3. Mr Kamran Mallick

MR KAMRAN MALLICK (affirmed).

Questions From Lead Counsel to the Inquiry

Mr Keith: Could you please commence by giving the Inquiry your full name?

Mr Kamran Mallick: My name is Kamran Mallick.

Lead Inquiry: Mr Mallick, thank you very much for attending and also for providing a witness statement, INQ000280035, which I believe you signed on 21 September 2023.

Mr Mallick, whilst I ask you questions, could you please remember to keep your voice up and go as slow as you humanly can, in order to aid our stenographer.

Are you the chief executive officer of Disability Rights UK?

Mr Kamran Mallick: Yes, I am.

Lead Inquiry: Was Disability Rights UK founded in 2012, and is it a leading national disabled people’s organisation?

Mr Kamran Mallick: Yes, it is.

Lead Inquiry: It has, no doubt, a number of functions, and carries out an enormous number of worthwhile tasks. Could you please, in outline, tell her Ladyship what in essence Disability Rights UK does, starting from the degree and the extent to which it engages with disabled persons and represents their voice?

Mr Kamran Mallick: Of course.

So the first thing I would just want to start with, my Lady, is that we refer to ourselves as a disabled people’s organisation. We meet the United Nations definition of a disabled people’s organisation, in that it’s led by and in control and governed by disabled people. That differentiates us from the disability charities that exist in the country, so disabled people – organisation like ours are run by and for disabled people.

We are a membership organisation. That means that we have individual disabled people as members of the organisation, and other local and regional disabled people’s organisations up and down the country who are also members of us.

Our job is to listen to what’s going on, what life is like for disabled people around the country, to learn, and to then advocate to bring about equality, justice and equity for disabled people in our country.

We also play a role in making sure that disabled people themselves have access to quality information about their rights and equality.

Lead Inquiry: Are you in fact, as a DPO, a disabled people’s organisation, therefore majority led, directed, governed and staffed by disabled people?

Mr Kamran Mallick: Yes, we are.

Lead Inquiry: In terms of the work that you do to listen to disabled people and disabled people’s organisations, you obviously receive letters, you receive emails and calls, but do you also have in place and do you operate an independent living helpline, a student helpline, and also a group which you manage called “Our Voices” group, which is a meeting of a variety of people, CEOs and staff from other DPOs across England?

Mr Kamran Mallick: Yes, we do.

Lead Inquiry: All that is of course aimed, is it not, at the state, at the government, in order to be able to communicate the views and concerns of your members and the other groups to government in order to pursue the aims that you believe are required to be raised with them?

Mr Kamran Mallick: It is. So we use all of those methods to understand what life is like for the vast numbers of disabled people around the country. We are not impairment-specific, so we look at all impairments, as well as people with long-term health conditions. And it is our role, kind of our job is to understand what life is like and where there are inequalities and what should be done about them, and then to take that position and advocate, lobby, influence people in positions of influence and power such as government.

Lead Inquiry: So, in short, you listen to the concerns of disabled people, you give them a voice, you take information from them and then you campaign with government and other bodies for work to be done and for improvements to be made?

Mr Kamran Mallick: Yes, that’s correct.

Lead Inquiry: I think you have a substantial regional social media, with a very large number of followers from X, formerly known as Twitter, and during the pandemic you had over a million visitors to your website?

Mr Kamran Mallick: That’s correct.

Lead Inquiry: All right.

During the pandemic, so that is to say between January 2020 and spring 2022, did you, by a variety of methods, seek to raise with the government issues faced by disabled people?

Mr Kamran Mallick: We did. So we would do a number of things. We wrote countless letters where we were raising issues with given government officials in different government departments. We would write to the Cabinet Office, to the Prime Minister directly, raising concerns about a wide range of issues, as they were occurring, pretty much in real time almost.

We would also, where the opportunity arose, if there was a meeting that was put on by government we would attend and make sure that the views of disabled people and our concerns were highlighted in those.

And of course we were then publishing both on our website and through our Disability Rights UK’s electronic newsletter, that was going out weekly at the time making sure that all of our positions were made public, about what we were doing and what we were asking for and what our concerns were.

Lead Inquiry: That was your direct engagement. Would you also and did you also encourage members of your organisation and persons who had been in touch with you to contact their own local MPs if they had concerns and worries, and invite them to raise those matters with those MPs?

Mr Kamran Mallick: So – absolutely. So we kept an ongoing record on our website of all the government decisions as they were being announced, on our website. We would promote them through our electronic newsletter. And then the Our Voices group that you mentioned, it was meeting every week on a Tuesday morning for two hours, and the purpose of that was to share that information across and make sure that local people could lobby, influence local decisions, if that was relevant. So we were doing that throughout the two years.

Lead Inquiry: Now I want to ask you some more detailed questions about the meetings that you had with government and the correspondence into which you entered with them.

As a matter of coincidence, did you have arranged and therefore did you attend a short meeting on 29 January 2020 with the Minister for Disabled People, Health and Work, Justin Tomlinson MP?

Mr Kamran Mallick: Yes, so we were asked to attend a short meeting with the minister at that point.

Lead Inquiry: Was Covid on the agenda at that meeting? Was it discussed?

Mr Kamran Mallick: No, from – my recollection is that it wasn’t discussed, no.

Lead Inquiry: All right.

Now, when the pandemic began, and of course the terrible consequences of the outbreak started to become apparent in March, were you extremely concerned on behalf of disabled people generally as to what the impact would be of the government’s response and, of course, what the future would hold?

Mr Kamran Mallick: We were extremely worried and we wrote a letter dated in March, March 16th, outlining a list of our concerns, but actually even before then, just by listening to what was happening around the world and how – what the impact was in other countries – and also it’s our job to know disabled people in our lives and how we are potentially affected by potential disasters that may be coming along our way – so we – we were aware of what some of the risks would be, how our community lives their lives, the different ways that people have structured their lives to manage the inequality that they experience every day.

So we, just through the sheer kind of engagement, but also the fact that we were disabled people ourselves, so we were living through and had the same concerns and worries that many of our members and constituents would have around the country, so we became aware and consciously concerned about it quite early on.

Lead Inquiry: Because, of course, the government’s response and the decisions that the government took were of such great width and there were so many of them, there was a great capacity, wasn’t there, to affect disabled people in a number of very different ways?

Mr Kamran Mallick: There was. So when –

Lead Inquiry: I’m going to ask you in a moment about each of those areas.

Mr Kamran Mallick: Okay, yes.

Lead Inquiry: So you needn’t enumerate them all –

Mr Kamran Mallick: Sure.

Lead Inquiry: – by way of a response. But in blunt terms, you were having to address a large number of issues and cover a very wide turf in terms of the areas of concern that you were raising with the government?

Mr Kamran Mallick: Yes, we were.

Lead Inquiry: Let’s have a look at that letter that you mentioned, Monday, 16 March. It’s INQ000238504.

(Pause)

Lead Inquiry: There we are. A letter from Disability Rights UK dated 16 March 2020 addressed to Justin Tomlinson MP, minister of state, Minister for Disabled People, Health and Work, and Helen Whately MP, Minister for Care.

Just looking at that first page, please, Mr Mallick, you plainly identified to the ministers, the two ministers, the expression of concern. On this page specifically in relation to the guidance on coronavirus, because you say it:

“… does not go far enough to safeguard the lives of disabled people, people with long-term health conditions and older people.”

When you refer to “current guidance”, did you mean the guidance published by the government addressed towards disabled and other people in relation to how they could be expected to respond to the pandemic and respond and deal with the government’s steps?

Mr Kamran Mallick: So we were referring to guidance issued by government in relation to disabled people in particularly select areas that they had released.

Lead Inquiry: Geographical areas?

Mr Kamran Mallick: No, so in terms of – so, for example, advice for care homes. So that kind of guidance that was being released at that time.

Lead Inquiry: There was guidance to the country as a whole, but specifically England, issued around that time to the care sector. Is that the guidance that you had in mind?

Mr Kamran Mallick: Yep.

Lead Inquiry: Ah, I see.

Over the page, you identify more specifically the concerns that you had. Firstly:

“Care homes are already stretched thin by a pre-Brexit exodus of qualified, skilled workers.”

They lack proper and meaningful advice.

And you say:

“The advice issued … does not take full account of the ease of transmission of this virus within confined communities, relying too much on modelling for influenza.”

What did you mean by that reference to the fact that you believed the guidance relied too much on modelling for influenza?

Mr Kamran Mallick: So it was looking at how, I guess, their response to influenza and the modelling that they had around that, so how people should protect themselves, and – but we were in a situation where we had a virus that had arrived, there was no vaccinations for it, people in care homes, by the nature of why they’re there, are – often have underlying health conditions, would have long-term health conditions, and so were at greater risk. And of course if you are in a care home, you are in an environment with other people who are equally potentially at risk, and have underlying health conditions. And so the advice being given wasn’t adequate to protect those individuals.

Lead Inquiry: The Inquiry has heard evidence that pre-pandemic the government’s strategy was based upon a historical approach to influenza pandemics, and there was a presumption that the influenza pandemic or, as in this case, the coronavirus pandemic would break upon the United Kingdom’s shores and it would progress through, spread through the population. There was no debate about lockdowns or stay at home orders or anything of that sort, or society-wide restrictions.

Was your reference here to the government having placed too much reliance upon that strategy, and upon modelling, a reference to the need, as you saw it, for the government to keep the virus under complete control, to stop it spreading, to reduce, to use the terminology, the level of incidence?

Mr Kamran Mallick: Yes. So the influenza modelling would be around kind of that idea of herd immunity, that if you let it spread there is natural protection that develops within people. We felt that that was not the right thing to be doing within this particular virus.

Lead Inquiry: Was it your position that the best protection was not to have measures for hand washing or for trying to control marginally the spread of the virus, but to apply complete control to reduce the overall levels of infection?

Mr Kamran Mallick: Yes, yeah.

Lead Inquiry: All right.

Is that because realistically, but particularly in the care sector, it is impossible to hermetically seal away any segment or part of the population?

Mr Kamran Mallick: Absolutely. And the way both care homes are structured but also the care sector is much wider than just care homes, people receiving care at home, in their own homes, where you’ve got carers moving from home to home, visiting different clients through the day. So there’s that increased risk of the infection being travel – going from place to place just because of that nature.

There was – because of the crisis the care systems was under, you had lots of temporary staff who were being brought in as well.

And so because of those, the way the care structures are designed, it produced greater risk.

Lead Inquiry: So in essence, Mr Mallick, were you calling for, because of your concerns in particular about the care sector, a suppression approach rather than a mitigation approach?

Mr Kamran Mallick: Yes. Yeah.

Lead Inquiry: If I may say so, very prescient.

On that page, you refer, however, also to certain particular areas of concern: funding for isolation areas, advice to protect people giving and receiving care, emergency support, the training of new care workers, the stopping of attendances for benefits, which you deprecate, but you welcomed the move to suspend face-to-face personal benefit assessments, and the general need to get money to people quickly and to reduce financial anxiety.

So all more specific concerns that your group had.

Did the government reply addressing each of those specific concerns or not?

Mr Kamran Mallick: No, the government reply was incredibly disappointing. They only referred to – the response really only talked about the benefits changes that they were making. They addressed none of the other concerns in their response to us.

Lead Inquiry: Could we have, please, INQ000238515. The government was of course at this time – the letter is dated 9 April – in the full face of the storm that was the pandemic, and may therefore be given some leeway in relation to its ability to be able to respond to correspondence.

However, was the only issue that it actually sought to address at all in this letter the issue of the new guidance about claiming benefits and the introduction of the Employment and Support Allowance Regulations 2020?

Mr Kamran Mallick: It was, yes.

Lead Inquiry: Did it respond at all in relation to any of the other areas that I’ve asked you about, or in particular the massively important strategic issue of whether or not seeking to mitigate the impact of the virus, as opposed to controlling the virus, would have on the very vulnerable care home sector?

Mr Kamran Mallick: No, so they didn’t address any of those points specifically. They make general comments about how the government will do whatever it takes to support people.

Lady Hallett: Is the Minister for Disabled People, Health and Work based in the Department for Work and Pensions?

Mr Kamran Mallick: Yes, they are, my Lady.

Lady Hallett: Ah, right.

Mr Keith: In your statement, Mr Mallick, you raise, in fact, this issue, because you make the point at paragraph 90 – perhaps we could have that paragraph up on the screen from the witness statement, which is INQ000280035, page 27 – you make this very point, the same point that my Lady has made, which is that:

“… the Disability Minister sits within the Department for Work and Pensions and has [therefore] a low profile in Government.”

You also make the point that:

“There have been five different Disability Ministers since [you] joined [Disability Rights UK] in July 2017 …”

From your viewpoint, does it appear that, politically, the lack of a high profile for the disability minister has had an impact on the degree to which the government has, as you see it, been able to respond and address the particular needs of disabled people?

Mr Kamran Mallick: Without doubt. The fact that the minister sits within the DWP and therefore the remit of the minister is purely within the remit of what the DWP is about.

And from our perspective, as a disabled people’s organisation, the DWP is fundamentally about getting people off benefits, reducing the benefit bill, and getting people into work. That’s the main focus that that department has had for many years, and that’s the focus of the minister.

When we meet with the minister and raise issues to do with housing or transport or health, the response will often be, “That’s not within my remit, therefore I can’t answer that question”.

The other issue within government is if you localise the response to disability and disabled people in one department, it then means that the rest of government has no oversight, has no onus to respond to how – what they should be doing in order to affect disabled people’s lives.

Lead Inquiry: You refer to a unit in the Cabinet Office called the Disability Unit. The Cabinet Office is, of course, that part of central government which seeks to co-ordinate government matters, broker issues between particular government departments, and plays a centralising role.

Was there at one stage an expectation or a hope that the Disability Unit would increase the profile of disability-related issues in government?

Mr Kamran Mallick: So we looked upon it as a potentially positive move, that by situating the Disability Unit within the Cabinet Office, centralising it, would have the ability to access other departments, ministers, and other people that we needed to speak to, and that actually we hoped that if a request came from the Disability Unit in the Cabinet Office, departments would feel compelled to respond. But our experience was not that way.

Lead Inquiry: Before we look briefly at each of the areas that you raised with government, I omitted in fact to take you to an important part of your statement which concerns the figures that you provide for the numbers of disabled persons in the United Kingdom.

Could we have, please, page 3, paragraph 6. Do you provide figures, in fact provided by the Department for Work and Pensions, based upon a family resource survey – my Lady, that’s the same survey to which Professors Shakespeare and Watson referred a few moments ago – for the financial year 2020-21, which showed that:

“… there are … 14 million disabled people in the [United Kingdom]; we make up 22% of the population”.

So was that a survey, Mr Mallick, based upon self-reported information from disabled persons? Could you just help us with the terminology or the phraseology upon which the survey was based? Did it ask people whether or not they were disabled a lot or disabled a little or not disabled? Was it that sort of survey?

Mr Kamran Mallick: So I can’t remember – exactly recall how the questions are asked in the survey. But often these are defined by disabled people themselves, whether they recognise themselves as disabled people. Often there is a delineation of kind of – you know, classed as a physical disability, sensory, cognitive, and people would be able to tick those boxes, as it were.

Lead Inquiry: Right.

Mr Kamran Mallick: But, yeah, that’s generally how these surveys are done.

Lead Inquiry: Thank you.

Returning to the chronology, you wrote to central government on 23 March raising concerns on the part of Disability Rights UK and a number of other charities, in fact, relating to the impacts of the Coronavirus Act on disabled persons’ rights relating to education, social care and mental health protections.

Was there any resolution of those concerns? You raised concerns about the Coronavirus Act, but the Act – or rather the Bill had already been published and was just about to proceed through Parliament; were there any changes in the Bill as far as you could see?

Mr Kamran Mallick: Not that we saw as a direct result of what we’d – the concerns we’d raised.

Lead Inquiry: You provided feedback as part of the National Voices group in late March on the framework for the Moral and Ethical Advisory Group, MEAG. Was that because MEAG was primarily concerned with providing guidance for intensely difficult ethical issues, matters of triage and the like, which would be bound to have a huge impact upon disabled persons?

Mr Kamran Mallick: We were, and we were specifically concerned that what resulted was a frailty index, and that frailty was being conflated with disability, and that the risk was that you would be seen to be frail just because you had a health condition or that you were a disabled person.

But also our concerns were, in those kind of situations, if someone arrives in hospital and potentially is unconscious or is not able to advocate for themselves, how that index may tilt the kind of decision of medical people about who is and isn’t frail.

So we were extremely worried that disabled people would be judged to be frail purely based on their health condition.

Lead Inquiry: My Lady, of course that, as you know, because you’ve so ordered, is an issue that will be looked at in Module 3, the issue of triage and the frailty index.

You also wrote on a number of other subjects, just to highlight what those subjects were, you wrote in relation to the arrangements for the delivery of essential groceries and supplies to disabled and vulnerable people; you wrote in relation to the impact of the regulations upon disabled people’s incomes; you wrote in relation to your concerns that treatment decisions were not being applied and made in a way that would be discriminatory of the position of disabled persons; you wrote in relation to shielding, access to food. Was that throughout this whole period of March through to the summer of 2020?

Mr Kamran Mallick: Yes, it was.

Lead Inquiry: In your statement, you deal with another issue, which is that of data. Did you write to government and also to local government about the degree to which government was assembling sufficient and adequate data on disabled people for the purposes of being able to better inform its decision-making?

Mr Kamran Mallick: Yes, we did.

Lead Inquiry: Is it the position – we’ve heard a bit of evidence about this from Professor Watson and Professor Shakespeare – that there was a general dearth of information relating to data, a general absence of data relating to disabled people generally?

Mr Kamran Mallick: Yeah, so there’s no – during that period there was no systematic and formalised way of collecting this data and aggregating it across.

Lead Inquiry: You wrote also in relation to the reductions or adjustments or easements that were being put into place by local authorities in relation to their provision of support and services, and also you discussed with the ministers the reasonable adjustments that were being made in relation to people working from home?

Mr Kamran Mallick: Yes, we did.

Lead Inquiry: Now I just want to ask you also, please, about certain fora, or forums that were set up by the government.

In July 2020, did you have two meetings with Justin Tomlinson MP as part of a lead-up to a new organisation or forum that the government intended to set up called DPO Forum, Disabled People’s Organisations Forum?

Mr Kamran Mallick: Yes, we did.

Lead Inquiry: Did you have those two preliminary meetings?

Mr Kamran Mallick: We did, yeah.

Lead Inquiry: In the event, did the government say that it intended to have a number of DPO Forum meetings?

Mr Kamran Mallick: So the government said that these would be regular meetings where the minister would be present. Ongoing, yeah.

Lead Inquiry: There was a first DPO Forum meeting on 22 July, and a second one on 27 August 2020. Did the minister, Mr Tomlinson, attend the second meeting?

Mr Kamran Mallick: Erm …

Lead Inquiry: If you’ll take it from me, because I’m reading from paragraph 48 of your statement, Mr Mallick.

Mr Kamran Mallick: Yep.

Lead Inquiry: Were meetings scheduled for 17 September 2020, 13 October 2020, 12 November 2020, and then again in December 2020, January 2021 and February 2021?

Mr Kamran Mallick: Yes, they were, yeah.

Lead Inquiry: Did they all take place?

Mr Kamran Mallick: No, they did not. Many – certainly at the latter end of it many got cancelled, and the forum effectively ended in 2021 with the final three meetings all being cancelled.

Lead Inquiry: So the only two that took place were those two I’ve mentioned in July 2020 and August 2020?

Mr Kamran Mallick: Yes.

Lead Inquiry: Was there any meeting again between the DPOs and the government before May 2022?

Mr Kamran Mallick: Sorry, would you repeat the question.

Lead Inquiry: Yes. Did you have any meetings again between the DPOs, the disabled people’s organisations, and government, between then, that’s to say February 2021, and May 2022?

Mr Kamran Mallick: No, so they were – the DPO Forum meetings were discontinued, and so therefore there was no further DPO meetings with the government. The ones that they had set up.

Lead Inquiry: In your statement you suggest that, and this is paragraph 50, the next meeting you recall between DPOs and the government did not take place until May 2022. As a result, there was no line of communication between the DPO Forum and central government for around 18 months; is that correct?

Mr Kamran Mallick: That’s correct, yes, yes.

Lead Inquiry: Nevertheless, you continued to write open letters and letters directly to a number of government departments, and you’ve set those out in the following few pages of your statement.

Did you make an offer to Mr Tomlinson to meet with the Disability Unit in the Cabinet Office every two months?

Mr Kamran Mallick: Yes, we did.

Lead Inquiry: Did the government take you up on that offer?

Mr Kamran Mallick: No, so they didn’t take us up on that offer, no, from memory.

Lead Inquiry: There was, I think, a suggestion from the government that a meeting that had been due to take place on 18 February, this is 18 February 2021, would instead be replaced by a series of smaller group conversations, individual meetings, with DPO Forum members.

Mr Kamran Mallick: That’s right.

Lead Inquiry: So there was no replacement of the wider –

Mr Kamran Mallick: No, there wasn’t.

Lead Inquiry: – significant DPO Forum structure?

Did you continue to write a variety of letters, through, in fact, to the summer of 2022?

Mr Kamran Mallick: So we continued to raise issues as they were coming to our attention. Any government announcements, any guidance that was being released by government ongoing we would be scrutinising that and making representations.

Lead Inquiry: Was long Covid an issue which you drew particularly to the government’s attention?

Mr Kamran Mallick: Yes, we did, yeah.

Lead Inquiry: Did you publish in fact a number of articles relating to long Covid –

Mr Kamran Mallick: We did.

Lead Inquiry: – in the course of the pandemic? And did those articles note the huge rise in disabled people during the pandemic suffering in particular or including from long Covid?

Mr Kamran Mallick: Yes, we did. So we started to realise that long Covid itself could, under the Equality Act, be defined as a disability.

Lead Inquiry: Finally, did you draw to the government’s attention a number of reports prepared either under your auspices or the auspices of non-governmental organisations or the UN and the WHO, for example the WHO guidance on disability considerations during the pandemic, the UN Secretary General’s policy brief on a disability-inclusive response, and a number of reports from civil society?

Mr Kamran Mallick: We did, and we particularly, you know, raised issues around the – all of these reports had something in common, which was about engagement, and engagement both with disabled people and disabled people’s organisations. It’s a central aspect of – when we talk about engagement. And some other methods behind that are things like co-production and co-design, the idea being that you don’t bring people in at the end, once you’ve already designed something, you actually bring people in right at the outset. So you bring in people who are going to be affected by these decisions or changes, so the thinking can be co-produced, co-designed.

And it’s about kind of ongoing conversations, so these are not consultations or meetings, these are ongoing processes, structured processes, where civil society is funded to engage with government. And what – one thing we’ve always said to government is, when they bring in consultants, they will be required to pay for that, but when we bring disabled people in, we’re expected to do it for free. And that’s not acceptable, because what people are bringing is their lived experience. That, if brought into design and thinking, can fundamentally change the way we address issues like the pandemic but general inequalities in society.

Lead Inquiry: It is obvious, Mr Mallick, that the pandemic and the government’s response had massive impacts upon the day-to-day lives of disabled people. You’ve set out in your statement some of the broad areas where that impact was most obvious. Are they these: disabled people were obviously likely to be more clinically vulnerable, they were more vulnerable generally on account of socio-economic conditions, the pandemic and the government’s response led to an abrupt transformation on their day-to-day lives, and there were, lastly, before I come to the issue of mortality, very real problems in terms of their continued access to health and care support as a result of the pandemic and the government’s response?

Mr Kamran Mallick: Yes, we did, and we defined vulnerability as a situation someone finds themselves in, and that vulnerability is not inherent in being a disabled person or having a health condition, but actually the decisions that were being made and the situation that was being created was what was creating that increased vulnerability.

Lead Inquiry: Then, of course, worst of all, and terribly, it became apparent, and the figures immediately establish this, that there was a much higher rate of mortality for those who were disabled?

Mr Kamran Mallick: That’s correct, yes.

Lead Inquiry: There were reports from the ONS but also from Public Health England, in particular a report dated November 2020, which showed conclusively that the rate – or the death rate, the risk of death, was a multiple of times higher for disabled persons than for the remainder of the population?

Mr Kamran Mallick: That’s correct, yes.

Mr Keith: Thank you very much.

Mr Mallick, thank you very much.

Questions From the Chair

Lady Hallett: Mr Mallick, could I go back to the point you made about the disability minister being in the Department of Work and Pensions. I can see how that could be difficult for you, particularly difficult, if that minister said, “And I don’t deal with health and I don’t deal with education”, and I think you were suggesting that responsibility for disability ought to be with every government department.

In another context, I have been urged to consider a minister responsible for resilience, so the idea being that if you put one specific person who has nothing else to do but think about that. I mean, I’m just wondering how you would suggest that the interests of disabled people and the concerns will be best taken into account. Is it one minister who understands that they deal with all the issues?

Mr Kamran Mallick: So – thank you. So I would say that, yes, having a disability minister is good and important, but it’s the remit of that minister that’s vital.

Lady Hallett: Yes.

Mr Kamran Mallick: The remit should be cross-government and not isolated to one area of government, which is currently Department of Work and Pensions. It should be given a higher profile. I would be arguing that it should be part of the Cabinet, so that it’s central to all thinking and all conversation, that the experiences of disabled people are being fed in. But it also relies on the government having structures in place to engage with a wider audience of disabled people, funded structures, that are ongoing, so that the minister is engaging with a group of people on an ongoing basis, they’re not just trying to do something when a crisis hits, but actually just as a matter of course, and centralising it.

Lady Hallett: So the Disability Unit is in Cabinet Office?

Mr Kamran Mallick: Yes.

Lady Hallett: And are you suggesting the minister ought to be within Cabinet Office?

Mr Kamran Mallick: Yes. We think the minister should be centralised, and should be part of the government’s Cabinet, so it raises the profile. It’s currently, how we see it, a junior position, and in my time since 2017 at DR UK we have had a number of ministers come in and go, and therefore you get no continuity, and ministers will come in and have a flagship thing that they want to do to mark their time as minister, and then we kind of roll on to the next one.

Lady Hallett: Does the problem then come, if you’re trying to run Cabinet Office, and you have other interest groups, for example a Minister for Children, a Minister for Women, a Minister for Equalities – I mean, there is a limit, obviously, to how many ministers you can have within Cabinet Office.

Mr Kamran Mallick: There is. I think disability is different because, unlike some of the other ministers that you’ve just mentioned, disability is across the board. Anyone will – could have a disability. I mean, I often say anyone in this room at some point will experience what it is to be a disabled person. It could be through injury, health or just ageing process. And therefore it’s really important that the experiences and the barriers and challenges that disabled people experience are across government, because how we build our cities and communities and structures and institutions should be affected by that thinking, and the idea of inclusive design, inclusive thinking. Because when you bring that into your thinking across government, it benefits everybody, not just disabled people. You create a society that’s truly inclusive for everybody.

Lady Hallett: Thank you.

Summary of questionnaire responses

Mr Keith: My Lady, as you know, you’ve directed that questionnaires be sent out to a range of individuals and organisations concerned with the affairs of disabled persons.

To summarise the material we received back, the Inquiry took evidence from seven disabled people’s organisations about how government decision-making affected the disabled people they represent. There were four broad themes identified in the responses and in the evidence.

Firstly, the barriers and inequalities in communication and accessibility. Many of the respondents noted the difficulties faced by disabled people and the fact that they were exacerbated by the lack of consistency in the use of accessible communications for disabled people during the pandemic. Others noted the delay in recognising and responding to those barriers, and some believe that they saw that failure to deal with the barriers, ineffective communication, as being part of a broader pattern of failing to meet the requirements of the Equality Act.

A second theme was the need to improve understanding among decision-makers. Most of the organisations stated their belief that the government had neglected their needs. Mencap in particular explained that the blanket restrictions on visiting hospital settings and accompanying disabled people in ambulances did not provide for necessary reasonable adjustments. Many of them pointed to this issue of the absence of proper methods of data collection.

A third theme was the use of do not resuscitate, do not attempt cardiopulmonary resuscitation notices, DNACPRs, which my Lady will be looking at, of course, in Module 3.

The fourth theme was a general statement of general belief that the government had failed to engage properly and sufficiently with DPOs during the pandemic, notwithstanding the obligations of the Equality Act which provides, as my Lady knows, for the public sector equality duty. A number of organisations felt that, particularly during the early stages of the pandemic, the government had failed to consider the importance of consulting the disabled people and organisations representing disabled people, and they call generally for a proper, more structured approach to engagement.

My Lady, that concludes this part of the evidence in relation to that particular theme, the theme of disabled persons’ rights.

Lady Hallett: Thank you very much indeed, Mr Mallick, and thank you for all that your organisation and others with similar interests did during the pandemic, and I’ve no doubt for many years to come. Thank you very much indeed.

The Witness: Thank you, my Lady.

(The witness withdrew)

Lady Hallett: I have been asked to break for five minutes.

Mr Keith: Thank you.

(12.28 pm)

(A short break)

(12.33 pm)

Lady Hallett: Ms Cecil.

Ms Cecil: Yes, my Lady, may I call Professor Laia Bécares.

PROFESSOR LAIA BÉCARES (affirmed)

Questions From Counsel to the Inquiry

Ms Cecil: Professor Bécares, if you could just state your full name, please.

Mr Kamran Mallick: Laia Bécares.

Counsel Inquiry: Thank you. Thank you for coming today to assist the Inquiry. Can I ask that you keep your voice up, and that we take our answers slowly, because as you can tell we have a stenographer making a note in court. Thank you.

If there is a question from me that you do not understand or you need me to repeat, please just say so.

Just to deal briefly, if I may, with your professional background and expertise, you are a professor of social science and health at King’s College London; is that correct?

Mr Kamran Mallick: That is correct.

Counsel Inquiry: And you have a particular expertise in the role of structural and societal determinants leading to health inequalities?

Mr Kamran Mallick: That’s right.

Counsel Inquiry: Within that area of specialism you focus specifically on LGBTQ+ populations and ethnic minorities?

Mr Kamran Mallick: Yep.

Counsel Inquiry: In fact you co-authored the report on ethnicity from which we heard from Professor Nazroo last week; is that right?

Mr Kamran Mallick: That’s right, yes.

Counsel Inquiry: Thank you.

Today we’re focusing on a separate report that you’ve written for the purposes of the Inquiry, and that is on pre-existing inequalities experienced by LGBTQ+ groups. You can see that it’s been brought up on the screen for you.

For those following, the reference for that is INQ000280059.

We see here, don’t we, a declaration by you in relevance to your provision of an expert report, simply confirming that it’s your own work, the facts stated in the report are within your own knowledge, you understand your professional duties and the fact that you are an independent expert providing independent evidence to the Inquiry, and then you go on to explain that you’ve made clear where those facts and matters referred to in the report are within your own knowledge and those that are not; and that’s correct, isn’t it?

Mr Kamran Mallick: That’s correct.

Counsel Inquiry: Thank you.

Now, if I can just take us to the very beginning, really, of your report, we’ve referred, as you’ve heard me, to LGBTQ+. Can you just assist the Inquiry with those definitions for each of those initials?

Mr Kamran Mallick: Yes. So LGBTQ+, it’s a broad umbrella term that refers to people who self-identify as lesbian, gay, bisexual, trans, queer, or questioning, and the plus refers to people who do not identify with any of the labels I’ve just said but who do not identify as heterosexual or cisgender either.

Counsel Inquiry: It’s often otherwise referred to as “and more”?

Mr Kamran Mallick: Yes.

Counsel Inquiry: Just dealing with that population, is it fair to say at the outset it’s not a homogenous group?

Mr Kamran Mallick: That’s right, it’s very heterogeneous.

Counsel Inquiry: Thank you. Now, you say in headline form that inequalities for those groups is both stark and long-standing, with worse health, healthcare and social outcomes, and I’m going to go through and break that down a little bit more with you.

But before we do so, can I just establish with you the scope and limitations of your report. Okay?

The first is in relation to data and the datasets that you rely on, and you explain that a significant proportion of the underlying evidence that you rely on is from government bodies and arm’s length bodies. What bodies are those?

Mr Kamran Mallick: So in 2017 the Government Equalities Office conducted a very large, the largest, study on LGBTQ+ health and social circumstances, so I referred to this in my report. Public Health England has also commissioned reports to ascertain the level of health amongst LGBTQ+ people. The Scottish Government has conducted reports, and also voluntary sector and academics have conducted reports.

Counsel Inquiry: Thank you. I think you also refer to the Scottish Government reports as well?

Mr Kamran Mallick: Yes.

Counsel Inquiry: Generally your views within the report are expressed on a UK-wide basis?

Mr Kamran Mallick: Yes, that’s right. So, many of the data I have used have sampled LGBTQ people across England, Scotland, Wales and Northern Ireland, so yes, all the – and where not, I have used data or studies for particular devolved nations.

Counsel Inquiry: Thank you.

You explain within each category that you identify whether that data relates to a particular nation or not?

Mr Kamran Mallick: Yes.

Counsel Inquiry: Thank you.

I just want to deal with, if I may, one difficulty that you have encountered in terms of writing your report and expressing your views, and that’s on, actually, an absence of data in terms of population level studies; is that right?

Mr Kamran Mallick: Yeah, so we do not have a population level study that’s representative of the whole of the LGBTQ+ population in the UK, but what we do have are very large social and health surveys that are generalisable to the population, the general population of the UK, and many of these studies collect data on sexual orientation, very few on gender identity. So we can analyse these large representative studies that have collected data on sexual orientation to understand and to assert whether there are health inequalities for LGBTQ+ people. So we have these surveys, but we do not have a survey specifically for LGBTQ+ people.

Counsel Inquiry: It’s correct to say that the situation with regard to data is even more limited with regard to both Northern Ireland and Wales; is that right?

Mr Kamran Mallick: That’s right, in particular Northern Ireland.

Counsel Inquiry: Thank you.

Within your report, you refer to convenience sampling in relation to a number of the studies that you rely upon. Can you just assist the Inquiry firstly with what a convenience study is?

Mr Kamran Mallick: Yes. So a convenience sample is a sample that’s a non-probability sample. This means that not everybody in the population has an equal chance of participating. Instead, a convenience sample selects participants into a study based upon a particular characteristic, so either they live in a particular region or a city, they have attended a particular clinic or a social setting, or they might have been selected into the study via social media. So they are samples that are convenient to the researcher. And these studies provide very crucial and critical information on the lives of the participants but are not generalisable to a total population.

Counsel Inquiry: That’s essentially the limitation of that material within the report?

Mr Kamran Mallick: That’s right, yeah.

Counsel Inquiry: Thank you.

Then just again dealing with the scope of your report, you have been asked to opine on the situation pre-pandemic with respect to inequalities that –

Mr Kamran Mallick: That’s right.

Counsel Inquiry: – individuals in this group may have faced.

If I can just turn, firstly, to health inequalities prior to January of 2020, in your report you don’t set out all of the available evidence in relation to health inequalities but what you’ve chosen to do, as you say, is focus in on those which have or you consider to have a strong potential to lead to adverse outcomes, whether that’s by way of Covid-19 infection and outcomes or as a consequence of the non-pharmaceutical interventions that were put into place, the NPIs.

Turning first then to those in relation to health and physical health, you refer in here to obesity and being overweight, which, as we will hear in due course, is a risk factor for Covid. How does that impact within the LGBTQ population?

Mr Kamran Mallick: Yes, so there’s evidence that bisexual women and lesbian women are more likely to be overweight than heterosexual women, so there are higher rates of obesity and overweight.

Counsel Inquiry: Thank you. The next category, paragraph 12, is in relation to respiratory conditions, and you’ve looked specifically at asthma there, and we see similar issues for lesbian and bisexual women; is that right?

Mr Kamran Mallick: That’s right, yes.

Counsel Inquiry: Thank you.

Then turning to cardiovascular disease, this is a little bit more complex, because what you refer to within your report is an elevated risk of cardiovascular disease risk factors, so not the actual disease itself but those risk factors that underline the likelihood of getting cardiovascular disease; is that right?

Mr Kamran Mallick: That’s right.

Counsel Inquiry: Thank you. And in relation to that you identify specific risks for lesbian women and gay men, and heightened risks again for those within the trans population. Is that right?

Mr Kamran Mallick: That’s right.

Counsel Inquiry: We see that for trans women there’s an increase of thromboembolic events, ie blood clots?

Mr Kamran Mallick: Yes, following hormone therapy.

Counsel Inquiry: Yes, thank you.

You then turn to look at cancer within your report, and can you just assist us with cancer within the LGBTQ population as opposed to the heterosexual population?

Mr Kamran Mallick: So, yes, lesbian, bisexual, gay women and gay men and bisexual men are more likely to have certain types of cancer than heterosexual people. So for lesbian and bisexual women, they are more likely to have breast cancer, for example, stomach and endometrial cancer, so different types of cancer. And gay men and bisexual men are more likely to have penile cancer and anal cancer, and it’s important also to say that they are less likely to engage in screening behaviour with regards to cancer.

Counsel Inquiry: Thank you.

Mr Kamran Mallick: It’s not just the incidence but the behaviour.

Counsel Inquiry: So it’s not simply the incidence but it’s also the engagement with health services –

Mr Kamran Mallick: That’s right.

Counsel Inquiry: – in relation to cancer and diagnosis and therefore timing of diagnoses?

Mr Kamran Mallick: That’s right.

Counsel Inquiry: Thank you.

HIV you identify as a potential risk factor owing to studies that connected that as a risk in relation to Covid-19 infection rates.

Mr Kamran Mallick: Yeah.

Counsel Inquiry: I think I can take this relatively swiftly with you, but there is a clear higher incidence of HIV within homosexual men and bisexual men; is that correct?

Mr Kamran Mallick: Yeah, so heterosexual men who have sex with men have higher rates of HIV than men who have sex only with women. Also gay men and trans women have higher rates of HIV. But within the LGBTQ+ community, minoritised ethnic gay men and trans women have higher rates of HIV than white LGBTQ+ people.

Counsel Inquiry: Thank you.

We’ve heard a little bit about self-reporting and self-reporting of health and health outcomes, and you cover that off within your report. I’m going to summarise it, if I may, that, in terms of general health, typically the LGBTQ population, people, report worse health outcomes and worse health situations, is that right, than –

Mr Kamran Mallick: That’s right, they have (inaudible) health.

Counsel Inquiry: – the heterosexual population?

And the same is true, as you note at paragraph 17, of limiting long-term illnesses.

Mr Kamran Mallick: That’s right.

Counsel Inquiry: Can I just pick up briefly on disability. Obviously we’ve been hearing from experts in disability and individuals representing disabled people this morning. But in relation to those with a disability, in the broader context, in terms of the LGBTQ population, disability is lower than the general population; is that right?

Mr Kamran Mallick: So if you are referring to point 18, this survey does not compare LGBTQ+ people to heterosexual or cisgender people, so what this point refers to is that trans people within the LGBTQ+ umbrella are more likely to have a disability than cisgender LGBQ people.

Counsel Inquiry: Certainly I was going to move to the specific position of trans people in due course, and that’s certainly correct that it’s a higher proportion, but is it right that in terms of the rate of disability in the general population, the LGBTQ population in the national LGBTQ survey, was approximately 17% compared to 22% that could be seen across the population. Can you assist us with that or not?

Mr Kamran Mallick: So I don’t see this in point 18, and the LGBT survey did not compare to a heterosexual population, so we could compare with other surveys, comparing the prevalence, but – yeah, but this is not what –

Counsel Inquiry: Not at all, but we see a particular issue in relation to trans respondents.

Mr Kamran Mallick: That’s right.

Counsel Inquiry: And it’s probably fair to say in relation to trans people that we see that frequently in terms of exacerbated inequalities within the various areas; is that right?

Mr Kamran Mallick: That’s right, yes.

Counsel Inquiry: Now if I may turn to mental health, it’s paragraph 19 of your report onwards, in general terms, in headline terms, what was the position prior to January of 2020 with regard to what was known about the LGBTQ population and mental health?

Mr Kamran Mallick: Yes. So, based on robust representative studies of the general population, we know prior to the pandemic that LGBTQ+ people have worse mental health, so they have higher rates of depression, anxiety, suicidal attempts and self-harm compared to heterosexual and cisgender people. And so this happens across the life course, but it’s particularly stark perhaps for LGBTQ+ youth, who have, compared to heterosexual youth, really stark, alarming levels of poor mental health.

Counsel Inquiry: Indeed. And just picking up, if I may, on the adolescent and young people aspect for a moment, at paragraph 21 you identify that in relation to suicide that there is a specific increase in risk for adolescents, and heightened yet again in relation to transgender young people; is that right?

Mr Kamran Mallick: That’s right, yes.

Counsel Inquiry: Turning to more general issues of loneliness, isolation and social support, is that a specific issue that’s raised in relation to LGBTQ people?

Mr Kamran Mallick: Yes, so LGBTQ+ are more likely than heterosexual and cisgender people to experience social isolation. This is particularly stark with regards to youth and older people, so people aged 50 and older.

Counsel Inquiry: So we see it at two ends, effectively, young people and then people from 50 plus?

Mr Kamran Mallick: That’s right.

Counsel Inquiry: Why is that, do you know?

Mr Kamran Mallick: Well, it’s a complex causal mechanism behind social isolation, but young LGBTQ+ people experience really high rates of bullying and exclusion within their network, so within school, for example, and I provide some of the evidence in the report. Then older people also – they may experience higher rates of digital exclusion that we’ve seen. They have experienced a life course of exclusion and discrimination, so I think this community of exposure leads to increased social isolation in later life.

But I think it’s important also to think about the different types of social support and social networks that LGBTQ+ people have. These are less likely to be kin-based, so less likely to be related to family, so they are more likely to be based on friends and past partners, perhaps, but also these social networks are more likely to be geographically dispersed as compared to social networks of heterosexual and cisgender people.

Counsel Inquiry: So the implication there being that they may need to travel to access those?

Mr Kamran Mallick: That’s right, yep.

Counsel Inquiry: Related to that is caring responsibilities, if I may just pick up on that aspect for one moment, and what you do explain in relation to LGBTQ+ individuals is that often that begins earlier in life for them, taking on a caring role, a caring responsibility for relatives or friends; is that right?

Mr Kamran Mallick: That’s right, yes. Yeah.

Counsel Inquiry: Picking up on an issue that has obviously touched many people in many different ways in the pandemic, you write in your report about grief, and in particular the additional complexities or challenges that are potentially faced by those within the LGBTQ community. Can you just expand on that a little, please?

Mr Kamran Mallick: Yes, so I think grief is really – has strong implications for mental health, but for LGBTQ+ people this is compounded by the fact that the grief that they experience may have to be hidden from others because it comes from a relationship that perhaps was not recognised, is not valued or accepted, and so it’s a grief that they cannot share with others, they have to keep to themselves, they cannot seek support, even if it’s formal or informal support, and so this compounds the impact of grief on mental health. So it’s an additional complexity.

Counsel Inquiry: Thank you.

Now, leading on from health, I just wanted to touch upon, if I may, access to healthcare. It’s from paragraphs 56 to 62 onwards, but seems to me to be convenient to deal with it, if I may, with you now.

Can I just summarise that, because it’s a mixed picture, isn’t it, within the LGBTQ+ community, and that is that they are – individuals are less likely to visit a GP?

Mr Kamran Mallick: Yes.

Counsel Inquiry: But more likely to access emergency services, often more likely to use NHS online and telephone services, comes from some Scottish studies, and more likely to have accessed or tried to access public healthcare overall; is that right?

Mr Kamran Mallick: Yes, I think because LGBTQ+ people experience exclusion from health and social care, they are less likely to seek primary care, so they’re less likely to access their GP. Then their health complications worsen and so then they have to seek emergency care. So that’s why they are different in the seeking behaviour.

Counsel Inquiry: Thank you, that’s helpful.

Now if I may turn, then, leave healthcare to one side for a moment, just turn very briefly to pre-existing social and economic inequalities, I’m just going to touch on four of those if I may. There is a wealth of material within your report. But the first one is: to what extent are LGBTQ people likely to face material disadvantage, in brief terms?

Mr Kamran Mallick: Yeah, so LGBTQ+ people are less likely to experience material disadvantage. For example, I provide an example of area deprivation, so they are more likely than heterosexual or cisgender people to live in the most deprived quintiles of England and Wales.

Counsel Inquiry: Thank you. The second area is exposure to violence and harm in the home, so domestic abuse or hidden harms essentially. We’ve heard a little bit about that, but are there increased risks to LGBTQ+ populations in their homes?

Mr Kamran Mallick: Yes. So studies show a really high rate of exposure to domestic violence, whether this is physical or emotional or sexual or threat of violence, because of one’s sexual or gender identity.

Counsel Inquiry: Thank you. And I think you give statistics within your report of 44% of lesbian or bisexual women and 41% of gay or bisexual men of having experienced domestic violence or abuse for more than a year?

Mr Kamran Mallick: Yes.

Counsel Inquiry: Thank you.

Another area that we will touch upon within Module 2 is that in relation to residential care, and very briefly, if I may summarise that for you, you explain a little bit like in terms of seeking assistance and help with regard to public health services, that individuals within that population are more likely to delay entering residential care, with the consequence that when they do enter residential care they’re likely to have more complex needs at the point of entry, and that’s at paragraph 52. Is that right?

Mr Kamran Mallick: Yes, that’s right. So they are more likely to delay care because of experienced discrimination in the past and anticipated discrimination, because they have to hide a crucial part of their identity, who they are in terms of sexual orientation and gender identity.

Also it’s important to note here that lesbian and bisexual women and gay men and bisexual men are less likely to have children and grandchildren compared to hetero and cisgender people, and that has implications for arranging care and making decisions around care.

So it’s a complex picture of why they delay care.

Counsel Inquiry: Thank you, that’s really helpful. If I can then just turn to the final topic under this heading and that’s homelessness and housing and what particular challenges are faced within the LGBTQ+ population in relation to housing and homelessness.

Mr Kamran Mallick: Yeah, so as we discussed before, the violence within the home often leads to people and particularly young LGBTQ people leaving the family home, which leads to increased rates of homelessness. And within housing and housing provision, oftentimes housing providers do not take into account the needs and challenges of LGBTQ+ people, so that means that they may put clients or, yeah, people seeking housing, social housing, in circumstances that they may feel threatened and be dangerous for them in terms of violence.

Counsel Inquiry: Thank you. And we see specific statistics that you set out at paragraph 64 of your report, where 24% of homeless young people, those aged 16 to 25, are LGBTQ, and so overrepresented within the cohort.

I want to turn now to the final area within your report, and that’s the one of structural discrimination, and in relation to that you use the terms “heterosexism” and “cisgenderism”. Can you just explain briefly what each of those are.

Mr Kamran Mallick: Yes. So heterosexism is a system that structures societal policies, institutions, practices, norms and values under the assumption that everyone is heterosexual, and heterosexism denies and stigmatises sexual orientations or communities or relationships that are not heterosexual.

And cisgenderism is a system that denies and denigrates gender identities which are not congruent with gender assigned at birth.

Counsel Inquiry: Where and in what areas is structural discrimination in your view most acutely felt by those within the LGBTQ+ population?

Mr Kamran Mallick: Well, I think because it’s a system that impacts on policies and institutions, it’s very hard to say there is one area that’s more acutely felt because it – yeah, it’s porous, it goes everywhere. And I think the important concept to think about here is that it accumulates across employment, education, housing, healthcare, social care, and then individual interactions as well.

So every single aspect that matters to one’s life is heterosexist or cisgenderist.

Counsel Inquiry: Thank you. I just want to focus in on one area, if I may, and that is in relation to the lack of data, which you attribute to heterosexism and cisgenderism? Is that right?

Mr Kamran Mallick: That’s right.

Counsel Inquiry: Why do you say that?

Mr Kamran Mallick: Well, there is a persistent underinvestment in the infrastructure and research for LGBTQ+ populations, and data are crucial because unless we document inequities we cannot intervene on them and we cannot monitor how we are progressing around that.

I put a statistic here around UKRI funding in relation to Covid and how, of all the funding provided for understanding how Covid was impacting on different populations, only 0.13% was given to LGBTQ+ research. So I think this is very disproportionate and it leads to us not knowing how the pandemic was impacting LGBTQ+ populations.

Counsel Inquiry: Thank you.

Circling effectively back down to almost where we began, with data and investment, you’ve explained the consequence of that data gap. We’ve seen the introduction of the 2021 census, is that right, which for the first time includes questions in this respect?

Mr Kamran Mallick: That’s right.

Counsel Inquiry: To what extent does that assist in closing that gap?

Mr Kamran Mallick: Well, it’s a very positive step to include sexual orientation and gender identity in the census. It doesn’t fully close the gap because it collects data on sexual orientation, but we really need to understand what are the mechanisms driving this LGBTQ+ inequities that are so stark and persistent, and so it’s a great step but it’s not sufficient.

Counsel Inquiry: What improvement, in your opinion, is required to data collection and research infrastructure for LGBTQ+ populations generally?

Mr Kamran Mallick: Well, we first need a greater amount of funding to be able to conduct the research and we need a study that collects sufficiently large samples of LGBTQ+ people to make it generalisable.

But it’s not just about the numbers, it’s about the questions asked as well, so these surveys need to have the questions that enable us to understand why are we seeing these stark inequities and where can we intervene.

Counsel Inquiry: Thank you.

Then my final questions for you are, firstly, you set out a number of missed opportunities within your report and we have those in front of us, and those no doubt will be considered in due course so I’m not proposing to go through those in detail. Many follow on from what you have said at earlier points either today or, indeed, within your report, and some have been touched on or emphasised by others in other aspects of the evidence.

But may I just simply ask this: should the LGBTQ+ population have been identified as a vulnerable group?

Mr Kamran Mallick: Yes, I think so, because of the pre-existing stark physical inequalities, worse levels of mental health, but also with regards to social vulnerability, for example violence within the home, differences in social networks, increased levels of social isolation, which had strong possibilities of increasing vulnerability and inequalities for LGBTQ+ people.

Ms Cecil: Thank you.

My Lady, I have no further questions for Professor Bécares. There are no Rule 10 requests. Does your Ladyship have any questions?

Lady Hallett: No, I have no questions. Thank you very much indeed for your help.

The Witness: Thank you.

(The witness withdrew)

Lady Hallett: 2.05, please – unless there is anything else?

(Pause)

Ms Cecil: No, my Lady.

Lady Hallett: Anything coming from Ms Davies?

Ms Cecil: No, my Lady, thank you.

Lady Hallett: Thank you. 2.05.

(1.05 pm)

(The short adjournment)

(2.05 pm)

Lady Hallett: Summary of questionnaire responses

Ms Cecil: My Lady, I’m grateful. If I may continue now to review the questionnaire responses that were received firstly in relation to LGBTQ+ representative organisations, of which sadly there were none, despite efforts made by your team. Then, secondly, move to those in relation to sex and gender, do you recall, which we heard evidence of on Friday.

As I say, unfortunately and regrettably, despite efforts to obtain a response, no response was forthcoming in relation to LGBT groups. As such, the Inquiry legal team, with the assistance of your policy and research team, have distilled relevant and available open source material to assist the Inquiry and to provide some context for you.

You have just heard about pre-existing inequalities faced by the group, however very little academic research has been published about the pandemic’s impact on the health and wellbeing of people from the LGBTQ+ communities and especially those living within the United Kingdom.

The research that has been conducted notes, building, indeed, on Professor Bécares’ evidence today, that data is limited and that the quality of available evidence is also limited. The National Centre for Social Research in November of 2021 conducted a review of available evidence and data with regard to the experiences of UK LGBTQ+ communities during the Covid-19 pandemic.

The report again acknowledges that there are significant evidence gaps on the experiences. In particular there is a need to explore the experiences of LGBTQ+ people from black and minority ethnic groups and communities, as well as those facing with disabilities.

Surveys were predominantly conducted by LGBTQ+ voluntary and community sector organisations via their own networks and service users, ie those non-representative convenience samples that you’ve heard about, and other research largely comes in the form of small-scale qualitative studies.

But in summary, as perhaps could be anticipated, the pandemic had a negative impact on the mental health of those within the LGBTQ+ population, and many of the risk factors identified today by Professor Bécares were reflected: increased levels of anxiety, depression, isolation and loneliness.

There was a loss of safe, supportive and identity-affirming peer groups, communities and spaces according to the reports. The mental health of younger people within the cohort was particularly negatively affected, and that in part was attributed to those younger people feeling the most unable to connect with those outside of their households during the pandemic. The mental health of trans people was also specifically noted as deteriorating.

In terms of access to health services, the research notes a reduced level of access, including lack of HIV checks, lack of access to STI tests, worries around renewing prescriptions and, importantly, including PrEP prescriptions and medication. That is the medication that reduces the likelihood of contracting HIV. Then ancillary to that, the monitoring of those medications and side effects.

A new harm arose, it is reported, during the pandemic, that is of online harassment and discrimination, essentially reflecting and, the reports say, as a consequence of the move to online meetings.

Finally, picking up on a point that was articulated earlier by Professor Bécares, in relation to home pressures, working from home, similarly, individuals articulated increased pressures to come out to their families while home working, or their colleagues, during the pandemic, which in turn had a negative impact on those relationships and their mental health.

Secondly, as I said at the outset, I propose to turn now to the impact in relation to gender and sex. My Lady, the Inquiry received responses from 13 voluntary sector and civil society organisations in relation to issues facing women. Areas ranged from gender equality to maternity rights and domestic abuse. Flowing through each one was one primary theme, that the government did not adequately consider how decisions would specifically affect women. Further, that the measures taken in response were piecemeal and fragmented, with the result that not only pre-existing inequalities were exacerbated but new inequalities were created, with disproportionate impacts upon women.

In respect to that, the Women’s Budget Group outlined that without robust analysis or consideration of women in the policy making phase of the pandemic, the government was not able to anticipate how inequalities were likely to be exacerbated by the pandemic and ensure that it influenced the policy response, including in relation to employment, welfare, childcare, pregnancy and maternity.

Similar comments were received by the Northern Ireland Women’s Budget Group, emphasising there were little to no targeted measures from either government to mitigate specific issues impacting women.

Southall Black Sisters added to that point, noting that ethnic minority women and refugee women are vulnerable to compounding disadvantages. And of course my Lady you have already heard reference to the triple threat that they say they faced.

One critical example of government decision-making not considering the impact on women is said to be violence against women and girls. Southall Black Sisters, Refuge, Solace Women’s Aid and Women’s Aid across Scotland, England and Northern Ireland all noted that the pandemic exacerbated existing issues for service users and, as we’ve heard them termed, survivors of domestic abuse struggling to access both public services, welfare provisions and indeed, in some respects, it’s been reported, the justice system.

Picking up from the evidence that you heard on Friday, my Lady, Refuge also noted that government communications around lockdown did not make it clear until April of 2020 that survivors or victims of domestic abuse were able to leave their homes. Organisations noted that these issues were foreseeable. Southall Black Sisters pointed and emphasised the fact that countries such as China, who had locked down earlier, reported rises in rates of domestic abuse and that this in turn had been reported within the domestic UK media.

They say, yet the government seemingly ignored international experience as well as domestic expertise when decision-making.

All organisations consistently reported the government failing to provide funding to the sector in terms of emergency funding until 2 May of 2020 and that it was slow to reach the frontline.

Various issues were raised in relation to the staff working in such refuges in relation to a lack of clarity as to whether they were eligible for testing and PPE, vaccination priority of course a matter for subsequent modules, and a lack of specific guidance in relation to managing social distancing and infection control measures in such places.

Various lessons have been suggested, one of which is that the domestic abuse commissioner should play a key role in policy development and decision-making and that violence against women and girls sector experts should be consulted. A secondary aspect relates to communications, and of course, my Lady, you have heard a lot about that already.

The secondary impact that was emphasised by respondents was that on pregnant women. Firstly in relation to pregnant women within the workplace, Maternity Action flagging that, flagging both with regard to return to work maternity leave but also in relation to the Covid-19 financial support schemes, again matters that will no doubt be explored in subsequent modules.

Finally, in relation to matters that were identified that may be relevant to Module 3 and healthcare systems, birth rights highlighted the fact that restrictions on maternity services were not lifted at the same time as wider restrictions, with partners not being allowed to attend, even as the Eat Out to Help Out scheme encouraged people to attend restaurants.

Then impacts upon mental health and wellbeing of new mothers, alongside limited community healthcare provision, was highlighted.

My Lady, that concludes the summaries of questionnaires for today. At this stage, may I formally ask permission for the Inquiry to publish the witness statements for each of the witnesses from whom you heard last week and indeed today, and the ancillary expert reports?

Lady Hallett: I so order. Thank you.

Ms Cecil: Thank you very much.

Lady Hallett: Thank you, Ms Cecil.

Mr O’Connor.

Mr O’Connor: My Lady, may we now please call Professor Henderson.