I came before this House on 4 June, just after Public Health England had published its report ‘COVID-19: review of disparities in risks and outcomes’, as the Prime Minister had asked me to lead the cross-government work to address the findings of the review.
I return today to update the House on the progress I have made and to announce publication of my first quarterly report to the Prime Minister.
My work to date has focused on the impact of COVID-19 on ethnic minority people. There is a wider strand of work within government that is considering other groups that may have been particularly impacted by COVID, for example disabled people, and I will include updates on this wider work in future reports.
My report summarises the significant measures that government departments and their agencies have, to date, put in place to mitigate the disproportionate impacts of COVID-19.
And Mr Deputy Speaker I have spoken with the Speaker and many members of the House staff about how impressed I have been with the measures put in place by the Parliamentary Authorities to protect all of us who use the Parliamentary estate.
It is clear that there is a lot of good work underway. For example, as we’ve reported in Parliament, more than 95% of frontline NHS workers from an ethnic minority background had had a risk assessment in the workplace to ensure good understanding of the necessary mitigating interventions in place.
The NHS is working hard to restore services inclusively, so that they are used by those in greatest need, with new monitoring of service use and outcomes amongst those from the most deprived neighbourhoods, and from Black and Asian groups.
We issued revised guidance to employers in July and again in September, highlighting the findings of the PHE review and explaining how to make workplaces COVID-secure.
We also reached out to all parts of the community through our information campaign. From March to July we spent an additional £4m on reaching ethnic minority people through tailored messaging, strategically chosen channels, and trusted voices.
We have published messaging in well over 600 publications, including those that have high proportions of ethnic minority readership.
We have reached more than 5 million people through the ethnic minority influencer programme.
We have translated key public health messages into numerous languages, which initiated a marked improvement in recognition of our crucial ‘Stay Alert’ campaign.
My report also summarises how the NHS, Public Health England and others are implementing the recommendations from the summary of the rapid literature review and stakeholder engagement work led by Professor Kevin Fenton.
The PHE review indicated that people from ethnic minority backgrounds were disproportionately impacted by COVID-19. It told us what the disparities in risks and outcomes were, but not why they had arisen, and therefore it did not make any recommendations.
It is therefore absolutely imperative that we understand the key drivers of the disparities and the relationships between the different risk factors, in order to ensure that our response is as effective as possible.
That response has involved collaboration across government, the Office for National Statistics, and with universities and researchers.
It includes some of the 6 new research projects to improve our understanding of the links between COVID-19 and ethnicity which received £4.3 million in government funding in July.
These research projects will give us new information on a range of issues including the impact of the virus on migrant and refugee groups and the prevalence of COVID-19 amongst ethnic minority health workers.
These projects will also help to develop targeted, digital health messages in partnership with ethnic minority communities. They will also provide a new framework to ensure the representation of ethnic minorities in clinical trials that are testing new treatments and vaccines for COVID-19.
We now know much more about the impact of the virus than we did in June.
We know more in particular about why people from ethnic minority backgrounds are more likely to be infected and die from COVID. The current evidence shows that it is a range of socioeconomic and geographical factors – such as occupational exposure, population density, household composition, and pre-existing health conditions – which contribute to the higher infection and mortality rates for ethnic minority groups.
However, according to the latest evidence, part of the excess risk remains unexplained for some groups and further analysis of the potential risk factors is planned for the coming months.
What has emerged is that interventions across the entire population are most likely to disproportionately benefit ethnic minorities and are least likely to attach damaging stigma. This is best captured through our experience of the national lockdown and the shielding programme.
And, as the CMO has said, we must assess the impact of COVID-19 based on all-cause mortality to incorporate its indirect impact. On this specific metric, early evidence suggests that there is no disproportionate impact across different ethnic groups. Indeed, the openSAFELY study of 17 million adults from 1 February to 3 August concluded: ‘National data from England and Scotland has shown that most ethnic minority groups have both better overall health and lower rates of all-cause mortality than white groups’.
The evidence base is growing fast and we will continue to work with academics and the SAGE ethnicity sub-group to improve our understanding of the relationship between COVID-19 and ethnicity.
I am particularly keen to deepen our understanding of how comorbidities interact with occupational exposure. This is a major gap identified by several studies to date and may well account for the residual risk between different ethnic groups of poorer outcomes from COVID-19.
In general, we must move away from seeing COVID-19 as something that affects discrete groups in society and towards helping individuals understand their own particular risk profile as the evidence base grows.
Looking forward, we know that a vaccine is likely to present a long-term protection against this deadly disease. The only way to check how well a coronavirus vaccine works is to carry out large-scale clinical trials involving a diverse group of thousands of people. That is why I am leading by example and participating in a trial myself at Guy’s and St Thomas’ hospital.
And just last week, I wrote to all colleagues urging them to encourage more of their ethnic minority constituents to sign up to the NHS Vaccine Registry, as these groups are under-represented in vaccine trials.
We have made good progress but more needs to be done. In particular, we need to work with local communities to protect the most vulnerable. I am therefore announcing today a new ‘Community Champions’ scheme that includes up to £25m in funding to local authorities and the voluntary and community sector. This will help to improve the reach of official public health guidance, and other messaging or communications about the virus into specific places and groups most at risk from COVID-19.
Our Community Champions funding will support those groups at greater risk of this disease, to ensure key public health advice is understood and safer behaviours are followed. This will help to build trust, reduce transmission, and ultimately play a part in helping to lower death rates in the targeted areas and beyond.
Councils have been working tirelessly to support and engage their communities throughout this crisis – they know how to do this best. The funding, for a target group of councils, will enable them to do more of what they know works, but also to go further, by enhancing existing schemes.
Learning from the Community Champions scheme will be shared with all councils and across all relevant government departments – enabling government and local authorities to hear directly from individuals in communities on the impact of the crisis.
There are other measures we can take to protect those most at risk and particularly those from minority groups. So in my report to the Prime Minister I outline a number of recommendations and next steps. These include:
Mandating the recording of ethnicity data as part of the death certification process, as this is the only way we will be able to establish a complete picture of the impact of the virus on ethnic minority groups.
Appointing two expert advisors on COVID and ethnicity who will bring huge expertise from the fields of medicine, epidemiology and clinical research to the government’s work going forward.
Ensuring that new evidence uncovered during this review relating to the clinically extremely vulnerable is incorporated into health policy.
Supporting the development, and deployment, of a risk model to understand individual risk from research commissioned by the CMO.
I also want us to capture the good work being done by local authorities and Directors of Public Health so that we can learn the lessons of what works at a local level. So there will be a rapid, light-touch review of local authority action to support ethnic minority communities.
The package of measures I have announced today are the first steps in my year-long review. They will give us a better insight into how the virus is impacting ethnic minority groups, how we can best protect those who may be most at risk, and how we can address longstanding public health inequalities.
I will report back to the House with a further update at the end of the next quarter.