2. Professor Nicholas Watson

PROFESSOR NICHOLAS WATSON (affirmed).

Questions From Lead Counsel to the Inquiry

Mr Keith: Professor Shakespeare, could you commence, please, by giving your full name.

Professor Shakespeare: So, I’m Professor Thomas William Shakespeare and I am professor of disability research at the London School of Hygiene and Tropical Medicine .

Mr Keith: Thank you. And, Professor Watson, you too.

Professor Watson: I’m Nicholas Watson and I’m professor of disability research at the University of Glasgow.

Mr Keith: You have been both been good enough to produce a joint report to this Inquiry on structural inequalities and disability. And there we have it, INQ000280067.

At the bottom of the page, of that first page, professors, if I can address you collectively, have you provided confirmation of the accuracy and the substance of your joint report?

Professor Watson: We have, yeah.

Mr Keith: And the declaration is dated 21 September 2023.

Can I turn, please, to your professional qualifications.

Professor Shakespeare, you’ve told us that you are professor of disability research at the London School of Hygiene and Tropical Medicine. Have you written extensively on the issues of disability, development and bioethics for many years now.

Professor Shakespeare: I have. I got my PhD in 1995, and since then I’ve written mainly about Britain and disabled people’s experience.

Mr Keith: Thank you.

Professor Watson, you are, as you have told us, Chair of Disability Studies and Director of the Centre for Disability Research. In Glasgow, the University of Glasgow, have you also written for many years extensively on a range of disability issues?

Professor Watson: Yes.

Mr Keith: Do those issues, for both of you, cover obviously the issue of disability but, in your case, disability in childhood, social care, social support for disabled people, disabled young people and public service reform and poverty?

Professor Shakespeare: Yes.

Professor Watson: Yes, they have.

Mr Keith: Right.

Gentlemen, whilst you give evidence, please if you could remember to keep your voice up and speak as slowly as you humanly can in order to aid our stenographer. If I ask a question the meaning of which is not clear, please don’t hesitate to ask me to put the question again.

We have, in the interests of transparency, discussed the way in which you are proposing to give your evidence. One of you, you’ve had a think beforehand, will go first in answering the particular topic that I raise, and if the other then wishes to add an answer or add some explanatory further comment in relation to that topic, then of course you’ll do so.

The report commences on page 3 with this statement, which I might observe would, I hope, be taken to be a statement of the obvious:

“The potential for disabled people to be at higher risk of harm from Covid-19 was well understood before the pandemic took full effect.”

You refer in the report thereafter to two particular pieces of learning, one from the US Centers for Disease Control, but in your joint opinion, was it obvious that, in the face of a viral pandemic, both the pandemic and the response of the government, the response of any government, would be likely to have a disproportionate impact upon disabled people?

Professor Shakespeare: Yes, it was. We feel from the evidence that disabled people not only have a primary vulnerability, not all but some, a primary vulnerability to a SARS-like infection, but they also have a narrow margin of health, and are more likely to be in a situation of deprivation.

Mr Keith: Do you in fact identify in your report five separate areas in which there was potential – and the potential, as you’ve said, must have been well understood – for greater vulnerability and impact?

Professor Shakespeare: Yes. Yes, we do.

Mr Keith: Let us see whether we can identify each of them, drawing the threads together from your report.

So firstly, in terms of vulnerability, do disabled people suffer from a greater vulnerability in terms of their overall health?

Professor Shakespeare: Not all, but some certainly, and particularly people with intellectual disability or who are older would be more vulnerable to an infection of this kind.

Mr Keith: Secondly, is there a greater vulnerability in terms of clinical vulnerability, that is to say a propensity to become infected, to be vulnerable to the virus itself?

Professor Shakespeare: For some people, not for all. Particularly for people living in congregate living situations, who are more likely to be older or disabled, they would, by virtue of their proximity to each other. But also people who have suppressed immune systems as a side effect of their primary condition would be more likely to become infected and therefore become ill.

Lady Hallett: I’m sorry, Professor, I missed the word, and I think the stenographer did too: living in something situations?

Professor Shakespeare: Sorry, congregate living situations.

Lady Hallett: Congregate.

Professor Shakespeare: So, many – certainly older people but also people with intellectual disability, mental health conditions may live together. It might be not necessarily an institution, which would be the past experience, but more congregate than most of us would live in.

Mr Keith: Professor Shakespeare, whilst you give evidence, could I ask you to go a little more slowly. These are important, and well, scientific issues in part, and it’s very important that we understand what you have to say.

The third area that you identify in your report is that of the greater risk of infection on account of the socio-economic conditions of some disabled people, so that is to say the greater risk of infection from their housing or from general deprivation.

Professor Watson, do you want to agree with that proposition?

Professor Watson: Yes, I think so. I think for some disabled people, they – I mean, Tom’s talked a lot about how disabled people can be vulnerable to SARS-like viruses, but disabled people can be made vulnerable to SARS-like viruses as well, and I think that what we have seen here is that, through structural inequalities, we’ve placed disabled people in a position where they’re more at risk, both of acquiring a SARS-like virus but also of not responding as well to a SARS-like virus, should that happen.

Mr Keith: Then fourthly, is there the issue of resources? So some disabled people may have a greater lack of access to the necessary health and care resources which would plainly be needed or required in order to be able to combat consequences of the virus?

Professor Watson: There’s evidence of significant inequalities in access to healthcare for disabled people. I mean, there’s a substantial body of evidence to show that disabled people face discrimination when trying to access healthcare.

Professor Shakespeare: But – can I add to that? – in addition, some disabled people, not all, have higher needs for healthcare, whether that’s a physical healthcare or psychiatric healthcare, and therefore if their primary physician is, as it were, diverted, they would be at some risk.

Mr Keith: And although, Professor Watson, you used the word “discrimination”, in this context, we’re examining, are we not, objectively, a lack of access to health and care resources?

Professor Watson: Yes.

Mr Keith: Is your point that some disabled people, for whatever reason, may encounter a greater lack of access to the resources that are required in order to be able to combat the virus?

Professor Watson: Yes.

Mr Keith: All right.

Then lastly, do you identify this last, fifth, area, which concerns the general impact, which you say is disproportionate, of the pandemic control measures which the government brought into effect in order to combat the virus?

Professor Shakespeare: I mean, I would say, from the evidence that we’ve seen, there would be the way in which, for many people, their social world is constructed by the state and voluntary organisations. I’m talking about particularly people with intellectual disability. And therefore, when all that has to be withdrawn, what can they do? They will stay at home and watch television. And then other people, who – the nature of the pandemic control measures, there were a certain number of people who were, as it were, given priority in shopping, but then we excluded from a lot of other people, and – things like social distancing, if you’re visually impaired, it’s impossible for a guide dog to understand what is necessary. So all of those aspects would be more difficult.

Professor Watson: Sorry, I think also, moving things digitally online works for a lot of people, but obviously there was a lot of – we point to the digital exclusion that disabled people are more likely to experience. So one of the responses to the Covid pandemic was to move things online. Well, if you’re digitally excluded, then that greatly increases the disadvantage experienced by those who are digitally excluded.

Mr Keith: So you’ve both given some examples of the ways in which the government decision-making and the restrictions that it applied on the population as a whole would have had a disproportionate impact on disabled people. But the nub of it, in relation to this fifth category, is this, isn’t it: that the government decision-making and the measures it imposed had a direct impact on the day-to-day lives of disabled people, who, because they are disabled, would therefore tend to be disproportionately affected by that impact?

Professor Watson: Yes.

Professor Shakespeare: Yes, that’s true. And I would add to that, that disabled people were an afterthought in many of the provisions. They were not centrally thought about, and therefore they were excluded from measures that were taken to protect the general population.

Mr Keith: By that, Professor, do you mean that when one examines the non-pharmaceutical interventions, the social restrictions, the lockdown orders, the stay at home orders, the social distancing and so on and so forth, the measures that were put into place, on their face they don’t appear to pay any regard to this particular part of society?

Professor Shakespeare: Exactly, yeah.

Mr Keith: All right.

So that we are clear, however, as to the extent to which you were asked to look at this area by the Inquiry, we didn’t ask you, in fact, to look at the actual nature specifically of the government response and see to what extent the needs of disabled people were expressly considered?

Professor Shakespeare: We cannot comment on that, we haven’t studied it.

Mr Keith: Thank you very much. Well, that’s very clear.

Can we now turn, please, to some of the figures that you’ve produced, very helpfully, at paragraph 3 of your report.

The Department for Work and Pensions produced a survey, the Family Resources Survey. Did it estimate that in 2021, 22% of the United Kingdom’s population reported a disability?

Professor Shakespeare: Yes, it did.

Mr Keith: And what was meant in that survey by “reported a disability”? The Inquiry has seen, and we’ll come to this tomorrow, some ONS data, both by way of statistical material and also what’s called an opinions and lifestyle survey, that those who are disabled have the ability to be able to report whether they are disabled a little or disabled a lot.

What sort of reporting structure was the foundation for this survey?

Professor Shakespeare: Well, that would have been a survey of people claiming benefits and people not claiming benefits, and therefore it would – I think it would take the definition of disability in the single Equality Act, which is that physical or mental impairment, a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities. That is what is meant.

Mr Keith: Thank you.

The survey postdated the pandemic, at least insofar as it drew upon figures from 2020 to 2021. Is it possible to say, from the survey, or from your own researches, to what extent levels of disability have fluctuated in the course of the pandemic or as a result of the pandemic?

Professor Shakespeare: That would be supposition on our part, we don’t have that data.

Mr Keith: All right.

Professor Watson: I don’t think that these data would be sensitive enough to pick that up, but I think the – there is a possibility that we could look at that.

Mr Keith: For those of state pension age, 46% reported a disability, and the figure for those of working age was 21%, the figure for children was 9%, and 24% of females reported a disability compared to 20% of males.

Did those figures for or based upon the criteria of age or sex or occupation vary by jurisdiction?

Professor Shakespeare: I think that, generally speaking, people in Scotland and Wales tend to have a higher rate of disability than people in England, because disability is related to deprivation, there’s a strong poverty gradient, and therefore you can see that Wales has got the highest figure.

In this statistics Scotland has got the lowest, but, you know, there are others which would put it higher.

Professor Watson: I think that there’s a huge variation. No one knows – when this report came out, lots of people had been speculating as to why Wales has such a high figure. But no one really knows, because it could be age, it could be – it will be a mixture of age, poverty and other – industrial – legacies of industrial injuries and things.

Mr Keith: Although we didn’t ask you in the report to address this issue, are you able to say how these figures compare to other comparable Western European countries?

Professor Shakespeare: The trouble is, I’m sorry to disappoint you, but people used a different definition of disability. I mean, Britain has got the highest levels of disability in Europe, but that may be an artefact of the way that we count disability. I mean, Norway and Germany, Norway 10.7, Germany, 9.4, those are not what we would count as disability. We are more like France, at 17.8, Switzerland, at 20.9. I think Sweden is about the same. So those would be comparable to us, but we would caution extreme care, because we’re not clear on what basis they have defined people as disabled. Disability is a bit like a piece of string, it depends where you cross the line.

Mr Keith: Thank you. Well, that’s extremely clear and not altogether surprising.

Your report then deals in general terms with three areas: vulnerability, the areas in which disabled people suffer the greatest degree of vulnerability; the area, secondly, in which they suffer from discriminatory practices; and thirdly, the issue of access to resources, and in particular to health and care resources on the part of the state.

So picking up, firstly, that issue of vulnerability. Is it well established that in general terms – and I emphasise in general terms – disabled people have a much narrower margin of health and face significant health inequalities? What is meant by a narrower margin of health?

Professor Shakespeare: People I think are more likely to have secondary conditions, that is conditions consequent on their primary health condition. They’re more likely to be poor and, therefore, they might have comorbidities which are unrelated to their primary condition, and of course things like age or gender would also have a role.

Professor Watson: I think they’re also more likely to respond less well to a health challenge, because there’s an increased vulnerability, so if they get flu, they’re more likely to face mortality or morbidity resulting from flu.

Mr Keith: Because they are more vulnerable?

Professor Watson: Because they’re more vulnerable, they’ve got that narrower band of health, would be the way …

Mr Keith: Now, you’ve referred to comorbidities, Professor Shakespeare. Are comorbidities serious health conditions from which a person may suffer alongside the disability or some other aspect of their day-to-day life or their societal position? So, in the case of a disabled person, they may suffer from hypertension or heart disease or respiratory disease alongside the disability?

Professor Shakespeare: Exactly. And if I can take the example of people with intellectual disability, often people are overweight or obese, and of course there’s lots of consequent health risks on that as well as any primary health risk they might have because of their intellectual disability.

Mr Keith: As a general proposition, it’s obvious from this report and the other reports that the Inquiry has looked at that there is a great need for care and a degree of nuance when examining these issues.

A disabled person may have a greater chance of suffering from a comorbidity not because they are disabled but because there are aspects to their day-to-day life or their condition, of which the disability is a part, which exposes them to a greater risk of that comorbidity; is that the position?

Professor Shakespeare: Exactly. So taking the example of people with intellectual disabilities that I provided before, often they’re supported by other people and often they might eat ready meals, those might contribute to their obesity. They’re not eating a balanced diet, in other words, because that takes time to prepare.

Professor Watson: I think work from colleagues in the Scottish Learning Disabilities Observatory estimate that at age 20 a person with a learning disability has the same number of comorbidities as a person without a learning disability at age 50, and a lot of this is down to poor access to healthcare and also to inequalities experienced throughout the life course, as they go through. So I think it’s – and the fact that they live in poverty. There’s this – disability and – impairment and poverty is a circular relationship. So we know that poverty causes disability, but we also know that disability can create poverty. So it becomes like a positive feedback loop, and it can exacerbate the problems of poverty, and then poverty exacerbates the problems of disability. So it’s that circular relationship, if you like, that you get through there.

Mr Keith: With that in mind, do you then go on to identify certain vulnerabilities or aspects of disability which has made those persons who are disabled in this way more vulnerable to the Covid-19 disease? The first vulnerability you identify is age. Does disability entail a strong age gradient? Or, putting it another way, a significantly large proportion of elderly people have a disability?

Professor Shakespeare: Absolutely, yeah, far more so than in younger people. So something like up to 50%, really, on average, for people, 47.1% are females. That’s of older people who are limited a lot.

Mr Keith: It may be an obvious feature: do you conclude, therefore, that approximately half of people significantly affected by disability are over 60?

Professor Shakespeare: That is statistically correct, yeah.

Mr Keith: And, again, they are disabled or they suffer from a disability or they have a disability not because they are elderly but because they have a disability associated with age, there’s a convergence of condition, if you like?

Professor Shakespeare: Exactly. And many older people are perfectly fit and well and no disabilities at all.

Mr Keith: What about the connection or the link or the convergence between disability and intellectual disability and health? You refer in the next paragraph to people with intellectual disabilities having as many health conditions at age 20 as the rest of the population aged 50 and over.

Is that a significant aspect of disability?

Professor Shakespeare: We would say so. And so, for example, the relative risk of respiratory-related deaths is 2.5 times higher for people with mild intellectual disability and 5.8 times higher for people with profound and multiple intellectual disability.

So the more severe the condition, the more they’re likely to have poor outcomes and to contract respiratory infections.

Mr Keith: So if you have an intellectual disability of the type that you’ve described, you are more likely to catch and to suffer from a respiratory disease or condition –

Professor Shakespeare: Yes. LADY HALLETT:

Mr Keith: – and, indeed, to die from it?

Professor Shakespeare: Yeah, indeed. And during the 2017/2018 flu epidemic in the Netherlands, people with intellectual disability were three times higher deaths than in the general Dutch population. And often it’s younger people as well. It’s very unlikely for a young person without intellectual disability to become seriously ill. It’s not unlikely for a person with intellectual disability.

Mr Keith: Whilst reminding you, please, to keep your evidence as slow as you can, are there other groups of disabled people who are at increased risk of respiratory infection?

Professor Watson: I think many. You know, there’s lots of different groups that we could look at. People with MS, with multiple sclerosis, for example, you could talk about being known to be at increased risk of viral infections. People with spinal cord injury are more likely to be at risk of respiratory infections. Same with rheumatoid arthritis and many other conditions, like people with chronic obstructive airways disease or coronary heart disease, diabetes.

So a lot of what we might call chronic illnesses but also have – will also be included under disabled, as disabled people. So all of these put people at increased risk of respiratory infections.

Mr Keith: May I ask, professors, is that feature, is that increased vulnerability, well known? Is that something that’s known not just within your particular speciality, the field in which you are experts, but known more widely?

Professor Shakespeare: I would say it is known more widely. It’s known through public health, it’s known, obviously, through disability research, and it’d be known through social policy. It would be very evident.

Professor Watson: I mean, I think the fact that respiratory infections are the major cause of death of people with a learning disability, it would make it – that obviously would be very well known or should be well known by anybody who works in this area.

Mr Keith: The next category you identify is that of self-isolation. Do you make the point that, on top of the intrinsic vulnerability to Covid, a disabled person’s needs for care and support may mean that it’s much more difficult to self-isolate and, thereby, to reduce the risk of catching the virus in the first place?

Professor Shakespeare: Absolutely. I mean, we’ve talked about disabled people who live in congregate living situations. Now, you can shut the door, but you need somebody to dress, undress, feed, transport you, and often it’s the same person who performs those services for somebody else. So it might be at a care home, it might be in your private home, but very few people work only for one person, and therefore to isolate might be to shut yourself off from sources of care and support.

Mr Keith: Thank you, that’s very clear.

You then turn, in paragraphs 13 and 14, to the issue of unequal access, the topic that I introduced at the beginning of your evidence, lack of access or inequality of access to healthcare.

It is self-evident there may be some disabilities which require a greater degree of access to health and care support. In very general terms, and we’re not, of course, looking in detail at the detail of health and care resource in the United Kingdom in this module, but in very general terms, are there inequities or variations in the degree of access?

Professor Watson: Yes, I mean, there is a significant body of evidence that points to the disadvantage disabled people face when trying to access healthcare, and then, when they access healthcare, about their health needs being poorly understood, that are specific to their impairment.

Mr Keith: You then turn to the issue of discrimination, and you make the general proposition, you express the general opinion that despite over 20 years of antidiscrimination legislation, disabled people in the United Kingdom continue to face disadvantage compared to their non-disabled peers.

I should make plain what is I hope obvious, which is that this is not an inquiry into discrimination nor into the needs of disabled people or any other part of the population, but that level of discrimination is plainly relevant to the degree to which the government could or should have responded to the pandemic by measuring its responses in light of that degree of discrimination.

Has this issue of how a government might, in an emergency situation, respond to dealing with the needs of disabled people been raised at the UN level in the past few years?

Professor Watson: Yes. In the 2017 or 16 –

Professor Shakespeare: 16.

Professor Watson: – 16 response, the committee, in paragraph 28 in its report on – that we refer to in paragraph 16 – the inquiry concerning the United Kingdom of Great Britain and Northern Ireland, it said that:

“The Committee is concerned about the impact on persons with disabilities in situations of emergencies, including floods and fire, and the absence of comprehensive policies related to disaster risk reduction that include [people] with disabilities in the planning, implementation and monitoring process of disaster risk reduction.”

So I think it was highlighted to the government prior to the pandemic.

Mr Keith: Let’s unpick that a little, then. So is this the position, that the United Kingdom is a signatory to and has ratified the UN Convention on the Rights of Persons with Disabilities?

Professor Watson: And the optional protocol as well.

Mr Keith: I was going to come to that.

It ratified that convention. The convention is itself dated 3 October 2017 – I do apologise, it’s dated 2009.

Alongside the ratification of the convention, the United Kingdom agreed to an optional protocol by way of a side agreement. Following that process, did the UN Committee consider the position of disabilities in the United Kingdom and consider a report from the United Kingdom on the Committee’s views on the level of disabilities here?

Professor Watson: There was concern about the impact of changes in welfare spending, and this was expressed in 2000 – this culminated in the Inquiry published in 2016 that you refer to.

Mr Keith: In its concluding observations, dated 3 October 2017, did the UN Committee consider, amongst a myriad of other issues, and I should say there were some areas in which it commended the United Kingdom for the positive aspects of its response, as well as addressing and identifying principal areas of concern, but one of the areas, in paragraph 28 in fact, that the committee expressed concern about was whether, bluntly, the government was sufficiently considering the likely impact on persons with disabilities of emergencies?

Professor Watson: Yes.

Mr Keith: All right. And that is a document and of course is a concern which is relayed directly to the government?

Professor Watson: Yes.

Professor Shakespeare: Yes, it is.

Mr Keith: Was another specific area of concern, in the same concluding observations dated October 2017, a concern about the availability of high-quality, timely and reliable data disaggregated, that is to say addressing disability?

Professor Shakespeare: Yes, it was.

Mr Keith: And, Professor, what, in general terms, was the nature of the concern that was there expressed?

Professor Shakespeare: I think that there’s not enough knowledge about the situation in which disabled people live, and where there are more general surveys or evidence around emergencies or pandemics or whatever, that isn’t sufficiently disaggregated, so you can see whether disabled people are doing better or worse. And I think the fact that we’ve referred and can refer to so much data about intellectual disabilities is because of the Learning Disability Register, which all people with learning disabilities can be part of, and that does not exist for other forms of disability, and therefore it’s harder to get data.

Mr Keith: All right.

You then turn to a number of other areas, areas in relation to which you say disabled people face discrimination. Could we perhaps briefly review some of the figures.

In relation to employment, in 2018, which appears to be the last time for which these figures were available, were 51% of disabled people employed compared to 81% of non-disabled people?

Professor Watson: Yes.

Mr Keith: And there are variations also in relation to levels of pay and whether or not the occupation is part or full-time?

Professor Watson: Yes.

Mr Keith: Deprivation. Were and are disabled people as a group in a weakened situation relative to non-disabled people in the United Kingdom on account of the degree of deprivation that they encounter?

Professor Watson: Yes.

Mr Keith: Do you provide figures in relation to the poverty rate for disabled adults and disabled adults in working age families?

Professor Watson: Yes.

Professor Shakespeare: Yes, we do.

Mr Keith: All right.

I’m not going to ask you questions about the links between poverty, morbidity and mortality, because that is not at the core of the Inquiry’s work. But may I ask you this, professors: again, was this information, that’s to say the levels of deprivation and the links between poverty, deprivation, housing and, in the context of disabled people, morbidity and mortality, well known to government?

Professor Shakespeare: Yes, it was, and it was published by Joseph Rowntree Foundation and by the Equality and Human Rights Commission in 2018, so that would have been publicly very available.

Mr Keith: And are disabled people therefore more likely to live in inadequate housing, to have lower levels of security, be at greater risk of sexual and domestic violence and to be at greater risk of social exclusion?

Professor Watson: Yes. And I think another – not only are disabled people more likely to live in poverty but actually it is more expensive to live with a disability. There is an added cost to disability. So not only are people, disabled people – not only do they have less income, it costs them more.

I think SCOPE do an annual extra cost of disability per month figure, and the poorer you are, the greater the additional cost as well. And these are all available, all of these will be well known.

Mr Keith: Turning to education, are there varying degrees of access to proper educational facilities, and in particular a lack of access to special educational needs and disabilities resources?

Professor Watson: Yes.

Professor Shakespeare: Yes, and the situation has worsened in the last ten years.

Mr Keith: Is that the same across the United Kingdom, so does it vary by jurisdiction?

Professor Shakespeare: Well, it will do, but it’s broadly the same across the United Kingdom, in Northern Ireland, in Scotland, in Wales.

Professor Watson: I think Wales have recently introduced a new system, but most – I think it’s fair to say that there are inadequacies in the provision of special educational needs for children across the country.

Mr Keith: Paragraph 25, digital exclusion. This is relevant of course to the impact of stay at home orders and to social distancing measures.

Do disabled adults make up a large proportion of those adults across the United Kingdom who do not use the internet and therefore who may be said to be digitally excluded?

Professor Watson: Yes.

Mr Keith: Again, those are quite significant figures. Is that broadly known and understood as well?

Professor Watson: Yes, I mean, it’s well – it was – it’s easily available, the information, so yes.

Mr Keith: All right.

Security, I needn’t trouble you with, because I don’t think there’s a sensible argument that measures imposed in the face of a viral pandemic need to be particularly nuanced to deal with the possibility of being a victim of crime and security.

What about social isolation and loneliness? Are many disabled people subject to high levels of social exclusion and segregation?

Professor Watson: Yes.

Professor Shakespeare: Yes, they are.

Sorry to interrupt you and to correct you, but due to the pandemic people may spend longer at home, and if there are domestic violence issues in the home, they’ll be more subject to them, and therefore it is relevant to the condition brought round through lockdown orders.

Mr Keith: Yes, I should say, Professor, that paragraphs 27 and 28 appear to deal, on their face, with what I might call “external” crime, hence security.

Professor Shakespeare: Yeah, yeah, yeah.

Mr Keith: You’ve raised there the issue of domestic violence, which is different to the question that I asked you.

Professor Shakespeare: I beg your pardon.

Mr Keith: But let’s have a look at that.

What can you say about, in general terms, the levels of domestic violence on disabled persons?

Professor Watson: I think it’s fair to say that home is not always a safe place for disabled people. There is a lot of hate crime and so-called “mate crime”, where the person who’s providing the care for disabled people can become the perpetrator of the hate crime towards them.

So I think there’s a need to – this is well recognised, that disabled people are often subject to such crimes, and that locking people down in that area is one that I think where there was significant risk and should have been –

Professor Shakespeare: I think disabled women were twice as likely to experience sexual assault in a given year than non-disabled women. That’s very stark.

Mr Keith: So that we are clear about the position, the point that you make, jointly, is that stay at home orders would, of course, have a tendency to increase the vulnerability of disabled people, insofar as they may be subject to domestic violence?

Professor Watson: Yes.

Professor Shakespeare: A small minority, it certainly would.

Mr Keith: Yes.

Can we then turn, please, to the issue of access to health and social care. Without engaging in polemic debate about the merits or demerits of austerity, is it clear that there have been reductions, objectively, in the overall levels of funding for disabled persons over recent years?

Professor Watson: Yes.

Professor Shakespeare: I would say that fewer people are getting support from the state. So it’s the numbers. For any individual, it might not have gone down, but the numbers of people being supported have certainly gone down.

Mr Keith: Were those reductions in the levels of funding, were they prevalent across society? So are they reflections of reductions in levels of funding in central government or at local authority level or in terms of access to the third sector? Was it a particular area or was it generally across the board?

Professor Watson: Generally across the board, I think. But I think there’s a general cut in the funding of social care, particularly so in England, and a reduction in the spending – and of course social care is delivered either by the local authority or by non-statutory agents such as the health authorities, or through the third sector or private sector. So cutbacks would have been – so cuts in funding was apparent to all – across all of those sectors.

Mr Keith: As there were reductions in levels of funding, presumably the third sector, that’s to say voluntary and community sector organisations, would step in to greater or lesser extent to assist.

In the run-up to the pandemic, were there any changes in the capacity of the third sector or its ability to be able to provide services and resources where the state could not?

Professor Watson: Well, the evidence is that there have been significant cuts to the third sector by sort of 2017 and that the cuts are greatest to those third sector agencies that are working in the areas of highest social deprivation. So actually it was – you know, the inverse care law, where more support was needed there was more likely to be cuts to the services that provide care in those areas.

I think that these have reduced the capacity of local authority – of services to provide social care and support to people in those areas. And I think one of the things that’s really important here is – I know we’re not talking about the pandemic, but actually the third sector played a really significant role in the response to the pandemic, and actually we’d already set up, so we were disadvantaging – these third sector organisations that were working in areas of high social deprivation were the ones that were finding it hardest prior to the pandemic to keep going.

Lady Hallett: And you mean by the third sector, just so everybody watching knows? By third sector you mean?

Professor Watson: Third sector I mean voluntary sector organisations, not provided by statutory funding.

Mr Keith: I think I described it to you as voluntary and community sector organisations.

Professor Watson: Yeah, yeah.

Mr Keith: So non-state bodies –

Professor Watson: Non-state bodies, yeah.

Mr Keith: – that operate and work in this area and provide help.

Professor Watson: Yeah.

Professor Shakespeare: And because there were cuts that operated through local authorities – they are commissioning care, either in care homes or domiciliary care – they can’t pay as much, so the wages of staff has decreased and therefore there are fewer staff, and therefore more, as it were, unmet need at the frontline. And that’s prior to the pandemic, that’s by 2018.

Mr Keith: So what you’re saying in essence is that the viral pandemic and the impact, of course, of the government’s necessary steps to combat it had a huge impact on the third sector, and it was the third sector which was already under very real stress and strain even before the pandemic?

Professor Shakespeare: Absolutely. And, as Professor Watson has just said, would go on to play a really important part during the pandemic.

Mr Keith: Yes, and I know my Lady will be looking at that particularly in the course of the healthcare and care sector modules later.

Finally, although the passage and the part of your report is entitled “Conclusions and Missed Opportunities”, in fact you provide quite a bit of information about the access and the availability of data concerning disabled persons, and therefore I want to ask you, in general terms, about the provision of data, and mindful of what the UN Committee said in its concluding observations in relation to the need for data relating to disabled persons.

As at the pandemic, as at the onset of the pandemic in 2020, was there widely available data expressly addressing the position of disabled persons?

Professor Watson: No. Not that we know of. Not …

Mr Keith: Are you aware of whether or not the statistical authorities in the United Kingdom had produced either datasets dealing expressly with disabled persons or data extracted from opinion and lifestyle surveys, for example?

Professor Shakespeare: I think you’re going to look at the Office of National Statistics tomorrow or in future days, and I think that only recently have they turned their attention to this issue. In the distant past there were big surveys, more recently they have done much better, but in the era which we’re concerned with, there was nothing.

Mr Keith: You refer, and it’s plain from paragraph 40, that there was, Professor Watson, a research study carried out by the ONS concerning mortality. So, in England, people with disabilities made up 59% of deaths from Covid. That was based, wasn’t it, upon a 2021 census, so by definition that must have been after the pandemic started?

Professor Watson: Yes.

Mr Keith: All right. You are, I think, aware, and we’ll hear more about it tomorrow, of an ONS opinions and lifestyles survey which reported in April 2020 on the impact of coronavirus on disabled people, but again that was after the pandemic had commenced?

Professor Watson: Yes.

Professor Shakespeare: Exactly.

Mr Keith: All right.

So is your general conclusion, at paragraph 41, that these broad areas of vulnerability and lack of access to resources all well known, well debated, and therefore known to government?

Professor Shakespeare: Yes, these were in the public domain.

Mr Keith: Thank you very much.

Those are all the questions I have for you, Professor Watson, Professor Shakespeare. I don’t believe there are –

Lady Hallett: I think I’ve got Ms Morris to ask a couple of questions.

Questions From Ms Morris KC

Ms Morris: Thank you, my Lady.

Good morning, Professor Shakespeare. Good morning, Professor Watson. I ask questions on behalf of the Covid Bereaved Families for Justice. I have just a few questions for you, please, to expand on the single topic digital exclusion.

Mr Keith has taken you through paragraphs 25 and 26 of your joint report. Just to draw on a few of those facts and figures, please, for a moment. You have highlighted there that disabled adults make up a large proportion of those who don’t use the internet.

Professor Shakespeare: Yeah.

Ms Morris: And you provided data from 2017 which estimated that the number of people not using the internet was around 22%. You say of that, about 56% were people with disabilities?

Professor Watson: Correct.

Ms Morris: You have broken that down by age. I’m just interested in that for a moment, please.

You report that in 2017 that 60% of non-internet users aged 16 to 24 were disabled people, and this proportion was in fact the same for those over the age of 75. So what does that tell us in terms of the age range of those who are disabled people and non-internet users?

Professor Watson: I think it’s to say that disabled people – I mean, like you said, on the report, disproportionately disabled people make up the largest numbers of people who were not internet users. I mean, we couldn’t find the statistics that were disaggregated by poverty to see if this is – there might well be an impact, because we know that more disabled people live in poverty, this might be to do with poverty as well, but there also will be significant numbers and there are significant numbers of disabled people still who don’t use the internet. There will be some that don’t use the internet for reasons that are impairment-related, but there are also some who just won’t have had, who didn’t have prior to the pandemic – I think, the pandemic, a lot of third sector organisations stepped in to help a lot of disabled people through those early years – I know, you know, organisations that I’m involved with were sending out tablets and instructions to disabled people at the start of the pandemic –

Ms Morris: You’re ahead of me, Professor Watson, thank you, that’s very useful.

Are there particular disabilities that impact on online use? You have mentioned intellectual disabilities. Is that the only example?

Professor Watson: I think – yes, and the sight impairment might also be one. I mean, that’s one of the ones that’s listed in the thing, so just – where the internet is not accessible to disabled – well, it’s not made accessible.

Ms Morris: Moving then to sort of the public health context, and you’ve touched on this already, Professor Watson, in particular, about the movement of things online during the pandemic.

What challenges are faced with individuals with, for example, intellectual disabilities and their families and their carers in receiving public health information?

Professor Shakespeare: We obviously did research with disabled people during the pandemic, and I think people with intellectual disabilities found the messages very complicated, and they didn’t – they were changing and they didn’t always understand them, and even when they listened to broadcasts they didn’t understand them.

Ms Morris: Mr Keith touched on, a moment ago, some of the important topics that might include – like stay at home orders, testing, self-isolation, rules around contact with others, to give but a few examples. Are those areas where digital exclusion could have a disproportionate impact on disabled people?

Professor Watson: I mean, I think so, I mean, in terms of explanation, that a lot of these – this was made available through the television, but for people to try and get access. And I know that, you know, a lot of learning disability organisations were putting the information online. But if people didn’t have access to that information, then it …

And a lot of the Easy Read – where organisations relied on Easy Read, getting Easy Read out to people would have required online access and if people didn’t have the online access it would have been pretty pointless putting it out there.

Ms Morris: Can you expand on what Easy Read is, please.

Professor Watson: Sorry, it’s a method of writing that’s designed to be accessible to people with a learning disability, so it uses a lot of pictures and simpler –

Professor Shakespeare: Simpler phrasing.

Professor Watson: Simpler phrasing.

Ms Morris: I think we have an example of that, in fact, available to see at INQ000273831.

This is an Easy Read document provided by Mencap, so one of those third sector organisations you mentioned a moment ago. If we could please move through, see an example.

Is that what you’re describing, pictorial representations, clear English –

Professor Shakespeare: Fewer words, yeah.

Ms Morris: Simple fonts.

Professor Shakespeare: Yeah.

Ms Morris: Easier to follow instructions.

Professor Shakespeare: Yeah.

Ms Morris: Okay.

Just to expand on what you said a moment ago, Professor Watson, about what was providing this information, and who would be able to get this into the hands and in front of people who needed it, this is an example of something that’s available on a website, would it need to be printed out for somebody who didn’t have access to the internet?

Professor Watson: Yes, and it would have to be delivered to them.

Ms Morris: Okay. Then who would ordinarily do that?

Professor Watson: Well, I’m not sure, I don’t know. I mean, GPs or other means of …

Ms Morris: Does it follow, sorry, that if someone requires this easy to read information, they are dependent on somebody else providing it to them from an internet source?

Professor Shakespeare: Very much so.

Professor Watson: Yeah.

Ms Morris: Thank you very much indeed.

Thank you, those are my questions.

Thank you, my Lady.

Lady Hallett: Thank you, Ms Morris.

Mr Keith: Thank you, my Lady. There are no more questions, I believe, for the two professors, so thank you very much.

Lady Hallett: Thank you very much indeed, professors.

In my time I have seen a lot of expert reports and heard a lot of experts give evidence. If I may say so, yours was particularly helpful, focused and analytical, and really good. Thank you.

Professor Watson: Thank you very much.

Professor Shakespeare: Thank you.

(The witnesses withdrew)

Lady Hallett: Perhaps I’ll –

Mr Keith: Would my Lady rise for a few moments?

Lady Hallett: I think I have been asked to take the morning break now.

Mr Keith: So be it.

Lady Hallett: So I think I shall return at 11.40.

(11.27 am)

(A short break)

(11.40 am)

Lady Hallett: Mr Keith.

Mr Keith: My Lady, the next witness is the chief executive officer of Disability Rights UK, Kamran Mallick.