Coronavirus (COVID-19): Our shared role in containing the virus: Analysis of responses submitted as part of the Scottish Government's second public engagement exercise

5) Protection and Support

Much of the discussion revolved around questions concerning who the restrictions should apply to, and who should be categorised as ‘at risk’. Views on ‘community spirit’ were divided with some seeing a positive impact on a feeling of togetherness in local areas and neighbourhoods, while others felt judged on their actions. There was widespread concern about NHS access and resilience in terms of non-COVID related conditions, and many contributors wanted to see dental practices opening up in particular. Mental health was one of the most central themes across the exercise and it was discussed across the different topics – but especially in relation to social restrictions.

Key themes of discussion included:

• Protection
• Health sector response
• Mental health, loneliness and isolation
• Community Support

Protection^[12]

A number of contributions covered the sort of protection and support that would be available for those that would have to self-isolate or be less able to participate in society.

In terms of economic harms, contributors discussed having lost their livelihoods or their fear of this happening. There was a suggestion to introduce a universal basic income due to the concern that poverty – current or impending – has meant some people are unable to isolate when needed. Some highlighted that the restrictions, as they were at the time, meant that you could only see friends and family indoors if you were able to pay to socialise in places such as hospitality settings.

Health sector response^[13]

More generally, with more information becoming available on the backlog within the NHS of scans, operations, cancer treatment etc, many respondents highlighted the need to keep all areas of the NHS mobilised, including dentists, opticians, physiotherapists and GP surgeries, as well as acute care, surgery and medical treatments in hospital settings.

‘Many conditions including cancer, eye disease, mental health, arthritic hips, and dental decay are not being managed properly. The numbers of people affected, QALYs[^[14]] and impact on economy far outweigh the COVID numbers. We must rebalance or we lose the progress made over previous decades. Invest more money in the system, retrain our people to help.’

There were calls for GP surgeries to open up for more in-person consultations. The lack of access to dental care in particular was mentioned across a number of contributions. One contributor suggested recruiting younger or ‘low-risk’ volunteers to support local NHS services over the winter.

It was argued that the restrictions on hospital visits can have serious mental health impacts for pregnant women or new mothers. In particular, restrictions on having partners attend scans or neonatal appointments, limiting the time a birth partner can spend with the mother during labour, and not allowing the father, partner or a named person visit after the birth were mentioned.

Care homes continued to be a key topic of discussion, and some contributors highlighted the severe impact of preventing people from visiting loved ones. It was argued that not being able to visit those in care homes was accelerating the deterioration of other health conditions, particularly dementia, and leaving many care home residents extremely confused and distressed. It was also stated that within care homes themselves, residents are required to socially distance from each other, thus further limiting social and physical contact other than with members of staff. A range of suggestions were made for allowing more contact between residents and their families, including testing of visitors, and more facilitated outdoor visits. It was pointed out that many of these concerns also extend to older patients in hospitals.

While many called for a COVID-19 vaccine to be rolled out as soon as possible, there was also concern regarding the safety and reliability of such a vaccine and that it should undergo rigorous verification prior to being deployed.

Mental health, loneliness and isolation^[15]

Mental health was one of the most discussed issues on the platform, and it cut across different themes and topics. It was noted that ‘mental health is frail country-wide at the moment’. However it was mainly discussed in relation to social restrictions and the lack of social contact. There were many contributions asking to continue to allow extended households and social interaction, and this was especially seen as key in the effort to support those seen as being ‘the most vulnerable’. The relationship between grandparents and grandchildren was raised in relation to mental health concerns. There were calls to allow grandparents to see grandchildren regardless of whether they are eligible to form a social bubble.

‘My mental health as a grandparent suffered when I couldn't see my grandchildren during lockdown. I missed their birthdays and they have missed 3 planned holiday times with me already this year due to the various restrictions. I offer family support, informal childcare during key holiday periods and they keep me young and energised. I do not go to pubs, clubs or restaurants, it's just not my thing!’

Many contributors, especially those who were single and/or living by themselves, expressed that they felt isolated and lonely. The following quote came from someone who had migrated to Scotland, and therefore highlights some of the particular difficulties and ‘double isolation’ faced by those whose families live in a different country:

‘My friends are my family in the UK and at the moment I can only see one friend in doors as she lives on her own. I also been working from home and my current team has not put any effort into online socialising as they have extra caring responsibilities (I understand them) but I never before felt so isolated and cut off from the world.’

Community support^[16]

Some contributors felt that the virus had brought to the fore community strength and resilience, and brought communities together. The importance of community involvement and inclusion were highlighted as a key health determinant and contributors argued that community initiatives that had started during the pandemic should be supported and maintained in the long term. It was also suggested that communities should be given more decision-making power in their local areas.

‘The power of communities to affect not only health and wellbeing but also prevent use of formal services make them cost effective, preventative and allow for targeted and not generic resource use from the public sector. This is a rare opportunity to regain some of the traditional family and community strengths of the past.’

Others highlighted negative impacts in their community, including feeling unfairly vilified for apparent infringements, and the frustration at the lack of compliance in others, seen in a variety of threads. Secondly, people missed the community services which keep people connected and supported (including within the school setting).

‘I don’t particularly feel that there is a community when all the extra-curricular activities have so many restrictions a lot of them can’t even go ahead (eg toddler groups, out of school activities). It’s hard to feel like you’re part of the school community when you’re not allowed in for parents evening. You feel like you’re doing the wrong thing taking children to the shops because there’s so many rules. There’s nowhere to go. It’s very isolating at the moment if you have young kids, and there’s no opportunity to make new friends.’