Lessons from Lockdown

Planning and managing service delivery in the NHS: looking to the future

Professor Kath Checkland

COVID-19 has reinforced the necessity of effective planning of health services, treatment and prevention capacities in primary and secondary care, and both protecting and optimising our healthcare workforce. Here, Professor Kath Checkland reflects on the renewed centrality of “commissioning” to health policy debates that will follow in the wake of the pandemic, and draws lessons from research here at Manchester for the policymakers and practitioners who will need to address this debate in the months to come. 

The organisation and management of the NHS can seem to be a dry subject, full of esoteric language and highly technical details. Acronyms abound, with NHSE overseeing CCGs which in turn support PCNs whilst contributing to ICSs, with CQUINs offering incentives – with the LTP setting out the strategy for the next 10 years. And if you understand that sentence then you have clearly spent far too much time reading about government policy!

However, one thing that the current crisis has taught us is that the oversight and management of the NHS matters. Planning – usually known in the NHS as commissioning – is the function which ensures that the right services are available for the right people at the right time. Providing sufficient capacity in both hospitals and community services, and co-ordinating between different types of care providers to make sure that patients experience joined up services require complex systems and oversight. As the NHS and social care services adapt to and recover from the pandemic, it is important to consider how planning works, and how it may need to change.

Development of organisation and planning from 2012

In 2012 a vast reorganisation of the NHS took place which affected all parts of the system. Our team has been researching these changes for the past 8 years and in a recently published book we offer a comprehensive overview of the changes made and their impacts on the governance, accountability and functioning of the health system in England.

The Health and Social Care Act 2012 distributed responsibility for commissioning services to a much wider range of organisations, and required service providers to compete with one another to a greater degree than in the past. Public health was moved outside the NHS to Local Government, and a new Arm’s Length Body, NHS England, was established to oversee the service as whole. The result was a significant fragmentation of care planning across the NHS, with some emerging evidence of a potential deterioration in the provision of some types of care.

Less than 10 years after its enactment, many of the principles underlying the Act have been discarded, with a move away from competition and a new focus on collaboration and integration of care. However, the legislative structures put in place in 2012 remain, and the new collaborative structures which are being built rest upon agreements and partnerships rather than being enshrined in statute. Our research found that confused lines of accountability could be a problem, and that skilled managers with a good knowledge of their local area were vital in the planning process. The fragmentation which resulted from the Health and Social Care Act was at least partially mitigated by the hard work of skilled commissioning managers who, in their words, ‘knitted the system back together’. We also observed that different functions require activity on a different scale, with planning of primary care services needing a much more local focus than larger scale hospital reorganisations and collaborations to deliver more specialised services.

The building blocks of the more collaborative system set out in the NHS Long term Plan of 2019 include collaborations across populations of 1-3 million, known as Integrated Care Systems (ICS), and local neighbourhood collaborations between GP practices and other community-based services, known as Primary Care Networks (PCN). ICSs are focused upon the big issues of resource distribution between hospitals and the best way to organise services such as emergency care and specialist surgery. PCNs are focused upon how best to provide services outside hospital, with GP practices working together with other community services to provide comprehensive services and hopefully keep people out of hospital. Clearly the current pandemic will have affected these developments, with collaboration at all levels even more important in the current emergency.

Organisation and planning: lessons for the future

So what can we learn from our research to date which may be relevant to regional collaboration (in Integrated Care Systems) and in local neighbourhood working (in Primary Care Networks) as they develop and work together to manage the crisis?

The NHS which emerged from the Health and Social care Act 2012 is a very complicated one, with overlapping layers of regulation and accountability. The Covid-19 crisis has led to a centralisation of many aspects of NHS decision making, and this may well be appropriate for short term crisis management. However, as the NHS returns to normal it may be that this is an appropriate time to consider the level within the system at which different types of decision are made. Our studies have raised the question as to whether the regional level of co-ordination should be put on a statutory footing, as used to be the case with Strategic Health Authorities. The different pace and impact of the pandemic in different areas suggests that a regional tier of management with a  clearly defined role, responsibilities and lines of accountability may offer considerable advantages in the recovery period and in the longer term.

Our research highlighted the complex regulatory structures to which NHS organisations are subject, from national inspection regimes to the application of EU law on procurement. The current crisis has led to the short term suspension of many regulatory requirements, such as individual practitioner revalidation and CQC inspections. It is much easier to increase regulation than it is to reduce it, and this may be an opportunity to critically examine each element of the regulatory system to consider how and in what circumstances it adds value or prevents avoidable harm, only re-introducing those where a clear rationale can be described.

Our research has shown that the planning and management of primary care requires detailed local knowledge, and the pre-Covid 19 push for Clinical Commissioning Groups to merge and cover much larger populations may make this more difficult. In the aftermath of the pandemic there will be an opportunity to critically examine how local services adapted and what factors helped them to do that. A measured consideration of what planning functions need to take place over what geographical scale would be of value, and could inform future decisions as to optimum CCG size.

One of the drivers of CCG mergers is the reduction in management costs. All of our studies have shown that high quality management is of vital importance in the delivery of high quality NHS services, and that personal knowledge and relationships underpin the planning and delivery of these services. Valuing managers and the relationships that they have built should be the cornerstone of the NHS as it builds for the future.

Originally published 26 May 2020

What should transport and mobility responses be now and beyond?

Dr Ransford A. Acheampong

The measures we put in place around transport and mobility are critical to how we emerge from this pandemic and rebuild in the coming years.  Dr Ransford A. Acheampong examines how to make transport safe as some of the most vulnerable groups are returning to work, and shows that active travel is essential to reducing pressure on public transport and should become central to our transport and mobility futures.

Low-wage vulnerable workers, who cannot work from home and are at greater risk of catching the virus, tend to depend on public transport for commuting purposes.

Social distancing can be achieved with walking and cycling, making a mass cycling culture critical to our collective health, well-being and resilience now and in the future.

There is a unique opportunity to learn lessons and to invent new futures for towns and cities, including the way we travel.

The COVID-19 pandemic has brought major disruptions to social life, work and the way we travel. There is already evidence pointing to serious ramifications for the global economy. In the UK, after months of lockdown to protect public health, the government is desperate to have the wheels of the economy turning again. The lockdown is gradually being eased since mid-May, and people are being asked to return to work.

It is clear that the measures we put in place around transport and mobility will be critical to how we emerge from this pandemic and rebuild in the coming years. This is particularly important in the face of real concerns that the government’s responses regarding transport and mobility, in the short to medium term, will have serious implications on whether or not there is a second wave of infection of the virus.

In the months of the lockdown, we have witnessed an overall decreasing trend in movement by different modes, including public transport, car-based transport and even walking and cycling. As people return to work, we are also witnessing a gradual increase in traffic on our roads and in the use of public transit in our major towns and cities, such as London. One of the key questions we now face is how to make transport safe for people who are returning to work?

Figure 3. Changes in transport habits across the lockdown period saw rail and tube experience massive drops in footfall

In response to this, the UK government has issued transport and travel guidelines, which essentially advices commuters to avoid public transport, if they can, and instead drive, cycle or walk. What could the likely impact of these transport measures be?

Some of the most vulnerable groups are returning to work

Firstly, we know from the evolving evidence that while COVID-19 poses serious risks to the population as a whole, people from ethnic minority backgrounds are some of the most affected groups in the UK. While factors such as prior health status and underlying health conditions have been attributed, it is possible that the differential levels of risk and vulnerability are partly the result of the occupations that people are engaged in. It appears that people in low-wage work across different sectors of the economy are at greater risk of catching the virus, partly because of the nature of their work. These low-wage vulnerable workers, who cannot work from home, also tend to depend on public transport for commuting purposes.

On the one hand, UK Transport Secretary Grant Shapps has indicated that it is a ‘civic duty’ for people to avoid public transport. On the other hand, we know that public transport is essential for most people to access opportunities, including going to work. Indeed, in 2018/19, some 4.8 billion journeys were made by people using their local buses in Britain, constituting about 58% of all public transport journeys. In London, 27% of workers drive to work, with many of the remaining workers depending on other modes, including public transport. This means that some of the most vulnerable population who are now returning to work, do need public transport to be able to do so.  Consequently, there is real risk that people will continue to use public transport in large numbers despite government advice, potentially risking their health and that of the general population.

Making public transport safe and reducing travel-related transmissions

So, how do we ensure that transportation measures being taken actually protect public health?

Increase public transport service frequency. The UK government’s latest safer travel guidelines indicate that there is going to be reduced capacity of public transport services. However, in order to avoid overcrowding on public transport, as we are starting to see on tubes and buses in London and elsewhere, it is crucial that capacity is increased by increasing the frequency of services, especially during peak-hours of travel.

Make public transport faster. Again, the UK government’s safer travel guidelines signals that travel may take longer than normal on some routes. Longer travel time, added to social distancing not being possible as a result of overcrowding, could increase the time that passengers come into contact on public transport, thereby increasing risk of travel-related transmission of the virus. As more people return to work driving, congestion could return, and travel delays on public transport in our major towns and cities could return to the pre-pandemic levels or even worsen. Thus, in the short-to-medium term, it would make sense to reallocate more road space by creating new dedicated bus lanes with the aim to making service more frequent and faster.

Ensure social distancing on public transport and at stations. Basic measures such as reducing occupancy on public transport, marking seats where passengers can sit and controlling passenger flow in stations could go a long way to making public transport use safe and protecting the vulnerable populations who depend on it. Obviously, doing so will amount to reducing capacity, but this can be offset by increasing the frequency and speed of services, such that at regular intervals, more buses, tubes and trams are available for people to board.

Active transport—are more people going to cycle?

The benefits of cycling and walking are obvious, and it does not come as a surprise that the safer travel guidelines encourage more people to do so as they return to work. From the UK government’s position, as reflected in the travel guidelines, walking and cycling are essential to reducing pressure on public transport. Social distancing can be achieved with walking and cycling, with added benefits to the environment and the health of those who do it. The government’s plans for cycling in particular, and some of the actions backing those plans, including the ‘creation of a £2 billion package to create a new era for cycling and walking’, are steps in the right direction and are welcome. However, we need to be careful and even cautiously optimistic about what levels of cycling could actually be realised in the short-to-medium term.

Compared to countries such as The Netherlands and Norway, the UK is a low-cycling country. Nationally, cycling constitutes just about 1% of total trip mileage. In London, where cycling has increased significantly in recent years, less than 3% of all trips were undertaken using the bike pre-COVID19 pandemic. Females and older adults as well as ethnic minorities and low-income groups are under-represented in the number of people who cycle.

A plausible scenario for the UK is that car use will return to pre-pandemic levels or even increase as people avoid public transport. This could make cycling seem unsafe, especially for those that the government is intending to encourage to change their behaviours. If commuters do not drive and cannot cycle, then they have no option but to use public transport. Thus, in the short-to-medium term, as more people return to work, the focus should be on making public transport safer, faster and reliable, by implementing the measures already outlined in this article.

Beyond the pandemic—inventing our transport and mobility futures

In the coming months and years, society and economies will recover from the devastating impacts of COVID-19. There is a unique opportunity to learn lessons and to invent new futures for towns and cities, including the way we travel. Sustained, long-term investment in cycling, walking and public transport should be central in these futures.

As this pandemic has shown, a mass cycling culture, is critical to our collective health, well-being and resilience now and in the future. There is the need for policy to help remove barriers to cycling among under-represented groups, to create inclusive transport futures. In the unfortunate event of another pandemic, we can be sure that the investments we make in cycling and walking, in particular, will yield dividend in aiding our rapid recovery.

Above all, making transport sustainable will be crucial to reversing climate change and averting potential cataclysmic impacts now and in the future.

Originally published 3 June 2020

Can shipping emissions be kept in check in a post-COVID future?

Simon Bullock

The shipping sector is playing a vital role in the COVID-19 pandemic, keeping Britain supplied with everything from pasta to PPE. But what role does it need to play in another great crisis – preventing catastrophic climate change? Here, Simon Bullock from the Tyndall Centre, Manchester, looks at what needs to be done in order to keep shipping emissions below the 1.5 degrees Paris Climate Agreement.

Ships typically emit less carbon dioxide (CO₂) per tonne of freight than lorries or planes. But the global impact of shipping is still huge: if it were a country, it would be the 6^th highest emitter in the world. So what needs to be done?

New research from the Tyndall Centre explores this issue for shipping through the concept of “committed emissions”. Committed emissions are those emissions we can expect to see in years to come from existing infrastructure – in this case, existing ships that will continue to emit CO₂ across their 30-year lifetime.

Our research considers ships travelling to and from the EU in 2018 – how much CO₂ they are emitting, and how long they are likely to stay in service. The committed emissions just from these existing ships exceeds the amount of CO₂ EU shipping is allowed to emit overall if it is to make a fair contribution to the Paris Climate Agreement’s goal to keep global warming below 1.5 degrees. Because ships have average lifetimes pushing three decades, it is existing ships, not new ships, that will be responsible for most of shipping’s future CO₂ emissions. This is in contrast to the road transport sector, where there are shorter product lifetimes, and a much faster turn-over of the vehicle fleet.

But, there is hope. There are many ways in which emissions from existing ships can be cut: slower speeds, fitting modern sails, using green electricity when in port, retrofitting vessels to be more energy efficient, greater use of hybrid vessels using batteries, and retrofitting vessels to use zero-carbon fuels such as ammonia and hydrogen.

Our research shows that if new vessels are able to run on zero-carbon fuels from 2030, then a strong suite of policies targeting existing vessels – on speed, operational efficiencies, blended fuels and zero-carbon fuel retrofits – could keep shipping’s emissions within the Paris Agreement’s 1.5 degree carbon budget. But only if this action to retrofit the fleet happens quickly.

What needs to happen next?

First, the International Maritime Organisations (IMO) current target of at least 50% cuts in greenhouse gas emissions by 2050 needs to be significantly tightened to be compatible with the Paris 1.5 degrees goal. Our research indicates that keeping within 1.5 carbon budgets would need shipping CO₂ emissions to fall to net-zero by 2040.

Second, the IMO’s policy focus is predominantly on measures for new ships, such as the Energy Efficiency Design Index (EEDI) energy efficiency policy, which sets emission levels per tonne km for new ships. While this and at-scale deployment of zero-emission fuels and ships by 2030 are both essential, it is critical that the IMO focusses on measures that cut emissions from existing ships as well, as existing ships will produce the bulk of future emissions. “Slow steaming” is one of the best short-term measures to cut energy use and emissions; ship operators still widely practice this since the financial crash, to cut fuel costs. This has cut the CO₂ intensity of ships by 30% since 2008. Further savings are possible still but require some form of international policy mechanism. One problem is that progress at the IMO is mired in complex wrangles over policy design, with reluctance to make any measure mandatory. Breaking the international impasse on progress on slower-speeds is a priority.

Third, the research shows wide variety in the lifetimes and committed emissions profiles of different classes of ships, implying that targeted policies are needed. Refrigerated cargo ships have an average of 9 years likely future life, whereas for passenger ships it is 29 years. For ships and ship types with shorter remaining life, it’s hard for ship-owners to make a strong economic case for actions on their own, so the successful uptake of emission reduction measures requires action from policy makers, such as regulating on speed, setting standards on retro-fitting to improve efficiency, or market-based mechanisms that impact on fuel price.

Efficiency improvements on new ships won’t be enough

The committed emissions from ships are significant, yet a combination of policies on very low-carbon ships from 2030, combined with speed and operational measures from the early 2020s, could keep shipping within a Paris-compatible carbon budget. However, any delay to appropriate policy implementation would mean additional measures, including demand-side or early scrappage interventions, are needed to meet the Paris climate goals.

The time left to deliver on what is dictated by the global Paris Agreement is too short to rely on measures that predominantly focus on improving the efficiency of new ships. Policy makers should include a focus on measures that clearly target the existing fleet.

Originally published 15 June 2020

Build in haste, repent at leisure? Post-pandemic planning at the precipice

Professor Iain White, Professor Graham Haughton and Dr Nuno Pinto

The COVID-19 pandemic has led to discussions on what shape planning should take post-crisis. Here, Prof Iain White, Prof Graham Haughton, and Dr Nuno Pinto outline how current regulations have exacerbated difficulties for some people in lockdown, discuss how opportunistic developers or politicians may seek to hijack the policy responses, and suggest solutions to ensure the post-pandemic recovery is beneficial for all.

A wide-ranging discussion on the implications of the COVID-19 pandemic by city mayors, academics, and others, has evoked new ideas on how we live and move, and on how to transition economies to be greener and cleaner. Despite such good intentions, as the dust settles, we run the risk of returning to ‘business as usual’ and we are already seeing much new thinking side-lined, alongside a reversion to familiar narratives of ‘speed’ or ‘red-tape’. We must be cautious about altering the planning system so it can do the wrong thing more efficiently.

The cost of fast-tracking infrastructure

Under pressure for quick results, there are signs that some governments seek to short-circuit the planning system in order to expedite development. For instance, the mooted ‘shovel-ready’ infrastructure stimulus in New Zealand aims to create a fast-track process, where politicians select projects and there is no opportunity for citizen involvement. Significantly, the Minister in charge said that there should be a high level of certainty that consent is given. Meanwhile, Australia’s version of ‘fast-tracking infrastructure’ sees a call not just to cut ‘red-tape’ but ‘green-tape’ too—that is, environmental regulations. In the UK, the Transport Secretary recently used the term ‘bureaucratic bindweed’ to describe rules in the current system that presumably need to be eliminated.

During the current pandemic, English local authorities were initially forced to abandon their planning committees, instead giving greater powers to officials, sometimes aided by senior local politicians, to decide on major, occasionally contentious, projects. Requirements to publicise site notices have been relaxed in England, while the Housing Secretary has announced that instead of traditional methods, local councils and developers can use social media to publicise applications to ‘unblock’ planning. This is bad news for those without social media or access to technology or data, discriminating particularly against the elderly and the most vulnerable. While some local authorities in England have now adopted virtual planning committees, many have been slow to introduce them.

Under these relaxed measures, opportunistic developers may have been emboldened by relaxed planning requirements to bring forward proposals that are likely to be locally contested, hoping this might improve their chances of slipping projects through.

We structure our discussion about improving the processes of planning under three headings: better planning before, during, and after future pandemics.

Better planning anticipating pandemics

Having now experienced social distancing and lockdown, and with the prospect of a pandemic a recurring possibility, planners need to prioritise actions that better prepare for the implications. It is clear we need better provision of both private and public space. Homes need to be built to higher standards. Under current English regulations – as a recent case in Watford revealed – it is possible to build homes without windows, a decision upheld by the planning inspectorate, against the objections of local planners and politicians. Imagine an elderly or vulnerable resident being locked-down inside such a development.

Fortunately, the considerable public outcry, media attention and political opposition appears to have seen the developer reconsider the scheme. This only goes to show the importance of proper local scrutiny of development proposals. The problem here is that the English planning system no longer does this in all cases, and fast-tracking may give more power to developers. Rather than give away more permitted development rights, we should be looking to limit them, restoring local democratic scrutiny and the rights of local residents and citizens.

Better planning during pandemics

Local authorities need clear plans in place for how planning decisions will be made in any future lockdown or enforced social distancing. Major projects must not be waved through under emergency rules, and predatory developers wishing to exploit any perceived relaxation in planning approvals need to be discouraged, perhaps by removing their right to appeal any planning decisions taken under lockdown and instead giving the public the right to appeal.

In terms of planning to exit a future pandemic-related recession, rather than relying on large scale mega-projects ushered through without adequate political scrutiny and public consultation, there is much to be said for encouraging smaller projects that emerge out of local consultation and that are open to robust challenge under effective local planning systems.

Local projects might be slightly slower to be approved, but much quicker to build than, for instance large-scale road projects. They also tend to be better fitted to the nature of places that they occur in and jobs more likely to be local.

Better planning processes, fit for rebuilding the post-pandemic world

Considering how the public expectations of transparency and fairness have been raised during the pandemic, we should also expect citizens to question the politicians who use expert advice to deflect, blame or limit meaningful opportunities for public engagement.

Over the past decade, in England and elsewhere, planning systems have been loaded in favour of developers and their advisors and against local communities. Backing up this state of affairs has been growing recourse to poorly specified technical processes which serve to bamboozle and outmanoeuvre the public.

The planning system needs to be reset, so that the language and techniques of planners, developers, and consultants are intelligible, transparent and favour honest communication between politicians, stakeholders and the public. The fear is that in the rush to rebuild, the bigger projects that are being politically favoured, tend to be complex and technical, and if they are rushed through, there will be even less space for better processes.

Conclusion

Rather than build in haste and repent at leisure, we need to think deeply about how the planning system can be repurposed to suit the emerging challenges for cities, not least in relation to the once-in-a-generation investment and the revised expectations from the public around transparency and fairness. Planning, like policing, is at its best when it works on the basis of consent–attempts to reduce opportunities for scrutiny, challenge and dissent threaten the legitimacy not just of planning, but the whole development process.

Originally published 27 May 2020

The voluntary and community sector and COVID-19: Going to war without ammunition?

Sophie Yarker, Kirsty Bagnall, Tine Buffel, Patty Doran, Camilla Lewis and Christopher Phillipson

COVID-19 has forced us all to rethink how to maintain social connections in the neighbourhoods where we live and work. For the voluntary, community and social enterprise sector (VCSE), this has meant a rapid rethink in how to provide services whilst observing social distancing guidelines. Here,  Sophie Yarker and Kirsty Bagnall, along with Tine Buffel, Patty Doran, Camilla Lewis, and Chris Phillipson from the Manchester Urban Ageing Research Group (MUARG), discuss the challenges the sector is facing and suggest an alternative approach to providing support.

Whilst the demand on organisations continues to increase, their ability to respond to COVID-19 has been  substantially reduced due to  cuts in public sector funding, which has reduced or disappeared over the years. Research  suggests that smaller charities (with annual incomes of between £100,000 and £500,000) lost nearly half  of their income from local government  in the five years following the 2008 financial crash. On top of cuts to their own funding, the social infrastructure that supports the third sector has also been under attack. Some examples include: 12,000 public spaces  sold in the past decade  by UK Councils ; the closure of libraries (800 since 2010); the privatisation of leisure centres; and the decline of local shopping centres in many areas. All of of these developments have led to the decline of spaces vital for social participation. The present crisis has further revealed inequalities in the extent to which neighbourhoods are able to respond to the challenges arising from COVID-19. The presence of mutual aid networks, for example, has emerged overwhelmingly in places with  strong neighbourhood networks and a thriving social economy. Such communities are much better equipped to develop responses,  as compared to those with less capacity to mobilise resources and reach out to vulnerable groups. The COVID-19 crisis is thus amplifying existing inequalities between poorer and richer neighbourhoods.

Reducing social isolation in a time of social distancing

VCSE organisations are a vital part of the social infrastructure of neighbourhoods providing places of support, advice and social contact. As such, the sector is particularly important for older people, who are often more reliant on their immediate locality for both social participation and support. VCSE organisations have increasingly been tasked with mitigating social isolation and loneliness for older people by providing opportunities for social interaction with others. The question, then, is how can initiatives aimed at reducing social isolation continue to be delivered in the context of social distancing?

Our research into tackling social isolation and building age-friendly communities in Greater Manchester has  identified several innovative ways community organisations are responding to the challenge. The majority of Age UK branches, for example, have moved their services online or by telephone, with branches trialling new approaches to addressing social isolation. Infrastructure organisations, such as local community and voluntary services and organisations, whose operations are based around food, have moved towards direct services, co-ordinating and providing food parcels, and managing volunteers. And ethnic minority organisations, such as Europia, have developed informative videos for a number of communities for whom English is not their first language, and would therefore miss out on important information about COVID-19. In many cases, this extends the vital work organisations have already been doing to reach the most marginalised groups in our communities.

Figure 6. 84.3% of people provided support via shopping to non-household members

Unequal impact

Not only do the uneven impacts of austerity challenge the capacity of communities to respond to the immediate crisis of providing essentials such as food, medicines, support and advice, there is a significant risk that these inequalities become even further entrenched as the community and voluntary sector starts to re-orientate itself towards a future of working with social distancing.

One of the most pressing issues concerns the loss of funding. Back in March, the #EveryDayCounts campaign, led by NCVO, calculated that the charity sector could miss out on a minimum of £4.3bn of income between April and June 2020. At the beginning of April, the government announced a £750 million package to support the work of charities during the current crisis. This support, whilst welcome, is unlikely to be accessible to large parts of the sector. Many smaller organisations are likely to miss out, despite the injection of funding.

Over 80% have an income below £100,000; those with an income over £1 million are fewer but account for more than four-fifths of the sector’s income. There is a  substantial risk that emergency COVID-19 funding will disproportionately go to larger voluntary organisations, with concerns those with the most resources will apply first and take most of the money allocated. The latest State of the Sector survey carried out in 2017, showed that 46% of VCSE organisations in Greater Manchester have less than three months of running costs in reserves, a major concern given the depth of the crisis facing communities.

An alternative approach

We have already seen many within the VCSE sector using emergency funding and reserves to rise to the challenge of adapting existing projects in response to the challenges posed by COVID-19, from coffee mornings moving online, telephone-supported digital inclusion courses, and craft clubs introducing postal delivery of materials, to allotment groups making adaptations around social distancing and hygiene measures allowing them to return.

However, there is a further, more complicated challenge in creating means of new social connection, rather than adapting what already exists. Reaching and supporting those who do not already have connections within their local communities is made all the more difficult by the pandemic. Organisations will undoubtedly require financial support but this is unlikely to be sufficient to meet the challenges facing voluntary groups – especially those working in poorer communities. Based on findings from our research in Greater Manchester, we argue an alternative approach is required, one which allows organisations to test new ways of working, invest in skills and leadership, and share learning about new ideas.

Offering smaller pots of money for investment (up to £2000) can encourage organisations to take more ‘risks’ and to be more innovative with their ideas, knowing that they do not have to ‘get it right’ first time.  The learning from projects that have not gone as planned can be just as useful if shared through networking events and co-operatives. Examples from the Ambition for Ageing programme include a Crafting Co-operative in Bury set up to bring together local groups interested in craft work, and in Bolton networking events were set up in each ward to bring together those who had received similar funding to share their experiences and future plans with each other.This could be supported by a delivery and management approach that prioritises relationships and dialiogue-building by, for example, giving contractors a set of quality standards from which to design their own specific goals and targets which reflect the needs of the communities they work with.

This more flexible approach will be essential for the community and voluntary sector to respond effectively to the new context of social distancing. This requires a closer dialogue between organisations and funders to allow organisations the time and support to do this work. This aspect will be crucial for equalities organisations who themselves are the least resourced yet working with those who are often affected the most by COVID-19. This might mean adjusting procurement and commissioning to reflect a more flexible test and learn approach, and methods of monitoring and evaluation may also need to be revised to reflect different goals and outcomes.

However, any recovery or indeed reinvention of the sector will be shaped and constrained by place-based inequalities. For older people living in low income communities, who are already more at risk of social isolation, a declining community and voluntary sector will mean less support available on their doorstep and less opportunities for social and civil participation. Alarming statistics from the ONS reveal that those living in the poorest parts of England and Wales are twice as likely to die from COVID-19 than those living in more affluent areas. Far from being a ‘great equaliser’ this highlights the seriousness of the crisis facing our already most besieged communities.

Originally published 16 June 2020

Levelling up regional resilience

Dr Marianne Sensier and Dr Elvira Uyarra

Dr Marianne Sensier and Dr Elvira Uyarra have conducted research comparing the economic resilience, community wellbeing, sustainability and governance of Greater Manchester and Preston in recovery from the 2008 financial crisis. The financial crisis provided a window of opportunity for some places to develop new arrangements to adapt and diversify regional economies. Here, they explore the lessons learnt from the financial crisis that could help in recovery from the COVID-19 crisis.

Regional economic resilience is the capacity of a place’s economy to withstand, recover from and reorganise in the face of market, competitive and environmental shocks. Shocks might be global (the 2008 financial crisis and the 2020 coronavirus pandemic), national (1990s house price crash) or local (closing of a factory) in origin. But what makes a region more resilient?

Academics point to factors such as the concentration of related industries in a local economy, access to knowledge networks and good quality and adaptable institutional and governance structures. In a study on the effect of the 2008 financial crisis on UK regions, we found that those areas with greater shares of: knowledge-intensive and high-tech services, higher-level qualifications, and managers and professionals had higher output, jobs and productivity growth rates in recovery from the financial crisis. We found that the South East of England was the most resilient region to the crisis, while the North East and Yorkshire and Humberside regions were the least resilient along with Northern Ireland.

Regional differences in wellbeing

It is important to understand resilience in not just economic terms but also in terms of wellbeing of citizens and the sustainability of places. In another study, we compared measures of resilience and wellbeing and found that while the City of Manchester scores highly for economic resilience, it ranks the lowest of all the districts of Greater Manchester for inclusive growth in local conditions, with lower rates of healthy life expectancy pulling down this measure. Peripheral districts, like Bolton and Wigan, have been the least resilient, suggesting that policies targeted at dense agglomerations have not benefitted surrounding areas. Preston, in following community wealth-building policies, has had a more equitable recovery and is improving wellbeing for its citizens.

The UK has large regional economic and social disparities and these have widened since the financial crisis. The current government has stressed the need to level up across different regions, which reflects the failure of an overly centralised style of governance and a decade of austerity, which has exacerbated rather than ameliorated inter-regional differences.

Regional resilience to the COVID-19 pandemic

It is fair to assume that those places least economically resilient in the recovery from the 2008 financial crisis will also be least resilient to this current crisis. The uneven economic impact of the pandemic has been analysed by the Centre for Towns and City REDI. Data on consumer spending during lockdown show that rural places that rely heavily on tourism have so far been hardest hit. We assume that as countries gradually emerge from lockdown an adjustment process will ensue to a ‘new normal’ until a vaccine is available. Social distancing measures are likely to continue in some form and this could inflict lasting economic damage. In cities, agglomeration advantages may turn into disadvantages, requiring significant investment to adapt the transport and urban infrastructure (on which agglomeration advantages depend). In this crisis, the consequences of inequality have been laid bare. The COVID-19 pandemic has already been shown to hit poorer areas more. High-density urban areas with high incidence of health inequalities and deprivation such as inner London, Birmingham and Manchester have suffered outbreaks and death rates significantly worse compared to rural areas in England and Wales.

The role of local government

The pandemic has also underlined the importance of local decision-making in times of crisis. In England, government action to respond to the pandemic has been highly centralised, with some resources redistributed by local authorities (grants and business rate relief). Local authorities have been at the forefront of fighting the pandemic, in critical areas such as health, social services and economic development. However, their capacity to react is depleted after years of austerity; and the higher costs of fighting the pandemic and the loss of commercial income is threatening the delivery of essential local services. The limitations of England’s centralised system of governance and lack of a coordinated strategy across levels of government has been evidenced by the UK’s slow testing response compared to other countries such as Germany.

In recovery from the current crisis, the levelling up talk must become a reality. The fact that recently announced central government bailout allocations to local councils in England appears to take no account of deprivation levels is not a good sign. To be meaningful, local and national policy should be directed at regenerating sustainable and equitable regional economies. Resilience is not the same as rebounding – it does not mean returning to the pre-shock state of affairs. As many have argued, the crisis presents a window of opportunity to embrace changes towards a more sustainable and fairer economy. This includes revaluing ‘key workers’ and the foundational economy in which they work. Unlike in the 2008 crisis, government bailouts to rescue specific sectors of the economy such as retail, property or aviation, should come with strong strings attached in terms of environmental, tax and civic responsibility. More collaborative and co-operative approaches are also needed to share the proceeds of growth more equitably.

Having seen the benefits of clearer skies and streets emptied of cars, political leaders in the north of England have suggested lasting improvements such as building cycling and walking networks, boosting internet connections and retrofitting of houses to improve energy efficiency and create jobs. Local industrial strategies should include measures to incentivise green innovation in areas that contribute to sustainable social value in economic recovery. The pledge for increased and geographically better-balanced R&D expenditure is more important than ever, and so is a reversal of years of centralisation and austerity cuts so that councils have greater capacity and revenue funding to plan and react faster and respond to future crisis. We now need bold economic policies to transform how our economy provides for citizens and the planet before this window of opportunity closes.

Originally published 12 May 2020

Transport and logistics during the COVID-19 pandemic

Dr Sheena Johnson and Dr Lynn Holdsworth

While the majority of the population is urged to stay at home, the country is relying on the transport and logistics sector to maintain the delivery of goods, and most importantly food and medical supplies, which have seen a substantial increase in demand. People working in the haulage industry are identified as key workers given the importance of maintaining a supply network during the COVID-19 crisis and related lockdown in the UK. There has been, though, relatively little open discussion about how the situation is affecting the industry and its workers. Dr Sheena Johnson and Dr Lynn Holdsworth discuss the changes to the working environment in the sector, and the support necessary for drivers.

As part of our research into the health and wellbeing of the ageing workforce within the transport and logistics sector, we set up the Age, Health and Professional Drivers’ (AHPD) Network, which works to highlight the importance of protecting the health and wellbeing of professional HGV drivers. Professional HGV drivers are an ageing workforce exposed to a variety of health risks linked to the nature of their work. The transport and logistics sector was already facing driver shortages and a struggle to maintain driver numbers given the high proportion of older workers approaching retirement, and the limited numbers of younger drivers entering the workforce.

The AHPD Network now wants to focus a spotlight on the impact the COVID-19 crisis is having on the industry, and its professional drivers. We argue the current situation, alongside the ageing workforce and the health risks associated with the job, brings the perfect storm of issues that could negatively impact on the professional driving workforce. We asked AHPD members to tell us what the situation is like for them as the industry responds to the COVID-19 crisis and draw on some of their answers here.

Changes in guidelines

Changes in regulations intended to help with the flow of goods have been implemented in the transport and logistics sector in response to COVID-19, including:

·      Relaxation of driver hours to allow drivers to work longer hours;

·      Relaxation of driver training requirements;

·      Rule changes meaning drivers whose qualification card expires between March and September can continue driving without renewal;

·      The exemption of MOT testing for vehicles for three months;

·      Temporary removal of routine medicals to facilitate renewal of driving licenses.

These changes are likely to have implications for the health and safety of drivers, and companies have to manage a fine balancing act to keep goods moving and protect their drivers.

Impact on companies

Companies have been disparately affected, with some reporting being run off their feet, especially those involved in food distribution. Online orders have also increased. Others though have seen their work dry up almost completely, with an estimate of nearly 50% of lorries currently parked up. Companies that are still moving goods have been affected by staff absences due to shielding, childcare or sickness. Whereas some companies have been able to provide full pay to individuals not able to work or have taken advantage of the Government’s furlough scheme, others have offered no more than statutory sick pay, which may encourage people to work whilst unwell for financial reasons.

Impact on individual drivers

The average age of a HGV driver is estimated at 57 years with about 13% over the age of 60. Professional drivers are recognised within the transport and logistics sector as comprising an older, and potentially less healthy, workforce due to some of the risks to health that are associated with the nature of the job. These risks include obesity, unhealthy diet, lack of exercise, exposure to stress and sleep deprivation or disturbance. Given the associated risks of COVID-19 to older individuals, and those who have underlying health conditions, this is a concern. A significant proportion of the workforce are absent from work due to adhering to shielding guidance or because they are experiencing symptoms associated with COVID-19, with reports of over a fifth of the workforce being absent in some companies. Other employees are still in work but fall into the vulnerable category meaning extra care must be taken to reduce the increased risk they face associated with contracting COVID-19.

In addition to reducing risks to physical health, it is important that companies remember to also place emphasis on mental health and wellbeing. Professional drivers are facing numerous challenges that could negatively impact on this. For example: concerns about contracting COVID-19; the extension of their working hours and increased work demands; increased isolation due to furloughing or whilst on the road and experiencing reduced contact with people due to social distancing measures; uncertainty about jobs, incomes and possible redundancy down the line; concerns about potentially increasing the risk to their family members if they are placed at increased risk whilst at work.

Looking after the workforce

Both employers and employees need support during this outbreak. Companies would benefit from the recommendations highlighted in the joint industry letter that has been produced, asking for more changes to protect the industry stating that the existing changes are welcome but not enough.

Both the Government and employers can support individual staff. Before the COVID-19 crisis the AHPD Network produced Health and Wellbeing Best Practice Guidelines, giving information and links to resources and support. These are arguably more important than ever as the transport and logistics sector responds to the COVID-19 crisis. Alongside the current changes in regulations, we urge the Government to remind companies of the importance of the health, safety and wellbeing of their drivers. We hope that the best practice guidelines provide concrete, practical recommendations that the Government can include in guidance for the industry during this time.

We further suggest that the Government make recommendations, both within the transport and logistics industry and more broadly to employers in general, to ensure the impact of the COVID-19 crisis on mental health is understood and employee mental health protected.

In addition to the best practice guidelines, we recommend that employers pay attention to:

·      Adhering to specific guidelines linked to COVID-19, such as social distancing;

·      Ensuring good communication is in place with drivers, now more than ever they can feel isolated from other employees. This should include furloughed employees;

·      Placing increased emphasis on the protection of employee mental health. Mental health support can include the support already provided by a company and specific COVID-19 mental health support (e.g. Mind, the mental health charity has published COVID-19 related advice);

·      Providing bereavement support.

Originally published 28 April 2020

With special thanks to our contributors:

Ransford A. Acheampong is a Presidential Academic Fellow in Future Cities at the Manchester Urban Institute (MUI) and Department of Planning and Environmental Management, University of Manchester. He is interested in questions around creating sustainable transport futures and the place of new and emerging transport technologies in inventing those futures.

Cathy Atkinson is the Curriculum Director of the Doctorate in Educational and Psychology within the Manchester Institute of Education and a Health and Care Professions Council (HCPC) registered Educational Psychologist.

Kirsty Bagnall is Communications and Influence Officer at Ambition for Ageing, a Greater Manchester wide cross-sector partnership, led by GMCVO and funded by the National Lottery Community Fund, aimed at creating more age-friendly places by connecting communities and people through the creation of relationships, development of existing assets and putting people aged over 50 at the heart of designing the places they live.

Emma Barrett is Professor of Psychology, Security and Trust and The University of Manchester Strategic Lead for Digital Trust and Security. She is also Director of SPRITE+, the EPSRC NetworkPlus for Security, Privacy, Identity and Trust.

Nasima Begum is a poet, producer and creative practitioner. She is a trustee of Young Identity, Manchester's most exciting collective of writers, musicians and artists who are currently resident artists at HOME. She is currently the Youth Project Coordinator at Ananna, an organisation for women and girls to enable positive change within their community. In her role she works with marginalised young people to access opportunities and reach their potential through creative workshops and 1-1 work. Nasima is also a member of BRAG (BAMER Research Advisory Group).

Tine Buffel is a Senior Lecturer at The University of Manchester, where she directs the Manchester Urban Ageing Research Group (MUARG). She has published widely in the field of ageing, with a particular focus on issues relating to urban change and social exclusion in later life.

David Buil-Gil is a Research Fellow in cyber crime at the Department of Criminology of The University of Manchester. His research interests cover environmental criminology, crime mapping, emotions about crime, new methods for data collection and open data.

Simon Bullock is a PhD researcher in shipping and climate change at The University of Manchester’s Tyndall Centre. He has an NGO background in UK climate policy and carbon budgets; his Tyndall research is focussing on the potential of electricity to decarbonise the shipping sector.

Kath Checkland qualified as a GP in 1991, and still works 1 day a week in a rural practice in Derbyshire. She is Professor of Health Policy and Primary Care, in the Centre for Primary Care at the University of Manchester. Her research focuses upon the impact of health policy changes on the NHS. She is co-lead of the Primary Care Theme for NIHR Collaboration for Leadership in Applied Health and Care Research Greater Manchester,and Associate Director of the DH Policy Research Unit in Commissioning and the Healthcare System.

Juan Manuel del Nido is a social anthropologist and economist. His research interests include examining how everyday residents understand the political and that which transcends it; and labour and economic relations in Argentina.

Ola Demkowicz is a Lecturer in Psychology of Education in the Manchester Institute of Education. Ola’s research focuses on adolescent mental health, risk and resilience, and gendered experiences of mental health, and she has a professional background working with vulnerable children and their families.

Patty Doran is a Research Associate for the UK Data Service based in the Cathie Marsh Institute for Social Research at The University of Manchester. Patty’s research has focused on ageing, inequalities, social support and the life course, and using mixed methods to address complex research questions.

Daniel Dresner is Professor of Cyber Security at The University of Manchester. Danny is also a founder and director of the IASME Consortium which champions cyber security for small businesses and runs a cyber security programme for neurodiverse individuals, employing them in a community security operations centre offering security oversight for charities, SMEs, and vulnerable people.

Pete Duncan is an incoming PhD Criminology candidate at The University of Manchester. For his PhD, Pete has been awarded a full ESRC scholarship to research financial crimes – including fraud, tax evasion and money laundering – in professional football.

Francesca Gains is a Professor of Public Policy and academic co-director of Policy@Manchester. Before becoming an academic she worked in local government & the probation service, and has both government funded and Parliamentary research experience. She is a Fellow of the Academy of Social Sciences and on the editorial board of the Journal of Public Policy, Local Government Studies and the International Review of Administrative Sciences.

Terry Hanley is the Interim Director of Social Responsibility for the School of Environment, Education and Development (SEED) and the Programme Director of the Doctorate in Counselling Psychology within the Manchester Institute of Education. He is co-editor of ‘The SAGE Handbook of Counselling and Psychotherapy’ and regularly presents at national and international conferences on therapeutic issues relevant to children and young people. He currently volunteers as a Football Therapist with the charity ‘Freedom from Torture’ in Manchester.

Graham Haughton is Professor of Urban and Environmental Planning at The University of Manchester. Graham's research interests include sustainable urban development, urban regeneration, regional development, and water conflicts.

Brian Higgins is Project Manager for the Cyber Foundry programme at The University of Manchester and the UK security spokesman for Comparitech.com. He has previously served as an Officer of the Serious Organised Crime Agency from 2008 until 2013, completing his time in law enforcement in what is now the National Cyber Crime Unit.

Lynn Holdsworth is a Chartered Occupational Psychologist registered with the Health and Care Professions Council, and Lead Researcher and Network Co-ordinator for the Age, Health and Professional Driver’s Network. Lynn’s research interests include health and wellbeing, the ageing workforce, and empowerment.

Debra Howcroft is Professor of Technology and Organisation in the People, Management and Organisation Division of Alliance Manchester Business School. Debra’s research interests cover the area of ICTs and organising, particularly in relation to work and employment.

Sheena Johnson is a Chartered Occupational Psychologist registered with the Health and Care Professions Council, and a Senior Lecturer at the Alliance Manchester Business School. Sheena set up the Age, Health and Professional Driver’s Network and her research interests include health, wellbeing, and the ageing workforce.

Camilla Lewis is a Senior Lecturer in Ageing and Urban Studies at Newcastle University. She joined in July 2019 from The University of Manchester, where she led an ESRC-funded project about ageing in place. She is a social anthropologist interested in interdisciplinary approaches.

Nicholas Lord is Professor of Criminology in the Centre for Criminology and Criminal Justice at The University of Manchester with research expertise in white-collar, financial and organised crimes, such as corruption and fraud, and their regulation and control.

Marianne Mannello is an Assistant Director: Policy, Support and Advocacy at Play Wales, the national charity for children’s play, in Wales, UK. She has over 30 years experience in many aspects of play and playwork, including play policy consultation and development. Marianne has worked with the Welsh Government to support the development of a toolkit to support local authorities to undertake statutory Play Sufficiency Assessments. She is a member of the Active Healthy Kids (AHK) Wales expert group and the Wales United Nations Convention on the Rights of the Child Monitoring (UNCRC) Group.

Warren Mansell is Reader in Clinical Psychology at The University of Manchester. He researches, trains and practises universal psychological interventions for mental health problems and wellbeing. He also uses a theory known as perceptual control theory to develop and test new approaches to experimental psychology, mental health, dementia, human action control, and robotics.

Miguel Martínez Lucio is Professor of Human Resource Management at Manchester Business School. He has researched issues of workplace absence, health and safety, labour regulation and worker participation – amongst others – since the 1980s.

Yaron Matras  is Professor of Linguistics at The University of Manchester School of Arts, Languages and Cultures. He specialises in the study of multilingual societies and the documentation of various languages including Romani, Kurdish, and Arabic dialects. He is the founder of the Multilingual Manchester research unit.

Jo McBride is a Senior Lecturer of Industrial Relations, Work and Employment at Durham University and the President of the British Universities Industrial Relations Association. Her research focuses on collectivism, social perceptions of the value of jobs and the causes and consequences of low paid work and multiple employment.

Chris Phillipson is Professor of Sociology and Social Gerontology in the School of Sciences at The University of Manchester. He has published extensively on issues relating to ageing in cities, and issues relating to the transition from work to retirement.

Nuno Pinto is Lecturer in Urban Planning and Urban Design at The University of Manchester. His research interests focus on the use of quantitative methods in urban planning and their integration in decision-making processes.

Michael Prentice is a research fellow focusing on digital trust and security within the Digital Futures initiative. His research focuses on the impact of securitisation on office life and culture in the UK and Korea.

Marianne Sensier is a Research Fellow in Economics and the Alliance Business School at The University of Manchester. Marianne’s main research focus is on the application of econometric methods to macroeconomic problems.

Bella Starling is a Wellcome Trust Engagement Fellow and Director of the Public Programmes team at Manchester University NHS Foundation Trust. Her career has spanned neuroscience, genetics and stem cell research, science writing, biomedical ethics, public engagement, patient involvement and science policy, as a practitioner, action researcher, strategic adviser and funder. She is passionate about inclusion in, and democratisation of, research; her Fellowship explores how public engagement with research acts as a catalyst for social change.

Elvira Uyarra is Reader in Innovation Policy and Strategy at the Alliance Manchester Business School and Director of the Manchester Institute of Innovation Research. Elvira is also adjunct professor at the Mohn Center of Innovation and Regional Development at the University of Western Norway and visiting fellow at the Centre for Innovation Management Research (CIMR) of Birkbeck, University of London. She teaches and conducts research on science and innovation policy and management and on regional innovation. She is fellow of the Regional Studies Association (RSA) and Chair of the North West of England branch of the RSA.

Arpana Verma is Head of the Division of Population Health, Health Services Research and Primary Care. She is Director of Manchester Urban Collaboration on Health (MUCH) a WHO Collaborating Centre and honorary Consultant in Public Health at PHE.

Iain White is Professor of Environmental Planning at the University of Waikato. He researches issues connected to the interface between science and decision-making.

Abbie Winton is a Doctoral Researcher at the Work and Equalities Institute. Her research considers issues surrounding sociotechnical change in the UK retail sector, with a particular focus on the widening of gender inequalities and the degradation of work and employment.

Sophie Yarker is a Research Fellow at the Manchester Institute for Collaborative Research on Ageing (MICRA). She has a background in human geography and sociology with research interests in community, belonging and civil society.

@UoMPolicy

The opinions and views expressed in this publication are those of the respective authors and do not necessarily reflect the views of The University of Manchester.

August 2020

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