Written evidence submitted by the Borough of Lewisham (MRS0267)

The unequal impact: Coronavirus (Covid-19) and the impact on people with protected characteristics [London Borough of Lewisham Submission]

I write regarding the above-mentioned Parliamentary Inquiry and in response to the Women and Equalities Committee Call for Evidence.

As this submission is being made, the social and economic impact of COVID-19 is still being felt across the country. At the same time, courageous efforts continue to be made by brave health service professionals and other key workers to reduce the spread of infection and save lives.

Much as the pathology of COVID-19 is indiscriminate, what has also become clear is that certain sections of society are at greater risk of infection than others. As a borough that celebrates its demographic diversity, Lewisham is particularly concerned at the way in which the pandemic is impacting upon our communities. We now better understand that factors such as how many people live in a household and even the industry in which a person is employed, can increase their risk of infection.

It is critical that we seize this opportunity to learn lessons so that we can better mitigate future risks and protect vulnerable communities.

Lewisham looks forward to being part of this process of learning and in response to the Committee’s Call for Evidence, I attach the Council’s submission.

Introduction Lewisham Council is a public body located in south east London. The Council serves a population of 303,5001 residents and 133,000 households. By population size, Lewisham is the 14th largest borough in London and the 6th largest in Inner London2. The role of the local authority is to promote the social, economic and environmental wellbeing of the borough and its residents.

The London Borough of Lewisham is an administrative body. Our directly elected Mayor, Damien Egan, serves the whole borough and 54 elected Councillors serve the borough’s 18 wards (three for each ward). The Council is the largest employer in the borough, employing some 2,000 staff of which 51 per cent live locally3. In addition, the Council is a provider and convenor of public services.

For Lewisham, the rationale for making this submission is simple; we believe that the process of learning lessons from COVID-19 starts now, not at some point in the future. We also believe that it is important to recognise that there are indeed specific communities that face greater exposure to risk than others and that the ‘next wave’ of COVID-19 could well be the long term socio-economic harm that is visited upon those whose circumstances make them most vulnerable as well as those who have now become vulnerable as a result of COVID-19. As such, thinking and planning as to how best to mitigate the above mentioned risks must be at the forefront of the Government’s thinking as it co-ordinates its short, medium and long term response to the pandemic. How people have been affected by the illness or the response to it

The effects of COVID-19 on Lewisham’s population have been similar to those in boroughs elsewhere. Lives have been significantly disrupted as people infected by the virus have self- isolated, been admitted to hospital or tragically lost their lives. Businesses and schools have been closed and opportunities for people to enjoy social recreation with friends and family or fulfil religious observances have been significantly curtailed. There are also the obvious changes in behaviour that have been occasioned by the social distancing guidelines and the various restrictions that have been placed on the free movement of individuals.

At the time of making this submission, there have been more than 850 confirmed COVID-19 cases in Lewisham4. The current rate at which COVID-19 cases are being confirmed in the borough is above both the London and Inner London averages. In total there have also been over 200 COVID-19 related deaths in Lewisham5. Of these the vast majority of deaths (more than 170) have occurred at Lewisham Hospital, with smaller numbers of deaths occurring in the community and in care homes.

At present, Lewisham Public Health are seeking access to NHS data containing demographic information for COVID-19 cases that are hospitalised at University Hospital Lewisham, to build a local picture of any disproportional impact of COVID-19 on protected characteristic groups.

It is hard to characterise any issues that have arisen as a result of COVID-19 as Lewisham specific, although there may be issues that are common to boroughs with a similar demographic profile and these are explored further in this submission. As knowledge of the virus has developed, it has become clear that its pathology is quite unpredictable. There are those who experience severe symptoms and life threatening consequences and there are those who seem to be asymptomatic. Then there are those who have underlying conditions and are able to recover from the virus and those who appear not to have underlying conditions, who sadly succumb to it. For the most part, the impact of COVID-19 locally appears to be broadly consistent with elsewhere in London and across the country. Lewisham residents are understandably anxious and uncertain. However, despite the upheaval, they are also patient and resilient.

Equally, although there are no quantifiable measures of assurance, anecdotal evidence suggests that Lewisham residents have been broadly compliant with social distancing guidelines and are observant of the various restrictions placed on the movement of individuals. Clearly, we have noted exceptions to this, with the recent Easter break being a specific example.

There have also been less tangible issues that have been clearly manifested such as the fear and anxiety of individuals. This was perhaps most clearly demonstrated in anticipation (and during the very early stages) of the nationwide ‘lockdown’ and was evidenced by panic buying and the artificial scarcity of goods in local supermarkets. In recent weeks however, this issue appears to have settled down somewhat as local shops have introduced their own protocols including controlling the number of people accessing their establishments at any one time and designating shopping times for specific groups such as older people.

Broader impact and response The ways in which COVID-19 has impacted Lewisham residents is evident in the various concerns that have been raised by those calling the Council’s COVID-19 helplines. The help-lines which the Council has set up have taken more than 1,200 public enquires to date. A number of those calls are from residents who have raised queries about issues including the following:

 Whether their child will still be able to access free school meals  Financial support for those who have lost their jobs or are self-employed and unable to work  Support for those without close family or friends and who are living alone  The length of time that schools will be closed  The rights of tenants who may be facing eviction by their landlord  Advice for those who want to volunteer and help

On its part, the Council has acted quickly to re-purpose its entire function in response to the needs of local residents for information and to ensure that our hospitals are supported, capacity is created by ensuring discharge at the earliest opportunity and the needs of the borough’s most vulnerable residents such as older people living in care homes and vulnerable children and young people are safeguarded, as well as ensuring that staff working in social care services have access to Personal Protective Equipment.

These concerns have informed the Council’s emergency planning response. For example we have called for volunteers from across the various services in the Council not directly involved in the Council’s response to COVID-19. To date more than 170 members of staff have responded and dozens have been deployed to critical service areas.

Across the Council, our services have remained resilient in the face of the current pressures and demands of COVID-19. However, we are mindful of factors that sit outside of our control such as disruption to the local government supply chain, which has affected access to essential goods such as personal protective equipment, hand sanitizer and other essential items. The Council is working hard to address these challenges alongside other local authorities and with central government.

If there have been specific impacts on people due to them having a protected characteristic

Exposure to risk

Disaggregated data for COVID-19 related deaths is limited. Nationally with the exception of age, gender and those with underlying conditions (a proxy for disability), the availability of lower layer reporting on the impact of COVID-19 on protected groups, is patchy.

For those with underlying conditions, a particular concern for Lewisham is the fact that the borough performs significantly worse than London and England across the following measures: mortality rate from all cardiovascular disease6, estimated diabetes diagnosis rate7, childhood obesity (including severe obesity)8 and tuberculosis incidence rate9. By implication therefore, Lewisham residents with the above conditions could face an increased risk of COVID-19 infection, compared to residents in other boroughs who present with the same conditions and where performance against the above measures is better or in line with regional and national averages. In respect of the now widely reported impact of COVID1-9 of BAME communities, where data is available, it does seem to suggest that the pandemic has had a disproportionate impact. As a case in point, the Intensive Care National Audit and Research Centre found that 34 per cent of more than 4,800 critically-ill patients with COVID-19 identified as black, Asian or minority ethnic. This is despite the fact that only 14 per cent of people in England and Wales are from ethnic minority backgrounds, according to the 2011 census.10

We are also mindful that there are other metrics that may suggest that Black and Minority Ethnic Communities in Lewisham face a higher risk of exposure to COVID-19 than their White counterparts. In total, some 46 per cent of Lewisham’s population is of BAME heritage.11 However, in terms of households where there is great propensity for over- occupancy, some six in ten Lewisham households with one fewer room/bedroom than required are BAME, compared to four in ten that are White12. Across London, Lewisham has the sixth highest rate of household overcrowding, with nearly one in ten households in the borough considered to be overcrowded against the Bedroom Standard. Nationally, Lewisham ranks 13th out of 326 (1 equals high) local authority areas in England in terms of relative deprivation affecting ‘barriers to housing’13 (which includes a specific measure on household overcrowding).

Although socio-economic status is not a characteristic protected by the Equality Act of 2010, we are mindful that socio-economic inequality is very much part of the lived experience of many of those who reside in our borough. We are also mindful that socio-economic status, particularly as it relates to sector of employment, may increase exposure as it relates to the risk of COVID-19 infection.

As a case in point, compared to London, Lewisham has a higher proportion of residents working in the ‘human health and social work’ sector14 (18 per cent) compared to the average for London (10.3 per cent) and Great Britain (8.9 per cent). A higher proportion of Lewisham residents also work in the ‘accommodation and food’ sector (9.1 per cent), compared to the average for London (8.4 per cent) and Great Britain (7.6 per cent). In addition, a higher proportion of Lewisham residents work in the ‘wholesale and retail’ sector (13.6 per cent) compared to the average for London (12 per cent).

The over-representation of Lewisham residents in the above ‘front-facing’ occupations suggests an increased exposure to risk of COVID-19 infection compared to those employed in the same sectors in London and Great Britain. A specific example of the risk to protected characteristics is the fact that 75 per cent of those employed in the ‘human health and social work’ sector in Lewisham are women of which 54 per cent are also BAME15. As proportion, people of BAME heritage also represent 53 per cent of all those employed in the above- mentioned sector in Lewisham. Another way to look at it is to say that women employed in the ‘human health and social work’ sector may face a greater risk of exposure to COVID-19 infection than men, employees of BAME heritage working in the above mentioned sector may face a greater risk of COVID-19 exposure than those who are White and women of BAME heritage, working in the same sector, may face a greater risk of COVID-19 exposure than their White female counterparts.

Lewisham understands that a dedicated Government inquiry will be looking at the disproportionate effect of COVID-19 on the BAME community. However, we would strongly recommend that the Select Committee accept Lewisham’s recommendation that BAME death data must be captured going forward, so that local authorities and other public agencies are able to measure the scale of the problem, consider appropriate responses and target effort accordingly.

Lewisham has one of the smallest economies in the capital (contributing about 2 per cent of London’s output).16 There are 66,000 employee jobs in the borough of which 62 per cent are full time (73 per cent for London) and 38 per cent are part time (27 per cent for London). Average gross weekly pay17 (£654) in the borough is lower than the London average (£699). As such, contraction in the Lewisham’s economy resulting from business closures and potential job losses will impose particular hardships on the borough and its households. This could be further compounded by recession in the wider London economy, where Lewisham exports some 60 per cent of its workforce each day.

In addition to the above, Lewisham has a high proportion of small and micro-business (91 per cent) compared to the average for London (87 per cent). In total there are some 10,300 businesses in the borough employing less than 9 people.18 It is also worth noting that a higher proportion of small businesses operating in Lewisham are run by the BAME community. We are understandably concerned about the resilience of our economic base and the impact on those who are currently employed in micro-enterprises in the borough.

The above socio-economic impact is already being observed in the data that the Council is seeing in the number of those who have self-referred for emergency food aid. To date, more than 3300 people have made requests to the local authority to assist with food aid and in response more than 3,100 food packages have been delivered.19

Other impacts

Some 76 per cent of Lewisham’s schools population,20 69 per cent of all referrals to Children’s Social Care and nearly 70 per cent of all Children Looked After by the local authority are of BAME heritage.21

For pupils attending Lewisham schools there is a specific issue relating to the Government’s decision to close all schools and the way in which the Office of Qualifications and Examinations Regulation (Ofqual) proposes to determine the outcome of this year’s GCSEs and A levels (using predictive grades) and the possible implications for BAME students. In an open letter to the Secretary of State for Education22 published on 5 April, the Runnymede Trust set out that predictive grades can disadvantage BAME pupils, who tend to perform better in external exams. The above position is supported by Lewisham’s BAME Network, in its own letter to the in April 2020.

With schools closed, more children and young people face the risk of being exposed to domestic abuse in their homes, either directly or more likely through witnessing adults in abusive situations. The impact of poverty (more than three in 10 children under 16 live in below income households in Lewisham), fear, lockdown in confined spaces and increased use of alcohol and drugs are all likely to be factors contributing towards this. However, the consequence could mean that more children need to be placed on the child protection register, require Child and Adolescent Mental Health therapy due to trauma and lockdown or are brought into care as a result of neglect. It is worth noting that some of the children who are vulnerable to the above factors may not be known to the local authority currently and, whilst schools are maintaining contact with all pupils through this difficult period, the impact of lockdown on them and their families may not be evident. As such, therefore, some vulnerable children may not be covered by the Department of Education’s designated list of vulnerable groups.

Whether there may be unforeseen consequences to measures brought in to ease the burden on frontline staff, for example relaxing the measures under the Mental Health Act and Care Act)

There are no specific consequences that are foreseen as a result of the introduction of the above measures. Lewisham is content to re-valuate this in due course. There have been no Care Act easements applied to date and based on evidence to date it looks unlikely that this will be deemed to be necessary. Some Mental Health Act assessments have taken place using “virtual meetings” in order to reduce risk of harm to service users and staff. We know that BAME males are over-represented in the cohort of people who present in mental health crisis. To date there is no evidence that this has changed.

Conclusions

Whilst it continues to play out, it is clear that the impact of COVID-19 on the health and well-being of Lewisham residents, its impact on our local economy and the disruption to the normal pattern of everyday life of the boroughs households has been huge. As set out in this submission, these effects are not just immediate, but also likely to be long lasting in terms of severity and scale.

In addition to the above, there has been a major impact upon Council finances, with Lewisham spending significant sums of money to tackle the outbreak. Going forward, this has implications for the various services that vulnerable residents rely on, which we are asking the Government to fund. It is therefore essential that the Government reflects this reality in the programme of support extended to local authorities in the immediate and longer term. This will help to ensure that the COVID-19 recovery phase can be managed effectively.

April 2020

References

1 2018 Mid-Year Population Estimates, Office for National Statistics 2 ibid 3 Lewisham Employee Profile 2018-19 4 Public Health England https://coronavirus.data.gov.uk/#local-authorities 5 London Borough Lewisham Registrars Service, March - April 2020 6 Public Health England (based on ONS source data), November 2019 7 Public Health England, February 2019 8 NHS Digital, National Child Measurement Programme, December 2019 9 Office for National Statistics, August 2019 10https://www.bbc.co.uk/news/uk-politics-52405243) 11 2011 Census, Office for National Statistics 12 ibid 13 English Indices of Multiple Deprivation 2019 14 NOMIS, 2018 15 2011 Census, Office for National Statistics 16 Interdepartmental Business Register, October 2019 17 NOMIS 2019, Annual Survey of House and Earnings 18 Interdepartmental Business Register 2019 19 London Borough of Lewisham [‘the number of people contacting food aid organisations/ local authority requiring support’] submission to London Command April, 2020 20 Lewisham School Census 21 London Borough of Lewisham - Monthly Report Children and Young People Characteristics, February 2020 22 Runnymede Trust https://www.runnymedetrust.org/blog/predicted-grades-bme-students-letter-to-ed-sec