COVID-19, Scarring and UK Priorities for 2022-23

By Geoff Mulgan with Sarah O’Meara and Rachel France

IPPO’s latest global scans of the effects of the pandemic shows that the last two years have brought the sharpest retreat in terms of human development and equality in living memory. Alongside a death toll of perhaps 18m, we know that hundreds of millions have suffered with mental health problems and just as many with stark cuts in income. While the crisis is still very much alive in much of the world – with the the arrival of the Deltacron variant and sharply rising infections in some countries – the second anniversary of the first lockdown is a good opportunity to try to make sense of what happened, what it meant, and what needs to be done next.

IPPO’s work so far has touched on many dimensions of the crisis, from the problems it revealed about the state of care for the elderly to the distrust many communities felt around vaccines, from spikes in domestic violence to the uneven impacts on women and minority groups who often bore the brunt of the crisis. We’ve looked at topics ranging from the skills challenges facing young people to the lessons from action on street homelessness.

Here we summarise research on six issues that need to be prioritised in COVID recovery plans. Many of these are less visible challenges than the very visible ones of infections, mortality and economic slowdowns. But they now need a comparable attention and energy to avoid the risk of lasting harms.

Children and Young People

The first priority is to help the many children and young people who missed out on school and lost part of their childhood. UNDP data estimates that the effective out-of-school rate has significantly increased since the start of the pandemic, with around 60% of children losing out on learning worldwide. This is the largest reversal of this indicator of human development in history. Across the UK many fell behind in terms of academic achievement (especially maths) as well as socialization and confidence.  During school closures one study found that 20% of children were doing less than two hours of home learning each day. Unequal access to technology also played a part. A tenth of primary school children were either using a mobile phone or no device at all. A large number – though it’s hard to say precisely how many – have not returned to school after the lockdowns. This summer we need a much richer offering of chances to do sports, arts and have fun alongside more traditional academic catch-up opportunities and tutoring to rebuild confidence – part of a broader rethink of what education is for.

Population Mental Health

The second priority is mental health, which suffered as a result of long periods of isolation and stress. According to the ONS well over a quarter of the population experienced ‘clinically significant’ levels of distress and the same proportion of 18-year-olds considered self-harm. From March 2020 onwards, the prevalence of anxiety and depression took a sharp rise, after remaining relatively static over the last 30 years.  Mental health remains the poor cousin of physical health in terms of spending and attention, but attention now needs to turn to strategies for population mental health, not just the most acute needs. There are now good examples of what could be done. The Australian government, for example, provided a package of mental health support measures including a 24×7 phone counselling service, job opportunities for Australians to be trained as counsellors and funding for online and peer support tools. Population mental health is the topic of an IPPO systematic review now underway.

Looking After Frontline Staff

A third priority is care for the thousands of NHS staff (and care home staff) who have borne the brunt of the crisis, many of whom now feel burnt out. According to the 2020 NHS Workers Survey, nearly half of NHS staff in England (44%) reported feeling ill as a result of work-related stress, the highest rate in the past five years. Recent research suggests that frontline healthcare workers need a range of ‘flexible’, ‘easily accessible’ and ‘consistent’ psychological support to overcome the significant mental health burden resulting from the pandemic. But to date there is little research specifically on how best to support the mental health needs of frontline workers. They need support and respite and a better deal: one extraordinary aspect of the crisis was that it revealed that many of the most essential jobs in our societies are amongst the lowest paid and lowest status, with low pay levels for nurses that has contributed to a growing staffing crisis. An IPPO rapid evidence review will be published later this spring.

Cities, Community and Social Capital

A fourth priority is to attend to community. The crisis confirmed the vital importance of community and social capital – people’s ability and willingness to help each other, whether with food deliveries, visits or emotional support. Learning the lessons from this and suggesting recommendations for the future is the focus of one of IPPO’s current systematic reviews. These everyday patterns of mutual support are likely to be changed in the long-run by shifts in the role of cities and the organisation of work, with a probable shift away from traditional five-day working in offices. Over 80% of UK workers have expressed a preference to work remotely at least one day per week. There’s been a large jump in net migration from cities prompting experiments such as free bus travel to address both the revival of city centres and moves to net zero. Research from the UK indicates that while footfall has recovered somewhat, it’s still significantly down in major cities such as London, Manchester, Cardiff and Birmingham. It’s too soon to say which places will suffer lasting ‘scarring’ effects. But it’s already clear that land-use planning may have to change radically.

Rethinking How Government Works – At Every Level

A fifth priority involves government. Government itself has been challenged by the crisis, though with very different patterns at different levels, from the UK government to devolved administrations, cities and local authorities. Some of the problems at the top were very visible, and the upcoming UK COVID inquiry is set to examine mistakes made over lockdowns and problems in the organisation of science, data and policy. While action on physical health and the economy was often rapid and effective, government did much less well in responding to the less visible issues of mental health and social harms. A particularly striking failure was the lack of coordination between the different levels of UK government, from Whitehall to the devolved administrations and local government. Other countries have well-developed systems to help them work together. These were largely lacking in the UK: fixing this now needs to be a priority.

Making the Most of the Positives

The pandemic was a scarring experience in many ways.  But there were also some good aspects to it.  For example the rapid action taken around street homelessness should be a prompt for more comprehensive action once the pandemic is over. Some of the changes made in uses of technology in welfare, education, health and other public services were overdue and now need to become part of normal practice. Many lives may also be improved by a shift to more homeworking.

Lessons and the Future

We know that the costs of the crisis will be with us for many years to come. Some of the costs can already be seen in terms of the ‘scarring’ effects on children and young people. Many businesses will struggle to recover, despite the support of furlough and other schemes. The public finances will be affected for years to come with a cost to taxpayers estimated at anywhere between £300bn and £420bn.

But the risk now is that our understandable relief at the pandemic entering what could be its final phases shuts off the willingness to address the harms it leaves behind. At the time of the financial crisis in 2008, President Obama’s adviser (and later Chicago Mayor) Rahm Emanuel famously said: “You never want a serious crisis to go to waste. And what I mean by that is an opportunity to do things that you think you could not do before.” Early in the pandemic surveys showed that the majority of the public in many countries hoped that the crisis might be a catalyst for tackling fundamental problems, from climate change to inequality. But those hopes largely faded as the crisis went on, and most people now just want a return to normality. Yet Emanuel’s comment remains relevant: it’s not too late to ensure we use the rest of 2022 to ensure the crisis isn’t wholly wasted.  This is why we see the public inquiries as so important. They have the potential to be a tool for learning lessons throughout society – from schools and hospitals to central government – so that future crises can be handled better and so that some of the deep-seated problems that were amplified by the crisis can be put right.

How well was science used – and why were some disciplines so much more influential than others? What went right or wrong in public communication? Why, for example, has Portugal been more successful than the UK in vaccination? Why did countries like Finland suffer so much less economic harm? Why did countries in east Asia have so much more sophisticated administrative systems for handling testing and lockdowns?  How can governments make use of good advice and develop synthetic strategies that mobilise all the different kinds of knowledge relevant to decisions?  As the recent Lancet survey on global mortality rates showed the patterns of the crisis are complex and don’t fit neatly into preconceived ideas.  But this is a unique opportunity to learn with humility, to help us make the most of the crisis and to prepare better for future ones.