The Health Protection (Coronavirus) (Requirements) (Scotland) Amendment Regulations 2022 and The Health Protection (Coronavirus) (Requirements) (Scotland) Amendment (No. 2) Regulations 2022: equality impact assessment

Disability

Background

According to the 2019 Scottish Health Survey, 32% of men and 37% of women in Scotland reported living with a limiting long-term condition. For people aged 75 and over, 58% had a limiting long-term condition.^[111] 1 in 5 Scots identify as disabled, and more than a quarter of working age people have an acquired impairment.^[112]

Covid has had a disproportionate impact on the health of disabled people: 93% of people who died from Covid-19 up until April 2021 had at least one pre-existing condition.^[113] Research by National Records of Scotland with deaths data until January 2021 found that, after adjusting for age, disabled people were between 1.8 to 3.2 (women) and 1.8 to 3 (men) times more likely to die with Covid-19 than non-disabled people, depending on the extent to which disability limited their daily activities.^[114] Similarly, research in England which analysed data from up to February 2021 estimated that, after adjusting for age, sex, ethnicity, and geographical location, adults on the learning disability register were 5.3 times more likely to be hospitalised in relation to Covid-19, and 8.2 times more likely to die due to Covid-19.^[115]

Covid-19 restrictions have impacted disabled people particularly hard. Evidence has highlighted how, for wheelchair users, their main option to meet others was indoors, whilst others with dementia or learning disabilities struggled to understand the rapidly changing restrictions.^[116] Other evidence suggests that people with pre-existing mental or physical conditions feel negatively affected by the fact that others seem to now be living more normally than they do, and those with physical health conditions are among the sub-groups with the highest level of concern about the occurrence of another wave of Covid-19.Error! Bookmark not defined.

A report produced by the Scottish Government^[117] on wellbeing issues over the duration of the pandemic, amongst different groups, noted that in March 2021, disabled respondents reported higher levels of anxiety and loneliness, were more likely to need help with mental health, shopping or getting medicines and manage less financially. The same report also noted that disabled people were more likely to feel cut off from friends and family and were more likely to be sleeping badly.

There have also been wider mental health impacts from the Covid-19 pandemic, with NHS data showing a 75% increase in the number of people referred to mental health services for their first suspected episode of psychosis between April 2019 and April 2021.^[118]

Differential impacts

Positive impacts

If the policy objectives to reduce the risk of transmission is achieved, this would positively impact those disabled people who are at a far higher risk of poorer health outcomes if they contract the virus.

Some disabled people who are clinically extremely vulnerable were asked to shield at the start of the pandemic. Anecdotal evidence suggests that while shielding officially ended on 26 April 2021, concerns about contracting the virus have remained, and many individuals have continued to behave as if they are still shielding, leading to an adverse impact on their lives and quality of life.

Stakeholders have suggested that Covid restrictions and protective measures can support disabled people to feel safer when in public and participating in society. A recent poll conducted by Disability Equality Scotland found that 82% of respondents had no concern about Covid Status Certification. Views on the Covid Status Certification were mixed however, as some respondents perceived it as reassuring and a way to improve participation in society for those at risk, but some respondents would like to see Covid Status Certification extended to more settings.^[119] Inclusion Scotland also noted anecdotal evidence that some carers would like to see Covid Status Certification extended to more settings as they felt the risk of attending settings where Covid Status Certification is not in place is too high and as a result the people they care for have been acting as if still shielding. Covid Status Certification could therefore provide reassurance for these people and support them to feel safer and more confident in society.

As 26.6% of the accommodation and food services sector workforce are disabled^[120], extending Covid Status Certification to the food sectors could then reduce their chance of catching Covid (which they may have worse health outcomes from) at work.

Disability Equality Scotland reiterated that clear communications are necessary to help disabled people understand what restrictions are in place and why. They said that restrictions and the added security they give can give some disabled people reassurance, but also then that lower compliance with measures like wearing face coverings can then reduce these feelings of safety, and so clear communications are vital not just on new restrictions, but on those which are still in place.

Additionally, if the policy objective to allow higher risk settings to continue to operate as an alternative to closure or more restrictive measures is achieved, Covid Status Certification could benefit disabled people as socialisation plays a key role in disabled people's wellbeing. Therefore, if Covid Status Certification supports settings to remain open and facilitates socialisation, such as the ability to attending the settings in scope with family, friends and support groups and services, this would have positive impacts on disabled people.

Negative impacts

As with age, digital exclusion is a key consideration for disabled people. Glasgow Disability Alliance reports that 60% of their members feel digitally excluded^[121] and that, while disabled people may have a smartphone, it may be too old to support certain apps.^{[122] [123]} Some disabled people may use an older model of a mobile phone as it meets their accessibility needs, and so may not want to upgrade their phone to a new model which can support the NHS Scotland Covid Status App. A paper vaccine certificate can be requested by phoning the free Covid-19 Status Helpline which is open every day from 10:00-18:00. Additionally, people do not need to have a 'smartphone or tablet to display their negative test result any mobile phone that can receive text messages or access emails is sufficient.

If disabled people do have a smartphone which is compatible with the App, they may experience other barriers to access. For example, people who have motor or musculoskeletal problems which may mean they find it difficult to hold a camera steady for the time required to complete the biometric face scan. Stakeholders raised that for blind people or people with visual impairments it is difficult to complete the biometric face scan, as though the App is compatible with screen readers, people do not know whether their face is within the very specific space required to complete the scan, and the App does not provide enough prompts to support someone to move the camera to the right place. While a carer, friend, or family member may be able to help in such instances, this still impacts on a disabled person's ability to live independently. In response to a recent poll conducted by Disability Equality Scotland, respondents suggested that the NHS Scotland Covid App was not accessible as it requires an email address and a driving license or passport to register and verify the user's identity.

This is an issue which the Scottish Government has raised with the contractor, Jumio, and which we will continue to raise in order to seek a satisfactory solution, noting we are reliant on a global solution which cannot be tailored for Scottish use only. Work is underway to identify options for an individual's identity to be confirmed in person as an alternative to the existing biometric verification process, such as at a trusted local office. It would require technical developments to the App to record the in person verification in the App so an individual can use the App if their identity has been verified in person. We are also considering whether a person's identity can be verified over a secure video call.

As with older people, disabled people who cannot show test results via a mobile phone may also struggle to access these via home or public printing services, especially if these services do not meet their accessibility needs. This could create an issue for disabled people who cannot be vaccinated but are not given an exemption as they could complete a negative test, but who would then have difficulty displaying the record of test result. Also as with older people, relying on another person to display their test status for them may impact disabled people's ability to live independently.

The EQIA on the core testing strategy^[124] found that, for some people, there was concern that the process of testing may feel intrusive and could trigger difficult reactions. It was felt that increasing awareness of the potential intrusiveness of the testing process among frontline delivery staff might mitigate this risk. The Mental Welfare Commission has received a number of calls through their advice line from people about testing. Sensitivity to home testing kits can also be difficult for disabled people either to be undertaken themselves or by a carer, particularly when they do not understand why.

Stakeholders also felt that clearer communications were needed on Covid Status Certification and other baseline measures. They also felt that, while the inclusion of LFD testing was generally positive, there is the possibility that people could fraudulently use the system, which may increase the risk of infection in spaces in scope and potentially reduce disabled people's trust in the measures.

As with many other products which are part of everyday life such as bus passes, there may be limited circumstances where a disabled person finds it challenging to maintain either a digital or paper Certificate. According to the latest statistics, in 2019 there were 23,584 adults in the autistic spectrum or with learning disabilities known to local authorities in Scotland.^[125] Some of these people may find it more challenging to maintain Certification, which could lead to negative impacts if it results in them not being able to access a setting in scope. They may also find the experience of being turned away confusing and distressing. In these circumstances, the individual can call the Covid-19 Status Helpline and request a paper copy of Certification. A carer or relevant adult can also call the helpline and request a paper copy of Covid Status Certification on behalf of the person they are caring for. If the individual is time limited and cannot wait for a paper Certificate to arrive, they can take an LFD test and register the result on the GOV.UK website. They can then use the SMS or email confirmation of a negative test to enter a regulated setting.

There are exemptions in the regulations for the very small percentage of the population who cannot be vaccinated and tested for medical reasons. Some people who are exempt from vaccination and testing may have a condition which would constitute a disability under the Equality Act.^[126] While the details of a person's exemption will not be displayed on their exemption Certificate – it will simply say 'Exempt' – stakeholders have nonetheless raised concerns about data protection, as health data is special category data and protected under human rights legislation (Article 8 right to respect for private and family life). Stakeholders have also raised concerns that, for the very small proportion of disabled people who are exempt, some may be denied access to the regulated settings, even though they have an exemption, as has been experienced with face covering exemptions. Medical exemptions cannot be displayed on the international section of the App due to EU specifications. Their integration into the app is under consideration. We continue to engage across the four nations to ensure that work around exemptions is taken forward collectively.

As with younger people and other groups (such as those living in poverty), disabled people may also have difficulty accessing the vaccine if they are unable to access vaccination sites. Disabled people may have less access to transport than non-disabled people if public transport is inaccessible or not suitable for them, and if other forms of transport (such as taxis) are prohibitively expensive. While we are committed to an inclusive vaccination programme, record of a negative test can be used as an alternative to access the regulated spaces until people have been fully vaccinated. This NHS Inform page also contains information about how to contact local health boards for assistance in attending vaccination appointments.

Stakeholders also highlighted that disabled people are more at risk of becoming victims of a variety of scams, and this is substantiated by an information briefing from Citizens Advice in June 2018.^[127] Covid Status Certification may then provide "phishing" opportunities for scammers, which may impact disabled people more than non-disabled people.

Covid Status Certification may negatively impact disabled people if their carer has a different status to themselves. Data from England shows that 91% of carers known to local authorities care for someone with a physical disability or a long-standing illness^[128] and 31.3% of Scottish adults with a learning disability live with a family carer.

As with older people, there is the potential for a Covid Status Certificate to be used as a tool to exert coercive control. A report from Public Health England in 2015 indicated that disabled people experience higher rates of domestic abuse and suffer it for longer periods of time, more severely and more frequently.^[129] Data from Glasgow over 2018-20 shows that 12% and 22% of Adult Support and Protection investigations involved someone with a physical or a learning disability, respectively.^[130]