Community solidarity, economic division: the story of a year
In many ways communities and individuals have shown extraordinary resilience over the past year, but, writes Janet Sillett, the key story has been the brutal exposure and exacerbation of a myriad of social and economic inequalities. Where do we go from here?
This article is part of a week of reflection on the past year and what it has meant for individuals, communities and local government Unlocked: local stories from a global pandemic.
Predictions March 2020
“Coronavirus will affect everything local authorities do – as community leaders, public health authorities, education authorities, employers, partners with other public, voluntary and private sector actors, and service deliverers.” (LGIU Briefing 17 March 2020).
This prediction was completely correct. But did we really believe that a year later we would be where we are now: with the series of lockdowns, tiers and new variants? I doubt it. But it was also not foreseen that vaccines would be developed and rolled out so quickly – the situation is both worse and better than envisaged – a Schrodinger’s Cat pandemic.
The briefing also spelled out how critical local government was going to be in managing this sudden crisis – as authorities responsible for local public health, partners in local resilience bodies and as community leaders.
The themes highlighted in the briefing have all been prominent over the last year in England and in Scotland, and especially for local government, the difficulties of the relationship with central governments. Even as early as March last year, with the first English lockdown about to start, there were concerns that there had been little recognition by the UK government of the role of local authorities.
The briefing also recognised what was to become a dominant and disturbing story over the next year: that although the impact of Covid-19 will affect all of us “it must be the case that some groups and individuals could face greater hardship than others. The recent report on health inequalities and the Marmot Review ten years on may have to be revisited in the months and years after the pandemic is over”.
Our first Covid-19 briefing ended with this: “local government will be at the centre of what is going to be a very challenging time for individuals, the economy and democracy itself”. “Very challenging” has proven to be an understatement.
For me, the key story of Covid-19 has been the way it has brutally exposed existing social, health and economic inequalities and that these will have been made worse over the last year.
Covid-19 has laid bare a myriad of existing inequalities. The House of Commons Women and Equality select committee has been examining the impact of the pandemic on different groups. Many organisations, thinktanks and charities have been monitoring disparate impacts on individuals, groups, communities and places. The same groups have fared the worst in many countries. A large number of factors interrelate in determining the impact of the crisis – for individuals, factors like access to green space, technology (especially for children), type of employment and the ability to work from home, gender, existing disability and ill health, housing conditions, immigration status, and race.
Covid-19 has brought to wider consciousness inequalities in areas from healthcare to technology and they are manifested in many ways, from ethnicity to income, disability to job status. Covid-19 has thrown socio-economic inequalities into sharp relief. As early as April 2020 the impact on disadvantaged groups was becoming apparent – we were (and still are) facing two crises – the public health crisis and the economic and social crisis.
The Health Foundation, which is an LGIU member, launched its Covid-19 impact inquiry last October. It is exploring the pandemic’s implications for health and health inequalities, how people’s experience of the pandemic was influenced by health and existing inequalities, as well as the likely impact of measures to control the virus on people’s health and wellbeing.
But there is already evidence of the health and wellbeing of impact of Covid-19. Those already facing the greatest disadvantages in society have had a higher risk of exposure to Covid-19, and existing poor health puts them at risk of more severe outcomes if they contract the virus. The government’s and wider societal measures to control the spread of the virus and save lives now (including the lockdown, social distancing and cancellations to routine care) are exacting a heavier social and economic price on those already experiencing inequality.
The deaths from the virus have shown a clear link between income and death rates, with higher deaths in the most deprived areas. This is hardly surprising given that health outcomes are worse for those who are poor and that this relationship continues up the income scale: “Poor health is twice as prevalent for the bottom 40 per cent of people than it is among the top 10 per cent and even being in the top 10 per cent is associated with better health than being merely in the top 30 per cent.” (Health Foundation).
We also know certain occupations are more vulnerable to Covid-19. ONS data shows that men working in what are classified as ‘elementary’ occupations had the highest rate of death involving Covid-19, such as packing goods and security. The links between income and health are complex, as different factors interact with each other, but the relationship is clear enough. People on low wages are seven times as likely as high earners to work in a sector that has closed down leading to economic insecurity, and low income jobs were more likely to mean having to go to work rather than working at home, and therefore being more exposed to the virus. It was more difficult for people on low incomes to self-isolate after being in contact with someone with the virus. Poorer people were less likely to have access to gardens or were living in more crowded situations: green space helps to promote both physical and mental wellbeing. Children in low-income families had fewer opportunities to have home schooling during lockdown.
People with existing health conditions are more likely to die from Covid-19, and existing health inequalities mean that it is the already disadvantaged who are more likely to be in this group. The WHO explains that “people with disability experience poorer health outcomes, have less access to education and work opportunities, and are more likely to live in poverty than those without a disability”. For example, across the EU, less than one person out of two with basic activity difficulties is employed, according to Eurostat.
The ‘causes of the causes’ of health inequalities – the interconnected social determinants – are, according to Professor Marmot, linked to worse outcomes in Covid-19: deprivation, poverty, poor living conditions like overcrowding and poor-quality housing, pre-existing health conditions, low incomes and insecure employment. These factors have a cumulative impact on health and disproportionately affect people living in specific areas and regions, particularly the North, and on specific groups of people – particularly Black, Asian and minority ethnic groups.
The impact on Black, Asian and minority ethnic communities groups has had the most high profile exposure – in the UK, but also globally. The pandemic has highlighted the structural disadvantage and systemic discrimination they have faced.
“Throughout the coronavirus pandemic, Black, Asian, and minority ethnic (BAME) people have been acutely affected by pre-existing inequalities across a huge range of areas, including health, employment, accessing Universal Credit, housing and the no recourse to public funds policy. As the pandemic progressed, many of these underlying inequalities made the impact of the pandemic far more severe for BAME people than their White counterparts.”
(The House of Commons Women and Equalities Committee Unequal impact? Coronavirus and BAME people.)
In December 2020, the Institute for Health Equity and the Health Foundation published Build Back Fairer: The Covid-19 Marmot Review, which gave an update on how the virus is increasing existing health inequalities in England (see this LGIU briefing on the report).
Are the public in the UK aware of the unequal impacts of Covid-19? It seems that awareness varies – people are aware of issues around health and race, but not gender, according to this research by Development Engagement Lab. Ninety per cent of respondents reported awareness of Covid-19’s unequal impact on the elderly while only 31 per cent reported hearing statements about its unequal effects on women. Being aware of certain types of inequality doesn’t necessarily equate to whether people judge them as important: health inequality moved from seventh in awareness, to the second most important:
“Even more startling is the shift of racial/ethnic inequality when comparing awareness and importance. People seem to think they are very aware of racial/ethnic inequality (it ranked second after age) but when asked if it was important, ranked it last.”
Researchers at Kings College London have recently published findings that are equally disturbing. They found in a survey that nearly half of people believe those who lost their job during the pandemic were likely to have been underperforming, and it also showed a significant minority thought a widening post-Covid income gap between White people and BAME groups would not be a problem.
“This analysis throws up the complexity of people’s view about inequalities,” said Paul Johnson, director of the Institute for Fiscal Studies, which will use the research for its five-year review of inequalities. “The British public is clearly concerned about some inequalities, but also sets great store by individual responsibility.”
People care more about differences between geographical areas than races, genders and generations. In one of the starkest findings, one in eight said they think black people are more likely to be unemployed and have lower incomes because they “lack motivation or willpower”.
Of the more than 2,000 people polled, the largest number thought gulfs between geographical areas of more and less deprivation were the most serious form of inequality faced by the nation, followed by income and wealth. Less than half of people polled put racial differences in their top three or four most serious types of inequalities and less than a third included gender inequality.
Amid evidence of adverse labour market consequences for women in Britain resulting from the crisis, the study found that a third of people would not consider it a problem if inequality between genders got worse because of the crisis.
Whether these surveys are an accurate reflection of public opinion needs further research, but they do seem to pose major challenges to public policy makers, particularly in relation to race.
Central-local relationships: a testing case
Covid-19 exposed very early on the fragilities in the relationship between local and central government; flaws that largely stem from the centralising tendencies of the UK government. Clearly, governments have to take command in a crisis and this was particularly so at the beginning of this one. But many experts, both in local government and outside, would argue that there has been excessive centralisation, and a failure of the UK government (and sometimes the Scottish government) to consult and listen to local government, and it seems like there was a deliberate refusal to use the expertise and knowledge of councils and local public health teams in managing the pandemic.
The command and control approach was apparent throughout the last year in how the UK government worked (or didn’t work) with local leaders on lockdowns and the imposition of tiers. Local government leaders and elected mayors were not fully involved or consulted about new measures in their areas, and there have been a multitude of difficulties over local areas getting current and detailed local data. Indeed, the main political tensions emerged over the differences of opinion over local lockdowns, with leaders and city and metro mayors claiming they had not been involved in their development. Who will forget Andy Burnham’s speech, at St Peter’s Square, the site of the Peterloo Massacre, about the tensions between Westminster and Greater Manchester over the lockdown plans for the region?
But it is Test and Trace in England that has been the most critical manifestation of what, at times, seemed a virtual break down of the relationship between the local and the centre. The government set up a centralised system through private companies, which did not deliver. There were serious problems with testing, especially earlier on – such as failing to detect asymptomatic people and those who were unwilling or unable to be tested and issues around false negatives. Reaching contacts proved difficult. Necessary links in the chain between testing and people self-isolating were often broken. In September 2020, SAGE concluded that it was having only a marginal effect on the spread of the virus.
Yet local authorities and public health teams had the necessary expertise and experience in contract tracing but that experience was sidelined. Writing on the BMJ Opinion website, Martin McKee, professor of European Public Health at the London School of Hygiene & Tropical Medicine and a member of the UK Independent SAGE, had this to say:
“The NAO reports that “We have not seen evidence that they considered whether to make use of local authority capacity for call handling”. Worse, the ADPH and the Local Government Association reported that national bodies involved in developing the new system had not engaged sufficiently with them “on key decisions about the design of test and trace services or the practicalities of implementing these services”. The Board of what is misleadingly termed NHS Test & Trace (as the NHS plays very little role in it) had also commissioned a review of international experience which found that none of the other 15 countries studied had adopted an outsourcing model. Thus, in several important respects, there was a failure to draw on crucial evidence.”
Evidence from the Association of Directors of Public Health (ADPH) felt that the early response to the pandemic had been an NHS response rather than a public health response, and that public health had received less priority and less support. The legacy of cuts to public health funding and preventative services meant that public health had to play “catch up”. Furthermore, the UK government seemed to have a poor understanding of the role of local public health teams, resulting in an over-centralised response, disjointed communication and a failure to harness local resources.
The Public Accounts Committee have just published their report on test and trace and it is damning. Meg Hillier, the chair of the committee, said the enormous amounts spent on the scheme leaves the impression that the public purse has been used like a cashpoint.
“Despite the unimaginable resources thrown at this project, test and trace cannot point to a measurable difference to the progress of the pandemic, and the promise on which this huge expense was justified – avoiding another lockdown – has been broken, twice. British taxpayers cannot be treated by the government like an ATM machine. We need to see a clear plan and costs better controlled.” (Meg Hillier, MP)
The report highlights the missed opportunities to use local expertise:
“A range of stakeholders have queried why local authorities and NHS primary care bodies were not more directly involved in testing and tracing activities at the outset, given their existing networks, experience and expertise.”
The care home scandal
In both England and Scotland the high number of deaths in care homes has been for many the most distressing issue since the start of the pandemic. The House of Lords report into lessons from Covid-19 for public services stated that the impact of Covid-19 in the care sector was identified by many witnesses as the most significant and devastating public service failure during the pandemic.
What does the care home tragedy (if that is the right word) tell us about the state of social care in the UK, ageing and society, and the relationship between social care and the NHS?
The Association of Directors of Adult Social Services (ADASS) gave evidence that the focus on acute health services during the initial phases of the pandemic directly impacted on the social care sector. Patients were discharged from hospitals into care homes as quickly as possible, often without testing. Care providers struggled to access PPE, leaving workers and care recipients at risk of infection. The UK government’s action plan for care settings in England was not published until mid-April, a month after the action plan for health services.
The pandemic has exposed to a wider audience than the sector itself the huge challenges faced by social care and the sharp divide between the NHS and social care. The crucial role of social care in stemming the spread of the virus was never explicitly recognised. Even some supplies desperately needed in care homes (where our most vulnerable people live) were diverted to NHS facilities. Residential facilities lost professional and clinical support.
There are a myriad of reasons why there was a sharp increase in Covid-19 related deaths outside hospitals and some are due to what many commentators say are policy mistakes early on in the crisis – the early policy to discharge hospital patients back into care homes without testing and with inadequate PPE was a contributory factor in the virus spreading.
There has been criticism of a lack of transparency about data and how the data was not known at a local level. How can local health services, public health and local authorities plan and assess future demand when the data is fragmented or out of date? It was (and still is, even though the situation generally has improved) essential that local areas can see where local hot spots are occurring for example.
But social care was never going to be able to withstand the enormous shock of the virus without there being major problems, because both home and domiciliary care were fragile before the outbreak. The sector, especially in England, had little resilience to major disruption.
“After four decades of policy initiatives on integrated care, Covid-19 has exposed once again the deep-rooted differences between the NHS and social care, even though their undisputed inter-dependency will be tested to the limit in the days and weeks to come. Procurement and planning for a national, centrally managed service like the NHS will not work for social care services, which involve 152 local authorities and 18,000 independent providers. Many providers have described ‘going round in circles’ trying to procure essential personal and protective equipment (PPE) for their staff and the people they support.” (Richard Humphries, The King’s Fund)
The dire state of social care pre Covid meant the sector was battling high staff vacancies and turnover, serious financial pressures, a low paid and undervalued workforce, and being seen as very much the poor relation of the NHS. The huge commitment of those who work in social care has meant the system didn’t collapse, but it is a system that was very much at risk.
It is worth reminding ourselves of the conclusions from the House of Lords select committee report on lessons for public services from Covid-19. The committee cited many examples of public services responding swiftly and innovatively to the challenges, and of breaking down pre-existing barriers to joint working, but it also highlighted that the UK’s public services went into the pandemic with low levels of resilience due to a decade of under-investment, particularly in preventative services, leaving disadvantaged communities especially vulnerable to the virus and its economic impacts. They concluded that unless public services are fundamentally reformed, the good work achieved during the pandemic could be lost.
What happened in care homes and to test and trace is clear evidence backing up what the House of Lords report says. How many times, for example, have we heard that governments are going to fundamentally reform social care and then nothing has happened?
Community and communities are slippery words and hard to pin down. When we talk about the resilience of community during the pandemic are we referring to places, community action, community engagement? Is community about where we live; or a community of interest? Everyone defines it differently.
Yet it is fair to say that we have seen a real growth of activity in local places in response to Covid-19 and this happened from the very early days of the first lockdown. Groups based on streets or wider local areas sprang up to support neighbours who were shielding or struggling to cope in other ways. Covid-19 generated a high degree of community spirit and common endeavour.
It is also true that Covid-19 has facilitated closer and more effective relationships between communities, the third sector and local government. The sudden crisis demanded urgent action and innovation. There were new partnerships created and existing ones strengthened.
Of course this is not new – councils have been working with community groups, common interest groups and the voluntary sector for decades, sometimes with great success, sometimes not. But the unprecedented scale of the pandemic crisis necessitated in some cases fast cultural change and an unprecedented growth in community action.
Covid-19 has reflected major strengths in many communities, but it has also exposed sharp differences between and within communities, groups and neighbourhoods. Not every place will have had the necessary community strength to respond effectively.
The principles behind community involvement and action are self-evident – without engagement and collaboration how can councils understand their places. You can’t build resilience without building it from the grassroots. You can’t effectively redesign services or respond to crises without communities themselves being part of the design and the response.
However, community action shouldn’t replace the role of local authorities or other state players – and this is even more important as a principle at a time when public services are under severe pressure and life is getting harder for many as a result of the pandemic. We have seen a huge growth, for example, in food banks – which have been a lifeline for many people – but they are not a substitute for decent wages, sustainable jobs or adequate benefits. And supporting communities to act locally often requires some sort of financial support or support in kind. This will be increasingly difficult with local authorities facing growing financial difficulties.
How to work with community groups was a focus of the Place and Community pillar of the LGIU’s Post-Covid Councils project. We published an article from The Carnegie Trust, which emphasised the need for an intersectional response:
“Over the past few months, the Trust has been exploring how Covid-19 has affected the relationship between local government, public services and citizens. Early evidence suggests that the pandemic has accelerated a shift to a more agile model of delivery – moving towards one that supports people and communities to achieve positive change for themselves. More relational, creative, and showcasing strong leadership, the immediate responses from local government have demonstrated that there is a different way of working with communities.”
Black Thrive discussed how local government can collect and respond to data in ways that are centred on the perspective of communities rather than reinforcing stereotypes. They drew on their experience of developing a Community Research model, which was tested during the Covid-19 pandemic:
“Our response was to build a model that challenged the traditional research approach. It’s a way of working that gives communities the tools and resources to share their own experiences and have ownership of their data. For too long, a lack of understanding about Black people has created fear and led to misinformed “solutions” to the issues faced by our communities. With this model, communities are put at the centre of defining their own issues and creating culturally relevant solutions to tackle them at the root.”
Engaging communities, groups, neighbourhoods, and the third sector will get more critical, not less, as we go into ‘recovery’. How can the positives be built upon?
And how can those who have suffered most from the crisis be meaningfully involved in future planning? What should be the nature of the relationship between the local authority and community organisations? It is easy enough to develop strategies for consultation and co-production, but far from easy to put into practice.
It has never been easy, but Covid-19 has confronted all of us with uncomfortable realities about disadvantage, inequalities and discrimination and the need to get this right, however difficult, is more urgent than ever.
If not now, then when?
From early on in the global pandemic the idea of ‘building back better’ grew – the opportunity to rethink how society, economics and communities are organised.
But how realistic is it?
For local government, optimism comes from how it responded to an unprecedented crisis. Decisions that would have probably taken weeks or months had to be made almost immediately. Existing cultural and organisational barriers to closer partnership working with communities, the third sector and other public sector organisations were dissolved. Local networks sprang into action. Local authorities internally had to adapt fast and managed to do so in extremely difficult circumstances.
However, as we slowly emerge into recovery, will this climate of flexibility, innovation and mutual support be maintained? Will culture change endure: what works in a crisis may not work in more normal times? Beyond this there are huge difficulties and challenges facing local communities. Covid-19 has worsened the situation of many places and people that were already in a bad place. Local economies have been battered and some sectors have only survived because of external government support. Unemployment levels will be dire. There is expected to be a spike in mental health problems. We don’t yet know how serious ‘long Covid’ will prove to be. Meanwhile, the financial situation in many councils, already poor, will get worse.
Initial positivity about being able to translate what seemed like opportunities of the last year into action have somewhat dissipated. Perhaps particularly in relation to sustainability and climate change. Or maybe we are now being more real? This was reflected in a recent LGIU blog written by one of my colleagues, Kim Fellows:
“Since we launched our post-covid councils work, we have talked optimistically about a ‘new normal’ and ‘building back better’. Personally, I have attended countless virtual events talking about a green recovery and have been hopeful that the pandemic would speed the world’s response to climate change. However, while this crisis exposed the elusive magic money tree, as governments across the world continue to bail out business as usual while counting the cost of green recovery, questions remain as to whether this crisis is enough to make the change on the scale that is so urgently needed.”
The UK March budget had little to say about a green recovery.
Can we be optimistic about building back better in other areas? There is undoubtedly a sense that this has to happen – whether it is about tackling structural disadvantage, discrimination or growing health inequalities: that recovery should mean ensuring investments deliver more inclusive, resilient and environmentally friendly outcomes. But there is little consensus about how. It is possible that what will prove more successful will be where there had been new thinking before Covid struck; in local government in the UK, for example, the ideas around inclusive growth and Community Wealth Building.
There are also tensions that are not easy to work through, and this applies locally as well as nationally and globally – between, for example, long- and short-term objectives.
The pandemic has seen interconnected health, economic and social crises. As the Carnegie Trust pointed out that produces an extremely complex and intersectional set of challenges. Deciding priorities, timescales, and focus in these circumstances is not going to be easy.
At the local level, each place and council will respond differently according to their situation. It is likely there will be common themes – children and young people, for example, have suffered considerably from lockdowns – and there will no doubt be priority given nationally and locally to education, training and young people’s employment.
But we know that there have been and will continue to be very diverse health, wellbeing and economic outcomes in individual council areas, due – to a large extent – to pre Covid circumstances. Some boroughs in East London, for example, experienced the highest rates of infections and deaths in the second wave – for a variety of reasons, such as populations with existing comorbidities, poor or overcrowded housing, high levels of deprivation and poverty, large numbers of low paid jobs in catering and retail and with many residents working in jobs that can’t be done at home. The priorities of councils in the most deprived areas will be different to councils in more affluent areas, with many people able to work from home, fewer jobs lost and healthier residents (though some will have seen large numbers of deaths due to an ageing population profile). The experience of Covid-19 has made this even more true – what works in one area with certain people may not work as well with a different set of people. There are no absolutes and no one answer to every situation. Some councils may suffer from a number of factors, including their existing local economy, demographics, the level of health inequalities, or age profile.
Although it will be up to local government to lead on recovery in their places, how successful recovery is will also depend on decisions taken by national governments – on sticky issues such as reforming social care, local government finance, the future of the welfare system.
However, it is local government that better understands the importance of place and different perceptions of local identity with places. It is local government that understanding the complexities around place is essential for engaging within organisations, to challenging assumptions about engaging with communities, groups and individuals. Covid has changed some places, maybe temporarily but possibly for the longer-term. It is critical to understand what has changed, what hasn’t, and it is local government that can develop place-based initiatives to respond to the complex challenges of growing inequalities, health and wellbeing and inclusion and social cohesion.
“Whatever it is, coronavirus has made the mighty kneel and brought the world to a halt like nothing else could. Our minds are still racing back and forth, longing for a return to “normality”, trying to stitch our future to our past and refusing to acknowledge the rupture. But the rupture exists. And in the midst of this terrible despair, it offers us a chance to rethink the doomsday machine we have built for ourselves. Nothing could be worse than a return to normality. Historically, pandemics have forced humans to break with the past and imagine their world anew. This one is no different. It is a portal, a gateway between one world and the next. We can choose to walk through it, dragging the carcasses of our prejudice and hatred, our avarice, our data banks and dead ideas, our dead rivers and smoky skies behind us. Or we can walk through lightly, with little luggage, ready to imagine another world. And ready to fight for it.” (Arundhati Roy, written as part of an article for the Financial Times.)