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

Disability

1. Background

Persons with disabilities are diverse and heterogeneous. Some groups of people with physical, mental and intellectual health conditions are at the highest risk of severe illness if they catch COVID-19.^[22]

People with disabilities can have a range of long-term physical health conditions, such as those affecting the heart and respiratory system, with some people being immunocompromised. These are linked to increased vulnerability to COVID-19^[23]. Of the 14,106 people whose deaths were recorded as involving COVID-19 between March 2020 and March 2022, 93% had at least one pre-existing condition^[24].

Mental disabilities can affect care received as well as everyday life in relation to COVID-19. Anxiety can deter people from receiving care if they are concerned about safety and mask use. It is important to highlight patients are still able to wear a mask in a healthcare setting however they may not be routinely supplied one.

People with learning/intellectual disabilities are also at higher risk of severe COVID-19. The Scottish Learning Disabilities Observatory produced research looking at COVID-19 infection and severe outcomes for people with learning (intellectual) disabilities in Scotland^[25]. They found that throughout the COVID-19 pandemic, data indicated that people with learning disabilities were more likely to contract COVID-19, have a more severe case of COVID-19, and were at least three times more likely than people without learning disabilities to die from COVID-19.

According to the 2021 Scottish Health Survey^[26], a third (34%) of adults in Scotland reported living with a long-term condition that limited their day-to-day activities. For people aged 75 and over, 60% had a limiting long-term condition. 1 in 5 Scots identify as disabled, and more than a quarter of working aged people have an acquired impairment.

2. Evidence / Date – Related to Healthcare Settings

Staff in Health Care

According to NHS staff respondents to iMatter 2022, when it asked, “Do you consider yourself to be disabled within the definition of the Equality Act 2010?” 88% responded with ‘no’, 6% with ‘yes’ and 6% provided no comment.^[27]

People engaging with healthcare services

Figure 3. A graph showing respondents to a health survey sent out to those registered to a GP. It shows over half of those surveyed as having pre-existing long-term conditions. The severity of each impairment is not defined, however, with 37% of people reporting it had an impact on their day-to-day life, it could be assumed that a third of those surveyed at are at a higher risk of a more severe outcome.

The Viral Respiratory Diseases (including Influenza and COVID-19) Surveillance in Scotland demonstrates that daily hospital admissions due to COVID-19 were highest at various points between July 2020 through to July 2022 and have declined in 2023. Although numbers still fluctuate, the highest peak in 2023 is approximately half the number of admissions from the previous years.^[29]

This indicates there is less strain on hospitals as a result of COVID-19 and less chance of possible transmission to others.

In line with expert advice provided by the JCVI^[30], the COVID-19 vaccination programme has been offering primary course and booster vaccinations to protect those at higher risk of developing severe COVID-19 symptoms.

Additionally, COVID-19 treatments are available for specific groups of people with coronavirus who are thought to be at greater clinical risk.

Visitors to healthcare settings:

There is a lack of data around demographic breakdown of visitors to healthcare settings. We have used general population data for the purpose of supporting this equality impact assessment.

2011 general population data shows Scotland having a population of 5,295,000.

• 82.2% (4,352,490) of people described their health as good or very good.
• 19.6% (1,037,820) of people said their day-to-day activities were limited by a long-term health problem or disability.
• 9.3% (492,435) of people provided unpaid care to family members or friends^[31].

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 disability?

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 withdrawal of this policy has some perceived positive impacts. The removal of facemasks increases communication and can improve relationships. People who are deaf or hard of hearing will see benefits in lip reading and the removal of masks supports the development of relationships with those who suffer from Alzheimer's or Dementia.

Other benefits can be seen in the quality of breathing for those who suffer from Asthma as well as in those who suffer from skin conditions caused or worsened by wearing a mask. Skin conditions can vary in severity and tends to result from a warm, moist, occlusive environment around the face produced by mask use. Added to this is the frictional effect of the material held in place with elastic.^[32]

People with certain disabilities or impairments were not required to wear a facemask throughout the pandemic. People for whom putting on, wearing or removing a face covering/ face mask caused severe distress were exempt.

There may also be a perceived negative impact for some people with certain disabilities and/ or are immunocompromised. Some people may be concerned about the removal of the routine use of facemasks for patients, staff and visitors. This is because they may feel that they are more at risk from acquiring COVID-19 and at more risk of significant illness as a result. This may be seen most severely in those with anxiety, both healthcare workers and those requiring care which could lower attendance in these settings.

As a result of the success of the vaccination programme and the availability of new medicines to treat COVID-19, the COVID-19 Highest Risk List was ended on 31 May 2022^[33]. The decision to end this list was based on strong clinical evidence indicating that the majority of people on the list were at no greater risk from COVID-19 than the general population^[34].

Advice^[35] remains in place for people with a weakened immune system as defined under “immunosuppression” in the Green Book Chapter on COVID-19, tables 3 and 4^[36].

Some people with a weakened immune system may still be at higher risk from COVID-19. They may not develop the same level of immunity from the vaccination as others, although many do get protection. It will be important that people or their representative in Health and Care settings are able to discuss this with their GP, nurse or healthcare professional.

Although there is variation in COVID related hospital admissions the figure remains comparatively low^[37], generally vaccination levels are high^[38], COVID-19 induced immunity has been developed^[39], the risks associated with COVID-19 are lower and there is a more positive clinical picture^[40]. That said, it will be important to ensure continued comprehensive efforts at ensuring high vaccination coverage in national programmes for staff and the population in both wider and closed settings.