Withdrawal of the 'Coronavirus (COVID-19): use of face coverings in social care settings including adult care homes' guidance: Equality Impact Assessment

Context

Before the pandemic, guidance on the use of face masks in health and social care settings was set out in the National Infection Prevention and Control Manual (NIPCM).

Scottish Ministers first took the decision to have specific guidance on the use of face masks and face coverings in hospitals, primary care, wider community care and adult care homes on 23 June 2020. This followed a paper from the World Health Organisation recommending the use of Fluid Resistant Surgical Masks (FRSMs) rather than face coverings in these settings. This guidance was in addition to the NIPCM which remained (and remains) extant.

Scottish Government guidance on the use of face masks in adult social care and healthcare settings was amended several times during the pandemic as a result of evidence evolving and with scientific and clinical advice being updated. These amendments included a split in the guidance for healthcare settings in June 2021 when separate guidance for adult social care was published.

By early 2023, the face mask guidance for adult social care had been amended so that staff, visitors and users of adult social care settings had stopped routinely wearing face masks months before. Factors behind this change included high vaccination rates amongst this population and lower clinical severity of the dominant variants, as well as the communication barriers and wider harms of face mask use to the mental health and wellbeing of supported individuals. Guidance on the use of face masks had therefore reverted to circumstances as set out in the NIPCM with one addition: “Staff, visitors and those receiving care and support may choose to wear a mask and this should be supported”.

In March 2023 it was considered timely to review the face mask/face covering guidance in health and social care settings. There were several factors influencing this:

• We were in a different phase of the pandemic with the availability of treatments and vaccines, and the World Health Organisation had declared that the global emergency that the pandemic caused was over^[4].
• The Care Inspectorate had raised concerns with the Adult Social Care Oversight and Assurance team that some social care services were adopting blanket or routine face mask use by their staff [which was having an adverse effect on service users]. Poor IPC measures relating to donning/doffing face masks were also reported.
• It is essential that there is adherence to broader Infection Prevention and Control (IPC) principles. Not wearing PPE, including masks, appropriately can cause further IPC issues and unintended consequences. The guidance for social care may have been encouraging inappropriate mask use, including when there is not a clinical need.
• In older adult care homes in particular, where around 66% of the residents are living with dementia, face mask use can lead to other harms such as communication issues, negatively impact the health and mental wellbeing of individuals and create challenges in building and maintaining meaningful relationships.

Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) Scotland and Public Health Scotland were therefore commissioned to provide expert advice on the current evidence base around the use of face masks in health and social care settings. ARHAI Scotland recommended that this line of guidance was removed as it was unnecessary and also increased the risk of confusion and misinterpretation. ARHAI Scotland recommended that guidance on the use of face masks in adult social care settings reverted to the NIPCM, which is based on clinical need and risk assessment.

For clarity, staff, visitors and those receiving care and support in adult social care settings always had (and continue to have) the right to choose to wear a mask. The removal of this line of guidance would not remove that right.