Coronavirus (COVID-19): evidence gathered for Scotland's route map - equality and Fairer Scotland impact assessment

7. Key Findings

The Scottish Government's Coronavirus (COVID-19): Framework for Decision-Making and Scotland's Route Map through and out of the Crisis, along with the updates published on 28 May and 18 June, make clear that COVID-19 is first and foremost a public health crisis, and the measures to combat it have been necessary to save lives – indeed they have been vital to protect the right to life.

The Route Map sets out the range and phasing of measures proposed for Scotland as it moves out of lockdown. Recognising the extraordinary impact of the measures, Scottish Ministers have put in place a statutory requirement to review the restrictions at least every three weeks to ensure they remain proportionate and necessary. The phases, although they seek to restore as much normality as possible, are gradual and incremental. Decisions on the correct time to progress through the phases will be taken depending on the transmission of the virus in the population, the balance of harms and an informed understanding of the impact of measures across the diverse population.

Given the fast paced environment required to respond to the health crisis, this publication is the first overview of equality and socio-economic considerations for the measures in the Route Map^[57], but, such considerations have been part of the Scottish Government's work to respond to the crisis since the start.

A series of measures were put in place at the start of lockdown to offer some protection to people who would be most at risk from the virus or from the impacts of the lockdown provisions. This included funding, a national phone line, as well as guidance, support and provisions for specific groups including the shielded population, vulnerable children, disabled people, older people, children of key workers, homeless households, pregnant women, women at risk of domestic abuse and Gypsy Travellers.

As attention has turned to the exit from lockdown, in formulating the Route Map and in its implementation, individual Scottish Government policy teams have been working with stakeholders to understand the effect each measure will have upon people and communities. Therefore, this document is based on existing Impact Assessment related material, stakeholder consultation and research, analysis and supporting evidence brought together by those policy teams for each measure. However, given the importance of the Route Map as a whole, it is important to bring these considerations together. For each sector identified in the Route Map, this document identifies key measures over the phases and summarises the likely impacts of the change and any differential impacts, where they are known. It also identifies any mitigating actions/actions to eliminate discrimination that have been put in place for earlier phases or that are being considered to help reduce negative impacts or reinforce positive impacts in later phases.

COVID-19 is an extreme shock to normal life that has affected everyone; but it is clear that the harms caused by the pandemic are not felt equally by all of society. People with lived experience of poverty or disadvantage due to one or more protected characteristics are more vulnerable to negative impacts from the virus itself or from the resultant social, economic or non-COVID health harms. For these people, the impacts of COVID-19 exacerbates structural and systemic disadvantages - commitments have been made to build back better. Implementation of the Route Map can only be part of the rebuilding process: it will take longer term economic and social renewal, centred on the principles of equality and human rights, to bring about meaningful, long-term structural changes.

The following summarises the mitigating action/actions to eliminate discrimination from the first two phases of the Route Map.

Summary of Phase 1 and Phase 2 impacts

Protections: The protections of hand washing, physical distance and cough hygiene have been in place from the start of lockdown. As the release progresses, there is more emphasis on wearing masks in indoor public spaces and Phase 2 makes this mandatory on public transport. The protection measures in place throughout all phases rely on all people being able to understand and comply with the regulations. The document identifies groups who may find it difficult to understand these provisions including young children, people suffering from dementia, people who may not have English as a first language and do not have other support and people who might struggle to comply because they do not have access to suitable facilities such as homeless households, Gypsy Travellers, and people experiencing poverty. Support has been provided to help people gain access to suitable facilities and a detailed assessment of impacts has led to identified exemptions for people wearing masks. Public marketing campaigns have been used to disseminate protection messages to ensure that adults understand the message and can help children. These are provided in various forms across traditional and social media including easy-read, audio, and translations into different languages to be as accessible as possible

Seeing friends and family: Initial lockdown restricted most movement and prevented households from mixing. Although the measures were supported by the public as a necessary response to COVID-19, they did have negative impacts across the population^{[58] [59]}. Young people, lone parents and single pensioners were particularly impacted by isolation and loneliness during lockdown. Evidence also highlighted that before COVID women were more likely to meet socially; and that women were also more likely to experience anxiety during COVID, partly because they have increased responsibility for childcare and other unpaid work. The phased releases have allowed households to start to mix with other households initially outside and then inside. In Phase 1, households were allowed to meet with one other household outdoors, permitting friends and families to reunite up to a maximum group size of eight. In Phase 2, households are allowed to meet two households outdoors and form an extended household with one other household indoors. Shielded people are also allowed to exercise, and to meet others, outdoors. On the whole, the impact assessment shows that being able to meet friends and family is good for mental health and wellbeing across all groups, although it can also carry some additional anxiety about transmitting or catching the virus and about complying with rules.

Specific impacts identified in Phase 1 related to lack of access to private gardens for socio-economically disadvantaged people and some ethnic groups; access to toilets for women, young children, older people and disabled people; and potential issues around household size limits for some ethnic groups and religious groups who may live in larger or multi-generational households. Although these impacts were understood, the balance of health risk supported the measures at that time. Phase 2 measures aim to reduce these negative impacts where possible. The extended household that can meet indoors will be beneficial for older people and disabled people who may have felt less confident about meeting outdoors, as well as single people and lone parents who can seek additional support. Allowing people who are visiting the outdoors of a private property to use the toilet indoors from Phase 2 is beneficial to a number of groups with protected characteristics such as young children, pregnant women, disabled people, and older people.

Schools, Early Learning and Childcare (ELC) and other educational settings: the closure of all schools, ELC, colleges, community learning, and universities has impacted across the workforce and children and young people. It has also negatively impacted on parents, particularly mothers, who are required to juggle child care, home schooling, and paid work. Phase 1 provided for school staff to return to schools and increased the number of children accessing critical childcare provision. It also signalled that transition support should be made available to P1 and S1 students, where possible, while Phase 2 releases some preparation phases and research facilities.

Over the first phases of the Route Map, only critical provision remained in place for the children of keyworkers and children identified as more vulnerable. Negative impacts were therefore identified for children and young people not attending early learning or school hubs because of the loss of learning and experiences school and ELC typically provides, including the opportunity to associate with their peers. Negative impacts were also identified for some children not accessing critical provision for whom their school or ELC setting was a place of safety and consistency, where home does not present the same stability.

Many schools, colleges, community learning services and universities have moved learning on-line to mitigate impacts for children, young people and adult learners. However, evidence shows that disabled children, those with additional support needs, and those who are socio-economically disadvantaged, remain negatively impacted because they may not have the same range of resources and parental support for home learning; while boys are generally less willing or able to home learn than girls.

Evidence suggests that children and young people will experience poorer mental health and wellbeing and are likely to experience anxiety as they prepare to return to school. Other wellbeing impacts may also have occurred, including increased exposure to domestic abuse, and potentially increased child protection concerns. To reduce negative impacts from these closures, vulnerable children, as well as the children of key workers, have continued to have the opportunity to attend school in person throughout the summer term; free school meals have been continued through the school summer holidays until August. In addition, ELC settings can re-open from 15 July, so some settings might be available prior to 11 August.

Devices and data are being made available to socio-economically disadvantaged and care experienced children to ensure they can participate in blended learning from home in the short term. Transition support will aim to reduce anxiety for children moving to a new phase of school education. The return to schools will enable support to be provided for the wellbeing of children and young people. The opening of research labs will benefit young people and researchers, many of whom are international students.

Women are particularly impacted because they comprise the majority of the education workforce. As they return to the workplace, the risk of transmission or catching the virus increases. For women who are also parents, any return to the school or ELC workplace in Phase 2 will require them to juggle work with care and home schooling. In addition, evidence shows that as women in society tend to be the primary carers, mothers have experienced a much harder time balancing work and caring, which could have long term impacts on gender equality in the workforce. The extended household may help lone parents if they previously used this type of relationship to obtain additional support.

It has been announced that schools should be preparing for children to be able to return to school full time in August (conditional upon ongoing scientific and health advice). This date may fall in Phase 3 or Phase 4, depending on broader progress. The blended model of schooling remains a contingency plan. The table in the Annex provides further detail on these later phases.

Getting Around: During Phase 1, public transport maintained essential infrastructure for key workers but public or private travel was generally not available for other purposes. As restrictions on going outside for exercise were eased, private travel was permitted for a restricted range of purposes within the local area (roughly five miles from home). At all times, active travel was encouraged. In Phase 2, as some businesses start to open, public transport increases but with restricted capacity due to physical distancing and with mandatory wearing of masks. Public transport is usually used more by socio-economically disadvantaged people, young people, women^[60], disabled people, and minority ethnic people. All of these groups will be impacted by these changes. Transport Scotland has developed a Transport Transition Plan^[61] to keep the public in Scotland safe when travelling during the COVID-19 pandemic. Contained within the Transport Transition Plan is guidance for operators and guidance to assist the public to travel safely during the COVID-19 pandemic^[62]. The Mobility and Access Committee for Scotland (MACS) were fully engaged when compiling the guidance. Additionally, they produced their own guidance to operators^[63] when assisting disabled passengers.

Working or running a business: The economic impacts of the virus and its protection measures are widespread, with evidence that people in equality groups and socio-economically disadvantaged are particularly vulnerable. Younger people, women, and black and minority ethnic workers are all more likely to be, on one hand, key workers asked to continue to work throughout the pandemic, and, on the other, over-represented in occupational sectors that are shut-down resulting in significant loss of income and jobs.

Phase 1 allowed some outdoor workplaces to open, such as construction preparation, but for most remote working remained the default position. Parents had to juggle work, home schooling and child-care, with evidence suggesting this burden falls disproportionately on women. Evidence also suggests that remote working was mainly available to higher income workers. Others remained reliant on the UK Government and Scottish Government employment support packages.

Phase 2 allows some indoor workplaces to open including factories, warehouses, labs and research facilities, with appropriate hygiene and physical distancing measures. It also allows construction to move to the next phase of its plan. Many of the industries opening up in Phase 2 employ a higher proportion of men, e.g. in construction and manufacturing, which will increase workplace risk while potentially safeguarding their income. Phase 2 also allowed for preparation work to start for businesses in later phases, such as retail, to ensure physical distance and hygiene measures were in place. Employers are asked to use staggered starts and flexible working but past evidence suggests that lower income workers, including young people, minority ethnic, women and disabled people may be least likely to be able to access flexible working.

Specific guidance has been developed by occupational sectors, such as construction and manufacturing, and will be subject to regular review. The guidance development has involved a wide range of employer, employee, trade union, and other bodies.

Shopping, Eating and Drinking Out: While essential shops, such as food, newsagents, cycle shops, remained open, all non-essential shops closed, as well as pubs, cafes and restaurants. Phase 1 allowed the re-opening of drive through outlets and take-away cafes, along with outdoor garden centre and plant nurseries. Phase 2 allows opening of street-access retail shops but pubs, cafes and restaurants remain closed.

Opening of business will have positive financial impacts for businesses and for people returning to work in those businesses. Young people, women, disabled people and minority ethnic people are all over-represented in the retail workforce. Although the virus has been controlled by Phase 2, the easing of restrictions provides potential for infection and transmission in the community to increase, which could be detrimental to those more susceptible to severe illness. Workers responsible for hygiene and sanitation and customer facing staff may have anxieties about returning to work, due to risk of infection and transmission within their households. Self-employed business owners or employees with caring responsibilities may find it challenging to open without suitable provisions for childcare. This is especially true for women (who are often primary carers) or lone parents (majority of whom are women) that may not have anyone else to help out with caring responsibilities.

Opening of shops may be welcomed as a return to normality, especially smaller local shops. However, it may also increase anxiety over the virus, especially for those who are more susceptible to serious illness such as older people or the shielded group. The physical distance measures may be particularly problematic for disabled people if it restricts their access within shops.

Version 1 of the COVID-19 Retail Guidance^[64] was published on 26 May 2020. The guidance will be reviewed in line with the regular three weekly review of lockdown requirements. Staggered start times and flexible working are encouraged in the Route Map to address concerns over physical distancing on public transport and in public spaces, as more people begin to return to work and visit retail premises. The next version of the guidance will include guidance for retailers and customers on catering for disabled people. Raising awareness of the difficulties experienced by disabled people is particularly important at this time. The guidance was presented to the BME Employment Steering Group, an external stakeholder, who are currently consulting on it. As soon as their comments have been received, they will be considered for amendments at the next review.

Sport, Culture and Leisure: In the initial phases of lockdown it was recommended that outdoor exercise was limited to once per day, within the local area. Participation in exercise was very mixed pre-COVID with men and boys more likely to exercise than women and girls. Phase 1 updated guidance to remove the recommendation that exercise should only take place once a day and replaced it with guidance that unrestricted outdoor exercise could be pursued safely, which should be beneficial for all although it will be of particular benefit to those who were more used to exercising. Certain activities, which were by nature physically distant, were also allowed to restart (golf, canoeing, outdoor swimming and angling). Restarting these sports will be of great benefit to those who participate in them, however, evidence suggests this is mainly older men and more likely to be people with a higher income.

Phase 2 allowed for the opening of outdoor sports courts, playgrounds, zoos and garden attractions and the resumption of a limited number of professional sports behind closed doors. Playgrounds are likely to be used more by, and will therefore benefit, younger people and families with children. Zoos are also very popular with families with children but due to the cost are unlikely to be frequented by socio-economically disadvantaged. Garden attractions may be more popular and used more by older people.

The ordering of the opening of sports and the nature of physical distance measures will determine equality impacts for this phase and moving forward. sportscotland is supporting Scottish governing bodies of sport and local partners to plan for the return of sport. It issued them with a template with a number of prompts for them to plan against for each phase of the route map. These prompts include the need to be inclusive and participant centred and to design safe and innovative opportunities for their sport within physical distancing guidelines. Scottish Disability Sport (SDS) has developed a document of Principles for Participants with Disabilities Returning to Physical Activity and Sport in Scotland, which they are discussing at planning sessions with all sports.

Communities and Public Services: Phase 1 and 2 see the gradual resumption of key support services at the community level with appropriate physical distancing and hygiene measures. This included the planned restarting of face to face Children's Hearings; increased direct contact for social work and support services with at risk groups and families; access to respite/day care to support unpaid carers and for families with a disabled family member; opening of Household Waste Recycling Centres and re-opening of court and tribunal buildings and, in Phase 2, increased visiting support to Housing First tenants and the resumption of area-based energy efficiency schemes. The impact of services re-opening on protected characteristics and socio-economic disadvantage depends on the nature of the service.

During the initial phase of lockdown, courts and tribunals restricted business to that which was essential or necessary. Emergency legislation has been put in place to enable a wider use of technology to support the justice system's response to the coronavirus outbreak and to introduce flexibility to address the impacts of physical distancing and the need for self-isolation where possible. Increasing the capacity for digital access will help to mitigate inequalities relating to the ability to physically attend court and mitigates against growing delays that would heighten inequalities. However, this does require a level of digital access which is lower amongst older people, socio-economically disadvantaged and disabled people. Support for victims of crime, including support specifically for those impacted by gender-based violence, which are predominantly women, has been augmented and third sector support providers have adjusted their operating models to ensure continued access and availability.

Actions on respite care and day services focus on helping support providers navigate physical distancing and hygiene guidance to allow traditional and non-traditional modes of support. Once in place, these will be of benefit to disabled people and unpaid carers who are mainly women and include a significant proportion of older people and disabled people.

The re-opening of Household Waste Recycling Centres (HWRC) is an important step. However, due to the recognition that some groups are less likely to be able to access these services, especially older, disabled, shielded, and socio-economically disadvantaged, the Scottish Government has worked in partnership with COSLA to ensure that the re-opening of sites should not negatively impact on wider efforts to recover other waste services on which households are reliant.

Gatherings and occasions: In Phase 1 no public gatherings were permitted except for meetings of two households, outdoors and with physical distancing. This meant that family occasions such as weddings and civil partnerships were effectively halted and funeral attendance was restricted to close family members or close friends with strict physical distancing and hygiene requirements, which has been difficult for bereaved families. Places of worship were closed.

Joint birth registration is one of the main ways for unmarried fathers and second female parents to obtain parental responsibilities and rights. Lack of the ability to access this service will have negative impacts on these people. Couples with faith, such as those who do not wish to cohabit until married, are largely unable to enter a marriage or civil partnership as a result of restrictions on gatherings. Given that older people are, on average, at a higher risk of contracting COVID-19 and more likely to be shielding, they are likely to have had to miss attending funeral services in person to avoid placing their health at risk. As they are less likely to be digitally aware, they may also not be able to watch funerals through live links.

In Phase 1, faith communities were unable to attend places of worship for ceremonies, services or prayer, except for very limited purposes, including funerals, to broadcast an act of worship, or to carry out essential voluntary services. In Phase 2 places of worship can open for the purposes of individual prayer or contemplation alone, or with a member of their household. This will be positive for people who are able to return to their place of worship to pray - although not all faith communities have a need for individual prayer or contemplation. Faith and belief communities are unable to access wider, communal ceremonies or services at their place of worship as restrictions will remain in place until later phases. The Scottish Government has engaged closely with faith and belief stakeholders to support them during a time when places of worship have been unable to open, except for very limited purposes. This has included providing funding for the purchase of equipment and software to facilitate online worship services.

The opening of registration offices in Phase 2 will reduce backlogs; provide reassurance to new parents; provide parental responsibilities and rights to unmarried fathers and second female parents who are not in a registered relationship; and allow more marriages and civil partnerships to take place. However, restrictions remain on funeral arrangements - those aged 70 and over or people shielding are strongly advised not to attend gatherings.

Guidance on funeral services was issued setting out who can attend a funeral, so attendance can be planned according to individual circumstances and raise awareness of the need for physical distancing and other public health measures. We have also encouraged members of the funeral industry to make provision or arrangements for livestreaming or broadcasting funerals to allow a greater number of people to attend virtually. This will be helpful for all people who have access to suitable digital equipment and internet access but will be less helpful for some older people, disabled people, people with learning disabilities, and socio-economically disadvantaged people, who are less likely to have the resources or skills required to use the internet.

Health and Social Care: COVID is a health emergency which required the mobilisation and restructuring of health resources with many NHS services being temporarily stopped.

Phase 1 saw the phased resumption of certain NHS services, including primary care and community services, elective surgery, mental health, NHS IVF treatment, resumption of GP services supported by an increase in digital consultations, the roll-out of the NHS Pharmacy First Scotland service in community pharmacies, increased care offered at emergency dental hubs, and emergency eyecare as practices prepare to open.

Phase 2 sees the formal implementation of remobilisation plans by Health Boards and Integrated Joint Boards to increase provision for pent up demand, urgent referrals and triage of routine services. In this phase some chronic disease management is reintroduced and phased screening services along with continued phased resumption of dentistry, optometry, GP services and referral to secondary care.

Women account for a disproportionate number of the health and social care workforce. There is likely to be ongoing workplace risk, which may be particularly stressful for black and minority ethnic workers and older workers. The stress and anxiety of working long hours are negative impacts which weigh against a stable income in a time when many people are without work. As keyworkers, NHS and care staff can use critical places at schools and nurseries. However, for carers there may still be significant issues in balancing work with family and caring responsibilities.

The resumption/increase in availability of services is based on local as well as national clinical priorities, so there is scope for Health Boards to be flexible to suit local requirements in protected groups. Impacts of opening of services for patients will be varied depending on the nature of the service. While there may be a risk of certain groups feeling that they are not getting the same access to services as before, clinical guidance, associated with urgent and elective care, and sound local decision making should help to ensure that decisions are driven by clinical risk assessments. The current plans are intended to cover the period to the end of July. NHS Boards are expected to have appropriate procedures and policies in place when planning or developing services.

Digital innovation is a key part of remobilisation, which could create a risk that disabled people, older people, and socio-economically disadvantaged people may be further disadvantaged if they do not have access to the required technology or the relevant skills, experience or support to use it.

As remobilisation plans are implemented significant engagement is planned to ensure that negative impacts are fully understood and can be tackled and that positive impacts can be rolled out further. For example, for resumption of screening programmes, a Communications Action Plan is being developed, led by Public Health Scotland.

Phase 2 also includes consideration of a phased resumption of visiting to care homes, starting with outdoor visiting where it is clinically safe to do so.