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

Age

1. Background

It is well recognised that older people^[7] and people who have underlying health conditions^[8] may be particularly vulnerable to COVID-19 and more likely to have complex co-morbidities which place them at greater risk of complications if they contract COVID-19.

Older people are now more likely to be worried about their health and the risks of contracting COVID-19. When this policy change was actioned in May 2023 YouGov polling^[9] showed consistent levels of concern about coronavirus between age groups. 19% of those aged 18–24 agreed or strongly agreed with the statement ‘I feel worried about the coronavirus situation’ compared with 17% of those aged 75+.

2. Evidence / Date – Related to Healthcare Settings

Staff in Health Care

As of 31 March 2023, there were 156,178.7 Whole Time Equivalent (WTE) staff employed by NHS Scotland^[10].

The median age of the people employed in NHS Scotland on 31 March 2023 was 44.

The age distribution of people employed in NHS Scotland varies between job families.

Patients in Health Care

As of 22 August 2022, Scotland’s population was at 5.44 million.

Below is the population of Scotland split by age^[11]:

Scotland’s most recent census figures show Scotland as an ageing country with more people being over 65 than under 15.^[12]

The Scottish Health Survey (2022)^[13] main report highlights that the proportion of adults describing their general health as ‘good’ or ‘very good’ generally decreased as age increased and in tandem, the proportion of adults who reported their general health to be ‘bad’ or ‘very bad’ generally increased with age.

The likelihood of being admitted to hospital is highly correlated with age, the older you are the more likely you are to be admitted to hospital. Older people are also more likely to attend an outpatient clinic.^[14]

Figure 1. A graph showing how the structure of Scotland’s population has changed over time in relation to age. In 1921 the average age was under 20 now the most common range is 55 to 59.

Age and Vaccine uptake:

Vaccine uptake amongst older people has been consistently high. The 2023 Spring booster programme saw over 82% of those aged 75 and over and 90.6% of older adult care home residents receive a fourth dose of the COVID-19 vaccine up to July 2023. ^[16]

As of April 2022, over 12 million doses have been administered in Scotland, including 4.39 million first doses, 4.1 million second doses and 3.47 million third doses. This corresponds to 90.3%, 85.8% and 72.6% of those aged 12+ respectively.^[17]

Figure 2. A graph showing the number of monthly COVID-19 related deaths by age in Scotland, between January 2022 and March 2024. The numbers for all age groups (<1, 1-14, 15-44, 45-64, 65-74, 75-84 and 85+) were at their highest between January and April 2022, with a sharp decline into May. This pattern of COVID-related deaths declining was observed again in May 2023.

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 because of their age?

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.

The NHS as an employer is responsible for each member of staff’s health and safety. This includes having to complete risk assessments and refer to Occupational Health where necessary. Upon assessment any reasonable adjustments must be made which includes the routine use of face masks. The General Medical Council Code^[19] and The Nursing and Midwifery Council^[20] 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.

It is clear from the YouGov data that People of all ages may be concerned about increased health risks from the withdrawal of the enhanced use of facemasks in health care settings. Therefore, this does not necessitate that the withdrawal of this guidance increases concern levels dependent on age.

The evidence presented above suggests that patients across NHS Scotland hospitals tend to be older. Older people (patients, visitors and staff) may be particularly vulnerable to COVID-19. However, the withdrawal of the extended guidance does not appear to lead to a greater level of risk for an older person in a healthcare setting as demonstrated in Figure 2. It is also important to consider intersectionality with age as other factors such as co-morbidities and social impacts may contribute to a higher risk of mortality.

The Scottish Government mandated that face mask policy/guidance applied to everyone over the age of 12^[21]. Children under 12 were exempt due to scientific evidence showing that children and young people, especially those under 12, are less likely to develop serious illness and to spread COVID-19 to other children and adults. This guidance was general population level however was mentioned in previous extended facemask guidance in Health and Social Care settings.

Some children and young people (aged between 12 and 17 years) were exempt from wearing a face covering. In line with the regulations, parents, carers and other relevant adults were able to use individual discretion to determine whether the child or young person could tolerate wearing a face covering appropriately.

The positive impact of the withdrawal of this guidance is the easing of communication and relationship building barriers encountered by facemask use. Facemasks (including transparent facemasks) can inhibit communication for the hard of hearing and cognitively impaired and the removal of these allow for reading of lips as well as potentially less muffled speech.