Coronavirus (COVID-19): phase 3 measures - equality and fairer Scotland impact assessment

4. Summary of impacts of Phase 3 measures by protected characteristics.

This section summarises the evidence provided in the Annex by protected characteristic and socio-economic disadvantage. It attempts to pick up significant themes but does not discuss every impact set out in the tables.

Age

Older people

The term older people covers a wide spectrum of people with different outlooks, views, experiences and needs. While many older people will have welcomed the Phase 3 release of measures allowing them to meet up with family and friends more easily indoors and outdoors, others will have been distressed by the increased contact and risks of transmission.

The opening up of non-essential shops, cafes, pubs, restaurants, libraries and galleries will have been positive for many older people allowing them to access the goods and services that they would normally use. Libraries will be particularly helpful for those who do not have access to digital technology at home.

There will also be health benefits for older people from the further expansion of screening programmes such as the bowel screening programme for people over 50 years old; the breast screening programme aimed at women over 50 years old; the AAA screening for men at the age of 65. Other health services which are used by older people such as podiatry, optometry and physio were also opening for routine care.

However, reduced public transport and lack of access to IT technology may have meant that older people were less able to make and attend appointments. In addition, for many older people physical distancing can be difficult especially in smaller shops and retail services, and physical distancing may also impact on the availability of assistance to those who need it, while queueing systems may be difficult for those who cannot stand for long.

There were wellbeing benefits to older residents of reinstating some communal living in care homes. Communal activities with opportunities to connect with others, for example though meal times and other activities, will have provided meaning and structure to everyday living. This will have been even more important for the high proportion of residents with advancing dementia to help avoid or alleviate stress and distress.

For older people who were more anxious the revised (14 September )^[33] measures allowing a maximum of two households and six people to meet indoors will have been a slight comfort, reducing their personal risk but allowing care and informal support to continue.

Younger people

The key measure for young people during Phase 3 was the restarting of Early Learning and Childcare, Schools, Colleges and Universities.

For pre-school children, increased access to high quality childcare will support young children to develop and learn, to build social skills and networks. Evidence has shown that high quality Early Learning and Childcare can in time reduce the poverty related attainment gap.

The full-time reopening of schools from August is expected to have had and continue to have a positive impact on most children and families. With appropriate hygiene and physical distance measures children are able to continue with their learning in a routine that they had previously grown used to. They will benefit from the interaction with their peer groups and specialist educational staff. This will reduce feelings of isolation and help children reach expected milestones for their age and stage of development.

For children in unsafe home environments, schools (and pre-school settings) can also offer some relief from the Adverse Childhood Experiences (ACE)^[34] they may be living with, as well as presenting more opportunities for professional staff to pick up on any Child Protection issues.

However, there may be certain age groups that will have found the return to school more challenging such as those transitioning to a new stage e.g. P1, S1, or onto college or university, and who may have missed out on induction steps that previous year groups have been afforded. Some children may have been anxious about the return to school and may have found it difficult and confusing to have to wear face coverings in communal areas. It is also expected that there will be some learning loss for all age groups due to schools closures. However, the pressure to ‘catch-up’ may be felt more by some age groups than others especially those in exam years.

Phase 3 measures allowed for children under 12 to mix much more freely and for young people under 18 to meet in groups outdoors. However the measures on 10 September re-imposed measures to only allow two households to meet and a maximum of six people. Children under 12 were not included in the total number of people but the two household restriction remained. The inability to play informally with friends outside of school may have felt odd to children. Mixed messages for children and young people at a time of great change could have further exacerbate the challenges they already face around anxiety, mental, emotional and physical health.

A change was introduced to Phase 3 on 25 September, in response to rising transmission rates caused by meeting in homes socially. From that date households were not able to visit another household indoors socially unless they were in an extended household or a non-co-habiting couple. In addition, only two households with a maximum of six people were able to meet outside socially. This will have had an increased impact on this age group.

Under-12s did not count towards the maximum number of households or number of people who can meet outdoors. Under-12s did not have to physically distance, which will have been a positive for many children and their families in this group as play is essential for children’s development and mental health, and a recognised human right. A maximum of six 12 to 17 year olds could meet outdoors socially, with no household limit, but with physical distancing. This will have enabled this group to maintain social contact and emotional support from peers.

The re-opening of organised sports, clubs and activities was a positive step for children and young people. They provided space for them to play, socialise and interact with their peers. Often they will have been for hobbies or personal interests that the children could not get elsewhere and some children may have attended multiple groups or clubs at different days across the week. However, the release of informal play with peers outside of school will have been welcomed by low income families who could not afford organised activities.

Universities and colleges also restarted in Phase 3 with a blended learning approach and a restart of university and college halls of residence and Purpose Built Student Accommodation (PBSA). While a resumption of Higher and Further Educational learning will have been very welcome, some staff and students will have experienced anxiety on return to their education setting. For new students unable to meet in traditional social events, e.g. Fresher’s Week or to join clubs, the isolation of being away from home, the increased restrictions around meeting in pubs, along with high virus transmission rates requiring self-isolation with comparative strangers, will have put significant stress on the mental health of many students.

Phase 3 allowed for non-cohabiting couples to meet up and resume their relationship. It is likely that many young adults will be in non-cohabiting relationships and will have benefitted from this measure.

In the UK, young people are more likely to be working in sectors that have opened during Phase 3 including retail, hospitality and some aspects of tourism. For young people returning to work, reopening will therefore have positively increased their income, but could also negatively increase their health risks, potentially raising anxieties about returning to work and infection transmission within households.

Disability

The term disabled people covers a wide range of people with a wide range of different health conditions and impairments. Some will be at a higher clinical risk from COVID-19 and may be more anxious about community transmission of the virus, but many will have a condition that does not necessarily increase their risk of serious illness.

For many disabled people the increased ability to see family and friends indoors and outdoors in Phase 3 will have been welcomed. The 14 September restriction to two household and six people will have curtailed this a little but there were care exemptions and families and friends were still be able to visit in smaller numbers to provide informal support. This would have had a positive impact on mental wellbeing from reduced isolation while feeling more protected from the virus. From 25 September^[35] households will not have been able to visit another household indoors socially unless they were in an extended household or a non-co-habiting couple. In addition, only two households with a maximum of six people were able to meet outside socially. This will have had an increased impact on this group.

The opening of more local shops, libraries, pubs and restaurants in Phase 3 will have been of benefit to some disabled people who are comforted by a more normal life. For example, disabled people may not have had access to e-readers and may have struggled to access digital resources while public libraries were closed. Many public library services also provide a way for people to pick up hearing aid batteries in their local branch.

However, the protections required to reduce virus transmission in Phase 3 may be difficult for some disabled people. Physical distancing may be more difficult in small shops and retail services, and this and the need to stand in queues could be a particular challenge for people with limited mobility.

The wearing of face coverings was compulsory in public spaces in Phase 3. It was recognised that the wearing of face coverings may not be appropriate for disabled people with particular impairments or health conditions. The Regulation therefore exempts the wearing of face coverings for disabled people^[36] for whom it is not appropriate or where there are justifiable reasons e.g. where individuals may have a hearing impairment or lip read. However, not everyone understands the restrictions meaning that disabled people may be unfairly challenged for not wearing a face covering. A new exemption card seeks to mitigate this issue.

The need for physical distancing on board public transport also made it more difficult for disabled people to travel due to fewer seats overall, including fewer accessible seats and spaces for wheelchair users. The reduction in the distance to be observed on public transport in Phase 3 from two metres to one metre may have eased this a little, although it is likely there will still be difficulty for disabled people to travel given reduced capacity.

In line with the NHS mobilisation plan the increased expansion of a variety of health and social care support services will be of benefit to disabled people. However, reduced public transport to get to face to face appointments and the need for access to specialist IT technology to access video appointments may be difficult for some disabled people. For others, being able to contact the GP and health specialists from home may have positive impacts reducing the stress, expense and inconvenience of attending in person.

Gender reassignment

Transgender students who returned home during lockdown may have done so to family environments that were unsafe and which make it harder to meet their needs. The opportunity to attend informal meetings with friends early in Phase 3 could have provided significant peer support as has the opening of educational settings and campus living. This support may have reduced as the number of households able to meet was reduced on 10 September. From 25 September only two households with a maximum of six people were able to meet outside socially. This is likely to have had a slightly increased impact on this group in terms of social isolation.

Pregnancy and maternity

Phase 3 enabled women and their families to have additional support at antenatal appointments, during and after birth which will be a significant comfort during these important life events where women may feel more vulnerable.

Allowing households with younger children to meet in Phase 3 also enabled mutual support and bonding, improving the mental health of parents and the children. The opportunity for children aged under 12 to play with friends without physical distancing may have reduced anxiety for those accompanying or supervising them during outdoor meetings. It is recognised that relaxations earlier in Phase 3 were more beneficial than the restrictions that were put in place on 10 September.

There is strong evidence that combined aerobic and resistance exercise interventions during pregnancy can maintain, or improve, cardiovascular fitness without adverse effects leading to improved maternal health after delivery, decreased complications during labour & delivery, and quicker maternal recovery. The re-opening of gyms and low-impact fitness classes for pregnant women are seen as beneficial.

Race

The evidence shows that some minority ethnic groups, particularly South Asians, are at a higher risk of catching and being seriously ill from COVID-19. The release of many measures in Phase 3 will have both provided income from work and improved access to goods and services, but also increased the potential for virus transmission.

It is recognised that some minority ethnic groups tend to have larger households. Any rules to restrict the number of people who can meet may disadvantage larger, intergenerational households. The easing in Phase 3 of the number of households and the total number of people allowed to meet together was positive for families with larger households. The subsequent measure on 10 September, re-imposing restrictions on the size of households who can meet will be less welcomed but could reduce the chances of people from some minority ethnic groups contracting COVID-19.

Returning to work for sectors opening in Phase 3 will have been financially welcomed by minority ethnic people while also likely to bring some health anxieties. Guidance has been developed across sectors to assess risk for individuals, with employers asked to provide suitable mitigation for high risk employees and customers. For example, when compared to the overall population, a larger proportion of college and university staff and students who will have been returning in Phase 3 are from minority ethnic backgrounds. Minority ethnic workers are also prevalent in the hospitality and tourism sector. In these latter sectors some will be working while others, such as those in the events industry, remain on furlough or may be without work.

As Phase 3 rolls out and brings changes in the normal rules and access to services it is important that communication is fully inclusive for people where English is not their first language or where there are other cultural issues to consider. Various sectors have developed guidance in different formats or with stakeholder groups to meet these needs.

We already know from developing the National Transport Strategy that public transport can provide a space in which perpetrators can target violence or threat of violence at certain groups of society. As public transport returns towards a normal schedule there could be an increase in racial discrimination and / or hate crime.

Almost half of students in halls of residence are from outside the UK^[37] so those staying in university halls of residence and external Purpose-Built Student Accommodation are potentially more likely to have a wider variety of ethnic backgrounds. Continued physical distancing requirements could mean they are less able to access wider peer support networks and thereby exacerbate feelings of isolation.

Religion and belief

Members of faith communities have been able to attend places of worship for communal or congregational worship and / or prayer, and wider activities, ceremonies and services since 15 July. This Phase 3 measure has been of particular benefit to groups for whom individual prayer or contemplation is less significant than group prayer.

People attending a place of worship have been required to wear a face covering from 8 August, unless they are exempt for health reasons. The individual leading the act of worship is exempt from this requirement. For some, these conditions may impact on the spiritual connection experienced in practicing their faith in a place of worship.

There were also limits on the number of people who could attend a Place of Worship to exercise their religious rights The restriction to the total number of people who could attend a Place of Worship at one time may have had a negative impact on faiths that have larger catchment areas for an individual Place of Worship, which ordinarily has a high capacity, such as Muslim and Sikh communities.

Additionally, some restrictions on high risk activities, such as singing, remain in place, which will have a negative impact on some faith groups.

The relaxation of the measures to meet other households indoors and outdoors earlier in Phase 3 could benefit Muslims, followed by Hindus, who were most likely to live in overcrowded households in 2011^[38]. The updated measure on 10 September to reduce the numbers of people and households able to meet could cause issues for those who have larger households.

Although universities and colleges reopened in Phase 3 which is seen as beneficial for all young people, due to the restrictions in numbers, colleges and universities may not be unable to offer a full programme of religious observance. Over a third of students declared as having a religion or belief in 2018.^[39]

Easing of restrictions on funerals in Phase 3 has allowed more people who are not close family to attend funeral ceremonies held in places of worship. Numbers are still limited and funeral services will remain small, especially compared to pre-pandemic levels.

Sex

Men

Many of the positive impacts of Phase 3 for men relate to the opening up of sectors which can provide work and income, the re-opening of pubs, cafes and restaurants and the re-opening of sports, gyms and other activities. Outdoor contact sport is predominantly undertaken by young men and the opening of snooker / billiards / pool and indoor bowling which are significantly more popular amongst men than women^[40] will have been of benefit to those who participate.

Men, especially older men, are at a greater clinical risk from COVID-19 so while increased community activity and a return to more normal life may be beneficial for many men, this will be accompanied by an increased risk from the transmission of the virus.

Evidence suggested that boys and young men struggled more than girls and young women with home learning during lockdown. The return of school settings in Phase 3 and increased peer and teacher contact will have been beneficial for their attainment. Men who are parents and undertake childcare will also benefit from the return of childcare and educational activities, as well as the opportunity to resume co-parenting when both parents live in different households.

Women

The initial Phase 3 release for people to see family and friends will have been beneficial for women, especially those offering or receiving informal care and support. Women were also at greater risk from domestic abuse, therefore being able to meet family and friends, or leave the home, may have made it easier to access the usual routes to support and safety.^[41] The subsequent restriction in the number of households that could meet from 10 September may have reduced the initial positive impacts of this release. For example, it could have impacted on childcare (which is predominantly provided by women) and on parents’ ability to ‘return to work’. From 25 September only two households with a maximum of six people were able to meet outside socially. This will have had an increased impact on this group.

The increased public transport options will also be beneficial for women who tend to use public transport more than men. The proposals to stagger travel times and working times alongside mitigation measures being put in place by public transport operators will go some way to addressing anxieties from using public transport. However, women are more likely to make multi-stop and multi-purpose trips, combining travel to work with trips for other purposes e.g. caring responsibilities; taking children to school. This means that there may be complexities around the staggering of times for employment and education (especially as schools and ELC have re-opened) and how this will impact on the time of day people travel.

Increased accessibility to childcare provision in Phase 3 will have had a particularly positive impact on those who were disproportionately affected by closures e.g. women; children for whom home is not a safe or stable environment and for those where childcare provides resources and experiences that are not available at home.

Compared to other forms of physical activity, gyms provide an important role in providing women and girls with opportunities to be active. The opening of gyms and swimming pools in Phase 3 will have been of significant benefit in maintaining or increasing physical activity.

The further expansion of health services in Phase 3 under the breast screening programme and cervical screening programme will also have brought particular health benefits for women.

Women are more likely than men to work in the retail and personal retail industry and reopening these sectors in Phase 3 will have had a positive impact both financially and from a mental health perspective on people who work in those sectors and their customers.

A disproportionate number of victims of certain crimes (e.g. stalking, domestic abuse, sexual offending) are women.^[42] The resumption of paused justice services in Phase 3 will be seen as positive but it is recognised that significant negative impacts will arise from ongoing delays due to a backlog in cases.

Sexual orientation

In Phase 3 an extended household could be formed by any two people who are in a relationship but do not live together. This will be beneficial for any couples who were living in separate residences.

More generally, inviting Lesbian, Gay, Bisexual (LGB) people into the home may not have been an option for people who live in a homophobic environment, so the opportunity to meet more households indoors and outdoors in Phase 3 will have been positive. From 25 September households were not able to visit another household indoors socially unless they are in an extended household or a non-co-habiting couple. In addition, only two households with a maximum of six people were able to meet outside socially. This will have had an increased impact on this group.

LGB students who returned home during lockdown may have done so to family environments that are unsafe and which make it harder to meet their needs. This may have negatively affected their wellbeing, and therefore their ability to complete their academic work. The return of universities and colleges and on campus living may have improved this situation for some.

For young LGB people, living away from home for the first time, campus living might be the first opportunity that they have to explore their sexuality openly. Due to the reduced opportunities for meeting fellow LGB students, this important part of their development may be restricted causing further anxiety and isolation.

Socio-economic disadvantage

The opportunity in Phase 2, and the further extension earlier in Phase 3, to meet more households in public outdoor space, and for some to form extended households, will have been beneficial for socio-economically disadvantaged households who were less likely to have a private garden space. The tightened restrictions put in place on 10 September may slightly reduce these social benefits but as people living in more deprived areas are at a greater risk from the virus, reducing the transmission will also have health benefits.

Those living in more deprived areas are more likely to have longstanding illnesses. They will have seen some benefits from the Phase 3 expansion of health services such as GPs, district nurses, podiatry, physio, optometry and emergency dentistry.

Though physical distancing on public transport reduced from two metres to one metre in Phase 3, public transport capacity continued to be constrained while restrictions remain in place. Those with lower car ownership levels are more likely to rely on public transport to access health, education, employment and other services / activities and were therefore likely to be impacted by this restricted capacity and be more concerned about the risk in the transmission of the virus.

Any increased access to high quality childcare in Phase 3 will support young children to develop and learn, to build social skills and networks, and in turn to help reduce the poverty related attainment gap. Reopening Early Learning and Childcare (ELC) services will have also positively impacted families who seek or receive wider support through their child’s attendance at childcare settings. For example, we know that for families affected by poverty and disadvantage, access to food during a childcare session (Free Meals at ELC, breakfast clubs and snacks included with afterschool clubs) is a vital support.

With the opening up of all regulated childcare services, local authorities will have been able to meet their statutory duty to provide funded ELC and will increasingly be working towards the expansion to 1,140 hours. Parents in low-income households with young children will therefore benefit from increased access to funded childcare.

Learners from socio-economically disadvantaged backgrounds were more likely to struggle with home learning during lockdown due to a lack of access to suitable space, resources, the internet, and tutoring. Return to school in Phase 3 will therefore be of benefit in helping children to get back on track as well as providing wider support as needed.

Young people at college from a socio-economically disadvantaged background are more likely to study practical subjects at college, such as construction, care and social care support^[43]. Although colleges and universities have restarted, these practical subjects are more likely to be disrupted by remote learning and continued physical distancing.

Unregulated children’s’ activities and services are predominantly low or no cost. Some services will offer food and drink. Children and young people from deprived areas may have felt their loss more keenly, as both a safe space to socialise with peers and as a source of nourishment. For at risk children the re-opening of these services in Phase 3 will have been important as the activities are a vital part of their wellbeing, development and even safety.

Individuals from lower income backgrounds often rely on public libraries to access support services, learning resources, gain internet access and / or simply books to read for pleasure. Internet access is often essential to work, study and access to essential goods and services, including applying for benefits. Restoring some library services at Phase 3 will therefore be of benefit.

People who are socio-economically disadvantaged, including those who may have lost jobs or have seen their incomes reduced during lockdown, may be less able to afford to use many non-essential shops or hospitality businesses. The opening of these in Phase 3 may only have had limited beneficial impact to socio-economically disadvantaged people as customers. However, the opening of the sectors will have generated work and helped preserve jobs which could have provided some financial stability to households.