This post was authored by Juliet Bouverie OBE (Chair, The Richmond Group of Charities)
Last week, the government announced its long-term strategy for living safely with Covid. The Richmond Group is urging a rethink of the approach, which has left many vulnerable people feeling abandoned and invisible.
As a group of national health and care charities we provide support to more than 13 million people with long-term physical and mental health conditions each year. Together, we focus on influencing health and care leaders and policy makers to address multiple conditions and health inequalities.
Living with more multiple long-term conditions is the new normal. 1 in 4 of us now live with two or more long-term conditions and people with two or more long-term conditions have a 48% higher risk of a positive Covid test. In addition, many of them not only have serious health conditions but also live in socio-economic circumstances that contribute to their ill health. The impact of Covid has been and continues to be even greater on them.
And yet the current plan does not offer any reassurance to people with long-term conditions as to why it offers the right approach. Many of the people we serve have been shielding or living in fear and social isolation for the last two years. Most are now vaccinated, however we know there are some groups where the vaccines don’t offer as much protection (for example some people living with cancer).
We stand ready to provide advice and support to people living with long-term conditions as they navigate living safely with Covid. However, to do that, we need a lot more detail about the evidence base behind the plan. There are a number of things we’d like to see:
1. A much more inclusive definition of who needs protection and what that support should look like. In addition to the over half a million people living with conditions that compromise their immune systems, it is estimated that 15%-30% of the population is living with two or more long-term health conditions. Well before the pandemic, we had evidence that people in the most deprived areas of the country were acquiring chronic illnesses 10-15 years earlier than in the least deprived areas. These people have to use health and social care services and are not in a position to pay for ways to reduce social contact, such as online grocery shopping.
This plan as written will not end restrictions for the millions of people our charities represent. Instead, it will end the protections that we should be proud to have implemented as a society for our most vulnerable people. Removing them will mean that people living with chronic illness and disability, their families and their communities, will be faced with greater restrictions than ever before. This is not living well, and it is certainly not living fairly, with Covid. Unless the needs of people living with chronic illness and disability are recognised and met, this strategy will fail.
As our charities know too well, little to no social contact with loved ones has caused significant decline and deterioration in people living with a range of conditions during the pandemic. Are we now to accept that huge swathes of society must live in isolation because we have no plan in place that includes and protects them? For the health and wellbeing of the nation, the consequences would be devastating. We stand by the principles and approach set out by the Association of Directors of Public Health’s guidance that any long-term strategy must be about living safely and fairly with Covid. As a first step, urgent clarity on eligibility for the spring boosters and how these criteria have been decided and how roll-out will learn from the winter booster campaign that failed to prioritise those in residential care or housebound is required.
2. Implementation of a revised testing regime, built on a clear evidence base, that safeguards people’s health and maintain support for self-isolation. The people we support report high levels of anxiety and fear at the prospect of ending free testing, particularly those who are, or who live with, someone who is clinically vulnerable. People living with chronic illness and disability are not rare. About 26 million people in England alone have at least one long-term condition. For the friends and family of the immunocompromised, whether symptomatic or asymptomatic, if they want to test, they will have to pay. An end to free testing will make it more difficult for socio-economically deprived and minority populations (who often have comorbidities) to take precautionary actions and seek medical treatment. How can we defend a policy that means only those who can afford it can see their loved ones? We’d like to see a revised testing regime, built on a clear evidence base, that safeguards people’s health. If testing is recommended or necessary, it should be free, and for everyone else it should be capped at a reasonable price.
We are concerned that the removal of support for self-isolation will mean that some people with multiple long-term conditions will be forced to make the impossible choice between feeding their family or protecting them from the virus by not going to work. This is a choice no one should have to make. The Covid provisions within the Statutory Sick Pay and Employment and Support Allowance regulations must be maintained. Passing on costs to families and carers is unjust when we have evidence that other countries' efforts to reduce rates of infectious illness through improved sick pay have proved effective. The scientific advice to Ministers on these points is very clear. A cap on the cost of testing for all would mean that everyone who needs to access testing can access it.
3. A broader plan for living well and fairly with Covid on an ongoing basis to be developed. Evidence suggests that protective behaviours developed during the pandemic can easily reduce or cease if not promoted longer term. Living well and fairly with Covid means developing a wider plan for how we respond to these challenges. That plan should include a focus on preventative Covid treatments and priority given to further research into treatments and vaccines. It should include resourcing surge testing for new variants and investment in prevention and cure of Long Covid. It should include local government and public health working with employers and businesses to tackle outbreaks, maintaining the health and safety requirement for every employer to explicitly consider Covid in their risk assessment. It should include ensuring schools and care homes have access to testing, as well as other important steps to tackle Covid in local communities. It should include maintaining the £500 compensation for self-isolation provided to a minority of people. It should include proper ventilation in schools, hospitals, childcare settings and educational institutions. It should include the continued promotion of protective behaviours, with voluntary adherence regarded as a contribution to collective wellbeing.
Lifting restrictions in this way will put yet another burden, without additional funds, on a system that is already overstretched. In doing so, it risks the unintended consequence of making it even more difficult to achieve the government’s ambitions in the elective care recovery plan. Tackling waiting lists quickly and well is a top priority for patients and the public, and an end to the physical and mental pain so many people suffer while waiting for treatment can’t come too soon.
In conclusion, we need a plan to end this journey as we began it – taking care of one another, together. Whilst so much remains uncertain about the long-term impacts of Covid, we urge government to take a more equitable approach. If the government is serious about Levelling Up as a moral, social and economic imperative then the long-term strategy for living safely with Covid cannot discount the negative impacts on a much wider group of clinically vulnerable people including people with multiple long-term conditions and marginalised individuals and communities.
Summary of Richmond Group calls to action:
- Implement a revised testing regime, built on a clear evidence base, that safeguards people’s health. If testing is recommended or necessary, it should be free, and for everyone else it should be capped at a reasonable price
- Maintain Covid provisions within the Statutory Sick Pay and Employment and Support Allowance regulations
- Maintain the health and safety requirement for every employer to explicitly consider Covid in their risk assessments
- Maintain the £500 compensation for self-isolation provided to a minority of people
- Safeguards to protect the clinically vulnerable from being infected by their carers
- Urgent clarity on eligibility for the spring boosters and how these criteria have been decided
- Clarity on contingency plans in place if new variant develops