The pandemic’s implications for wider health and wellbeing


Health care services for non-COVID-19 conditions were reprioritised to manage increased demand from COVID-19. Childhood vaccinations and access to prescription medication were maintained, but reduced treatment of existing conditions has resulted in a backlog of unmet care need. People living with long-term conditions, disabled people and those shielding experienced reduced access to health services.

Access to social care services has declined despite an increasing need during the pandemic. This will have longer term effects on the health and wellbeing of those in need of services.

Mental health impacts from the pandemic are not uniform but worsened for many. One-fifth of the population had experienced a sustained increase in poor mental health by September 2020. Rates of anxiety and depression were particularly high during periods when the tightest social distancing restrictions were in place. Those facing financial hardship fared worse than others.

Domestic abuse and child protection risk increased during the first lockdown. Reported incidents of domestic abuse increased during the first wave of the pandemic. With children out of school, child safeguarding referrals reduced suggesting children were left exposed to harm.

Health risk behaviours, such as smoking and drinking alcohol, decreased during the first lockdown. However, this reduction masks an increase in these behaviours among heavy smokers and drinkers.

The measures brought in to suppress the spread of the virus have had wider implications for the health and wellbeing of people in the UK. These are less well understood and are likely to have longer term implications for the population’s health. They arise from the following main causes:

  • reduced access to routine care services
  • the consequences of lockdown on people’s mental health
  • the consequences of lockdown on vulnerable groups
  • changes in people’s health risk behaviours.

Access to health care services for non-COVID-19 conditions

Health services were reprioritised to manage the increased demand from COVID-19-related illness and to allow for new social distancing restrictions, which meant fewer patients could be treated. While this was a necessary precaution, in most sectors this has led to reduced treatment of existing conditions and a backlog of unmet care need.

Primary care

Despite the restrictions, in April 2020, 98% of people with a long-term condition who needed prescription medications were still able to obtain them. 73% who needed treatment via a GP still received the services they needed and 65% were able to see a pharmacist. Childhood immunisations appear to have held at pre-pandemic levels in England., Health Foundation analysis shows that all regions across England saw a 30% drop in GP consultations per patient between March and May 2020. This was despite the efforts to enable online and telephone consultations. An unintended consequence of this service shift has meant that access has been more challenging for those digitally excluded or people more reliant on face-to-face services.,  The greatest reduction in consultations has been for patients without a pre-existing condition, as shown in Figure 10 (15% versus 6% for those with one pre-existing condition and 2% for those with two or more pre-existing conditions).

It is not known what proportion of the missing consultations is a direct result of a reduction in need because of the pandemic; for example, fewer treatments following car accidents or a reduction in the prevalence of non-COVID-19 communicable disease (especially among younger patients). The size of the reduction in consultations, however, suggests that there will be a high number of people with undiagnosed conditions coming into contact with the health system at a more advanced stage of their condition.

The relative reduction in consultations has been similar across ethnic groups, apart from those from a Chinese ethnic background who saw larger reductions and previously had a below average consultation rate.

By October 2020, primary care consultations had recovered to pre-pandemic levels and remained so until the end of January 2021.

Figure 10: Percentage change in consultation rate in 2020 compared with 2019, by number of pre-existing conditions and age, England, 2020

Source: Clinical Practice Research Datalink (CPRD), Aurum database, Analysis from CPRD protocol number 20 143.

Note: Data for under 11 year olds with two or more pre-existing conditions are not available.


At the beginning of the pandemic there was a substantial drop in 2-week wait for suspected cancer and urgent referrals. By autumn 2020, the rates of 2-week wait referrals and urgent referrals were broadly the same as in previous years. However, 2-week wait referrals did not increase enough to account for the substantial reduction during the first lockdown. Around 250,000 estimated 2-week wait referrals were ‘missing’ by the end of January 2021.

Routine referrals dropped by 74% during the first lockdown. This had not recovered by end of January 2021.

A&E visits

A&E visits began to fall 2 weeks before lockdown in March 2020 in England, falling to 48% compared with the same week in 2019 by the end of March. This recovered slightly to reach 64% of 2019 levels by mid-May. The fall in visits was greater for injury (54%) than for illness (32%). This is likely due to a combination of changes in NHS operations, in patient behaviour and in prevalence of conditions.

Those from the most deprived areas had 23.3% fewer emergency admissions in March to December 2020, compared with a 20.2% reduction for those in the least deprived areas. The IFS reported that the absolute gap in activity between local areas is substantially larger, since more deprived areas generally have more emergency admissions.

“Only 27% of people with long-term health conditions who needed NHS treatment in April 2020 received it, because of NHS cancellations.”

Elective care

During 2020, treatment activity fell in some specialties more than others. The largest impact was in trauma and orthopaedics, oral surgery and ear, nose and throat (ENT), with respective falls of 38%, 37% and 37% compared with 2019. In England, there were regional differences, with the largest fall in the north west (31%) and the smallest reduction in the south west (24%). The fall was greater in the most deprived areas (9,162 per 100,000 compared with 6,765 per 100,000 in the least deprived areas).

Survey data show that only 27% of people with long-term health conditions (such as cancer or cardiovascular disease) who needed NHS treatment in April 2020 received because of NHS cancellations. For other health conditions during this period, the NHS cancelled such treatment for more than two-thirds of people and around 5% of people cancelled treatment themselves.

There was a 29% decline in the number of patients referred to consultant-led elective care. In other words, there were 6 million ‘missing patients’ who did not seek treatment in 2020. If 75% of these ‘missing patients’ are referred for treatment as social distancing measures ease further, the waiting list for elective treatment could increase to 9.7 million by March 2024. By August 2020, almost three times more people had waited for more than 18 weeks as compared with August 2019.


The number of patients seen for suspected cancer by a specialist dropped by 60% in April 2020 compared with 2019. Similarly, 37% fewer patients started treatment for cancer in May 2020. These numbers improved over the summer, narrowing to 8% and 10% respectively by October 2020.

Endoscopy activity from 23 March to 31 May 2020 was 12% of that between 6 January and 15 March 2020, which resulted in only 58% of the expected cancer cases being detected. From April to October 2020, over 3,500 fewer people had been diagnosed and treated for colorectal cancer in England than would have been expected. Survival from colorectal cancer is closely linked to the stage of disease, with over 90% of those diagnosed at stage I surviving 5 years compared with only 10% at stage IV.

Self-management of existing conditions

The fall in NHS treatments has adversely affected the health and wellbeing of people with existing conditions, as restrictions made their conditions harder to manage. For example:

  • Diabetes (affected 3.9 million people in UK in 2019) – some adults with diabetes reported that their confidence to self-manage their condition fell during the summer (between 24 April and 31 August 2020), particularly their mental wellbeing (37%), as well as their physical activity (32%), eating patterns (29.6%) and ability to maintain a healthy weight (27.1%).
  • Eating disorders (affected 700,000 people in UK in 2019, 90% of whom are women) – between June and July 2020, 83.1% of adults with an eating disorder reported a worsening of symptoms.
  • Epilepsy (affected 600,000 people in the UK in 2010) – in June 2020, one in three young people with epilepsy reported that their seizures had increased during the pandemic and the majority reported that their sleep, mood and levels of physical activity had deteriorated.

Shielding population

Due to particularly high case numbers, the UK government advised 2.2 million of the most clinically vulnerable people to shield. Early data from NHS Digital shows that by mid-April, the drop in emergency admissions for shielding patients in England was greater than that for the general population (46% versus 33%). By July 2020, more than one in three of the shielding population had reduced access to care. Outpatient attendance for this group had fallen by 43% and elective admissions by 51%.

Perinatal and antenatal care

Women saw disruptions to perinatal and antenatal care. Scans became less frequent at the beginning of the pandemic and women reported difficulties discussing sensitive issues virtually and fears of further burdening the health system. Initial restrictions meant many women gave birth without a birthing partner and even once this changed there were still limitations on how long they could stay to support mothers. In Northern Ireland travel restrictions meant that women could not travel to England to access abortions.

Access to social care services

The pandemic has had a profound impact on social care services in England. Against a backdrop of pre-existing problems, such as chronic underfunding, workforce issues and system fragmentation, COVID-19 has made some of these challenges worse.

Analysis by the Health Foundation has found that despite an increase in care needs during the pandemic, fewer people have accessed local authority-funded long-term care than before the pandemic. In September 2020, 800 fewer younger adults and 12,150 fewer older people were supported in residential and nursing care than in March, a decrease of 2.6% and 10.5% respectively. This unmet need for care is occurring at the same time as an increase in unpaid care.

The COVID-19 impacts on care home residents and staff in terms of mortality, infection risk and access to PPE are covered in Section 5.

Mental health impacts of the pandemic

The mental health impacts of the pandemic have been mixed. For many, initial declines in mental health during periods of lockdown subsequently improved. A significant cohort have experienced a reduction in mental health, posing a potential longer term risk to the nation’s health.

Analysis from the ONS showed that around 21% of adults experienced some form of depression in early 2021 (27 January to 7 March), more than double that observed before the COVID-19 pandemic (10%). By March 2021, anxiety and depression had returned to levels seen during the lockdown easing in summer 2020.

However, one-fifth of the population experienced a sustained period of poor mental health relative to their previous levels by September 2020. By January 2021 around a quarter of working age people had experienced a new mental health problem during the pandemic. Diagnoses of self-harm, depression and anxiety and first anti-depressant prescribing decreased substantially in April across England, Wales, Scotland and Northern Ireland. In England, the rates returned to expected levels in September but remained about a third lower than expected in the other nations. The evidence suggests that access to mental health care declined with implications for individuals, health care services and for society as a whole.

Who has been disproportionately affected by worsening mental health?

Analysis of two longitudinal studies (the Avon Longitudinal Study of Parents and Children and the Generation Scotland: Scottish Family Health Study) found that in April–May 2020 those with financial problems, lower educational attainment, lower incomes or living in a more deprived area had disproportionately high rates of anxiety and depression.

The ONS also found that during 27 January–7 March 2021 a higher proportion of adults renting their home experienced some form of depression (31%) compared with adults who own their home outright (13%). Almost 3 in 10 (28%) adults living in the most deprived areas of England experienced depressive symptoms, compared with just under 2 in 10 (17%) living in the least deprived.

The pandemic is compounding mental health and economic hardship. Those experiencing income loss, loss of pay or with minimal safety net have been more likely to report poorer mental health. In January 2021, 43% of unemployed people had poor mental health. This was greater than for people in employment (27%) and for people on furlough (34%). This suggests that furloughing has provided some protection for people’s mental health.

Self-reported declines in mental wellbeing were twice as high for women as men. This is likely due to differences in caring responsibilities, social engagement and health behaviours. Women were more likely to spend longer doing housework and home schooling, alongside facing fears of redundancy and greater feelings of loneliness.,  When home schooling returned in January 2021 there was a significant increase in psychological distress among mothers, higher than in earlier waves, and compared with younger people during this period.

“Young people and disabled people experienced worse mental health outcomes compared with the general population.”

Young people and disabled people experienced worse mental health outcomes compared with the general population. The outcomes for these groups are explored further in Section 5.

Domestic abuse and child protection

For some people, having to stay at home increased the risk of experiencing domestic violence and abuse.

Analysis of domestic abuse cases held by the Metropolitan Police between 23 March 2020 and 14 June 2020 shows that abuse by current partners and family members had increased by 8.5% and 16.4% respectively, while abuse by ex-partners had declined by 9.4%.

Survivors reported escalating abuse during the first lockdown. Almost two-thirds (61.3%) of respondents to one survey said the abuse they were experiencing had worsened during lockdown; 54.8% said they had felt more afraid since the start of lockdown and 71.7% reported that their abuser had more control over their life.

Calls for help have remained high during both waves. Refuge reported an average 60% increase in monthly calls to their helpline between April 2020 and February 2021 compared with the start of 2020. 72% of these calls were from women directly experiencing domestic abuse.

Similarly, orders to stay at home have increased the risk to children experiencing violence and abuse at home. The NSPCC recorded a 53% increase in monthly average calls to their helpline between April and December 2020. The number of calls peaked in November 2020.

Research also suggests that school closures have resulted in fewer safeguarding referrals, indicating that children and young people had reduced opportunities to ask for help and no safe places where they could disclose. One study found a 37% decrease in referrals for child protection medical examinations between February and June 2020 compared with the same period in 2019.

Health risk behaviours

On average, health risk behaviours such as smoking and drinking alcohol decreased during the first lockdown. The percentage of adults smoking reduced from 14% pre-pandemic (in 2018/19) to 11% in April 2020. This reduction persisted and was still 11% in January 2021.

The same was true for drinking, with a slight decrease in the average number of units consumed per week – from 14.9 to 13.4 between March and June 2020.

However, this average reduction in smoking and alcohol consumption masks an increase in these behaviours among heavy smokers and drinkers. Lighter smokers were more likely to quit during the first wave, but in people who smoked more than 20 cigarettes a day there was no change.

By September 2020, 8.5 million people’s drinking levels were considered high risk, compared with 4.8 million in February 2020. There was also a 20% increase in alcohol-specific deaths in 2020 compared with 2019, the increase occurring between April and December, with deaths 28% higher in the fourth quarter of 2020 compared with a year earlier.

Analysis by Sport England, for ages 16 and older, found that physical activity levels declined during the early stages of the pandemic where there were just over 3 million fewer active adults (doing 150+ minutes a week of physical activity). As restrictions eased these declines in physical activity improved but did not recover to pre-pandemic levels.

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