The Independent Scientific Advisory Group for Emergencies (SAGE) | July 3, 2020 | Disparities in the impact of COVID-19 in Black and Minority Ethnic populations: review of the evidence and recommendations for action
The question of why more people from black and ethnic minority (BME) backgrounds appear to be at greater risk of hospitalisation and deaths with COVID-19 – and the need for urgent action in order to address this – has become one of the most urgent issues in this pandemic in the UK. Our review of the evidence suggests that the reasons why some BME groups appear to be at greater risk of dying with COVID-19 are complex with interplay between socio-economic disadvantage in BME populations, high prevalence of chronic diseases and the impact of long-standing racial inequalities being key explanations. The Marmot Review in February 2020 highlighted that people from disadvantaged backgrounds or deprived areas, and BME backgrounds, were not only more likely to have underlying health conditions because of their disadvantaged backgrounds, but they were also more likely to have shorter life expectancies as a result of their socioeconomic status (including greater representation in poorly paid and insecure employment). Bangladeshi men and Pakistani women were identified as groups with the lowest life expectancy. Housing conditions, including overcrowding is also likely to have had an impact on vulnerability to COVID-19. Overcrowded households among BME populations are also much more likely to be multigenerational, making social distancing, self-isolation and shielding much more difficult, and increasing opportunities for within-household coronavirus transmission. We also know that ethnic minorities have been over-represented in key worker jobs during COVID-19: transport and delivery jobs, health care assistants, hospital cleaners, social care workers, taxi drivers, security guards, and in nursing and medical jobs. These occupations have been frontline jobs with increased the risk of exposure, infection and death. There have also been concerns that some of these occupations have been the last to receive supplies of personal protective equipment. Rates of mortality have also been higher in BME heath care workers. Racial inequalities has been a recurring theme with doctors and nurse surveys experiencing difficulty getting access to personal protection equipment. The long-awaited report from Public Health England on ‘Understanding the impact of COVID-19 on BME groups’ highlighted a pervasive concern among stakeholders: that the experience of racism, discrimination, stigma, fear and trust among black and ethnic minority communities, including key workers within the National Health Service, made BME groups more vulnerable to COVID-19.
It is also important to consider the social and economic consequences of COVID-19 on ethnic minority groups. There is considerable evidence that COVID-19 has amplified pre-existing inequalities. Bangladeshi, Pakistani, Black African and Black Caribbean men are all much more likely to have had jobs in shutdown industries, such as the restaurant sector and taxi driving. These communities are already afflicted with high rates of child poverty with nearly half of Black children and well over half of Pakistani and Bangladeshi children living in poverty. The COVID-19 pandemic is not just a health crisis; it is also a social and economic one, which in turn will also have a longer term impact on health. It is already clear that this burden of the pandemic is not equal across all population groups; we may all be weathering the same storm, but we are not in the same boat.
In this report, we make a number of recommendations to address the greater risk of adverse health outcomes in BME populations. These include recommendations with immediate impact on the course of the pandemic (to mitigate the differential risk of exposure, infection and transmission, and to inform local outbreak control strategies) and longer-term action to reduce health inequalities (Source: SAGE).
Scientific Advisory Group for Emergencies | May 2020| What are the options for the UK? Scientific Advisory Group for Emergencies:Recommendations for government based on an open and transparent examination of the scientific evidence
Here the Independent SAGE publishes its recommendations for government based on an open and transparent examination of the scientific evidence. The report focuses on the priorities for measures to be taken to support a gradual release from social distancing measures through a sustainable public health response to COVID-19. This will be essential in suppressing the virus until the delivery of an effective vaccine with universal uptake.
Recommendations from the report:
The government should take all necessary measures to control the virus through suppression and not simply managing its spread. Evidence must show that COVID-19 transmission is controlled before measures are relaxed. We detect ambivalence in the government’s strategic response, with some advisers promoting the idea of simply ‘flattening the curve’ or ensuring the NHS is not overwhelmed. We find this attitude counter-productive and potentially dangerous. Without suppression, we shall inevitably see a more rapid return of local epidemics resulting in more deaths and potentially further partial or national lockdowns, with the economic costs that will incur.
The government should refocus its ambition on ensuring sufficient public health and health system capacities to ensure that we can identify, isolate, test and treat all cases, and to trace and quarantine contacts. Quarantine should be for 14 days and not seven. The government must develop a clear quarantine and messaging policy which takes account of the diversity of experiences of our population, variations in household structures, and with appropriate quarantine facilities in the community. This should be accompanied by real time high quality detailed data about the epidemic in each local authority and ward area.
Government ministers, NHS bodies and their officials should adhere to the Code of Practice for Statistics and the UK Statistics Authority should reports breaches of the code. There is concern about inaccurate, incomplete and selective data presented by government officials at the daily PM press briefings. We recommend the involvement of statisticians responsible for analyses, and the Office for Statistics Regulation should publish further assessments of these data. The UK Statistics Authority, an independent body responsible for oversight of the statistics produced by the Office for National Statistics and other government departments and public bodies has a Code of Practice. The Code requires i) trustworthiness: confidence in the people and organisations that produce statistics and data, ii) quality: data and methods that produce assured statistics and iii) value: statistics that support society’s needs for information. It is vital the public has trust in the integrity and independence of statistics and that those data are accurate, timely and meaningful.
The government evaluates alternatives to complement conventional epidemiological modelling, such as dynamic causal modelling—e.g., via the expertise established by the RAMP initiative. Dynamic causal modelling (DCM) enables real-time assimilation of data quickly and efficiently to estimate the current levels of infection and ensuing reproduction rates (R). The computational efficiency of DCM may allow pressing questions to be answered; for example, would a devolved social distancing and surveillance policy—based on local prevalence estimates—be more efficacious than a centralised approach? In short, there is a pressing need to evaluate alternative approaches (and hypotheses) that may support real-time policy-making.
Recognising the centrality of human behaviour in virus transmission, the government should ensure that as social distance measures are eased, measures are taken to enable population-wide habit development for hand and surface disinfection, using and disposing of tissues for coughs and sneezes and not touching the T-zone (eyes, nose and mouth).
Outbreak risks must be minimised in high vulnerability and institutional settings. No-one should be discharged from hospital to another high-risk setting such as a care home without having been tested and found to be non-infectious. The government should rapidly invest in the elimination of transmission in the currently recognised “high risk” settings, including but not limited to social care and health service facilities, prisons and migrant detention facilities, homes with multiple occupancy, and households that are overcrowded or contain multiple generations. This includes staffing, testing, protective equipment and guidance for effective household isolation. Community facilities and requisitioned hotels are likely to be needed to house a significant proportion of infected people and their contacts.
Ensure preventive measures are established in workplaces, with physical distancing and support to enable personal protective behaviours. Health and safety regulations appropriate for COVID -19 suppression and adequate surveillance should be agreed with trade unions and other staff representatives, with sanctions that are large enough to deter unsafe practices. There should also be a facility for workers to report unsafe working conditions, with no victimisation for those using it.
There must be reform of the process of procurement of goods and services to ensure responsive and timely supply for primary and secondary care, and community infection control, in anticipation of a second wave of infection. This reform must take account of the documented challenges and failures of procurement over the last three months.
Managing the risk of importing cases from other countries, with consequent high-risk of transmission, is vital. This should be introduced as soon as possible, treating Great Britain and the island of Ireland as distinct health territories. We welcome the government’s recent commitment to establish a port control and quarantine strategy as an adjunct to other control measures. Managing the testing, thermal assessment, collection of contact details and quarantine facilities, such as requisitioned hotels, will be essential to stop imported cases.
Communities and civil society organisations should have a voice, be informed, engaged and participatory in the exit from lockdown. This pandemic starts and ends within communities. Full participation and engagement of those communities on issues such as childcare and public transport will assist with enabling control measures Conversely, a top-down approach risks losing their support and trust. We are deeply concerned about the effects of the infection and the lockdown on BAME, marginalised, and low-income groups. There is an urgent need for government to demonstrate such active participation from communities from around the country.
The government should take steps to ensure all children, irrespective of their backgrounds, have technology and internet at home, and where required additional learning support which does not rely on parents at home. The government should also ensure that resources are available for schools to conduct remote learning. access to The closure of schools due to the COVID-19 pandemic has caused unprecedented challenges for everyone involved – students, teachers and parents- but we are particularly concerned about the detrimental impact (and widening of educational inequalities) of long-term social distancing measures on learning for children from lower socio- economic backgrounds. Education is a human right which should not be compromised in the context of COVID-19.
The government must ensure that health and social care services are planned, strengthened, and prepared for future waves of infection while continuing to provide the full range of services to all. For health services, this will require planning to ensure there are capacity and resources to meet need safely and to resume elective services including hospital, mental health and community health services. For social care this will require having accurate data on all staff and needs of residents; making good the serious shortages in staffing, increasing qualified staffing levels, and ensuring all staff terms and conditions of services include full sickness benefits when they fall ill.
The government should rapidly strengthen the social safety net, including addressing low income benefits and housing, thereby ensuring protection of the most vulnerable in our population. It is now clear that COVID-19 has disproportionately affected older people, low income groups living in deprived areas, BAME communities, and those who are otherwise marginalised. We also note the over-representation of BAME communities as low paid care workers in health and social care settings which makes them vulnerable to COVD-19-related infection and deaths.
The management of often multi-organ COVID-19 disease has been based in hospital and ICU settings. Hospitals have had to radically alter non-COVID patient flows in order to deal with these pressures, and Nightingale facilities have also needed to be developed. There is clear evidence of increasing non-COVID mortality in association with the pandemic. The government should work with the Royal Colleges and professional societies to ensure that capacity and treatment guidance is updated and disseminated as evidence emerges.
There should be a re-evaluation of current plans to reduce overall hospital beds in the NHS per head of population and consider ICU bed and staffing requirements to provide future surge capacity. We also recommend a rapid engagement with primary care and community health settings to support those recovering from COVID-19 disease, and the sequelae, including mental health problems, as well as support to rapidly identify and manage future local outbreaks.
The government should urgently review and improve co-ordination in the response to the pandemic across the multiple bodies tasked with pandemic planning, both within England, including different government departments, the NHS, PHE, and local authorities, and others, among the Westminster and devolved administrations.
In order to underpin our recommendations, the future long-term management of the pandemic should be based on an integrated and sustainable public health infrastructure. The government has adopted a top-down approach with vertical structures for test and trace programmes. The over- dependence on outsourcing of key operational functions limits the sustainability of this approach. A more appropriate infection control response will require adaptation for local needs. Leadership from local public health and primary care professionals is essential. We do not specify which organisations should be responsible for these roles and functions as this will vary in the four nations of the United Kingdom but, in each of them, there should be a clear system map setting out responsibilities, accountability, and lines of communication.
In the longer term we recommend that legislation to enable an integrated National Health and Social Care System for England is considered, along the lines of the NHS in Scotland and Wales and the integrated NHS and social care system of Northern Ireland.
The Independent SAGE will continue to meet to consider some of these specific recommendations and to offer constructive solutions to government to ensure that the coronavirus is suppressed, that lives are saved and that the economy is able to recover as rapidly as possible.
Royal College of Obstetricians and Gynaecologists | March 2020 | Each Baby Counts: 2019 progress report
The Royal College of Obstetricians and Gynaecologists has published its progress report for 2019: Each Baby Counts: 2019 progress report.
The Each Baby Counts is a national quality improvement programme that collates the results of local investigations into stillbirths, neonatal deaths and brain injuries occurring during term labour to understand the bigger picture, share the lessons learned and prevent babies from dying or suffering brain injuries in the future.
This report presents key findings and recommendations based on the analysis of data relating to the care given to mothers and babies throughout the UK, to ensure each baby receives the safest possible care during labour.
BMA | February 2020| Supporting a healthy childhood: the need for greater investment in services in England
BMA has published its reportSupporting a healthy childhood: the need for greater investment in services in England. The BMA’s analysis of recent data highlights insufficient investment in England across a range of services to support a healthy childhood, with funding for a number of different services being cut in recent years. This lack of resource is likely to have an adverse impact on child health in England.
The report includes:
Analysis and findings of spending on children’s social care in 2019/20
Recommendations for a cross-government ‘healthy childhood strategy’
Recommendations to reverse budget cuts to children’s services in England
NHS Confederation | January 2020 | Equipped for Success? What clinical directors need for effective primary care networks
Equipped for Success? What clinical directors need for effective primary care networks is a new report from the NHS Confederation that outlines 3 key areas for action if primary care networks are to succeed. These are:
NHS Providers | October 2019 |Providers are delivering and here’s how
NHS Providers is launching a major new programme of work, Providers deliver, to celebrate and promote the work of NHS trusts and foundation trusts in improving care.
At the core of this rolling programme is a new publication series. The first of these biannual reports focuses on how trusts have responded to feedback from the Care Quality Commission (CQC) in a positive and systematic way, encouraging great ideas that have made a difference for patients and service users.
It is striking that whereas in 2014, over half (68%) of trusts were rated ‘requires improvement’ or ‘inadequate’ by CQC, in 2019, the majority of trusts (59%) are now rated ‘good’ or ‘outstanding’ Between August 2017 and August 2019 the number of trusts rated ‘outstanding’ by CQC increased from 14 to 24 and the number rated ‘good’ increased from 96 to 107.
The report Providers deliver-batter care for patients demonstrates how – in difficult circumstances – trust leaders and staff are coming up with ideas and solutions to deliver better care. We will develop this approach in future publications, alongside work to promote these achievements in our media and stakeholder engagement, through a range of channels including social media, our website, and our networks (Source: NHS Providers)
Skills for Care Workforce Intelligence | October 2019 | The State of the adult social care sector and workforce
Skills for Care Workforce Intelligence have published a new report, the report looks at the adult social care sector and workforce in England. The State of the adult social care sets out the CQC’s assessment of the state of care in England in 2018/19. Using data from CQC inspections and ratings, to inform judgements of the quality of care.
The report indicates that quality ratings have been maintained overall but people’s experience of care is determined by whether they can access good care when they need it.
World Health Organization | October 2019 | World report on vision
The World Health Organization (WHO) has published its World report on vision, this report provides evidence on the magnitude of eye conditions and vision impairment globally, draws attention to effective strategies to address eye care, and offers recommendations for action to improve eye care services worldwide. The key proposal of the report is for all countries to provide integrated people-centred eye care services which will ensure that people receive a continuum of eye care based on their individual needs throughout their lives (Source: WHO).
Royal College of Psychiatrists | September 2019 | Choose Psychiatry: Guidance for medical schools
The Royal College of Psychiatrists has explored the factors that make an impact on medical students’ views and experiences of psychiatry while at medical school. They have now published guidance- Choose Psychiatry: Guidance for medical schools to provide medical schools with advice on how to enhance medical students’ experience of psychiatry.
The report identifies four key areas for action:
Excellence in teaching
Leadership from psychiatrists in undergraduate education
Health Quality Improvement Partnership | September 2019 | National Maternity and Perinatal Audit (NMPA) clinical report 2019
The Health Quality Improvement Partnership (HQIP) The National Maternity and Perinatal Audit (NMPA) aims to improve the treatment of mothers and babies during their stay in a maternity unit by evaluating a range of care processes and outcomes in order to identify good practice and areas for improvement.
This clinical report presents measures of maternity and perinatal care based on births in English, Welsh and Scottish NHS services between 1 April 2016 and 31 March 2017. It builds on the NMPA’s previous report from 2015/16 with some additional measures. It highlights areas that require monitoring, in particular around induction of labour, timing of birth and timely delivery of babies that are small for gestational age (Soruce: HQIP).