“Same storm, different boats”: addressing covid-19 inequalities and the ‘long term challenge’

MS Queen Elizabeth in Stornoway

The coronavirus pandemic has impacted upon almost every aspect of life.  However, this impact has not been felt by everyone equally. Some groups of people have been particularly badly affected – both by the virus itself and by the negative social and economic consequences of social distancing measures.  The phrase ‘same storm, different boats’ has been used widely to emphasise this.

The pandemic has exposed and deepened many of the deep-rooted inequalities in our society, including gender, ethnicity and income.  It has also shone a light on more recent inequalities too, such as the growth of precarious employment among sections of the population.

As we move out of lockdown, the long term consequences of the pandemic will continue to be felt unevenly across different sections of society, with those on the lowest incomes being most vulnerable.

As thoughts turn to recovery, there is a growing sense that now is the time to consider how we can create a more equitable society that benefits those most in need.

 

The long-term challenge

During a recent Poverty Alliance webinar, ‘Build Back Better: Poverty, Health and Covid-19: emerging lessons from Scotland’, Dr Gerry McCartney, Head of the Public Health Observatory at Public Health Scotland noted that the coronavirus pandemic was causing three concurrent public health crises:

  • the direct impact of the virus (through ill health and/or death);
  • the indirect impacts on health and social care services (e.g. reduced hospital admissions/referrals, delayed diagnoses); and
  • the long term unintended consequences of physical distancing measures

Dr McCartney’s recent research sets out the different groups at particular risk from covid-19 and outlines a number of ways in which the unintended consequences of physical distancing measures may negatively impact upon health via a complex set of pathways – including reduced physical activity, fear, anxiety, stress, boredom and loneliness, economic stresses related to reduced income and unemployment, the impact of the loss of education, as well as the risk of abuse and exploitation of children not in school, substance abuse, and domestic abuse and violence.

Dr McCartney has also been involved in a project that sought to quantify the direct impact of the pandemic in terms of years of life lost.  The results showed that, over 10 years, the impact of inequality on life expectancy is actually at least six times greater than the direct impact of the pandemic itself.

Dr McCartney referred to this as the “long-term challenge” and argues that in order to address these inequalities, it is crucial that society aims to ‘build back better’ following the pandemic.

Build Back Better

But what does this mean?  Put simply, Build back better argues that pandemic offers an unprecedented opportunity to refocus society on the principles of equity and sustainability.

A recent paper by the Wellbeing Economy Alliance (WEAll) sets out 10 key principles for ‘building back better’, covering a range of environmental, social and governance issues:

It highlights international examples of each of these principles in action, for example, speeding up the adoption of the doughnut economics framework in Amsterdam in response to the pandemic, and through the wellbeing principles implemented by the Wellbeing Economy Governments (WEGo) group, consisting of Iceland, New Zealand and Scotland (and recently joined Wales).

Indeed, in Scotland, the independent Advisory Group on Economic Recovery, established by the Scottish Government, have recently published their findings on how to support Scotland’s economy to recover from the pandemic.  It states that “establishing a robust, wellbeing economy matters more than ever”.

Unequal employment impact

One of the guiding principles set out by the Advisory Group on Economic Recovery is to “tackle inequality by mitigating the risks of unemployment, especially among groups hit hard by the crisis”.

Indeed, unemployment following the pandemic is unlikely to affect everyone equally – women, young people, BAME individuals and the low-paid are predicted to suffer the brunt.

In a subsequent Poverty Alliance webinar, ‘Addressing unemployment after Covid-19’, Tony Wilson from the Institute for Employment Studies (IES) highlights the scale of the problem.  He states that unemployment is rising faster than at any point in our lifetimes (barring a blip in 1947), and is likely to increase by 3 million as a result of the pandemic.

Again, the impact of this will be uneven.  Anna Ritchie Allan, director of Close the Gap, discusses the impact upon women in particular.  As well as being more likely to work in a sector that has been shut down, women are also more likely to have lost their job, had their hours cut, or been furloughed. As women are also usually the primary carers of their children, they have disproportionately affected by the closure of schools and home learning.

A recent report by Close the Gap highlights how the impending post-covid downturn is different than previous recessions, as the restrictions imposed to tackle the virus have impacted most heavily upon sectors that employ large numbers of female (e.g. hospitality, retail, care), as well as services that enable women’s participation in the labour market (e.g. nurseries, schools, and social care). Young and Black and minority ethnic (BME) women have been particularly affected.

For example, Kathleen Henehan, Research and Policy Analyst at the Resolution Foundation, considers how young people’s employment prospects have been affected by the pandemic. She notes that young people leaving education are likely to be worst affected.  However, again, inequalities exist – with those with lower levels of qualifications being particularly affected, and women and BME individuals within those groups affected most of all.

According to Anna Allan, policy to address unemployment as a result of the pandemic needs to be both gender-sensitive and intersectional – taking account of the fact that women are not one homogenous group, and ensuring that any job creation is not just providing more ‘jobs for the boys’.  For example, recent research by the Women’s Budget Group shows that investing in care would create 7 times as many jobs as the same investment in construction: 6.3 as many for women and 10% more for men.

Building forwards

In a third webinar, ‘Disability, rights and covid-19: learning for the future’, Dr Sally Witcher, CEO of Inclusion Scotland, suggests that as well as exposing and deepening existing inequalities, the coronavirus pandemic has created the scope for new inequalities to be created – ‘faultlines’ created by the differing impacts of the virus.

Dr Witcher questions the term ‘build back better’ – she asks whether indeed we should want to build back, when the old normal didn’t work for a large proportion of people, particularly those with disabilities. Dr Witcher also questions ‘who’ is doing the building, and whether the people designing this new future will have the knowledge and lived experience of what really needs to change.

Dr Witcher suggests that for any attempt to ‘build back better’ to be meaningful, it needs to reach out to the people that don’t currently have a voice – the people who have been most heavily affected by the virus.  Not only do these groups need to be involved, but they need to be leading the discussion about what a post-covid future looks like.

A post-covid future

Whilst the coronavirus pandemic has had a massive, devastating impact on people and economies around the world, it has created an opportunity to reflect on what is important to us as individuals and as a society.

There is strong public demand for change. According to a new YouGov poll, only 6% of the public want to return to the same type of economy as before the coronavirus pandemic.

Building back better recognises that addressing the causes of the deep-rooted and long-standing inequalities in our society is critical to a successful post-covid recovery.

There is also a need to protect and enhance public services, address issues of low-pay and insecure work, and prioritise wellbeing and the environment through a ‘green recovery’.

As Tressa Burke, of the Glasgow Disability Alliance, states:

History will recount how we all responded to the coronavirus outbreak.  We need to ensure that the story told demonstrates our commitment, as a society, to protecting everyone from harm, particularly those most at risk of the worst impacts of covid.”


For further discussion of the wellbeing economy, you may be interested in our blog post ‘How well is your economy? Moving beyond GDP as an indicator of success

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Knowledge from a distance: recent webinars on public and social policy

During the national lockdown, it’s been impossible for most of us to attend conferences and seminars. But many organisations have been harnessing the power of technology to help people share their knowledge, ideas and experience in virtual seminars.

In the past few weeks, the research officers at The Knowledge Exchange have joined some of these webinars, and in today’s blog post we’d like to share with you some of the public and social policy issues that have been highlighted in these online events.

The liveable city

Organised by the Danish Embassy in the UK, this webinar brought together a range of speakers from Denmark and the UK to consider how our cities may change post COVID-19, including questions around green space, high street recovery, active travel and density and types of residential living accommodation in our towns and cities.

Speakers came from two London boroughs, architectural design and urban planning backgrounds and gave examples of experiences in Newham, Ealing and Copenhagen as well as other more general examples from across the UK and Denmark. The seminar’s website also includes links to presentations on previous Liveable City events in Manchester, Edinburgh, Bristol and Glasgow.


What next for public health?

“Healthcare just had its 2008 banking crisis… COVID-19 has generated a real seismic shift within the sector and I don’t think we will ever go back”

This webinar brought together commentators and thought leaders from across the digital health and tech sectors to think about how public health may be transformed by our experiences of the COVID-19 pandemic and the significant shift to digital and online platforms to deliver care.

The speakers discussed data, privacy and trust and the need to recognise different levels of engagement with digital platforms to ensure that specific groups like older people don’t feel unable to access services. They also discussed the importance of not being driven by data, but using data to help us to make better decisions. The webinar was organised by BIMA, a community of businesses, charities and academia across the UK.


Green cities

This project, organised by the Town and Country Planning Association (TCPA), included 3 webinars each looking at different elements of green infrastructure within cities, including designing and planning, assessing the quality of different types of green infrastructure and highlighting the positive impacts of incorporating more good quality green spaces for mental and physical health, as well as for environmental purposes.


Rough sleeping and homelessness during and after the coronavirus

Organised by the Centre for London, this webinar brought together speakers from across the homelessness sector within London, including St Mungos, the Greater London Authority (GLA) and Croydon Council to explore how the COVID-19 pandemic was impacting people who are homeless or sleeping rough in the city.

Each speaker brought insights from their own experiences supporting homeless people in the capital (so far) during the COVID 19-pandemic. They highlighted some of the challenges, as well as some of the more positive steps forward, particularly in relation to co-operation and partnership working across different levels of government and with other sectors such as health.

They also commended everyone involved for the speed at which they acted to support homeless people, particularly those who were vulnerable or at risk. However, concerns were also raised around future planning and the importance of not regressing back into old ways of working once the pandemic response tails off.


Poverty, health and Covid-19: emerging lessons in Scotland

This webinar was hosted by the Poverty Alliance as part of a wider series that they are hosting.  It looked at how to ‘build back better’ following the pandemic, with a particular focus upon addressing the long-standing inequalities that exist throughout society.

The event included presentations from Dr Gerry McCartney, Head of the Public Health Observatory at Public Health Scotland, Dr Anne Mullin, Chair of the Deep End GPs, and Professor Linda Bauld, Professor of Public Health at University of Edinburgh.

A key message throughout was that while the immediate health impacts of the pandemic have been huge, there is an urgent need to acknowledge and address the “long-term challenge” – the impact on health caused by the economic and social inequalities associated with the pandemic.

It is estimated that over 10 years, the impact of inequalities will be six times greater than that of an unmitigated pandemic. Therefore, ‘building back better’ is essential in order to ensure long-term population health.


Returning to work: addressing unemployment after Covid-19

This webinar was also hosted by the Poverty Alliance as part of their wider webinar series on the pandemic.

The focus here was how to address the inevitable rise in unemployment following the pandemic – the anticipated increase in jobless numbers is currently estimated to be over three million.

The event included presentations from Kathleen Henehan, Research and Policy Analyst at Resolution Foundation, Anna Ritchie Allan, Executive Director at Close the Gap, and Tony Wilson, Director of the Institute for Employment Studies.

The webinar highlighted the unprecedented scale of the problem – noting that more than half of the working population are currently not working due to the pandemic, being either unemployed, furloughed or in receipt of self-employment support.

A key theme of the presentation was that certain groups are likely to be disproportionately affected by unemployment as the support provided by the government’s support schemes draw to a close later this year.  This includes women – particularly those from BAME groups, the lower paid and migrants – and young people.  So it’s essential that the support provided by the government in the form of skills, training, job creation schemes etc addresses this, and is both gender-sensitive and intersectional.


Supporting the return to educational settings of autistic children and young people

The aim of this webinar, provided by the National Autism Implementation Team (NAIT), was to offer a useful overview of how to support autistic children and young people, and those with additional support needs, back into educational settings following the pandemic.

Currently around 25% of learners in mainstream schools have additional support needs, and it is generally accepted that good autism practice is beneficial for all children.

The webinar set out eight key messages for supporting a successful return, which included making anticipatory adjustments rather than ‘waiting and seeing’, using visual supports, providing predictability, planning for movement breaks and provision of a ‘safe space’ for each child.  The importance of listening to parents was also emphasised.


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Ellisland Farm, Dumfries. “P1050381.JPG” by ejbluefolds is licensed under CC BY-NC 2.0

Burns at Ellisland

Our Research Officer, Donna Gardiner has also been following some cultural webinars, including one that focused on the links between Scotland’s national poet and the Ellisland Farm site. The webinar was led by Professor Gerard Carruthers, Francis Hutcheson Chair of Scottish Literature at the University of Glasgow and co-director of the Centre for Robert Burns Studies.

Robert Burns lived at Ellisland Farm in Dumfriesshire between May 1788 and November 1791, and is where he produced a significant proportion of his work – 23% of his letters and 28% of his songs and poems, including the famous Tam O’Shanter and Auld Lang Syne.

The presentation looked at how Robert Burns was influenced by the farm itself and its location on the banks of the River Nith.  It also touched on his involvement with local politics and friends in the area, which too influenced his work.

It was suggested that the Ellisland farm site could be considered in many ways to be the birthplace of wider European Romanticism. The webinar also included contributions from Joan McAlpine MSP, who is chair of the newly formed Robert Burns Ellisland Trust. She discussed how to help promote and conserve this historic site, particularly given the impact of the coronavirus on tourism.


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Digital Housing Week: How coronavirus is affecting housing

Throughout this week, Inside Housing magazine has been providing a series of webinars offering debate, learning and innovative thinking on how housing providers are responding to present-day challenges and preparing for future demands.

One of the webinars focused on the ways in which Covid-19 has accelerated the move to agile working for housing associations (HAs) and council staff, and how housing providers can tackle the  mental health and wellbeing issues experienced by staff and residents.

Responding to the new normal

Anita Khan, from Settle Housing Association in Hertfordshire explained how her HA responded to lockdown by mobilising its continuity plan. Settle’s first responsibility is to engage with and support its customers, and once the plan was enacted, agile behaviour took root.

Anita described how automated contacts with HA customers enabled it to identify which people were in isolation or shielding. At the same time, methods of enforcement had to change, as the UK government banned evictions. Anita explained that once the HA stopped sending messages warning customers of enforcement of the rules on rent payments, the residents started to engage more positively with it.

Working practices at Settle also changed substantially, with a move away from a face-to-face culture towards remote working. Anita described the process of change HA staff experienced, from relief at not having to make long commutes, followed by fatigue from too many video conferences, and more recently recalibrating to a situation that works.

Agile working in the age of coronavirus

Tony Morrison, an agile working consultant, described the measures taken by Newham Council  to modernise the way the local authority worked. He explained that in 2019, Newham got a new leadership team, and deployed a plan to make the first investment in IT for eight years. The aim was to make sure everyone was mobile by default, and to pivot a local authority with 14.5 million pieces of paper towards a paperless organisation. The plan was already under way when the lockdown was imposed.

Immediately, the council had to adapt to the new situation. Around three thousand members of staff didn’t have effective ways of working from home, and so the council identified who most needed assistance, and delivered laptops and mobile devices to these 500 individuals.

At same time, the council deployed Office 365 and migrated Skype for Business, and enabled staff to communicate with customers using Zoom.

Newham has now rolled out a further 2000 devices to staff, and it’s clear that the lockdown experience has demonstrated the possibilities of remote working.

The council is already looking to the post-pandemic period when it might not require so much expensive office space. Tony explained that now would not be the right time to consider disposal of offices because so many other organisations are in the same position. Instead, Newham is looking at alternative uses for its property estate, including cohabiting with other organisations, pop-up spaces and conversion to affordable housing.

Housing on the frontline of a mental health crisis

There’s now little doubt that the coronavirus pandemic is having a significant effect on mental health. With the loss of lives and livelihoods, and the growing demands for support from already overburdened health services, the fallout from the pandemic is likely to be on an unprecedented scale.

During the Inside Housing webinar, consultant psychiatrist Raj Persaud talked about the unique role housing can play in tackling mental health issues among staff and residents.

He noted that housing staff may be among the first to identify signs of mental illness among residents, because fewer people have been attending GP surgeries during the pandemic.

He suggested that housing staff in this position should raise such issues with community mental health teams. He also highlighted the importance of contacting NHS services by letter. Because letters are legal documents, health professionals are more likely to pay attention to issues raised in this way.

Raj highlighted a key issue housing staff can focus on when dealing with people who have mental health problems:

“Too often, the aim has been to concentrate on the causes of mental illness, but that misses out on the coping skills people have used in the past. The right skills can make a person super resilient, and so it’s always useful to engage in conversation about coping skills people have used for previous life events.”

All of the speakers in the webinar stressed the importance of the human factor in tackling the challenges raised by the coronavirus pandemic. Raj Persaud noted that, in the absence of the water cooler, the pub or the staff room, physical locations have to be recreated virtually. Doing this may feel clunky at first, but even if things don’t feel right, housing staff and others should persist until they find a method that suits them, and enables people to feel they are less isolated.

Final thoughts

One thing is certain: post-Covid will be very different from pre-Covid. But this webinar demonstrated that housing providers are embracing the fluidity of this situation. In an age of thinking differently, those who consider alternative solutions to the problems of the present may be better equipped for the challenges of the future.


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Digital infrastructure supporting health care during the COVID-19 pandemic

Healthcare is a key frontline service in the response to the COVID-19 outbreak. The NHS has had to react at pace to plan and deliver services in new and innovative ways.

Digital healthcare solutions are at the fore of ensuring not only the delivery of acute care for those patients suffering from COVID-19 but are also supporting the successful continuity of care and the day to day running of a health service which still needs to maintain “normal service” as well as its pandemic response. Digital infrastructure is helping the NHS and other partners to adapt and to meet the demand for health and care in a number of ways.

Supporting the delivery of care

In many ways, the NHS and frontline care in particular were already making inroads towards transitioning to digital and online platforms before the pandemic emerged. Many GP surgeries allow online appointment booking, and where appropriate, monitoring of those with long term conditions can be done remotely through at-home testing facilities, such as home heart monitors or monitors to help people monitor their diabetes.

Many care providers also already offer telehealth solutions for clients, and patient records are now stored online. However, in many ways the COVID-19 pandemic has catalysed uptake of digital solutions to healthcare diagnosis and delivery, with an increase in online consultations, greater use of the NHS Digital and NHS24 online and app platforms and a rise in the development of digital solutions to better support care in the community.

Support and training for frontline staff

In addition to supporting the direct delivery of care to patients, digital health infrastructure is also being adapted and used to deliver training and support to staff on the frontline. Blogs and online forums, including social media groups are enabling people to share experiences and best practice, and to create a sense of community among healthcare workers. In addition, virtual and e-learning opportunities are being developed to enable staff to access educational activities remotely. These include supporting the rapid education of the healthcare workforce in how best to manage the respiratory conditions encountered, as well as providing education to staff who may have been redeployed to other departments or settings as a result of the pandemic response. Online learning has also been used to help train volunteers and help the public to keep up to date with the latest developments across the health service.

Beyond healthcare to support the response to the pandemic

Artificial intelligence and data analytics also have a vital role to play in helping prevent the spread of coronavirus and other infectious diseases as digital solutions look to be developed to help beyond acute healthcare responses.

Predictive analytics and scenario modelling can be used to help identify those populations who are at risk of spreading the virus and of falling most severely ill to help support shielding campaigns and protect vulnerable groups as lockdown measures ease.

A project run by UK firm Biobank is looking to use samples collected by volunteers to map genetic sequencing in order to identify whether certain genetic characteristics make people more predisposed to become seriously ill, or more likely to contract the virus in the first place. This may help in the development of a vaccine and can also help identify those groups who will be most vulnerable when lockdown conditions are lifted so that they can be monitored more effectively.

Modelling and analytics can also be used to try and project any potential “second waves”. It is hoped that AI, analytics and machine learning will be able to help organisations learn from events such as the SARS epidemic, as well as quickly creating new knowledge from the millions of data points being generated in this outbreak.

Final thoughts

The significant humanitarian response to this global pandemic is being underpinned by a digital infrastructure, the extent of which we have never had at our disposal before. This digital support, of care delivery, communication, analytics, and modelling is being used in conjunction with insight from health and scientific specialists to try and help us find a path through this pandemic, deliver care, aid recovery and prevent re-emergence.

Making best use of the data and digital capacity we have throughout our health and care infrastructure will be a key part in preparing and meeting the needs and challenges that communities are facing.


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Further reading: articles on COVID-19 from The Knowledge Exchange blog

Coping with covid: supporting autistic children through and beyond lockdown

The measures put in place to reduce the spread of coronavirus (COVID-19) have impacted almost every aspect of our lives – from our contact with family, friends and loved ones, to how we work, eat, shop, relax and learn.

Adapting to and living with these new measures has been universally challenging.  For autistic people, the changes to daily life associated with the COVID-19 outbreak present a number of additional challenges.  In this blog, we are going to discuss some of these additional challenges, with a particular focus on autistic children and young people.  We also highlight some available supports.

Change of routines

A key feature of autism is the desire to follow certain routines and/or avoid unexpected or unpredictable events. Thus, adjusting to the changes caused by COVID-19 poses particular difficulty for many autistic people, for whom changes to routine may cause additional anxiety, distress and in some cases, emotional overload.

Other autistic people may be distressed because of the lack of structure their day now has – being unable to tell one day from the next, when there are no defining characteristics, can feel particularly disorientating.

Scottish Autism have produced guidance for autistic people and their parents/carers on helping to maintain a routine and the reasons why this is important.  They explain that not only does maintaining a routine provide a sense of security and stability, it can also help to provide a sense of calmness, support emotional self-regulation and encourage health and positive habits.

Many autistic children already use visual schedules and/or calendars to let them know what is happening and what to expect next.  These can be helpful in the current circumstances to help children adapt to new routines at home, and bring some sense of predictability and control to their changed lives.

 Being at home

Another change that COVID-19 has brought about is that more people within the household are at home than is typical – for example, one or both parents/carers may be working from home, along with any siblings/other householders who are usually in education or work.

This may be present challenges for autistic people both in terms of the change to routine and also in terms of sensory issues (e.g. noise).  For example, the household being busier than usual may be more challenging for autistic people as they will subsequently have less time and/or space to themselves, which may be needed in order to self-regulate and/or avoid sensory overload.

Special interests

Many autistic people have special interests that form a large part of their daily routines, and may play a key role in enabling them to relax, self-regulate and recover from sensory overload.

The coronavirus ‘lockdown’ has prevented most outdoors activities from taking place.  Thus many autistic people may have found that their special interest is no longer open to them – from train spotting to bird watching.  The removal of this activity from their life may be experienced as particularly distressing, and make self-regulation more difficult.

School closures

The widespread closure of schools means that many parents of autistic children have found themselves responsible for educating their child at home.

Educating children at home under these new circumstances is challenging for all parents.  However, for parents of autistic children, it presents additional challenges.

Many autistic children require additional support with their learning, and may experience difficulties sustaining concentration.  Autistic children may also have additional support needs such as dyslexia or dyscalculia, which may require the use of specific approaches and/or learning aids.  This presents additional challenges for learning in the home environment for parents that are unaccustomed to providing a full time education for their child.

In school, many autistic children receive additional support in class either in a 1-2-1 or in a small group lesson from practitioners skilled in addressing these additional needs. Replicating this level of support at home is of course challenging for parents who may not be familiar with the techniques used, or skilled in their use.  They may also struggle to provide the necessary 1-2-1 support if they are also expected to work from home themselves, or have other children to care for.

Concern about their child being disproportionately affected by school closures without the skilled support that they receive in schools may also add considerable stress.  For example, the United Nations has recently noted in a briefing paper that children with disabilities and special needs are among those most dependent on face-to-face services and are least likely to benefit from distance learning solutions.

As well as adequately supporting special educational needs, there are also challenges in relation to an autistic child’s ability and/or willingness to undertake schoolwork at home.  Some autistic people have difficulties with what is termed ‘flexible thinking’. This may include, for example, the ability to see something in a new way. Autistic children may be more likely to have a fixed perception of home as distinct from school.  Thus, it may be more difficult for autistic children to accept and adapt to schoolwork being done at home.  Similarly, they may not readily accept the notion that their parent or carer is now also their ‘teacher’, particularly if this person is usually relied upon as being their primary source of comfort and safety when distressed.

Accessible home learning

While this is without a doubt a difficult situation for both autistic people and their parents/carers, the good news is that there is an increasing amount of support and sources of advice available to help support autistic people to adapt and respond to the ‘new normal’ that the coronavirus pandemic has created.

On Twitter, the #accessiblehomelearning hashtag has been trending, with people sharing lots of home learning ideas and support for parents and carers, including tools to support individuals with dyslexia and/or reading and writing difficulties.

Lucy Chetty, Head Teacher at New Struan School has also shared her top tips on education at home.  She notes that different young people will experience the changes to life differently – some will enjoy having more control over their day outside of school, whereas others will miss the routines that they are used to.

According to Lucy, happiness and fun is a key aspect of learning. Thus parents and carers should try to find something that interests and motivates their individual child special interests may be of particular help in this regard.

On a practical level, ensuring clarity is hugely important.  This includes providing clear instructions, and setting out a clear beginning, middle and end to the activity.  Also recommended is ‘chunking down’ activities into smaller pieces so that there are regular breaks, and the use of visual strips and/or timers to help illustrate how long an activity will last.

 Re-opening schools

As we look ahead to the future, there are a number of critical issues that need to be considered to support autistic children and/or adults to transition back out of lockdown.

Transitioning back into the school environment will be challenging for many autistic children, particularly those that have previously found it difficult to attend school, and/or have experience of ‘school refusal’.  For many autistic children, successful school attendance has required a great deal of input from teaching and support staff, parents and the child themselves. This is because the school environment is often experienced as being particularly challenging for a number of different reasons – for example, sensory issues (e.g. noises, smells, lighting), difficulties with processing information, and/or social communication challenges (social skills, etiquette, etc).  Many autistic children also experience heightened levels of anxiety, which is exacerbated by the school environment.

Many autistic children will need additional support with the change of routine back to school days and hours, and also with their anxiety levels – particularly if they have concerns about catching and/or spreading the virus, or if other people within the school are perceived to be ‘not following the rules’.

Additional support for transitioning back into school will be particularly important if the new school environment looks significantly different to that which the child is used to as a result of social distancing measures – for example, by attending different hours or days at school, or having different classroom set ups to allow for social distancing – both of which are options currently being considered by the Scottish Government.

Transitioning out of lockdown

In recognition of the difficulties facing many autistic people and their parents and/or carers, the Scottish Government recently announced new funding to help provide additional support in the form of an extended helpline run by Scottish Autism, and the creation of online social support groups by the National Autistic Society Scotland. 

Researchers at UCL Institute of Education are also currently conducting research into the experiences and needs of parents and carers of autistic children during the pandemic, which will hopefully help inform how they can best be supported as we transition out of lockdown and into the future, where we learn to live alongside coronavirus.

In Scotland, the Education Recovery Group is currently exploring options for stabilising the education of pupils with additional support needs as “an early priority”.

While there is still a degree of uncertainty about how and when lockdown will be eased across the UK, what is certain is that the easing of lockdown – whenever it happens – will present additional challenges for many autistic people and their parents/carers. Listening to the voices of autistic people and their parents and carers will be hugely important if they are to be successfully supported in this transition.


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The three keys to successful home working

wfh

by Scott Faulds

Over the past few weeks, we have all had to make massive changes to the way we live our lives in order to protect ourselves and those around us from Coronavirus. From the closure of gyms to the socially distanced queues outside of supermarkets, it really is impossible to imagine a single aspect of our daily lives that has not been altered in some way. Until a viable treatment or vaccine is found, it appears that we will need to get used to this, “new normal”, with social distancing measures likely to be in place for the foreseeable future. As a result, many of us are now coming to terms with working from our homes for an indefinite period of time.

The sudden shift from working in an office to working from home has required many of us to quickly adapt and get to grips with new ways of working, such as conducting meetings virtually via Zoom. A survey conducted, during the first two weeks of the UK’s “lockdown” by the Institute for Employment Studies, has found that workers who are new to working from home are more likely to be experiencing poor mental health and 50% of those surveyed are now no-longer happy with their work-life balance. Additionally, the survey revealed that a majority of workers are concerned that they are no longer getting enough exercise and have reported a variety of new physical health issues, such as loss of sleep; back/neck pain; eye strain and headaches. 

The issues raised in the Institute for Employment Studies survey are concerning, especially when it is not clear when we will be able to return to our places of work. Therefore, it is vital that we consider what actions we can take to ensure that we are able to successfully work from home, without compromising our physical and mental health. 

1. Routine

Although working from home can be challenging there are some benefits, such as significantly shorter commutes to the office, which allows us to have a little bit longer in bed. Even though it may be tempting to get up at a different time each day and get straight to work, this irregularity in your normal day-to-day routine may be having a negative impact on your mental wellbeing. 

Research has shown that sticking to a daily routine can help to reduce stress and alleviate anxiety. Therefore, even though we may no longer have as long a commute to the office, ensuring that you are waking up and getting ready for work at a regular time each day, can help to put you in the right mindset to have a productive day. 

Although it might seem like a good idea to stay in your pyjamas all day, getting dressed for work (even putting on informal clothes) helps us to psychologically prepare to start our working day. Consequently, getting changed back into comfy clothes at the end of the workday can have the opposite effect and help us enter a more relaxed state of mind. The simple act of changing our clothes can help to create a mental separation between work and home, which is important when our physical environment remains the same.

2. Breaks

Ensuring you have a good routine is clearly important when working from home. However, being sedentary and staring at a computer screen all day can negatively impact your physical and mental health. Taking regular breaks, even just to make a cup of tea, can help to break up the monotony of the working day. Research has shown that frequent short breaks are more beneficial than less frequent ones, and can improve your overall productivity. In particular, it is important not to eat lunch at our desks, as research by the University of Surrey has found that food eaten whilst you are distracted does not fill you up and can lead to overeating.

Although our morning commutes may sometimes be annoying, they did at least ensure that we were leaving the house once a day. Breaking-up your working day by doing some exercise, such as going for a short walk or following an online exercise class, can help to improve your mood. Regular exercise has even been proven to boost the body’s immune system.

3. Boundaries

Undoubtedly, working from home does involve some degree of boundary blurring between our places of work and our homes. For many this has translated into working longer hours and feeling less rested and more anxious throughout the day. As previously discussed, the physical act of getting ready and commuting to work allows our brains to shift from “home” to “work” mode. Setting out clear boundaries regarding when, where and how we work is vital to maintaining our wellbeing and maximising our productivity.

For example, although it may be tempting to work from your bed or couch, these areas are predominantly associated with relaxation. Blurring the lines between work and home in these spaces may reduce your productivity when you are trying to work and prevent you from relaxing when work is over.

Additionally, working from your bed or couch may cause you physical health problems. If you have to sit in front of a computer for an extended period, the NHS advises that you should be sitting in a chair which supports your lower back, your feet should be on the floor and your screen should be at eye level.

Final thoughts

Working from home for an indefinite period of time may not be ideal, however, it is vital in order to stop the spread of the Coronavirus. During this period of uncertainty, it is important that we look after our physical and mental health and recognise the ways in which we can improve our “new normal”.

Although it may be tempting to work from the couch in our pyjamas, research has shown that in order to maintain our wellbeing, it is vital to retain a sense of division between our home and work lives. Therefore, we can protect our wellbeing and ensure we remain productive through following a regular routine, taking frequent breaks when required and ensuring there are clear boundaries in place between home and work.

If you require any advice regarding how to work from home, you can find useful resources at ParentClub.Scot and on the NHS website.


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Guest post: Economic effects of coronavirus lockdowns are staggering – but health recovery must be prioritised

By Pushan Dutt, INSEAD

In all my years as an economist, I have never seen a graph like the one below. It shows unemployment claims in the US – observe the spike for the week ending March 21. The global financial crisis, the dot-com crash, Black Monday, oil price shocks, 9/11, none of these historic shocks are even visible in the graph.

Figures: US Department of Labor

 

The spike in unemployment claims is the proverbial canary in the goldmine. We should expect a swathe of bad economic numbers coming down the pipeline. The head of the St. Louis Fed expects a 30% unemployment rate and a 50% drop in US GDP by summer. More importantly, as the health crisis rises and crests at different times in different parts of the world, the horrifying numbers on GDP growth, unemployment, business closures are not likely to let up in the near term. Multiple countries are in a recession, and eventually, the whole world will fall into a deep recession.

The plunge from prosperity to peril will be as swift as the switch to lockdown protocols in most countries. We cannot even rely on the data we have to reveal the speed and depth of the crisis since this is collected and updated with lags. For instance, the US monthly jobs report for March collects data in the second week of March, failing to capture the massive spike in unemployment claims that appears after March 12.

In the meantime, sources such as restaurant booking website OpenTable can offer some insights into the magnitude of things. The figures below show the recent plummet in diners eating at restaurants in four countries. Observe a sudden stop in the entire restaurant industry by the third week of March.


Annual % change in restaurant diners from end of February to end of March.

Data: OpenTable

 

Combine a black swan event with missing data, and it is not surprising that markets are swinging violently.

Deep freeze

The question is not one of whether we are in a recession – we are. The more pertinent questions are: how long it will last? How deep it will be? Who will be impacted the most? And how swift will the recovery be?

These questions are complicated and even top economists must admit a lack of confidence in their answers. We are not experiencing a standard downturn. Nor is it simply a financial crisis, a currency crisis, a debt crisis, a balance of payment crisis or a supply shock.

We have not seen anything like this since the flu pandemic of 1918. Even there, identifying the effects of the flu is confounded by the first world war that took place at the same time. What we have here is something different. At its heart, we are experiencing a healthcare crisis with various parts of the world succumbing in a staggered fashion.

To slow down this global health crisis (the “flatten the curve” mantra), we have chosen to put the economy into deep freeze temporarily. Production, spending, and incomes will inevitably decline. Decisions to reduce the severity of the epidemic exacerbate the size of the contraction. While the initial decision to reduce labour supply and consumption are voluntary, this will likely be followed by involuntary reductions in both, as businesses are forced to lay off workers or go bankrupt.

Of course, government policies will attempt to mitigate these effects. Some are using traditional monetary and fiscal policies (cutting interest rates, quantitative easing, increasing unemployment insurance, bailouts). Others are trying out non-traditional methods (direct cash transfers, loans to businesses conditional on maintaining unemployment, wage subsidies).

Public health priority

How long the economic impact lasts depends entirely on how long the pandemic lasts. This, in turn, depends on epidemiological variables and health policy choices. But even when the pandemic ends, the resumption of normalcy is likely to be gradual. Countries will persist with a strict containment regime like in China today, and continue to impose travel restrictions to various parts of the world where the disease continues to spread.

The many factors at play in this complex, interlinked crisis that affects both people’s health and the global economy introduces massive uncertainty into anyone hazarding the pace, the depth and the length of the impact. As a result, we should treat any precise estimates (such as “GDP will decline by X%” or “markets have reached their bottom”) with scepticism.

Especially frustrating is the idea that there is a conflict between academic disease modellers and hard-edged economists saying that steps to slow the spread of coronavirus has trade offs. This could not be further from the truth. Among economists there is near unanimity that countries should focus on the healthcare crisis and that tolerating a sharp slowdown in economic activity to arrest the spread of infections is the preferred policy path. In a recent survey carried out by the University of Chicago, respondents universally agreed that you cannot have a healthy economy without healthy people.

The health crisis has naturally created a crisis of confidence. This, in turn, can have damaging long-term effects with continuing uncertainty leading firms and households to postpone investment, production and spending. Restoring confidence requires a singular focus on containing and reversing the spread of COVID-19.

Slowing the rate that people fall ill with COVID-19 is not the end in itself. It is a means to temporarily reduce the pressure on hospitals and give time to identify treatments and a vaccine. In the interim, we must build testing capacity, perform contact tracing, setup the infrastructure for extended quarantines, rapidly expand the production of masks, ventilators and other protection equipment, build and repurpose facilities into hospitals, add intensive care capacity and train, recall and redeploy medical personnel.

All of this is also the way to restore the economy’s health and economic policy must complement it. In the short run, economic policies should mitigate the impact of lockdowns and ensure that the current crisis does not trigger financial, debt or currency crises. It should focus on flattening the recession curve, ensure that the temporary shutdown has only transient effects, and facilitate a quick recovery once the economy is taken out of the deep freeze.

In the meantime, it’s important to also recognise that this is an unprecedented crisis. Everybody has their role to play, but nobody is infallible and uncertainty is inevitable.

Pushan Dutt, Professor of Economics, INSEAD

This article is republished from The Conversation under a Creative Commons license. Read the original article.


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Safeguarding in social isolation: how social care teams are adapting to the new normal

We are all adapting to life in “lockdown”. For many of us this is a period of transition which will require some changes to our normal daily routine, perhaps working from home or socialising less. But what if you are a vulnerable person who is already socially isolated or if the place you call home is not safe?

The First Minister of Scotland Nicola Sturgeon in a briefing to the media stressed that life shouldn’t feel normal, but for many people who work in social care or social services they are trying to carry on as normal, providing key services to some of the most vulnerable people in our communities.

Social care teams across the county are working flat out to ensure they can maintain vital services and provide support and care to vulnerable adults and at risk children. Advice has been published by the government and by professional bodies like the BASW  (British Association of Social Workers) to try and provide some guidance to frontline care staff. But the reality is that care workers, both in social work and residential care are having to adapt to new and unprecedented circumstances to keep vulnerable people safe in our communities.

Funding for councils announced to support continuity of care

Councils have been allocated £1.6bn of funding by the Chancellor, designed to help them manage the impact of Covid-19 on services, including social care. Additional measures also include £1.3bn which is designed to help the discharge of patients from hospitals to continue their care in a community setting, to free up vital NHS resources over the coming weeks.

Councils have been advised to use this money as they see fit. However, one key priority is the continuity of care for service users, particularly as the virus spreads further into the community and there is a greater chance of care staff having to self-isolate and remove themselves from the workforce for a period.

Another measure designed to help ease this pressure on frontline staff are the social care clauses included in the emergency Coronavirus bill which temporarily remove the duties placed on councils to provide adult social care to all who are eligible. Instead councils will be able to prioritise care for those they consider to be most at risk in the event that adult social care services become overwhelmed. However these measures have been met with criticism from some charities who have said they will place already vulnerable adults at even greater risk.

Concerns raised for vulnerable children

The Children’s Commissioner for England has raised concerns about children who live in chaotic households, impacted by domestic abuse or substance abuse, and the effects that social distancing could have on their physical and mental wellbeing. For many children who are on the radar of social services, lockdown could be an especially isolating and difficult time. Additional concerns have been raised about vulnerable care leavers and young homeless people.

Government plans have ensured that some places have been kept in schools for vulnerable children to continue to attend. The definition of “vulnerable children” outlined by the government advice includes all children supported by social care, including those on child in need and child protection plans, looked-after children, children with disabilities, and children with education, health and care plans. However, the plan has drawn some criticism, including around its potential for heightening stigma experienced by children, and for putting the health of foster and kinship carers at risk.

How staff are adapting to new ways of working

It is not news that even before the outbreak of Covid-19 in the UK, the social care system was under significant stress.

Increased demands on those who work in residential and domiciliary settings include the practical challenges, increasing use of PPE, infection control and refresher training regarding contingency and emergency plans for residential care homes and challenges with supplies, including food and medication for residents. Additional challenges include the social and emotional stress of residents who may not receive visitors and must, where possible, socially distance from others.

Those who work in child and family social work are having to be increasingly flexible, managing many more cases and where possible managing elements of their work remotely via telephone or videoconferencing. Essential services are being prioritised.

In some instances there have been discussions around inviting final year social work students, or students studying social care to help support staff with additional tasks, or as has been the case with the NHS inviting retired colleagues back for a period to help already stretched teams.

An uncertain next few weeks

Many social workers and care staff have raised concerns around continuing to carry out their statutory duties as the population enters a lockdown phase and the additional risks this not only places on them as frontline staff but also the additional risks it may present to vulnerable children and adults.

Many are calling for explicit guidance from government on how social carers and social workers can be best supported to safeguard people at particular risk of harm, isolation and neglect. This includes practical support like the allocation of protective equipment, the enabling of improved sharing of information via digital channels and professional support, including the implications for registration if they are unable to meet duties, timescales or usual legal compliance during this crisis.

As the care system and its staff begin to feel the strain caused by this outbreak, calls are being made for social care to be recognised and acknowledged by government and others as a vital service. While one charity, the Care Workers Charity is launching a scheme to provide grants for those care workers who need to self isolate, many of whom will do so without pay, the GMB union have warned the coronavirus crisis could lead to the total collapse of the care system. It said care staff were being left with no protection against the virus, no childcare and poverty sick pay if they become infected.

Staff safety and continuity of service are clearly the priorities for the social care sector as we begin this period of unprecedented “lockdown”. It is clear more guidance and support is needed for staff who are on the frontline as they continue to deliver vital care and support services to some of the most vulnerable people in our communities.

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An ageing workforce and growing emotional demands call for more sustainable employment

People Turning in Gears - Synergy

As a result of the global demographic challenge of an ageing population and the increasing diversity of working life, there has been a growing focus on sustainable work over the life course which has also placed greater emphasis on the importance of the quality of work and working conditions. As more and more people are having to work longer before retirement, it is important that they are able to do so.

A recent Eurofound report examined working conditions and their implications for worker’s health. Its findings confirmed a clear link between working conditions and the health and well-being of workers, highlighting the need to make work more sustainable.

Working conditions, health and wellbeing

Eurofound’s report found that this relationship can be depicted in a model based on the European Working Conditions Survey (EWCS), showing that health outcomes are the result of two processes: health-impairing processes (exhaustion) and motivational processes (engagement).

Health-impairing processes are associated with exposure to adverse work demands which tend to increase exhaustion, while motivational processes are associated with access to work resources that support engagement.

Such demands can include:

  • physical risks
  • work intensity
  • work extensity (long working hours)
  • emotional demands
  • social demands

Such resources can include:

  • social resources
  • work resources
  • rewards

It is noted in the report that the demand and resources model partly explains how well-designed jobs – characterised by high rewards, high work and social resources and suitable levels of demands – translate into better health: “Whereas job demands are linked to higher levels of exhaustion (which, in turn, are related to poorer health), job resources are associated with higher levels of work engagement (which, in turn, are related to better health and well-being).”

It is therefore suggested that as job control, social resources and rewarding working experiences all have positive effects, employers should be encouraged to introduce initiatives that focus on motivational aspects of work.

As recently highlighted, the discipline of worker health has traditionally focused on worker exposures to various workplace hazards. However, this has more recently broadened to include the concept of worker well-being, which is seen as increasingly important. Not only is it important for the individual but it is an important determinant of productivity for enterprise and society as well. Indeed, the Eurofound report highlights this growing importance.

Emotional demands

While the report notes that physical hazards have a direct effect on worker’s health and wellbeing and are undoubtedly remain important, these have not increased, but emotional demands have. This, it is argued, underlines the growing importance of psychosocial risks. It argues:

“In the context of ageing societies and services-dominated economies, it becomes more pressing to address these risks as the incidence of exposure increases.”

Other research has also highlighted the significance of emotional demands at work in relation to health. One recent study in the Danish workforce, for example, found emotional demands at work predicted a higher risk of long term sickness absence.

With the growing need for long-term care in ageing societies, it is argued that these demands are likely to increase further and, therefore, require particular attention. Different groups of people also face varying demands and are considered in the report. In particular, gender differences are considered throughout – highlighted as significant in some areas

Gender

The report found that men tend to report better health and wellbeing, and fewer health problems and better sleep quality than women. Men were also found to report fewer days of sickness absence and fewer days of presenteeism.

This is consistent with other research findings that show ill-health is more prevalent in women. One study exploring the association between work-related stress in midlife and subsequent mortality, and whether sense of coherence (measured as meaningfulness, manageability and comprehensibility) modified the association, found that occupation-based high job strain was associated with higher mortality in the presence of a weak sense of coherence – a result that was stronger in women than in men.

The Eurofound report findings show that as women often work in sectors like health or education, they are especially exposed to the psychosocial risks associated with these emotionally demanding jobs.

The report also notes that workers under 25 are most likely to face high demands while having the least access to work resources, and health sector employees in particular, face high emotional and social demands. It is therefore suggested that there should be investment in working conditions for particular risk groups, such as occupations requiring lower skills levels, reporting job insecurity, or witnessing workplace downsizing. Measures to promote high union density, good employment protection and gender equality which are likely to improve working conditions and contribute to workers’ health and wellbeing are also highlighted.

Way forward

The findings of the Eurofound report, and indeed other research, highlight the need to look beyond the ‘traditional’, narrower framework of occupational health and safety to include the psychosocial risks such as emotional demands, along with motivational aspects of work. This calls for a reduction in health-impairing conditions and a fostering of health-promoting ones.

Of course, the world of work will continue to change, particularly in an increasingly digital world. However, striking the right balance between demands and resources through coordination between different policy fields could contribute to a higher quality of working life that is sustainable, regardless of the ever changing environment.


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An app a day … how m-health could revolutionise our engagement with the NHS

It seems like almost every day now we see in the news and read in newspapers about the increasing pressures on our NHS, strains on resources and the daily challenges facing already overworked GP staff.

Mobile health applications (m-health apps) are increasingly being integrated into practice and are now being used to perform some tasks which would have traditionally been performed by general practitioners (GPs), such as those involved in promoting health, preventing disease, diagnosis, treatment, monitoring, and signposting to other health and support services.

How m-health is transforming patient interactions with the NHS

In 2015 International Longevity Centre research found some distinct demographic divides on health information seeking behaviour. While 50% of those aged 25-34 preferred to receive health information online, only 15% of those aged 65 and over preferred the internet. The internet remained the favourite source of health information for all age groups younger than 55. And while not specifically referring to apps, the fact that many people in this research expressed a preference to seek health information online indicates that there is potential for wider use of effective, and NHS approved health apps.

A report published in 2019 by Reform highlighted the unique opportunity that m-health offered in the treatment and management of mental health conditions. The report found that in the short to medium-term, much of the potential of apps and m-health lies in relieving the pressure on frontline mental health services by giving practitioners more time to spend on direct patient care and providing new ways to deliver low-intensity, ongoing support. In the long-term, the report suggests, data-driven technologies could lead to more preventative and precise care by allowing for new types of data-collection and analysis to enhance understandings of mental health.

M-health, e-health and telecare are also potentially important tools in the delivery of rural care, particularly to those who are elderly or who live in remote parts of the UK. This enables them to submit relevant readings to a GP or hospital consultant without having to travel to see them in person and allowing them to receive updates, information and advice on their condition without having to travel to consult a doctor or nurse face-to-face. However, some have highlighted that this removal of personal contact could leave some patients feeling isolated, unable to ask questions and impact on the likelihood of carrying out treatment, particularly among older people, if they feel it has been prescribed by a “machine” and not a doctor.

Supporting people to take ownership of their own health

Research has suggested that wearable technologies, not just m-health apps, but across-the-board, including devices like “fitbits”, are acting as incentives to help people self-regulate and promote healthier activities such as more walking or drinking more water. One study found that different tracking and monitoring tools that collect and analyse health and wellness data over time can inform consumers of their baseline activity level, encourage personal engagement in health and wellbeing, and ultimately lead to positive behavioural change. Another report from the International Longevity Centre also highlights the potential impact of apps on preventative healthcare; promoting behaviour change and encouraging people to make healthier choices such as stopping smoking or reducing alcohol intake.

Home testing kits for conditions such as bowel cancer and remote sensors to monitor blood sugar levels in type 1 diabetics are also becoming more commonplace as methods to help people take control of monitoring their own health. Roll-outs of blood pressure and heart rhythm monitors enable doctors to see results through an integrated tablet, monitor a patient’s condition remotely, make suggestions on changes to medication or pass comments on to patients directly through an email or integrated chat system, without the patient having to attend a clinic in person.

Individual test kits from private sector firms, including “Monitor My Health” are now also increasingly available for people to purchase. People purchase and complete the kits, which usually include instructions on home blood testing for conditions like diabetes, high cholesterol and vitamin D deficiency. The collected samples are then returned via post, analysed in a laboratory and the results communicated to the patient via an app, with no information about the test stored on their personal medical records. While the app results will recommend if a trip to see a GP is necessary, there is no obligation on the part of the company involved or the patient to act on the results if they choose not to. The kits are aimed at “time-poor” people over the age of 16, who want to “take control of their own healthcare”, according to the kit’s creator, but some have suggested that instead of improving the patient journey by making testing more convenient, lack of regulation could dilute the quality of testing Removing the “human element”, they warn, particularly from initial diagnosis consultations, could lead to errors.

But what about privacy?

Patient-driven healthcare which is supported and facilitated by the use of e-health technologies and m-health apps is designed to support an increased level of information flow, transparency, customisation, collaboration and patient choice and responsibility-taking, as well as quantitative, predictive and preventive aspects for each user. However, it’s not all positive, and concerns are already being raised about the collection and storage of data, its use and the security of potentially very sensitive personal data.

Data theft or loss is one of the major security concerns when it comes to using m-health apps. However, another challenge is the unwitting sharing of data by users, which despite GDPR requirements can happen when people accept terms and conditions or cookie notices without fully reading or understanding the consequences for their data. Some apps, for example, collect and anonymise data to feed into further research or analytics about the use of the app or sell it on to third parties for use in advertising.

Final thoughts

The integration of mobile technologies and the internet into medical diagnosis and treatment has significant potential to improve the delivery of health and care across the UK, easing pressure on frontline staff and services and providing more efficient care, particularly for those people who are living with long-term conditions which require monitoring and management.

However, clinicians and researchers have been quick to emphasise that while there are significant benefits to both the doctor and the patient, care must be taken to ensure that the integrity and trust within the doctor-patient relationship is maintained, and that people are not forced into m-health approaches without feeling supported to use the technology properly and manage their conditions effectively. If training, support and confidence of users in the apps is not there, there is the potential for the roll-out of apps to have the opposite effect, and lead to more staff answering questions on using the technology than providing frontline care.


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