Written evidence submitted by Liverpool City Region Combined Authority Fairness and Social Justice Advisory Board (MRS0236)

Submission to the Women and Equalities Parliamentary Select Committee Inquiry on Unequal impact: Coronavirus (Covid-19) and the impact on people with protected characteristics, by the Liverpool City Region Fairness and Social Justice Advisory Board

The Liverpool City Region Fairness and Social Justice Advisory Board (FASJAB) was established by Metro Mayor Steve Rotheram as one mechanism to ensure that fairness and social justice are at the heart of the Combined Authority’s programme. It provides a voice for the full diversity of the communities of the city region, but particularly people with protected characteristics. Its role is to measure every policy, every service and economic initiative against the commitment to deliver a fairer and more equal City Region. As such the unequal impact of Covid-19 on people with protected characteristics in the Liverpool City Region is of particular concern to the Advisory Board, hence this submission.

Women

The Advisory Board is concerned by data identifying that women are more likely to work in the low paid and insecure positions in sectors most adversely impacted by Covid-19 and that, in common with the impact of 10 years of austerity, it is women that will disproportionately shoulder the economic impact of Covid-19. For example, 19% of women in Liverpool City Region work in a shutdown sector, compared to 16% of men (Learning and Work Institute). The IFS finds that low earners are seven times as likely as high earners to have worked in a sector that is now shut down. We know that many of these will be women and from an LCR perspective we also know that we have a greater proportion of jobs in lower paid roles likely to be disproportionately filled by women, compared to the national average, and that a high proportion of these roles are such that they cannot work from home in the interests of social distancing.

In addition women are disproportionately represented amongst the low paid key worker occupations that are on the front line of the Covid-19 pandemic, such as health and caring professions. They are therefore arguably exposed to a higher risk of infection, albeit more victims of Covid-19 are male.

School closures are likely to have a differential impact on women, who are most often the unpaid carers.

When women have less decision-making power than men, either in households or in government, then women’s needs during an outbreak of this magnitude are less likely to be met. The pandemic is therefore likely to magnify the impact of women being under-represented in decision making structures both locally and nationally.

Black and Minority Ethnic communities

Equally the Advisory Board is concerned by data identifying unequal impact on BME communities. For example, a BMG poll found that 46 per cent of BAME people reported that their household income had reduced as a result of coronavirus, against 28 per cent of white British households. Some 15 per cent of respondents from ethnic minorities said they had lost their job, compared with 8 per cent of white Britons.

Similarly with women, people from BME communities are disproportionately represented amongst the low paid key worker occupations that are on the front line of the Covid-19 pandemic, such as health and caring professions. They are therefore arguably exposed to a higher risk of infection, hence potentially the data finding that 35% of victims of Covid-19 are BME when they only make up 13% of the UK population. The prevalence of poverty-related underlying health conditions and the related issue of overcrowded housing conditions amongst BME communities also undoubtedly contributes to this statistic.

Where members of BME communities and others are victims of hate crimes and incidents, the Anthony Walker Foundation believes the current lockdown circumstances are highly likely to exacerbate feelings of vulnerability as well as isolation, fear and anxiety because of the difficulties of providing the level of emotional support that would be the norm. Hate crimes and incidents directed against people of Chinese origin, or who appear to be, are a particular issue at this time. Due to the port, the Liverpool City Region has one of the longest standing Chinese communities in the UK.

One group within BME communities being particularly impacted by Covid-19 are refugees and asylum seekers, who have lost most face-to-face support, may face language barriers to understanding what is happening, and are expected to survive at absolute if not less than subsistence.

Disabled people

Care providers have had a lack of PPE equipment to use, which has resulted in precarious working conditions. Similarly, people who require support and should be implementing shielding measures have had to rely on staff who do not have appropriate equipment. This will, undoubtedly, lead to higher risk of virus transmission.

Disabled people receiving personal budgets/personal health budgets, through direct payments, have not received any national guidance until week commencing 20th April 2020. Prior to this, individuals were not aware of how to acquire PPE equipment, nor how to organise their staff during the crisis and address any employment issues that arise. It is still not clear how disabled people can maintain existing levels of support if staff need to isolate for their own health. For example, if existing members of staff need to shield/isolate for their health, there is no indication as to how the disabled person can maintain existing levels of support. Clinical Commissioning Groups and Local Authorities are reluctant to increase disabled people's budget allocation needs for assessed needs, to ensure the individual can receive existing levels of support whilst also paying staff who are unable to attend work due to isolation measures.

Following the Coronavirus Act, the impact on Local Authorities and Clinical Commissioning Groups is deeply concerning. The "easements", which have been taken by number of authorities will have a detrimental impact on people's access to support. The Wirral Clinical Commissioning Group has suspended all new assessments and reviews, which means people with access to a personal health budget can no longer have their needs reviewed during the pandemic. Furthermore, those who would like to have an assessment for a personal health budget have no access to an assessment. The guidance from NHS England is that Clinical Commissioning Groups can suspend personal health budget offers if the Clinical Commissioning Group has no capacity to carry out this area of work. There is no guidance nor transparency as to how the decision can be made that a Clinical Commissioning Group does not have capacity to carry out personal health budget delivery. Esteemed scholars of disability law, such as Luke Clements and Oliver Lewis, have questioned the rationale of the Coronavirus Bill/Act suggesting measures make little or no sense economically or in protecting front line emergency staff.

One Local Authority has also sent out letters to some direct payment users, indicating that the allocated support for "socialisation" needs will be suspended. The rationale is that because people are social distancing, thus there is no need to provide support for people to participate and have access to social situations. Ensuring that people are not isolated during the pandemic is paramount, and disabled people need to have access to support (whether personal or through technologies) to maintain access to social networks.

There has been no guidance on how employers can meet reasonable adjustments of disabled people who are required to work from home. There has been no information from the government scheme: Access to Work, which helps disabled people to maintain access to the labour market.

The guidance for people who require support in their homes has been minimal, fragmented, and inconsistent. Little attention has been paid to people who require 24-hour assistance, and how to manage social distancing and shielding measures during this time. This is particularly the case when an individual has numerous members of staff coming in to their home throughout the day. Statements by parliamentarians and chief medical advisers has emphasised the importance of isolation, but it is framed as promoting self-sufficiency and independence. Disabled people require support in various forms continuously, and it appears they have been abandoned throughout the development of policies and proposals surrounding the pandemic. Much of the discussions have prioritised the need to "protect vulnerable people", and this provides little detail as to how disabled people should be supported, where to access support, and what happens if there is a health or care crisis. It is important to acknowledge that disabled people are placed in vulnerable situations, and the vulnerability that arises from this pandemic does so because of the political and economic decisions made by those in influential positions.

Local Councils for Voluntary Service have identified that some vulnerable people, particularly older disabled people, are struggling to access the support they need to stay shielded and are at risk of isolation, often linked to digital exclusion. This may result in them exposing themselves to risk of infection. At the same time those previously dependent on public transport are having to resort to using taxis, with the additional cost implications this entails.

Policy prescriptions

On the basis of the above evidence the Advisory Board recommends:

3 Week policy prescription – Local authorities need to be provided with greater and urgent financial support and the legislation should be amended to restore their duties, in order to ensure proper protection for the rights of disabled people.

– Government to produce statement and clarity on the importance of: prohibiting the denial of treatment on the basis of underlying health conditions, and identity as a disabled person. This is to ensure direct guidance can be disseminated to hospitals, GP practices, and clinical commissioning groups.

– Provide specific grants allocated to the region's universities, hospitals, civil society organisations and civil service, to develop research on the impact of the pandemic upon marginalised communities and those who identify with protected characteristics.

– Provide resources to allow the combined authority to carry out impact assessments and access audits of treatment facilities, such as hospitals, testing areas, and quarantine facilities. Also, provide funding to produce alternative formats of local health information and communication. This includes, but not limited to, easy read documentation, BSL translation, and Braille.
– Provide additional support to prioritise testing of individuals in institutions, group homes, and care homes in the combined authority region.

– Request automatic extension of soon to expire disability-related entitlements, to ensure disabled people in the local region have the necessary financial support to participate and engage in the local community.

– Provide financial compensation specifically to self-employed disabled people, who are currently entitled to support through existing schemes such as: Access to Work

– Provide financial support to employers in the region who need to provide additional equipment to disabled people in order to continue working. This is important because disabled people will be expected to continue "shielding"/social distancing beyond the initial release of lockdown measures.

– Collaborate with the combined authority to determine where there is concerns/gaps in the supply and access of medication.

6 month policy prescription – Equalities objectives should be enshrined in legislation with the government obliged to report to Parliament. This is even more vital now given the unequal impacts of Covid-19 in order to assess the effectiveness of both universal and targeted approaches to reducing inequality.

– Provide funding to carry out equality training of health workers, to prevent discrimination based on prejudice and bias of individuals with protected characteristics.

– Provide specific funding, and further resources, to establish a working group on understanding the barriers and impact of the pandemic on people living in institutions, group homes, and care homes in the combined authority region. This is also a significant point in time to further deinstitutionalisation strategies, to ensure disabled and older people who want to live in their own home, within the community, have the support, resources, and advocacy to do so.

– Provide specific guidance and expectations with regard to remote learning and accessible software for disabled students attending schools, colleges, and universities in the combined authority region.

– Provide funding for the combined authority region to establish sanitation services for homeless communities, including street level access.

- Efforts to improve women’s representation within local and national decision-making should be re-doubled, with commensurate objectives and reporting.

April 2020