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

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

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

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

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

Delays in healthcare and routine screening

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

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

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

A reluctance to visit hospitals and use primary care services

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

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

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

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A potential future crisis for the NHS

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

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

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

Where next?

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


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Covid-secure workplaces revisited: how businesses can help people get back to work

This is the first in a series of republished blog posts from The Knowledge Exchange. These articles will revisit important topics with ongoing relevance for public policy and practice, as well as for communities and wider society. The first revisited post covers the workplace, and focuses on the ways in which employers can ensure their employees can return to Covid-secure places of work. At the end of the republished article, we’ve updated the post to report on recent developments.

As well as being a public health emergency, the coronavirus (COVID-19) has had wide-reaching economic implications. It’s something of an understatement to say that it has had dramatic effects on all our working lives.

And while successive lockdowns have helped in reducing the number of COVID-19 cases, business cannot remain on hold forever. Gradually, carefully, workplaces have been reopening, and growing numbers of workers are preparing to return to their jobs in offices, shops, schools and construction sites.

In 2020, a White Paper produced by The Knowledge Exchange explained how the workplace has to change in response to the COVID-19 pandemic.

A redefined workplace

Before the pandemic, the workplace landscape was already changing. But now it is being totally redefined. Organisations of all shapes and sizes, in all sectors, are facing hard decisions. And how to reopen their workplaces, in a way that protects the health and wellbeing of their employees, is a key challenge.

The White Paper focuses on what employers have to consider when thinking about how to reduce the spread of the coronavirus. The most important challenges concern:

  • social distancing, including areas where this is more difficult, or not possible;
  • organising the workplace, including the location of desks and the installation of additional features, such as screens and hand-drying facilities;
  • cleaning and sanitising, including what needs cleaning, who will do it and when.

As well as complying with guidance, employers have to make sure their staff are confident in the plans for reopening workplaces. A survey for the Chartered Institute of Personnel and Development in May 2020 showed that almost half (44%) of respondents were concerned about catching COVID-19 at work.

How businesses can prepare for reopening

Every organisation needs to introduce sensible measures to control risks. Therefore, before reopening a workplace, it is vital to conduct a COVID-19 risk assessment, in line with guidance from the Health and Safety Executive.

A risk assessment should:

  • identify what work activity or situations might cause transmission of the virus;
  • think about who could be at risk – paying attention to whether the people doing the work, or those they live with, are especially vulnerable to COVID-19;
  • decide how likely it is that someone could be exposed;
  • act to remove the activity or situation, or if this isn’t possible, control the risk.

During the risk assessment, it’s essential  to consult with workers and afterwards to share the results. Different industries and sectors may require specific measures. On construction sites, for example, access between different areas may need to be restricted, and high traffic areas may have to be regulated to maintain social distancing. The UK government has published guidance covering a range of different types of work in places such as offices, factories, shops and outdoor working environments.

Actions to make the workplace COVID-secure

The UK government and the Scottish, Welsh and Northern Ireland devolved administrations have provided guidance on how to work safely. This gives practical advice on how the guidance can be applied in the workplace.

In planning to reopen their workplaces, every organisation should translate this guidance into the specific actions it needs to take, depending on the nature of their business. At the same time, employers must also ensure that everyone in the workplace continues to be treated equally. Discrimination against anyone because of a protected characteristic, such as age, sex or disability is against the law, and employers also have particular responsibilities concerning disabled workers and new or expectant mothers.

The White Paper contains a checklist of actions which all organisations need to take. These include

  • developing cleaning, handwashing and hygiene procedures;
  • helping people to work from home;
  • maintaining social distancing;
  • managing transmission risk where social distancing is not possible.

CAFM Explorer: an invaluable support tool for getting back to work

Much of the workload involved in ensuring a safe and effective return to work will be taken on by facilities managers. Keeping workplaces clean, managing shift patterns, ensuring availability of personal protective equipment and creating procedures for inbound and outbound goods are just some of the many considerations to be made.

The White Paper highlights the value of the CAFM Explorer software solution to help organisations manage and consolidate information on the vital elements of a COVID-secure workplace, such as one-way systems, desk spacing, cleaning, staggered hours and hand sanitising stations.

Developed by Idox, a trusted supplier of digital software and services, CAFM Explorer can also trigger work orders as a result of an action – for example, ensuring a desk is cleaned once it has been booked – as well as providing processes to support working at home.

Final thoughts

It is too early to say what lasting effects the coronavirus will have on UK society and business, but it’s likely we will all be living in the shadow of COVID-19 for the foreseeable future. It’s essential, therefore, that organisations make themselves aware of the steps necessary for preparing, implementing and managing the Covid-secure workplace.

To receive your free download of the Getting Back to Business White Paper, please visit the CAFM Explorer page or email marketing@idoxgroup.com.

What happened next

When this blog first appeared, in June 2020, lockdown restrictions in the UK were being lifted, and there were signs that more people who had been working remotely were ready to return to their usual places of work. However, in the autumn the emergence of a more infectious strain of the coronavirus – the Delta variant – forced governments to reimpose restrictions. For most of 2021, many people have continued to work from home, although this benefit has not been available to people working in key sectors such as health, public transport and retail.

The development of vaccines to prevent the worst effects of Covid-19 has resulted in governments again relaxing restrictions. Although, the guidance on returning to work from the administrations in England, Wales, Scotland and Northern Ireland may differ, the increasing numbers of people who are double-vaccinated indicates that by the end of 2021 more people will have returned to their usual place of work, at least for some of the working week.

While some employers are urging their staff to return to the workplace, others are stressing that no pressure is being put on their workers to go back to the office right away. In the United States, some employers may be planning to cut the pay of those who continue to work from home, while others are trying to lure their workers back with incentives. At the same time, as the UK government’s furlough scheme comes to an end, many employers must consider whether they can continue to employ their workers, or make them redundant.

It’s now clear that the Covid-19 virus will be part of our lives in the long term. What’s not yet clear is how we can learn to live and work with it. So, the guidance on returning to the workplace that was highlighted in our original blog post and our White Paper still stands. And the CAFM Explorer solution remains an important tool in ensuring that, when the time is right, people can return to their workplaces safe in the knowledge that they are Covid-secure.


Further reading: articles on employment and the workplace from
The Knowledge Exchange blog

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The Knowledge Exchange remains open for business and continues to provide current awareness and enquiries services to our clients. If you have any questions, please get in touch.

How have health librarians been responding to the Covid-19 pandemic?

The impact of the coronavirus pandemic over the past 18 months has highlighted the vital role of information and knowledge services in supporting health and social care, public health, and medicine.

Last month’s Annual CILIPS Conference included a presentation about #HealthLibrariansAddValue – a joint advocacy campaign between CILIPS and NHS Education for Scotland (NES) which aims to showcase the skills of health librarians and demonstrate the crucial role of health libraries.

Library and knowledge services in the health sector have faced increased pressures and a multitude of challenges throughout the pandemic as they have continued to develop and deliver vital services and resources to colleagues under unprecedented restrictions and changed working practices. With the demand for trustworthy and reliable health information higher than ever, it is clear that well-resourced, coordinated and accessible knowledge services are essential.

Supporting the frontline

Throughout the pandemic, the work of health librarians has been vital in supporting frontline workers including doctors, nurses, pharmacists, and social workers. Hospital library services have been directly involved in medical decision-making, providing evidence and resources to support patient care and the training of medical staff. As the information needs of the medical workforce have changed through the course of the pandemic, health libraries have had to be fast and flexible to provide time sensitive and urgent information to those on the frontline.

A project undertaken by the NHS Borders Library Service saw the creation of a new outreach service for local GPs, which involved the delivery of targeted current awareness bulletins, resource lists, and Covid-19 research updates, all of which directly informed the provision of primary patient care and helped to keep GPs up to date on emerging knowledge about the coronavirus.

Health Education England’s (HEE) Library and Knowledge team adapted their services to meet changing workplace needs, ensuring 24/7 access to digital knowledge resources, gathering evidence on how to keep staff safe while working, and developing training programmes to support virtual working practices for healthcare staff.

Supporting decision-making across sectors

Health librarians have played a major role in informing the UK’s pandemic response at a national level, aiding public health decision-making and facilitating partnership working across sectors.

Librarians from Public Health Scotland’s (PHS) knowledge services have worked closely with PHS colleagues to coordinate Scotland’s response to the pandemic. Their work included the creation of daily Covid-19 updates for PHS’ guidance teams, distributing the latest and most relevant research on key topics, and adapting these updates in line with PHS’ changing priorities (for example as their focus shifted from virus transmission to vaccine efficacy). Librarians at PHS have also been involved in creating evidence summaries to support specific Covid-19 research projects, such as an investigation into the relationship between Covid-19 and vitamin D. The evidence gathered by knowledge services helped PHS to formulate their response on the issue and make national recommendations relating to vitamin D intake.

On 12 July 2021, PHS launched their Covid-19 research repository, which is managed and maintained by the library team and collects, preserves, and provides access to Scottish Covid-19 research. This project aims to support policymakers, researchers, and the public by bringing together Scotland’s Covid-19 research in one place and making it easily accessible for all who need it. It is also aimed at reducing duplication of effort, which health librarians had recognised as a concern during the pandemic.

Similarly, Public Health England (PHE)’s library aimed to tackle the duplication of effort across England by creating their ‘Finding the evidence: Coronavirus’ page which gathers emerging key research and evidence related to Covid-19 and makes it accessible in one place. Many resources on the site are freely available and include a wide range of resources including training materials, and search and fact checking guidance.

Health libraries have also been informing decision-making across the social care and third sectors, with NES librarians facilitating digital access to research and evidence via the Knowledge Network and Social Services Knowledge Scotland (SSKS), and providing training and webinars to help users make the most of such services. NES librarians have been involved in partnership working with organisations such as the Care Inspectorate, SCVO, and Alliance.

Keeping the public informed

A key challenge for health librarians during the pandemic has been in dealing with the information overload and spread of harmful misinformation around Covid-19.

Library and information professionals have had a key role to play in providing trustworthy information to patients and the public, helping people to make informed choices about their health and wellbeing. As previously mentioned, librarians have helped agencies like PHS to deliver clear, meaningful, and authoritative guidance to the public, as well as making up-to-date and reliable Covid-19 research centralised and widely accessible to the public.

The World Health Organization (WHO) emphasises the importance of health literacy in enabling  populations to “play an active role in improving their own health, engage successfully with community action for health, and push governments to meet their responsibilities in addressing health and health equity”. Health librarians have been at the forefront of efforts to promote and improve health literacy during the pandemic.

NES’ knowledge services have been delivering training and webinars to health and social care staff on how to improve people’s health literacy, and health librarians working with HEE have created targeted Covid-19 resources for specific groups such as older people and children and young people.

Final thoughts

Clearly, the work of health librarians has been crucial to the UK’s pandemic response and recovery so far, and advocacy campaigns like #HealthLibrariansAddValue are central to highlighting this important work and demonstrating its impact.

Looking forward, it is clear that innovative and high-quality knowledge services will be essential in a post-pandemic world as they continue to aid recovery, promote health literacy and support the health and social care workforce. As set out in HEE’s Knowledge for Healthcare framework, investment is required at a national and local level to build expertise and support the digital knowledge infrastructure which will be required.


Further reading: more on health from The Knowledge Exchange blog

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

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

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

The same storm but different boats 

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

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

Key findings from the research include: 

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

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

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

A new-found appreciation for the sector 

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

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

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

Supporting the sector to move forward

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

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

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


GrantFinder and the Knowledge Exchange are part of Idox Funding and Information Services.

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Levelling up: can charities get a piece of the action?

Horizon Europe goes live

Horizon Europe goes live

Horizon Europe is finally a reality. After months of false starts, soft launches and stalled negotiations, 22 June saw hundreds of funding calls published on the European Commission Funding and Tenders Portal. Researchers, institutions and other organisations can now access the seven-year, €95.5 billion research and innovation programme.

Horizon Europe is the ninth European Research and Innovation Framework programme (2021-2027). In the wake of the COVID-19 pandemic, it is one of the key instruments of the European Union’s efforts to steer and accelerate Europe’s recovery, preparedness and resilience.

The initial work programme covers the period 2021-2022 and consists of €14.7 billion in funding, which will be allocated based on competitive calls for proposals.

Around €5.8 billion in total will be invested in research and innovation to complement the European Green Deal and the EU’s commitment to become the world’s first climate-neutral continent by 2050. Supporting the EU’s goal of making the 2020s ‘Europe’s Digital Decade’, core digital technologies will receive around €4 billion over 2021-2022. Finally, direct investments of around €1.9 billion will be made towards helping repair the immediate economic and social damage brought about by the COVID-19 pandemic.

Mariya Gabriel, Commissioner for Innovation, Research, Culture, Education and Youth, said:

“With 40% of its budget devoted to making Europe more sustainable, this Horizon Europe work programme will make Europe greener and fitter for the digital transformation. Horizon Europe is now fully open for business: I would like to encourage researchers and innovators from all over the EU to apply and find solutions to improve our daily lives.”

Associated Countries: UK in, Switzerland out

Although the European Commission has yet to secure final agreements with non-EU countries on participation in Horizon Europe, a 17 June document revealed a list of 18 countries where association negotiations are ‘being processed or where association is imminent’.

The 18 provisionally associated countries are: Albania; Armenia; Bosnia and Herzegovina; Faroe Islands; Georgia; Iceland; Israel; Kosovo; Moldova; Montenegro; Morocco; North Macedonia; Norway; Serbia; Tunisia; Turkey; Ukraine; and the United Kingdom.

Most notably, while the UK is in, Switzerland has been excluded. Reports cite Swiss government officials as saying the European Commission did not give any notification of its intention to exclude the country from provisional access to Horizon Europe.

Writing on Twitter, Senior Policy Officer at the League of European Research Universities (LERU) Laura Keustermans described the move as not only bad news for Switzerland ‘but also very bad news for everybody involved in EU Research and Innovation’. LERU President Kurt Deketelaere also responded, urging the Swiss Government to work to gain access for the Swiss research and education sector, ‘which benefited greatly from association to EU programs in the past’.

UK Research and Innovation (UKRI) is urging researchers to start applying for Horizon Europe funding, with UK researchers and companies eligible for all Horizon Europe calls, apart from applying for equity funding from the European Innovation Council (EIC). The UK will also have to reach agreement with the Commission on rules for participating in sensitive projects in quantum and space technologies.

Free events mark programme launch

To mark the official opening of Horizon Europe, the European Commission arranged two free-to-air conferences for all citizens and stakeholders.

The European Research and Innovation Days, the Commission’s annual flagship Research and Innovation event, was held on 23-24 June. Policymakers, researchers, innovators, and other stakeholders took part in over 70 sessions and workshops to discuss the future European research and innovation landscape. Sessions included ‘tips and tricks’ for writing Horizon Europe proposals; an overview of the Commission’s Funding & Tenders Portal; discussions over lessons learnt from the COVID-19 pandemic; and an overview of the Africa Initiative in Horizon Europe. Recorded sessions from the event can be accessed via the event platform.

Running from 28 June to 9 July, the Horizon Europe Info Days will provide an in-depth overview of some of the main funding channels provided under Horizon Europe. The sessions will specifically focus on the six Clusters under Pillar II – Global Challenges and European Industrial Competitiveness, ­as well as the Marie Skłodowska-Curie Actions, Research Infrastructures, and Widening Participation and Strengthening the ERA (European Research Area) strands of Horizon Europe. With the exception of the Cluster 3 – Civil Security for Society session on 30 June, the event is open for participation without prior registration, and attendees will have the opportunity to ask questions, find out what is new in Horizon Europe and obtain further details about how the programme will operate. Interested parties can access the event’s online portal here.


ResearchConnect: the essential source of research funding information

This post was written by our colleagues in ResearchConnect, a specialist research funding database built for and designed by the international research community.

ResearchConnect’s up-to-the-minute database covers all of the key research disciplines and is updated by an expert team who monitor and report on a wide range of funding sources including charitable trusts, government, research councils, foundations and corporate sponsors. The ResearchConnect team maintains regular contact with funding administrators and policy managers across a wide range of sources, providing advance notice of new funding opportunities and policy changes.

For more information, visit the ResearchConnect website.

Fair and flexible labour market: building back better

Much has been reported on the recovery from the pandemic and how things can be ‘built back better’ but what about those groups that have been disproportionately affected?

Recent research has highlighted the unequal impacts the pandemic has had on particular groups within the labour market.  From the lowest paid to part-time workers and women, research has considered how things could be moved forward so that those that have borne the brunt of the economic impact are not left behind. In this blog, we take a look at some of these publications, each of which highlights the need to create a fairer and more flexible labour market.

Low paid workers: new settlement needed

The Resolution Foundation’s latest annual Low pay Britain report has warned that the low paid are at greatest risk of becoming unemployed once the furlough scheme ends in September.

Despite the positive backdrop for low paid workers in the run up to the crisis with a fast rising minimum wage following the introduction of the National Living Wage (NLW) in 2016 – which has driven the first sustained fall in low pay for 40 years – the Covid-19 crisis has adversely affected the low paid to a much greater degree than the higher paid. The research showed that workers ranked in the bottom fifth for pay were three times more likely to have lost jobs, hours or have been furloughed than the top paid fifth. Low paid workers are also more likely to work in the sectors most impacted by the pandemic – hospitality, leisure and retail.

As the economy reopens, however, so too do the sectors most restricted over the past year which improves the prospects for low paid workers. Indeed, they are now returning to work fastest. In April alone, almost a million workers came off furlough – more than half of them employees in hospitality, leisure or retail.

But while the report highlights the positive prospects for the low paid, it also addresses several key issues that policy makers will need to consider if the low paid are to benefit from the recovery. Major risks for the low paid are identified:

  • higher unemployment
  • decreasing job security
  • infringements of labour market rights

It argues that low paid workers’ relative unemployment risk after the pandemic is likely to be particularly high given the possibility of structural change concentrated on low paying sectors. And if unemployment rises, it is noted that job quality and infringements of labour market rights are likely to deteriorate.

The Resolution Foundation calls for a new settlement for low paid workers, arguing that “policy makers must look beyond the minimum wage – to job security and labour market regulation – for ways to ensure it’s a recovery that benefits low paid workers”.

Part-time employees: must be included in the recovery

As we move towards the end of restrictions and of the furlough scheme, cracks have also started to emerge for part-time workers, who have been “clinging on in a volatile labour market” according to recent analysis by the Timewise Foundation.

This report notes that part-time employees are one demographic that hasn’t had the same level of scrutiny in the literature as other disproportionality affected groups.

The experience and outlook for part-time employees appears “particularly bleak” according to the report. Despite the furlough scheme being effective in protecting millions from unemployment, it is argued that it is actually masking significant challenges – most notably for part-time workers. The disproportionate impact on part-timers has seen them face higher levels of reduced hours and redundancy. They are also less likely than full-timers to return to normal hours and to hang on to roles during lockdowns.

Evidence shows 44% of part-time employees who were away from work during the first lockdown continued to be away from work between July and September 2020, when restrictions began to temporarily ease. This compares to 33.6% of full-time employees.

The majority (80%) of part-time workers also do not want to work more hours but as Timewise data shows, only 8% of jobs are advertised as part-time – “simply too big a problem to ignore”.

In response to the analysis, a vision for change is set out, focusing on creating a fair and flexible labour market that will:

  • support those in everyday jobs to access flexibility
  • help the millions of people who want or need to work flexibly to find flexible opportunities
  • remove some of the barriers to support those trapped in low-paid work and unable to progress

Women: promoting a gendered recovery

Women have also been disproportionately affected in the labour market, particularly as they are often employed in low-paid and part-time jobs within shutdown sectors such as hospitality and retail, which are notoriously characterised by job insecurity.

This was highlighted in a recent briefing paper by Close the Gap and Engender which looked at the impacts of Covid-19 on women’s wellbeing, mental health, and financial security in Scotland. The paper confirms pre-existing evidence that women have been particularly affected by rising financial precarity and anxiety as a result.

The closure of schools and nurseries and increased childcare disproportionately affected women’s employment and women’s propensity to work part-time places them at greater risk of job disruption. The data shows that young women and disabled women are being particularly impacted by the pandemic.

Key findings include that women are more likely than men to be receiving less support from their employer since the first lockdown, and were significantly more likely than men to report increased financial precarity as a result of the crisis – this was particularly the case for young women and disabled women. Timewise points to the potential for this to add to a growing child poverty crisis.

Similarly to the above reports, which call for the specific affected groups to be included in any future employment strategy, this report concludes by highlighting the importance of a gender-sensitive approach to rebuilding the labour market and economy.

Final thoughts

While furlough has undoubtedly protected many within those groups who have been disproportionately affected by the pandemic, this is only temporary and as all three reports above suggest, these groups are at greatest risk of unemployment and job insecurity when the scheme finally ends.

The research clearly calls for a fairer and more flexible labour market with stronger and better rights for all workers. Failure to address this in the attempt to build back better will only serve to increase the inequalities that already exist in the labour market.


The reports highlighted in this blog post have recently been added to The Knowledge Exchange (TKE) database. Subscribers to TKE information service have direct access to all of the abstracts on our database, with most also providing the full text of journal articles and reports. To find out more about our services, please visit our website: https://www.theknowledgeexchange.co.uk/

Further reading on employment issues from The Knowledge Exchange Blog:

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

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

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

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

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

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

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

Mental health

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

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

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

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Structural reform

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

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

Digital transformation

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

Final thoughts

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

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

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


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

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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

Are ‘dark stores’ bringing some much needed light to the high street?

As we pass the first anniversary of the initial lockdown and look towards opening things up again, will we see a change in footfall trends in favour of the high street as people yearn to get out again, or will it continue to experience a downward trend?

Judging by pre-pandemic trends, it would seem that high street businesses will need to do more than just open back up to entice people back to the high street. Indeed, there were signs of diversification on the high street before the pandemic in response to declining footfall. And the pandemic has led to many more innovating to survive the current challenges, such as creating pop-up ecommerce centres. Perhaps such moves could help save the high street, albeit not as we know it.

A downward trajectory

The recent news of permanent closures of big-named high street stores such as Debenhams, Laura Ashley, Top Shop and Dorothy Perkins after the collapse of Arcadia Group, and the closures of more John Lewis outlets, suggest a bleak outlook for the high street. And the pandemic has spurred the worst decline on record.

Recent figures from PwC reveal that an average of 48 stores, restaurants and other leisure and hospitality venues closed every day in 2020 – a total of more than 17,500 outlets.

This may be the worst decline on record but it is also a continuation of the downward trajectory that the traditional high street was already on. And it has been argued that this is actually a reflection of things that happened pre-pandemic, with its full impact ‘yet to be felt’.

In its quarterly footfall monitor, the British Retail Consortium highlighted in May 2019 that high street footfall had fallen by 1% year-on-year and that vacancy rates on local high-streets had risen to 10.2%, equivalent to one in ten shops having succumbed to the high street crisis. This was the highest vacancy rate in four years and it continued to increase in the next quarter.

Support through a crisis

It has become clear that trends before the pandemic have just been accelerated by it. The continued growth in online shopping and the impact of government policy costs such as business rates are just a couple of the causes of the decline in high streets over the years that see little sign of abating. But the urgency of the current situation has seen a huge increase in government support across the board which has helped many businesses stay afloat as they try and wait out the storm.

In December 2020, the UK government announced it would invest up to £830 million from the Future High Streets Fund in local high streets across England to help them recover from the pandemic and drive long-term growth.

In September 2020, funding was secured for England’s historic high streets through the £95 million government-funded High Streets Heritage Action Zone (HSHAZ) programme, which is delivered by Historic England. The aim of this is to help transform and restore disused and dilapidated buildings into new homes, shops, work places and community spaces, restoring local historic character and improving public realm.

And just this month, the government has announced a series of new measures to support a safe and successful reopening of high streets and seaside resorts, including a £56 million Welcome Back Fund to help councils boost tourism, improve green spaces and provide more outdoor seating areas, markets and food stall pop-ups. This builds on the £50 million Reopening High Streets Safely Fund announced in May 2020. Similar support schemes have been introduced by the devolved administrations in Scotland, Wales and Northern Ireland.

Of course, this hasn’t been enough to save the high street stores that have announced closures. But it brings to the fore once more that high streets are about more than just shops as each funding programme highlights the aim of transforming high streets into vibrant mixed-use places where consumers can enjoy social experiences.

Adapting to survive – dark stores bringing light to the high street

As the PwC study suggests, it is really about keeping up with consumer behaviours that is the challenge for retail, perhaps even more so in times of crisis. And there have been many examples of high street retailers adapting to survive.

With the huge increase in online shopping during the pandemic, many manufacturing and distribution centres were operating at maximum capacity which led to some retailers unlocking the potential of their local high street stores to provide local distribution hubs, known as ‘dark stores’.

Lush is one company that changed the way they used their retail space so they could continue to use it while their stores were closed. It created Lush Local, a pop-up e-commerce centre which used the shop as a local distribution centre so they could fulfil local orders and not let their current stock go to waste.

Some businesses have also partnered with others to make use of local unused space such as Crosstown Doughnuts which have been trialling the use of dark stores in Cambridge and Walthamstow, partnering with independent operators so it can provide on-demand deliveries and collections to customers.

As ‘bricks and mortar’ retailers try to adapt to support their online capability, providing efficient local deliveries, at the same time as utilising their physical retail space, the ‘dark store’ trend may be here to stay. Pre-pandemic, it was reported that using dark stores and offering click and collect can reduce delivery costs and increase profit margins. Analysis showed that if deliveries from dark stores increase by 50%, profit margins could grow by 7% as a result of lower delivery costs and higher delivery throughput compared to conventional stores (while also not affecting store operations).

And it has been suggested that this model can be further adapted to provide ‘hybrid stores’ as shops re-open. These hybrid stores enable local stores to combine space for their fulfilment centre with their physical shop so consumers can still benefit from the tangible experience offered in store that can’t be replicated online.

Final thoughts

Only time will tell if recent innovations will have the desired effect. What is clear is that the rate of change cannot continue at the pace it was before the pandemic if high streets are to have a fighting chance. Dark and hybrid stores could be part of the answer. But much more is needed.

The most successful high streets, it is argued, will offer a mix of retail, entertainment, culture and wellbeing as they focus on the experiential side of things, because, in the words of retail guru Mary Portas, “vibrant, innovative, socially dynamic high streets will help this country not just heal, but thrive.”


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