Recovery: risks and opportunities


The pandemic has left people facing long delays in access to health care and poorer mental health. As well as the significant toll on people’s health, there are substantial financial implications of tackling the backlog of unmet need.

Further risks to people’s health may come from a decline in living conditions. Pandemic restrictions have led to reduced social activities, changing work conditions and loss of work and income for some. In addition, gaps in education due to school closures, and loss of work and income, are likely to have longer term implications for people’s health.

The UK entered the pandemic following a decade of stalling life expectancy. Factors such as the fragility of the welfare state and inequalities in jobs, housing and education have all contributed to declining health. These same factors also led to increased exposure to COVID-19.

The recovery presents an opportunity to ensure no one is left behind. Greater investment and government action to build economic and social resilience, harnessing the economic, social and political changes of the pandemic, could address these risks. While the effects of the pandemic present clear risks to people’s future health, these will only prevail if there is failure to act.

The pandemic has been a major assault on the health of the population and risks casting a long shadow on the nation’s future health. Good health is an asset – and a healthy society will be essential to a fair and lasting recovery.

This section reflects on conditions in the UK prior to the pandemic, how this has contributed to outcomes and explores the pandemic’s likely future consequences for health, highlighting the main risks and how these might be mitigated.

Risks to future health

Rising physical and mental ill health

The need to reprioritise resources within the health care system to deal with the pandemic has led to cancelled or postponed consultations, referrals and planned admissions. This has resulted in reduced diagnosis and management of new conditions as well as support for existing conditions.

Health Foundation analysis shows that there are 6 million ‘missing patients’ who did not seek treatment in 2020, suggesting poor health is going untreated and is likely to require more extensive care when people present at GPs or in hospitals. In cases of acute need, such as cancer care, where treatments have been delayed, there will be a higher number of avoidable deaths.

Government restrictions, although needed to limit the spread of the virus, have also led to higher prevalence of poor mental health with a sustained deterioration in mental health for one-fifth of the population by September 2020.

Long COVID has emerged as a new condition that is leading to disruptions in employment and a further reduction in quality of life. The duration and extent of this condition is yet to be understood.

Before the pandemic, the NHS and social care already required substantial investment to provide adequate services. In November 2020, Health Foundation analysis estimated that an additional £10bn will be needed in the next year to deal with the backlog of health care, the rising demand for mental health services and the service improvements set out in the NHS Long Term Plan.

Decline in the conditions needed for good health

The pandemic risks having a further impact on people’s longer term health through the decline in living conditions. This is being seen more immediately through the increases in poor mental health. However, the gaps in education due to school closures and remote learning, and the effects on work and income due to the economic shock, are likely to have longer term implications for health.

The loss of education during the pandemic risks widening the gap in future health outcomes in two ways. First, the cohort of children and young people who have missed periods of education could lag behind older cohorts who had finished education before the pandemic. Second, the loss of education has not fallen evenly. By autumn 2020 children from more disadvantaged backgrounds experienced a greater deterioration in their educational outcomes – 2.2 months of learning loss compared with 1.5 months – creating an inequality between children of the same age.

Government support measures have helped to reduce the scale of the economic shock people have experienced so far. Some people whose income reduced may see it rise once restrictions are lifted – but they will still have endured a sustained period of reduced resources.

In May 2021, 2.8 million fewer people were estimated to be in employment than prior to the pandemic. The Coronavirus Job Retention Scheme has prevented a significant rise in unemployment so far though once the scheme is phased out in the autumn, unemployment is expected to rise. For lower income families, assuming the Universal Credit uplift ends in September 2021, around 6 million families will experience a drop in income.

“In May 2021, 2.8 million fewer people were estimated to be in employment than prior to the pandemic.”

Unemployment is a key risk to health. Periods of unemployment are associated with poorer physical and mental health. This is due to the experience of not having work – lacking the status and structure it brings – as well as loss of income.

Income, and having other financial resources to draw on, are also key determinants of health. Many families, particularly those with lower income, have increased their debt to manage during the crisis. Repaying these debts will create continued financial strain after restrictions have lifted.

At the same time, rental arrears have been mounting for some families and the measures introduced to prevent evictions were removed at the end of May. Without additional support there is likely to be an increase in homelessness. Such an outcome will have important implications for health, while also placing greater financial strain on local authorities to provide new accommodation.

Managing the risk to future health

The prolonged weak economic recovery following the 2008 financial crisis led to a fragility in public services and the economy.

Many people have boosted their incomes by working more and for some, increasing personal debt. Forms of insecure work have increased since the financial crisis. This has left some in a precarious position, less able to deal with a sudden shock to income. This insecurity has been compounded by the residualisation of social security over the past decade: the long-term shift towards a means-tested rather than universal or contributory system which has reduced benefit entitlements, including support with housing.,

From 2010, a programme of significant cuts in government spending had helped reduce the annual deficit to pre-financial crisis levels with day-to-day government spend reduced by approximately 15% on a real-terms per capita basis between 2009/10 and 2018/19. While the Department of Health and Social Care was the main protected department, in other areas of ‘unprotected’ government spending budgets fell by over a quarter. In education, per pupil funding was cut by 8% in real terms between 2009/10 and 2019/20.

The overall shape of these cuts has led to the prioritisation of services that meet acute need rather than prevention. This channelled resources towards older people and pensioners, and away from working-age families and children. Longer term investments in services that help to maintain good health, such as Surestart or housing support, were reduced.

Despite relatively better funding, health and social care services were also under strain. Analysis by the Health Foundation and the REAL Centre has shown that in the decade leading up to the pandemic there was a reduction in hospital capacity and staff shortages – particularly in full-time nurses. Reform of the social care sector has been delayed for years, with provision remaining fragmented and underfunded. These systemic vulnerabilities made it harder for the UK to adapt and cope with COVID-19.

Opportunities to improve health in the recovery

Good health is an asset. It is necessary for a prosperous and flourishing society as it enables people to participate in and contribute to society in different ways. The potential economic benefits of ensuring the best possible health of the population are substantial.

Poor health has been estimated to cost the UK economy £100bn a year in reduced productivity. For those in the workplace, developing a ‘physical impairment’ doubles the probability that a person will experience a reduction in productivity, while the onset of clinically poor mental health leads to a threefold increase in reduced productivity. The presence of a health condition is associated with poorer educational attainment and greater school absence – affecting long-term earnings potential.

Building on the economic, social and political changes that have occurred through the pandemic, the recovery presents an opportunity to address these issues through greater investment and government action.

The pandemic has increased awareness of pre-existing inequalities and the disproportionate effect on some groups, including disabled people, ethnic minority communities, care home residents, people in forms of insecure work and people experiencing homelessness. This awareness can open new debates about how to address inequalities and clear the way for employers, service providers, local communities and governments to take more action to support these groups.

There has also been greater political acceptance for government action and spend to support recovery, through job creation schemes and capital investment projects. These will be crucial for younger people as they enter the job market, as well as those reskilling and entering new types of employment.

There has been greater recognition of the potential power of different levels of governance as the varying roles played by UK, national, regional and local government have become more prominent. This could accelerate the move towards greater devolution of power and increase public recognition of the important role local government can play in shaping the conditions in which we live.

Strengthened local communities can help increase local social and economic resilience. If sustained, the increase in community-based organisations, mutual aid groups and people home working and spending more time locally could build long-term social resilience. It could create novel ways to adapt and deliver services to meet local needs – particularly for those at risk of isolation, such as older people and disabled people. There is also potential for greater investment in local economies due to increased spend by home workers, leading to longer term support for local and smaller businesses and support for local economic growth.

Increased flexibility around remote working and remote access to services will be especially important for working mothers, families and disabled people. Such adaptations could lead to new employment opportunities for these groups, as well as more inclusive working environments and services. Flexible working also enables employers to look beyond their usual geographical markets and access a wider labour pool.

The pandemic saw greater use of new and collaborative data sources and rapid data and evidence collection to inform policy, as well as the high-profile use of scientific expertise in making key policy decisions. An expansion of collaborative data sources has the potential to offer linked data and address data gaps that are currently hampering efforts to fully map the needs of groups that lie below the data line – for example, some ethnic minority communities and people experiencing homelessness.

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