Covid-19: Disparate Impact
(4 years ago)
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Baroness Wilcox of Newport (Lab) [V]
My Lords, at last I can ask you to note my entry in the register of interests: I am proud to announce that I have been asked to join several noble Lords by becoming a vice-president of the LGA, and I have gladly accepted.
This side of the House welcomes the work being done on equality issues as noted in the quarterly report, but we are deep into the second wave of this virus, and what is before us in this Statement falls far short of what is needed. We are in great want as a country of a concrete, forward-looking strategy and action plan to improve outcomes for those most at risk in this pandemic. The first Covid disparities report has several recommendations that the Prime Minister has apparently accepted in full, but few of these are quantifiable or, more importantly, accompanied by timetables for delivery. Recommendation 3 in the report is for a rapid, light-touch review of actions taken by local authorities to see what works.
I pay tribute to my colleagues in local government, who have had an unrelenting work schedule since the onset of the pandemic. I simply do not know how they have kept up after a decade of chronic underinvestment in public services. In Wales, local councils have worked with the Welsh Government in taking ownership of the test and trace system with much success, proving far more successful than the contracting-out model given to private companies in England. The Government should have listened to the expertise in local government, although I believe that some moves are being made by English councils, taking matters into their own hands and setting up their own systems.
I therefore ask the Minister for more information on this review of local authorities. When will it be started and completed? Who will run it, and how will the Government share its best-practice findings? Furthermore, and most importantly, how much additional financial support have the Government allocated to the already overstretched and underfunded local authorities where the most at-risk communities have been identified?
We welcome, in recommendation 9 of the report, the intention to make ethnicity reporting mandatory in the death certification process. How will that data be used and shared to effectively impact on policy? We know that there are several different policy areas that interlink to increase Covid risks. What we are clearly missing is a government strategy to tackle deep structural inequalities, including in housing and in employment opportunities—which have such an impact here. Where is the action on these areas? Poverty and inequality have been remorselessly highlighted across the UK by this disease. There is a higher prevalence and mortality in areas of high deprivation. In addition to people from black, Asian and minority ethnic groups being at risk of Covid, disabled people accounted for nearly 60% of all deaths between March and July. They are more likely to live in poverty than non-disabled people and accounted for one-third of the 300,000 people who were not eligible for social security support. What are the Government doing to protect disabled people’s lives as we enter the second wave of this deadly pandemic?
I further note an issue that surrounds the lack of data around health outcomes for LGBT people, not least in respect of the intersectionality with BAME people in respect of the pandemic. This deficit was identified in the LGBT action plan. Will the Minister therefore ask her department to collect this important information by ensuring that future public health surveys record data on all protected characteristics?
I must commend the Minister for Health in Wales, Vaughan Gething, on the work he has been doing on these disparate issues. Through his early identification of these problems he set up a task force, putting in place measures to address the “adverse and disproportionate impact” on people from BAME communities.
I am grateful to my noble friend Lady Lawrence for chairing the report—originated by the leader of the Labour Party—into Covid-19. It is published today with the title An Avoidable Crisis. We proudly welcome this report and the concrete steps it takes to address the issues that have arisen for the BAME community during the pandemic. We urge the Government to implement the actions contained in the report.
The report provides a snapshot of the impact of Covid-19 to date and the structural inequalities faced by black, Asian and minority ethnic people. There are immediate recommendations to protect those most at risk as the pandemic progresses. The report also demonstrates the next steps to begin to tackle the underlying causes of inequality in our society. As noted in the report, this virus is having an unequal and devastating impact on ethnic minority communities. Sadly, people are dying at a disproportionate rate. They are also overexposed to the virus and are therefore more likely to suffer the economic consequences of the pandemic.
The Government have failed to take notice and have not implemented any counteraction that could help halt this devastation. Coronavirus has undoubtedly highlighted the inequalities throughout British society. Black, Asian and minority ethnic people are more likely to work in front-line sectors and thus are overexposed to Covid-19. They are also more likely to have comorbidities that increase the risk of serious illness and more likely to face barriers to accessing healthcare.
Black, Asian and minority ethnic people have also been subject to disgraceful racism as some have sought to blame different communities for the spread of the virus. Barriers include a lack of cultural and language-appropriate communication, not being taken seriously when presenting with symptoms, a lack of clinical training on the presentation of different illnesses across communities and the “no recourse to public funds” rule that prevents many migrants from accessing state assistance. Labour fully supports an immediate review of this rule and its impact on public health and health inequalities.
We neither want, nor expect, the report to sit on a shelf gathering dust. The recommendations are both immediate, with measures that can be taken by the Government within weeks, such as ensuring that employer risk assessments are published and, in the longer term, ending the hostile environment that has surrounded us this past decade. Keir Starmer said today that Covid lays bare the racial inequalities that have long existed in our society and announced that the next Labour Government will introduce a new race equality Act to tackle the structural inequalities that led to the disproportionate impact of this crisis. It will begin to transform what has become a bitter landscape for our BAME communities across the country.
I ask the Minister to request, with immediate effect, a suspension of the “no recourse to public funds” rule during the pandemic and to initiate the review that we are calling for into its impact on public health and health inequalities. We have been calling for this review since April and yet again a major issue has fallen on deaf ears, despite massive public engagement in a campaign led by Marcus Rashford, a wonderful example of a young man speaking out against the injustice of a nation not feeding its poorest children.
This implacable Government continue to turn their face against the wall in the hope that it will all go away, while repeating the same tired mantras of money already being allocated. Sadly, it is too little, too late. These problems—these inequalities—will not just go away. We know it, the Government know it and, more importantly, the people of the United Kingdom know it.
The whole response to this pandemic has fallen far short in so many areas and the disproportionate effect on the BAME community is carefully documented in the excellent report from the noble Baroness, Lady Lawrence, published today. I urge all noble Lords to read it and I urge the Government to adopt its immediate and longer-term recommendations without delay. To do nothing less would be simply incomprehensible to the decent vast majority of the British people who have shown over the past week that once again they understand the importance of supporting our children and trying to rid our society of the scourge of poverty and inequality. I ask the Minister to please read the report, and to implement it.
Baroness Hussein-Ece (LD) [V]
My Lords, the Covid pandemic has disproportionately impacted women. The Women’s Budget Group found that women are twice as likely to be key workers. It said that 77% of high-risk workers are women. They are being paid poverty wages. These inequalities are pronounced and exacerbated across the country, especially for those marginalised by other factors, including race, ethnicity and disability. We know that people with disabilities have been hardest hit, with an unacceptably high mortality rate. What support will the Government commit to providing women facing particular hardships due to the Covid pandemic and to address these glaring inequalities?
In addition, many thousands signed a petition urging the Government to establish a Covid race equality strategy. Back in June, I asked the noble Lord, Lord Bethell, whether the Government would consider establishing this strategy. This was urgent in June; it is now the end of October, and the evidence in the Statement clearly shows that these groups are still suffering hardship, are still in the front line and are still disproportionately affected. The pandemic has shone a light on inequalities that, sadly, already exist in our society. We need urgent action, not further reviews.
Recent statements on Covid in the past few months have said little about how people from BAME communities can be better protected. Will the Government now establish and develop a proper Covid strategy to address the inequalities that have already been mentioned? We do not need further reviews. The evidence is overwhelming. When can we expect action and implementation of the numerous reviews to address the inequalities that this terrible virus has unfortunately visited on sections of society that are not best placed to protect themselves, due to the nature of their lives, where they live, their households, their jobs and their health problems? I ask the Minister to answer that and what resources are being put in place to address this.
The Parliamentary Under-Secretary of State, Department for Education and Department for International Trade (Baroness Berridge) (Con)
My Lords, I welcome this review and quarterly report, which has been published and sent to the Prime Minister, who has endorsed its recommendations, as the noble Baronesses said. First, I pay tribute to the enormous number of NHS workers from black and minority ethnic backgrounds. Unfortunately, it is not the case, as outlined by the noble Baroness, Lady Hussein-Ece, that we know the evidence. We know that there are disparities but, even now, we do not fully know the cause of them. We know much more about the disease and those disparities than we did three months ago, but the picture is not complete. With £4.3 million, we have funded six further research projects, because we need to understand what is causing these disparities.
I assure the noble Baroness, Lady Wilcox, that the healthcare plans for the NHS, facing the second wave of the epidemic, particularly the plans for the extremely clinically vulnerable, will take into account the evidence from this report and the PHE review of the disparities. It is important and has been accepted that death certification must include data on ethnicity. There is cross-government data sharing on this now, which is how some of this data will be used. That group also works with PHE and the Office for National Statistics, which is our expert on statistical data. We are monitoring the policies of at least 10 departments to see how they are affecting ethnic minority communities.
We have been listening to local government and we are aware that public health is part of local government’s responsibility. Some £25 million is going to be targeted to specific local authorities where we are aware that the public health messaging has not necessarily penetrated to grass-roots level. In addition to the action that has been taken, we are funding community champions with links with the grass-roots to build on those communities and ensure that the message is getting out, because communication and awareness is so important here. The Government have also reached 5 million people through social media influencers to try to ensure that black and minority ethnic communities have awareness raised. Billions of pounds has also been given to local government, much of which is not ring-fenced.
On the review of the noble Baroness, Lady Lawrence, I pay tribute to her work. I will be sending that review to the Commission on Race and Ethnic Disparities, which has a call for evidence at the moment and is dealing with other matters of structural inequality. Many of the recommendations made in that review have already been enacted: the NHS, for instance, has purchased over 2,000 powered respirators so that healthcare clinicians, such as Sikhs who wear turbans, can be protected when wearing a mask is not possible. Much of what is outlined in risk assessments in the workplace is already in health and safety law and enforced through the Health and Safety Executive. However, there have been two updates since the public health report in June on guidance in the workplace—one in July and one in September—outlining the responsibility of employers to risk-assess their workplaces to ensure that precautions are taken in relation to Covid risks.
We have also responded to specific risks for black and minority ethnic populations, for whom disparities are caused by socioeconomic and geographical factors but also by occupation. That is why it is now compulsory to wear a face covering in a private hire vehicle; that specific protection was changed. Also, the advice relating to the hospitality sector has changed, so specific action has been taken.
Of course, there are other groups in society for whom there are disparities. The two main factors associated with Covid are age and gender, but there are issues around those with disabilities. Dr Emran Mian is leading the wider piece of government work on Covid disparities. I will have to write to the noble Baroness about the specific timing of the local government light-touch review so that we can learn from best practice. There is a specific health adviser in relation to LGBT issues.
As I outlined at the start, unlike in most workplaces, where the workplace itself is assessed, the NHS is assessing staff, particularly BAME staff, who are at the front line. Over the summer, 95% of BAME NHS workers have been individually risk-assessed, so the NHS is taking its responsibility seriously.
On public health information, there has been increased language translation of public health messaging, particularly the recent “Hands, Face, Space,” which seems to have reached different communities better.
Unfortunately, it would not take just a few weeks to publish risk assessments of all employers on a government portal; we are talking about millions and millions of workplaces. When I send a report to the commission, I will look at the recommendation from the Lawrence report. It is not a simple overnight fix. The work of the Commission on Race and Ethnic Disparities remains open and that information will be passed on.
Turning to the questions raised by the noble Baroness, Lady Hussein-Ece, about women, there have been significant support schemes. There are 1.7 million self-employed women in this country, and there have been specific initiatives such as self-employed income protection and investment in businesses started by women. We have seen a greater take-up of investment in companies set up by mixed gender groups. In fact, it accounts for 82% of the Future Fund, which is £720 million. By way of comparison, the Female Founders Fund report said that only 10% goes to mixed gender groups. So, we are focused on that issue.
On the question of women and the pandemic, we have given enormous support to the childcare sector. The entitlements money, £3.6 billion a year, has been given to those providers regardless of the number of children who are actually going through the door. That is carrying on until the end of the year to support those businesses, many of which are female-owned.
So, we have taken action on this issue; we have not rested on our laurels. We have more evidence now as to the cause of these disparities but, as I say, the picture is not yet complete. I will update the House further when there is more evidence.
The Deputy Speaker (Lord Duncan of Springbank) (Con)
We now come to the 30 minutes allocated to Back-Bench questions. I ask that questions and answers be brief so that I can call the maximum number of speakers.
Baroness Coussins (CB)
My Lords, according to a Written Answer that I received in July, the Government were not even considering then that the lack of Covid information in languages other than English might be a possible factor in the death rate of certain ethnic minorities, so I am glad that this report recognises the importance of communication in relevant languages. I ask the Minister to reassure me that community champions will be multilingual, that all translated materials in all formats will be promptly updated whenever the English versions are, and that an urgent review will now check whether all the right languages are included so that no minority group, including asylum seekers, is disadvantaged.
Baroness Berridge (Con)
I am grateful to the noble Baroness. In fact, £4 million has been spent on communications translating public health information, along with 600 targeted publications to ensure that the messages reach various communities. Local authorities with those specific communities will be targeted, but I will take back the noble Baroness’s concern about making sure that materials are translated promptly. Every avenue is being looked at to ensure communication with different communities. We have also been making use of stakeholder groups, charities, community groups and places of worship; indeed, a task force has been set up because obviously, a very high proportion of black and minority ethnic people attend a place of worship. My honourable friend Kemi Badenoch has even written to a number of high commissioners in London about their diaspora, asking them to help communicate the information to their communities. We are seeking to get the evidence out through traditional means and using social media influencers where we can.
Baroness Whitaker (Lab)
My Lords, the Welsh Government have explicitly included Gypsy, Roma and Traveller children along with other minority ethnic groups in their list of groups that are particularly vulnerable to Covid-19. That is absolutely right, both because of their legally recognised ethnic minority status and because of such data as exists on the disproportionate impact of the virus on the communities, reflected in my noble friend Lady Lawrence’s excellent report. What attention have the Government paid to these communities? Will their specific ethnicity be recorded on death certificates and elsewhere?
Baroness Berridge (Con)
I am grateful to the noble Baroness. As Minister for Women, one of my specific concerns is the underachievement of Gypsy Roma in most categories. The Government are firmly committed to delivering a cross-government strategy to tackle these inequalities. I will have to come back to her on the specific point about BAME; I presume that BAME registration would include that as an ethnicity but I will double-check. My noble friend Lord Greenhalgh, who is the MHCLG lead on this issue, wrote to local authority chief executives in April to point out the specific support that those communities might need in terms of services such as water sanitation and waste disposal on their sites. We have been working closely with the various representative organisations to ensure, again, that the message gets out to communities that might be harder to reach than others.
Baroness Barker (LD)
My Lords, in April the Government produced statistics on the furlough scheme on a local authority and parliamentary constituency basis, and then they stopped. First, will the Minister find out why? Secondly, can she see whether it is possible to produce up-to-date data on that basis so that decision-makers at national and local level can work out whether there is a correlation between access to furlough payments and infection rates?
Baroness Berridge (Con)
My Lords, we are working closely with the Office for National Statistics and analysts from PHE. I will have to check with them and will write to the noble Baroness in relation to the specific data, which I have to confess I was not aware was out in that form and then not out in that form.
Lord Singh of Wimbledon (CB) [V]
My Lords, the Statement does little to address the disproportionate impact of the pandemic on minority communities. We already know that ethnic differences linked to diet and lifestyle are important, alongside other causal factors emanating from racism, including crowded housing and economic disparities, leading to a preponderance of black and ethnic minorities in poorly paid jobs in hospitals, the care sector and other overexposed front-line services. Does the Minister agree that the Government should do more to focus on already clear areas of disadvantage, rather than spend millions on more and more costly academic research into the glaringly obvious?
Baroness Berridge (Con)
My Lords, I hope that I have been clear that what is glaringly obvious is the disparities. The answer to the next question, which is why there are those disparities, is not so glaringly obvious, and we must be careful not to jump to conclusions. As I said, they are partly explained by comorbidities—pre-existing health conditions—but that does not explain them fully. Some of them are explained by socioeconomic and geographical factors. That is why we have issued guidance on multigenerational households and areas of population density where people cannot socially distance properly. However, that does not fully explain the picture. For instance, a British black African man is 2.5 times more likely to die of Covid, but a British black Caribbean man is only 1.7 times more likely to die of Covid. Therefore, unfortunately, there are still gaps in understanding, not of the fact that there are disparities but of what is causing them. Unless we know that, we cannot address them.
Viscount Waverley (CB) [V]
My Lords, I express my compliments to the noble Baroness, Lady Lawrence. She is to be thanked. Healing, respect and reconciliation are needed for a divided kingdom of nations. Will the Government take the initiative and establish a root-and-branch royal commission on an integral strategy fit for a caring nation to address systemic failures of structural discrimination, covering the health service, race and ethnicity, housing, education, skills and training as a starter? Fast-tracking this is a matter of priority and appropriate for consideration to bring forward in the upcoming Queen’s Speech, as it would deliver dividends many times over. On a practical measure, since the wearing of masks is necessary and mandatory, will the Government care to consider distributing masks and hand gel at no charge as a practical gesture in what could become a situation of real need?
Baroness Berridge (Con)
My Lords, I am grateful to the noble Viscount. It might not be a royal commission, but the Commission on Race and Ethnic Disparities has been set up by the Government, building on the Race Disparity Unit. It is reviewing inequality in the UK, focusing on areas such as poverty, education, employment, health and the criminal justice system. Again, we know that there are disparities, and we want to know why and what the causes are. If the noble Viscount would like to submit evidence, there is a call for evidence at the moment. I have not read of any government policy on distributing hand gel and so forth, but there has been most impressive work in transport interchanges and so on, and a lot of institutions, including Parliament, have taken it upon themselves to make those kinds of precautionary measures available.
Lord Mann (Non-Afl)
The Statement looks forward to the availability of a vaccine, which will be—when it happens—warmly welcomed in this House, of course, as well as across the country and indeed the world. But one ethnic minority group will have a kickback at that time. A report I have just released, a copy of which has gone to the Minister’s department for her personal perusal, shows how the anti-vaccine movement is deeply embedded with anti-Semitism. Some 79% of the anti-vaccine groups organising in this country publish vehement anti-Semitism in their discussions; for example, categorising Bill Gates as Jewish, talking about the Zionists being responsible, blaming Israel for the creation of coronavirus—the Rothschilds and the new world order. Those are the same old conspiracy theories. Does the Minister agree that we need to take on the extremists on the far right and the far left of the anti-vaccine movement both now and in advance of a vaccine being available? Their conspiracy theories are garnering too many views online, and perhaps too many supporters, with deeply worrying anti-Semitism at their heart.
Baroness Berridge (Con)
I am grateful to the noble Lord and I am sure that I will give his report my personal perusal and respond to it. Of course, we need to ensure that the public health messages going to communities are accurate and truthful. Obviously, there are various laws around correcting information and making sure that it is truthful. Conspiracy theories need to be debunked so that people have the information on which to make their decisions. We are all looking forward to a vaccine, but it is also apparent that not enough black and minority ethnic individuals are coming forward to the NHS Covid-19 vaccine registry. The honourable Kemi Badenoch MP has written to every MP asking them to encourage their constituents to come forward to ensure that the vaccine, when we get it, is effective among black and minority ethnic people.
Lord Willis of Knaresborough (LD) [V]
My Lords, the main conclusion of the report that
“a range of socio-economic and geographical factors”
are the principal causes of higher infection in ethnic minority groups was, quite frankly, blindingly obvious six months ago, as the noble Lord, Lord Singh, rightly said, and was entirely predictable. The real research should have been on the “excess risk” which this report says these groups face. Given that in September, 30% of all ICU Covid patients were from BAME communities, doing this research over the coming months will simply not do; it is urgent now. Will the Government seek the support of the regional NIHR Applied Research Collaborations—I declare an interest as the chair of the Yorkshire group—to use their unique position combining regional research in universities and major teaching hospitals on this mission? Spending £4.6 million on research based at the heart of large BAME communities in the regions surely makes good sense.
Baroness Berridge (Con)
My Lords, I can only reiterate that it is important for us to know what factors are the causes of these disparities; that was not clear earlier, and as I say, there are still gaps in what is causing these disparities. I will take away the suggestion of using the regional network referred to by the noble Lord, but I am happy to say that research has also been commissioned by the Chief Medical Officer that we are taking forward to build a risk profile model for healthcare.
Lord Touhig (Lab) [V]
My Lords, I welcome the commitment to widen future Statements on the disparate impact of Covid to include people with disabilities. Yesterday, in a briefing organised by Sense, we heard from the parents of disabled children about the devastating impact that the sudden withdrawal of support services has had on their lives. The National Autistic Society, of which I am a vice-president, has also produced a report called Left Stranded, which makes similar points. I ask the Minister to examine the Forgotten Families campaign by Sense to reinstate community support, as well as looking at the Left Stranded report. Will she write to me setting out how the Government will respond to this cry for help from some very desperate families?
Baroness Berridge (Con)
My Lords, the noble Lord raises a very difficult issue. Many of us will have seen footage of the situation for many families when outside support was removed during the period of lockdown: it is incredibly moving, as well as incredibly distressing. The Government have tried to support families with children with additional disabilities—obviously, with a school place, if that was appropriate, and with more funds being given to the family fund. I will, of course, write as the noble Lord requests when I have received the report he mentions, and, as I say, I will draw it to the attention of Dr Emran Mian, who is doing the wider work on disparities and Covid.
Baroness Bennett of Manor Castle (GP) [V]
My Lords, in response to the Front Bench contributions, the Minister said we do not have evidence of the reason for these disparities. I am sure she is aware of the report published by Citizens Advice in June that nearly 1.4 million people in the UK have no access to welfare payments because they have a “no recourse to public funds” status. Research conducted by the Migration Observatory at the University of Oxford found that “no recourse to public funds” falls disproportionately on people in the BAME community. Some 82% of people who were helped with a “no recourse to public funds” issue by Citizens Advice in the last year were from a BAME background.
People with “no recourse to public funds” status have difficult choices: they have to risk exposing themselves or simply having no money. Is there not clear evidence that “no recourse to public funds” is discriminatory, and is indeed a structurally racist policy? Further, do the Government have, or are they planning to secure, data on the death and infection rates for people with “no recourse to public funds” compared to those for otherwise similar individuals?
Baroness Berridge (Con)
My Lords, noble Lords will have heard me earlier make reference to the fact that the children of many people who have “no recourse to public funds” have been able to access free school meals. The furlough scheme and the job retention scheme are not counted as public funds, so those in the category that the noble Baroness outlines were able to access them. No one in this country is charged for testing or treatment for Covid-19, and certain services, including primary care and A&E, are free to all. It is very clear that, if there are charges to be applied, treatment that is considered by a clinician to be urgent or immediately necessary must not be delayed or withheld. We have made essential healthcare available to all people who are within the boundaries of our country.
Lord Bilimoria (CB) [V]
My Lords, men have a higher risk of death and account for just over 70% of Covid ICU admissions. People with obesity account for more than 30% of those in intensive care. When it comes to ethnic minorities, Dr Chaand Nagpaul, the BMA council chair said:
“As we sit amid a second wave of infections, we know that about a third of those admitted to intensive care are not white—showing no change since the first peak.”
Some 15% of the population are from an ethnic minority, so this is double the proportion. Can the Minister explain the situation? Furthermore, the IPPR’s Dr Parth Patel, a research fellow, commenting on the government report said:
“The government should be acting to address the underlying structures behind ethnic disparities … Failure to act quickly will lead to thousands of unnecessary deaths during this second wave—this is about public health as much as it’s about racial justice.”
Does the Minister agree?
Baroness Berridge (Con)
My Lords, yes. As I have mentioned, one of the other factors in the disparity is that working-age men are more likely to die of Covid than working-age women. In relation to obesity, the Government published in July, I believe, the obesity strategy, and we are aware that dealing with that issue is important in terms of co-morbidities. We are working closely with PHE, the Office for National Statistics and the BMA, which gave the advice in relation to taxis and private hire vehicles which led to masks being made mandatory in those vehicles. Yes, we now know more about exposure: black and minority-ethnic people are in certain densely populated areas and multigenerational households, so we have been taking action to try to reduce the risk. We will continue to act going forward.
The Deputy Speaker (Lord Duncan of Springbank) (Con)
My Lords, all speakers have now spoken.