Extended use of facemasks and face coverings guidance in hospitals, primary care and wider community healthcare settings (referred to as 'Healthcare settings'): Equality Impact Assessment

Socio-Economic Disadvantage

1. Background

During the pandemic, those on lower incomes or in insecure work (and without access to either contractual or statutory sick pay) may have had no option but to work as a result of being unable to afford the reduction in pay associated with being ill. This may have resulted in colleagues being exposed to illnesses and viruses including COVID.

There are also intersectional considerations, such as the increased risk Black, South Asian^[72] or disabled people face regarding being on lower-than-average incomes. This in turn leads to an increase in the chance of ill health and poorer health outcomes^[73].

Addiction and mental health issues^[74] are associated with socio-economic disadvantage. People who use drugs and people with mental ill health are more likely to have poorer health outcomes and are more likely to access healthcare.

2. Evidence / Date – Related to Healthcare Settings

Figure 9. A graph which demonstrates the proportion of people in relative poverty after housing costs in Scotland from 2018-2023. White people in Scotland are far less likely to live in poverty which is a key factor in health outcomes. Approximately 20% of White people live in relative poverty whilst around 50% of Asian or Asian British and Mixed, Black, Black British and Other do. The graph also shows the gap widening by around 10% in the last 10 years.

Healthcare staff

With over 1.3 million staff working for the NHS in the UK, and in-work poverty affecting one in eight workers before the current cost of living crisis emerged, healthcare staff are undoubtedly being affected^[76].

Patients and Visitors to Healthcare settings:

There is a lack of data regarding the socio-economic status of patients and visitors to healthcare settings in Scotland however, we have used general population data to support this equality impact assessment. It is assumed most people will access healthcare settings at some point in the year. 24% of children were living in relative poverty after housing costs in 2019-22. 21% of working-age adults were living in relative poverty after housing costs in 2019-22. 15% of pensioners were living in relative poverty after housing costs in 2019-22.^[77]

3. Impact Summary – Related to Healthcare Settings

Does the withdrawal of the extended use of facemask guidance in healthcare settings have a positive or negative impact on people as result of socio-economic disadvantage?

There may be a perception of increased risk of COVID-19 transmission due to the withdrawal of the extended guidance in healthcare settings. This potentially allows for an increased risk of transmission due to staff who work in a healthcare setting that are unable to follow the stay-at-home guidance despite having symptoms of a respiratory illness.

Although it is still possible to wear masks in healthcare settings, they may not be provided due to the change in guidance. Risk assessments can be carried out for staff and be provided based on clinical needs; however, service users and patients may have less accessibility due to masks not being routinely provided for all. People from lower income backgrounds may not be able to afford masks and may go without even if it suits their needs.

Lower income is associated with lower health outcomes however this demographic is not considered a protected group and therefore don’t have access to a booster which can place those with a lower income at higher risk.

It is important to emphasise that the use of face masks will still be in place in healthcare settings if they are required clinically or as a result of outbreak/ incident management.