Written evidence submitted by The Health Foundation (CLL0089)

About the Health Foundation

The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. Our aim is a healthier population, supported by high quality health care that can be equitably accessed. We learn what works to make people’s lives healthier and improve the health care system. From giving grants to those working at the front line to carrying out research and policy analysis, we shine a light on how to make successful change happen.


Executive summary

This submission provides an overview of relevant analysis and commentary published by the Health Foundation, during the first six months of the COVID-19 pandemic. We hope this evidence is helpful to the Committees joint inquiry to identify lessons to be learned from the response to the coronavirus pandemic so far.

With the pandemic still ongoing, and as the UK experiences a ‘second wave’, it is too early to make a definitive assessment of the government’s handling of the pandemic. Nevertheless, we can draw out some emerging lessons from the early evidence and indications featured in our submission.

Firstly, the pandemic has exposed and exacerbated major inequalities in our society. COVID-19 and the knock-on effects of lockdown and social distancing measures have affected everyone in some way, but some groups have felt the effects more harshly than others. For instance, people of black ethnicity are four times as likely to die from COVID-19 compared to people of white ethnicity[1]. The virus has demonstrated the need for greater government action, including through a national cross-departmental health inequalities strategy. You can read our evidence on this in the ‘equity impact’ section of our submission.

Secondly, the pandemic and policies to control the virus will have long-term impacts on health and health services. For instance, the delaying and cancelling of elective care during peak periods in the pandemic will have consequences for the size of the NHS backlog, meaning patients will have unmet care needs and face longer waiting times for consultant led care. The mental health consequences of the pandemic are a considerable concern too. On average over the next 3 years we estimate that there could be 11% more mental health referrals a year, costing between £1.1 and 1.4bn extra each year[2]. Similarly, the impact of the pandemic on young people’s employment, education, and health outcomes is likely to be felt for several years to come. One in three 1824 year olds have been furloughed or lost their job – twice the rate amongst working-age adults[3]. As we gradually move from crisis management to recovery in 2021, government will need to reflect the medium and long-term impacts of the pandemic in its response.

Thirdly, the pandemic has further highlighted the fragility and neglect of our social care system. Government action to support social care during the first wave of the pandemic was too slow and inadequate. Protecting and strengthening social care was given far lower priority by national policymakers than protecting the NHS. However, the response was also constrained by longstanding policy failures. We entered the pandemic with a system that was underfunded, understaffed, undervalued and at risk of collapse. Any response to COVID-19 – however fast or comprehensive – would have needed to contend with this legacy of political neglect. Making the system fairer, more sustainable, and reforming the funding system should be a key priority for government. Better data in social care would also help to develop our understanding of the challenges faced by the sector.

Finally, public polling tells us that the public’s perception of the government’s handling of the virus has changed during the course of the pandemic. In July, the public were more critical of the government’s handling of the outbreak compared to May. Polling results from July also showed that the clarity of the government’s official guidance varied, across the range of measures in place at the time.

We will continue to learn lessons as our understanding of the impacts of the virus develops. We hope the information in this submission is useful to the Committees’ inquiry.


Excess mortality: comparing COVID-19’s impact in the UK to other European countries in the first wave[4]

The number of deaths from coronavirus (COVID-19) has often been used to compare countries but is an unreliable metric for making meaningful comparisons. The way COVID-19 deaths are counted varies across countries and may change over time. A better measure is excess deaths (or excess mortality) – the number of deaths in a given period over and above the number expected (such as the number in an average week). Comparing excess deaths across countries, regions and localities can provide valuable learning about differences in impact, and what has contributed to them.

This chart overleaf shows the weekly excess deaths (as a proportion of usual deaths) for selected European countries, during the first wave of the pandemic. Spain had the highest peak, with deaths in the peak week being 155% more than usual. The UK also had a high peak (109%) and experienced a slow descent. Until the first week of April, France and the UK seemed on the same trajectory, but this was actually the peak week in France and their curve flattened quickly thereafter. Meanwhile, the UK’s deaths kept on growing. Germany is notable for the flatness of its wave. Over the 11 weeks of the first wave, the UK had 52% more deaths than usual, trailing Spain (56%), but ahead of Italy (35%), France (20%) and Germany (4%).

Comparing excess deaths per capita, tells a similar story about how the UK has fared compared to other countries. Over the 11-week period, the UK experienced 965 more deaths per million of the population than usual, compared to 1,023 for Spain. The rate in France was less than half that of the UK. In Germany it was less than a tenth.

Overall, this analysis suggests that the UK has been one of the worst affected countries against other European comparators.


The Health Foundation’s COVID-19 Policy Tracker

The policy responses to COVID-19 have been complex and rapidly evolving – with different countries pursuing varying approaches to managing the pandemic. Documenting these policies can help us understand and assess government responses to COVID-19 over time.

The Health Foundation’s COVID-19 policy tracker documents national government and health and social care system responses to COVID-19 in England, and how they change over time[5]. The interactive timeline - shown in the image overleaf – illustrates the key policies and events since 31 December 2019. The full tracker includes data on what changes have been introduced, when, why, and by whom – as well as how these changes have been communicated by policymakers. Within the tracker, policy changes are tracked across five areas – from health and care system changes to wider social and economic policy. New and updated versions of the tracker are uploaded fortnightly.

The impact on the social care sector

Overall, central government support for social care during the pandemic came too late. Some initial policies targeted the social care sector in March, but the government's COVID-19: adult social care action plan[6] was not published until 15 April – almost a month after countrywide social distancing measures had been introduced. Another month passed before government introduced a dedicated fund to support infection control in care homes.

In July 2020 we published Adult social care and COVID-19: Assessing the impact on social care users and staff in England so far[7] – our analysis of the scale of the impact of COVID-19 on social care in England during the first phase of the pandemic. The key findings from our report were:

In July 2020, we also published Adult social care and COVID-19: Assessing the policy response in England so far[8] - our analysis of the national government policy response during the first phase of the pandemic. Our key findings were:

On 17 September, the Department of Health and Social Care published a COVID-19 winter plan for adult social care[9], which described a mix of new and existing policies to help social care services cope with COVID-19 over winter. Government funding to prevent and control infections in social care was extended to March 2021. The extra £546m funding was allocated to help restrict staff movement between care settings and pay staff who are self-isolating. The plan also committed to free PPE being provided to all social care providers over winter.

Yet the winter plan did have notable gaps, including on testing and on measures to support the rest of the social care workforce—and the millions of unpaid carers. The plan was a further example of a short-term fix for a sector that needs long-term reform.

Further to our own analysis, the Health Foundation commissioned The Institute for Employment Studies in June 2020 to carry out research and produce a report[10] on how government COVID-19 policy may have impacted the adult social care workforce. This includes policy areas such as Test and Trace, the Action Plan for Adult Social Care, Statutory Sick Pay and the Care Home Support Package. The key findings of the report were:



Impact on NHS services

Elective care

The pandemic’s full impact on access to elective care in England is still emerging. In November we published analysis[11] using routine data on 18-week waiting times for consultant-led elective care, to look at what we know so far:


Urgent & Emergency care

COVID-19 has led to radical changes in the way people have used NHS and social care services, and emergency care is no exception.

Analysis from the Health Foundation published in June this year found that at the start of the outbreak, the numbers of people attending major A&E departments fell sharply to 52% below normal[13]. By mid-May, A&E visits had increased but were still 36% lower than expected for this time of year. Visits for ‘any type of injury’ fell to a low of 65% below normal, far lower than the 44% seen for visits related to ‘illness’. Furthermore, figures from October show that attendance at major A&Es are still 19% lower than the same month in 2019.

In September, we published analysis examining how children and young people’s use of A&E had been impacted by lockdown and social distancing[14]. We found:


Primary care

The impact of COVID-19 on face-to-face GP consultations since the start of the pandemic has been widely reported. This has raised questions about the care of non-COVID patients, people with long-term health conditions, and the potential for delayed diagnoses.

During the first wave of the pandemic, care provision in GP practices dramatically changed due to COVID-19, with remote consultation rapidly introduced to protect patients and staff from the risks of infection. Our analysis from July suggests that GP practices familiar with conducting appointments remotely were able to adapt quickly to the demands of COVID-19 and undertake more care remotely without significantly impacting the total number of consultations delivered[15]. As the pandemic has progressed, these practices demonstrated resilience by responding flexibly to variations in demand for care throughout April to June. These results point to the benefits of using digital technology in general practice and suggest the NHS should continue to invest in digital-first primary care. Doing so in the short term may make primary care more resilient to future waves of the virus. However, research is required to answer questions about the impact of remote consultation on the quality of care, patient experience and access, and workload.

In September 2020 we published analysis using patient-level primary care data up to the end of June 2020, to explore how different activities and patient pathways were affected around the peak of COVID-19 in England[16]. We also looked at how these effects varied by age, sex and for patients with pre-existing illness.


Further to this analysis, in August this year we looked at how COVID-19 could affect the numbers of GPs available to see patients in England during the pandemic[17]. In England, many GP practices shifted to a ‘telephone first’ approach to providing patient care during the early phase of the pandemic. Yet some patients need face-to-face consultations for specific health problems. We applied risk scoring to calculate the number of GPs practising in England who are likely to be at high or very high risk of death from COVID-19:

Our analysis suggested there are a relatively large number of GPs at high risk of mortality from COVID-19, and there is geographical and socioeconomic variation in the distribution of affected GPs.


Government communications and public health messaging

Public perceptions of health and social care in light of COVID-19

During the pandemic, the Health Foundation commissioned Ipsos MORI to carry out a representative survey of the general public in Great Britain to gather their views on a range of health and care issues in light of COVID-19[18]. The polling was carried out in two rounds; the first round of polling was carried out between 1 and 10 May 2020, and this was followed by a second round between 17 and 29 July 2020.

Below we provide a summary of results from July’s polling, and how they compared to May’s results.


Testing and contact tracing

The difficulties associated with implementing an entirely new national programme of testing and contact tracing should not be underestimated. It is no small achievement that a system only launched in May is now delivering millions of tests every week and reaching hundreds of thousands of cases and close contacts. However, NHS Test and Trace (NHSTT) is not yet the world-beating contact tracing programme that was promised and significant scope for improvement remains. As case rates remain high and until an effective vaccination programme has been implemented, a well-functioning test and trace system is crucial for keeping schools and businesses open, and to effectively target support and resources to those most in need.

NHS Test & Trace: the journey so far

In September we published a long-read outlining how the NHSTT programme works and analysed the key stages in the development of testing and contact tracing in England. We also highlighted some of the ongoing challenges faced by the programme and offered suggestions about how these challenges might be addressed[19].

We identified four key challenges that the programme faced in September:

We outlined a series of recommendations in September for how NHS Test & Trace could increase its reach, many of which still apply. The recommendations from September included:


NHS Test & Trace Performance Tracker[22]

In the Health Foundation’s NHS Test & Trace Performance Tracker, we monitor and reflect on the performance of NHS Test and Trace. We analyse the latest statistics on the number of positive cases reached and the number of contacts who were asked to isolate each week since the launch of NHSTT on 28 May 2020. The tracker is updated on a fortnightly basis. See the Sankey diagram below from the most recent update to the tracker.


During the development and initial launch of the NHS COVID-19 app, we repeatedly called for greater transparency about the development of the app, and for the government to publish evidence from pilots of the app to demonstrate it was ready for mass roll-out[23]. We have argued that publishing the evidence to demonstrate the app works is a key part of building public confidence and trust in the app, and therefore an enabler of overall success.

Our analysis highlighted a particular concern about how the app would impact, and potentially exacerbate, existing health inequalities. Piloting the app in Newham, one of the most ethnically diverse areas of the country, with a high population density and significant areas of deprivation, offered the opportunity to understand how it worked among different populations. However, without the publication of any findings from the pilot study, we do not know whether these major concerns were addressed before the app was launched in September.

A particular concern was the potential negative impact of a ‘digital divide’, with those without access to the app not receiving the same level of benefit in terms of up-to-date information about their risk of infection from contact with others. Results from our commissioned survey of the public in July 2020 (mentioned already above), highlight two areas in which this could manifest[24]:

At the time of writing this submission, two months after the NHS COVID-19 app was launched across England and Wales, there remains an absence of evidence about how well the app is working in practice, or what contribution it is having in combatting the spread of the virus.


Equity impacts

The COVID-19 pandemic and the wider governmental and societal response have further exposed inequalities in our society. COVID-19 and the knock-on effects of lockdown and social distancing measures have affected us all, but they have impacted some groups more than others. In this section, we summarise and link to some of our emerging evidence on the unequal impact of the pandemic.

In addition to the information below, a Health Foundation blog series[25] rounds up the emerging evidence on the unequal impact of the pandemic and the wider governmental and societal response in the UK.

Living in poverty was bad for your health long before COVID-19

As we learned the fatality rate for COVID-19 was far higher among people from more socioeconomically deprived areas, there was rightly a sense of outrage. Mitigating the impact of COVID-19 on deprived communities should be a key concern for government and health care leaders. But the unequal impact should not have come as a surprise.

Not everyone has the same opportunity to live a healthy life, and one key driver for these health inequalities are the inequalities in society itself. This is not new, but COVID-19 has thrown it into sharper focus. Analysis we published in July 2020[26] explored the nature of the economic shocks experienced in recent years, including those stemming from COVID-19, and the consequences these might have on people’s health.


Emerging findings on the impact of COVID-19 on black and minority ethnic people

In analysis published in May 2020[27], we found that the risk of COVID-19 related death is more than four times as high for people of black ethnicity, than for those of white ethnicity after adjusting for age.

Ethnic inequalities in health in the UK have been extensively documented before COVID-19. A wide variety of explanations for these have been examined, ranging from upstream social and economic inequalities to downstream biological factors. Experts in the field point to racism as a ‘fundamental cause[28], affecting health in multiple ways. A strong evidence base has demonstrated that racial discrimination affects people’s life chances through, for example, restricting access to education and employment opportunities. Black and minority ethnic groups tend to have poorer socioeconomic circumstances which lead to poorer health outcomes. In addition, the stress associated with being discriminated against based on race/ethnicity directly affects mental and physical health through physiological pathways[29].

Public Health England’s report from June 2020, disparities in the risk and outcomes of COVID-19[30], highlighted that the burden of this pandemic has not being shouldered equally. PHE’s findings add to the growing body of evidence showing that older people, those living in more deprived areas, people from black and minority ethnic groups, and those working in certain occupations are at a significantly higher risk of dying from COVID-19.


The impact on young people: ‘Generation COVID-19’

As policymakers look towards a recovery from the COVID-19 pandemic, young people’s long-term health needs to be at the heart of their decision making. In August, we published a long read on young people’s future health[31], drawing on insights from the Health Foundation’s young people’s advisory group, and original analysis of YouGov and Understanding Society survey data conducted by the Health Foundation. We found:

Securing the foundations for young people’s healthy futures will require focused and comprehensive action across the range of factors that influence long term health. In August, we recommended that decision makers should prioritise action in the following areas:


The links between inequalities - intersectionality

Intersectionality theory[32] is a framework to consider how disadvantage on multiple social dimensions combines to affect outcomes. In May we examined data on socioeconomic deprivation, gender and COVID-19 mortality, to show how acting on only one aspect of possible inequality can prevent us observing and tackling the intersection with others. We found that women living in the most deprived areas of England are 133% more likely to die from COVID-19 than those in the least deprived areas, with the gap for men being smaller.

This analysis illustrates one combination of how social factors may be linked to increase risk of COVID-19. An intersectional approach to inequalities encourages deeper thought about how other combinations could accentuate risk and requires us to consider whether a universal public health approach alone will ensure those high-risk groups are protected from the impact of the virus.

There is a real danger that COVID-19 will increase inequalities. The government response to this crisis must be designed to mitigate this by taking account of the ways in which some people bear the brunt of multiple impacts.


COVID-19 Impact Inquiry[33]

The Health Foundation has recently opened a call for evidence[34] to its COVID-19 impact inquiry. The inquiry – due to report in the summer of 2021  aims to provide a comprehensive analysis of the factors that will need to be addressed to put the UK back on the road to recovery and ensure that everyone can enjoy the same opportunities for good health and wellbeing. The Health Foundation is inviting individuals and organisations to submit evidence which will help to build greater understanding of how experiences of the pandemic have been influenced by people’s existing health and social inequalities.

The COVID-19 impact inquiry is being carried out by an in-house secretariat at the Health Foundation, guided and informed by an expert advisory panel, chaired by Dame Clare Moriarty.


The importance of health and care data in the fight against COVID-19

Data relating to the COVID-19 pandemic has become a constant feature of our lives since the pandemic emerged, with our days being punctuated by regular updates on the numbers of cases, deaths and hospitalisations. Data has told a horrifying story about the toll that the pandemic is taking. It’s also playing a critical role in the response to the virus, informing national and international policy, the search for new treatments and vaccines, and the rapid innovation that is happening across the NHS. Data can never solve a problem like COVID-19, but it can help in the fight to protect the most vulnerable.

We launched our data analytics for better health strategy[35] in January, with the ambitious aim to ensure that analytics and data-driven technology benefit everyone in the UK. We knew data was critical for the UK to overcome problems like health inequalities, accelerating service improvements, strengthening social care, and now also COVID-19.

The COVID-19 pandemic has exacerbated and amplified many of the longstanding issues within social care, one of which is a problematic lack of data. There are key gaps in the information that is collected, particularly outside the care home system. From the patient and public involvement work we have carried out as part of our research, it is clear that the available data contains large gaps in capturing the needs of those receiving care, particularly in areas such as mental health or the impact of unmet social care needs on wellbeing.

There are particular challenges in how data are collected, shared and used in social care. For example, some care providers may be reluctant to share data for fear of the consequences on their finances, and the data collected may not focus enough on how care can empower users to live independent lives. Most datasets collect information about care from provider organisations, which omit care provided by individuals (paid or unpaid). Addressing these problems will require a new data strategy for social care with the primary objective of improving the quality of care. Such a strategy needs to come with investment so that the data collected can be used to improve care, for example by establishing better data infrastructure to enable real-time analysis, building skills in analysis, and fully incorporating the lived experience of users into the interpretation and use of the analysis.

Better person-level data on staffing, social care capacity, testing and health care and social care provision are needed to better prepare for subsequent waves of COVID-19, and would also bring long-term benefits. During the pandemic, we have seen how valuable health data have been in enabling new treatments and supporting innovation, such as via the RECOVERY trial. With further investment, similar innovations are possible within social care.


[1] The Health Foundation, The same pandemic unequal impacts, November 2020: Available at: https://www.health.org.uk/news-and-comment/charts-and-infographics/same-pandemic-unequal-impacts

[2] The Health Foundation, Managing uncertainty: COVID-19 and the NHS long term plan, November 2020: Available at: https://www.health.org.uk/publications/long-reads/managing-uncertainty

[3] The Health Foundation, The same pandemic unequal impacts, November 2020: Available at: https://www.health.org.uk/news-and-comment/charts-and-infographics/same-pandemic-unequal-impacts

[4] The Health Foundation, Understanding excess mortality: comparing COVID-19's impact in the UK to other European countries, 2020. Available at: https://www.health.org.uk/news-and-comment/charts-and-infographics/comparing-covid-19-impact-in-the-uk-to-european-countries

[5]The Health Foundation, COVID-19 policy tracker. Available at: https://www.health.org.uk/news-and-comment/charts-and-infographics/covid-19-policy-tracker

[6] https://www.gov.uk/government/publications/coronavirus-covid-19-adult-social-care-action-plan

[7] The Health Foundation, Adult social care and COVID-19: Assessing the impact on social care users and staff in England so far, 2020. Available at: https://www.health.org.uk/publications/reports/adult-social-care-and-covid-19-assessing-the-impact-on-social-care-users-and-staff-in-england-so-far


[8] The Health Foundation, Adult social care and COVID-19: Assessing the policy response in England so far, 2020. Available at: https://www.health.org.uk/publications/reports/adult-social-care-and-covid-19-assessing-the-policy-response-in-england

[9] The Department of Health & Social Care, Adult social care: our COVID-19 winter plan 2020 to 2021. Available at: https://www.gov.uk/government/publications/adult-social-care-coronavirus-covid-19-winter-plan-2020-to-2021/adult-social-care-our-covid-19-winter-plan-2020-to-2021

[10] The Institute for Employment Studies, Potential Impact of COVID-19 Government Policy on the Adult Social Care Workforce, 2020. Available at: https://www.employment-studies.co.uk/resource/potential-impact-covid-19-government-policy-adult-social-care-workforce

[11] The Health Foundation, Elective care in England, 2020. Available at: https://www.health.org.uk/publications/long-reads/elective-care-in-england-assessing-the-impact-of-covid-19-and-where-next

[12] The Health Foundation, Managing uncertainty: COVID-19 and the NHS long term plan, November 2020. Available at: https://www.health.org.uk/publications/long-reads/managing-uncertainty

[13] The Health Foundation, Exploring the fall in A&E visits during the pandemic, 2020. Available at: https://www.health.org.uk/news-and-comment/charts-and-infographics/exploring-the-fall-in-a-e-visits-during-the-pandemic

[14] The Health Foundation, How has children and young people’s usage of A&E been impacted by lockdown and social distancing?, 2020. Available at: https://www.health.org.uk/news-and-comment/charts-and-infographics/how-has-children-and-young-peoples-usage-of-AE-been-impacted-by-lockdown-and-social-distancing

[15] The Health Foundation, How has COVID-19 affected service delivery in GP practices that offered remote consultations before the pandemic?, July 2020. Available at: https://www.health.org.uk/news-and-comment/charts-and-infographics/how-has-covid-19-affected-service-delivery-in-gp-practices

[16] The Health Foundation, Use of primary care during the COVID-19 pandemic, 2020. Available at:


[17] The Health Foundation, How might COVID-19 affect the number of GPs available to see patients in England?, 2020. Available at: https://www.health.org.uk/publications/long-reads/how-might-covid-19-affect-the-number-of-gps-available-to-see-patients-in-england

[18] The Health Foundation, Public perceptions of health and social care in light of COVID-19 (July 2020). Available at: https://www.health.org.uk/publications/reports/public-perceptions-of-health-and-social-care-in-light-of-covid-19-july-2020

[19] The Health Foundation, NHS Test and Trace: the journey so far, 2020. Available at: https://www.health.org.uk/publications/long-reads/nhs-test-and-trace-the-journey-so-far

[20] https://www.sciencedirect.com/science/article/pii/S0033350620300718

[21] https://www.medrxiv.org/content/10.1101/2020.06.01.20119040v1.full.pdf

[22] The Health Foundation, NHS Test and Trace Performance Tracker, 2020. Available at: https://www.health.org.uk/news-and-comment/charts-and-infographics/nhs-test-and-trace-performance-tracker

[23] The Health Foundation, Government must publish evidence that the contact tracing app works and will not fail those most at risk of COVID-19, 2020. Available at: https://www.health.org.uk/news-and-comment/news/government-must-publish-evidence-that-the-contact-tracing-app

[24] The Health Foundation, Public perceptions of health and social care in light of COVID-19 (July 2020). Available at: https://www.health.org.uk/publications/reports/public-perceptions-of-health-and-social-care-in-light-of-covid-19-july-2020

[25] The Health Foundation, COVID-19, health and health inequalities, 2020. Available at: https://www.health.org.uk/what-we-do/a-healthier-uk-population/useful-publications-and-resources-on-healthy-lives/covid-19-and-health-inequalities-blogs-series

[26] The Health Foundation, Living in poverty was bad for your health long before COVID-19, 2020. Available at: https://www.health.org.uk/publications/long-reads/living-in-poverty-was-bad-for-your-health-long-before-COVID-19

[27] The Health Foundation, Emerging findings on the impact of COVID-19 on black and minority ethnic people, 2020. Available at: https://www.health.org.uk/news-and-comment/charts-and-infographics/emerging-findings-on-the-impact-of-covid-19-on-black-and-min

[28] https://discoversociety.org/2020/04/17/racism-is-the-root-cause-of-ethnic-inequities-in-covid19/

[29] https://www.annualreviews.org/doi/full/10.1146/annurev-publhealth-040218-043750


[30] Public Health England, Disparities in the risk and outcomes of COVID-19, 2020. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/889195/disparities_review.pdf

[31] The Health Foundation, Generation COVID-19, 2020. Available at: https://www.health.org.uk/publications/long-reads/generation-covid-19

[32] https://chicagounbound.uchicago.edu/uclf/vol1989/iss1/8/

[33] https://www.health.org.uk/what-we-do/a-healthier-uk-population/mobilising-action-for-healthy-lives/covid-19-impact-inquiry


[35] The Health Foundation, Data analytics for better health – realising the potential for all, 2020. Available at: https://www.health.org.uk/news-and-comment/blogs/data-analytics-for-better-health-realising-the-potential-for-all


Nov 2020