COVID-19 resources

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To what extent does evidence support decision making during infectious disease outbreaks? A scoping literature review

Evidence and Policy

Background: Infectious disease outbreaks require decision makers to make rapid decisions under time pressure and situations of scientific uncertainty, and yet the role of evidence usage in these contexts is poorly understood. Aims and objectives: To define and contextualise the role of scientific evidence in the governance of infectious disease outbreaks and to identify recommendations for overcoming common barriers to evidence-informed decision making. Methods: A scoping review and an expert workshop to provide additional input into recommendations on enhancing evidence uptake during infectious disease outbreaks taking place in European settings. Findings: Forty-nine records reporting on multiple decision-making processes during infectious disease outbreaks of the past ten years were included in the study. Decision makers prioritise expert advice, epidemiological data and mathematical modelling data for risk characterisation and management, but tend to be challenged by scientific uncertainties, which allow for conflicting interpretations of evidence and for public criticism and contestation of decision-making processes. There are concrete opportunities for optimising evidence usage to improve public health policy and practice through investment in decision-making competencies, relationship building, and promoting transparent decision-making processes. Discussion and conclusions: It is not necessarily a disregard of evidence that puts a strain on decision making in health crises, but rather competing interests and the lack of clear, unambiguous and rapidly available evidence for risk characterisation and effectiveness of response measures. The relationship between science and public health decision making is relatively understudied but is deserving of greater attention, so as to ensure that the pursuit of evidence for decision making does not challenge timely and effective crisis management.

Last updated on hub: 09 September 2020

Too many at-risk children are still invisible to social care

Children’s Commissioner for England

This briefing assesses the extent to which the pandemic and lockdown have contributed to making children at risk invisible to social services. Since March 2020 when schools closed at the start of the first national lockdown, more families have fallen into poverty and all the major risk factors to children – domestic violence, poor parental mental health, and alcohol/substance abuse – have heightened. At the same time there has been a significant fall (by 10% compared to the last 3 years) in referrals to children’s services as children became increasingly ‘invisible’ under Covid-19. Children have been out of school for most of the year, less likely to attend health services, and are less able to access informal support like children’s centres, many of which closed or moved online throughout the year. Many local authorities anticipated a spike in social care referrals in September with the school return. However, this spike did not occur. The latest data from the DfE showed that in November 2020, referrals were 12% lower than usual – despite schools being open at this time, so better able to identify vulnerable children. The current national lockdown and school closures risks even more at-risk children going undetected and not getting help. The response from councils to these alarming figures has been varied, with some taking insufficient action to find children who are suffering behind closed doors, despite statutory expectations to do this. Local authorities have also had access to emergency funding, although there are concerns that this has been focused on adult social care. The paper calls for all local areas to urgently and proactively work to identify vulnerable children who are not coming to the attention of services as they would usually do. Otherwise, children at risk in increasingly harmful situations will remain invisible to the system.

Last updated on hub: 25 January 2021

Towards a social work of home?

Qualitative Social Work

This paper seeks to begin a consideration of the relationship between social work and home in the time of the Covid-19 global pandemic, where staying at home has become a matter of public health. It draws on my own experiences as a practising social worker as well as more personal reflections on the meaning of home, to suggest that social workers are uniquely placed to understand home. It suggests that despite this, we have perhaps lost sight of the emotional and spiritual necessity of home and that there are significant costs to doing so. As such, it calls for a re-centring of home within social work practice.

Last updated on hub: 16 March 2021

Towards an understanding of inequalities in accessing residential and nursing home provision: the role of geographical approaches

Health and Social Care in the Community

Suggestions of the existence of so-called ‘social care deserts’ in England in the years leading up to the COVID-19 pandemic drew attention to the potential impact of geographical inequalities on the availability of residential, nursing and domiciliary care. To date, much of this analysis has been conducted at spatially aggregated scales such as that of local authorities or postcode sector. Hidden within such aggregate-level analysis however are geographical differences in the local provision of care services. This paper draws attention to geographical modelling techniques that can be used to examine local trends in the supply of social care services in relation to potential demand. These spatial models can be used to examine variations in the number of facilities (or choice) within reasonable drive times/distances. Drawing on a national database of residential and nursing care beds in Wales for March 2020, this paper illustrates the potential of such techniques to provide an insight into current patterns in access to care homes, and to monitor future changes in the fall-out from the effects of the COVID-19 pandemic on the care home sector. The concentration of care home sites in metropolitan areas and in the heavily populated post-industrial valleys in the south-east is identified, but significant demand present in these areas ameliorates scores towards mid-range ratios. This paper concludes by suggesting that the types of techniques used in this study enable disparities in provision within localised areas to be better explored, thereby helping planners and policy makers to address potential inequalities in provision.

Last updated on hub: 07 March 2022

Towards resilience: making community matter in social care

Local Trust

This report summarises findings from an event co-hosted by Think Local Act Personal (TLAP) and Local Trust. It explores the fragility and fragmented nature of adult social care both before and during the pandemic. It highlights how community focused initiatives are key to a more resilient future for all those that draw on, provide or commission adult social care support. Key points include: the pandemic has shown how transformation can be achieved when state, communities and individuals work together – what we choose to do next with this opportunity is key; services should take a person-centred approach and move away from being service led; we should invest in transformation by scaling back activities that don’t work; convene and support a network of people developing asset-based areas – making visible the myriad of skills, knowledge, connections and potential within a community (the assets), and focusing on nurturing the strengths and resources of people and communities as basis of social care commissioning; Local Authorities (LAs) should actively engage with community groups, such as Big Local Partnerships, to help accelerate trust and confidence in devolving more responsibility, funding and decision-making to local citizen led groups.

Last updated on hub: 07 June 2021

Towards resilience: redesigning our systems for a better future

Local Trust

This report considers the role resilience – the ability of a system to withstand disruption and to recover within a reasonable time period – has played during the Covid-19 pandemic and how systems, infrastructure, and way of life can be configured to 'build back better' from the crisis. It identifies five areas of structural weakness that lack resilience and are in need of urgent attention: poorly performing economy; disconnected decision-making; social fragility, including fragility of the social care sector; labour market precarity; and environmental vulnerability. Taking these areas of structural weakness into account, the report suggests how best to conceive an approach to building a resilient Britain, based on five domains: economic resilience – supply chains, food security, energy; public sector resilience – pubic services, government structures; community resilience – community groups, voluntary sector organisations; environmental resilience – climate change prevention and mitigation, environmental regulation; and workforce resilience – skills, precarity, labour market change and conditions.

Last updated on hub: 17 September 2020

Tracking the mental health of home-carers during the first COVID-19 national lockdown: evidence from a nationally representative UK survey


Background Unpaid carers who look after another member of their household (home-carers) have poorer mental health than the general population. The first COVID-19 national lockdown led to an increasing reliance on home-carers and this study investigates the short and longer-term impact of lockdown on their mental health. Methods Data from 9,737 adult participants (aged 16+) from the UK Household Longitudinal Study (Understanding Society) were used to explore changes in 12-item General Health Questionnaire (GHQ-12) score between (a) pre-pandemic (2019) and early lockdown (April 2020) and (b) early and later (July 2020) lockdown. Results GHQ-12 scores among home-carers were higher pre-lockdown and increased more than for non-carers from 2019 to April 2020 with further increases for home-carers compared with non-carers between April and July. Compared with respondents caring for a spouse/partner, those caring for a child under 18 had a particularly marked increase in GHQ-12 score between 2019 and April, as did those caring for someone with learning difficulties. Home-carers of children under 18 improved from April to July while those caring for adult children saw a marked worsening of their mental health. Home-carers with greater care burden saw larger increases in GHQ-12 score from 2019 to April and from April to July, and increases through both periods were greater for home-carers who had formal help prior to lockdown but then lost it. Conclusions The mental health of home-carers deteriorated more during lockdown than non-carers. Policies that reinstate support for them and their care-recipients will benefit the health of both vulnerable groups.

Last updated on hub: 20 February 2021

Transformation of a recreational youth group into community service group during the COVID-19 pandemic

Social Work with Groups

This narrative is based on the solidarity of a recreational youth group during the COVID-19 pandemic. (Note: Youth refers to older adolescents and young adults, 17–28). The narrative describes the journey and transformation of the youth group from playing cricket to the engagement in community service during the lockdown period. This paper also presents how the presence of the group shifted from physical to a digital platform, and the focus turned from recreation to social support; with that change in the focus, how a small group of youths turned into a larger group to mobilize and utilize resources for community service during the crisis time.

Last updated on hub: 15 January 2021

Transforming aging services: Area Agencies on Aging and the COVID-19 response


For over four decades, Area Agencies on Aging (AAAs) have served as focal points to help older adults remain in their homes and communities. AAAs partner with other organizations to administer services authorized under the Older Americans Act (OAA). AAAs represent loosely coupled systems; they are responsive to guidelines established by the OAA while maintaining flexibility to leverage limited resources, establish partnerships, and create innovative programs to meet community needs. As stay-at-home orders and concern for safety have kept many older adults homebound during the COVID-19 pandemic, an important question is how the Aging Network, including the over 600 AAAs, has responded to these rapidly changing needs. Although time and more systematic assessments are required, available information suggests that the loosely coupled network of AAAs has been a key, adaptable resource. This article begins with a description of the Aging Network and its history before turning to how the community-specific, collaborative, and evolving nature of AAAs places them at a unique position to respond to the challenges that arise with COVID-19. It concludes with how AAAs can continue to adapt to meet the needs of older adults and the people who care for them.

Last updated on hub: 27 January 2021

Transitioning into care: moving into a care home

Age and Ageing

For those who are LGBT+, the move to a care home can be influenced by worries about being placed into a community they do not identify with, potentially encountering homophobias, and that their choice of friends will not be welcomed to the extent they feel uncomfortable displaying photos of those they care most about. These perceptions and experiences are common within LGBT+ research literature occurring across neighbourhoods and health and social care settings in the UK. However, positive change is afoot and this article examines approaches and initiatives designed to help the transition into care for LGNT+ people.

Last updated on hub: 26 May 2021

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