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

Race

1. Background

Scottish data has shown an increased risk of serious illness and death from COVID-19 among many minority ethnic groups. This mirrors similar trends seen in other countries of the UK^[59].

A report by the UK Cabinet Office’s Race Disparity Unit (RDU), drawing on evidence from the Scientific Advisory Group for Emergencies ethnicity subgroup, found that a range of socioeconomic and geographical factors, coupled with pre-existing health conditions, contributed to the higher infection and mortality rates for minority ethnic groups^[60]. The RDU reported that the main factors behind the higher risk of COVID-19 infection for minority ethnic groups included occupation (particularly for those in frontline roles, such as NHS workers), living with children in multigenerational households, and living in densely populated urban areas with poor air quality and higher levels of deprivation. Once a person was infected, factors such as older age, male sex, having a disability or a pre-existing health condition (such as diabetes) were likely to increase the risk of dying from COVID-19.

The risk of severe COVID-19 is higher for people with certain underlying health conditions. Prevalence of some of these health conditions (including diabetes, coronary heart disease and cardiovascular disease) is known to be higher in certain minority ethnic groups^[61]. This inequality is seen clearly in certain groups with Muslim males being 2.5 times more likely to die from the infection when compared to Christian males^[62]. Vaccination is the best way to protect against the known risks of COVID-19 for those with pre-existing conditions. However, although there has been a high uptake of COVID-19 vaccinations in Scotland overall, uptake levels have not been equal across all population groups. Uptake has been lower in most minority ethnic groups, with Polish, Gypsy/Traveller and African groups having particularly low levels of uptake^[63]. This could increase inequality in vulnerability to COVID-19.

Minority ethnic individuals are over-represented in jobs with increased exposure risks to COVID-19, including health, care and other key worker roles^[64]. Risk of exposure to COVID-19 in health care settings is mitigated by the infection prevention and control measures. Additionally, healthcare workers have been eligible for COVID-19 vaccination as advised by the JCVI^[65].

2. Evidence / Date – Related to Healthcare Settings

Staff in Healthcare settings:

In response to the iMatter survey 2022^[66] when asked ‘what is your ethnic group?’ NHS staff identified themselves as; White 90%, mixed or multiple ethnic groups 1%, Asian, Scottish Asian or British Asian 2%, African, Scottish African or British African %, Caribbean or Black less than 1%, another ethnic group, less than 1% and no answer given was 7%.

Patients in Healthcare settings:

Figure 7. A graph showing the breakdown of ethnic group in Scotland. 96% of people identify as White; 1% as mixed or multiple ethnic groups; 3% as Asian, Asian Scottish or Asian British; 1% as African; 0% as Caribbean or Black and 1% as Other ethnic Group. It is important to acknowledge only 24% of those sent the survey replied, it does however give a rough insight into patients/ service users in Scotland.

National Records of Scotland analysis of population data suggests that “Scotland is becoming more ethnically and religiously diverse, with an increasing number of people who live in Scotland being born outside of the UK”. This greater diversity among the Scottish population, will be reflected in health care populations. A note of caution around the data as it draws from the 2011 Census.^[68]

Visitors to Healthcare settings:

Currently there is a lack of data around the demographic breakdown of visitors to healthcare settings however, we have used general population data to support equality impact assessment.

The 2011 census found that^[69]:

• Scotland's population was 96.0% white, a decrease of 2.0% from 2001
• 91.8% of people identified as ‘White: Scottish’ or ‘White: Other British'
• 4.2% of people identified as Polish, Irish, Gypsy/Traveller or ‘White: Other’
• the population in Asian, African, Caribbean or Black, Mixed or Other ethnic groups doubled to 4%

Figure 8: A graph shows the uptake of winter booster by those eligible which demonstrates that uptake was low within certain ethnic groups. White people had the highest uptake of 75.8%, the next highest was those who did not disclose at 67.4%, followed by Mixed Multiple demographics at 48.8%. There has been a lower uptake across the board but seen most severely in the African community at only 26.2%. This could result in certain groups suffering more severely from contracting the virus^[71]. Other groups include Asian at 44.7%, Caribbean or Black at 38.2% and Other at 45.2%.

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 race?

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.

We believe there is both a positive and negative impact on the withdrawal of the face mask guidance on people as a direct result of their race.

A positive impact of the removal of routine mask use in healthcare settings is the increased ability to communicate. Removing this barrier to communication can promote health literacy and further encourage access to healthcare.

The removal of the enhanced facemask guidance is supportive of a person-centred, risk-based approach to facemasks in different settings as was in place pre-pandemic, it is not specifically linked to people’s race.

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.

Patients have the option to wear a mask at their own discretion however these will not be provided unless clinically required. Issues regarding health literacy and language barriers may limit awareness of this and pose a risk to certain people. 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.