Scotland was slow to remove mask mandates in the general population. The legal requirement to wear a mask in public spaces became ‘guidance’ on April 18th 2022 but continued as a strong recommendation in health and social care settings. This policy was again reviewed in June but mask-wearing continued to be strongly recommended, meaning that many residents in care homes possibly never saw an unmasked face for over two years. However, a concerted campaign has – finally – achieved a change in policy that should end routine mask wearing in social care settings.
Prompted by the disappointing review in June, and after two years of frustrating and fruitless communication with health and social care organisations in Scotland on the subject of harms caused by mask-wearing, I reluctantly sent an open letter to CEOs of Scottish health and social care organisations on July 19th, imploring them to urgently challenge the Scottish Government to end illogical and harmful mask-wearing policies.
I received non-committal responses from statutory organisations but one CEO was honest enough to tell me he had neither the “authority nor governance” to challenge Government policy. This was surely the fundamental source of the problem and the reason why my communications had been received with resistance or silence (but, rarely disagreement). This CEO promised to communicate my concerns with the Scottish Government but was clearly unable to include a personal opinion or to dissent from the organisation’s position. Indeed, two other CEOs stated they had neither the time nor resources to engage in this debate but wished me well in “my campaign” and asked to be kept informed of progress.
However, Scottish Care and Alzheimer Scotland were quick to respond, both expressing agreement with the concerns I had raised and the need for a roundtable discussion with key stakeholders and Government officials. Subsequently, Alzheimer Scotland took a lead role in arranging a meeting, despite having no statutory role in the support and protection of adults or in workforce regulation.
The well-attended roundtable discussion was convened relatively quickly and took place on August 16th, chaired by Henry Simmons, CEO of Alzheimer Scotland. I attended in my role as an Independent Practitioner along with the following representatives:
- Care Home Relatives Scotland: three members, which included an individual campaigner;
- Alzheimer Scotland: three representatives, which included an Action on Rights adviser;
- The National Dementia Carers Action Network: two representatives;
- Scottish Care: Workforce Lead;
- The Care Inspectorate: Infection Prevention & Control Improvement Adviser;
- Scottish Government: five representatives which included policy, nursing & medical advisers.
Scottish Government officials considered it unnecessary for Public Health to be represented because it has no policymaking role. The Mental Welfare Commission for Scotland and the Scottish Social Services Council, both key statutory organisations in Scotland, were absent from this crucial debate – the first opportunity in over two years to have face-to-face discussion about harms caused by mask-wearing.
All credit to the Chair, who over two hours gave everybody fair opportunity to express their views, including powerful and moving testimonies from those with first-hand experience of the harms caused by mask-wearing. The two main areas of concern discussed were harms associated with mask-wearing and the limited evidence base being used to promote mask-wearing as an effective infection control measure.
The general consensus and recommendation on the harms caused by mask-wearing to both those impacted by hidden faces and to staff wearing them for lengthy periods was reflected in the meeting position statement. There was also consensus that removing masks would be a concern for some who would require support and reassurance if mask-wearing was to become a choice as opposed to a recommendation.
There was no consensus following the fairly heated debate around the evidence base which was identified as a critical issue in addressing concerns about removing masks, but this detailed discussion was not included in the position statement.
Three weeks later, on September 7th, the guidance was again updated, this time removing the recommendation for routine mask-wearing in social care settings; a huge relief for many. Specifically, the new guidance contained the following statements:
- “staff do not need to routinely wear a face mask or face covering at all times during their shift”
- “visitors to adult care homes and other settings do not need to wear a face mask or a face covering including in communal areas”
Bizarrely, having clearly identified harms, this update did not apply in healthcare where routine mask-wearing is still strongly recommended in most situations.
The updated guidance was, however, accompanied by promotional materials intended to alleviate anxieties around removing masks but instead appears to promote mask-wearing as a positive choice and an effective IPC measure with little reference to the benefits of removing masks as very clearly stated in the guidance document.
It is of course important to recognise that the Scottish Government has taken a very positive step in acknowledging that mask-wearing polices are detrimental to the health and wellbeing of those both giving and receiving care and support. Unfortunately, the refusal to acknowledge the absence of a robust evidence base has allowed the Scottish Government to promote masks as an effective infection control measure. Consequently, the guidance enables public health officials to demand their reintroduction at any point with infection control measures being assumed as priority over other clearly identified risks and actual harm caused.
It’s little wonder then that some care settings have been slow to remove masks when the prevailing message encourages them to believe that the risks of removing masks are likely to outweigh any benefit. This myth-based message also supports the continued use of masks in healthcare where there is still no acknowledgement of the harms that have been candidly acknowledged in social care.
By all accounts, the removal of masks in social care has been welcomed by the workforce and health and social care organisations, whose governance it seems prevented them from raising concerns with the Scottish Government, even when harms were so clearly documented. The health and social care workforce, along with organisations who have leadership and regulatory roles, are integral to our normally robust public protection system. If they had been supported to express concerns and engage in open and balanced debate with policymakers, inordinate suffering could have been addressed at source rather than regretted with hindsight.
Valerie Nelson is an independent Mental Health Trainer and Consultant.