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Covid-19: Disparate Impact

Volume 682: debated on Thursday 22 October 2020

With permission, Mr Deputy Speaker, I will make a statement. I came before the 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 that 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, such as disabled people, and I will include updates on that 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.

I have spoken to Mr 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 a lot of good work is under way. For example, as we have reported in Parliament, more than 95% of frontline NHS workers from an ethnic minority background have 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 among 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 £4 million to reach 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 readerships with a high proportion of ethnic minority people. 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 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 imperative that we understand the key drivers of the disparities and the relationships between the different risk factors to ensure that our response is as effective as possible.

That response has involved collaboration across Government, with the Office for National Statistics and with universities and researchers. It includes some of the six 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. The research projects will give us new information on a range of issues, including the impact of the virus on migrant and refugee groups and its prevalence among ethnic minority health workers. The 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 a range of socioeconomic and geographical factors, such as occupational exposure, population density, household composition and pre-existing health conditions, 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. That is best captured through our experience of the national lockdown and the shielding programme.

As the chief medical officer has said, we must assess the impact of covid-19 based on all-cause mortality to incorporate its indirect impact. On that 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 that

“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 at Guy’s and St. Thomas’ hospital. 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 still 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 £25 million 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 that key public health advice is understood and safer behaviours are followed. This will help to rebuild 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 through this crisis. They know how to do this best. The funding for a targeted 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 and communities on the impact of the crisis.

There are other measures we can take to protect those most at risk, particularly those from minority groups. So in my report to the Prime Minister I outlined 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 advisers on covid and ethnicity who will bring 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 extremely clinically vulnerable is incorporated in health policy; and 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. Therefore, there will be a rapid light-touch review of local authority action to support ethnic minority communities.

The measures in the package 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 long-standing public health inequalities. I will report back to the House with a further update at the end of the next quarter.

I thank the Minister for advance sight of her statement.

Coronavirus continues to expose deep-rooted structural inequalities in our society, and these drive the health inequalities. Today, the Minister has published her first quarterly report on progress in addressing covid health inequalities, but it is now well over four months since both Public Health England reviews were published. The country is now sadly well into a second wave of the virus, yet we are still lacking a forward-looking national strategy and action plan.

Just this week the Institute for Public Policy Research and the Runnymede Trust showed that well over 2,000 black and south Asian deaths could have been avoided during the first wave of the pandemic if those populations did not experience a higher risk of death from covid-19, and that 58,000 people would have died in the first wave if the white population experienced the same risk of death from covid as our black populations. The Government must be prepared to admit and act on the root causes of the hugely disproportionate impact that coronavirus has had on our black and ethnic minority communities.

I welcome the Government’s decision to make the recording of ethnicity as part of the death certificate process mandatory, but collecting data is only one part of what needs to be done. The Minister mentions that there will be further research, but we do not know when this research will report or how quickly the Government will act on its findings. It is also unclear how the Government can measure or demonstrate the effectiveness of their public health communications for diverse communities and ensure that such communications are inclusive and accessible. Given the scale and the urgency of this crisis, the Government have fallen short of doing what is needed.

This first quarterly report does not commit to much that is quantifiable or timed, so I ask the Minister these questions as a matter of urgency. She mentions that she will be looking into the clinical groups of people who are severely in need of support. When will that review take place, and when will those groups be added to the list of those who are shielding?

Where is the Government’s plan of action to address the long-term structural inequalities, such as the deep-rooted inequalities in housing and employment, including occupational discrimination? Where is the Government’s implementation plan, with milestones, for protecting our black, Asian and ethnic minorities during this pandemic? Which local authorities will receive some of that £25 million funding for the community champions programme, and how did the Government reach that amount? How will that funding be allocated to the local authorities and what will the criteria be?

Will the Minister now publish in full any or all of the equality impact assessments of the likely impact on our black, Asian and minority ethnic communities of the Government’s covid-19 responses? It is absolutely right that the NHS has carried out 90% of its occupational risk assessments, but why have the Government updated the guidance only for employers, rather than putting in place proper checks and balances to ensure that our workers are being protected? Finally, why has it taken so long for the Government to act on the disproportionate impact that covid-19 is having on our ethnic minority communities? The volume of evidence that we have seen has been coming to us for months. We are already in the second wave, and this is now beyond urgent.

It does not appear to me that the hon. Lady has actually read the statement that I sent to her. She asks about what the Government are doing. I have just given a statement about what the Government have been doing over four months.

I think we need to restate this: we did not wait until today to say what we were going to do. As soon as we discovered this disproportionate impact, actions were put in place. The hon. Lady talks about our not issuing revised guidance to employers, but we did that in July and, as I said in my statement, we did it again in September, highlighting the findings of the PHE review and explaining how to make workplaces covid-secure. We required passengers to wear a face covering in taxis and private hire vehicles, and we asked for this to be done for hospitality staff, many of whom are from ethnic minority backgrounds. We provided £4.3 million in funding for six new projects. We provided a range of guidance to support those living in multi-generational households. We spent an additional £4 million on reaching ethnic minority people through tailored messaging, strategically chosen channels and trusted voices.

The hon. Lady talks about the NHS guidance and risk assessments as though that was the only thing we have done. We have been implementing new payments for people in low-income areas with high rates of covid-19 who need to self-isolate and cannot work from home. What we are not going to do—it is clear what the hon. Lady and her party are expecting—is implement segregated policies for people from ethnic minority backgrounds. What we are doing is looking at risk groups, but tailoring support for the whole population.

The hon. Lady talks about the IPPR report, and my response is that I do not recognise those figures. Its methodology was not transparent, and our statisticians in the Cabinet Office could not understand where it got the numbers from. I found the presentation scaremongering and alarming. It is really important to me that we let people have trust and faith in the Government, and that we let them know what we are doing. That is why I am standing here in Parliament giving this oral statement, rather than just making a report to the Prime Minister.

The hon. Lady talks about what the Government have done. I wrote a letter to every single Member of Parliament asking them to share with ethnic minorities and their communities how they can join the national vaccine register, and I have been taking vaccines myself. Opposition Members have not been doing so. Especially when it comes to the hon. Lady, knowing that she has a large ethnic minority population in her community, what has she done to tell them to join the national vaccine register? We have not seen anything to that effect on her social media. It would be good if Opposition Members showed us that they are looking to help people, rather than looking for reasons to bash the Government. We must not politicise covid-19.

I thank my hon. Friend the Minister for advance sight of her statement, which arrived while I was at a conference with Dr Tony Sewell, the chair of the Commission on Race and Ethnic Disparities. His passion for ensuring that there is no stigma is equalled only by that of my hon. Friend. I welcome her commitment to mandatory recording of ethnicity data on death certificates, but could I ask her to give us a little more information about the commitment on new evidence relating to the clinically extremely vulnerable? Exactly how will that be incorporated in health policy, and by when?

I thank my right hon. Friend for that question. That is something that should happen right now. We want to make sure that things do not happen separately in Government, and I have been very keen to ensure that there is no silo working. A frequent problem is that different Departments do different things, and they often duplicate information and work, so we have been at great pains to make sure that that does not happen.

I share every single thing that I do with Ministers across Departments. We have a group of Ministers who look at equalities in the Department for Work and Pensions, the Department of Health and Social Care and the Department for Education, and we feed into that group everything that we learn. The findings from the Race Disparity Unit and ONS research are fed in as those Ministers make policy, whether in health or otherwise. We do not want this to be a separate Government project that requires new oversight; we all have to work together, and that is how I plan to do it.

I thank the Minister for her statement. I am interested in everything that it contains, and I commend her for volunteering to be part of the vaccine programme.

I want to raise two issues—possibly three, if I have time. Minority ethnic women are particularly over-represented in frontline care roles, so they are at particular risk of job disruption, as highlighted in a report by Close the Gap. Why have the UK Government not matched the Scottish Government’s action of a 3.3% wage increase for all adult social care workers to ensure that at least the real living wage is paid across frontline care, covering all hours worked, including sleepovers?

The Minister said that help that is provided across the population disproportionately benefits black, Asian and minority ethnic people, but that does not apply to those who have no recourse to public funds. I know that she has spoken about this before, but most people who have no recourse to public funds are from black, Asian and minority ethnic communities. Will she support our calls to enable them to get support?

Finally, I note that the Minister said that she would include in future reports updates on other groups who are disproportionately impacted, and I want to make sure that older people are one of those groups. We know that people living in poverty are disproportionately impacted, and one way to lift older people out of poverty is to make sure that they know about pension credit, and to make it as easy as possible to apply for. The more voices across this House and across the Departments who commit to ensuring that older people know about the £2 billion-plus that is unclaimed every year in these islands, the better. I hope that she will commit to paying particular attention to that.

I thank the hon. Lady for her questions. She is absolutely right to mention older people, who are the most disproportionately impacted group. Someone who is over 70 or 80 is 80 times more likely to have the disease, whereas someone from an ethnic minority background is between 1.2 and 1.8 times more likely to have it. We must keep this in perspective, and we are looking at everybody who is impacted and vulnerable in whatever way.

The hon. Lady asks about money we are spending on adult health and social care. We are spending an unprecedented amount in the pandemic. We have targeted as much money as we possibly can at all the groups we believe need it. It may not be exactly what people asked for, but we are looking at decisions in the round to ensure that we are covering all groups.

I congratulate the Minister on a comprehensive report. She has clearly done a great job of identifying the numerous factors that exacerbate the problem and acting rapidly on them. However, of the first 26 doctors in the national health service to die of covid-19, 25 were from minority ethnic backgrounds. Those doctors will have been comparatively well paid, so poverty cannot be the full explanation.

Vitamin D deficiency is prevalent across virtually all the groups who suffer disproportionately from covid-19, from the elderly to the obese, diabetics and ethnic minority communities. Today’s review considers only two studies on vitamin D and does not consider a huge range of new evidence that has come out in the last couple of months that shows powerful links. Will the Minister commit, as her colleagues at the Department of Health and Social Care have done, to looking at the latest evidence on this matter?

It was the number of ethnic minority doctors who died right at the beginning of the pandemic that alerted us to this issue. We did look across a range of issues to see why that was the case. I remind my right hon. Friend about occupational exposure, which we believe is the biggest cause, and those doctors were the most exposed, probably doing the shifts right before we knew what was going on and catching the virus. We looked at vitamin D. The SAGE report from 23 September shows that it looked at vitamin D studies to see if it had had an effect and did not find any relationship.

We have found that there is a small residual risk, and I am looking at the interaction between comorbidities and occupational exposure, which we think provides the explanation. We had a second literature review and stakeholder engagement report where many people talked about their experiences of systemic racism—I asked the Race Disparity Unit specifically to look at that—but the findings were that systemic racism did not explain that. For example, when we take into account comorbidities, Bangladeshi women and white women have the same rates of mortality. Systemic racism also does not explain the differences between groups, such as black Africans and black Caribbeans. If it was systemic racism, we would expect the figures to match and they do not.

There is still quite a lot going on as we look at the socioeconomic and geographical factors, occupational exposure, population density, household composition and pre-existing health conditions. We will continue to do this work. Remember that this is the first report, not the last, and the review will be ongoing.

Having volunteered in recent months to become a community champion locally, I welcome the additional funding announced by the Minister and sincerely hope that our excellent scheme in Slough will be able to gain some of that funding. The report mentions a SAGE sub-group on ethnicity. What are its terms of reference, membership and programme of work?

The SAGE sub-group is looking at this issue. Not all of our research is original—much of what we have found out has come from that sub-group. Emran Mian has been leading from within the sub-group and is working with us. I am afraid that I do not have the sub-group’s terms of reference, but I will write to the hon. Member to provide more information. However, we are very supportive of the work of all community champions, and the work he is doing in Slough is very important. If it is possible, we will ensure that he can access the community champions fund. He will have to apply through the regular process, but we want to do as much as we can to support MPs across the House.[Official Report, 5 November 2020, Vol. 683, c. 6MC.]

I join my hon. Friend the Minister in encouraging Carshalton and Wallington residents to follow her lead and volunteer for vaccine trials. I welcome her statement, including the appointment of independent experts and the mandatory reporting of ethnicity on death certificates. Does she agree that that gives us the opportunity to learn a lot more about the impact of covid on our black, Asian and minority ethnic constituents? Will she say a little more about how that data will be used to improve health outcomes for everyone in the country?

The reason I have asked that we mandate recording is that that was one of the gaps identified. We did not get a full picture of what was going on, and we need to have a full picture. As my hon. Friend rightly says, everything we are doing will help the whole population. We are not segregating people on the basis of this disease. Mandating ethnicity data will not just help ethnic minority populations; it will help everybody.

I am sure the Minister will be well aware of the research by the Financial Conduct Authority showing that while one in three of our fellow citizens has seen an income cut because of covid, that rises to 40% among black, Asian and minority ethnic communities. The impact is not just on individuals or even households: where there is a concentration of people from BAME backgrounds, it affects the much wider community. What research will the Minister engage in on the economic impact, because we know that economic collapse leads to lower mental and physical health and all the other social aspects that come with it?

That would be outside the terms of reference of the review that I am leading over the year. However, as a Treasury Minister, I can tell the hon. Gentleman that we have distributional analysis that comes out with all this information and influences all the policies that we put out in terms of economic interventions for specific groups.

I commend my hon. Friend for her statement and for the report. Given the high level of concern about the impact of covid-19 on ethnic minorities, and given that a vaccine will be a very large part of the solution to the pandemic, why does she think there has been such a disproportionately low number of ethnic minority people coming forward to volunteer for the NHS vaccine registry?

That is an excellent question. I have been particularly disappointed at the number of anti-vaxxer disinformation campaigns that are out there. I have received three separate messages myself from people telling ethnic minorities not to take part in vaccine trials. I am really sorry to say that an Opposition Member said in this House that the Government were using ethnic minorities as cannon fodder in their battle against coronavirus—one of the worst things that I have ever heard said in this House. That really causes division and tension. We need people to have faith in the Government. We need people to have faith in our health service and trust it in order to take part in things like vaccine trials. I hope that the work we are doing will go some way towards remedying some of the scaremongering.

I welcome the Minister’s acknowledgement early in her statement of the disproportionate impact of covid on disabled people. She said that work is ongoing and there will be future reports, but I hope she will agree that we need urgent action. She will know that disabled people are 11 times more likely to die from coronavirus. We have also heard very disturbing reports of “do not resuscitate” orders being put in place, particularly for those with learning difficulties, without consultation with their families. I recognise that the Care Quality Commission is investigating this, but will she commit to ending this injustice urgently?

The Government rightly take very seriously the outcomes for those with disabilities. The largest disparities were by age for both males and females, done by gender. However, there is a wider strand of work that the hon. Lady references, where this will be looked into. We cannot allow any part of the population to feel that they have been forgotten; they have not. I can assure her that we are taking this seriously, not just in the Equality Hub but in the Department for Work and Pensions.

My hon. Friend will know that my constituency is home to a wide variety of people from different nationalities and ethnic backgrounds, particularly people from the Indian subcontinent. Very sadly, we have seen many deaths, particularly among people from the Indian subcontinent. One of the reasons suggested for this is one of the virtues of that community—namely, that they often have grandparents, parents and children living in the same household, where the grandparents look after the children when they come home from school, and the parents go to work and commute, particularly into central London. In those instances, many people seem to have been infected with the disease and very sadly died. Will my hon. Friend look at this particular issue to see whether it is that mixing of people that is causing so many problems among our ethnic minority friends?

My hon. Friend is right. Household composition was definitely one of the things that we looked at; it was identified as a factor, and we are looking further into its significance. In the interim, the Government have provided a range of guidance to support those who are living in multigenerational housing, alongside detailed advice to employers and key workers on how they can protect themselves. We will continue to ensure that our guidance is clear, enables people to protect themselves adequately and includes guidance for those who are shielding. To support this, we have given councils an additional £1.6 billion of the covid budget fund to help them to protect and support people during this national emergency. As I always say, the Government will do everything we can, but we cannot do everything, which why we need people to know how they can protect themselves.

Since the start of the covid pandemic, the all-party parliamentary group on deafness has repeatedly called on Ministers to ensure that all communications are accessible and inclusive, but on Monday we saw reports that deaf children are being deprived of their access to education. I note that the Minister has promised future updates, but is the Race Disparity Unit working across Government to ensure that all communications are accessible to deaf and blind people? What is she doing to ensure that black, Asian and minority ethnic disabled people are not doubly disadvantaged by the measures needed to control the virus?

The hon. Lady is absolutely right. This is an issue that we have looked at; for instance, the Government have looked at sourcing personal protective equipment for people who need to lip—read, so that they can continue to communicate. She is also right to point out that some people are affected in multiple ways, but looking at each issue separately does not mean that one aspect will be forgotten. They will be helped by all the separate work that is being done across the board to look at vulnerability.

I thank my hon. Friend for her comprehensive statement; I note that she seems to be on a bit of a roll in the Chamber this week. Will she recognise that there remains a paucity of data around health outcomes for LGBT people, perhaps not least in respect of the intersectionality with BAME people in the context of covid? The data deficit was identified in the LGBT action plan. Will she recommit the Government to securing the data, not least by ensuring that future public health surveys record data on all protected characteristics?

My hon. Friend is right that we are looking across the board, but I just remind him that we are looking at those who have been most disproportionately affected and are most vulnerable. Although we have not found that LGBT groups specifically have been disproportionately affected, we know that they are losing out where healthcare services have been unavailable because they have had to close or provide other services to deal with the pandemic. We are looking to improve that, but the review that I am carrying out looks specifically at vulnerability and disproportionate impact.

I am glad that information is available in different languages; real language choice provides a clear functional gain, as we know in Wales. However, I am against shifting away from seeing the pandemic as affecting discrete groups. Will the Minister commit the Government to continuing and extending economic support as further evidence reveals the groups who have been hardest hit?

The hon. Gentleman is right to speak of making sure that people have access to all the information available. Much of the work that we have been doing has been with PHE, which looks mainly at England, but I will find out what information I can provide about the work that is being done in Wales. The Government are looking to ensure that everybody has access to the information, and we are working with the devolved nations to make sure that they have examples of the best practice that is happening across the board.

I thank my hon. Friend for her statement, which highlights a whole range of factors that are distributed right across the country. We know and understand the cost of covid to a certain extent, but there is also the cost of the lockdown. National figures, for example, show reduced GP appointments, cancer screening and hip operations. Will my hon. Friend commit to working with ministerial colleagues to produce a constituency-by-constituency covid lockdown health impact assessment, because in order to represent our constituents we have to have that local data?

That is an interesting suggestion. I believe that information like that exists. I am happy to meet my hon. Friend to discuss the issue further, to understand exactly what it is that he is looking for and see if we can do something to produce information like that.

With data showing that only one in 10 lower earners can work from home and that 69% of low earners are women, women have clearly started this crisis from a position of economic disadvantage. In many areas they have led the fight against coronavirus, but millions of women are stuck in low-paid and insecure jobs. Why, then, according to Business in the Community, have the Government chosen to exempt companies from having to file any gender pay gap data this year, resulting in only half of businesses actually doing so?

The reason we suspended gender pay gap reporting is that it was right in the middle of the pandemic and we wanted to reduce burdens on businesses that were facing an unprecedented situation. We were not going to put any additional burdens on them. Companies that are able to do so can continue to carry out their gender pay gap reporting, but I remind the hon. Gentleman that this review is about those who are affected most disproportionately medically, and at the moment that is actually men, not women.

I very much commend my hon. Friend on her statement. The educational attainment of white working-class boys is among the lowest, and that has only been exacerbated by the effects of covid-19 and their not being able to be in school. What discussions has she had with our right hon. Friend the Education Secretary to ensure that any child from any background can achieve and will not be left behind, for the future wellbeing of our country?

My hon. Friend is right to allude to the importance to children and young people of being in school. The Government have been very clear that limiting attendance at school should be a last resort, even in areas where the local alert level is high or very high. We have been providing laptops to the most disadvantaged pupils, and 4G routers to families who do not already have mobile or broadband, for example. In the unlikely event that certain schools will need to reduce attendance, we are also helping them to deliver quality remote education. More broadly, on ethnic disparities and attainment, the Commission on Race and Ethnic Disparities, announced by the Prime Minister in June, will look at outcomes for the whole population, and it is looking specifically at education.

I hope that the Minister has also been liaising with my constituency colleague, the Minister for Health in Wales, Vaughan Gething, on the work he has been doing on these issues. He was one of the first to identify them, set up a taskforce and put in place measures to address what he said in his recent statement was a very clear

“adverse and disproportionate impact on people from BAME communities.”

The evidence from the UK Intensive Care National Audit and Research Centre has shown consistently throughout the crisis that, compared with the general population, a higher frequency than expected of patients from BAME backgrounds have required critical care. The latest figure is over 30% in the past few weeks, which is very disproportionate compared with the wider population. Why does the Minister think that is happening, and is she incorporating that important research into the evidence that the Government are looking at?

We have been considering the factors of occupational exposure and comorbidities, but we have not finished looking at the research; there are so many research projects out there that are trying to find out exactly what is causing sevenrity and criticality of infection, for example. I think that the RDU has looked at that. We have taken information from across the board, from many universities and researchers and the ONS, and I believe that that has been fed in. If it has not, we can look to do that in the next quarter.

Our BAME communities face a medical risk not only from covid but from the fallout from other health conditions. Does my hon. Friend agree that we should encourage the BAME community to access the treatments that are available to them, such as cancer treatment, because those are important for their health?

My hon. Friend is absolutely right. We must reduce fear and build confidence among ethnic minority people about engaging with NHS services. Phase 3 of the NHS covid-19 response is taking urgent action to reduce health inequalities and regularly assess progress. NHS trusts are encouraged to restore services inclusively, so that they are used by those in greatest need. Covid wards and spaces are being separated, which should give people confidence to return and allow more routine procedures to continue.

The Minister mentioned further research. One area where there is very specific and clear research is pregnancy. The UK obstetric surveillance system showed that black pregnant women were eight times more likely to be hospitalised than white pregnant women due to covid, and half of all pregnant women in hospital due to covid are from black and ethnic minority backgrounds. That research came out in May and June this year. Will the Minister update us on what is being done to protect black pregnant women from the risks of covid and whether there will be an investigation into that specific issue?

I thank the hon. Lady for that question. I co-hosted a roundtable on maternal mortality rates for ethnic minority women with the Minister for Patient Safety, Mental Health and Suicide Prevention on 2 September, to develop appropriate solutions to benefit pregnant women and their babies during this period. Because covid-19 has fundamentally changed the way that women access maternity services, the national maternity safety champion and chief midwifery officer for England published a four-point plan for all maternity services in England to follow. That includes increasing support for at-risk pregnant women, reaching out to and reassuring pregnant ethnic minority women with tailored communications, ensuring that hospitals discuss vitamin supplements and nutrition in pregnancy with all women, and ensuring that all providers record on maternity information systems the ethnicity of every woman, as well as other risk factors. This topic has been of particular interest to me, because I returned from maternity leave after having my third child this year, so it is close to my heart. I am doing quite a lot of work on it and will continue to do so.

I welcome the appointment of independent experts on covid-19 and ethnicity, such as Wycombe resident Dr Raghib Ali. What main risk factors has my hon. Friend identified, working with them, to explain why BAME communities are so disproportionately affected? Will she take steps to make those risks more apparent to the individuals affected?

I am delighted to announce the appointment of Dr Ali and Professor Neal, specialist epidemiologists and health technology advisers who are experts on covid-19 and ethnicity. I am appointing them to provide medical expertise as critical friends, not just people to agree with everything that we say over the coming months.

On the risk factors, analysis from the ONS, PHE and academia reveals that differences in covid-19 mortality between ethnic groups were strongly associated with geographical and socioeconomic factors. The ONS found that the risk of death from covid was substantially reduced when factors other than age were accounted for, but there was still a higher risk for black and Indian adults and Pakistani and Bangladeshi males. Similarly, an Oxford University study found that ethnic differences persisted even after accounting for key explanatory factors, such as the ones that I mentioned, and we are still looking at that as part of this work.

Data shows that nearly a third of covid patients admitted to intensive care since September are from black, Asian and minority ethnic backgrounds, meaning that once again we are bearing the brunt of the coronavirus. It appears that no lessons were learned or effective actions taken over the summer. The chair of the British Medical Association, Dr Nagpaul, has described the situation as “groundhog day”. Does the Minister recognise this failure?

No, I do not recognise that statement. In fact, I have had meetings with Dr Nagpaul, and we have had many discussions about further recommendations that he has given directly to me, which we have taken forward.

I thank the excellent Minister for coming to the House to make this statement. I think she said that people over 70 were 80 times more likely to be affected by covid. If that is the case, what measures are the Government taking to protect people who are 70 or older? [Interruption.]

I may have misspoken. It might have been that people over 80 are 70 times more likely. I need to make sure I am getting the statistics right. I will confirm that for Hansard.

The Government take this extremely seriously. We have made sure that people have the guidance on what to do, depending on their individual risk profile. People who are elderly, especially those who are clinically extremely vulnerable, as my hon. Friend will know, were shielded. We are making sure that information is being provided to local authorities, NHS trusts, GP surgeries and other support within the community to make sure we continue to do so. This might be something that the community champions can reinforce.

It is very clear that, alongside BAME communities, women have been disproportionately impacted by the pandemic. They make up the large majority of workers in those sectors that are unable to operate and in very many cases they are obviously carrying much larger roles in caring, both informally and formally. Northern Ireland already had the lowest levels of employment for women, and that is in the context of the UK, even before the pandemic, slipping down gender inequality rankings. Will the Minister be advocating for specific targeted economic support for women to address the structural inequalities that are being very much exacerbated by covid-19?

The approach that the Government Equalities Office is taking is that support has to be given in the round. We are not isolated as individuals and we are certainly not segregating. On gender, for example, in the work we have been looking at in this report, it is men who are disproportionately impacted medically. Economically, depending on the sector they work in, it is women who are disproportionately impacted. We need to look at helping everybody. What we are not able to do is say—in fact, it might contravene the Equality 2010 Act—that we will give specific help to women, but not to men or to specific groups based on protected characteristics. We need to provide support based on need, and that is what we will continue to do.

I congratulate my hon. Friend on the community champions scheme and on the new funding today. Our excellent Lancashire local resilience forum has been advocating for that, and there is no substitute for on-the-ground intelligence. Will she ensure that the champions are prioritised for tier 3 areas such as Lancashire, to make sure we can make the most of getting the transmission rates down?

Evidence shows that Government covid-19 guidance is not reaching certain communities or audiences who are being disproportionately impacted. That is why we are providing up to £25 million to local authorities, and voluntary and community sectors, to improve the reach of official public health guidance and other messaging into specific places and groups most at risk—and that does include tier 3. We want to ensure that the funding is used to support communities and groups who have been shown to have suffered a disproportionate impact.

The Minister acknowledged that disadvantage through ethnicity can be compounded further by disadvantage through disability. In those circumstances, will she press her Government colleagues to recognise the vital need to address poverty that compounds it still further, and argue for the retention of the universal credit uplift and an extension to legacy benefits, including those for the disabled?

I know that my right hon. Friend the Secretary of State for Work and Pensions and my right hon. Friend the Chancellor have spoken about that specific issue many times in this Chamber. What I would say to the hon. Gentleman is that poverty, deprivation and various factors are contributing to health inequalities. That is something we do know. Those issues will not be solved by a year-long review. They need to be looked at across Government, as he says, and the Government are absolutely committed to that. We talk over and over again about levelling up. That is absolutely the ambition of this Government and we will do it in the ways that we believe are best.

I welcome the update from my hon. Friend and applaud her on the excellent work she is leading in this arena. Will she tell the House what steps she is taking to improve public health communication, especially to those communities that are normally harder to reach?

We have worked with the covid comms hub in the Cabinet Office and ministerial colleagues to build on the way public health messages are delivered effectively to ethnic minority people. In addition to the central marketing campaign, we have spent approximately £4 million to reach ethnic minority people through tailored messaging, strategically chosen channels and trusted voices. Additional funding and resources from the central campaign are also used to reach communities in specific regions, supporting local authorities to deliver bespoke translated material on request.

On 3 May, Ranjith Chandrapala, a bus driver from Hanwell in my constituency, became one of the many BAME frontline workers to die of covid-19. Since then, I have asked the Chancellor and the Transport Secretary to extend the Government’s covid-19 life assurance scheme for families of health and care workers to others, including the families of bus drivers, such as Ranjith’s. Unfortunately, I have received only promises that support for key workers will continue to be reviewed. As the Minister mentioned that today’s report highlights a significant occupational exposure, will she commit to meeting me and Ranjith’s family to discuss how we can ensure that this scheme is extended?

I thank the hon. Gentleman for his question and share the deep sympathy he has for the suffering of his constituents. All of us, across the House, are seeing this. I have had cases such as this in my constituency and they are devastating and heartbreaking. I know that many Members across the House have lots of suggestions for specific interventions we can make. I do not stand here just as an Equalities Minister and a Treasury Minister. We have said we are going to do whatever it takes, but we cannot do everything that everyone likes. If the hon. Gentleman will write to me on the issue—I have not had sight of this—perhaps I will be able to provide him with further information.

In our continued battle against covid-19, we have become much more knowledgeable about this terrible disease. However, what remains unclear is why some people are more at risk than others, including the more elderly residents of North Devon. Does my hon. Friend agree that if we are to tackle this virus effectively, it is essential that we understand the key drivers of its disproportionate impact?

I thank my hon. Friend for that question. I like re-emphasising that we should not jump to conclusions—we need to know why. If we misdiagnose, we are not able to solve the problem. We need to find out the exact reasons why things are occurring so that we can have the right solutions.

I totally and utterly agree with that. I thank the Minister for her statement and promise to read it carefully after today in order to work out what I can personally do in my constituency to aid this work. In June, I urged the Government to act upon the unequal risks before the second wave, and I pointed out that black and Asian people were not properly represented in the clinical trials. The second wave is here and the data has shown that the same inequalities are occurring. So will the Minister assure me and my constituents that from now on research projects and clinical trials will involve the appropriate numbers of people from black and minority communities, reflecting their higher risk?

I agree with the hon. Lady; she and I are not going to have a disagreement on this issue. We need to get as many people as possible from all communities represented, but we cannot force people; we need to encourage them and get them to see the benefits of that, so I urge everyone across the House to do that. If we scare people or allow those who are sending misinformation about vaccines to continue with their messaging, we will not see that. So I agree with her and thank her for raising the question.

I thank the Minister for her statement and congratulate her on the further support for community champions, who are vital at this exceptional time. Can she share further details as to why the measures are not targeted specifically at ethnic minorities and what that means for my constituents in Wales?

I know that my hon. Friend is a real champion for communities in Ynys Môn, particularly with her hidden heroes campaign. I thank her for her hard work on that and on behalf of her constituency. The current evidence is showing that there is a range of factors, which I have mentioned already, particularly occupational exposure and co-morbidities. These factors affect the whole population, regardless of race, and we need to protect the whole population. But I am also keen that we do not stigmatise ethnic minorities or make it seem as though they are carriers of the disease. Targeting specific things and saying, “This is just for black people. This is just for Asian people” will create division and stigmatise, and the support will not necessarily go to the people who need it most. That is the message I would send to her colleagues in Wales. This is what we have found. We hope that they agree with us and accept this as the way to go. It is about targeting the whole population, knowing what the vulnerabilities are, and not stigmatising groups.

I spent most of my professional career in London working with friends and colleagues from the BAME communities, so it was upsetting for me to find that more than 70% of all NHS and care deaths during the first wave of covid were among the black and minority ethnic communities. Although the reasons for those deaths are not fully understood, there is some anecdotal evidence that the deployment of staff from BAME communities to high-risk or low-protection areas may have played a role in that feature. Will the Minister advise me what action has been taken, in collaboration with the Department for Health and Social Care, regarding potential structural issues in the care services to prevent any repeat of this in the second wave?

The hon. Gentleman is right to raise that issue. As he will remember, I mentioned that 95% of ethnic minority workers have had risk assessments—we have spoken about that at several points during oral questions in the House. That is the issue that we have been trying to tackle. It is important that risk factors are taken into account before people are deployed in various sectors. We know that ethnic minorities are over-represented in lower-paid parts of the NHS, and we will be tackling that structural issue. But risk assessments are the key thing to ensure that people understand their risk, and that is how we will deal with that.

I welcome the Minister’s statement, and the Health and Social Care Committee is also starting to consider this area. Is she aware of the paper in The Lancet entitled “The impact of ethnicity on clinical outcomes in COVID-19: A systematic review”, which was published in June? It broadly picked up three areas: biological, the ACE2 receptors and difference in immune responses; the medical aspects, people having different cardiovascular or diabetic risks; and the socio-economic factors around crowding and job type. The study noticed limitations with all those areas and had questions about which predominates, so will the Minister commit to a road map to get more evidence and research to better understand the factors that we can control, and those we cannot?

Many cleaners, facilities management staff and security staff working in Government buildings are from black and minority ethnic backgrounds. What action is the Minister taking to address the terrible disparity in employment terms and conditions for those staff? That leaves them without the protection of full sick pay in the event that they have symptoms or need to self-isolate, putting them, and others working in the same buildings, at greater risk.

The Government are providing money to those people who have to self-isolate. On the broader issue of people from ethnic minority backgrounds working in lower-paid employment, this is one of the things that we dealt with as part of the employer risk guidance, which we issued repeatedly in July and September.

May I say what a fantastic job the Minister is doing in tackling some of the most difficult issues head-on? I pay tribute to her for her courage and I thank her for participating in the trial at Guy’s and St Thomas’s. It is abhorrent that any Member of the House should do anything to discourage participation in any such trial. Does the Minister agree that it is the duty of every Member of the House to work with our communities, as leaders, in encouraging participation in such an important trial?

I agree with my hon. Friend and, as I said to the hon. Member for West Ham (Ms Brown), this is not something that should be a cause for division in the House. We should be working together on this. I did not write the letter just to Conservative colleagues; I wrote it to all colleagues, and I hope that people will take up the notices in it and share them across their communities.

I am glad that the Minister referred to her letter, because I have just checked and I certainly have not received a letter from her; she referred to the matter in her answer to our shadow Minister, my hon. Friend the Member for Battersea (Marsha de Cordova).

On 19 April, I wrote to the Secretary of State for Health and asked about languages specifically, offering my help and support in reaching ethnic minorities. I represent a large minority. I come from Bradford—a diverse city—and Bradford West is one of the most diverse constituencies in the country.

I also asked about languages commissioned in September, in a written question, as have others. While I appreciate that today the Minister has said we have spent £4 million, the truth is that, while this debate has been going on, I have spoken to commissioners for Geo News, Dunya News, ARY and Channel 44, and £4,000 has been commissioned for the 12 channels that I know of that communicate in the language of Urdu, and that is without speaking to all the BAME media. Sunrise Radio, the largest Asian radio station outside London, has had one campaign, from 2 to 7 May, in Hindi, Punjabi and Urdu, but it had nothing from 7 May until 19 October. How can the Minister stand here and tell this House that the Government have been reaching out to BAME communities? Jang newspaper had to go to Downing Street and negotiate for written—not for radio communication and not for TV—adverts. So when will the Conservative party get real about communicating honestly with black and minority ethnic communities in their languages?

We have issued public health messages in over 600 publications. If the hon. Lady would like to write to me with places that have not received communications, that is something I can take up with the Cabinet Office, but I myself have engaged in quite a bit of media—BBC Asian Network, BBC Radio Manchester and other local media outlets—and lots of social media activity. We have had ethnic minority influences reaching 5 million people. I am sorry to say that if the hon. Lady is not seeing these things, perhaps she is not watching, but the money that we have spent is a testament to how hard we are working to reach people.

There are still some hard-to-reach communities, and that is why we have the community champions, because at the end of the day it cannot just be TV and it cannot just be social media. We need local authorities and people who know their local areas to be able to go out and find those people who still are not hearing the message. I hope that is something the hon. Lady will do. I will find out from the House why she has not received the letter. It should have been sent to all colleagues, and I know that many across the House have received it.

I recently had the honour of becoming the ambassador for BSC Multicultural Services in Ipswich, which, as well as supporting our large and thriving Bangladeshi community, supports people from over 50 other nationalities. Throughout the covid-19 pandemic, it has one invaluable work giving food parcels to the most needy from those communities, but right now its finances are under strain ever so slightly. I wonder if the Minister could give both me and the other leaders of the group some reassurance about potential financial assistance to them.

I commend my hon. Friend for the important work he is doing to support his community. The Government agree that charities play an invaluable role in this country, which is why we have committed a £750 million package of support specifically for charities, social enterprises and the voluntary sector can that they continue their work through the outbreak. That includes £200 million that has been distributed by the National Lottery Community Fund through the coronavirus community support fund. The fund closed to new applications on 17 August, but about 97% of the total fund value had been awarded as of 13 October. In addition, £150 million has been released from dormant accounts to help social enterprises get affordable credit to people who are financially vulnerable and to support charities tackling youth unemployment.

Covid is the disease of poverty. The evidence clearly shows that there is a higher prevalence of, and mortality from, the disease in areas of high deprivation. In addition to people from black, Asian and minority ethnic groups being at risk of covid, disabled people accounted for nearly 60% of all deaths between March and July. They are more likely to live in poverty than non-disabled people, and also accounted for a third of the 300,000 people who were not eligible for social security support in the spring. I understand that the Equality and Human Rights Commission is examining discrimination of disabled people during covid, but what are the Government doing to protect their lives and livelihoods in the second wave?

As I said earlier, the Government really take seriously the outcomes for those with disabilities. There is a lot of work happening across Government, across very many Departments. We are not leaving anyone behind; we are making sure that support is available, not just at national level through support schemes, but through local authorities and through the Department for Work and Pensions locally. If the hon. Lady wants more information, I am sure that this is something I can write to her about. I do not have the full information to hand, but I know that there is a lot of work going on across Government.

I thank my hon. Friend and welcome this incredibly important ongoing work. Does she agree with me about the importance of using science to determine individual risk as a way to help people make informed decisions about their lives and their work?

Yes, absolutely; it has to be evidence-led. Everything that we are doing in the Equality Hub is evidence-led. We have a real focus on data, to ensure that we base our decisions on what is actually happening and do not take them for reasons of politics or other reasons that are not science-based. I completely agree with my hon. Friend; I do not think there was anything to disagree with in what he said.

When, in Tuesday’s Black History Month debate, I said I was angry that six months into this pandemic all we seem to know is that black and ethnic minority people are two to three times more likely to die from covid, but not why, the Minister intervened on me and said that she would give me the answers today. I am sorry, but she has not. She seems to be saying that there is no link with ethnicity but it is up to individuals to protect themselves. The report is quite clear in that it mentions factors such as socioeconomic background, but it does not say whether those factors are causes or correlations. So I ask her again: when will we have the data-based evidence as to the causes of this heightened risk? Specifically, are the Government using artificial intelligence techniques to correlate the different factors so that we know why this is happening in our black communities?

I disagree with the hon. Lady. I think we have answered the question. Saying that something is a factor means it is having an effect—it is part of the reason. She says—[Interruption.] It does mean that. She asks for the causes of covid. What is causing the disease is people catching it; it is a contagious disease. This is not rocket science. What we are explaining is why certain groups are disproportionately impacted. We have explained that it is household size, it is population density, it is geographic factors, it is socioeconomic factors—all those things are having an effect.

I know what the hon. Lady is getting at, but we have also explained that in some groups, such as Bangladeshi women and white women, when we take out comorbidities, the disparity is completely gone. I am sorry that the report does not give her the answer that she is looking for, but as my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) rightly said, we are basing it on the science, not politics.

I thank the Minister for her statement and for answering 39 questions over an hour. I also thank the technicians, as many of the questions were virtual. Thank you very much.

Virtual participation in proceedings concluded (Order, 4 June).