Research and analysis

Appendix B: Progress implementing recommendations and next steps from first 3 reports

Published 3 December 2021

Recommendations from the first quarterly report

Recommendation 1

NHS England must ensure that Trusts implement NHS plans for the next stage of the pandemic, and that these plans continue to reflect the latest evidence about ethnic disparities and risk factors.

Status

Completed

Progress update

On 25 March, NHS England and NHS Improvement (NHSEI) former chief executive Sir Simon Stevens and chief operating officer Amanda Pritchard wrote to NHS organisations to outline the fourth phase of the response to COVID-19 and the NHS’s priorities from 1 April 2021.

The focus for this phase is on recovering NHS services through enhanced system working. Implementation guidance has also been published. The guidance includes a priority to accelerate preventative programmes that proactively engage those at greatest risk of poor health outcomes including ethnic minority groups.

Recommendation 2

Departments must put in place arrangements for the effective monitoring of the impacts their policies are having on people from ethnic minority backgrounds including:

• the uptake of particular COVID-19 policies or grants of funding by ethnic minority individuals and groups
• monitoring and assessing the level of infection, hospitalisation and mortality rates across ethnicities, where appropriate
• assessing how effectively these policies have been understood by those people at whom they are targeted

Status

Completed

Progress update

The RDU has worked with departments to assist them in putting effective monitoring arrangements in place through a cross-government working group on addressing COVID-19 disparities amongst ethnic minorities.

A technical annex setting out how to measure ethnicity impacts was also developed. Examples include building in monitoring structures into the Community Champions scheme to ensure that the programme delivers assistance to those groups who most need it.

Recommendation 3

Light-touch review of action taken by local authorities and Directors of Public Health to support people from ethnic minority backgrounds, in order to understand what works at a local level.

Status

Completed

Progress update

RDU conducted this rapid review in time for the Second Quarterly report by focusing on local authority areas, identified by MHCLG under the Community Champions applications process, with larger proportions of at-risk communities and entrenched community transmission of COVID-19, using a variety of data sources. The findings from this are summarised in Chapter 1.

Recommendation 4

Departments should continue to work at pace to develop new policy interventions to mitigate COVID-19 disparities, informed by the latest evidence.

Status

Ongoing

Progress update

This work is ongoing as departments are continuing to develop interventions to address the disproportionate impact of the pandemic. A summary of government interventions to date, and how these changed over the lifetime of this project, is included in Chapter 1 of this report.

Recommendation 5

Support should be given to the development and deployment of a risk model to understand individual risk that is being developed from research commissioned by the CMO by an expert subgroup of academic, scientific and clinical experts and the University of Oxford.

Status

Completed

Progress update

The QCOVID research was peer-reviewed and published in the British Medical Journal in October 2020, approved by the Medicines and Healthcare products Regulatory Agency in December and independently validated by the ONS in January 2021. The clinical tool was made available across primary and secondary care as a secure public beta webtool from 16 February 2021.

Recommendation 6

Ensure that new evidence uncovered during this review relating to the clinically extremely vulnerable is incorporated into health policy.

Status

Completed

Progress update

The QCOVID model enabled DHSC to incorporate the findings from the research into national policy and has used it to identify a new cohort of patients at equivalent risk to the Clinically Extremely Vulnerable. This group was added to the Shielded Patient List as a precautionary measure, and was entitled to priority access to the COVID-19 vaccine.

The Joint Committee for Vaccination and Immunisation also reviewed the underlying data from the QCOVID model in shaping its advice on COVID-19 vaccine prioritisation. The Minister for Equalities has also shared the findings from the first 3 quarterly reports with the JCVI.

Recommendation 7

Government departments and academics should prioritise linkage between health, social and employment data to build a complete picture of ethnic group differences in COVID-19 risk and outcomes.

Status

Ongoing

Progress update

ONS linked health and mortality statistics with census 2011 to obtain employment and social characteristics. The latest analysis from ONS took all these characteristics into account. Viruswatch provided further evidence on the risk of transmission for certain occupations. The University of Leicester provided evidence on the risk of transmission for Healthcare workers and shift workers. UK-REACH is exploring further the risk of transmission for Health care workers so this work is continuing.

Recommendation 8

RDU should introduce and publish a new “Summary of evidence about COVID-19 and ethnicity” report, working collaboratively with external experts, which would be updated every time (significant) new statistics and research are published.

Status

Completed

Progress update

In December 2020, ONS introduced a COVID-19 Dashboard (including a section about ethnicity), which provides an easily-accessible and up-to-date summary of the main statistics about COVID-19. This is regularly updated.

Recommendation 9

The recording of ethnicity as part of the death certification process should become mandatory, as this is the only way of establishing a complete picture of the impact of the virus on ethnic minorities. This would involve making ethnicity a mandatory question for healthcare professionals to ask of patients, and transferring that ethnicity data to a new, digitised Medical Certificate Cause of Death which can then inform ONS mortality statistics.

Status

Ongoing

Progress update

This work is well underway. DHSC laid a Statutory Instrument and accompanying Directions in December 2020 which made changes to the regulations governing GP contracts.

The overall approach still remains to make ethnicity a mandatory question for healthcare professionals to ask of patients, and transferring that ethnicity data to a new, digitised Medical Certificate of Cause of Death.

Recommendation 10

Minister for Equalities to work with ministerial colleagues to establish metrics for assessing the impact of their policies to tackle COVID-19 disparities.

Status

Completed

Progress update

The Minister for Equalities wrote to ministerial colleagues in December 2020 encouraging departments to establish metrics for assessing the impact of their policies, accompanied by a technical annex setting out some of the important considerations when developing metrics based on ethnicity.

Recommendation 11

There should be a series of roundtables over the coming months involving faith leaders and other community representatives and focussing on those groups that are most at risk from COVID-19.

Status

Completed

Progress update

MHCLG has led on engagement with faith groups throughout the pandemic and the Minister for COVID-19 Vaccine Deployment attended a number of stakeholder events to promote vaccine uptake among ethnic minority groups and to combat misinformation about the COVID-19 vaccines.

The Minister for Equalities and RDU have hosted a series of roundtables between February and May on promoting vaccine uptake amongst South Asian groups and Black African and Black Caribbean Groups. Participants included faith leaders, community representatives and Commonwealth High Commissioners which generated a number of ideas and insights on how to improve vaccine uptake in these cohorts.

Recommendation 12

Work must continue on improving public health communication to enable the successful delivery of existing and new interventions to all parts of the community including hard-to-reach groups, especially those at greatest risk in areas of local lockdown and rising concern.

Status

Ongoing

Progress update

Since the first quarterly report, there have been a number of partnerships with trusted community media outlet to better engage hard-to-reach groups, including more than 50 ethnic minority titles across 10 different languages, 43 ethnic minority TV channels within a combined reach of 9 million and 14 community radio stations that broadcast in 13 different languages and reach 881,000 ethnic minority people every week. This is in addition to more specific engagement with faith leaders and other stakeholders.

Translation continues to be a priority to reach those whose first language is not English and/or who have other accessibility needs. This includes translation of videos into British Sign Language and posters into Easy Read and Large Print as well as language translation. In addition to the translation of national assets, local authorities can request translations of their own assets.

The work to improve public health communications will continue during the lifetime of the pandemic.

Recommendation 13

Dispel myths, reduce fear and build confidence among ethnic minority people. Over the coming months, the COVID Communications Hub in the Cabinet Office will need to keep sharpening its focus on rebuilding trust in government messaging, tackling misinformation and anti-vaccination narratives and encouraging engagement with NHS services.

Status

Completed

Progress update

Since the start of the pandemic, specialist government units have worked at pace to identify and rebut false information about coronavirus, including the vaccines. The cross-government Counter Disinformation Unit (CDU) brings together different monitoring teams across Whitehall including teams in the Home Office, Foreign Commonwealth and Development Office and the Rapid Response Unit (RRU).

To tackle mis- and disinformation among ethnic minorities, the government regularly produces myth-busting content, utilises trusted platforms and messengers within communities and takes specific targeted approaches on social media channels (such as Facebook and Instagram). We also use native language publisher sites such as Asian Voice, Leader, The Nation, JC and Desi Express as part of ongoing partnership work.

There has been an extensive cross-government campaign to encourage vaccine take up, specifically looking to tackle mis and disinformation and build vaccine confidence among ethnic minority communities. The campaign has included content with well-known personalities and medical professions aimed to build confidence and trust in the vaccines, across a range of channels from social media to media partnerships.

Next steps from the second quarterly report

1.1

Ministry for Housing, Communities and Local Government (MHCLG) to share with local authorities examples of good practice from the review of local authority activity.

Status

Completed

Progress update

MHCLG ran a programme of best practice webinars between local authorities and disseminated best practice materials via an online portal which can be accessed by local authorities who are not in receipt of Community Champions funding.

1.2

MHCLG to share with local authorities the findings from the initial, one-month review of returns from Community Champions.

Status

Completed

Progress update

Summaries of the monthly returns from the Community Champions scheme are included in subsequent quarterly reports. Participating local authorities are also encouraged to share knowledge, resources and practical solutions with non-funded local authorities to ensure other areas and their local communities benefit indirectly. For example, MHCLG is partnering with the NHS to host an online forum for both funded and non-funded areas to come together, download resources and discuss methods and techniques to engage disproportionately impacted groups.

1.3

Minister for Equalities to write to the Joint Committee on Vaccination and Immunisation (JCVI) summarising the latest data and evidence set out in this report, to inform future advice on vaccine prioritisation.

Status

Completed

Progress update

The Minister for Equalities wrote to the JCVI in March following publication of the second quarterly report.

1.4

The government will continue to monitor data on vaccine uptake among ethnic minority groups and, if necessary, take further steps to address any barriers among these groups.

Status

Ongoing

Progress update

NHS England produces weekly statistics on the number of people vaccinated by ethnicity and age, ethnicity and region. They also produce vaccine uptake rates by ethnicity for adults and people aged over 50. In addition, OpenSAFELY produced weekly updates by ethnicity and age group.

This is an ongoing commitment, with COVID-19 booster vaccines now being deployed.

1.5

The RDU will share the findings from the qualitative research into people’s personal experiences of COVID-19 across government, particularly in relation to the stigmatisation felt by a number of participants in relation to being singled out as BAME.

Status

Completed

Progress update

Presentations were given to individual government departments on the findings from the qualitative research. A summary of the findings can be found in Chapter 4.

1.6

Departments and other agencies should publish a statement on gov.uk outlining their plans to move their data collections to the Government Statistical Service’s (GSS) harmonised ethnicity data standard. Harmonisation is hugely important as it allows analysts to gain deeper insight and value from data.

Status

Ongoing

Progress update

RDU analysts are exploring the feasibility of this with the GSS Harmonisation Champions group. This work can be progressed further when a new harmonised standard is confirmed.

1.7

NHSEI, working with DHSC and others, should publish a quarterly report on progress in improving the recording of ethnicity in health care records.

Status

Completed

Progress update

RDU worked with analysts in PHE to produce the first progress update which was included in the third quarterly report. This was about determining ethnicity in health datasets to improve the accuracy of the coding.

Appendix F to this quarterly report summarises progress on different strands of improvements to health ethnicity data.

1.8

Departments should provide updated datasets on COVID-19 risk factors and secondary impacts for publication on the Ethnicity facts and figures website in line with the schedule in Annex C of the second quarterly report. This provides transparency of process to users, promoting trust and authority, as well as informing them when the most up-to-date data will be made available.

Status

Ongoing

Progress update

This work is ongoing as shifting departmental priorities and reduced resources have delayed the delivery of data and publication of a handful of measures.

1.9

The Minister for Equalities, the government advisers on COVID-19 and ethnicity, and the RDU will continue a programme of engagement over the next quarter. This will include work to promote vaccine uptake, alongside the engagement led by the Minister for COVID-19 Vaccine Deployment.

Status

Completed

Progress update

In the third quarter, the Minister for Equalities held roundtables with black and Asian faith leaders and Commonwealth Heads of Mission. Other stakeholder engagement activities included bilateral meetings with Professor Andrew Goddard, President of Royal College of Physicians and Dr Thomas Waite, Deputy Chief Medical Officer.

She was supported in this work by Dr Raghib Ali, one of the government’s independent advisers on COVID-19 and ethnicity. He participated in a number of webinars and question and answer sessions to tackle disinformation and promote vaccine uptake. This included events with the British Pakistan Foundation, the NHS Muslim network and Muslim Doctors Association, and numerous faith groups and community organisations.

1.10

The government will continue to tailor its communications strategy on vaccine roll out to reflect the latest evidence on vaccine uptake among ethnic minority groups.

Status

Ongoing

Progress update

Vaccine confidence (positive sentiment) has increased since December 2020 and the majority of people say they have already been vaccinated, or would be likely to accept a vaccine.

This is an ongoing commitment as the vaccine deployment continues.

1.11

The government will work closely with the new Community Champions to disseminate important public health messages, promote uptake of vaccine and tackle misinformation

Status

Completed

Progress update

The government has continued to work closely with the Community Champions. Additionally, as part of this scheme, funding was also provided to Strengthening Faith Institutions (SFI) and Near Neighbours (NN) in order to utilise their networks with at-risk communities. Both organisations are partnering with a host of community organisations as well as Community Champions across England and are making a real difference in vaccine uptake.

For example, SFI, in collaboration with community partners and champions, has organised 15 community-led webinars and roundtables to date. These include consultations with NHS Test and Trace for South Asian, black, Jewish, Sikh and other groups, and webinars for Arab Muslim, Gujarati Khoja, Somali, black Christian and black Muslim groups.

1.12

Government communications will reflect the findings of the qualitative research into people’s personal experiences of COVID-19 and will ensure that ethnic minorities are not treated as a single group and that public health messaging is not stigmatising.

Status

Ongoing

Progress update

Communications activity continues to align with the wider government messaging to avoid stigmatisation. The government has sustained a tailored approach to communicating with people from different ethnic minority groups, taking into account their own cultural and religious considerations, providing information in multiple languages, and working with partners, influencers and media channels who resonate and are trusted by specific ethnic minority groups, extending the reach and efficacy of messaging.

Next steps from the third quarterly report

2.1

The Minister for Equalities to share the findings of her third quarterly report with the Joint Committee on Vaccination and Immunisation.

Status

Completed

Progress update

The Minister for Equalities wrote to the JCVI in May to share the findings of the third quarterly report.

2.2

Department of Health and Social Care (DHSC) to consider how to apply the findings of the review of experiences of frontline healthcare workers and the UK-REACH study.

Status

Ongoing

Progress update

RDU analysts are working in partnership with Dr Pareek and Dr Ali on a project to understand the factors and circumstances that may have contributed to the deaths of healthcare workers from COVID-19.

2.3

NHS England’s published data on vaccination uptake by ethnicity should be further disaggregated to provide percentage uptake by vaccine priority group cohorts and sex. This should include levels of unknown ethnicity and an assessment of how this might affect the interpretation of vaccination uptake for different ethnic groups.

Status

Ongoing

Progress update

NHS England produces weekly statistics on the number of people vaccinated by ethnicity and age, ethnicity and region. They also produce vaccine uptake rates by ethnicity for all adults and people aged over 50.

2.4

NHS England and Improvement (NHSEI) should publish data about the use of the NHS COVID-19 app by different ethnic groups. This will inform activity to increase the uptake and continued use of the app.

Status

Ongoing

Progress update

Work on this is underway. Data on the use of the app by ethnic minorities has not yet been published.

2.5

DHSC and the NHS should further investigate practical barriers to vaccine uptake by ethnicity to assess and address any intention-action gap.

Status

Completed

Progress update

DHSC has undertaken work to engage with specific groups/forums who have lower uptake of the COVID-19 vaccine to gain insight as to what may be driving hesitancy in their communities, what are the barriers to access to the vaccine and feedback on how effective implemented interventions have been.

For instance, the then Vaccines Deployment Minister chaired a NHS Youth Forum Roundtable on 30 June to draw on perceptions and experiences from this group, to gain insight into vaccine hesitancy in young people, to understand what might be driving apprehension and what could be done to address it.

Earlier insight pieces from both the Cabinet Office and NHSEI informed a number of interventions to address identified barriers to vaccine uptake within specific groups. For example, a lack of accessibility to vaccines and the need for targeted communications were identified as barriers to uptake for certain communities. Interventions such as mobile delivery models, and translation of messaging into various languages, have helped to address these barriers.

DHSC continues to explore the possibility of commissioning further behavioural insights to help inform decision-making on interventions and support continued uptake of COVID-19 vaccines across groups.

At a local level, qualitative information and insight on the reasons for vaccine refusal is collected. DHSC has worked with the ONS to review survey options related to asking the wider population questions related to vaccine hesitancy.

2.6

DHSC should ensure that NHS organisations and GPs are provided with clear guidance and protocols about how ethnicity should be requested and recorded in health records.

Status

Ongoing

Progress update

DHSC is working with NHSEI, NHS Digital and other partners on the alignment of ethnicity data. The aim is to support meaningful comparisons of data on the access to, and experience of, health services and health outcomes. It will also enable policies and decisions to be based on better or more complete data.

2.7

RDU should engage with the Office for Statistics Regulation about priorities for improving the quality (including harmonisation, robustness and reliability) of ethnicity data on health records, drawing on others’ expertise as appropriate, and report back in the final quarterly report.

Status

Completed

Progress update

RDU and OSR hosted a joint roundtable event with ONS and the other main health departments in August 2021.

Priorities for improving data quality were discussed at the roundtable, and the results are outlined in the data quality section of this report.

2.8

The Minister for Equalities and the Minister for COVID-19 Vaccine Deployment will continue a programme of engagement in the next 3 months, focusing on promoting vaccine uptake and encouraging asymptomatic testing, particularly for those within higher risk occupations, as sectors reopen.

Status

Completed

Progress update

A summary of stakeholder engagement over the last period is set out in Chapter 4.

2.9

As the COVID-19 vaccine rollout continues, the government’s Vaccine Confidence campaign will aim to inform, educate and empower those aged 18 to 50 to take up their vaccine. Using the tagline ‘Every Vaccination Gives Us Hope’ content will take an optimistic tone, aiming to reach and persuade younger audiences, including ethnic minority groups.

Status

Completed

Progress update

Communications and campaign activity has focused on encouraging COVID-19 vaccine uptake as the vaccination rollout programme expands, as surveys conducted by the ONS have shown an increase in vaccine confidence amongst ethnic minority groups during this quarter. This activity built on relationships established with influencers and local communities, and uses effective media channels to reach ethnic minority groups with information about vaccines.

2.10

At each step of the government’s roadmap out of lockdown, tailored guidance and communications will continue to be shared through community and media channels to maximise reach and impact.

Status

Completed

Progress update

Communications and campaign activity has focused on encouraging COVID-19 vaccine uptake as the vaccination rollout programme expands, as surveys conducted by the ONS have shown an increase in vaccine confidence amongst ethnic minority groups during this quarter. This activity built on relationships established with influencers and local communities, and uses effective media channels to reach ethnic minority groups with information about vaccines.