STEMming the flow: the impact of coronavirus on the STEM workforce pipeline

It is well recognised that the UK faces a shortage in STEM (science, technology, engineering and maths) skills, and that at current projections, this gap in skills and knowledge is only going to grow in the coming years.

Before the coronavirus pandemic, in recognition of this impending skills deficit, there had been a drive from across those sectors involved in STEM skills development (IT development, cyber security, life sciences and engineering, to name but a few) to encourage more people to consider STEM careers, whether as a first choice for young people leaving school, or as an opportunity for older adults looking to retrain in another discipline.

However, as with many things, the pandemic has set these efforts back, and now employers and trainers face an even greater task to ensure we can meet the skills needs for a digital, green and globally competitive economy.

Encouraging interests in STEM from an early age

Children and young people have seen first-hand the vital work that sectors such as life sciences and medicine have on our day-to-day lives during the pandemic. However, in the UK we still struggle with uptake of STEM subjects past GCSE/NAT5. And the number of those with career aspirations to move into STEM sectors is also not growing at the rate that will be necessary to meet future need.

Engineering UK published a report in 2021 which looked at the provision of information and support to children in English schools and colleges on careers in STEM subject areas. The report found challenges and barriers to engaging children in STEM subjects, including a lack of staff time and a lack of funding to offer specialist training. In addition, the report highlighted challenges around career advice and options for future career development, which were linked to a lack of employer engagement, and a lack of visible diversity and equality within the sector, which put some learners off.

Another challenge to encouraging the uptake of STEM subjects, is high quality teaching, teacher recruitment and the perceived standard of qualifications on offer.  In addition, there is a growing problem of STEM teacher shortages and a lingering perception that apprenticeships offer an ‘easy’ alternative to higher education.

A 2020 report also published by Engineering UK found that a lack of knowledge about relevant STEM educational pathways can discourage young people from pursuing engineering careers. In 2019, just 39% of young people aged 14 to 16 said they ‘know what they need to do next in order to become an engineer’ – and this figure has remained fairly static over time.

The report also emphasised that key influencers such as parents and teachers need to be supported so that they, in turn, can advise young people. The report highlighted that fewer than half of STEM secondary school teachers and under one third of parents surveyed for the research express confidence in giving engineering careers advice, with both groups reporting low levels of knowledge about engineering.

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Supporting diversity and equality within the sector

Last year, a report from the All Party Parliamentary Group on Diversity and Inclusion in Science, Technology, Engineering and Maths, looked at diversity in the STEM workforce.  It highlighted that, despite efforts to make the sector more equitable and more accessible for people from different backgrounds, the pandemic has exacerbated existing inequalities and, in some instances, has actually made the levels of inequality worse.

Similarly, a white paper from STEMWomen published in 2021 and updated in 2022 found that 60% of the women surveyed felt their future career prospects in STEM have been affected by the coronavirus pandemic. There was a growing feeling of uncertainty and lack of confidence in the jobs market, with a proportion of female STEM students saying that they are now looking for any job rather than one within their preferred industry.

Figures from WISE published in 2019 found that, in 2019, for the first time, one million women were employed in core STEM occupations, with an estimated 24% of the STEM workforce in the UK now female.  And UCAS data provided by the Higher Education Statistics Agency (HESA) showed that 35% of STEM students in higher education in the UK are women. There are a number of initiatives which have been developed to try and encourage greater diversity within the sector, particularly among women and girls and in particular those who are disabled or from BAME backgrounds.

Stemettes is an award-winning social enterprise working across the UK, Ireland and beyond to inspire and support young women and young non-binary people into Science, Technology, Engineering and Maths careers. The project has a number of innovative programmes designed to encourage young women and girls into STEM careers through workshops, networking and mentorship schemes, and has helped 40,000 girls realise their STEM potential since its launch in 2013.

A silver lining?

One of the changes to emerge from the pandemic is the number of adults considering re-training or upskilling in STEM or digital disciplines like cyber security. Many people were forced to leave their jobs during the pandemic, being made redundant or choosing to leave and re-train to help improve their future job security.

Since the pandemic, there has been growing interest, particularly in “tech and digital” job roles – according to research by IT jobs board CW Jobs. More than one in five of all workers say they have undertaken tech training since spring 2020, and more than half of non-tech workers (55%) have considered making the transition into the sector since the pandemic.

In October 2021, the UK government rolled out 65 short and modular courses at ten Institutes of Technology across England, aimed at helping to upskill working adults in their local areas. The courses will cover subjects including Artificial Intelligence, Digitisation of Manufacturing, Digital Construction, Agricultural Robotics, and Cyber Security, to be delivered through a combination of classroom and online learning to support flexible study.

However research from the University of Warwick has also shown that attracting people to the sector, and keeping them there are two very different things; a large proportion of STEM graduates are likely to never work in the sector, and there may be more movement out of high skill STEM positions by older workers than in other sectors. The skills of those already in the sector and the development of those existing skills to meet the demand – and where possible even pre-empt future skills shortages – is going to be as important as attracting new talent.

Final thoughts… mending the “leaky” STEM pipeline

The COVID-19 pandemic has highlighted the importance of STEM skills in a wide range of areas, and the wider agenda to drive a green recovery from the pandemic will rest, in part, on the sustainable and consistent development of a STEM talent pipeline over the coming years, to produce individuals with the skills and knowledge to drive green and digital growth. Other labour shocks, like the impact of Brexit, which has led to a re-location of many people from the Continent with STEM skills, or who worked in the sector directly, are contributing to the high demand for skills in the sector. All of which makes the importance of attracting and retaining people in the sector greater than ever.

The leaky STEM pipeline, – a metaphor which describes how people, particularly women and people from underrepresented groups in the industry, are “lost” from the sector at various points on the route to their chosen career – is sometimes criticised as being over simplistic.  However, it is clear that something needs to be done to help tackle the number of people “lost” from the sector. This could be done by promoting opportunities for everyone interested in STEM and by driving the development of a strong, well-resourced and engaged STEM workforce, drawn from all parts of society and engaged in STEM from the earliest possible opportunity.

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Playing catch up: education and the pandemic

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The coronavirus pandemic impact has been far reaching and it is predicted that the impacts will be felt for a number of years to come.

However, one of the potentially longest-term impacts is that on children at school who have missed out on learning which has been significantly disrupted for the duration of the pandemic.

Whether it is the mental and socio-emotional impact of children being isolated from peers, those children who missed out on key early years learning, or those children due to take important examinations, the impact has been significant and few children, if any have been unaffected.

Politicians and commentators have speculated about how easy it will be for children to “catch up” on learning they might have missed. Some have questioned if it will even be possible at all, with suggestions that we could be feeling the effects of the educational impact of the pandemic for many years.

Lost learning

Research from the Organisation for Economic Cooperation and Development shows that in the first 12 months of the pandemic (March 2020-March 2021), 1.5 billion students in 188 countries and economies weren’t able to go to school, for varying lengths of time. 

Further research published by the Education Policy Institute in October 2021 estimated that by the second half of March 2022, lost learning in primary school had amounted to 2.2 months in reading and 3.5 months in numeracy. The research also showed that the impact of lost learning is not equal across groups of children, with those from lower income backgrounds or areas of higher deprivation facing a greater gap in learning than those from more affluent backgrounds.

There have also been significant challenges faced by children with special educational needs and disabilities (SEND). Research has found that in many instances the pandemic has created a “double disadvantage” for children and young people with SEND and that it has exacerbated challenges they already faced with accessing support. Many children and their parents felt “left behind” by decisions that were made around school and care setting closures which they say will have a largely negative impact on children with SEND, not just from lack of learning, but also loss of routine, access to specialist therapies and equipment and interaction with peers.

Trying to predict the impact

Researchers have been attempting to use data from previous crises, such as the Christchurch earthquake and the Second World War to look at the potential long term impact of learning disruption on employment and earnings in later life.

Those examples highlight that long-run negative effects are considerable, but can be mitigated by significant government, school and parental responses. In other words, catch-up is not a natural process: it requires active and sustained efforts.

However, researchers have also noted that the response to catching up is also unprecedented, with little previous comparison for the immediate recognition of the disruption and the efforts in strategies like remote learning which have been employed to try and reduce disruption.

This effort to allow children to maintain some level of learning during the pandemic and allow those who have missed learning to catch up after it could be key in ensuring that children aren’t left behind.

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How to “catch up” on learning

 A report by the United Nations-led Accelerated Education Working Group has proposed multiple ways to deal with pandemic-induced learning losses. These range from extending teaching time to implementing formal catch-up programmes with remedial education for struggling pupils.

In 2020 £350million was invested by the UK Government in the National Tutoring Programme, with a further £200million allocated in February 2021. 

Research exploring the effect of extending the school day and summer schools on educational attainment from the Education Endowment Foundation has found that these measures have a low impact but moderate associated costs. This suggests that it is not an effective way to address gaps in children’s learning created by the pandemic. The evidence also indicates that these interventions aren’t effective in meeting the needs of the vulnerable children who need most support.

There are many, though, who suggest that the focus on “catching up” is not helpful, for learners or teachers. They say that the notion that learners need to “catch up” or are “left behind” reinforces the idea that children only have “one shot” at a “traditional educational route” and that those children who don’t meet those standards have somehow failed. It also puts them under pressure to perform academically at a time which has been challenging and unprecedented for everyone, which could do long term harm to their wellbeing. Instead, they contend that children should be encouraged to celebrate the learning and successes they have had in the past 18 months, whether that is in formal academic assessments, finishing a book they previously hadn’t read or learning to bake or sew.

Children will be returning to school to “catch up” on missed learning from different places some will have made surprising progress, some will have seen developments in their socio-emotional learning, some will have endured a difficult series of months, some will be continuing to deal with challenges which have only been exacerbated by the pandemic.

The reality is that there is unlikely to be a “one size fits all” process that can restore children to expected curriculum targets as though the pandemic never happened.

Final thoughts

As announcements come of a potential return to formal examinations in 2022, both learners and teachers need to be supported to help make up gaps in knowledge and to ensure assessment is fair.

While learners need to be supported to catch up educationally, the pandemic has also had a significant impact on socio-emotional learning and mental health, and children and young people will need to be brought back into learning environments in ways which support this too. Teachers and those involved in schools and education are themselves under pressure from significant workloads and stressors on their own mental health and wellbeing which was also inevitably impacted by the pandemic.

There are, as yet, few studies which look at the longer term impact of large scale missed education, particularly the impact on older children who have missed, or will now be due to take, key examinations, or early learners who may have missed out on key developmental learning milestones. But the early research shows we face a significant challenge to help bring all children whose learning has been disrupted back to pre-pandemic learning levels.


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A better place for everyone: how investing in social infrastructure could be the key to levelling up

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Social infrastructure is a broad term which covers a range of services which meet the local and strategic needs of an area. It can defined in many different ways, depending on which reports you read, but definitions often include:

  • physical places, services and spaces like youth services, community health, recreation, green space and sport and education and outreach services;
  • community organisations, such as voluntary groups, charitable groups, neighbourhood fora, local business groups and social enterprises; and
  • the physical and social links between places and people, including digital infrastructure, and walking and cycling infrastructure.

While the definition is broad and sometimes disputed, one thing that is generally agreed on is that social infrastructure is a key part of joining up physical infrastructure with services and communities for the benefit of the people who live and work in an area.  It is important for social cohesion and effective placemaking and for that reason it has been highlighted by many commentators as a key part of the levelling up agenda.

A cornerstone of public life in our towns and cities

Many commentators have emphasised the role of “informal” spaces, libraries, parks, recreational spaces and community hubs as being overlooked and undervalued in the wider discussions of services and provisions within local areas for many years.

It seemed there was a perception that many of the services covered by the collective term “social infrastructure” were considered to be “supplementary” to core services delivered at a local level, like social work, and while the work they did within the community was recognised as positive, often they were first in line for cuts to services.

However, in recent years, the wider intangible value that these spaces and communities which social infrastructure supports has become recognised. Social infrastructure plays a vital role in supporting disadvantaged and marginalised groups within communities, often providing links to key services and support for people who had previously had significant barriers to access. More broadly social infrastructure can help with preventative and early intervention, with policies and investment that can reduce the need for more intensive (and expensive) support later on.

It is now considered common practice that investment should maximise public or ‘social’ value that is investments that deliver the best solutions to support the public good. In practice this means including wider non-financial considerations such as community wellbeing and environmental sustainability when making the business case, and prioritising and planning projects that achieve positive social value outcomes for the public.

Supporting inclusive growth, levelling up and the post pandemic recovery

Having poor social infrastructure has been found to contribute to the lack of inclusive growth and levels of low productivity for left behind communities. Even before the coronavirus pandemic The Inclusive Growth Commission called for investment not just in physical infrastructure in poorer communities but in the social infrastructure which ‘develops the capacities and capabilities of individuals, families and communities to participate more fully in society and economic growth’. The most deprived communities often have the worst social infrastructure, which can exacerbate already deep rooted inequalities around areas like wealth, health and race.

Eric Klinenberg’s Palaces for the People: How to Build a More Equal and United Society, published in 2018, highlights research that demonstrates how social infrastructure affects our personal and collective wellbeing, leading to safer, healthier, more tolerant and stable communities, and facilitates social capital the connections made between people. As we seek to “level up” those communities left behind, and those most significantly impacted by the pandemic, building these connections and improving social capital will be an important tool to help communities develop.

Research from Frontier Economics, published in June 2021, found that for every £1m invested, there are likely to be economic and fiscal returns worth £3.2m, including a £0.7m boost in employment, training and skills opportunities for local residents. And the Centre for Progressive Policy has illustrated in their recent programme of work that investment in social infrastructure plays a vital role in increasing the ​“health and skill levels of more deprived sections of the population and reducing place-based inequalities in line with the government’s levelling up agenda,” as well as offering good value for money and significant productivity returns.

Final thoughts

High quality and inclusive social infrastructure and its wider role in the creation of socially cohesive and economically vibrant communities is key to a successful levelling up agenda. New investment in social infrastructure will not only help to level Britain up, it will also unlock creativity, innovation and other local resources that can help rebuild the economy and build in local resilience for the future.


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Rescheduled, delayed, cancelled: the knock on impact of the pandemic on routine health care

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Recently published figures show that waiting times for some non-urgent care across the UK have risen dramatically with the pandemic squeezing the already stretched resources of the NHS. Figures from Public Health Scotland, published in June 2021 found that when comparing to pre-pandemic levels, the waiting list size is 30.3% higher than the 12-month average prior to the onset of the pandemic (Mar 19 – Feb 20), while in England figures published in August 2021 showed NHS waiting lists in England reached a “record” 5.45 million people.

In addition to strains on acute NHS care services on the frontline, there are warnings about the additional public health impacts of delays to preventative healthcare measures like screening and routine medical care as well as concerns about a surge in demand when people who have delayed seeking non-urgent diagnosis and treatment return to hospitals.

At the outbreak of the pandemic many hospitals took the decision to delay or stop entirely routine pre-planned surgeries and preventative screening and diagnostics. Some even suspended treatment for more urgent care like cancer treatment on a short-term basis. While many of these services have resumed since the beginning of the pandemic, albeit with a backlog of patients now to be seen, significant strain on the NHS as we come into the winter months because of coronavirus is still anticipated.

In many areas this has led to a backlog of care, both for those patients already in the system awaiting routine surgeries, as well as those who are yet to be diagnosed but would have been through preventative screening programmes run by the NHS.

Delays in healthcare and routine screening

Even before the coronavirus pandemic took hold, many NHS hospital trusts were under criticism because of the significant length of waiting times for people who required routine operations. Doctors across the UK are now warning that these delays could be increased further unless the NHS receives additional support to increase capacity across all areas of care not just urgent care in the coming months.

It has been suggested that delays in diagnosis and routine treatments could lead to an increased number of hospitalisations further down the line, requiring higher levels of care, longer lengths of stay, and increased hospital readmissions.

And despite the recent announcement of a new arrangement for health and care funding, commentators are quick to stress that the £1.4bn the new funding programme is expected to generate may not be enough to suitable address all of the concerns across health and social care, which they highlight has been chronically underfunded for a significant number of years, even before the pandemic exposed the frailty of parts of the system.

A reluctance to visit hospitals and use primary care services

Research from the Health Foundation found that there had been a significant reduction in the number of GP consultations since the start of the pandemic which has led to concerns about the care of non-covid patients, patients with long term health conditions and also the potential for delayed diagnosis. Primary care consultations also reduced and have remained low consistently since the beginning of lockdown.

Figures have also shown a reduction in the number of referrals, medical tests, new prescriptions and immunisations. While some of these reductions are the result of advice to delay routine referrals to free up capacity for hospitals to deal with the potentially large number of cases of Covid-19, routine referrals have still not recovered to pre-lockdown levels.

These figures, and other contributions from commentators and researchers suggest that government messages to ‘protect the NHS’ may have had the unintended consequence of discouraging people from seeking urgent medical care when it was required for fear of using services unnecessarily or for fear of contracting the virus when attending hospital or primary care settings.

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A potential future crisis for the NHS

Commentators are now warning that the treatment backlog which has been caused by the coronavirus pandemic, in addition to diagnostic delays and screening programmes, may lead to a future crisis of care or significant delays in care for people waiting to receive more routine treatment.

Delays in care have not only been reported in cases of physical health. There have also been significant delays in referrals for those seeking treatment for a mental health condition, an area of the NHS which was already facing significant delays in referral and transfer of care even before the pandemic. Research suggests that incidence of mental illness during the coronavirus pandemic increased. However, the numbers of people accessing services and being referred for treatment have not increased proportionate to this. People with mental health conditions may have been unable to access appropriate support through primary care pathways, which could potentially impact on their long-term health and care.

Finally, concerns have been raised about the wider social determinants of health such as employment and poverty. Public Health England (PHE) published a monitoring tool which looks at the wider impacts of the Covid-19 pandemic on population health, and it is likely that the knock-on impact of the virus could have far reaching consequences for public health in the future as the health implications of lockdown, lack of social interaction and rising unemployment could be significant. 

Where next?

While the NHS delivered some elective treatment during the course of the pandemic, the pressure of caring for large numbers of patients, many of whom were seriously unwell with COVID-19 has led to longer delays for the growing number of patients on waiting lists. Figures also show that access to elective treatment fell further in the most deprived areas of England during 2020. Tackling the backlog, and working towards the “levelling up” agenda to reduce health inequalities, both of which have been significantly exacerbated by the pandemic will be a key component of the work in health and social care over the coming months and years.


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Food for thought: how the UK food strategy is trying to revolutionise the way we think about and access food

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Research has shown that healthy food choices are three times more expensive than unhealthy ones, food bank use is at it highest ever level and the NHS is anticipating significant struggles in long term treatment of people with conditions linked to obesity and unhealthy lifestyles, like cancer, diabetes and heart disease.

A forecast published in a report by the Food Foundation showed that if we continue at our current rate and type of food consumption 22% of children born in 2020 will be overweight or obese by age 5, rising to 46% by the time they reach age 21.

But the impact doesn’t stop there. The food system – agriculture, food production, distribution and retail combined – releases more greenhouse gases than any other sector apart from energy. In the UK, the food system accounts for a fifth of domestic emissions – but that figure rises to around 30% if we factor in the emissions produced by all the food we import.

The food we eat – and the way we produce it – is doing damage to both the environment and our health and the government is now trying to take steps to mitigate the damage, and improve our health and wellbeing in the process through the roll out of a national food strategy.

Fixing a broken system

Figures from the Trussell Trust show that between April 2020 and March 2021, a record 2.5 million emergency food parcels were given to people in crisis. The increasing use of foodbanks shows just how deeply entwined inequality, food and health are, and how important it is for a robust and equitable food strategy to be rolled out.

The Broken Plate 2021 report from the Food foundation provides an overview of the food system in the UK, looking across four main themes:

  • making healthier options more appealing;
  • making healthier options more affordable;
  • making healthier and more sustainable options more available; and
  • addressing inequalities in food so that everyone can have the chance to live longer, healthier lives.

In July 2021 the UK government published a review into how the food system in the UK works and the interventions that could be brought in to prevent the harms from what we eat and the way we eat. The plan sets out recommendations and a strategy for the future which focuses on food being equitable, accessible, healthier, and sustainable.

The recommendations cover a number of key themes:

  • escape the “junk food cycle”, including introducing a Salt and Sugar Reformulation Tax;
  • reduce diet-related inequality, including extending eligibility for free school meals;
  • make the best use of our land – including guaranteeing agricultural payments to help farmers transition to more sustainable land use; and
  • create a long term shift in food culture, including the development of a robust system of data collection and reporting to help monitor long term progress.

Inequality exacerbated by unequal access to food

One of the most pressing issues around food is its availability and its ability to exacerbate existing inequalities, particularly among disadvantaged groups. We have already seen that food bank use is high (disproportionately so among lower income groups) and that eating healthier food is more expensive than unhealthy food.

The shelf life of more unhealthy and highly processed food is also often longer, so it is easier to store, and food can be spread out and eaten across multiple days more easily. Processed foods, which are often higher in sugar, salt and trans fats (unhealthy fats) also often require less cooking (both in terms of heat energy required to cook them and knowledge of how to prepare them) which for people with reduced access to kitchens, experience of fuel poverty or limited knowledge of preparing food can be more convenient. Research consistently shows that people who fall into these groups are significantly more likely to come from lower socioeconomic backgrounds and have experience of poverty.

Steps are being taken to try and improve access to healthier food for people living on lower incomes, including free school meals and (with a bit of persuasion from Marcus Rashford) a wider roll out to also offer meals during school holidays. The government also runs a voucher system for new parents to help them get access to fresh food like fruit and vegetables.

More recently there has also been discussion about the roll out of “food on prescription” services, both for those people on lower incomes and for those people who are at risk of medical complications or disease as a result of being overweight or obese.

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Sustainable as well as healthy

As has been made clear in the reports, food systems don’t just impact on us as individuals, they also have a significant impact on the environment. The changing climate is at the forefront of everyone’s mind, including multiple extreme weather events, the publication of an IPCC report on climate change, and the run up to COP26, due to be held in Glasgow. So the way we grow and process our food, and how this negatively impacts our environment is coming under greater scrutiny.

Currently, many practices are having a negative and detrimental impact on our environment across a number of areas including carbon emissions, water pollution, reduction in soil health, loss of biodiversity, land use/deforestation.

And commentators are now emphasising that our food system as well as being healthy and accessible should also be sustainable, with programmes developed to reduce food waste, support community-based agriculture schemes, help farmers to transition to more sustainable ways to farm and use land and stimulate demand for in season, sustainably grown, locally sourced food.

Final Thoughts

Food, and our relationship with it is becoming increasingly important, not only for our own personal health and wellbeing, but also for the health of communities more generally, and the health of our planet.

Sustainable, healthy and equitable food systems help to promote healthier choices and reduce our impact on the planet. And food can also play its part in helping to relieve other pressures on society, like food poverty, inequality and the rising use of food banks. Food on prescription services can help support people to make better choices and reduce the risk of diseases like cancer, heart disease, stroke and obesity.

In short, food is not just vital for life, but also for living well.


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Supporting our communities when they needed it most: how the VCSE sector has navigated the coronavirus pandemic

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Throughout the course of the pandemic many people have been reliant on the voluntary and community sector to provide support. With local authorities stretched, services in higher demand than ever and individuals making use of support in greater numbers than ever before, the voluntary, community and social enterprise (VCSE) sector has been a lifeline for many.

However, the sector is not immune from the pressures caused by the pandemic. They themselves have been stretched with demand for services increasing, and with income streams having beeen limited many are now facing significant challenges to survival. 

The same storm but different boats 

The VCSE sector is a varied and vibrant sector, often providing bespoke and specialist support to people in greatest need. Diverse, specialised and adaptable, the sector was quick to respond and able to offer support at the outset of the pandemic. But the sector has also been shown to be vulnerable in the face of tightening finances, reduced volunteer availability and increased demand for services. 

Research carried out by NCVO in March 2021 reported that charities and the voluntary sector have had vastly different experiences during the coronavirus pandemic, with the impact of the pandemic being reported across the sector as “uneven and unpredictable”. The research showed that while some organisations have expanded their service offer, others have seen their income shrink drastically, or have found delivering services increasingly difficult due to the restrictions being imposed during the national lockdowns. 

Key findings from the research include: 

  • Nearly half (46%) of those surveyed reported demand on their services increasing, versus just 19% seeing a slowdown. 
  • 35% say their costs have increased in the past year, while for 34% they have decreased. 
  • 46% of organisations have had to use their cash reserves to cope with the impact of covid-19 on their organisations. 
  • 44% of respondents say they could rely on their cash reserves for more than six months, while 9% either have no cash reserves or not enough to last them a month. 

A report by Equally Yours, commissioned by the Funders for Race Equality Alliance in April 2021 highlighted the challenges facing the Black and Minority Ethnic voluntary and community sector. This sector has historically experienced specific challenges (such as a high number of organisations being eligible to apply for only a small number of available funds). The research suggests that the pandemic has exacerbated their financial pressures, but also highlighted other challenges, such as regional inequalities in the availability of funding and support, the precarious position of many smaller charities and voluntary organisations who have not been able to access government support, and the challenges of short-term funding, which makes it difficult to create long term plans.

These sentiments were echoed in a separate report from researchers at Centre for Regional Economic and Social Research (CRESR) which looked at the value of smaller charities in responding to the crisis.

A new-found appreciation for the sector 

The voluntary sector made up a key part of the UK’s economy before the pandemic, not only as businesses and specialists within their fields, but also as part of the wider fabric of the communities in which they operate. Many within the sector would probably argue that they were not valued enough. Their expertise, flexibility and resilience in the face of challenging funding environments, have characterised the sector long before the pandemic.

During the pandemic, collaboration has been essential. In many areas the VCSE sector have been part of the vanguard of support for the most vulnerable in society, helping to organise local responses to the pandemic and fostering community resilience in the process. 

Research published in People, Place and Policy  in November 2020 observes that, at the local level, the pandemic has led to a strengthening of pre-existing ‘complementary’ relationships between the VCSE sector and local authorities, with voluntary organisations finding themselves further embedded in local systems of decision making, co-ordination and service provision. The research suggests that there is a newly visible and increasingly ‘complementary’ local role for previously ‘supplementary’ voluntary and charity-based organisations, responding to the needs of vulnerable members of the community.

Supporting the sector to move forward

Grantfinder is the UK’s leading provider of funding information for the VCSE sector in the UK. During 2020 we provided information on emergency Covid-related funding on our website and also offered all local authorities in the UK a free portal to signpost funding support to small businesses in their communities.

As the country starts focusing on recovery, we have recently launched a new funding portal that helps charities and community groups to find funding. My Funding Central is a simple to use tool, which provides users with regular news updates and tailored funding alerts. Annual subscriptions start at £50 and are free for small organisations, offering an affordable way of searching for available funding and connecting to potential funders. Over 1500 charities are already signed up and benefiting from being signposted to funding they may not have been aware of.

The impact of the voluntary sector is threaded through the wider fabric of our communities. As we come to terms with the social and economic trauma of the pandemic, these organisations will have a significant role to play. Ensuring that the sector is suitably valued and resourced will enable it to play as full a role as possible and help communities on the road to recovery. 


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Keeping our finger on the pulse: recent additions to our collection across health

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The health and care landscape has been changed in unprecedented ways over the past year. The coronavirus pandemic has not only highlighted strains within the system and required a response to a public health emergency unlike anything else that has been seen for decades, it has also provided an opportunity to push innovation in areas like digital infrastructure and partnership working, and encouraged decision makers to look at public health as an essential part of policy making in all areas.

The Knowledge Exchange database is full of reports, articles and documents which offer insight into these themes, published by organisations from across the heath and social care landscape. In this blog post, we’re highlighting some recent additions to our collection and some of the big themes being discussed within the sector.

Covid-19, “building back better” and a “health in all policies” approach

In March 2021 think tank IPPR published their report State of health and care: the NHS Long Term Plan after Covid-19. The recommendations form a £12 billion blueprint to ‘build back better’ in health and care and the report calls for an adaptation of the NHS Long Term Plan published in 2019 focusing on cancer, mental health, cardiovascular disease and multimorbidity. The authors believe the Long Term Plan needs to change to ‘build back better’ health and care post-pandemic, in relation to: ensuring a sustainable workforce; resourcing the NHS to deliver transformation; empowering integration; upgrading the digital NHS; funding and reforming social care; and levelling up the nation’s health.

Another report, from the Local Government Association (LGA), published in September 2020, provides specific guidance to local authority councillors on ways to improve the approach to population health and use of public health resources in dealing with the pandemic, highlighting the Health in All Policies (HiAP) approach to addressing health inequalities and improving wellbeing. There are a number of other resources which look at public health approaches to tackling other areas of policy such as youth violence and urban regeneration.

Build back fairer: the Covid-19 Marmot Review: the pandemic, socioeconomic and health inequalities in England, published by the Health Foundation and the Institute of Health Equity examines inequalities in coronavirus mortality, looks at the effects that the pandemic, and the societal response, have had on social and economic inequalities, the effects on mental and physical health, and the likely effects on health inequalities in the future. The report assesses the inequalities in the risk of COVID-19 and mortality and explores the impact of containment on inequalities in the social determinants of health, in terms of: early life; education; children and young people; employment and working conditions; a healthy standard of living; healthy and sustainable places and communities; and healthy behaviours.

Mental health

Mental health services have been under significant pressure in the UK for a number of years now, with children’s services (CAMHS) particularly stretched as the number of specialist practitioners is limited. The coronavirus pandemic has, according to many specialists, exacerbated existing pressures and placed even more demand on services. In April 2021 the All-Party Parliamentary Group on a Fit and Healthy Childhood published a report: The COVID generation: a mental health pandemic in the making – the impact on the mental health of children and young people during and after the COVID-19 pandemic  which explores a range of themes in relation to the impact of the pandemic on the mental health of children and young people. The report presents evidence from a range of sources on the potential implications of the pandemic on young people’s mental health and discusses the impact of school closures on children’s future health and well-being.

The Children’s Commissioner for England recently published a report  which looks at the progress made in improving children’s mental health services in England, and  the impact of the pandemic on the mental health of children. The report also examines the provision and accessibility of children’s mental health services in 2019/20, finding that access is still not adequate and not improving as quickly as expected.          

The other pandemic: the impact of Covid-19 on Britain’s mental health  explores how the mental health of people in the UK has been affected by the pandemic, drawing on a survey of over 4000 people. It describes the different experiences of groups across society and the highlights the disproportionate mental health impact on people who are exposed to higher levels of social deprivation, as well as on women, younger people and those who live alone.

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Structural reform

In August 2020 the Health Devolution Commission launched its final report, Building back health and prosperity. Among other themes, such as taking a “health in all policies approach”, the report found that devolving accountability and power to a more local level creates the potential to understand communities and places better, and to meet their needs.

One of the main focuses of the health and social care white paper published in February 2021 is around developing an integrated health and social care system and taking a ‘population health’ preventative approach to healthcare, while a report from the NHS confederation recommends a reformation of the framework for elective care and increased healthcare funding.

Digital transformation

Even before the pandemic, The King’s Fund was publishing widely on digital transformation. But their recent report Understanding factors that enabled digital service change in general practice during the Covid-19 pandemic  looks specifically at the impact of the pandemic on accelerating the transformation of the delivery of some services by GPs to focus more on digital delivery and whether this change can (or should) be sustained once the pandemic is over. It explores the challenges around trust, staff and patient digital literacy and the evaluation of digital tools in practice. Parliamentary Office of Science and Technology (POST) published their own review of AI and healthcare , providing an overview of AI in the healthcare system and its potential impacts on the cost and quality of healthcare, and on the workforce.

Final thoughts

The landscape of health and care is changing. The Covid-19 pandemic has placed unprecedented demands on a system which was already facing significant challenges. While in some instances this has led to innovation and accelerated the pace of change, it has also exposed some of the significant weaknesses of the system.

This blog highlights some of the big topics the sector is currently grappling with, but there is more available for TKE members on our database. Members can also sign up to receive our health Topic Update, which will provide fortnightly email updates of items recently added to the collection in health, easily allowing you to stay up to date.

If your organisation is not a member of the Knowledge Exchange and you would like more information, please contact us.


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A nudge in the right direction? Using behavioural insights in health

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Behavioural insight is a term which has been increasingly heard across a range of policy areas worldwide in the past decade. Essentially it involves using a combination of psychology, economics and studies of behaviour and decision making to better understand how people react to specific interventions, and evaluating and learning lessons from the way people react to help decision makers to develop better, more effective policies.

Its application has been widespread in the USA and Europe. In the UK, first under the Conservative-Liberal Democrat coalition and then more recently under the Conservative administrations in the UK, the approach has gained increasing traction, with the establishment of a UK government “behavioural insights team”.

The Behavioural Insights Team, also known as The Nudge Unit, is now a social purpose company. It is partly owned by the Cabinet Office, employees and Nesta

The coronavirus crisis has posed a big challenge for those who need to be seen to be creating policies that protect and support the public. It has also been challenging for those trying to predict how people will respond, whether they will comply and how we can “nudge” the public to make what the government sees as “better” choices.

As well as informing steps to ease lockdown and the recovery from coronavirus, behavioural insights is being more widely applied to understand how people make choices in relation to their health, and how these can be applied to preventative health measures and health based inequalities.

Nudging as part of policymaking

Nudging as a technique has been used widely across a number of different policy areas, including criminal justice and education. Its application in relation to public health has been wide ranging and has had significant implications for health policy of previous governments.

Key policy areas in public health for the UK behavioural insight team include:

  • antimicrobial resistance
  • vaccination
  • obesity
  • mental health

Using behavioural insights across all of these areas, the idea is to develop an understanding of how people think about these topic areas as issues and how their behaviour is influenced by their own thoughts, patterns of behaviour and environmental factors like ease of access to services.

Techniques like direct incentives (such as vouchers in return for healthy behaviour), measures that restrict choice (like restricting takeaways from schools), and outright bans (such as the restriction on smoking in public places) are all interventions designed in one way or another to “nudge” us towards certain behaviours.

Steps like text message reminders for appointments, offering salads or fruit instead of fries as a side, or opt out organ donation are further examples of how behavioural science techniques are being applied to encourage people to make healthier choices and reduce the strain on health services.

Many of the steps being taken are designed not only to save time and money for the public and organisations delivering services, but also to help encourage early intervention and preventative action, a key focus of public health strategies in the UK.

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A crucial role to play in understanding vaccine rollout

Vaccination decisions can be a complicated and emotive process, but with the rollout of the coronavirus vaccine understanding the routes to uptake and how people make decisions on vaccination are more important than ever.

Behavioural scientists have been at the forefront of the vaccinations programme, looking to create a better and more thorough understanding of how to manage the rollout and develop an understanding of how people see the benefits and challenges of vaccination, both collective and individual.

The ‘Increasing Vaccination Model’ they say is a helpful framework for categorising the barriers to vaccination and possible behavioural interventions. The evidence indicates that closing the ‘intention–behaviour gap’ in vaccination behaviour by improving ease of access (and thus removing practical barriers to vaccination) is the most effective type of intervention. In contrast, focusing on motivation or educational interventions appears to be less helpful.

However, behavioural scientists have noted that in relation to the coronavirus vaccine even more barriers exist, with one survey reporting that 16 per cent of UK adults would ‘probably’ or ‘definitely’ avoid a COVID-19 vaccine. There is a suggestion that compressed development timelines, misinformation and media reporting could all undermine confidence and therefore uptake. Behavioural scientists are working hard to understand what steps could be taken to understand vaccine hesitancy and improve uptake across all communities in the UK and internationally.

Final thoughts

Behavioural insights, data analytics and “nudge” techniques have been part of policy making for the best part of ten years. They aim to help policymakers understand people’s reactions to policies and use this insight to help more effective policy in the future.

The coronavirus pandemic has presented a new and challenging opportunity for behavioural insights and has required them to apply their knowledge and understanding of how policy is applied and received like never before, with vaccine rollout being just one key area, along with other lockdown measures which require mass compliance in order to be effective.

How behavioural insights will continue to inform the recovery and public health strategies more widely remains to be seen, but it does appear that for the meantime at least, the “nudging” will continue.


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Multi-agency partnerships and the transformation of domestic abuse support

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Domestic abuse has been rising up the political agenda in the past few years. 2019 saw the appointment of the UK’s first Domestic Abuse Commissioner, and last month, the updated Domestic Abuse Bill was introduced to the UK Parliament (expecting to see Royal Assent in April 2021). But domestic abuse is still a widespread and endemic problem across the UK, with figures suggesting incidents across all areas of the country and across multiple demographic groups.

Often people who experience domestic abuse are difficult to identify and can struggle to engage directly with domestic violence support services. However, there is a growing recognition that knowledge sharing, and partnership working between statutory services, like housing or health teams, is vital to identifying and supporting victims and survivors in a timely and effective way.

Increasingly, the criminal justice system, health sector, social housing providers, charities, and local government have been attempting to work together to ensure that they are all able to respond effectively and provide the necessary support to domestic abuse victims and survivors.

The impact of lockdown

The most recent Crime Survey for England and Wales released by the Office for National Statistics (ONS) showed that an estimated 2.3 million adults aged 16 to 74 years experienced domestic abuse in the last year (1.6 million women and 757,000 men). Research published by the London School of Economics (LSE) after the first lockdown found that in London domestic abuse calls to the police increased by 11.4% on average, compared with the same weeks in 2019. The increase was, in a large part, due to an increase in calls from third parties not directly witnessing the incident, including neighbours or family members.

Similarly a report from Women’s Aid found that those delivering services needed to grapple not only with increased demand for support, but also with the challenge of delivering effective support in a different way as many services were only able to be accessed virtually.

Coordinated community responses transforming support for survivors

Organisations are becoming increasingly aware of the roles they can play in supporting people who experience domestic abuse and in the early identification of people at risk. Research also suggests that if someone is experiencing abuse, there is a high likelihood that they will also be experiencing other “needs”, which may cause them to come into contact with multiple services at once. Co-ordinating the response between services encourages organisations to share information to ensure consistency of care and experience; it can also help identify any gaps in support and allow for appropriate signposting and places the onus on the organisations, rather than on the person experiencing abuse.

Coordinated community response (CCR) approaches encompass the broadest possible response to domestic abuse; CCR addresses prevention, early intervention, dealing with crisis, risk fluctuation, and long-term recovery and safety, working with a wide range of services, pathways, agencies, and systems.

The fundamental premise of the CCR is that no single agency or individual can see the complete picture of the life of a family or individual within that family, but all may have insights and can provide interventions that are crucial to their safety and wellbeing. The CCR enables a whole system response to the whole person. It shifts responsibility for safety away from individual survivors to the community and services existing to support them.

The CCR is made up of 12 components: survivor voice; intersectionality; shared objective; structure and governance; strategy and leadership; specialist services; representation; resources; co-ordination; training; data; policies and processes. Taking a CCR approach provides communities with method for coordinating a response to domestic abuse. It places survivors at the heart of decision making and is an approach many frontline services can and do take when designing and implementing support services for people who have experienced domestic abuse.

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A pilot roll out for wrap around housing support

The Whole Housing Approach (WHA) to domestic abuse was first conceptualised in 2018 by the Domestic Abuse Housing Alliance (DAHA) in collaboration with the National Housing and Domestic Abuse Policy and Practice Group This approach aims: “to improve the housing options and outcomes for people experiencing domestic abuse so that they can achieve stable housing, live safely and overcome their experiences of abuse.”

The approach enhances how people who have experienced domestic abuse have control over their own lives, considers what they want to achieve and change, and offers interventions based on this. The key principles of the WHA are outlined as: safety; inclusivity; empowerment; accountability; and prevention, with 12 additional key components which make up the practical application of WHA programmes.

The initial WHA pilot project was delivered in three areas from October 2018 to the end of March 2020. Six specialist domestic abuse organisations, as well as a civil society organisation, have been working with 10 local authority areas, including in London, Stockton and Cambridgeshire to establish comprehensive and consistent housing practices and deliver a WHA.

A whole housing approach toolkit has been published which contains more information on the pilots, evaluations and analysis of the programme. The toolkit includes a dedicated section for each of the twelve components of the WHA. Each section can be read as a standalone toolkit that outlines key initiatives to help survivors achieve safety and stable housing. It offers practical guidance and resources to local areas to deliver a consistent WHA to domestic abuse.

Image Via DAHA

Final thoughts

While the landscape of domestic violence support is varied and is delivered in different ways by different agencies, there is a growing understanding of the practical steps which should be taken to ensure that partnership working and effective coordinated responses between services are offered to survivors of domestic abuse. It is clear that there is an appetite among those who work within frontline services to improve the availability of support. The ultimate aim of a coordinated response and a wraparound service to survivors of domestic abuse is achievable if current best practice and effective pilot schemes can be built upon, with additional funding and wider roll outs.


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Devolving health and social care in England: an opportunity to transform how we approach health and care?

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In recent years, the Department of Health and Social Care (DHSC) has increasingly encouraged the transfer of powers over health and social care in England away from central government and towards city regions. These bodies, DHSC argues, are uniquely placed to understand the challenges faced by their local populations, the capacities and expertise of their local NHS and to develop plans for the future. This should enable them to approach health at a local level, promoting increased delivery of care in the community, and a greater integration between health and care services.

Putting local places at the centre of “Build back better”

In August 2020 the Health Devolution Commission launched its final report, Building back health and prosperity. Among other themes, like taking a “health in all policies approach”, the report found that devolving accountability and power to a more local level creates the potential to understand communities and places better, and to meet their needs.

The NHS Long Term Plan has also outlined a new direction for the NHS based on the principle of collaboration rather than competition, and the introduction of new structures such as Integrated Care Systems, Integrated Care Providers and Primary Care Networks. These partnerships bring health and social care commissioners together to plan and deliver integrated and person-centred care.

In the context of “building back better”, awareness of how our external experiences and contexts impact our health and wellbeing (for example the impact of poverty, deprivation, housing, and unemployment) is increasingly important.

Beyond the immediate recovery from the pandemic, health devolution could be one way of opening up the possibility of integrating not just disparate services within the NHS – or even NHS and social care services in a locality – but bringing together in a combined strategy and structure all of the services, systems and partners in a community that have an impact upon the health of a local population, and the care services to better meet their health needs.

“It doesn’t have to be a battle”- partnerships and balance are the key to effective devolution

The move away from centralised processes and organisations towards more local ones can sometimes be portrayed as a rejection or an attempt to “break free” from central government. However, practitioners have been increasingly stressing that devolution does not mean complete independence, and that while improved local decision making will improve outcomes for local people, that does not mean that the need for some centralised decision making is completely removed.

On the contrary, some decisions should and will be taken at a national level, but the ability to distribute power, decision making and accountability to a local level will have significant positive impacts for improving “citizen voice”, transparency and co-production in decision making.

This is where the Health Devolution Commission argues that balance, communication, and partnership between the local and national infrastructure needs to be aligned so that devolution can be successful and sustainable. Integrated planning and management of long-term health care strategies is important, as is the ability to bring citizens and local decision makers into discussions about national health policy.

The Voluntary, Community and Social Enterprise (VCSE) sector, including patient voice and carers organisations, also plays an important role in linking together services and communities. As well as partnering to deliver services, these organisations also often offer vital bridges between statutory systems and those communities which can often be excluded from engagement with services or who can find it harder to access them. The commission also emphasised the importance of bringing these bodies into the conversation on devolution going forwards as they will be invaluable partners in the process.

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DevoManc providing the blueprint?

In 2016, as part of a pilot, control of the health and social care budget for Greater Manchester was transferred to a partnership team in the area comprising local authorities, clinical commissioning groups, NHS foundation trusts and NHS England.

The combined authority identified that the health of its population was one of the key obstacles to its economic growth. By relating the concept of regional economic prosperity with health, they began to see health in a completely different way – as part of a wider plan and an investment for growth, not a burden.

“It’s better to have decisions made locally, because local people understand what local problems are and what Greater Manchester needs. We need to work together.”

Lord Peter Smith, Chair of Greater Manchester Health and Care Board

The Greater Manchester Health and Social Care Partnership are working in partnership with other sectors including education and housing to support everything from good eating habits and exercise to education and everyone’s ability to earn a decent living. The partnership is taking action to give children the start they need, support independence in old age, tackle illness earlier on and even prevent it altogether by improving the lifestyles of local people.

Other areas of England are also currently undertaking their own health devolution journeys, including London, West Yorkshire and Harrogate, as well as some other combined authority areas. However, one of the big challenges is that currently, while we can learn from the experiences of those already on their devolution journey, there is no common, consistent or comprehensive understanding of what good heath devolution looks like, full evaluations of the benefits it brings or overarching strategies on how it should be developed.

This is something that will need to be addressed if health devolution is to be successfully rolled out across England.

Final thoughts

Devolution of health to a more local level provides an opportunity to tackle the big public health challenges of our time at source, and to create a better, more joined up community health ecosystem. It also provides the chance to share and collaborate, learning from best practice and delivering improved health and social care services at a regional and national level.

It has been suggested that the coronavirus pandemic, while traumatic in more ways than one for the NHS and its staff, may provide the re-setting point needed to implement some of the changes proposed in relation to greater health devolution. Proponents of this view argue that improved funding to support effective and high quality care, improved integration between health and social care, and greater positioning of health and assessment of the impact of decisions on health across all policy areas, should be among the top priorities as the country looks to recover from the pandemic.

As the Health Devolution Commission underlines:

The pandemic has shown we cannot go back to the way things were. We need a ‘new normal’ and we believe that comprehensive health devolution is the only viable solution to the challenges the country now faces.”


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