10. Ms Nuala Toman

MS NUALA TOMAN (affirmed).

Questions From Counsel to the Inquiry

Mr Scott: Good afternoon.

Lady Hallett: Thank you for waiting until the end of the day. Sorry about that.

Mr Scott: Good afternoon, Ms Toman, would you please provide your full name for the Inquiry.

Ms Nuala Toman: Nuala Toman.

Counsel Inquiry: Thank you for your assistance to the Inquiry.

If I can just ask you to keep your voice up, speak into the microphone, and also not to speak too quickly, although I may be more guilty of that than you. I may ask you to repeat some or all of your answers, if it’s not clear what you’ve said; and if you need a break at any point, please just say.

You have provided the Inquiry with a witness statement dated 19 January 2024. I take it you’re familiar with the contents of that statement?

Ms Nuala Toman: (Witness nods)

Counsel Inquiry: At page 27, there’s your signature and a statement of truth. Please can you confirm that the contents of that statement are true?

Ms Nuala Toman: Yes.

Counsel Inquiry: And are you content to rely on that statement in evidence to the Inquiry?

Ms Nuala Toman: Yes.

Mr Scott: My Lady, we request permission for that witness statement to be published?

Lady Hallett: Certainly. That will be the default setting.

Mr Scott: Thank you, my Lady.

Ms Toman, you are the head of Innovation and Impact at Disability Action Northern Ireland, and that the role and work of Disability Action can be summarised in the following way: it’s the largest pan-disability organisation in Northern Ireland, represents more than 300 organisations, it works with people with various disabilities, you advocate for the rights of deaf and disabled people and provide them with services, and those services reach about 100,000 people per year?

Ms Nuala Toman: That’s correct.

Counsel Inquiry: As you do in your statement, you encapsulate deaf and disabled people with just the term “disabled people” and I’ll do the same for these questions.

Would you please be able to provide just some brief examples of what life is like in Northern Ireland for people with disabilities and in particular those who rely upon day centres, provision of personal care, assisted housing, residential homes?

Ms Nuala Toman: Is this during the pandemic or in general?

Counsel Inquiry: Yes.

Ms Nuala Toman: During the pandemic.

Disabled people during the pandemic were isolated, lonely, social care had collapsed, and disabled people faced challenges accessing food and medicine, with many disabled people going hungry. Added to that, we were largely invisible amongst public decision-making processes, and our voices went unheard. In terms of housing, the lack of socially adapted homes meant that many disabled people were living in unsafe and unsanitary conditions, and without access to social care had to live on the ground floor of their homes without access to proper toileting or bedroom facilities.

Counsel Inquiry: Thank you.

If I can just take you back a little earlier in time, at paragraph 15 of your witness statement you say that:

“In Disability Action’s experience, disability inequality is pervasive within Northern Ireland. Disabled people in Northern Ireland are not afforded the same level of equality and protections in comparison with their counterparts in the rest of the United Kingdom and in Ireland.”

Could you please provide some specific day-to-day examples relating to the pandemic that show how disabled people in Northern Ireland were at a disadvantage compared to those in the rest of the United Kingdom and the Republic of Ireland?

Ms Nuala Toman: The legacy of underinvestment in our public services is so severe that, as I’ve outlined, disabled people faced a number of significant challenges. Firstly, social isolation and the collapse of social care. Those who did have access to social care reported significant challenges with respect to the provision of PPE for people who were providing them with support and care. There was, added to this, a lack of infrastructure through which to identify and provide essential services to disabled people. This is largely characterised by the lack of cross-departmental co-operation that has been evidenced by other people, for example the Department for Communities led the emergency food response whilst organisations supporting disabled people and disabled children were funded by the Department of Health. As a result of this, disabled people’s organisations and organisations representing disabled children were not involved in the food emergency response planning, and disabled people and disabled children were largely invisible, meaning that they had no access to food or medicine. Parents of disabled children had no access to respite facilities. This was combined with an absence of bespoke housing, leading –

Counsel Inquiry: Sorry just to cut across you there. There’s a number of those aspects that you set out that sound like they have roots prior to the pandemic, so they’re not situations that necessarily arose in the very early stages.

Is it right that there is a history of inequality in Northern Ireland that arose prior to the pandemic?

Ms Nuala Toman: There’s no doubt that Northern Ireland as a society has been characterised by historical inequality and discrimination, that is reflected in our – with our recent and past history. That said, the approach to decision-making in the pandemic greatly increased the challenges facing disabled people by rendering us invisible, isolated, unheard, and in many cases uncared for.

Counsel Inquiry: Because you say in paragraph 28 of your statement that one of the effects of the absence of power-sharing was that there were no ministers to engage with so no one in place to address inequalities that are there. Are you saying that, was the situation any better when ministers were back in their posts in 2020?

Ms Nuala Toman: The political infrastructure within Northern Ireland is complex, so in the absence of a functioning government decisions were being made by unelected civil servants, and at that time disabled people told us that they felt like they were living under a dictatorship. The reinvigoration of the Executive was of course welcome. That said, the reinstatement of ministers did little to improve the position of disabled people. The emphasis placed upon decision-making on addressing the larger political issues and the challenges presented by cross-departmental working through the enforced five-party coalition were such that disabled people fell through the cracks and were largely unaddressed and unacknowledged within decision-making processes. That’s exemplified through the absence of data, the absence of reference to disabled people in strategies that were published during Covid.

Counsel Inquiry: If I can just jump in there, because there are a couple of elements in there, data and engagement, that I’d like to come back to. If I could just deal with the data point now, you set out in – if I can just take you to, it’s INQ000396793, which is an Assembly’s all party group on learning disability from May 2018, which will just come up on your screen. It’s in the box on the left-hand side marked number 3:

“While it is vital to have a clear picture about the numbers of people with a learning disability in order to appropriately target resources and improve outcomes, there is a general lack of disaggregated data in Northern Ireland for this population.”

So that was 2018. Had the situation improved by the time that the pandemic commenced?

Ms Nuala Toman: No, and there continues to be a lack of available data regarding disabled people in Northern Ireland.

Counsel Inquiry: Well, yes, you say that you’re not aware of any statistics available detailing the number of disabled people resident in care homes in Northern Ireland. Is that still the case?

Ms Nuala Toman: To my knowledge, yes.

Counsel Inquiry: And how is it, to your knowledge, that you were able to identify and then meet the needs of disabled people in Northern Ireland if you don’t actually have any sufficient data about disabled people themselves?

Ms Nuala Toman: From the public services perspective?

Counsel Inquiry: And from your perspective as a charity that represents them.

Ms Nuala Toman: So, from our perspective, we are a disabled persons-led organisation who have developed services for disabled people delivered by disabled people. We have a large network of organisations that we work with collectively, and on the basis of our service delivery we are connected to disabled people throughout the region. For example, we deliver transport on a regional basis and our membership extends across every county in Northern Ireland. We deliver employment services, and again we deliver those services across the whole of Northern Ireland. And I suppose it shouldn’t be left to us as a charity to identify disabled people on behalf of government, but by working together and the networks that we have, you know, we do the best that we can and we do deliver services for more than 100,000 disabled people annually.

Counsel Inquiry: So does your knowledge of the disabled people who use your services come from the interaction that you have rather than any kind of objective sources of information that you may gather separately?

Ms Nuala Toman: So we also, as an organisation, conduct research and regularly survey disabled people about their views on service provision in Northern Ireland, and we collect data regularly throughout the year. For example, a survey that we conducted in partnership with the Equality Commission identified that nine out of ten disabled people do not feel that housing and other services are accessible to them.

Counsel Inquiry: Thank you.

There is a line that people will remember from the course of the pandemic in the context of “the virus does not discriminate”. As far as disabled people are concerned, does that line paint the whole picture?

Ms Nuala Toman: No, and I think we need to acknowledge that in the context of the pandemic that real-time data regarding the number of disabled people who died due to Covid-19 was not available, it was continually sought after, and when it became available in late 2021 that data showed that disabled people, the number of deaths from Covid-19 accounted for a disproportionate amount of disabled people. So in that respect, disabled people were more likely to die from the virus than other groups.

Counsel Inquiry: Yes.

Ms Nuala Toman: Sorry, and by the time this data was published, we were well into the pandemic, and it’s important to recognise that at the outset every single message in the early days of the pandemic pointed towards the additional vulnerability of both older people and disabled people to Covid-19.

Counsel Inquiry: Yes, you say in your statement that disabled people were 42% more likely to die of Covid-19 than non-disabled people. Is that your understanding?

Ms Nuala Toman: Yes.

Counsel Inquiry: Yes. And when you were talking about the data that was produced, was that December 2021?

Ms Nuala Toman: Yes.

Counsel Inquiry: That came from NISRA. Would it have been of assistance for that data to have been provided, if it was possible to do so, prior to the second wave, for example?

Ms Nuala Toman: I think it would have been essential, particularly in a region whereby there are statutory obligations through which to both identify and mitigate the impact of policy and practice on disabled people and other section 75 groups, and those statutory functions cannot be effectively completed in the absence of data.

Counsel Inquiry: Yes. In terms of that section 75 function, I think one of the points you seek to make is that there’s the duty to mitigate as part of that function. Do you feel, as far as disabled people in Northern Ireland are concerned, that sufficient was made of that duty to mitigate?

Ms Nuala Toman: There’s no available evidence at this time to indicate that there were particular mitigations put in place for disabled people, and that’s apparent from the lack of engagement, the lack of visibility, and the absence of a targeted response towards disabled people during the pandemic.

Counsel Inquiry: One of the aspects that you touched upon earlier on today is the cessation or reduction of care in services.

Do you have any view on the reason why those services in particular were reduced or ceased to function?

Ms Nuala Toman: I think there were particular concerns around the transmission of Covid-19, and we have referred to that as the tension between trying to protect disabled people against the spread of the virus, but also leaving disabled people without access to care and support, and that extended to food and medicine, therefore effectively creating worsening conditions for disabled people, and breaching their human rights.

Counsel Inquiry: Yes.

We heard the very powerful accounts this morning in the video from Joanne and then Jim and Peter about the impact of people who weren’t receiving care or those who didn’t have any family and nobody to speak for them. Would you be able to describe the risk of either significant harm or the risk caused by loneliness, and particularly for those with intellectual or psychosocial disabilities, of the reduction or cessation of those kind of services during the pandemic.

Ms Nuala Toman: So the research that we conducted throughout April 2020 demonstrated that the collapse of social care led to declining physical and mental health.

We also have case study accounts from disabled people who describe being left dirty, lying in their beds, unable to go to the toilet, feeling hungry and not having access to food. We have had accounts from disabled people that are harrowing, of a young disabled man who, with access to care, could access his day-to-day employment but without access to personal care assistance, he was left in his home trying to access his toilet by crawling up the stairs.

Counsel Inquiry: And I think you set out in your statement difficulties with access to transport and food and medicines, so I won’t ask you about that now. But did disabled children and their families face any particular difficulties in relation to school closures or changes to daycare centres, for example?

Ms Nuala Toman: So during the first wave, special educational needs schools closed, disabled children and their families reported significant challenges in terms of having access to the necessary equipment to undertake educational activities at home. Disabled children and families were left alone and isolated. Parents didn’t have access to support to allow them to continue to develop their children’s cognitive needs.

Added to that, parents were experiencing emotional distress and mental distress as a result of having an absence of a wider support network around them, and have told us that they were left alone and isolated.

Counsel Inquiry: You have given some examples there. How pervasive were those experiences amongst disabled people in Northern Ireland? Did it apply to a small number, a large number? Are you able to give any kind of rough indication of the scale of the impact?

Ms Nuala Toman: So in the context of Northern Ireland, one in four disabled – you know, one in four people are disabled people. The challenges that I’m outlining, certainly for disabled children who were pupils in special educational needs schools, those experiences are uniform across that particular group of children.

Counsel Inquiry: Sorry, do you know roughly how many that is, or is there lacking data on that as well?

Ms Nuala Toman: There will be data around the exact number of children enrolled in special educational needs schools, I just don’t have it to hand at this particular instance, but we can provide you with that if you require it.

Added to that, I mean, disabled people are – represent an incredibly diverse population, but if you look at the survey that we conducted, we had 1,700 responses of which something like 65% reported a decline in physical and mental health, and a further 37% reported challenges in terms of accessing food and medicine. So for us, if you attribute that to the wider population of disabled people, what you see is an extent of experience that impacts upon a large majority of disabled people.

The people that we work with experienced everything from fear of going into hospital, wondering who would feed them, through to inability to access health appointments, to people who were blind and visually impaired being unable to access their doctors because they were being asked to take photographs of, you know, injuries and rashes and being unable to do so without assistance.

Counsel Inquiry: Thank you, Ms Toman, I don’t want to push you any further in terms of any examples have been provided.

I want to move on now to another topic in terms of the mortality differences and communications.

You say in your statements:

“Disability Action’s view that mortality differences between disabled people and non-disabled people must be understood in the context of the failure to consider communication needs of disabled people when providing public health information.”

You go on to say that there are usually two main factors in relation to disabled people accessing information: disabled people are less likely to be able to access the information than the general population; and, depending on conditions and impairments, they’re less likely to be able to understand and/or follow it without appropriate adjustments.

This leaves disabled people more vulnerable to infection and illness and more likely to further the transmission of the virus.

As far as you’re concerned, did public health messaging fall short of recognising those issues?

Ms Nuala Toman: Yes, and for example if you’re blind or visually impaired, if you receive a letter in a form of communication, you may require someone else to read that to you. If you’re socially isolating and don’t have someone to do that, then you have no access or information.

Counsel Inquiry: Sorry, in terms of any specific examples you could give about how the messaging just wasn’t fitting what you described as what disabled people need in order to make sure they’re keeping themselves safe?

Ms Nuala Toman: So the messaging was inaccessible in the format that it was delivered, particularly information that was delivered by letter. The public health information that was made available through TV communications was inaccessible because it wasn’t tailored towards people with learning disability.

There was an absence of information available via BSL or ISL vlogs, beyond some of the news reporting which was interpreted. There was an absence of Easy Read information. And in the context of changes to how people accessed services, including, you know, going to the supermarket, there were no audio descriptions to explain or raise awareness of the need to socially isolate or even to alert people who were blind or visually impaired to the fact that they had to queue outside a shop, and we know that some blind and visually impaired people actually walked into the doors of the supermarket because they were completely unaware in the early days of the pandemic that the way in which people were accessing supermarkets had completely changed.

Counsel Inquiry: Thank you.

We know that those communication difficulties were known about very near the start of the pandemic, if not before the pandemic; these weren’t matters that were discovered during the course of the pandemic, were they?

Ms Nuala Toman: No.

Counsel Inquiry: Did anybody from the government engage with you as a disability organisation in terms of how such messaging would be able to most effectively reach disabled people?

Ms Nuala Toman: We had very limited engagement with any public officials or politicians throughout the pandemic. No one reached out to us to ask for advice on accessible communication.

Counsel Inquiry: What was the level of engagement generally with you as a representative organisation from the government in terms of the impact of the pandemic upon disabled people in Northern Ireland?

Ms Nuala Toman: So we had one meeting with an ethics forum in response to a letter written to Minister Swann. We also had some very limited engagement around the disability strategy which did not at all focus on Covid-19. We had a commitment to meet with both the First and deputy First Minister, which didn’t happen because the political institutions then collapsed. There was absolutely no strategic approach to engaging with disabled people throughout the pandemic, to such an extent that we had to work with MLAs to establish an ad hoc review of the impact of Covid-19 on disabled people, so we literally had to work together to create a forum for disabled people to share their experiences and to try to have these placed on public record.

Counsel Inquiry: You used the word “forum” there. The Inquiry will hear evidence about other organisations and groups that were created in certain different sectors. What benefit do you consider that there would have been if there had been a forum or an organisation which would have been engaging with the government in Northern Ireland about the impact of the pandemic upon disabled people in Northern Ireland?

Ms Nuala Toman: I think what we need is to ensure that disabled people are at the heart of decision-making by creating structures that allow the voices of disabled people to be heard, then our requirements are built in from the outset, and mitigations and approaches can be developed to ensure that the requirements of disabled people are met. For example, something very, very simple, communication, better communication between the Department for Communities and the Department of Health could have ensured that Disability Action, or a similar organisation, all children in Northern Ireland were represented on the emergency response group, and in doing that, an access pipeline to disabled children and disabled people would have been there from the outset, meaning that disabled people and disabled children would have had access to food and medicine on an equal basis with others.

Counsel Inquiry: And finally from me, Ms Toman, at paragraph 114 of your statement, you say:

“The safety of d/Deaf and Disabled people should be a core consideration and their emotional and social well-being prioritised in the planning of services.”

Do you feel like that happened in response to the Covid-19 pandemic in Northern Ireland?

Ms Nuala Toman: No, unfortunately disabled people were neglected, forgotten, left behind, not taken into account in terms of the processes of decision-making, and it’s very sad to say that the legacy of political dysfunction and all of the challenges that were outlined today in terms of decision-making meant that we simply didn’t have a voice, that our needs were so low on the agenda that we simply were not heard. And unfortunately in this jurisdiction there are statutory obligations in place that if they were upheld would have, you know, would have changed the story entirely. It’s a legal requirement to consider disabled people from the outset in terms of policy development and unfortunately that didn’t – didn’t happen, but the framework is there.

Mr Scott: Thank you, Ms Toman. Those are all the questions that I have.

My Lady, as I understand it, there are no live Rule 10 requests.

Lady Hallett: I think there’s some – Mr Wilcock has some. Oh, it’s Ms Campbell.

Ms Campbell: We did have some questions which we were permitted to ask, but in fact given the clarity and the content of the evidence that we’ve just heard from Ms Toman, in fact everything’s been covered and we’re very grateful.

Lady Hallett: Thank you, Ms Campbell.

Ms Campbell: Thank you.

Lady Hallett: I should have trusted you, Mr Scott.

Thank you very much indeed for coming to assist the Inquiry, I’m very grateful to you, and I’m sorry you had such a sad story to tell –

The Witness: Thank you.

Lady Hallett: – about the way people are treated.

(The witness withdrew)

Lady Hallett: Very well. I think that completes the evidence for today?

Mr Scott: Yes, my Lady.

Lady Hallett: 10 o’clock tomorrow morning?

Mr Scott: Yes, my Lady.

Lady Hallett: Thank you all very much.

(4.13 pm)

(The hearing adjourned until 10 am on Wednesday, 1 May 2024)