MUSLIM COUNCIL OF BRITAIN−WRITTEN EVIDENCE (PSR0108)

In its explanatory notes, the House of Lords Select Committee on Public Services stated its desire to gather experiences of the Public Services during the Covid-19 crisis, particularly from those working in frontline services. The Committee also noted its intention “to take evidence from hard-to-reach groups and individuals with experience of accessing services during the Covid-19 outbreak.”

The Muslim Council of Britain (MCB) is grateful to the Select Committee for its extension of the deadline for submissions to 27th July 2020. The scope is taken as covering publicly funded bodies, delivering a public or government service (central and local, and including public corporations under their control) but not as a ministerial department.

Background

Muslims in Britain form the second largest faith community, numbering 2.7 million, or 5% of the population (2011 Census). The majority (76%) live in the inner-city conurbations of Greater , West Midlands, North West and Yorkshire and the Humber.

The MCB is a national umbrella body with over 500 , educational, charitable associations and professional networks affiliated to it. It includes national, regional, local, and specialist Muslim organisations and institutions from different backgrounds within British Muslim civil society, reflecting its diversity of ethnicity, language, culture and schools of thought.

Introductory comments

Britain’s faith institutions – that include about 1,200 mosques - have fulfilled a crucial role in safeguarding communities during this crisis and have emerged as an essential partner of public service delivery bodies at national and local level.

For example, UK Government called for the closure of all places of worship and imposed lockdown measures across the UK on 23 March 2020. However, the MCB had taken steps earlier, on 16 March, to strongly recommend to its network of affiliated mosques the temporary suspension of all congregational activities. This was widely taken up and has since been followed up by the MCB and its affiliate, the British Islamic Medical Association (BIMA), in numerous and on-going regional and national online briefings. The faith sector can reach out to the population promptly and effectively because it is a trusted voice with established lines of communication and networks that have grown in an organic way over the decades.

Given the day-to-day evolving picture on what is known of Covid-19 and its societal impact, this submission should not be seen as offering any definitive answers to the questions posed by the Committee, but a snapshot of ‘voices from the grassroots’. Moreover, the MCB is still in the process of collating data on the various efforts of its affiliates in providing services of public benefit, either to complement the public services, or to step in where there have been shortcomings or shortfalls in delivery.

With these provisos, this submission provides responses to a subset of the questions posed by the Select Committee from:

I. Carers and Care organisations II. Professionals in public health, and primary and secondary care services III. Policy Analyst in the MCB IV. Voluntary Sector Muslim civil society organisations – ten case studies of public benefit work

Some of the responses obtained overlap in content, offering different perspectives. Concluding observations and reflections are provided at the end.

I. Carers and Care organisations

What have been the main areas of public service success and failure during the Covid-19 outbreak? [HoL Committee Q. 1]

How have public attitudes to public services changed as a result of the Covid-19 outbreak? [HoL Committee Q. 1] Source Response Unpaid carer In May 2020, my local Council phoned me to ask me how I was coping with providing care. This was a good step and helped my morale. I was asked whether I needed face masks. A delivery was promised. It is now two months, and this has not come. Housing consultant & board What is clear is that community based member of housing organisations like some of the ones I associations with care home work, represent and am engaged with services (Manningham Housing Association, Unity Home & Enterprise, The Popda Society, Mount Cricket Club), are vital to ensure that there is two way communication as we have earned the trust of the communities and reassure them at a time of national crisis and therefore an essential partner to government and its agencies. The government has just adopted to date a one size fit approach which is not having the right impact amongst certain BAME communities.

Perhaps the biggest contribution we can make is speak up and communicate on behalf of our communities and raise the concerns and deficits in provision, PPE etc [that occurred in May 2020]. This is where we need to pull our effort to get the message back to government and its various agencies and partners.

Given the number of cases of Covid-19 and fatalities in the social care and independent living sector for older people, I am concerned that after all this is over or at least under control, that the perception and reaction from the BAME communities towards older person specific accommodation with care and support and provision might be viewed negatively given the high number of Covid-19 related deaths, yet it’s essential given the MCB research to reduce loneliness, isolation and economic hardship, that these perceptions are corrected. GP with special interest in Excess burden of illness in the Muslim elderly and palliative care and community and restrictions on hospital chair of community-led visitation policies resulted in ill patients organisation not wanting to go into hospital. They wanted to be cared for at home. This placed increased pressure on family members. There is stigma around care homes in the Muslim community, and this has not been helped by data which shows that despite making up 3% of the population of care homes, BAME care home residents made up approximately half of all care home deaths

II. Professionals in public health, and primary and secondary care services From a Public Health Response delivery perspective What have been the main Successes: areas of public service London was the epicentre of early success and failure during stages of the pandemic in the UK. the Covid-19 outbreak? Excess deaths and provision of allied services was well co-ordinated [HoL Committee Q. 1] (Logistics Cell) which involved participation of multidisciplinary Did resource problems or stakeholder groups that included capacity issues limit the coronial services, Metropolitan Police, ability of public services to funeral directors, cemetery operators, respond to the crisis? Are community and faith representatives. there lessons to be learnt The multidisciplinary stakeholder group from the pandemic on how worked collaboratively to address resources can be better issues such as storage, transport, PPE, allocated and public service infection control, real time sharing of resilience improved? resources and experience. The National Burial Council played a significant role [HoL Committee Q. 3] in representing the Muslim community.

Failures: Confusion about testing: An emergency national Public Health Laboratory Service, created in 1940 as a response to threat of bacteriological warfare, was converted to a Public Health Laboratory Service (PHLS) by an Act of Parliament 1946. The 50+ laboratories that were co-located and integrated with local NHS hospitals across the country provided a public health focus, well placed to participate in local and national public health response. Since the replacement of the PHLS by the Health Protection Agency (HPA) in 2003 and later by the PHE (2013), this important public health response capacity has been lost. The PHLS existed to provide the essential service to respond to outbreaks like Covic-19. It is hoped the Select Committee will consider recommending the reintroduction of dedicated public health microbiological services at local/regional level.

Pandemic preparedness: Following experience with the H1N1 influenza pandemic of 2009, UK developed its Influenza Pandemic Preparedness strategy (2011), the PHE Pandemic Influenza Strategic Framework (2014) was established. There is a need to assess to whether the strategy was implemented appropriately or was it not fit for purpose. Is an “Implementation Strategy” needed?

Infection control advice: Making people follow advice requires behavioural changes. Its dissemination and effective implementation require clear, precise and authoritative public messaging. Unfortunately, this has not been the case in the two important areas: wearing of masks and testing for the virus. There has been an appreciable dent in confidence.

Messaging: This could have been better and better directed for the communities (socially, culturally). Messages were often confusing – civil society devised innovative methods – need to acknowledge their role and work more closely with them, co- production, cobranding approaches

Lockdown: No strategy/criteria for easing lockdown.

Access to services: Accessing non- Covid related health services was difficult – need to assess to what extent this contributed to spread of infection in the community (e.g. care homes/carers; increase in pool of vulnerable in lockdown situation). It was difficult for some to get through the over-stretched 111 NHS line. There was confusion about who to contact- GP, 111 or 999. There have been delays with patients seeking advice on cancer and cardiovascular conditions/symptoms with a 50% reduction in presentation for heart attacks reported by some Trusts. Diabetes control and obesity levels have worsened; there were no proactive preventative programmes implemented to mitigate the impact on non-communicable disease Have public services been Vulnerable children: I think these were effective in identifying and well covered – I am aware that for meeting the needs of certain groups of children (e.g. special vulnerable groups during need), appropriate arrangements were the Covid-19 outbreak? For made, and appropriate advice/support example, were services given. able to identify vulnerable Adults with complex needs: Either did children during lockdown to not receive appropriate support or ensure that they were they were not fully aware of where to attending school or seek such support or what was receiving support from available. Disability: Almost two statutory services? How thirds of people who have died have adults with complex because of Covid-19 had a disability. needs been supported?

[HoL Committee Q9] Were groups with protected People living in areas of high characteristics (for deprivation (with high level of example BAME groups and comorbidities) have suffered most. the Gypsy, Roma and The pandemic has highlighted the Traveller community), or effect of failure to respond to (or people living in areas of address) recommendations in deprivation, less able to successive reports/commissions on access the services that health inequalities - the most recent they needed during and authoritative one – Marmot lockdown? Review 2010 - highlighted that inequalities are preventable: need to Have inequalities address social determinants of ill worsened as a result of the health (housing, employment, living lockdown? If so, what new conditions and the environment in pressures will this place on which a child is born determines public services? his/her life expectancy. Marmot considers life expectancy at birth as a [HoL Committee Q. 10] barometer or scale of health inequalities. Sadly, Marmot Review ten year on (Feb 2020) reported no changes over the decade. In fact, conditions had worsened in some areas. The selectively worse outcome in BAME and/or faith communities (well demonstrated by PHE’s disparities review) was predictable and preventable if Marmot principles had been implemented. There is now urgent need set up systems to address health inequalities and associated social determinants There is no data on disaggregated ethnicity or faith on vulnerable groups. Race and religion are protected characteristics. This data must be available across the clinical journey: at testing and surveillance, primary and secondary access and death certification. This is essential to monitor barriers to access and unequal outcomes. The pandemic has exposed disproportionate rates of transmission and fatalities among certain ethnic groups. The growing levels of disparity that BAME communities face – particularly as we confront an unprecedented economic downturn – have fuelled simmering tensions over racial injustice in the UK

Are there lessons to be Yes, this applies at all levels both for learnt for reducing healthcare and social care sectors, and inequalities from the new also the housing sector. Need to look approaches adopted by at this as a systematic failure by policy services during the Covid- makers as well as local providers. 19 outbreak? Need to develop (cultural and faith sensitive services) pertinent/fit for purpose to the geographical area of [HoL Committee Q 11] their responsibility. This is what local governments are for. Emphasis on local government – their role and accountability, education and training of local representatives. Better and effective use of community engagement. Develop effective, meaningful partnerships. Voluntary community and faith-based organisations have shown their potential and appetite to contribute. This should be harnessed. They need to be provided with appropriate funding to undertake such work. For housing there is an opportunity for change. This is long overdue as the system continues to perpetuate disparities and inequality in housing provision and access to BAME communities who are:

• over-represented in insecure private rented sector accommodation • more likely to be overcrowded and experience poor housing conditions impacting health • three times more likely to be over- represented in the most deprived local authority areas • three times more likely than white households to experience homelessness • twice more likely to be unemployed

What does the experience Little is known about a good patient- of public services during centred NHS project the Rapid the outbreak tell us about Response Service (Hillingdon) that we services’ ability to had experience of during the lockdown collaborate to provide period. This involved home visits by “person-centred care”? trained multiskilled senior healthcare professionals and follow up providing

an excellent person-centred service. Extension of such an approach is highly recommended. Faith and culturally-aware care key components of patient-centred care; there is little guidance and training for health and social care professionals on adequate cultural and faith competency. Community based medical groups issued guidance to healthcare professionals e.g. fasting for staff and patients during Ramadan and end of life issues. Restriction on hospital HoL Committee Q. 15] visitation policies during Covid19 is an example where person-centred care was not taken into consideration and created a barrier for patients accessing care. Chaplaincy services in hospitals were also restricted. This created psychological distress for patients and relatives. There should have been better planning around these issues through consultation with community-based faith and medical groups.

Can you provide any Civil society and faith-based examples of how public organisations took a leading role in services worked effectively addressing faith and culturally with a local community to sensitive aspects and offering support meet the unique needs of to the bereaved. the people in the area (i.e. e.g. MCB and National Burial Council taking a “place-based work within the communities – can approach” to delivering provide link to the guidance etc. services) during the Covid19 outbreak?

[HoL Committee Q. 18] Would local communities Yes, there needs to be a completely benefit from public services different approach to hospital care and focusing on prevention, as to social and preventive care. opposed to prioritising The essential role of local harm mitigation? Were governments working in meaningful some local areas able to collaboration with local communities must be recognised and the necessary reduce harm during resources should be made available. coronavirus by having The inequalities can be addressed only prevention focused public by differential arrangements to suit health strategies in place, the local needs. for example on obesity, Local governments must be substance abuse or mental empowered, and a robust monitoring health? system should be established to ensure implementation. HoL Committee Q. 19]

Better integrated into local There is a wealth of talent and systems going forward? professional experience in the community willing to do their bit. HoL Committee Q. 20 Many, if not all, of the recently retired are happy to do their bit for the society. May be a call for national service to contribute in the area of their expertise. Governments should listen and benefit from their experience. They are better placed to reflect on their in-service experience and advice Community engagement should be at the heart of any development programme. The enthusiasm of community organisations and community leaders and ‘community champions’ should be is an asset waiting to be tapped. Most of these groups work on voluntary or charity basis – given appropriate training and capacity building they provide an invaluable resource that can help/fast track integration of local systems/services. Voluntary sector faith based medical organisations issued numerous guidance and toolkits and educational webinars on supporting local communities. Public services must work with these organisations and provide adequate funding and resources. Most of the time when community organisations are consulted, this is on a pro bono basis, with larger public/third sector organisations absorbing all the funds. These unethical and unequitable arrangements under the guise of collaboration must be eliminated

From a primary and Response secondary health care perspective – (i) MCB affiliate, the British Islamic Medical Association (BIMA); the Muslim Doctors Association (MDA) Successes: • Building of emergency hospitals What have been the main at pace. areas of public service • Rapid integration of technology success and failure during in healthcare services to allow the Cov remote care. Covid-19 outbreak? • Development of Escalator Care Centres and then rapid HoL Committee Q.1 translation of these into centres for Visiting and Triage (West London GP Federation). • Prompted Muslim doctors to publish an extensive evidence- based guidelines for Muslim patients fasting in Ramadan. Failures: • Poor communication and mixed messages from authorities that have often caused confusion. • Poor and ambiguous guidance/policy, often not applicable to all communities. • Poor cross-border communication with devolved nations. • Reliance on voluntary organisations to clarify guidance for communities, without funding or resources. • A very reactive approach by authorities. • Lack of protective measures for frontline staff/and care homes. • Lack of prudent investigation into factors causing high BAME deaths, and subsequent lack of urgent action to redress these disparities. • Expired and poor-quality PPE supplied to front line staff. Lack of appropriate PPE for staff with beards. Substandard level of PPE in guidance in comparison to other developed countries. • Over-reliance on command and control approach and not listening to local communities or regional nuances. Not targeting public health messaging to communities known to be hard to reach and known to have health inequalities from lack of access to primary care, emergency services, or uptake of

conventional health messages. • Failure to incorporate real time evidencebased data on Have public services been morbidity (inpatient/ICU) in effective in identifying and addition to mortality, and to meeting the needs of sub stratify this by ethnic and vulnerable groups during the faith group. Covid-19 outbreak? For • Failure to provide an example, were services able appropriate risk assessment to identify vulnerable children tool to frontline workers and to during lockdown to ensure adequately respond to PPE that they were attending concerns by BAME staff on the frontline. school or receiving support • No additional support provided from statutory services? How to vulnerable child or adult have adults with complex needs been supported? services and many services HoL Committee Q.9] provided by faith organisations stopped due to closure. Vulnerable groups often socially isolated unless family or voluntary services were able to provide support.

Yes, and these have also been the groups significantly impacted Were groups with protected disproportionately. characteristics (for example • There is a lack of data on faith BAME groups and the Gypsy, and its intersectionality with Roma and ethnicity. Therefore, inequalities Traveller community), or amongst faith groups cannot be people living in areas of accurately assessed. Faith data deprivation, less able to needs to be collected across access the services that they public health, primary care and needed during lockdown? secondary care services, social Have inequalities worsened care, and on death certificates. as a result of the lockdown? • Lack of funding and support for If so, what new pressures will faith based mental health this place on public services? services.

• Inequalities have been exacerbated: additional [MCB note: religion is also a pressures on healthcare protected characteristic] services across the board, GPs to secondary care; additional [HoL Committee Q. 10] pressure on public services in terms of unemployment, welfare, food services etc; increased evictions etc meaning pressure on legal services and housing/council services. • Added pressure on the education system. • Pressure on the transport service to have them secure enough to be utilised. • Faith communities not called upon to participate in prevention, communication or support, despite evidence that places of worship and faith leaders can be important allies. Main Muslim groups were marginalised from conversations. • Muslim communities took it on themselves to proactively protect their congregations by calling for a lockdown on religious facilities one week ahead of the government, and for caution during recovery phase. • A one size fits all approach does • not work. There is a need for Are there lessons to be learnt better targeted approaches to for reducing inequalities from • assist those most vulnerable. the new approaches adopted Need greater by services during the Covid- • integration/cooperation across 19 outbreak? services. Not enough to just invest HoL Committee Q. 11] without understanding significant structural barriers/issues. • Forward planning by mosques helped ensure timely disposal Were some local areas, of bodies in a safe manner. where services were well • Areas where communities had integrated before the crisis, good relationships with better able to respond to the directors of public health, outbreak than areas where councils, MPs, police, and CCGs integration was less were able to respond better developed? Can you provide examples?

HoL Committee Q. 13] • When infrastructure and support is in place the What does the experience of collaboration and integration of public services during the • services is both effective and outbreak tell us about efficient. services’ ability to collaborate There needs to be further to provide “person-centred emphasis and funding for care”? integrated care.

HoL Committee Q. 15]

• Initiative led by [name withheld] to use a M] Can you provide any in Bolton (Masjid-e-Ghosia) to examples of how public • care for palliative care patients. services worked effectively Mosques situated near hospitals with a local community to provided and delivered food for meet the unique needs of the hospital staff during Ramadan. people in the area (i.e. taking a “place-based approach” to delivering services) during the Covid-19 outbreak?

HoL Committee Q. 18]

• Yes, it would have made public services better placed to deal Would local communities with the outbreak, mitigate its benefit from public services fallout and be more responsive focusing on prevention, as • in terms of next steps and opposed to prioritising harm solutions. mitigation? Were some local Not aware of any areas that areas able to reduce harm • had more prevention-focused during coronavirus by having public health strategies, if prevention-focused public anything it was the opposite. health strategies in place, for There is a need to consider example on obesity, broader measures of health in substance abuse or mental relation to fitness i.e. BMI is not health? as reliable in South Asian populations and may require HoL Committee Q. 19] other markers to augment this. Consider screening for hypertension, diabetes and dyslipidaemia in younger BAME patients. • The question of death certification is critical – for Muslims this needs to be as rapid as possible after death to ensure that burial can take place; but the precise cause of death, and, in particular, in a Covid-19 situation whether or not the virus itself is identified and implicated, is also of importance for protecting the health of the community, as well as underpinning the ONS data. • Review/lessons learned into how they were effective on the What lessons might be learnt ground – how this is factored about the role of charities, • into their inclusion going volunteers and the forward. How they organised community sector from the quickly and mobilised in order crisis? Can you provide • to deliver local services – examples of public services support to collaborating in new ways vulnerable/sick/elderly. with the voluntary sector Public services grants to during lockdown? How could provide services thereby the sectors be better removing burdens local integrated into local systems government. going forward?

[HoL Committee Q. 20]

III. Policy Analyst in the MCB

What have been the main areas of public service success and failure during the Covid-19 [HoL Committee Q. 1] How effectively have different public services shared data during the outbreak? [HoL Committee Q. 7] Source Response Statistician MCB would like to commend the Office of National Statistics (ONS) for its regular weekly provision of Covid-19 death data for England and Wales by age and by sex with number of deaths being given down to Lower Tier Local Authority (LTLA) level. This has enabled calculation of age and gender standardised Covid-19 mortality rates useful for comparing effect of Coronavirus on different areas Unlike Public Health England (PHE) and National Health Service England (NHSE), Covid-19 related data produced by ONS was complete and more reliable. (For PHE almost 5% of cases could not be allocated to the right LTLA as the post code was missing or incorrect, while for NHSE over 10% of Covid-19 death data had ethnicity not recorded or not stated.)

ONS should also be commended for making available to the public results of its study of correlation between Covid-19 deaths and known or suspected Covid-19 comorbidities, and for their initiative to bring the publication of UK mid- year population estimates for 2019- 2020 forward so as to enable Covid- 19 analysis to be based on the most current data. However, MCB is concerned that in order to determine the ethnicity and religion of someone dying of Covid- 19, ONS had to trace back individuals to their Census data, if available. On inquiring, ONS replied that this was done for the public good. If this practice is allowed to be used by other public bodies like police, immigration, DHSS etc. and the public becomes aware of it, it may lead to people not providing correct data in the 2021 Census.

To avoid similar data deficiencies in the future, MCB would like to recommend the inclusion of ethnicity and faith in both the birth and the death certificates. This will also help in the production of more accurate life expectancy and mortality rate by ethnic group.

IV. Voluntary Sector Muslim civil society organisations –case studies of public benefit work

Q.18 Can you provide any examples of how public services worked effectively with a local community to meet the unique needs of the people in the area (i.e. taking a “place-based approach” to delivering services) during the Covid-19 outbreak?

Note: individuals’ names and personal details have been withheld for privacy considerations.

1) Muslim Council of Britain’s collaboration with British Islamic Medical Association (BIMA)

BIMA has been collaborating with and supporting the MCB in facilitating 18 webinars and training sessions which saw over 10,000 participants and reached hundreds of mosques nationwide since the outbreak of the Covid-19 pandemic. BIMA also supported the MCB in adapting Covid-19 guidance by the UK, Scottish, Welsh and Northern Irish Governments to cater to Muslim communities in the respective nations, producing guidance in English and a number of community languages and broadcasting them widely. These resources seek to address various needs of communities ranging from queries concerning medical issues, burial rites and financial difficulties, to guidance on mental health issues and guidance on celebrating Ramadan and Eid during lockdown.

2) Muslim Doctors Association (MDA)

60% of reported medical deaths have been among Muslim doctors, despite making up 10% of the medical workforce. Concerns raised around bullying, harassment and discrimination and inadequate access to culturally sensitive PPE have contributed to this risk. MDA has been working with NHS bodies to address these issues and provide support spaces for frontline staff to discuss concerns. It is clear that frontline staff were discriminated and inadequately supported, resulting in avoidable loss of life. MDA has also created an online memorial gallery to commemorate the contributions of Muslim doctors who lost their lives on the frontline.

MDA has published an online Covid-19 social prescribing hub with information on organisations and services and published toolkits for Muslim communities on reducing risk from Covid-19 and mental health support for both the community and frontline staff. In response to growing concerns from Muslim communities about end of life care issues during Covid-19, the Muslim Doctors Association held a joint public webinar with the British Board of Scholars and Imams watched by 3,000 participants to give information and respond to questions on religious, ethical and medical perspectives around end of life care.

3) Home Oxygen Monitoring Service (HOMS) in Harrow

Home Oxygen Monitoring Service (HOMS) is a joint initiative from four Islamic Centres in Harrow, north London, providing free oxygen monitoring devices on a loan basis for those with Covid-19 symptoms and those at-risk1. The Islamic Centres involved are Hujjat Stanmore, Harrow Central Mosque, Sri Lankan Muslim Cultural Centre and Shia

1 https://hujjat.org/health/ Ithna’asheri Community of Middlesex2. These devices, the Digi Pulse Oximeters, offer convenience for those at-risk who need to monitor their oxygen levels from the comforts of their home in order to manage their illness better. According to [name withheld] from Hujjat Stanmore, this may help to prevent situations where patients end up at the hospital too late with very low oxygen levels and also for some infected cases who may look well but are showing ‘silent’ levels of low oxygen3. Thus, this device offers an early and timely intervention to prevent one’s deterioration of health undetected. This service is solely a delivery scheme; therefore patients would need to show the oxygen saturation and heart rate readings from the device to their respective medical professional or GP who will then decide on the best treatment option for them4.

4) NHS PPE Campaign by Loft25 and & Community Centre

In partnership with a volunteer-led project, Loft 25, Green Lane Masjid & Community Centre contributed in the production of PPE for the NHS. Loft 25 is a soft furnishings manufacturer owned by [name withheld] in Birmingham. The campaign was initially set up by [named withheld] and [details withheld] son, shortly after lockdown was announced when there was a critical demand for PPE5. Green Lane Masjid subsequently came on board to offer support to this campaign by increasing the number of volunteers, providing a lead project manager, project coordinators, admin, quality assurance checkers and over 150 delivery drivers. To date, they have donated about 10,000 PPE garments to the NHS, including various hospitals, hospices and GP practices6.

5) Nightingale Masjid in Bolton

Masjid-e-Ghosia in Deane, Bolton, anticipated that there would be high demand for beds and space during this pandemic and planned to repurpose their mosque to offer space for beds such that it would relief the burden of hospitals for Covid-19 patients. This plan was proposed by [name withheld], together with three others. [name withheld] planned to have up to 55 beds which can be utilised as hospital overflow or for those who are concerned about giving the best care in their own homes. He also would like to offer a space to delivery end-of- life care patients7. There were overall 50 – 60 volunteers which include

2 https://twitter.com/HarrowMosque/status/1247667130054643713 3 https://www.youtube.com/watch?v=gICUkkYnIc8 4 https://hujjat.org/health/ 5 http://ppe.loft25.co.uk/ 6 https://twitter.com/BeaconMosque/status/1260871974613659648/photo/1 7 https://www.theboltonnews.co.uk/news/18346402.mosque-help-make-space-hospitals-coronavirus/ doctors, nurses and pharmacists coming forward to contribute to this repurposed space.

6) UKIM Masjid Ibrahim iCare Food Bank

The food bank has been set up since April consisting of distributing essential groceries as well as providing evening home cooked meals daily8. It has since provided 500 free hot meals on a daily basis to homeless residents and those in need in in the London Borough of Newham9. This was especially impactful during the month of Ramadan which can be trying times for those who may be struggling and would usually be attending the mosque for dinner on a daily basis.

7) Eden Care

Eden Care UK is a BAME-led service by people who have lost loved ones through terminal illness.10 During the Covid-19 crisis it has provided advice and information to help the public better understand Government messages and to avoid hearsay. It has also provided Covid-19 burial support and PPE equipment.

8) Setting up of temporary mortuaries

The UK Government made an initial request for the possibility of cremation of the deceased regardless of faith, but subsequently agreed to amend the Coronavirus Bill and remove this requirement on 23 March11 . Nevertheless, there needs to be an urgent solution to address the surge of deaths in BAME and Muslim communities. In order to cope with the number of deaths from Covid-19, at least 10 mosques have been repurposed to use as temporary mortuaries12. One of the notable mosques which contributed to this is Green Lane Mosque in the West Midlands. [name withheld] one of the lead volunteers of the mosque, shared that they saw about 20 – 25 funerals a week which usually would be the average for a year. The mosque also used a 40ft refrigerated container to store extra bodies to accommodate the deceased. According to [name withheld], head of the mosque, protective measures and health policies were put in place which included getting direct contact from families of the deceased to arrange

8 https://twitter.com/MasjidIbrahimUK/status/1266121051060068352 9 https://www.youtube.com/watch?v=oNkjdfe2Je8&feature=youtu.be 10 https://edencareuk.com/ 11 https://mcb.org.uk/press-releases/mcb-thanks-government-for-its-changes-on-burial-measures-in-Covid-19- emergencylegislation/ 12 https://news.sky.com/story/coronavirus-mosques-set-up-temporary-mortuaries-to-cope-with-surge-in-Covid-19- deaths11982502 burial services and an agreement made for Imams not to wash the deceased for their safety13.

The , with the generous support of the Muslim community, raised funds to create a temporary mortuary in Tower Hamlets. The Mosque, one of London’s main places of worship also offering a wide range of community services, is located near the Royal London Hospital. It was able to respond to the need for additional mortuary services by adapting space within railway arches. 14

9) Federation of Muslim Organisations (FMO), Leicester

FMO, together with the Leicester Council of Faiths, has been working alongside the statutory services across Leicestershire to try and meet the needs and concerns of Leicester's diverse population15. This includes regular faith and voluntary sector forums to share relevant information in relation to Covid19 and working collectively to resolve issues. Examples of this are changes in the way deaths are reported to the coroner, support with advice around death and burial, support around managing places of worship, producing information in various languages and the provision of funding to support faith and Community groups. The FMO affiliate, the Muslim Burial Council of Leicester, has worked with partner agencies including the Bereavement Department of the Leicester City Council, Registration Services, Coroners, NHS Hospitals, Police, the Reliance Forum, Leicester Council of Faiths, and the National Burial Council.

10) Councillors’ briefings

The MCB’s Research & Documentation Committee has organised online briefings for councillors in East London boroughs (Newham, Tower Hamlets, Redbridge, Barking & Dagenham) with high Muslim populations in the April-June 2020 period to provide an opportunity for peer information sharing in dealing with Covid-19, with a Q&A session with a public health expert. The councillors commended the MCB’s leadership in providing guidance to communities during this crisis and appealed for more collaboration to address long-standing issues like structural inequality, deprivation, unemployment, and health inequality that characterises the lives of BAME communities in the UK which aided a disproportionate loss of lives in BAME communities.

13 https://www.aljazeera.com/news/2020/04/uk-muslims-stepping-coronavirus-crisis-200413122704311.html 14 https://www.theguardian.com/world/2020/may/04/were-ready-if-we-are-needed-east-london-mosque-opens- Covid19-morgue 15 https://www.leicester.gov.uk/your-council/coronavirus/religion-faith-or-belief/ Concluding observations and reflections

Issues highlighted in this Submission include:

Faith-based organisations have demonstrated their resourcefulness and capabilities as effective partners in the delivery of public services at both national and local levels. There is the opportunity now to embed means of working together as a matter of course, rather than await crises. Need to target public health messaging to communities known to have health inequalities arising from lack of access to primary care, emergency services, uptake of conventional health messages and other factors. Given earlier reports such as the Marmot Review, the selectively worse outcome in BAME and/or faith communities was predictable and preventable. There is now urgent need set up systems at local and national level to address health inequalities. Need to address the structural factors producing health inequalities - education, housing, employment and government policies, and endemic discrimination and racism in the NHS against both staff and patients.  Need to recognise local and regional nuances (important now in the context of lockdowns).  Public Health England and NHS to mandate data collection on ethnicity and religion for health surveillance and intervention programmes, primary and secondary care services (i.e. GP registration, hospital admissions, outpatient services) and for staff to monitor uptake, outcomes and experiences. The work of the ONS is commended in providing Covid-19 statistics in a timely manner. However, in order to determine the ethnicity and religion of someone dying of Covid-19, ONS has had to mine their Census data, if available - if this practice is allowed to permeate to other public bodies, there is concern with the privacy implications which can impact responses in the 2021 Census of England and Wales. The question of death certification is critical – for Muslims this needs to be as rapid as possible after death to ensure that burial can take place; but the precise cause of death, and, in particular, in a Covid-19 situation whether or not the virus itself is identified and implicated, is also of importance for protecting the health of the community, as well as underpinning the ONS data. To avoid data deficiencies in the future, MCB would like to recommend the inclusion of ethnicity and religion in both the birth and the death certificates. This will also help in the production of more accurate life expectancy and mortality rate by ethnic group. We commend the dedicated work of NHS staff at all levels – they worked despite the pressures even by putting themselves as risk – some paying the ultimate price. Safeguards must be placed urgently for personalised and culturally relevant risk assessments for all frontline staff with clear implementation of risk mitigation strategies from these assessments, zero tolerance to bullying and discrimination and psychologically safe work places and support structures to raise and deal with workplace-based concerns in the NHS.