. This discrepancy may be attributed to differences in skill sets acquired during training and the diverse career paths that HCWs follow after their qualification. Lower reports of redeployment among certain HCWs may be due to the potential to transition to remote work or the absence of direct patient care-related skills (as in the case of scientific staff) [26].

Our study highlights the challenges faced by HCWs in nursing roles, revealing increased patient contact in redeployed roles compared to doctors, potentially contributing to higher occupational exposure to SARS-CoV-2 and greater risk of infection [26]. Existing literature has already highlighted the adverse impact of the pandemic on their physical and mental well-being, noting increased susceptibility to COVID-19, and elevated stress and anxiety levels [27,28]. There are likely to be several factors underlying these observations including inadequate training, concerns about safety, shortages of personal protective equipment (PPE), and gaps in support and structured communication [28,29].

Our study highlights that HCWs from migrant backgrounds on the AfC pay band, were more likely to be redeployed compared to their counterparts born in the UK. Additionally, HCWs from an ethnic minority background were significantly more likely to report interaction with COVID-19 patients during the UK national lockdown close to the peak of the first wave. These findings raise serious concerns as HCWs from ethnic minority backgrounds already faced several compounding risk factors. They were at a higher risk of contracting COVID-19, and despite this increased risk, had limited access to risk assessments compared to HCWs from a White background, as revealed by the UK-REACH qualitative study [26,30]. It is crucial to note that our quantitative findings suggest that HCWs from an ethnic minority background were offered risk assessments but experienced no changes in their working practices [31]. This could be linked to structural discrimination as literature extensively documents that HCWs from ethnic minority backgrounds often felt less empowered to voice concerns about risk assessments, and had less autonomy in decisions related to their redeployment [25,32]. Furthermore, HCWs from an ethnic minority background are more likely to work in junior roles involving increased patient contact [9]. With evidence indicating insufficient access to personal protective equipment during patient interaction, these HCWs were further disadvantaged [5]. These challenges were exacerbated by existing socio-demographic disparities such as living in multi-generational households and underlying health conditions [10,11].

In addition to increased COVID-19 contact, we also found an association between ethnicity and the provision of training and supervision during redeployment. Notably, Asian HCWs, particularly doctors, were less likely to report receiving training during redeployment than their White counterparts. This finding is concerning, especially considering the recognised importance of training for successful redeployment during the pandemic [14,15]. A qualitative study conducted among ethnic minority staff in the UK pointed out that in addition to their exclusion from risk assessments, they were also excluded from training discussions, highlighting a lack of support when managers were from non-ethnic minority backgrounds [29]. In contrast, HCWs, especially doctors, from Black ethnic backgrounds were significantly more likely to report receiving supervision compared to their White counterparts. While clinical supervision has various benefits including reduced stress and anxiety, better quality of care delivery, and better working environment [33], it is essential to address any negative connotations associated with supervision among ethnic minority staff, such as being supervised due to a lack of trust in their experience and skills.

The increase in COVID-19 contact among ethnic minority staff, despite being at higher risk, lower reports of changes post-risk assessment, and reduced training during redeployment may be attributed to structural discrimination [31]. Their reluctance to voice concerns about risk assessments [34] and inability to challenge redeployment decisions [25] may potentially stem from past experiences of harassment, bullying or abuse at work [9]. Persistent structural discrimination within the NHS has been well-documented in literature [9,25,35]. The disparities in COVID-19 contact, training and supervision based on ethnicity, as highlighted in our study, warrant further investigation in the context of structural discrimination. Utilizing an intersectional lens will enable a better understanding of how these disparities proliferate.