Recovery, Renewal, Resilience

To plan for local outbreaks of the pandemic, local government in England were required to develop and publicise their Local Outbreak Plan on how they will manage any sporadic surges of the virus in their local area. To structure these outbreak control plans, UK public health authorities identified seven connected themes to cover: care homes and schools; high risk places and communities; methods for local mobile testing units; contact tracing and infection control in complex settings; integrating local and national data; supporting vulnerable people to self-isolate; establishing governance structures. Other countries (e.g. Ireland and New Zealand) have also required the development of outbreak control plans, especially for outbreaks in care homes.Consider how to:

• Review how other organisations have planned for outbreaks and learn from the contents of those plans
• Develop an outbreak control plan for how to manage a spike in COVID-19 case
• Use others' plans to confirm the contents of your plans and/or expand those contents
• How to exercise those plans and how to share the learning from those exercises with other organisations
• Developing bespoke outbreak control plans for specific sectors e.g. care homes

Every organisation has been affected by COVID-19 which has had impacts on operations, staff, suppliers, customers or other parts of its activities. Some organisations have temporarily stopped delivering certain activities or have achieved them through other means. This has led organisations to consider the value-added of those activities and evaluate certain activities that may no longer be necessary. To identify activities that can be stopped, consider:

• What activities were changed in response to the effects of COVID-19
• What has been learned about the actual value those activities were delivering, compared to the expected value
• How to stop or replace activities that were not delivering the expected value

In addition, consider:

• How to identify other activities that were not stopped during COVID-19 but that are not delivering the expected value so could be stopped
• How to measure the saving from stopping the activity
• What to do with the saved resource from stopping the activity e.g. reduce capacity or redeploy that capacity
• How other aspects of the organisation should change to support the stopping of activities (e.g. changing physical spaces, policies, processes, priorities, roles)

To accommodate social distancing rules, businesses such as bars and restaurants are able to use additional outside space. In Manchester city (UK), quick applications for temporary tables and chairs licences have been developed by the local council for those expressing interest in expanding their operations. Business owners are required to upload a scale plan of the proposed licensed area with the application. East Devon District Council (UK) provide the following COVID-19 checklist for businesses before they begin operations:

• Undertake a licence health check and a risk assessment to comply with COVID-19 regulations e.g. social distancing guidelines; hygiene information; entry/exit routes; pick up/drop off instructions; service and payment instructions
• Ensure the Designated Premises is named on the licence (the DPS) and still working at the premises, and update any changes to the premises licence or registered address
• Ensure relevant amendments are made to the current licence e.g. opening hours, operational conditions, or layout/plan. New areas may not be licensed e.g. the bar area may have changed
• Follow-up planning consent for building works and ensure compliance. Bars, marquees, structures or fixed furniture outside for more than 28 days may need planning consent
• Liaise with neighbours and resident associations as noise levels may increase due to outdoor operations so residents may be affected by noise
• Assess if the premises licence is fit for purpose e.g. modifications to trading hours or working conditions

Extreme fatigue, nausea, chest tightness, severe headaches, "brain fog" and limb pains are among the recurring symptoms described by some sufferers of COVID-19 for weeks/months after their diagnosis. NHS England has developed an online portal for people in England to access tutorials, contact healthcare workers and track their progress called "Your COVID Recovery". Consider development of similar services that include:

• Access to a clinical team including nurses and physiotherapists who can respond online or over the phone to any enquiries from patients
• An online peer-support community for survivors - particularly helpful to those who may be recovering alone
• Exercise tutorials that people can do from home to help them regain muscle strength, and lung function in particular
• Mental health support, which may include a psychologist within the service or referral into other mental health services along with information on what to expect post-COVID
• Face-to-face provision for physical rehabilitation where possible, ensuring the safety of staff and patients
• Support from professionals such as dieticians, speech and language therapists, occupational therapists
• Cultural practices and relationships with rehabilitation needs

There is also an ongoing need for data collection about a nation's health to understand the long-term effects of this disease.

Agoraphobia is an anxiety disorder characterized by symptoms of anxiety in situations where the person perceives their environment to be unsafe with no easy way to escape. People may feel ill, nervous, embarrassed or fearful in public places. With self-isolation and social distancing being a core component of 'living with COVID-19', people may feel trapped or particularly concerned about contamination and infection. Consider the provisions required to support people including:

• Helplines for those wanting to talk over the phone and support lines via live chat, text or email for those who don't wish to call or are unable to
• Webinars for the general public such as: how to be kind & compassionate to yourself', and 'dealing with COVID-19 negative thoughts when you already have anxiety'
• Access to approved therapists able to offer 1:1 support through therapies such as Cognitive Behavioural Therapy (CBT) and counselling

Signposting to supportive apps such as Headspace (www.headspace.com) or Calm (www.calm.com)

As countries begin to open their border to international travel, there is much to consider, not least the information provided to travellers before they leave your country, as they travel, and as they enter your country.

Information provided to travellers before they leave their country is key, so travellers can prepare themselves to travel to an overseas destination with the right supplies and knowing the expected behaviours. This is especially important during COVID-19 where countries have differing regulations regarding social distancing, travel within the country, and fines. Consider providing a government-issued 'safer travel information sheet' and advising travellers to download it before they leave the country. The information sheet could cover:

• Travel advisory for the country they are to visit
• Behaviours and supplies needed for COVID safe travel and at the destination e.g. face masks
• How to travel safely on all legs of the trip (from home to final destination) e.g. not arriving too early at departure points, ticketing, parking
• Expectations for safe travel practices such as social distancing, required face coverings and when/how to wear masks
• Tips for travelling using all types of transport e.g. cars, aircraft, ferries
• Exemptions for people e.g. who does not need to wear a face covering
• Where to find more information, key contacts and their contact information

The travel industry has a central role in advising travellers of travel-related and destination-specific COVID-19 information. The travel industry can provide advice to:

• Prepare travellers for practical departure and arrival procedures e.g. temperature sensors, health declaration forms
• Practice COVID-19 behaviours whilst travelling e.g. mask wearing, personal interactions, expectations on children and infirm
• Provide up to date information to travellers on the COVID-19 situation in the arrival country and how to access current information during their stay
• Identify what travellers should do if they suspect they have symptoms during their stay and before they travel home
• Inform travellers of mandatory acts on arrival, such as registering or downloading a mandated track and trace phone app
• Educate travellers on the local expectation for behaving safely in the country and local means of enforcement
• Detail what travellers should do on arrival e.g. quarantine, self-isolation, in the case of a local lockdown
• Where to find more information, key contacts and their contact information
• Penalties for non-compliance with local requirements for COVID-19

When travellers land in a different country, or even return to their home country, they may not have updated information or knowledge about COVID-19 transmission, or the local expectations or regulations put in place to encourage safe behaviours. Instead travellers may have COVID-19 practices that do not align with the expectations of the country they are in, so need information to make adjustments so they can live by the county's current protocols and legislation. So that travellers arriving into your country are able to act according to local advice, consider how to update travellers on practices they should follow, covering:

• Major local developments on the virus
• The impact of those developments on new behaviours, expectations, curfews, etc.
• Information on the sorts of services that are available, including holiday-related and travel
• Information on regulations, behaviours, practices and expectations e.g. quarantine, self-isolation, track and trace
• Information on residence permits and visas procedures
• Information on onward travel, transiting through the country and returning home
• Where to find more information, key contacts and their contact information

Appropriate channels should be considered to share this information with travellers e.g. travel providers, travel infrastructure providers, hotels.

To read this case study in its original format (including references), follow the source link below to TMB Issue 14 p.15-16.

The 'Edinburgh Lockdown Economy' is a listings directory for businesses in the city that has launched an interactive online experience to support firms suffering from lost revenue. The online directory provides an opportunity to resume trading for businesses that are struggling to run their usual services. Consider facilitating similar local platforms that allow:

• Small businesses to host virtual tours or experiences of their products and venues
• Customers to join live sessions such as wine tasting or massage workshops
• Products related to each experience or workshop to be delivered to customers in time for them to take part in the event
• Electronic payments to support less digitally enabled businesses

This guest briefing (written by Michael Palin, GC Consulting UK) outlines the potential economic risk to local areas before describing in broad terms how local areas might respond in terms of their economic recovery plans. A final section highlights a number of issues that have already been identified in some local areas as key economic recovery issues in their place.

Follow the source link below to read this briefing in full (p.2-10).

We have produced a video on how local authorities can begin processes for recovery and renewal: https://bit.ly/2BORO2e. It outlines how resilience partnerships can develop recovery strategies and ambitious plans for renewal of their areas. It covers how to:

• establish the basics of Recovery
• set up a Recovery Coordinating Group
• assess impacts from COVID-19
• implement recovery strategies

Recently, European Union countries have begun enforced lockdowns in smaller regions in response to new outbreaks of COVID-19, rather than bringing the entire country to a halt. 'Smart lockdowns' have been undertaken in Germany, Portugal, Italy, and the UK where local governments have declared local lockdown where cases of COVID-19 could not be contained.

Special consideration should be given to the identified causes of spikes in transmission. Localised COVID-19 outbreaks in Europe and the USA share a number of similarities. In most cases, overcrowded living conditions, poor working conditions, cultural practices, and/or limited socio-economic capital point to increased risk of infection and transmission. In Warendorf (Germany) and Cleckheaton (England), outbreaks were attributed to abattoirs and meat factories , which often employ migrant workers in poor working conditions on low-paid contracts. While the outbreak in Cleckheaton does not seem to have spread into the community, the fallout from the abattoir in Germany resulted in the lockdown of the city of Warendorf. Similar patterns are being witnessed in the USA, where workers from meat processing plants in Georgia, Arkansas and Mississippi, who are predominantly migrant workers or people of colour, have died from the virus or have become infected.

Conversely, in Marche (Italy) and Lisbon (Portugal) outbreaks originated in migrant communities that were living in overcrowded quarters or experiencing unsafe working conditions. Similarly, this week in Leicester (England), a local lockdown has been enforced. Possible reasons for the spike in cases shares stark similarities to the local lockdowns that have gone on elsewhere.

Reportedly, in Leicester some garment factories continued to operate throughout the crisis and forced their workers to work despite high levels of infection. Wage exploitation of the largely immigrant workforce, failure to protect workers' rights in Leicester's garment factories (a subject of concern for years), and poor communication of lockdown rules with Leicester's large ethnic minority community have all contributed to a resurgence in the disease.

Secondly, the East of the city, suspected to be the epicenter of the outbreak, has extreme levels of poverty, is densely packed with terraced housing, and has a high proportion of ethnic minority families where multi-generational living is common.

These patterns barely differ from the spike in cases in Singapore in May 2020 in which Singapore's progress on tackling COVID-19 was halted as tens of thousands of migrant workers contracted the disease due to poor living conditions and being neglected by testing schemes as their migrant status and relative poverty meant they were overlooked by the government.

Implementing smart lockdowns requires:

• Outbreak control plans for the COVID-19 partnership to be developed, written, and communicated to wider partners, specifying their role in the outbreak response
• Collaborate closely across the public sector to understand possible at-risk communities e.g. minority groups, migrant workers, those in poor or insecure housing, those in particular occupations
• Identify new cases early through rapid testing and contact tracing and sharing timely data across agencies
• Decide the threshold at which a cluster of new cases become an outbreak
• Decide the threshold at which an outbreak triggers the lockdown of an area, and how the size of that area is determined
• Collaborate closely with the public sector to communicate and enforce local lockdowns e.g. the police, the health and social sector, local leaders
• Ensure there is capacity in local-health care systems to respond to the outbreak
• Collaborate with citizens to ensure good behavioural practices are understood and adhered to e.g. hand washing, social distancing at work and in public areas
• Ensure the parameters of the local lockdown are clear. For example, in a UK "local authority boundaries can run down the middle of a street" which makes it different to differentiate what is appropriate for a city or region, and to understand how a local community identifies with the place and boundaries in which they live

Local outbreaks, whether in migrant worker accommodation, meat factories or impoverished areas of a city, clearly underscore the disproportionate impact of COVID-19 on minority, migrant, and poor communities. Increased engagement with, and attention to ethnic minority groups, marginalised people and impoverished communities is key to staving off local and national resurgences of COVID-19. Strong multi-organisational partnerships are required to account for varying needs and concerns with certain communities including addressing their living and working conditions and the risks this poses to public health.

To read this case study in its original format (including source links and references, follow the source link below.

Volunteer staff and students at Imperial College London are providing free weekly drop-in sessions offering tech support and advice for elderly residents in the local areas. Volunteers are:

• Teaching people how to send a text and send picture messages, creating videos, and fixing printers
• Helping isolated older residents by matching them with a phone buddy for tech and befriending support
• Providing some in-person sessions
• Managing referrals to the 'What the Tech' programme by local organisations
• Liaising with the local community team to help signpost vulnerable residents to local support services such as food shopping and medicine collection
• Using connections through the service to check in fortnightly on people's wellbeing

The main housing insecure groups include:

1. Asylum seekers (with and without access to statutory support)
2. Private renters
3. Prisoners who have been released

To support these groups consider:

• Mapping housing supply and working in partnership with private businesses, landlords and public services to develop ethical lettings agencies
• Leasing properties off private landlords for a substantial period and letting through ethical lettings agencies
• Ask contractors for commitments to build affordable housing rather than contribute cash donations
• Removing caps on housing benefits
• Ensuring housing allowances for renters meets the rent profile of the area they are renting in
• Mapping facilities e.g. recreation centres that can be turned into emergency shelters for homeless people
• Mapping risks of shared accommodation and capacity during heat waves/winter and risk of infection
• Providing prepaid cards for use for essential shopping e.g. food, medication

References: Chief Resilience Officer, USA and a representative of a UK Local Authority

View all issues of The Manchester Briefing: https://www.alliancembs.manchester.ac.uk/research/recovery-renewal-resilience-from-covid-19/briefings/

Isolation and loneliness is a big issue in rural communities which has been heightened by lockdown. Consider projects such as ConnecTED Together that offer:

• A phone befriending service
• Signposting to other agencies
• Fortnightly packs that are emailed featuring news, reviews, quizzes, short stories, and recipes
• A dedicated YouTube channel with video features on themes such as exercise, healthy eating and working with technology
• 'How to' guides e.g. use of digital devices

Campaigns that include the KnitTED Together campaign where people can share pictures of creative knitting and experiences via social media

This briefing details how to consider people who have been disproportionately impacted by COVID-19; how they can be identified; and how they could be involved and supported in recovery and renewal. We offer a methodology for identifying those impacts (the process), developed from the steps taken by Greater Manchester to identify the people in their area impacted by the pandemic.

Follow the source link below to read this briefing in full (p.2-7).

Public Health England have adopted a place-based, whole system approach to improving the health of the poorest. This strategy aims to build healthy, resilient, connected and empowered communities on mental health - and sits alongside wider strategies on "Place-Based Approaches for Reducing Health Inequalities". This involves scaling a range of community-centred approaches, addressing community level determinants. Consider addressing the following principles:

1. Scaling: Rolling out a flexible approach rather than applying a standard model using integrated community-centred approaches e.g. integrated wellness services at the local neighbourhood level. Utilise local resources and expertise
2. Involving: Gather community insights and encourage participation to better understand people's health needs
3. Strengthening: Grow local capacity and knowledge through workforce development to build core skills in the community. Encourage a thriving voluntary, community and social enterprise sector
4. Sustaining: Address social determinants of health, as they directly impact on people's resilience and ability to participate. Develop short, medium and long-term indicators about what matters to communities and share between agencies and communities

COVID-19 has exposed disparities in access to open and green space. Improved access can have positive effects on physical and mental health, communities as a whole and the environment. Consider impacts on:

The individual:

• Provides areas for exercise, and improves mental health
• Park closures and restrictions on movement due to COVID-19 negatively and disproportionately effects those without gardens and those who are less economically well off

The community:

• Increasing the quantity of green spaces reduces traffic which reduces pollution and encourages city safety
• Green space for social housing directly addresses socio-economic disparities regarding
• Can simultaneously address other environmental factors such as flood risk management

We consider here Recovery and Renewal and explore how recovery actions relate to the concept of Renewal, which we have discussed in previous weeks of The Manchester Briefing. We also consider the extent to which recovery actions will extend into renewal, and whether they may fizzle out as fatigue as other priorities, such as Brexit, close in.

To read this briefing in full, follow the source link below to TMB Issue 11 (p.2-7).

COVID-19 has had widespread consequences on all aspects of health and wellbeing. In particular, it has taken a toll on emotional health and wellbeing as a result of remaining isolated or physically distant from friends, family and normal support structures. Additionally, the effects of COVID-19 on risk factors including socioeconomic inequalities, poverty, debt, unemployment, food insecurity, and physical inactivity have had significant impacts on the emotional health and well-being of many

These impacts can be understood on a continuum, from those experiencing some effects on their emotional health and wellbeing, perhaps for the first time, such as intermittent loneliness; to those suffering from more serious mental health disorders such as anxiety, depression or post-traumatic stress disorder; and those who require medical intervention and psychiatric care. This presents three core challenges for mental health provision:

1. Prevent an associated increase in mental health disorders and a reduction in mental health wellbeing across populations
2. Protect people with a mental disorders from COVID-19, and the associated consequences, such as increased risk of COVID-19 infection and mortality due to increased vulnerability
3. Provide appropriate public mental health interventions including for health professionals and carers

The challenges of understanding how emotional health and wellbeing have been affected is complex as many people may develop negative psychological responses after an event, so, even as the threat of the pandemic lessens, more people may reach out for support. This is a particular concern for frontline medical staff, many of whom have not had time or space to process their experiences and may suffer from mental and physical fatigue.

The challenges faced in providing adequate care and support are not just related to the increasing numbers of people who require mental health services. Mental health services claim historically under-funding , and the expected compounding of the impacts of a global recession on the resources available; further stretching the sector. Across the UK, the voluntary sector has played a key role in service provision and developing innovative and flexible care models. Voluntary sector support ranges from helplines to peer support, and alternatives to inpatient care. They may be large national charities delivering a range of responses in different localities or smaller local social enterprises providing a specific service, such as a crisis cafe.

To meet the expected demand for mental health support, the Voluntary, Community and Social Enterprise (VCSE) sector organisations are working with their NHS and local government partners to respond to the pressing needs of the communities they serve and come from. Key priorities have been identified to maintain these services

• Rising service demands - there is a significant rises in helpline usage which has led to concerns about the provision of effective support to every caller; especially those in crisis
• Workforce - consideration of: reductions in personnel due to isolation or secondments to statutory services; gaining key worker status and recognition for voluntary mental health providers, and testing
• Loss of access to care coordinators - a care coordinator plays a key role in helping people to manage and monitor their care, including support with medication, physical health, housing, employment, finances and home care. Support service users who have not been able to contact their care coordinators due to their redeployment to COVID-19 response teams, and/or sickness, self-isolation, etc
• Infection control - PPE and clear guidance on its use is needed for regulated and unregulated services. A considerable number of staff are also working on the frontline with service users, and require protection
• Collaboration with statutory services - VCSE organisations have extensive experience of working alongside statutory bodies in the provision of mental health services. In many areas, partnership working between the VCSE sector, NHS and local government is well-established but, in other areas, it has not always been easy to form effective working relationships
• Advocacy services - appropriate access to advocacy services is important for people with mental health conditions. During COVID-19, some people who have been sectioned need more contact with others. While some people have been provided with mobile phones by hospitals, other people need more support to make contact with others to avoid isolation
• Adapting service delivery - with social distancing policies in place, many services are being moved online or to telephone. Provision for anxiety and crisis support have reported an increase in calls to helplines. Some have reconfigured services but consideration needs to be given to the sustainability of this
• Changes to legislation - emergency legislation (Coronavirus Act 2020) includes temporary changes to the Mental Health Act and local authorities Care Act. Consideration of the effects of this on the availability, accessibility, commissioning and provision of mental health care and support services is needed
• Sustainability of the VCSE sector - concerns about funding streams, cash flow, and long-term sustainability of service providers has been raised. While the Government have provided financial support, the long-term sustainability of the mental health sector at a time when services are needed should be considered

Follow the source link below to read this case study in its orgininal format, including references and source links.

[2] https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30240-6/fulltext

[3] https://www.hrw.org/news/2020/06/08/mental-health-support-necessary-during-covid-19-pandemic

[4] https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30240-6/fulltext

[5] https://scienmag.com/global-study-launched-to-examine-impact-of-covid-19-on-health-and-wellbeing/

[6] https://www.theguardian.com/world/2020/jun/07/health-experts-on-the-psychological-cost-of-covid-19

[7] https://www.tuc.org.uk/sites/default/files/Mentalhealthfundingreport2_0.pdf

[8]https://www.theguardian.com/world/2020/jun/07/health-experts-on-the-psychological-cost-of-covid-19

[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695387/

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695387/

Consider using the Emergency Planning College Business Continuity (BC) checklist to understand how well BC is incorporated into core areas such as risk management (see BS65000 for further examples). The checklist provides signposting to relevant guidance. Example guidance includes:

Roles, responsibilities and competencies

• Identify BC roles and command and control structures e.g. strategic leads; BC advisor/coordinator; incident management etc
• Promote effective leadership (e.g. ISO22301; ISO22330)
• Document information including plans, procedures, roles and competencies, and the recording of decisions, actions and rationale (e.g. ISO22301: Clause 7.5)

Monitoring and evaluation and decision making

• Effectively monitor impacts and use of trusted, key guidance for BC to inform decisions
• Agree decision-making methodology and governance structures for BC
• Use models such as the Joint Decision Model (JDM) for making decisions for multi-agency response or organisational level
• Agree processes for effectively standing response down, including decision makers and deciding factors (e.g. ISO22301: Clause 8.4.4.3)

Recovery of businesses and Maintenance of BC

• Promote recovery as a chance for innovation of current processes, organizations, communities and behaviours, which is in keeping with 'Continual Improvement' (e.g. ISO22301: Clause 10.2; 'Innovation' in BS65000)
• Advocate the lifecycle of the BC plan and the accuracy of priorities and how lessons are learned from incidents

Every local government area is likely to have a large number of people who are vulnerable but not eligible for a government food parcel delivery. Some of these people will not be able to access the food they need to stay at home due to:

• Too little money to buy food (including problems with benefits payments)
• Personal crisis for reasons other than COVID-19 (e.g. domestic violence)
• Health issues, disability or caring roles personally, or in the household
• Lack of friends, family or social support to deliver food

In Greenwich, strategic 'food pathways' have been mapped to organise partnerships for large-scale food provision for vulnerable groups, and to relieve pressure on food banks. Pathways include:

• • A model for local governments, local resilience forums and the voluntary sector to work in partnership.
  • To determine appropriate interventions, local governments triage those requiring food support into people who are:
    • financially secure but cannot shop
    • financially insecure and can shop
    • financially insecure and cannot shop
  • A model for community/ third sector groups. Based on this triage, community groups can assess the needs of community and provide appropriate interventions e.g. emergency individual meals or signposting to services

Universities have a positive impact on future regional growth of GDP per capita. In the UK, universities support community activity, work on an applied level with many smaller businesses, and students stimulate the local economy. Consider how to:

• Support existing university-business relationships and encourage new partnerships to benefit both parties
• Develop regional offices to help build local knowledge to identify and convey concerns of universities to national bodies. These may be co-located with other local partnerships and institutions
• Foster a bottom-up, local consensus across geographical areas that identifies the resources universities need from government
• Ensure that university cities are safe and secure places for students, and to be communicated as such
• Ensure that overseas students have access to health services as required

This week in the UK is Carers Week. Carers Week aims to raise awareness of caring and the challenges carers face. It is also a time to help people who may not identify as having caring responsibilities and to help them recognize this so they can access much-needed support[1]. This is particularly important as an estimated 4.5 million people in the UK have become unpaid carers for elderly, disabled or physically or mentally ill relatives since the COVID-19 pandemic[2]. This is on top of the existing 9.1 million unpaid carers that already provide support in the UK[3].

Around 2.7 million women and 1.8 million men have become new carers, typically helping with food shopping, finances, collecting medication and providing emotional support2. Others may be taking on more intense roles that include helping people with personal hygiene, movement around the home and meal preparation. 62% who have started caring since the outbreak are also juggling paid work alongside their caring responsibilities[4].

Unpaid carers in the UK have described facing mounting anxiety and frustration regarding getting access to vital medication from pharmacies and time spent queuing for medication or food shopping due to social distancing rules[5]. As a result, the following advice has been provided to improve carers’ experiences and ability to access the medicines they need. These include:

• Allowing two people into store when the carer has no choice but to take the person being cared for to the pharmacy with them
• Considering prioritising un-paid carers of vulnerable/shielding people for medicine delivery slots
• Recognising that, for some families, young carers are the only people able to collect medicines in the household

Recognising the role of young carers is extremely important. Of the 13 and a half million unpaid carers in the UK, an estimated 700,000 are children[6]. Evidence suggests that young carers and young adult carers are being disproportionately impacted by COVID-19 and are experiencing high levels of anxiety and isolation as a result of lockdown[7]. Many young carers are under increasing strain while schools remain closed as caring responsibilities increase and time away from these at school decreases[8].

Additionally, other systems used to support and safeguard young carers such as health and social care systems, are struggling under the pressure from COVID-19 impacts[9] as they continue to make changes to accommodate the needs of disabled and vulnerable people[10]. While this is vital, it may draw attention away from the often hidden and marginalised needs of young carers[11], and may miss many new young carers[12]. Where young carers are in contact with local authorities, they are encouraged to discuss with what support or services they need by[13]:

• Thinking about good and bad days being a carer
• Making notes about a typical day helping the person they care for, including their own needs and concerns
• Thinking about things which would help them cope, their aims, hopes, and what is important to them

Although there a huge challenges for unpaid carers, the issue is gaining visibility as a result of the rising numbers of people providing care and has led to calls to government to deliver social care reforms that detail long-term investment into care and support services[14]. This is increasingly important as the timeframes of the pandemic are unknown, and more people may be required to provide care for longer periods of time. Charities supporting carers have called for4:

• An increase in Carer’s Allowance – currently £67.25 a week
• A “one-off coronavirus supplement” in recognition of the role unpaid carers have played in the pandemic and the significant costs associated with caring
• Increased recognition of the vital work unpaid carers provide and the limited support they can currently receive due to COVID-19 restrictions
• Physical and mental support for carers and increased investment in support services
• Carers must be a priority for regular testing and PPE, particularly where they care for the most vulnerable

The government recommends that all carers create an emergency plan with the person they care for to use in circumstances where help from other people to deliver care is needed. This may be from family, friends or another care provider[15]. They advise the following details are provided:

• The name and address and any other contact details of the person you look after
• Who you and the person you look after would like to be contacted in an emergency
• Details of any medication the person you look after is taking

Details of any ongoing treatment they need and any medical appointments they need to take

References:

[1] https://www.carersweek.org/about-us

[2] https://www.carersweek.org/media-and-updates/item/493439-covid-19-pandemic-4-5-million-become-unpaid-carers-in-a-matter-of-weeks

[3] https://www.carersweek.org/media-and-updates/item/493439-covid-19-pandemic-4-5-million-become-unpaid-carers-in-a-matter-of-weeks

[4] https://www.carersweek.org/media-and-updates/item/493439-covid-19-pandemic-4-5-million-become-unpaid-carers-in-a-matter-of-weeks

[5] https://carers.org/news-and-media/news/post/42-organisations-work-together-to-improve-unpaid-carersa-access-to-medicines-during-the-covid-19-pandemic

[6] https://www.bbc.co.uk/news/av/uk-52948236/coronavirus-life-as-a-young-carer-under-lockdown

[7]https://carers.org/what-we-do/our-survey-on-the-impact-of-coronavirus-on-young-carers-and-young-adult-carers-

[8] https://www.bbc.co.uk/news/av/uk-52948236/coronavirus-life-as-a-young-carer-under-lockdown

[9] https://www.uea.ac.uk/about/-/new-project-examines-impact-of-covid-19-on-young-carers

[10] https://www.uea.ac.uk/about/-/new-project-examines-impact-of-covid-19-on-young-carers

[11] https://www.uea.ac.uk/about/-/new-project-examines-impact-of-covid-19-on-young-carers

[12] https://carers.org/what-we-do/our-survey-on-the-impact-of-coronavirus-on-young-carers-and-young-adult-carers-

[13] https://www.southlanarkshire.gov.uk/info/200220/carers_and_caring/505/carers/11

[14] https://www.itv.com/news/2020-06-08/millions-have-become-carers-due-to-covid-crisis-new-research-finds/

[15] https://www.gov.uk/government/publications/coronavirus-covid-19-providing-unpaid-care/guidance-for-those-who-provide-unpaid-care-to-friends-or-family

This briefing builds on The Manchester Briefing (TMB) 8 to discuss more about the effects and impacts of, and opportunities arising from, COVID-19; what these mean for developing recovery strategies and for Local Resilience Forums (LRFs) which plan the response to crisis.

Follow the source link below to TMB Issue 9 to read this briefing in full (p.2-10).

The youth may have vulnerabilities that include:

• Safeguarding concerns e.g. those with special educational needs, carers
• Exposed to domestic abuse, financial pressures and poverty, and additional caring responsibilities
• Limited access to computers for studies
• No internet access or costly data packages
• Reliance on public hotspots (currently unavailable)

Consider:

• Free, publicly available internet as part of corporate, and social responsibility providers
• Strategic investments that promote the safety of youth and information to counteract 'fake news'
• Wellbeing and safety of youth via specialised youth work during/post COVID-19 for those at risk of domestic abuse or exploitation (gangs, sexual)
• Creatively engage with youth through established organisations (schools, Youth Parliament and Young Peoples Foundations, community, faith-based organisations)
• Review of additional risks and legalities from COVID-19 legislation, in particular those 'at risk' of offending due to lack of understanding and communication aimed at youth
• Youth engagement in future recovery and renewal plans to co-develop preventative plans to support meaningful transitions to education, employment and training

PPE shortages, lack of testing, and a vulnerable population have seen care homes in England and Wales become hotspots of the COVID-19 epidemic[1]. The impacts of COVID-19 have been hugely disruptive in the care home sector; affecting patients and all aspects of care. The context of these challenges has been attributed to:

• A decline in funding for social care in the past 10 years, even as demand for care has risen as a result of an ageing population[2]
• Daily ~1.5 million older people – one in seven over-65s – go without the help they need with tasks such as washing, dressing and eating2
• Deaths in care homes (from all causes and Covid-19) are increasing - the increased community deaths reflects the prioritisation of social care[3]
• Moving such populations out of hospitals during Covid-19 means systems pressures are pushed elsewhere including into the community:
  • people were reportedly discharged from hospital to care homes without testing for Covid-19[4]
  • people who became ill in care homes were largely not tested for the virus and most were not admitted to hospital[5]

The UK Government has stated that their number one priority for adult social care is infection control during the COVID-19 pandemic[6]. While mitigating the spread of the disease is of paramount importance, protective measures such as isolation are associated with a morbidity of its own[7]. The lack of supervision as a result of staff shortages put care home residents at increased risk of injury and mental health issues, for example those with dementia often stop eating as a result of depression which can hasten death7.

Before the UK Government released their Plan to Rebuild[8] which includes a section on protecting care homes, a number of actions were identified within the sector to address growing concerns over how COVID-19 was being managed in care homes.

Actions to address the situation for care homes include:

• Central/local government and the care home sector should work together to make testing in care homes happen[9].
• More PPE, testing and funding to:
  • Ensure care home residents are safeguarded
  • Prevent avoidable hospital admissions
  • Improve the mental health of families who may be worried that their relatives in care do not have the support they need[10]
• More guidance for care home managers on:
  • Receiving residents from hospitals when they have not been tested
  • Permitting relatives to say goodbye to loved ones
  • Preventing staff making a dozen home visits a day - potentially spreading virus
  • Facilitating staff speaking out about unsafe conditions (five carers reportedly lost their jobs in the past fortnight after speaking out about their concerns)[11]
• In Scotland, the Care Inspectorate (the sector’s regulator) would examine every care home’s conduct during the pandemic12
• Social care should be viewed as part of healthcare and vice versa
• Nurses are working continually on helplines to support families affected[12]
• Consider relatives’ visitation/entry permissions to nursing homes as lockdowns ease[13]:
  • Limit the number of visitations per week and permit only one family member to visit at a time
  • Prevent children and young people (under 14) from visiting
  • Require visitors to reserve a time-slot– and not allow visitors unless they have made a reservation
  • Space visitors throughout the day and across the week to preserve social distancing
  • Prevent entry to visitors if they are ill, under quarantine or in isolation, or if they are waiting for the results of COVID-testing
  • Escort each visitor to use hand sanitizer on entering the care home and on departure
  • Escort each visitor to the resident’s room and back without stopping in the common areas
  • Visitors must adhere to the 2-meter distance regulations, and avoid direct contact with other care home residents
  • Urge visitors to download the COVID tracing app to their smartphone
  • Adapt this advice to circumstances of each care home (e.g. the size of the home, the situation at any given time, the number of confirmed infections in the local community)

The call to address these actions has been met by £3.2bn of additional funding for local authorities from the UK Government, which can be used to meet rising care home and additional pressures on social care. Additionally, a further £1.3bn has been provided for the NHS and local authorities to work together to fund the additional needs of people leaving hospital during the pandemic. The Governments priority areas are[14]:

1. Testing;
2. Infection prevention and control;
3. Workforce expansion through a recruitment campaign;
4. Clinical support through accelerated introduction of enhanced health support in care homes from GPs and community health services;
5. Guidance.
   

References:

[1] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31199-5/fulltext

[2] https://www.theguardian.com/commentisfree/2020/may/03/the-observer-view-on-care-home-deaths-being-an-indictment-of-our-society

[3] https://blogs.lse.ac.uk/politicsandpolicy/covid19-deaths-social-care/

[4] https://www.theguardian.com/commentisfree/2020/may/03/the-observer-view-on-care-home-deaths-being-an-indictment-of-our-society

[5] https://blogs.lse.ac.uk/politicsandpolicy/covid19-deaths-social-care/

[6] https://www.gov.uk/government/publications/our-plan-to-rebuild-the-uk-governments-covid-19-recovery-strategy/our-plan-to-rebuild-the-uk-governments-covid-19-recovery-strategy#our-roadmap-to-lift-restrictions-step-by-step

[7] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31199-5/fulltext

[8] https://www.gov.uk/government/publications/our-plan-to-rebuild-the-uk-governments-covid-19-recovery-strategy/our-plan-to-rebuild-the-uk-governments-covid-19-recovery-strategy#our-roadmap-to-lift-restrictions-step-by-step

[9] Age UK. https://www.ageuk.org.uk/latest-press/articles/2020/04/age-uk-response-to-more-care-home-deaths/

[10] Dementia UK https://www.dementiauk.org/coronavirus-care-home-deaths-up-hospital-cases-fall-our-response/

[11] https://www.theguardian.com/commentisfree/2020/may/03/the-observer-view-on-care-home-deaths-being-an-indictment-of-our-society

[12] Dementia UK https://www.dementiauk.org/coronavirus-care-home-deaths-up-hospital-cases-fall-our-response/

[13] National Commissioner of the Icelandic Police, Status Report on 24-4-20

[14] https://www.gov.uk/government/publications/our-plan-to-rebuild-the-uk-governments-covid-19-recovery-strategy/our-plan-to-rebuild-the-uk-governments-covid-19-recovery-strategy#our-roadmap-to-lift-restrictions-step-by-step

Annex A of this week's 'Briefing A' contains a menu of impact themes and impact areas that could be used to help local government plan an impact assessment (p.7-10). Follow the source link below to view this briefing.

Consider:

• Government schemes which pay young workers for employment in green industries to tackle unemployment
• Retraining older people in green industries to "leave no worker behind" in any transition towards a different economy
• Adaptation of plans for green industry by region. Some regions may be more adversely affected by job loss, for example, in areas that relied on tourism and hospitality so retrain these workers

This briefing outlines the key issues that should be considered by all partners in the initial stages of planning recovery and renewal, those which should be addressed prior to commissioning Impact Assessments. The briefing concludes by highlighting the need for RCGs to align with other local strategic partnerships to enable recovery and renewal, taking into consideration the breadth of effects, impacts and opportunities from COVID-19.

Follow the source link below to read this briefing in full (p.2-7)

In the UK, five tests must be met:

• Protect the healthcare system and its ability to cope so it can continue to provide critical care and specialist treatment
• The daily death rates from coronavirus must come down
• Reliable data must show the rate of infection is decreasing to manageable levels
• Have confident that testing capacity and PPE are being managed, with supply able to meet not just today's demand, but future demand
• Have confidence that any changes made not risk a second peak of infections

Five alert levels are developed to guide the level of lockdown restrictions.

LGTBIQ+ people have a number of vulnerabilities. Consider:

• LGBTIQ+ people are less likely to have safe homes and are at a higher risk of homelessness (especially young people) and are at a high risk of domestic abuse
• The impacts of losing safe community spaces and the additional mental health impacts of this
• The complications with access to healthcare which can be especially hard for trans people who have specific medical needs
• The use of test, track and trace facilities for this vulnerable group. In South Korea a new wave of infections have been attributed to 3,000 people attending clubs that accommodated the LGBTIQ+ community. But only half of people in attendance have gone for testing, due to fears that doing so would reveal their sexuality. Confidence in personal safety and confidentiality is paramount in track, trace and treat processes

Councils maintain crucial services, have set up community hubs, and established local teams for tracing and tracking. Councils provide food and shelter to people at risk, help local businesses stay afloat and have mobilised volunteers and therefore know their communities in depth which can support trace and track. Councils:

• Are naturally placed to respond quickly to the distinct needs, challenges and infection rates of their own area
• Are equipped with their own teams of public health professionals

This may include:

• Reimagining how cities are built and organised e.g. Brussels is creating 40km of new cycle paths; France is providing cyclists with subsidies; UK has announced a œ2bn infrastructure scheme to encourage more walking and cycling
• Accelerating environmentally friendly projects such as increased investment in electric vehicle infrastructure

Also consider the unintended consequences of green infrastructure solutions. In the case of battery production for electric vehicles, consideration should be given to the environmental degradation caused by mining for battery components for electric vehicles, the ethical considerations of using mines in developing countries, the lifecycle of batteries and how they will be recycled in large quantities.

Including:

• Clearly identify authoritative sources
• Encourage social media companies to correct disinformation
• Develop policies on media use of traumatic footage
• Mitigate individuals' risk of misinformation
• Improve health literacy and critical thinking skills
• Minimise sharing of misinformation through fact checking

In the UK, five tests must be met:

Five alert levels are developed to guide the level of lockdown restrictions:

This is a plan that will explain what is permitted and prohibited at each phase of easing the lockdown. The first phase would deliberately be called red, to ensure people stopped to think before they did things:

The red phase

• Some shops could re-open with strict social distancing, as most supermarkets do now
• Many shops might choose not to re-open for commercial reasons e.g. as demand would be low
• Travel should be discouraged and many international flights banned

The amber phase

• Over-65s should live as if under a hard lockdown
• Daily new cases <500 persons, Testing capacity >100k, Tracing capacity >50%, Shielding
• Work if your workplace is open and if you have a 'clear' reading on your contact tracing app. Use masks where possible. Otherwise only leave home as for Hard Lockdown
• Unlimited private car journeys allowed, although people are discouraged from crowded destinations
• Vary the rush hour with different opening and closing times to minimise pressure on public transport and reduce crowds
• Patrons encouraged to show a 'clear' reading on your contact tracing app. Must follow social distancing
• Wear masks and gloves when using public transport
• Restaurants could reopen but with strict seating demarcations to uphold social distancing
• Smaller shops could reopen

The green phase

• Daily new cases <100. Testing + tracing in place. Public gatherings <100 allowed
• Sporting events or mass gatherings could take place, and places of worship can reopen
• Mass transit could return to normal
• The return of international flights should be based on the risks of flying to other countries
• Macro-economic policies such as cutting VAT rates might be employed to boost spending

For example:

• Consider how trusted experts can support discussions about the climate change agenda and inform public policy
• Consider how new behaviours adopted through the pandemic can be encouraged to support the climate change agenda, and how people's adaptability can be harnessed
• Consider how short-term actions can be embedded in longer-term climate change actions e.g. the reduction of unnecessary air travel (e.g. for business meetings) and the encouragement of more home-working (e.g. using videoconferencing)
• Learn from 'known unknowns' - foreseen possibilities that are not obviously (such as pandemics and climate change) and therefore lacked effective emergency planning

Micro-volunteering opportunities have been developed in Salford, UK. 'Heroes from Home' support the wider COVID-19 response by sharing important messages to help to keep communities safe during the pandemic. Volunteers are encouraged to use their own social media accounts to share or post information about Salford's response - helping to ensure it is highly visible and readily available to those who need it.

For example:

• Collect data on the mental health effects of COVID-19 across the population and vulnerable groups
• Monitor and report the rates of anxiety, depression, self-harm, suicide, and other mental health issues
• Determine what psychological support is available to front-line medical/health-care staff and their families
• Determine the best ways to signpost and deliver mental health services for vulnerable groups, including online clinics and community support
• Use health messages to optimise behaviour change and reduce unintended mental health issues
• Design longer-term strategies to address an increased volume of mental health issues and their impacts on service demand
• Target population-level interventions to prevent and treat mental health symptoms (e.g. anxiety) and boost coping and resilience (e.g. exercise)
• Synthesise an evidence base of lessons learned for future pandemics, tailored to specific groups, to motivate and enable people to prepare psychologically and plan for future scenarios

Children across Northampton, UK who had a parent that worked in the local police force, received a letter from the Chief Constable. The letter:

• Thanked children for 'sharing their parents' and for the child 'being part of the team'
• Thanked children for washing their hands properly, doing their school work and only going for one walk a day, making it possible for their parents to work

Additionally the need to identify a social work action plan to support families and vulnerable people as restricted movements are relaxed. This plan can identify:

• The social work skills needed to support families and vulnerable children
• The projected demand for such skills
• The capacity of the current social work system to deliver those skills
• Shortfalls in supply versus demand of skills
• Skills can be supported through non-social work providers such as volunteer organisations
• The training, supervision and resources are needed for volunteers to be safely involved
• What types of families and vulnerable children may be supported with those skills from non-social work providers
• The shortfall in families and vulnerable children who will need professionally-trained social workers
• How that shortfall can be addressed by professional social workers
• How many professional social workers can be trained, and when they will be available to work
• How to address any remaining shortfall in the short term

There have been a range of incident types against key workers, so:

• Ensure deliberate coughing and spitting is addressed in official policy such as the UK Assaults on Emergency Workers (Offences) Act
• Patrol areas in which key workers work to provide protection from assault and mugging as a result of workers' association with COVID-19 response, and assumptions that some workers have access to medicine and food
• Release official statements from law enforcers to the public to bring attacks on key workers to light. Use the opportunity to fact-check claims which may appear on social media such as the one claiming that an Italian doctor had been charged with killing over 3,000 COVID-19 patients

Actively investigate hoax messages purportedly from official Government sources that could put key workers at risk

In the UK, parts of the city of York is made up of very narrow lanes in which social distancing would not be possible. The following measures, which could be applied to other locations with similar city designs are considered:

• Develop a pedestrian one-way-system with road markings, cones or barriers to mitigate people having to pass closely to one another. Consider markings that are temporary to preserve areas of historic interest
• Install hand sanitiser dispensers on streets, recognising that these may be alcohol based
• Initiate measures to keep pedestrians moving such as restricting photography

This response can include having the flexibility to create new capacity in the health system perhaps by creating new 'field' hospitals or by creating more space in existing hospitals.

For example, in the UK, capacity in the health system is being created by moving patients that are not at risk into hotels and similar facilities to free up health services for at-risk patients. Hotels in Dorset UK, with support from the local council, have offered rooms to "free up urgent bed space in the NHS by taking low risk patients and carers and being part of the solution... 230 hotels prepared to reopen their door". Developing a roster of hotels and similar spaces that can be used in case of resurgence would support emergency planning.

There has been a surge in homelessness as many businesses remain closed. In London, people working in service industries have been particularly affected. This often includes those working in bars, restaurants and hotels. Consider:

• How day centres offering support to the homeless can safely reopen again e.g. considering staffing requirements, PPE and how to accommodate service users
• Whether additional sites in community halls could be opened to assist with distancing guidelines, or sites with parking space could be used to manage queues
• The impact of closed cafes and soup kitchens on homeless people's access to food, including how volunteers could be utilised to effectively provide food
• How to keep homeless people connected: Many outreach organisations require a telephone number to call when accommodation or services are available. Closed cafes and public facilities mean there is nowhere to charge phones. With volunteers and charities, consider if some facilities could be opened to provide charge points, or outreach teams can be provided with wireless chargers. People could charge their phones at supervised charging stations
• How information about homeless people can be gathered. Many of those on the streets do not have access to benefits. Through soup kitchens or charge points, information about homeless individuals could be recorded and provided to local authorities
• Educating employers about safeguarding their precarious workers. Many newly homeless people worked in hospitality or through agencies and immediately lost their job. Employers could provide workers they cannot employ with government and charity-led information about who to contact, the benefits systems, and other welfare information

This includes converting spontaneous volunteers (SVs) into long-term volunteers by signing them up to established volunteer organisations so they can contribute on an ongoing basis. Key areas to consider include:

• Identify contribution of SVs to C19 so far - assess the nature and scale of SV volunteering effort and the gap left if SVs stop
• Share good news stories - to help SVs know that they are making a difference
• Needs assessment - identity ongoing tasks needed by service beneficiaries that may be suitable for volunteers
• Motivate SVs - create compelling case studies of the need. These will outline who are the service beneficiaries of those tasks and how volunteers have helped them. Communicate that SV opportunities will stop
• Identify sorts of volunteers needed - identify the skills and commitment needed from the volunteer so they can self-select tasks they want to perform
• Identify volunteer organisations - partner with a handful of volunteer organisations that volunteers can work through to fulfil each task. This can give volunteers a manageable list of organisations to select between. Short descriptions of the organisations can outline their different shapes so volunteers can identify the right organisation for them
• Remove SV opportunities - close down SV effort and convert willing SVs to ongoing volunteers
• Follow up volunteers - local government/voluntary organisations conduct welfare calls with volunteers to ensure that they are ok after their volunteering and to see if they have/want to convert. Facilitate conversion if needed
• Follow up voluntary organisations - local government complete the loop to see how many SVs have converted

Reference: UK County Councils

Lockdown could be eased through:

• Gradual school reopening because children are at low risk, and there are high economic and educational costs to school closure
• Gradual return to work with younger people first (age segmentation) as they are relatively less at risk of COVID-19 than older people
• Gradual return to work by sector/workplace (sector segmentation) as some pose less risky than others
• Gradual release of lockdown by geography (geographic segmentation) as COVID-19 cases and NHS capacity vary across regions

Consider risk assessments for each of these options, since there are challenges with each e.g. cross-sector supply chains limit the benefits of sector segmentation.

Consider the following factors in the assessment:

• Costs vs. benefits
• How quickly can it be done?
• Will it be seen as fair?
• How practical is it?
• Can it be enforced?

Many charitable and voluntary organisations are vital to ensure their communities function in periods of normalcy but may not be active in COVID-19 response. Consider:

• How voluntary organisations that are currently inactive can be supported, and their services retained
• The value of non-response organisations and their connections with local people and other diverse organisations, and how their services could be integrated or partnered with response organisations
• How these organisations can be operationalised during recovery to sustain informal voluntary actions that have arisen from COVID-19 responses, to ensure inclusive and resilient communities.

Reference: UK Voluntary Sector Report

Consider:

• How prayer spaces will be managed for keyworkers- allocate suitable spaces with social distancing requirements in mind, provide adequate notice should a prayer space be closed for cleaning
• Public information regarding Iftar and Eid; the breaking of fasting each day (Iftar) is usually a sociable even. Remind the public that despite its personal religious importance, social distancing measures need to be observed. The same measures also apply to the end of Ramadan (Eid). Eid is on Saturday, 23 May 2020, and even if some lockdown restrictions have been eased, it is important to remind the public that social distancing is still required. Consider working through local leaders, community members and where appropriate the police, to ensure public safety
• These lessons are applicable to other major religious events, or holidays - consider processes to manage events such as Diwali, etc. While later on in the year, it is likely social distancing measures will still need to be observed

This briefing shares our early thinking on recovery and renewal, and the opportunities COVID-19 has offered. We identify the opportunity to recover and renew how power and partnerships support working across five groups: national, local partnerships, organisations, local communities, and people. We call for the need to think about people, place, and, processes which have to recover and renew.

To read this briefing in full, follow the source link below to TMB Issue 4 p.2-6