Background

Extended use of face masks and face coverings policy timeline:

June 2020 - The extended use of facemasks and face covering guidance in healthcare settings was introduced by the Scottish Government. This initially strongly recommended wider facemask use in adult hospitals and care homes for the elderly.

September 2020 - The guidance was further extended to cover primary care and wider community care, in addition to acute hospitals and community hospitals.

June 2021 - The guidance for healthcare and social care settings was split. The extended guidance strongly recommended all staff, visitors and patients in hospitals, primary care and wider community healthcare settings to wear a fluid resistance surgical mask where possible.

July 2022^[1] - The need for the extended guidance was reviewed by the Scottish Government and it was recommended that the guidance should remain in place throughout the winter period (2022/23). This recommendation was made in recognition that healthcare environments continued to care for more clinically vulnerable individuals, as well as system pressures; the level of community prevalence of COVID-19; the waning protection from the COVID-19 vaccine; the latest international practices; and in preparation for winter 2022/23 (with the possibility of increased transmission of COVID-19 and other winter respiratory viruses in circulation).

May 2023 - The guidance on the extended use of face masks and face coverings in health care settings was withdrawn. The guidance was withdrawn based on recommendations made by key stakeholders and following consideration by Scottish Government professional advisors and clinicians. It was considered the right time to withdraw the extended face mask and face covering measures across health and social care settings. As Scotland continued to adapt to the COVID-19 pandemic there was a high uptake of COVID-19 vaccinations, especially amongst residents of care homes. This reduced severity of illness and hospitalisations, alongside the availability of treatments for COVID-19.

Withdrawal of the guidance and mitigations

In the absence of the extended use of face mask/face covering guidance; health and social care services were advised to follow the infection prevention and control (IPC) guidance on the appropriate use of personal protective equipment (PPE) for standard infection control precautions and transmission-based precautions as detailed in the National Infection Prevention and Control Manual (NIPCM).

In what was a turning point in relation to the pandemic response, in May 2023 the World Health Organisation announced the end of COVID-19 as a global health emergency (however, warned nations to not let down its guard, to dismantle the systems it has built, or to send the message to its people that COVID-19 is nothing to worry about^[2]) and Scottish Ministers agreed to transition Scotland’s management of COVID-19 from an emergency pandemic response to an enhanced business as usual approach, proportionate to the current phase of the pandemic^[3].

In the absence of the extended guidance on the use of facemasks and face coverings, the following mitigations are currently in place to manage COVID-19 in healthcare settings and are actively reviewed by the organisations who are responsible for the mitigation:

• Both Antimicrobial Resistance and Healthcare Associated Infections (ARHAI) Scotland and Public Health Scotland (PHS) responsibilities include the monitoring and escalation of emerging pathogens/incidents. Whilst assessing any emerging situation the IPC response would be considered through an Incident Management Team structure with decisions around controls and interventions made on a specific response basis, according to circumstances arising at the time.
• The National Infection Prevention and Control Manual offers guidance to health and social care staff on the appropriate use of personal protective equipment (PPE) for standard infection control precautions and transmission-based precautions, this includes cohorting of patients with the same infectious illness as well as PPE (facemask, aprons etc) for patients and/ or visitors. COVID-19 testing is also still in place based on clinical need and risk assessment.
• A further mitigation is the ‘stay at home’ guidance for all healthcare staff who are displaying symptoms of a respiratory illness. In their review, AHRAI emphasised that it would be important to consider reinforcing this messaging for staff who work in these settings.
• The General Medical Council Code^[4] and The Nursing and Midwifery Council^[5] Code is to ensure safe and effective care based on evidence. This could include risk assessment for use of masks where potential issue is identified.
• Should pandemic action be required again, the Scottish Government would lead the response, according to Management of Public Health Incidents (MPHI) this would be for exceptional circumstances.
• Other mitigations include the role out of the COVID-19 vaccination programmes which has always been guided by the expert advice provided by the Joint Committee on Vaccination and Immunisation (JCVI)^[6].
• Patients and visitors 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’. This advice advocates being respectful of those who are unable to wear a face covering and other people’s choices, whether they choose to wear a face covering or not.
• Staff who are concerned about the withdrawal of the extended facemask guidance are encouraged to speak to their line manager and/ or Occupational Health as necessary.

Equality Impact Assessment (EQIA)

The EQIA considers impacts on equalities groups based on the three tests:

• Does this policy change eliminate discrimination for each of the 9 protected characteristics (PC). If not is the discrimination justifiable? Can it be mitigated?
• Does this policy change advance equality of opportunity for PC groups?
• Does this policy change foster good community relations between people of PC groups?

Who will it affect?

The withdrawal of the guidance affected staff, patients and visitors as healthcare settings will be unlikely to have masks widely available. Withdrawing the policy also resulted in a move away from the Scottish Government strongly recommending the use of facemasks and return to a person-centred, risk-based approach i.e. using masks when clinically required as was in place pre-pandemic.

Stage 1: Framing

Results of framing exercise

• Change in policy could impact those who work in a healthcare setting, those who seek healthcare as well as those who visit healthcare settings.
• Will impact on areas where there are inequalities.
• Could inadvertently cause harm.

While the withdrawal of the extended guidance in healthcare settings reflects the stage of the pandemic that we were in, some people in these settings who were previously identified as being more vulnerable to COVID-19 (due to the disproportionate effect of COVID on race, age, ethnicity, gender, medical / health conditions) may worry about the withdrawal of this guidance. However, the proposals are argued to be justified on the basis that it aligns precautions in place for COVID-19 to that of other comparable viruses. It is important to note that the withdrawal of this guidance does not stop visitors or patients from wearing a face covering if they so wish. Staff who are concerned about the withdrawal of this guidance are encouraged to speak to their line manager and/ or Occupational Health as necessary.

Extent/Level of EQIA required

An EQIA is being carried out to assess to what extent the withdrawal of the extended use of facemask guidance was fair and whether the withdrawal of the guidance presents disadvantage to any protected groups of people.

Stage 2: Data and evidence gathering, involvement and consultation

The information below gives the results of the evidence gathering and an assessment of this evidence for each of the protected characteristics.