Coronavirus (COVID-19) dementia action plan: equality impact assessment

Framing

Results of framing exercise

Age

9. The framing exercise brought up the need to refer to Scottish evidence regarding age or demographics, rather than evidence for the UK, as much as possible. It also addresses the need to consider evidence about self-directed support. We already know that everyone does not receive the opportunity to choose which option they might want under self-directed support. It is estimated that nearly four out of five (79.4%) people were involved in choosing and controlling their support through self-directed support options (based on circumstances where people have a choice). There are specific challenges for people under-65 with dementia around self-directed support more widely, and evidence around these challenges needs to be considered.

Disability

10. The framing exercise found that there needs to be a focus on Scottish figures regarding learning disabilities and sensory loss, deafness or blindness, and an acknowledgement where this data is not available. Colleagues recognised the need to be conscious of the language being used around people with learning disabilities and those with sensory loss, or who are Deaf, deafened, deaf-blind or blind. In order to ensure correct evidence was gathered, evidence would be sent to colleagues within the learning disabilities and assisted communication teams.

Sex/ Gender

11. There was again a focus on the need to find Scottish figures regarding the gender differences between men and women with regards to dementia diagnosis and the disproportionate impact of the pandemic on people who care for those with dementia, most of whom are women.

12. A focus on the economic impacts of women during COVID-19 was also called for, including the disproportionate impact of furlough on women. It was noted that the only aspect that might impact on pregnancy/ maternity would be NHS guidelines about working from home after 18 weeks pregnant and continuity of care, which were not judged to be significant with regards to this plan.

Sexual Orientation

13. It was discussed that older lesbian gay and bisexual (LGB) people sometimes avoid using any form of social care because of the legacy impact of discriminatory attitudes and suggested to speak more of services and service providers rather than just health workers, as the perception goes beyond health workers alone.

Gender reassignment/ Transgender

14. The need to separate out sexual orientation from transgender identity was addressed, although it was noted that discriminatory attitudes can similarly effect trans and LGB people, for example because transgender people may avoid using any form of social care because of discriminatory attitudes and therefore considering social care services as a space where discrimination may take place.

15. It was noted that evidence around transgender discrimination from a 2010 survey was out of date, as well as suggested that speaking more of services and service providers rather than just health workers.

Race or ethnicity

16. The need to be consistent in using terms such as 'BAME' and 'BME' was addressed. It was noted that evidence on Public Health Scotland's findings regarding excess mortalities from COVID-19 for BAME people should be used, although Public Health England's findings should also be referenced given the limitations impacting upon Public Health Scotland's initial findings.

17. The need to ensure sensitive and appropriate language was used was stressed, as was the extent of the evidence available; including by checking with organisations such as the Govanhill Housing Association regarding whether evidence considers Roma as part of Gypsy/ Traveller communities.

Religion and belief

18. It was noted that much of the evidence regarding religion and belief overlaps with evidence on race and ethnicity, given the cultural influences which cross these distinctive categories particularly regarding attitudes to dementia and barriers to accessing health and social care.

Other

19. The need to consider other equality categories was discussed, including socioeconomic inequality, digital exclusion and the impact of rural/ remote location during the pandemic. The need to find evidence about lockdowns and the impact of COVID-19 on people from lower socioeconomic backgrounds was stressed, for instance by comparing lockdown restrictions and rates with the Scottish indexes of multiple deprivation.

20. The impact of complete withdrawal of public transport in remote and rural areas during some phases of COVID-19 was mentioned as was the substantial cost of deliveries for those in remote and rural areas of the Highlands and in the Shetland and Orkney islands.

21. It was noted that digital exclusion issues extend beyond remote and rural areas, as there can be connectivity issues due to limitations in providers, for example. The assumption that care home staff would have access to correct computer equipment for training was also flagged as an issue. The work of the Connecting Scotland work of the Digital Health and Care Initiative in addressing digital exclusion was discussed.