Covid-19: Disparate Impact

Baroness Hussein-Ece Excerpts

Tuesday 27th October 2020 Lords Chamber

[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.