Coronavirus (COVID-19) - disabled people: health, social and economic harms - research report

4. Wider impacts of COVID-19 on disabled people

Sections 1 and 2 have identified the high mortality rate for disabled people due to COVID-19, but this is not the only negative impact. Various documents^[52] have accounted for the impact of COVID-19 on disabled people across four harms: COVID-19 health impacts; non-COVID health and social care; social, and economic. This section summarises some of those factors:

4.1 Non-COVID health and social care impacts

Disruption of routine health and social care due to the pandemic has had a disproportionate negative impact on disabled people, who are more likely to require such services. A survey carried out by Inclusion Scotland in April 2020 found that almost half of respondents said that the pandemic had had an impact on the social care they get, formal and informal. Around a third (30%) of respondents had had their social care support reduced or stopped completely.^[53] Inclusion Scotland highlight that people were left in desperate situations as a result of this, with respondents describing how they had been forced to sleep in their wheelchair or were left unable get out of bed.^[54] In addition, Inclusion Scotland's survey demonstrated that 7% of respondents had had their medical appointments and/or routine health services had been cancelled or reduced since the start of the crisis.

Disabled people might also experience heightened anxiety around attending appointments due to the risk of contracting COVID-19 and experiencing severe symptoms. A survey conducted by the Glasgow Disability Alliance (GDA) found that 90% of the respondents have been worried about their physical and mental health during the pandemic.^[55][56] The NHS mobilisation plan outlines an increased expansion of health and social care support services to mitigate the negative impacts of reduced routine and normal health and social care due to the pandemic.^[57]

Many services, such as health care appointments, have relied on digital services during the COVID-19 pandemic. For some disabled people online appointments may have the positive impacts of reducing stress, expense and inconvenience around having to attend in person.^[58] However, online appointments can also be a potential barrier for disabled people, with 60% of GDA members reporting being digitally excluded. To tackle this, the Connecting Scotland programme^[59] has initially aimed to support 9,000 low income individuals at increased clinical risk from COVID-19.^[60]

The introduction of compulsory face coverings in public spaces has been recognised as not always being appropriate for disabled people. Regulations, therefore, exempt the wearing of masks for disabled people for whom it is not appropriate or where there are justifiable reasons. However, data gathered amongst members of Disability Equality Scotland (DES) demonstrated that while a majority of respondents were in favour of wearing face coverings as an extra precaution against transmission of the virus, many disabled people who were exempt from this requirement had faced difficulties when shopping, including verbal abuse.^[61] In addition, further DES polls showed that disabled people felt that they were experiencing a higher level of disability-based hate crime.^[62] An exemption card has been made available in order to mitigate the risk of challenge or abuse faced by disabled people.^[63]

Having a long term physical condition increases the likelihood of experiencing poor mental health, and vice versa. According to the most recent data from the Scottish Health Survey 2019, disabled people had lower mental wellbeing than non-disabled people (45.4 compared to 51.8 on a scale of 14 to 70). The COVID-19 pandemic, with its restrictions on social interaction and physical activity, is likely to exacerbate this.

Inclusion Scotland found that respondents to their April 2020 survey were anxious about their own and the health of the people they care about, with many "fearful for the future".^[64] In addition, in September 2020, disabled people in the UK reported more frequently feeling that the coronavirus pandemic was affecting their well-being, compared to non-disabled people. Disabled people reported that the pandemic was making their mental health worse (41% for disabled people and 20% for non-disabled people), that they were feeling lonely (45% and 32%), that they were spending too much time alone (40% and 29%), that they felt like a burden on others (24% and 8%), and that they had no-one to talk to about their worries (24% and 12%).^[65]

Research from Glasgow Disability Alliance has highlighted the increased isolation and loneliness that disabled people have felt during the COVID-19 pandemic. Disabled people were already significantly more likely than non-disabled people to experience loneliness.^[66] 82% of GDA members surveyed during COVID lockdowns had been concerned about isolation, with 80% of members not being aware of any local support services they could access during the pandemic and lockdown.^[67]

In addition, Inclusion Scotland's survey on shielding carried out between the 19^th and the 3^rd of July 2020 found that long-term shielding was having a substantial impact on respondents' health. Many respondents spoke about the loss of health care appointments and treatments which was causing distress and concern about deteriorating health.^[68]

To mitigate the disproportionately negative social impacts on disabled people, the Scottish Government has introduced an exception to no indoor mixing through extended households for disabled people needing informal care and support. This aims to have a positive impact on disabled people's physical and mental health through reducing isolation, while also still maintaining protection from the virus.^[69]

4.2 Social impacts

Restrictions imposed on public transport has had an impact on disabled people. Disabled people are more likely than non-disabled people to be reliant on public transport. The need for more physical distancing results in fewer accessible seats and spaces for wheelchair users, making it more challenging for disabled people to use public transport. The reduction of two metres to one metre physical distancing will have had some mitigating effect, but transport accessibility is likely to still be an issue for disabled people. For example, in May 2020 as a part of their weekly polls, Disability Equality Scotland asked their members if they had experienced any issues with physically distancing during their daily exercise or when undertaking essential journeys. 99% of respondents answered yes to this question.^[70] The Transport Transition Plan developed by Transport Scotland aims to mitigate these issues of reduced capacity and concerns amongst disabled people over being able to observe physical distancing measures.^[71]

In addition, the restrictions related to shopping and eating out have had disproportionate negative social impacts on disabled people. There is potentially a risk of heightened anxiety among disabled people due to a number of situations made by the COVID-19 pandemic, including: busier streets, one way systems, potential queuing and the requirement to physically distance. In an April 2020 poll Disability Equality Scotland found that there were issues around the accessibility of supermarket stores. For example, rules on shoppers having to be alone, and therefore unaccompanied by carers, presented problems for those who needed additional assistance.^[72] In addition, DES highlighted issues around the need to queue outside supermarkets with no seating available.^[73] Retail Sector Guidance has been published and is regularly reviewed to remove disadvantages for particular equality groups, including disabled people.^[74]

4.3 Economic impacts

Disabled people are more likely to experience poverty and less likely to be in employment.^[75] They are also more likely than non-disabled people to work in sectors which have been hit hard by COVID-19, including public administration, education and health, as well as the distribution, accommodation and catering sectors.^[76] The economic impacts of the COVID-19 pandemic are, therefore, more likely to affect disabled people compared to non-disabled people. A survey carried out in the UK in April 2020 showed that disabled people are more likely than non-disabled people to say that they will come out of the pandemic in more debt. 34% of disabled women said their household has already run out of money, compared to 24% of non-disabled women^[77]. Furthermore, research by GDA showed that among disabled people in Scotland, 57% have been worried about money and hardship during the pandemic.

For those who are unemployed, disabled people might face extra barriers to access information and receive support. According to GDA, 80% of their members were not aware of any local support services they could access, and 41% had difficulties accessing information in formats required.^[78]

For those who are in employment, disabled people might find it more challenging to return to work. In particular, disabled people may struggle to maintain physical distancing if they are required to return to work for essential purposes. In addition, the negative impacts of working from home, such as loneliness and decreased mental wellbeing, are likely to be particularly challenging for disabled people with a history of mental health illness. ^[79]

Another economic impact that might be affecting disabled people more than non-disabled people is food insecurity. Disabled people experienced higher prevalence of food insecurity prior to the pandemic.^[80] COVID-19 has further exacerbated the financial vulnerability of disabled people, and so increased risk to food insecurity, alongside introducing additional barriers to accessing food due to the need to self-isolate, shield or the reduction in access to unpaid care. Data from a YouGov poll shows that disabled adults across the UK were disproportionately affected by food insecurity during the first two weeks of lockdown arising due to all three drivers measured - financial hardship, lack of food in shops and isolation. Taking these drivers together, 37% of adults who reported that they were limited because of a health condition or disability reported that they experienced food insecurity compared with 19% of those limited a little because of a health problem or disability and 12% among those not limited by health problem or disability.^[81]

In addition, over half (53%) of respondents to Inclusion Scotland's April 2020 survey said that they had experienced difficulties accessing food for themselves and those that they care for.^[82] 1 in 8 people at high risk from COVID-19 told Inclusion Scotland that they were not able to effectively shield or isolate themselves because they did not have other support to access food and or medication.^[83]

Findings from Glasgow Disability Alliance published in August 2020^[84] indicates that their members experienced extra barriers to food security from supermarket delivery slots being overwhelmed and having a minimum spend barrier.^[85] Members of GDA also expressed concerns about delays and gaps in accessing eligibility status for shielding support and delivery priority slots, with many being expected to rely on the goodwill of friends and family when support lines were withdrawn as shielding was paused.^[86] Inclusion Scotland's July 2020 survey found that over 56% of respondents who were shielding without a letter (56%) said that they did not have access to the support they needed.^[87]