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.


If you liked this article you may also be interested in reading:

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

Virtual reality: a game changer for mental health treatment?

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

Cross-border handshakes: what’s next for digital contact tracing?

Living and working in an ‘age of ambiguity’

The pandemic is having a wide ranging impact on all aspects of people’s lives. From the massive shift to home working for many to the furlough scheme for others, employees have experienced a fundamental shift in the way they work and live.

According to a recent survey of workers, employee happiness has declined and there has been an increase in presenteeism during the pandemic, as the boundaries between home and work, which were once certain, have become blurred.

Blurred lines and a culture of presenteeism

The survey by Aviva, polled 2,000 employees in February 2020 and again in August 2020, finding that most people were happier before the pandemic and that a culture of presenteeism had emerged. Key findings included:

  • More than half (52%) agree the boundaries between their work and home life are becoming increasingly blurred – up from 40% in February.
  • The number of employees who are completely happy almost halved: 20% in February vs. 13% in August.
  • 43% of employees ranked their mental health between ‘very bad’ and ‘fair’, compared with 38% in February.
  • 84% say that they would carry on working even if they felt unwell.

A significant trend of presenteeism and the ‘always on’ culture was highlighted by the survey. The increased uncertainty and heightened anxiety has led to many employees working longer hours and taking fewer sick days. In February 2020, 67% of employees took zero sick days over a three month period; this increased to 84% in August.

Employees may feel the need to prove their productivity while working from home, particularly if they feel their jobs are at risk. But such e-presenteeism is likely to have a negative impact on productivity and inevitably mental wellbeing. According to the report “the ambiguity experienced is compounding behaviour that is detrimental to long-term employee wellbeing.”

Young people (18-25) were found to be particularly affected, with 53% reporting feeling anxious compared to the national average of 34% and 17% ranking their mental health as bad compared to an average of 11% across all age groups.

There have been changes in employee self-determination across the board and the main priorities for employees have shifted as they are increasingly looking for a greater work-life balance over salary – a trend which has increased since the pandemic struck.

Employer considerations

Most employers have implemented new ways of supporting employees, which has been welcomed, but the survey highlights that more needs to be done. Despite a majority of employees believing employers have made some effort to adapt, there is still a loss of motivation among employees. Just 15% of employees agree that their employer is trying really hard to understand what motivates them and only a quarter (26%) agree their employer is genuinely concerned about their wellbeing.

With research confirming a conclusive link between wellbeing and productivity – employees are 13% more productive when happy – no organisation can afford to ignore the issue of employee wellbeing.

Indeed, employee wellbeing was already rising up the corporate agenda pre-Covid-19 but the pandemic has propelled it further into focus for many organisations.

It is argued that a new partnership is required between employees and employers. Personal control surpasses employer control when it comes to what employees want and there is clear evidence that more tailored support, rather than a one size fits all approach, is required.

Aviva’s report argues that “now more than ever there is a case for employers to embrace the ‘Age of Ambiguity’ to support their workforce with their mental health, physical and financial wellbeing.” To this end, Aviva recommends five ‘employer considerations’:

  • Understand how they can deliver on emerging flexibility needs.
  • Personalise mental health and wellbeing support.
  • Create sense of purpose, clarity and autonomy in the workplace.
  • Prepare workers for fuller working lives and the transition from work to retirement.
  • Create more targeted interventions by understanding personality types.

Towards a happier future

As all personality types were found to desire flexibility, it is suggested that prioritising employee wellbeing as a ‘need to have’ rather than a ‘nice to have’ and incorporating flexibility into working life could be a way forward for businesses when it comes to recruiting and retaining the best workers.

The ‘age of ambiguity’ could be the perfect opportunity for businesses to make the necessary changes to support their employees, helping them to improve their physical, mental and financial wellbeing – for mutual benefit.

The pandemic has thrust the world of work into a period of intense change and uncertainty, but many of the trends were already underway, particularly the shift in employee outlook. Employees’ desire for flexibility continues to grow as they seek a better work-life balance and there is no sign of this abating. The Aviva survey has shone a spotlight on this trend and suggests that “employers who embrace their employees’ desire for long term flexibility will see the benefit of a healthier and happier workforce” – leading to a happier future for all.


Enjoyed reading this? Why not take a look at some of our previous posts on working conditions:

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Britain’s town centres: down, but not out

Image: Mayfield development, Manchester (U+I plc)

Town centres have taken a battering in the past year, with many shops and services forced to close during lockdowns and growing numbers of stores going out of business.

But even before Covid-19, UK high streets were already under pressure. Economic recessions, rising business rates, higher rents, the growth of online shopping and development out-of-town retail parks have left Britain’s town centres struggling to survive.

Last month, Planning magazine brought together a panel of experts to discuss the future of town centres. Among the issues considered were trends affecting town centres, how demand for town centre property is changing post-pandemic and how developers are responding to changes in market demand and planning laws.

The bigger picture: online shopping and working from home

Jennet Siebrits, head of CBRE UK’s research team, gave a helpful overview of two key trends affecting town centres.

In the past decade, e-commerce has seen a dramatic increase in activity. Since 2011, the value of online shopping has mushroomed from £23 billion to £58 billion –a 158% increase. But in 2020, even that figure was eclipsed, with the value of e-commerce rising to £84 billion – a 44% increase in just one year. The evidence from the first national lockdown suggests that this step change is here to stay.

The impact of this, along with the Covid-19 restrictions, has been grim for town centre stores. Over 11,000 shops closed in 2020, and while not all of those closures were due to online shopping, it’s clear that e-commerce has been a real driver of this.

Jennet suggested that, as the restrictions ease, it’s likely that supermarkets, along with in-store health and beauty and DIY stores will continue to attract customers. But other sectors will have to come up with innovative ways to lure consumers off their iPads.

Jennet also highlighted the increased move towards home working. Once people return to their workplaces, it’s likely that many will ask to continue working from home, at least for part of the working week.

The rise in home working may also affect demand for residential property, with more people moving further away from city centres. This could have a knock-on effect for ancillary services like coffee kiosks and sandwich bars, with local town centres capitalising on the losses experienced by city centres.

The legal perspective: changes to planning laws

David Mathias, a specialist planning solicitor at Shoosmiths law firm described some recent planning law changes that have particular relevance to town centres.

Since the demise of Woolworths in 2008, more and more UK department stores have been closing down, leaving big gaps on the high street. In future, it’s likely that many property developers will want to convert from retail to residential.

Until recently, permitted development rights for conversion to residential only applied in a limited set of commercial uses. But the UK government has announced new permitted development rights in England enabling greater flexibility on conversions without the need for planning permission. These will go ahead in August, subject to certain conditions.

In addition, further legislation on expansion of permitted development rights introduced last summer allows the construction of an additional storey on freestanding blocks and buildings on a terrace to create additional housing, and the demolition of buildings built before 1990 and construction of new dwellings in their place.

The government has argued that these changes will help to revive town centres, although others believe easing planning rules for developers will have the opposite effect. 

The developer’s perspective: re-imagining Manchester

Martyn Evans from the U+I Group offered his view of how developers are responding to changes in market demand and planning. He did so using U+I’s development at Mayfield in Manchester.

Located next to Piccadilly railway station, in the centre of the city, this 24 acre-site is being redeveloped from derelict railway land. A consortium of Manchester City Council, Transport for Greater Manchester and London & Continental Railways (LCR), along with U+I, has been working to regenerate the area, with the first buildings due for completion next year.

Right from the start, the consortium focused on the importance of creating a place where people want to live, work, rest and relax. One important feature of the development is a seven-acre park. Although it was planned into the scheme years ago, this green space has become all the more significant in the past year.

Image: Mayfield development, Manchester (U+I plc)

The pandemic has demonstrated the importance of green space as a vital part of city living, both for physical health and mental wellbeing. Such spaces not only attract workers, residents and visitors, they also increase the value of developments. And because decisions about commercial property are increasingly being taken by HR teams rather than finance departments, the wellbeing benefits of workers’ surroundings are being taken more seriously. In short, understanding quality of place gives developers more of a competitive edge. 

The local authority perspective: managing change

To conclude, Michael Kiely from the Planning Officers Society looked at what local planning authorities can do to help sustain town centres.

Michael described some of the planning tools local authorities can use, including strategic planning, masterplanning and local plans. But with recent changes in planning laws, including the use classes order, Michael argued that policies such as Town Centre First may be ineffective.

However, local authorities can still make a difference, through partnerships with other stakeholders, such as land owners and Business Improvement Districts (BIDS), and the use of intervention and compulsory purchase powers.

In closing, Michael suggested the need for a licensing or permitting regime to manage and curate activities so that they do not cause harm and town centres can thrive.

Future perspectives: rethinking town centres

A £150m project to revamp London’s Oxford Street signals that high streets are already re-imagining themselves as leisure-focused and “experiential shopping” centres. And the Mayfield site in Manchester has the potential to transform a part of the city centre that has been underused for decades.

These are just two examples of the planning community working together to help sustain town centres. Britain’s high streets face substantial challenges, but this interesting discussion suggested there are good reasons to optimistic about the future.

A recording of The Future of Our Town Centres discussion is available to watch on-demand at the Planning magazine website.


Further reading: more on town centres from The Knowledge Exchange blog

Glasgow Green photo essay: a park for all seasons

For generations, urban public parks have been places for communities to meet, to connect with nature and to enjoy recreational activities. Parks have multiple benefits for biodiversity, human health and the environment. They can help with flood prevention and during the summer can help control temperatures and humidity.

One of the oldest public parks in the UK is Glasgow Green, a short walk from the centre of Scotland’s biggest city. In 1450, the Bishop of Glasgow gifted the common lands of Glasgow Green to the people, and for centuries it was the city’s only green public space. The park has witnessed some important moments in the city’s history, including demonstrations, sporting and cultural events.

During the early years of the industrial revolution, the park became an oasis for residents from unhealthy housing and working conditions. Similarly, in our own times, Glasgow Green has been an important refuge during the restrictions imposed as a result of the coronavirus pandemic.

Today, Glasgow Green remains open 24 hours a day, with its 136 acres of lawns, flowerbeds, fountains and architectural monuments maintained by workers from Glasgow City Council’s Parks Department. This photo essay reflects on some of the sights and stories associated with Glasgow’s oldest public park.

Flora, fauna and the Glasgow Green geese

Glasgow Green is home to a variety of plants, flowers and trees, as well as a wide range of wildlife species, including birds, butterflies and red foxes. One of the more unexpected sights in the park is a flock of geese.

For more than 50 years, geese were deployed to guard the stocks of Ballantines whisky maturing in Dunbartonshire warehouses. Geese are famously territorial, and act as a vocal alarm against intruders. With the advent of CCTV in the 1990s, the “Ballantines Bodyguards” were retired to Glasgow Green, and placed in the care of the Glasgow Humane Society. Coincidentally, their new home looks onto a grain distillery, perhaps serving as a reminder of their past life.

A gathering place for sport and culture

In all weathers, Glasgow Green attracts walkers, cyclists and joggers, as well as offering open spaces for team sports. Rowers from both Glasgow and Strathclyde University boat clubs train on the River Clyde beside Glasgow Green.  The park also has strong historical sporting connections. Golf was played here as early as the 16th century, and Glasgow’s two famous football teams – Celtic and Rangers – were both established on Glasgow Green. In 2014, the Glasgow Green Hockey Centre was opened in time to host matches for the Commonwealth Games.

Glasgow Green has also played host to some of the biggest names in music, from Radiohead and Iggy Pop to Coldplay and Lewis Capaldi. In 1990, the park hosted a summer concert celebrating Glasgow’s year as European City of Culture, headlined by local heroes Deacon Blue. In the summer months, Glasgow Green also hosts the World Pipe Band Championships and Proms in the Park.  

Glasgow’s Arc de Triomphe

The McLennan Arch started life in 1796 as part of Robert and James Adams’ Assembly Rooms in the city centre. When these buildings were demolished, the arch was reconstructed at the northern edge of Glasgow Green. Since then it has been moved three more times, reaching its final resting place in 1991, a gateway to Glasgow Green’s western perimeter.

History matters: demonstrations, rallies and the birthplace of the industrial revolution

Glasgow Green has always been a focal point for popular demonstrations. In the 19th century, trade unionists and Chartists gathered in the park to campaign for workers’ civil rights. During the 1930s, at the height of the Spanish Civil War, thousands gathered in Glasgow Green to support the Spanish Republic against General Franco and his fascist allies. More recently, the park has seen rallies against war in Iraq and in support of Scottish independence.  

Close to the centre of the park, a statue of James Watt commemorates one of the driving forces of the industrial revolution. It’s believed that Watt came up with the idea for fixing the inefficiencies of the steam engine while taking a stroll on Glasgow Green. The moment of inspiration was the vital spark that would revolutionise Britain’s mining, iron, transport and manufacturing industries.

In the summer of 2020, a Black Lives Matter demonstration took place on Glasgow Green, and a notice was placed on the James Watt statue highlighting his role in the trafficking of enslaved people. History is being reassessed in Glasgow, a city that richly benefitted from the proceeds of the Virginia tobacco plantations and the slave trade.

A river runs through it

The River Clyde flows alongside Glasgow Green. In recent years, environmental protection regulations have cleaned up the river, and there are plans to make the Clyde a focal point of economic regeneration. However, the legacy of Glasgow’s industrial past continues to affect the river. A 2019 report by the Clyde Gateway regeneration agency revealed that toxic waste from a former chemicals factory was leaking into the river, posing risks to human health and the environment. Clyde Gateway and Glasgow City Council have been taking remedial action until a permanent solution can be found.

From carpets to cocktails

One of the most impressive architectural features of Glasgow Green is the Templeton Building. It was opened in 1892, and designed by William Leiper who modelled the building on the Doge’s Palace in Venice. The façade of the building reflects the exotic designs of the carpets that were made there for almost 100 years. The building has also been touched by tragedy. During construction, a gust of wind brought one of the walls down on a shed, where a large number of young women were weaving carpets. 29 of them died in the east end’s worst peacetime disaster.

Today, the Templeton building contains apartments, offices and a microbrewery. During the summer months of 2020, the bar extended its beer garden to create an open-air restaurant for visitors to meet together when the lockdown restrictions were relaxed.

A clean sheet

Almost from the start of its history in the 15th century, Glasgow Green was used for household washing and drying. The drying green, opposite the Templeton Building, was in regular use until 1977. The women of Glasgow washed their clothes in the nearby wash-houses (or “steamies”) and then chatted together while their weekly wash dried in the open air. Today, while the iron poles have been retained, they are rarely used for drying clothes.

On International Women’s Day in 2019, the drying green enjoyed a comeback when 30 bed sheets were hung to celebrate the work of women past and present. Local businesses sponsored each of the sheets, women gathered to celebrate their mothers and grandmothers, and the proceeds from the day went to charity.

The never-ending story

Glasgow Green is unique, but like so many other public parks around the UK, it is an important community resource, a gathering place and a link between the past and the present.

A study by the Social Market Foundation reported on research that estimated the wellbeing value of UK parks and green spaces at £32.4bn. A further 2020 report by NESTA highlighted the threat to parks as a result of budget cutbacks imposed on local authorities, noting that some councils have reduced spending on parks by as much as 87%.

But during the pandemic, the value of parks has suddenly become clearer, as individuals, families and communities have rediscovered the benefits of spending time in green open spaces. As visitor numbers have soared, councils have acknowledged the importance of parks. In March 2021, Liverpool City Council became the first UK local authority to legally protect the future of its parks and green spaces. As the council’s acting mayor observed:

“…the benefits aren’t just health related. Access to green spaces improves our neighbourhoods, tackles climate change, supports education and economic growth and they frequently become the stage on which we host many of our hugely popular cultural celebrations.”

That’s certainly true of Glasgow Green. More than 500 years after its establishment, the park continues to generate joy and jobs, stories and memories. Glasgow Green truly is a park for all seasons.


Further reading: more on parks from The Knowledge Exchange blog:

Cross-border handshakes: what’s next for digital contact tracing?

As we enter a new year, and a new phase of the Covid-19 pandemic, we are reminded of the need to follow public health advice to stop the spread of the virus. The emergence of new variants of Covid-19, which appear to be more transmissible, has resulted in tougher restrictions across the world. Although the emergence of new variants of Covid-19 can seem frightening, we are not powerless in preventing the spread of the virus; face coverings, social distancing, regular handwashing and self-isolating remain effective.

Additionally, the development and subsequent roll-out of numerous vaccines should provide us all with hope that there is light at the end of the tunnel. However, although vaccines appear to protect people from becoming seriously ill with the virus, there is still uncertainty regarding the impact vaccines will have on viral transmission of Covid-19.

Therefore, the need for those with symptoms to self-isolate, get tested and undergo contact tracing when a positive case is detected is likely to remain. This will become even more important in the months ahead, as we see the gradual re-opening of hospitality, leisure and tourism sectors.

Effectiveness of contact tracing

Contact tracing is a tried-and-tested public health intervention intended to identify individuals who may have been in contact with an infected person and advise them to take action that will disrupt chains of transmission. Prior to Covid-19, contact tracing was often used to prevent the spread of sexually transmitted infections, and has been heralded as vital to the eradication of smallpox in the UK.

According to modelling, published by the Lancet Infectious Diseases, a combination of self-isolation, effective contact tracing and social distancing measures, may be the most effective and efficient way to control the spread of Covid-19.

However, for contact tracing to be at its most effective, the modelling estimates that for every 1,000 new symptomatic cases, 15,000 to 41,000 contacts would have to be asked to self-isolate. Clearly, the logistical burden of operating a manual contract tracing system is high. As a result, governments have chosen to augment existing systems through the deployment of digital contract tracing apps, which are predominantly built using software developed by Apple and Google.

Digital contact tracing

As we go about our day-to-day lives, especially as restrictions are eased, it may not be possible to name everyone you have encountered over the previous 14 days if you later contract Covid-19. Digital contact tracing provides a solution to this issue by harnessing the Bluetooth technology within our phones to help identify and remember potential close contacts. Research by the University of Glasgow has found that contact tracing apps can contribute substantially to reducing infection rates when accompanied by a sufficient testing capability.

Most countries have opted to utilise a system developed by Apple and Google, known as Exposure Notifications, as the basis for digital contact tracing. Public health authorities have the option to either provide Apple and Google with the criteria which defines when an alert should be generated or develop their own app, such as the Scottish Government’s Protect Scotland.

Exposure notification system

In order to protect privacy, the exposure notification system can only be activated by a user after they have agreed to the terms; the system cannot be unilaterally activated by public health authorities or Apple and Google. 

Once activated, the system utilises Bluetooth technology to swap anonymised IDs with other users’ devices when they come into close contact. This has been described as an anonymous handshake. Public health authorities set what is considered as a close contact (usually contact at less than a 2-metre distance for over 15 minutes), and the app calculates proximity measurements over a 24-hour period.

Anonymised IDs are not associated with a user’s identity, change every 10-20 minutes and collected anonymised IDs are securely stored locally on user devices for a 14-day period (incubation period of Covid-19) before being deleted.

If a user tests positive for Covid-19, the public health authority will provide them with a code that confirms their positive diagnosis. This will then provide users with an option to upload collected anonymous IDs to a secure public health authority server. At least once a day, the user’s phone will check-in with this server to check if any of the anonymised IDs collected in the previous 14-days match up with a positive case. If there is a match, and the proximity criteria has been met, a user may receive a notification informing them of the need to self-isolate.

Analysis conducted by the National Institute for Health Research highlights that the use of contact tracing apps, in combination with manual contact tracing, could lead to a reduction in the number of secondary Covid-19 infections. Additionally, the analysis revealed that contact tracing apps identified more possible close contacts and reduced the amount of time it took to complete contact tracing. The analysis concluded that the benefits of digital contact tracing include the ability to trace contacts who may not be known to the infected individual and the overall reliability and security of digitally stored data, rather than an individual’s memory or diary.

Therefore, it could be said that digital contract tracing apps will be most effective when restrictions ease and we are more likely to be in settings where we may be in close contact with people we may not know, for example, when we’re on holiday or in a restaurant.

Cross-border handshakes

Covid-19 naturally does not respect any form of border, and as restrictions on domestic and international travel are relaxed, opportunities will arise for Coivd-19 to spread. In order to facilitate the reopening of the tourism sector, there have been calls for countries which have utilised the Exposure Notification system to enable these systems to interact.

Examples of interoperability already exist internally within the UK, as an agreement exists between Scotland, England and Wales, Northern Ireland, (plus Jersey, Guernsey and Gibraltar), that enables users to continue to receive exposure notifications when they visit an area they do not live in, without the need to download the local public health authority app.

EU Exposure Notification system interoperability, European Commission, 2020

Additionally, the European Union has also developed interoperability of the Exposure Notification system between member states, with a commitment to link 18 national contact tracing apps, establishing the world’s largest bloc of digital contact tracing. The EU views the deployment of linked apps as vital to re-establishing safe free movement of people between member states, for work as well as tourism.

Over the next few months, it is likely that links will be created across jurisdictions. For example, the Scottish Government has committed to investigating how interoperability can be achieved between the Scottish and EU systems. The interoperability of Northern Ireland and Ireland’s contact tracing app highlights that on a technical level there appears to be no barrier for this form of cross-jurisdiction interaction.  

Therefore, as restrictions ease, the interoperability of digital contact tracing apps may become a vital way in which to ensure safe travel, as we learn to live with the ongoing threat of Covid-19.

Final thoughts

Covid-19 has proven itself to be a persistent threat to our everyday lives. However, the deployment of effective vaccines provides us with hope that the threat will be minimized soon. Until then, the need to utilise contact tracing is likely to remain.

As the roll-out of mass-vaccination programmes accelerates, and restrictions are relaxed, we are likely to be in more situations where we will be in contact with more people, not all of whom we may necessarily know. This will be especially true as domestic and international tourism begins to re-open. In these scenarios, the Exposure Notification system, and interoperability between public health authority apps, will become increasingly vital to the operation of an effective contact tracing system.

In short, digital contact tracing may prove to be key to the safe re-opening of the tourism sector and enable users to easily and securely be contact traced across borders.


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

The year of living differently: reviewing The Knowledge Exchange blog in 2020

2020 has been a year like no other. A microscopic virus – 10,000 times smaller than the width of a human hair – has dominated, disrupted and redefined the way we live and work.

Although the pandemic is primarily a public health emergency, its effects have been felt in all areas of public and social policy, from economic development and employment to transport and the environment. Throughout this year, our blog has reflected on the impacts of the coronavirus and the restrictions introduced to prevent its spread.

The COVID-19 knock-on

While the coronavirus pandemic has dominated the news headlines, it has also obscured the knock-on effects on the NHS. In October, we reported on the impacts of delays to preventative healthcare measures, such as screening and routine medical care in the form of pre-planned operations for long-term chronic and non-urgent conditions.

As the blog post noted, the impacts have been wide-ranging, including not only delays in care for case of physical ill health, but also for those seeking treatment for mental health conditions:

“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.”

The ‘hidden epidemic’

Long before the coronavirus pandemic, domestic violence had become known as a ‘hidden epidemic’ in the UK. In September, our blog highlighted the unintended consequences of quarantine for domestic abuse victims.

After the UK entered lockdown in March, calls and online enquiries to the UK’s National Domestic Abuse line increased by 25%. Three-quarters of victims told a BBC investigation that lockdown had made it harder for them to escape their abusers and in many cases had intensified the abuse they received.

Despite additional government funding, the local authorities and charities which support victims of domestic violence have been struggling with the financial fallout from the pandemic. Even so,  important partnerships have been formed between local government, educational institutions and third sector bodies to provide safe spaces for women and their children fleeing violence. Among these was an initiative at the University of Cambridge:

St Catherine’s College formed a partnership with Cambridge Women’s Aid to provide over 1000 nights of secure supported accommodation during the lockdown period.

‘Same storm, different boats’

As the recent Marmot review has stressed, the coronavirus 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, such as the growth of precarious employment among sections of the population.

In July, we looked at the uneven economic impact of the pandemic, focusing on the heavy price being paid by young people, women, disabled people and Black and Minority Ethnic (BAME) communities.

Women often work in the frontline of care services and have had to juggle childcare during lockdown. BAME communities are over-represented in key-worker jobs, and so were particularly vulnerable to coronavirus.

And although there has been much talk about ‘building back better’, our blog post drew attention to the observations of Dr Sally Witcher, CEO of Inclusion Scotland during a Poverty Alliance webinar:

“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.”

The impacts of a pandemic

Many other aspects of the impact of COVID-19 have been covered in our blog:

  • How housing providers have embraced the fluidity of an emergency situation, including tackling homelessness, engaging effectively with tenants and addressing mental ill health.
  • Digital healthcare solutions for those with coronavirus and for the continuity of care and day-to-day running of the NHS.
  • Creating and managing a COVID-secure workplace.
  • How COVID-19 is changing public transport, including an acceleration towards contactless payment and mobile ticketing.
  • The additional challenges of the pandemic facing autistic children and young people.
  • The impact of the coronavirus restrictions on the arts.
  • The role of green new deals in tackling climate change and economic inequality as part of the post-Covid recovery.

Beyond the virus

Although the pandemic has been at the forefront of all our minds this year, The Knowledge Exchange blog has also taken the time to focus on other important issues in public and social policy:

We’ve also taken advantage of the ‘new normal’ experience of remote working to join a number of webinars, and to report back on the observations and ideas emerging from them. Most recently, our blogs have focused on a series of webinars organised by Partners in Planning, which included contributions on how the planning system can help address climate change.

Final thoughts

The health, economic and social impacts of the pandemic are likely to be long-lasting – restrictions on travel, work and socialising will continue into the spring, and insolvencies and unemployment numbers are likely to rise. And the continuing uncertainty over the UK’s new trading relationship with the European Union will generate additional challenges.   

But, as a frequently difficult, often challenging and sometimes distressing year draws to a close, there is cause for optimism about 2021. Vaccines to prevent the spread of the virus have been developed with lightning speed. Across the UK people are already being vaccinated, with greater numbers set to receive the jab in the coming months.

Here at The Knowledge Exchange, we’ll continue to highlight the key issues facing public and social policy and practice as we move towards the post-Covid era.

Season’s greetings

It’s with even greater meaning than ever before that we wish all our readers a happy Christmas, and a healthy, prosperous and happy new year.

Best wishes from everyone at The Knowledge Exchange: Morwen, Christine, Heather, Donna, Rebecca, Scott, Hannah and James.


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Guest post: How working from home could revitalise rust belt cities

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Michel Serafinelli, University of Essex

For years, we have been promised a work-from-home revolution, and it seems that the pandemic has finally brought it to pass. In April this year, at the height of the first wave of coronavirus, 47% of people in the UK were working from home, the vast majority of them doing so because of the pandemic. In a sense this is overdue: the work-from-home potential for UK employees is 32%; in France, Germany and Italy between 24% and 28%.

This structural transformation has the potential to at least partially undo another transformation from the previous century. With the decline of manufacturing in the United Kingdom after the 1970s, some cities – incuding Hull, Sheffield, Bradford and Stoke-on-Trent – entered a spiral of high unemployment and out-migration that has lasted to this day. This trend is echoed in other “rust belt” cities such as Saint-Etienne in France, Wuppertal in Germany and the American city of Detroit.

The rise of teleworking could end that spiral – if the right conditions are met.

The changing workplace

It’s unlikely that telework will end when the pandemic does – we will instead probably see workplaces encouraging a mix of in-office and home working. Some organisations may start asking workers to be in the office for only two to three days per week, while others may opt for a “conference model” (that is, a few consecutive days or a week per month for all employees).

This does not mean the death of big cities. London will probably stay attractive and innovative thanks to its very strong initial advantage. San Francisco and Seattle in US, Munich in Germany and Amsterdam in the Netherlands will all remain hubs for knowledge workers. Scholars believe face-to-face still rules when it comes to creativity, and such cities provide an environment that is conducive to innovation.

But rust belt areas are cheaper and can attract skilled workers to regularly spend more time there once the pandemic is over.

A busy street in Soho, London.
London will not lose its appeal. christo mitkov christov/Shutterstock

The job multiplier effect

How can formerly deprived cities thrive after the pandemic? To understand the potential for revitalisation of rust belt cities, we can invoke the job multiplier effect. This is where the presence of skilled workers helps create other jobs through increased demand for local goods and services. For example, after their day on Zoom (at home or in a local co-working space), skilled workers will want to go out. In this way they support a barista, a waiter, a chef and perhaps a taxi driver. Some will decide to renovate the house they live in, and ask a local architect. Once or twice a week they go for yoga. They may need a dogsitter when they travel.

This is not the only mechanism that could help with local revitalisation. Some of the people regularly spending more time in rust belt areas would be entrepreneurs, and we may see new business creation, as they seize new opportunities in industries such as culture, renewable energies, tourism, quality agro-food or handicraft.

In principle, therefore, our increased ability to work from home could lead to new growth opportunities.

Will it work?

But there are important caveats. Not all rust belt cities will be able take advantage of the post-pandemic world. After all, there were large differences in labour market performance after the 1970s, when the aggregate number of manufacturing jobs started to decline.

In the UK, both Middlesborough and Slough had 44% manufacturing employment in 1970. But their experience was vastly different in the three following decades, with Middlesborough employment declining by 13% per decade and Slough employment growing by 12% per decade. Places such as Norwich and Preston in the UK, Bergamo in Italy, and San Jose in the US were traditional manufacturing hubs that nonetheless performed well in the decades that followed the start of manufacturing decline in their countries.

To understand why we may see large differences across different cities again with the rise of working from home, we first have to think about differences in what economists call human capital endowments – this relates to the skills of the workforce in a particular place. For example, if locality A has a greater share of the workforce with a university degree than locality B, it has a higher human capital endowment and is more likely to recover from industrial decline.

The skill level of the workforce is important for the task of local reinvention – in our research team’s analysis of the reinvention potential for cities, we used the share of the workforce with a university degree as a proxy for this. To distribute these advantages across the board, scholars studying declining areas have called for measures aimed at boosting training and facilitating the assimilation of knowledge and innovation.

Another important challenge is the digital divide – the gap in speeds between areas with privileged access to the internet and the rest of the country. In the UK this is more than just a gap between urban and rural parts of the country – inner-city areas in London, Manchester, Liverpool and Birmingham are also left behind. A large reduction of this gap was important for job creation before COVID-19 – it should be a top priority now.

An overhead shot of a woman typing on a laptop at a table.
The UK’s digital divide affects cities too. marvent/Shutterstock

Local amenities also play a role. For skilled workers with family ties in a specific area, once they decide to regularly spend more time outside London, the choice of location is often pretty clear. For skilled workers without such ties, factors such as the cultural and recreational activities on offer in a new city become important, especially since they are used to a vibrant selection in London.

Overall, rust belt areas in Western economies face some opportunities for regeneration with teleworking, but there are also several important challenges. To maximise the potential for success, governments should consider measures that boost training, investment in high-speed broadband and improve transportation links between these cities and London.

These kinds of investments would help smaller cities such as Middlesborough, Hull and Stoke-on-Trent take advantage of the new opportunities presented by telework. Otherwise Manchester and, to some extent, other larger cities such as Birmingham and Liverpool could be the winners, among the rust belt, in the post-coronavirus work-from-home economy.

Michel Serafinelli, Lecturer in Economics, University of Essex

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


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Counting down the hours: could a shorter working week raise productivity and improve our mental health?

In 1930, the influential British economist John Maynard Keynes predicted that within 100 years the working week would have shrunk to 15 hours. He believed that as living standards rose people would choose to have more leisure time as their material needs were satisfied.

For a time, it looked as if Keynes might be right. In the post-war period, average working hours continued falling, and analysis by the New Economics Foundation has suggested that if this trend had continued we would currently have an average working week of around 34 hours.

But in the 1980s, labour market deregulation, reduced collective bargaining, and slower growth in pay for low income workers put the brakes on working time reductions.

In the UK, 74% of the workforce work an average of 42.5 hours a week. That’s longer than in any EU country, apart from Greece and Austria.

The benefits of a shorter working week

In recent years, the twin challenges of climate change and automation of jobs, along with growing concerns about mental health and work/life balance, have prompted a rethink on working hours.

For some, a shorter working week means compressing forty working hours into four days instead of five.  Others argue that a truly progressive four-day week involves fewer hours at work, with no reduction in pay.

While many employers may recoil at the prospect of paying the same wage for fewer hours, a growing body of evidence presents some strong arguments in favour of this approach:

  • Studies of working hours reductions have demonstrated increases in productivity over four days to compensate for the loss of the fifth working day.
  • Employees with reduced hours spend less time on inefficient tasks, such as meetings.
  • Fewer hours can mean less stress, greater work-life balance and increased motivation.
  • A 2020 study by Autonomy found that a four day working week could potentially reduce energy consumption for the extra non-working day by 10% and emissions intensity by 15%.
  • A shorter working week could have positive effects on gender equality.
  • Maintenance costs can be reduced if all employees are out of the office for an additional day each week.

The four-day week in practice: lessons from New Zealand

In May, New Zealand’s prime minister, Jacinda Ardern encouraged employers to consider the four-day working week as one of the ways the country’s economy could be rebuilt following the Covid-19 pandemic. She suggested that reductions in working hours could boost productivity and domestic tourism and improve work/life balance.

In fact, one New Zealand firm has already demonstrated the positive effects of a shorter working week. In March 2018, financial services company Perpetual Guardian began a two-month trial in which its 240 staff worked four eight-hour days, but got paid for five. The experiment was monitored by academics at the University of Auckland and Auckland University of Technology.

The findings from the trial showed that supervisors were able to maintain performance levels, and most teams recorded a marginal increase. Meanwhile, employees reported improved job satisfaction and a better work/life balance. In addition, many employees expressed a sense of greater empowerment in their work because of the planning discussions that preceded the trial. The success of the trial has now resulted in the four-day week being adopted as company policy at Perpetual Guardian.

The cost of cutting hours

Another working hours trial, in Gothenburg, Sweden, involved nurses in a care home being offered the chance to work six-hour shifts instead of eight, on full pay. While the trial resulted in improvements in staff satisfaction, health and patient care, the city had to employ an extra 17 staff, costing £1.4m. Critics of the scheme said the need to pump additional taxpayers’ money into the trial proved that it was not economically sustainable.

Cost is a potential stumbling block to further working hours reductions. A 2019 report from the Centre for Policy Studies (CPS) estimated that the cost to the UK public sector of moving to a four-day week would be £45 billion if attempted immediately, or £17 billion assuming generous productivity gains from shorter hours. The authors argued that such costs would require spending cuts in public services or substantial tax rises.

However, the Autonomy think tank has put the net cost of a 32-hour week at no more than £5.4 billion. Autonomy has also pointed to improvements in job quality for millions of public sector staff, the creation of 500,000 new jobs and reductions in the sector’s carbon footprint as potential benefits of shorter hours.

Burnout or rethink?

In October 2020, the 4 Day Week Campaign, Autonomy and Compass published Burnout Britain, looking at the impact of longer working hours. The report noted that over the past three years the length of the working day has increased steadily, resulting in a 49% rise in mental distress reported by employees. Women are experiencing particular pressures, with 43% more likely to have increased their hours during the Covid-19 crisis.

The report warned that beyond the coronavirus pandemic, the UK faces another serious public health emergency:

“…as well as an impending recession and mass unemployment, we are heading into an unprecedented mental health crisis”

The existing evidence suggests there’s a strong case to be made for reductions in working hours. Apart from the potential productivity gains and improvements in the quality of life, there are savings to be made in the costs of treating mental ill health caused by overwork.

Even so, government and employers will require further proof of the tangible benefits of a shorter working week before committing to permanent changes.

Crisis often accelerates change, and the Covid-19 pandemic has injected new urgency into the debate. Remote working, restrictions in the workplace and the threat of mass unemployment have demonstrated the need to reconsider the old rules that only months ago seemed set in stone.

We are still a long way from Keynes’ vision of a 15-hour week. But 2020 has shown that shining a light on previously unthinkable alternatives to our current ways of working is not only possible, but essential.


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The Covid-19 knock-on: public health and the impact of delays in non-urgent treatment and diagnosis

Since the beginning of the pandemic, concerns have been raised about the wider public health impacts of coronavirus. 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 in the form of pre-planned operations for long-term chronic and non-urgent conditions.

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. As a result, many hospitals are not working at full capacity in order to prepare for potential increases in admissions due to coronavirus or staff shortages over the winter.

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 programmes 

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, which in some parts of the UK can be as long as three years. 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.

Data released by NHS England in October 2020 showed the numbers waiting over a year for hospital treatment have hit a 12-year high, with almost 2 million patients waiting more than the target time of 18 weeks for routine care.

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.

A reluctance to visit hospitals and use primary care services

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.

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.

 

A potential future crisis for the NHS and a ticking time bomb for public health

Doctors 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 challenges of the coronavirus pandemic for the NHS will not be going away anytime soon, it is clear that it will be necessary for the NHS and other supporting services to act now to prevent a longer term public health crisis. It is critical that we not only focus on the acute care of Covid-19 patients, but also proactively manage patients without Covid-19, particularly those with time-sensitive, complex and long term conditions who are postponing their care. We must also consider the knock-on impacts of delayed diagnosis for those people who missed out on routine screening or who were unable or too afraid to visit their GP or hospital. This is important not only to sustain health and life, but to preserve hospital and NHS capacity in the future.


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Domestic violence during quarantine: the hidden crime of lockdown

Domestic violence is often described as a “hidden epidemic” within the UK. Even before Coronavirus forced the country into lockdown, support services faced funding and resourcing challenges, and many people fleeing domestic abuse already faced barriers to accessing support,  but as social distancing has become the dominant policy response to suppress Covid-19, it is clear there have been unintended consequences for domestic abuse victims which have exacerbated the challenges in providing and accessing support.

An increase in reporting of domestic violence

Figures show that calls to domestic abuse services have increased significantly worldwide during the Coronavirus pandemic. Calls and online enquiries to the UK’s National Domestic Abuse line increased by 25% after the UK entered lockdown in March 2020. More than 40,000 calls and contacts were made to the National Domestic Abuse Helpline during the first three months of lockdown; in June, calls and contacts were nearly 80% higher than usual, according to the charity Refuge, who runs the service.

An investigation by the BBC’s Panorama found that three-quarters of victims told them that lockdown had made it harder for them to escape their abusers and in many cases had intensified the abuse they received and research by a team at LSE showed that while the overall level of domestic abuse crimes (not calls) have remained stable when compared with the long-term trend, calls to the Metropolitan Police between March and July which related to reports of domestic abuse increased by 11% compared with the same period in 2019.

This same research from LSE also noted some changes in the characteristics of the cases being reported, with calls more likely to be made by “third parties”, such as neighbours, and that while abuse by ex-partners fell by 9.4%, abuse by current partners and family members increased significantly – by 8.5% and 16.4% respectively.

In early May, the government announced a £76m package to support the “most vulnerable in our society”, including victims of domestic violence and modern slavery, rough sleepers and vulnerable children. However, with many charities which support victims of domestic abuse struggling with the financial fallout from the COVID-19 pandemic and facing a significant rise in demand for their services, concerns are being raised that the availability of specialist support could be reduced, meaning people exposed to domestic abuse may not be able to access the help they need.

Local level support for vulnerable people fleeing violence

Lockdown offered an opportunity for local authorities to think about the support offered to vulnerable people, including those who were homeless due to fleeing violence.

In Greater Manchester GMCA formed partnerships early on to secure accommodation for women fleeing violence to ensure they would have a safe space. The accommodation was intended for women who are homeless or facing homelessness, including rough sleeping or in shared supported accommodation where the service was unable to meet public health guidelines regarding Covid-19. This included women experiencing domestic abuse, trauma, or contact with the justice system as well as other multiple disadvantages. The service delivery model was designed to be a Trauma Responsive Service Model in order to create a safe and secure environment for each resident and to avoid further traumatisation. The process marked a departure from how cases of female homelessness due to domestic abuse would typically have been handled pre lockdown.

Halls of residence at the University of Cambridge were also offered to homeless women and their children after students vacated them early due to the pandemic. St Catherine’s College formed a partnership with Cambridge Women’s Aid to provide over 1000 nights of secure supported accommodation during the lockdown period.

In both instances the partnerships allowed for practical and quick solutions to provide support to vulnerable women, filling the support gap some traditional routes like refuge shelters were unable to fill because Covid 19- restrictions on the mixing of households meant that homeless and refuge centres were operating with a limited capacity.

Final thoughts

People fleeing domestic violence already faced significant barriers to finding the safety offered by refuge services, even before the lockdown imposed by the Coronavirus pandemic. But we know now that the pandemic has made it harder for survivors to leave an abuser or to seek help, that their experiences of abuse were made worse by the conditions imposed by lockdown and that the circumstances gave abusers more control than ever. When the pandemic is over the majority of local services expect to see a spike in people looking to access their life-saving support, but at the same time the pandemic has threatened the sustainability of the network of services which makes up this support, many of whom were already experiencing a funding struggle.

The work being done to help support vulnerable people fleeing abuse and people facing barriers to accessing refuge is more important now than it has ever been, and continuing support from government and effective partnership working will be vital to ensuring these services continue in the future.


If you need help or support in the UK, call the national domestic abuse helpline on 0808 2000 247, or visit Women’s Aid online.

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