Recovery, Renewal, Resilience

We discussed co-production in TMB Issue 33 and detailed three barriers to co-production during COVID: Pace, Distance and Complexity. The Centre for Loneliness Studies recently developed a toolkit for co-production organised around a cycle of: "Co-commissioning; Co-design; Co-delivery and Co-evaluation/co-governance". This toolkit supports those who want to begin a journey of co-production. It is based on research on co-production with older people who experienced isolation and loneliness. The principles are transferable and useful to anyone thinking about how to do co-production. Consider:

• That co-production can apply to a broad range of contexts (e.g. co-producing service delivery for a city/region/on a national level or co-producing care delivery for an individual). Depending on the context, those involved should agree on what co-production means based on their context. This can be done by:
  • Define what co-production means e.g. to your organisation/to the group of people delivering a service/to those using a service
  • Agree a statement about what co-production means, to manage expectations and provide clarity on the direction of co-production activities
• Understand individual and group co-production values. This can help to direct work and activities and influence decision-making
• Empower each person involved by working "with people rather than for them"
• Promote equality, e.g. use the term 'stakeholders' to describe all of those involved in co-production to position all participants on an equal footing
• Seek to understand and make use of the skills, knowledge and experience of all stakeholders
• Ensure a diverse group of stakeholders are involved in co-production by considering:
  • Which stakeholders should be involved? (including those who represent current and potential future users of services)
  • What skills, experience, knowledge and resources are required to support co-production? (e.g. conduct an asset mapping exercise to understand needs)
  • How best to ensure a wide variety of stakeholders are included?
  • What resources might stakeholders require to keep them engaged?
• How to fairly share power and influence for co-production, e.g. hold regular deliberation meetings so that all stakeholders are heard, use voting systems, and feedback questionnaires
• Following each phase of the cycle:
  • Reflect on the experiences of each stakeholder and achievements of the group
  • Explore what worked well, the challenges that presented and how learning can be applied in future cycles of co-production
  • Identify any skills, knowledge, experience or strengths the group and co-production process could gain from and how to bring those into the process in the future

Risk communications as part of the Local Resilience Capability is our focus in this briefing. We explore the communication of risk before and during emergencies, and identify how two-way communications are central to local resilience capabilities. Follow the source link below to TMB Issue 37 (p.3-6).

The 2021 UK Census offers a unique opportunity to increase our long-term understanding of the health, social and economic impacts of COVID-19 on different communities. In due course, local government can use the insight that the Census provides to plan and provide funding for services that will be critical in recovery and renewal, such as changes in housing, education and healthcare. Grassroots organisations, charities and businesses can also use this information to inform their future work and to secure funding. Consider:

• A targeted and localised communications campaign that highlights issues that are relevant for local people in their community:
  • Engage local community members/groups that may have influence and knowledge on the priorities of specific communities to inform communications and support the encouragement of people to take part
• Partner with organisations that work with different communities to promote the value and benefits that the information gained through the Census will bring
• Tailor communications and ensure that the value and benefits detailed are relevant to particular groups (e.g. people with disabilities, ethnic communities)
• Develop a variety of resources that support people to take part, for example:
  • Create a variety of resources (e.g. animation films) that explain how to complete the Census and where people can get support with filling out the Census form, signpost people to organisations that can help
• Ensure all resources are accessible in terms of language and consider access needs of people with disabilities

Many people, particularly those shielding, may be anxious about having annual servicing and repairs done to their homes, property or possessions e.g. cars, bicycles. Thus, they may delay routine maintenance and servicing of gas and electric appliances, vehicles, etc. or be encouraged to personally attempt maintenance or repair that they are not skilled to safely complete. This may put them, and others, at risk. Consider:

• Communicating the importance of annual servicing, repairs and maintenance in keeping people safe, including:
  • Encourage residents to check the expiry of, and keep up to date with, servicing, maintenance and repairs to avoid the risks of faulty boilers, for example
  • Signpost residents to safe working conditions that customers may expect of local organisations when they work in people’s homes
  • Encourage local organisations to detail the COVID-safe work practices that they have in place
• When restrictions ease, there may be a rush for maintenance and repair services, (e.g. roadworthiness/vehicle testing and servicing), which may cause a backlog or delay in service delivery:
  • Remind residents and encourage them to check when they are required to renew their MOT – the UK introduced a 6 month extension for vehicle roadworthiness (MOT) certificates in the first lockdown as garages were forced to close, so this will have disrupted normal scheduling
• Those who may be struggling financially due to the pandemic may be concerned about the affordability of maintenance and servicing:
  • Remind residents that keeping up to date with annual services can prevent future maintenance that may cost more to repair/replace
  • Signpost residents to financial advisory services (see TMB 30)

As COVID-19 vaccine delivery programmes gain pace, attention has turned to vaccine hesitancy and the associated challenges to achieving optimal vaccination goals[1]. Public hesitancy has developed as people are anxious and uncertain about the safety and regulation of the vaccine[2]. Vaccination hesitancy has been found to relate to the public perception of risk, connected to two factors:

• The risk of morbidity or mortality
• Elements of an event that cause fear, worry, mistrust or upset to the public[3]

Recent studies have identified three predominant groups that are at higher risk of COVID-19 vaccine refusal, requiring targeted strategies and communications to address their concerns and hesitancy:

• Women aged 30-39[4]
• Low-income groups[5]
• Socioeconomically disadvantaged groups and BAME communities[6]

Potential causes of COVID-19 vaccine hesitancy:

• The speed at which the available COVID-19 vaccines were produced and approved may lead to scepticism or mistrust relating to their benefit, effectiveness and long-term side effects[7]
• Pregnant women were not included in the majority of COVID-19 clinical trials, so there was little data available to evaluate vaccine safety relating to fertility, pregnancy and young children[8]
• Misinformation through social media and the challenges caused by the anti-vaccination movement in developing and communicating scientific expertise and building public trust in the effectiveness of COVID-19 vaccines[9]

Strategies to address vaccine hesitancy

Although the WHO advise that there is no specific reason for risks that would outweigh the benefits for pregnant women in some vaccines[10], the inclusion of pregnant women in COVID-19 therapeutic trials is crucial to ensure the identification of efficacious and safe treatment[11]. The Behavioural Science and Public Health Network[12] and the European Centre for Disease Prevention and Control[13] offer the following recommendations to address COVID-19 vaccine hesitancy:

• Increase trust and confidence in the safety and effectiveness of the COVID-19 vaccine by:
• Clearly communicating its rigorous development and testing process
• Provide details of the COVID-19 development and testing process, highlighting the way in which the same rigour has been applied for previous vaccines
• Train health care workers to respond to hesitant patients, e.g. their common concerns, addressing those concerns
• Design community-level interventions to target high risk vaccine refusal groups by supporting the development of community networks:
• Leverage and support existing channels that have influence on decision making, such as; community and faith leaders of ethnic minority and low-income communities; teachers and youth/sport club leaders who interact with the parents of young children; online communities and networks[14], e.g. Mumsnet
• Establish community educational and promotional activities to inform on the safety and benefits of vaccination (via talks, videos, presentations and discussions)
• Launch advocacy campaigns supported by community members to promote vaccine safety and counter anti-vaccination messages, to mitigate the prevalence of misinformation in BAME communities[15]
• Establish an on-line decision aid for parents
• Use information from trusted health agencies to produce online information and vaccine information pamphlets for pregnant women and new mothers:
• Detail different vaccines in full, relative to their available safety data, to ensure women can make a factually informed decision
• Raise awareness of online information and disseminate pamphlets

References:

[1] https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(20)30016-8/fulltext

[2] https://www.ecdc.europa.eu/sites/portal/files/documents/Catalogue-interventions-vaccine-hesitancy.pdf

[3] https://oxfordmedicine.com/page/measles%20and%20the%20hesitancy%20to%20vaccinate/measles-and-the-hesitancy-to-vaccinate

[4] https://www.smh.com.au/politics/federal/covid-19-vaccine-advertising-campaign-to-target-specific-fears-20210109-p56svi.html

[5] https://www.sciencedirect.com/science/article/pii/S2666776220300120?via%3Dihub

[6] file:///C:/Users/r66633rj/Downloads/COVIDvaccinePaper4.pdf

[7] https://www.ox.ac.uk/news/science-blog/covid-19-vaccine-hesitancy-uk#

[8] https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30484-8/fulltext

[9] https://www.bma.org.uk/news-and-opinion/pushing-back-tackling-the-anti-vax-movement

[10] https://www.who.int/news-room/feature-stories/detail/the-moderna-covid-19-mrna-1273-vaccine-what-you-need-to-know

[11] https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30484-8/fulltext

[12] https://www.bsphn.org.uk/_data/site/54/pg/675/COVID-19-Vaccination-Reducing-Vaccine-Hesitancy.pdf

[13] https://www.ecdc.europa.eu/sites/portal/files/documents/Catalogue-interventions-vaccine-hesitancy.pdf

[14] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32642-8/fulltext

[15] https://socialcare.blog.gov.uk/2021/01/27/overcoming-vaccine-hesitancy-in-our-diverse-communities/

As the roll out of the COVID-19 vaccine gains pace, there has been reporting of a rise in criminal activity targeting people who await information about their vaccine. Examples of how fraudsters are exploiting the vaccine launch includes: scam text messages that request personal information such as bank details; fraudsters turning up at peoples' houses posing as National Health Service employees and offering vaccination for immediate payment. Fraud undermines public confidence in official programmes and contribute to a negative narrative around the vaccine programme. Consider public messaging to:

• Use a range of communication channels to build public awareness of fraudsters' tactics to encourage vigilance regarding vaccination communications
• Ensure communications about fraud awareness are available in different languages and different media e.g. to support migrants or support people with disabilities such as via informational videos: https://signhealth.org.uk/resources/coronavirus/
• Publish a list official government and health websites/social media channels that are authorised to provide official information on the vaccine
• Include in fraud communications information on the ways in which people will be invited for an official vaccine, and ways that they will not be invited
• Identify partnering organisations that can distribute messages about vaccine fraud e.g. organisations that run befriending schemes, check-in and chat services, vaccination partners
• Disseminate consistent information to these partnering organisations to advise them of how to provide information about fraud without concerning people about the safety of the vaccine itself

In Greater Manchester UK, the Greater Manchester Combined Authority (GMCA) Ageing Hub, Greater Manchester Health and Social Care Partnership, and partners launched the ‘Keeping Well this Winter campaign’ to support older residents in the region. The resources are designed to:

• Encourage conversations about keeping well during winter using a short film produced by older people, a talking tips guide and booklet to provide clear, practical resources containing key messages for staff and volunteers who have any contact with older residents, their friends or families

Resources are also being distributed directly to older residents through printed copies to avoid digital exclusion.

In addition, to support the promotion and dissemination of this information, a communications toolkit has also been designed for partners and includes:

• Leadership messages
• Briefings and networks/forums
• Internal and external electronic/printed newsletters
• Websites and social media accounts

The tips in these resources may be adapted to apply throughout the year and with other vulnerable people.

The novelty of the COVID-19 pandemic has meant that information about the disease has continually been changing. During the pandemic explicit or implied certainty has led to inaccurate predictions e.g. in death and infection rates. While so little is known about COVID-19 (meaning uncertainty is unavoidable), communicating preliminary or emergent data as certain facts had impacts on behaviours and lives. Consider how acknowledging uncertainty about COVID-19 may:

• Improve the atmosphere around scientific debate and build public trust through conveying that evidence and practice could/should change with more information and research
• Improve people's trust in government authority as the information they provide is transparent, and in respecting uncertainty are able to acknowledge credible yet conflicting evidence

Increase regular evaluation of pandemic management plans - emergency planner's understanding of influenza viruses has increased dramatically in recent decades, yet, there is very little certainty about the determinants of, and possibilities for, pandemic emergence ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862331/). This is illustrated by contradiction that: COVID-19 was largely unexpected, but that there are a large number of influenza pandemic management plans in circulation.

The COVID-19 pandemic has produced a huge amount of information from a variety of sources, not least on the rules for local lockdown. In the UK, COVID-19 rules vary depending on whether you live in England, Wales, Scotland or Northern Ireland. In addition, millions of people are also affected by local restrictions. In Greater Manchester, for example, these restrictions have differed between metropolitan boroughs. The BBC have created a webpage 'Local lockdown rules: Check Covid restrictions in your area' that provides an example of how to support the public in finding information about COVID-19 restrictions in their areas, or areas of interest, through postcode searches. This helps to provide information about restrictions in individuals' locations and that of their friends, family or workplaces.

Guest briefing by Dr. Su Anson and Dr. Katrina Petersen, Trilateral Research and Inspector Sue Swift, Lancashire Constabulary, prompts thinking on risk communication approaches in the context of COVID-19 and how the public can be active agents in their own response. The authors focus on: Identifying goals and outcomes; developing the message; channels for two-way engagement; and evaluating communications effectiveness.

Follow the source link below to TMB Issue 22 to read this briefing in full (p.2-7)

Research by University College London (UCL) suggests that confidence in understanding coronavirus lockdown restrictions varies greatly across the UK and has dropped significantly since early national measures were put in place in March. As part of their ongoing research UCL determine that people generally consider themselves compliant with restrictions, but UCL caution that this should be interpreted in light of previous reports that show understanding of guidelines are low; therefore possibly reflecting belief in compliance opposed to actual compliance levels. Consider how to ensure residents in lock areas understand the rules that apply to them:

• Make direct contact with resident via social or traditional media, messaging apps, or leafleting through doors to ensure people understand their local restrictions. This may be especially important in combined authority areas as restrictions differ across metropolitan boroughs, the boundaries of which may not be clear to residents
• Encourage the display of digital tools showing local information about which restrictions apply in certain areas. This may be a simple video, or an interactive tool which people could access through localised digital marketing on their smartphones
• Consider where local, clear information could be publicly displayed e.g. digital advertising boards at local bus stops, or localised social media and television adverts
• Consider the demographics, resources and capacities of each community to establish the most appropriate methods of dissemination and key actors who could support this. In Mexico, this included: Video and audio messages shared via WhatsApp; audio messages transmitted via loudspeakers; and banners in strategic locations

In the UK, first-person accounts of living through the 2020 COVID-19 pandemic have been collected to better understand how people respond to pandemics and how to help people cope better in the future. This is particularly important if viral epidemics become more common. This type of research can form an important digital archive for future researchers. Consider working with local and academic organisations to develop an online survey to collate people's experiences on:

• How COVID-19 and the measures to control it are affecting and shaping interactions between individuals in society
• The effect of the pandemic on community wellbeing, quality of life and resilience
• The impact of digital technology on community responses to the spread of coronavirus
• The impact of the pandemic on how and where support can be accessed

How people with physical and mental health problems, and disability, and those who are facing inequality or discrimination have been impacted

Local government are producing online materials to help people understand what has happened during response and what is meant by the next phase of COVID-19. This can communicate expectations and align aspirations for what recovery may involve. Consider:

• Producing a short video on how the response effort aims to support people and businesses
• Producing a short video on Recovery and Renewal
• Encouraging widespread dissemination of the video to households, classrooms, offices, waiting rooms, public spaces, social media
• Reach the widest audience by providing the video in different languages

Watch Barnsley Metropolitan Borough Council's video: https://www.barnsley.gov.uk/services/health-and-wellbeing/coronavirus-covid-19/coronavirus-covid-19-recovery-plan-for-barnsley/

There is a glut of information on COVID-19 and more often we are seeing news outlets attempting to check and correct misinformation that be being shared. This should aim to ensure that the public have conclusions about the virus which are substantiated, correct, and without political interference. Myths can be debunked, misinformation corrected, and poor advice challenged. Consider whether to:

• Provide your own fact-checking website
• Contribute to others' fact-checking sources
• Check facts of colleagues and partners to ensure correct information prevails
• Remind others of the importance of not spreading misinformation and checking other peoples' facts
• Link your website to official sources of information so not to promulgate misinformation

Tracking public opinion can provide insights into how a society is coping with rapid change, and provides organisations with data that can influence decision-making. During a pandemic this is particularly important as complex information is shared with the public at speed, understanding how this is being understood can help develop evidence-based interventions to support the population. Consider collecting the following types of public opinion information to inform recovery strategies:

• Perceptions of COVID-19 threats to the country, and to individuals
• Use of health services and health seeking behaviours e.g. how comfortable individuals are seeking treatment from hospitals or GPs
• Perceptions of health and care services and how well specific services are managing the pandemic
• Impacts on individuals' sleeping
• Perceptions of local, region or national partnerships e.g. businesses working with local authorities to combat COVID-19
• Impacts of COVID-19 on personal finances, whether positive, negative or neutral
• Perceptions of government performance in dealing with recovery

The population's outlook on getting 'back to normal'

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.

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

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

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

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

This can reflect different experiences of the crisis and its effect on our lives which are more uplifting and positive. Volunteers can help with this, as can the voluntary sector. Check out the "Together Cumbria" social media accounts which are run by voluntary organisations on behalf of the resilience partnership.

This can include the number of infected people, their status, characteristics (e.g. age, gender), number of inquiries to the call centre, number of people using subways, etc. The city can also provide the website's source code as open-data, so that other municipalities and institutions can use the data and replicate similar webpages.

Local government plays a key role in building trust in new measures and tackling misinformation. There may be a need for this in the UK. Of 2,250 adults surveyed:

• 15% of people thought seasonal flu was deadlier than coronavirus
• 31% believed "most people" in the UK had already had the virus without realising it
• 39% think they should be shopping "little and often to avoid long queues", when the advice is only to go out to shop for basic necessities and as infrequently as possible.
• 25% believed the conspiracy theory that coronavirus was "probably created in a lab" - one of several conspiracy theories currently circulating on social media platforms such as Facebook and YouTube.

Surveys like this help your organisation identify areas where their messaging is not as clear as it needs to be. Local government would benefit from continuing surveys on public opinion.