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:

Cities on the edge: edge computing and the development of smart cities

From Barcelona to Glasgow, across the world, a trend towards making our cities “smart” has been accelerating in line with demands for cities to become more responsive to the needs of residents. In the wake of the Covid-19 pandemic, there is a newfound urgency to ensure that the places where we live are more resilient and are able to respond to changes in behaviour. For example, the need to keep a two-metre distance from people outside of your household required cities to take action to widen pavements and deploy pop-up active transport infrastructure to prevent overcrowding on public transport.

Over the past twelve months, cities across the world have taken a variety of different actions in order to support the almost overnight transition to what has been described as the “new-normal”. In the year ahead, it’s likely we will see further changes in resident behaviour, as the vaccine roll-out enables a transition out of the public health emergency and allows for the gradual reopening of society. Cities once again will have to be ready to react to changes in how people interact with their environment. However, the extent to which people will go back to pre-pandemic behaviours is not yet clear.

Not so smart cities

The ability to monitor and analyse the ways in which people interact with cities has been heralded as a key benefit of the development of smart cities, and as highlighted above, in some ways it has never been more important. However, the way in which smart city infrastructure currently collects and analyses data tends to be relatively “dumb”, in the sense that data is sent to a separate location to be analysed, rather than occurring on the device that’s collecting it.

Due to the sheer amount of data being transferred for analysis, this process can be relatively slow and is entirely dependent on the reliability and speed of a city’s overall network infrastructure. As a result, the ability to take real-time action, for example, to change traffic management systems in order to reduce congestion, is potentially limited.  

A good example of a device that acts in this way is a smart speaker, which is capable of listening out for a predetermined wake-word but is relatively incapable of doing anything else without a network connection. All other speech after a user has said the wake-word tends to be processed at a central server, Therefore, any disruption to the smart speaker’s ability to communicate with a server in the cloud will prevent it from completing the simplest of tasks.

This is why Barclays have argued that the future of smart city development will heavily rely upon a technology known as “edge computing”, which enables data analysis to be conducted closer to smart city infrastructure, rather than being sent to a distant central server.

What is edge computing?

Put simply, the concept of edge computing refers to computation that is conducted on or near a device that’s collecting data, for example, a smart traffic light. Data collected by the device is processed locally, rather than transmitted to a central server in the cloud, and decisions can be made in real-time locally on the device. Removing the need to transmit data before any action is taken facilitates real-time autonomous decision-making, which some experts argue could potentially make our cities operate more efficiently.

Additionally, as edge computing is not reliant upon a connection to a central server, there are enhanced security and data privacy protections, which will reassure citizens that collected data is safe and makes smart city infrastructure less vulnerable to attack. However, if an attacker were to breach one part of the edge computing network, it would be easy isolate affected parts of the network without comprising the entire network.

In the near future, smart city infrastructure will be vital to enabling autonomous vehicles to navigate our cities, making security of these technologies all the more important.

Cities on the edge

An example of the application of edge computing in smart city infrastructure can be seen in the development of smart CCTV cameras. According to the British Security Industry Association, there are an estimated 4 to 5.9 million CCTV cameras across the UK, one of the largest totals in the world. Each of these cameras is recording and storing a huge amount of data each day, and for the most part, this footage is largely unused and creates the need for an extensive amount of expensive storage.

Edge-enabled smart CCTV cameras could provide a solution to this issue through on-device image analytics, which are able to monitor an area in real-time and only begin recording when a pre-determined event occurs, for example, a vehicle collision. This significantly reduces the amount of footage that needs to be stored, and acts as an additional layer of privacy protection, as residents can be reassured that CCTV footage will only be stored when an incident occurs.

Additionally, edge-enabled smart CCTV cameras can also be used to identify empty parking spaces, highlight pedestrian/vehicle congestion, and help emergency services to identify the fastest route to an ongoing incident. Through the ability to identify problems in real-time, cities can become more resilient, and provide residents with information that can allow them to make better decisions.

For example, if an increased level of congestion is detected at a train station, nearby residents could be advised to select an alternative means of transport, or asked to change their journey time. This could help prevent the build-up of unnecessary congestion, and may be helpful to those who may wish to continue to avoid crowded spaces beyond the pandemic.

Final thoughts

Over the past year, the need for resilience has never been more apparent, and the way we interact with the world around us may never be the same again. The ability for cities to monitor and respond to situations in real-time will be increasingly important, as it’s not necessarily clear the extent to which residents will return to pre-pandemic behaviours.

As a result, smart city infrastructure may be more important than ever before in helping to develop resilient cities which can easily respond to resident needs. Edge computing will act as the backbone of the smart city infrastructure of the future, and enable new and exciting ways for cities to become more responsive.


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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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Virtual reality: a game changer for mental health treatment?

Photo by fauxels on Pexels.com

Demand for mental health treatment in the UK far outstrips supply. And the outbreak of COVID-19 has forced many primary care services to think creatively not only about demand and supply, which has increased further during the pandemic, but also about delivery. GPs and community mental health teams in particular are thinking about more innovative ways to deliver remote support to people with mental health conditions, including the use of Telehealth and virtual reality (VR) platforms.

People are probably most familiar with VR in a digital gaming context, with devices like Oculus headsets offering immersive gaming experiences where players can place themselves “in the game”, but it has been suggested that integrating VR, alongside other telehealth options like apps and videoconferencing into mental health consultation and treatment could make counselling and alternative treatment options more accessible to those living and working remotely. Early research suggests that while discussions about investigating the benefits of this type of delivery of care have been accelerated by the coronavirus pandemic, researchers and practitioners were already beginning to explore how VR and Telehealth could be a tool that could be utilised more regularly in the treatment and engagement of people with mental health conditions, not just during periods where face to face contact is a challenge.

Blended treatments to help improve outcomes

Telehealth encompasses a number of different approaches and techniques, including using platforms like skype for mobile conferencing, or mobile apps to help people manage conditions and to help deliver some treatment options. It has previously been used in other areas of medicine, for example to help those with chronic conditions self-manage, with various levels of success and uptake.

One foundation embracing remote mental health support, even before the arrival of coronavirus, is Greater Manchester mental health foundation trust who use a mobile app called ClinTouch, to support people recovering from psychosis, schizophrenia and bipolar disorder. Although patients will typically see a care co-ordinator monthly, symptoms of a relapse can appear within days; with the app, users are asked how they feel a few times a day, and an alert is generated if a relapse looks likely.  Some NHS organisations have also adopted telepsychiatry – videoconferencing therapy sessions. 

Using VR for remote therapy almost takes telehealth a step further, and involves using a complete virtual environment, with the potential for this to be integrated into treatment plans, so clinicians can, for example, create a setting which looks like the inside of their office, or use virtual environments to model external scenarios that may cause anxiety to help patients practice coping techniques like breathing exercises.

One of the potential extended uses for VR and telehealth in a clinical mental health treatment setting which has emerged is its application for rural populations, or for people who are isolating because of exposure to coronavirus. However, this has raised some additional questions about the potential barriers to uptake exacerbated by digital illiteracy and poor access to digital devices, as well as the problem of poor or slow internet connections, something which will need to be considered by health boards if they decide to offer these treatment options.

Photo by cottonbro on Pexels.com

More research is needed, and is being done

While recent research has shown face-to-face therapy remains the optimal treatment method in mental health care, VR-based therapy has been found to be more effective than Skype-based or phone only counselling. The research also suggests VR-based Telehealth sessions could improve engagement, compared to phone only sessions and greatly reduce dropout rates for clients which in turn can support positive clinical outcomes. It appears the general consensus is that self-service, VR and automated technology, in the form of apps and notifications could support and augment healthcare professionals and help support the delivery of more traditional approaches.

The virtual reality lab at the NIHR-Wellcome Trust-King’s Clinical Research facility aims to improve the understanding of the mechanisms that play a role in the onset and maintenance of mental health problems. They use virtual reality environments to assess and develop treatments to improve the well-being of people with mental health problems.

Research is also being done on the specific reaction to young people of engaging with digitally driven treatment options. There are some suggestions that the delivery of digital interventions to support young people with mental health problems may help them to engage more, in part because they are more familiar with digital platforms and may feel more comfortable using them day-to-day, however there is also a suggestion that young people also prefer the feeling of “distance” and “impersonality” that a digital platform provides which can lead to some feeling more able to express how they are really feeling, compared to a face to face meeting with a clinician which can sometimes be a stressful and intimidating experience.

Where next?

So far in clinical psychology and psychiatry, the primary focus of VR has been its role in treating anxiety and stress-related disordersspecific phobiaspanic disorder, and post-traumatic stress disorder. However the disruption to face to face mental health treatments caused by the coronavirus pandemic has led to clinicians thinking even more creatively about the applications of VR and telehealth options to help support the treatment of people with a wider range of mental health conditions.

While it is clear that virtual treatments should not replace the face to face consultation in mental health treatment entirely, research suggests there is a growing role for VR and Telehealth options in augmenting face to face treatment options and that they could be offered as an option for those who are unable to attend face to face sessions. Telehealth and remote treatments are something which will continue to be explored beyond the coronavirus pandemic and could soon be integrated into practice as part of the standard delivery of mental health care and treatment.


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‘Bending the Curve’ of biodiversity loss – could Covid-19 be the catalyst for change?

dead forest pic

“The evidence is unequivocal – nature is being changed and destroyed by us at a rate unprecedented in history” (WWF)

The latest Living Planet report from the Worldwide Fund for Nature (WWF) finds that 68% of the world’s wildlife populations have been lost since 1970 – more than two thirds in less than 50 years – with the most striking result a 94% decline in tropical subregions of the Americas. The report says this ‘catastrophic’ decline shows no signs of slowing. The cause – human activity.

Until 1970, the ecological footprint of the human population was less than the rate of the Earth’s regeneration. Explosive growth in global trade, consumption, population growth and urbanisation means we are now using more of the world’s resources than can be replenished:

“To feed and fuel our 21st century lifestyles, we are overusing the Earth’s biocapacity by at least 56%.” (WWF)

The environmental impact of human activity is hardly a new topic but the numerous warnings over the years haven’t had the desired effect of changing society’s trajectory. The stark warnings from recent reports including the 2018 IPCC (Intergovernmental Panel on Climate Change) special report on the impacts of global warming, and popular programmes such as the Blue Planet II series which highlighted the devastating impact of pollution on the world’s oceans, have certainly helped heighten awareness and action has been taken across the world to address the climate emergency. Unfortunately, the progress made so far is not enough to reverse the current declining trends.

But the new report raises hope in that times of crisis new ideas and opportunities for transformation can arise and that the current Coronavirus (COVID-19) pandemic could perhaps be the catalyst for such change.

‘People and nature are intertwined’

COVID-19 has undoubtedly injected a new sense of urgency, emphasising again the interconnectedness of humans and nature. It has provided a stark reminder how unparalleled biodiversity loss threatens the health of both people and the planet.

Factors believed to lead to the emergence of pandemics – including global travel, urbanisation, changes in land use and greater exploitation of the natural environment – are also some of the drivers behind the decline in wildlife.

The report emphasises that biodiversity loss is not just an environmental issue, but also a development, economic, global security, ethical and moral one. And it is also about self-preservation as “biodiversity plays a critical role in providing food, fibre, water, energy, medicines and other genetic materials; and is key to the regulation of our climate, water quality, pollution, pollination services, flood control and storm surges.”

As well the pandemic, a series of recent catastrophic events are used to underline the intrinsic links between human health and environmental health, including: Africa’s plague of locusts in 2019 which threatened food supplies, caused by the unusually high number of cyclones; extreme droughts in India and Pakistan in 2019, leading to an unknown death toll; and Australia’s most intense bushfire season ever recorded, made worse by unusually low rainfall and record high temperatures, as well as excessive logging.

Alongside this, the “extraordinary gains in human health and wellbeing” over the past century, including reduced child mortality and increased life expectancy, are highlighted as a cause for celebration but the study warns that the exploitation and alteration of the natural environment that has occurred in tandem threatens to undo these successes.

Biggest threats to biodiversity

Clearly, biodiversity is fundamental to human life and it is vital that the drivers of its destruction are addressed; and quickly.

Drawing on the Living Planet Index (LPI), which tracks the abundance of mammals, birds, fish, reptiles, and amphibians across the globe, using data from over 4,000 different species, the report identifies the major threat categories to biodiversity:

  • Changes in land and sea use
  • Invasive species and disease
  • Species overexploitation
  • Pollution
  • Climate change

It may be surprising to learn that climate change has not yet been the main driver of biodiversity loss. In fact, globally, climate change features lower on the scale of threats than the other drivers in almost all regions. Changes in land and sea use is the biggest proportional threat, averaged across all regions, at 50%. This is followed by species exploitation at 24% with invasive species taking third place at 13%. Climate change accounts for 6% on average.

However, the report warns projections suggest the tables are set to turn with climate change overtaking all other drivers in the coming years.

But all is not lost yet. The report argues that it is possible to reverse these trends and calls for action to do so by 2030.

Bending the Curve’

This year’s report highlights findings from significant new research, the Bending the Curve initiative, which uses pioneering modelling of different human behaviour scenarios aimed at restoring biodiversity. It argues that this has provided ‘proof of concept’ for the first time that we can halt, and reverse, the loss of nature while feeding a growing population:

“Bending the curve of biodiversity loss is technologically and economically possible, but it will require truly transformational change in the way we produce and consume food and in how we sustainably manage and conserve nature.”

2020 has certainly made the whole world stop and think. And it has provided an opportunity to reset humanity’s relationship with nature. Encouragingly, there has been widespread talk of a ‘green recovery’ from the pandemic and the British public have recently backed a “fairer, greener Britain” amid concerns the government might be rushing the country back to a ‘business-as-usual’ model.

Achieving a balance with nature will clearly require systemic change, as the Living Planet report shows. In the words of Sir David Attenborough, above all it will require a change in perspective”.


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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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Skilling up: the case for digital literacy

As technology has advanced, and it has become harder to name simple tasks that have not become digitised in some form, the need for everyone in society to have a basic level of digital skills has markedly increased. From applying for jobs to ordering a coffee via an app, digital technology has undoubtedly changed the way we all go about our day-to-day lives. For those with the appropriate digital skillset, these advances may be viewed as a positive transition to more efficiently operated services. However, for those without the necessary digital skills, there is a risk that they will struggle to access even the most basic of essential services, such as opening a bank account.

Therefore, it is of no surprise that the issue of the digital skills gap is a concern for governments and businesses alike, with a recent report by the House of Commons Science and Technology Committee highlighting that the UK could be missing out on £63 billion in lost GDP each year, due to a general lack of digital skills.

The issue of the digital skills gap has never been more pronounced, as a result of the ongoing Coronavirus pandemic, where various restrictions have required us all to embrace digital technology, in order to work, learn and socialise with our friends and family.

Digital skills at work

The extent to which technology has changed the world of work cannot be overstated, with a recent CBI report stating that the UK is the midst of a fourth industrial revolution, spurred on by advancements in automation, artificial intelligence and biotechnology. Research conducted by the CBI found that 57% of businesses say that they will need significantly more digital skills in the next five years. Therefore, the workforce of the future will need to be supported to gain these digital skills, in order to gain employment and enable British business to benefit from the digital revolution.

Concerns have been raised regarding the ability of young people to access opportunities that will support them in developing transferable digital skills. Grasping key digital skills, such as the ability to navigate Microsoft Office, is undoubtedly necessary, but is no longer enough to meet the needs of employers.  

Digital literacy: the bedrock for a fourth industrial revolution

The ability to not just be able to use digital technology, but to truly understand how it works, is known as digital literacy. A report from the House of Commons Education Select Committee sets out how crucial digital literacy will be to the success of the fourth industrial revolution. The speed with which technology is advancing and changing ensures that within just a few years, digital platforms that we use today may become outdated. Therefore, it is unwise to focus on using a single platform when developing digital skills, as inevitably the platform will either gain new functionalities or become obsolete. Instead, digital skills should be developed in a way that ensures they are future-proofed and will not go to waste when the inescapable next big technological or societal change occurs.

Why do we need digital literacy?

An example of why digital literacy is important can be seen in the way in which many of us have adapted to work from home, as a result of the Coronavirus pandemic. Restrictions on face-to-face meetings forced us to consider new ways to work collaboratively and explore the myriad of platforms that facilitate video-calling, file sharing and instant messaging. Whilst we may have already had experience using existing video-conferencing platforms, such as Skype, it was clear that each organisation had to consider using new software, such as Zoom and Google Hangouts.

Many of us would never have used these software packages before and were expected to rapidly get to grips with it in real-time, and without the usual in-person back-up networks of colleagues and IT support. This highlights the importance of digital literacy: the ability to take insight gained from interacting with one digital platform and apply it to another was vital for business continuity during the initial lockdown. The ability to transfer knowledge gained from one platform to another, is vital to ensure that we harness the opportunities of digital advancements as they occur, and without the need for lengthy additional training.

Developing digital literacy

Developing digital literacy can be difficult. Research conducted by the Nuffield Foundation found that providing access to computers in schools was not enough to encourage the development of digital literacy. Instead, FutureLab advises that computers should be embedded and used across the curriculum. Ideas put forward within FutureLab’s Digital Literacy handbook, include:

  • Support children to make mistakes when using technology, allow them to create content that may not be to the high-standard we would expect and enable them to consider how they can improve the quality of their output.
  • Provide opportunities for children to work collaboratively online, e.g create a wiki or real-time document creation via Google Docs. Use this experience to highlight how anyone can make changes online, and develop critical understanding of how what we see online may not always be entirely trustworthy.
  • Harness the power of technology by going beyond the basics. Most children will be able to conduct a simple online search, then highlight ways this can be improved and advanced through Boolean search terms. Incorporate this into a lesson that discusses the value of critically assessing the value of information.

Final thoughts

Since the widespread adoption of the internet, the way we use technology has changed at an almost frightening pace. Therefore, the digital skills we all need to interact with technology must keep up if we are to truly harness the power and potential of these new advancements.

Ensuring that we are all digitally literate will enable us to take advantage of new digital platforms effectively and could potentially lead to future economic prosperity. Developing digital literacy, will not be easy, but it will be vital to ensure the future workforce have the skills they need to gain employment and play their part within the fourth industrial revolution.



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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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