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

Stage 4: Decision making and monitoring

Identifying and establishing any required mitigating action

Have positive or negative impacts been identified for any of the equality groups?

Having reviewed the evidence presented, no unlawful discrimination has been identified. However, there may be perceived concerns about the removal of facemasks in healthcare settings for three of the protected groups: age, race and people with disabilities.

The evidence demonstrates that older people and those with disabilities may be more vulnerable to illness as a result of COVID-19. A comprehensive list of mitigations in available on p4 and p5 of this document, however in summary following mitigations are in place to reduce the risk: vaccination coverage; availability of COVID-19 treatments, reinforcing of infection prevention and control measures, robust testing approaches still taking place based on clinical need and risk assessment; and staff following ‘stay at home’ guidance if symptomatic.

In their review, Antimicrobial Resistance & Healthcare Associated Infection (ARHAI) emphasised that it would be important to consider reinforcing ‘stay at home’ messaging for staff who work in these settings and to continue to encourage vaccination uptake. Therefore, in staff communications regarding the changes to guidance, we will continue to reinforce the above messaging and continue to promote vaccination programmes among the relevant populations as well as stay at home guidance.

Patients and visitors regardless of whether or not they belong to a protected group are able to wear a facemask if that is their personal preference and the Scottish Government reinforces this in their communications on ‘Respiratory infections including Coronavirus (COVID-19): staying well and protecting others advice’

Is the policy directly or indirectly discriminatory under the Equality Act 2010^[85]?

No

If the policy is indirectly discriminatory, how is it justified under the relevant legislation?

Not applicable

If not justified, what mitigating action will be undertaken?

Not applicable

Describing how Equality Impact analysis has shaped the policy making process

This EQIA has been undertaken retrospectively with the aim to assess the equality impact of withdrawing the extended guidance in May 2023. The outcome of this EQIA would have allowed action to be taken if necessary and amendments be made to what is currently in place if needed. We believe the evidence shows that, on the balance of risks, the right decision was made. Although future changes to guidance will sit with ARHAI this work will be shared with them to help inform any future changes and the manual that is reviewed regularly.

The EQIA has reinforced the need to continue to promote ‘stay at home’ messaging for staff who work in health care and to continue to encourage vaccination uptake. The Scottish Government expects NHS Boards to serve the needs of their local communities and ensure that both visitors and patients are aware that they are able to wear masks if they wish.

Monitoring and Review

The Scottish Government recognises that surveillance of respiratory infections is a critical part of our approach to monitoring and managing the spread and prevalence of COVID-19 and other respiratory viruses in Scotland. As such we support both Public Health Scotland and National Services Scotland Antimicrobial Resistance Healthcare Associated Infection (ARHAI) to undertake surveillance activity.

This surveillance helps us to determine the right public health strategies and timing, to manage transmission in the community. Public Health Scotland (PHS) is responsible for delivering Scotland’s National Respiratory Surveillance Plan (publichealthscotland.scot) with the support of the Scottish Government.

In Scotland, respiratory infection levels and their impact are monitored using various sources of data, including microbiological sampling and laboratory test results from community and hospital settings, NHS 24 calls, primary care consultations, and hospital admissions. The intelligence generated from these different data sources provide a comprehensive picture of current respiratory illness in Scotland.

It may be helpful to note that epidemiological information on seasonal respiratory infection activity in Scotland including COVID-19 is published online by PHS in their National Respiratory Infection and COVID-19 Statistical Report (Viral respiratory diseases (including influenza and COVID-19) in Scotland surveillance report 2 May 2024 - Viral respiratory diseases (including influenza and COVID-19) in Scotland surveillance report - Publications - Public Health Scotland) with the data updated through the PHS interactive dashboard which can be found at https://scotland.shinyapps.io/phs-respiratory-covid-19/.

ARHAI is responsible for the development and publishing of the National Infection Prevention and Control Manual (NIPCM). The NIPCM is updated real time with any changes required to be made to guidance as a result of the quarterly evidence reviews and our 3 yearly full literature reviews. ARHAI Scotland also has the ability to monitor respiratory activity via the outbreak reporting tool which trigger considerations and discussions regarding any additional precautions.

The Scottish Government works closely with both PHS and ARHAI. If data gathered through routine surveillance indicates the need to consider enhanced public health mitigations (in this case the reintroduction of routine facemask/ face covering use in health and social care settings) then PHS and/ or ARHAI will offer this recommendation as part of their advice to Scottish Government to help shape any policy change.