Written Evidence Submitted by The London School of Economics and Political Science

(CLL0098)

I am writing to submit as evidence to the Health and Social Care Committee’s “Coronavirus: lessons learnt” inquiry, research from a major new LSE report into the effect of the pandemic on care and social support networks for disadvantaged households in the UK.

This report - A Right to Care: The Social Foundations of Recovery from Covid-19 – is based on a comprehensive 6-month ethnographic study of the impact of the pandemic on disadvantaged households; comprised of in-depth interviews, surveys, and case studies across different communities. We find that the Government can improve adherence to restrictions and reduce the negative impacts of the pandemic on disadvantaged groups by placing central importance on the role of communities, social networks and households.

The report pays particular attention to the pandemic’s impact on vital and longstanding health issues - mental health and social care. Both areas have been severely impacted, with social network disruption, economic pressures, and not to mention the health worries and pressures of the pandemic worsening the situation in these areas across the UK. Moreover these effects fall hardest on those already vulnerable; exacerbating class, gender and regional inequalities and introducing new forms of inequality. The report however shows several ways that the Government can make huge strides in improving the situation, helping to alleviate suffering now, and building capacity to support a recovery and a better future for disadvantaged households beyond the pandemic.

Below I summarise the key strands of our work in relation to the Inquiry, however I would be very happy to send the full report on to the Committee, should you wish to see the research in greater depth.

Our key recommendations for Government

We suggest that in order to help to alleviate the care and mental health burdens caused by the pandemic, social network restrictions on households should move towards wider use of social bubble household policies rather than blanket regulations such as the rule of six, that do not match household practices, can discriminate against particular social groups, and sever vital social support and care networks.

A systematic dialling up and down of the numbers of households able to connect according to the severity of local outbreaks (as recommended previously by SPI-B) - allowing different levels of social bubbling in Tier 1 to 3 - would go a long way in terms of improving mental health, and supporting care needs.

Further to this, areas in Tier 2 and 3 should receive immediate, emergency mental health and care support in the form of financing the expansion of mental health care and subsidising, or in the most deprived regions, providing free of charge Covid-19 safer child and elder care facilities. These could be on the model of well-funded mutual aid networks helping in people's homes or otherwise through the subsidised use of existing private facilities.

Households should also be paid a care supplement similar to a Child Benefit throughout the second wave to recompense them for the huge burdens unpaid care-workers are bearing.

In the longer term, community renewal centres should be created. These should be broader in reach than the older Surestart Centres. They would provide formal free or highly subsidised child, elder and other care alongside mental health and access to small business grants.

There should be an effort to combat the growth of blame and discriminatory narratives in communications on the pandemic – instead emphasising the risk of exposure for those involved in the vital work of care in the community, which results in members of hardworking families becoming unwell with Covid-19. All new measures should be accompanied by government funding of community information and provision of support through GPs, peer-educators, community champions and mental health charities and professionals. More nuanced sociological and anthropological research should be conducted around issues of stigma, blame and mistrust as the vaccine is rolled out. Such insights should inform the delivery of local vaccination efforts.

Finally, vulnerability to Covid-19 should be mapped as a series of structural factors that intersect to create disadvantage in each social situation, and more nuanced national and local communications that give clear explanations for transmission in particular environments rather than ‘within communities’' need to be developed.

The importance of social networks for household mental health and caregiving

We found that for interviewees and survey respondents across all groups there was a sense of frustration at the impracticality and inequality of Government regulations around household interaction. Survey responses suggest that the lack of clarity and applicability of Government guidelines to the realities of life in their households led to poor life satisfaction across groups. We also found that frustration with the guidelines was often displaced onto relationships, leading to conflicts within and between households that further impacted on wellbeing.

Permeating the interview and survey responses was a sense that the concept of ‘household’ bounded by the physical house or flat was not the reality of many people’s significant unit for social support or emotional connection. Often key support relationships extended beyond this boundary, and people thought that they had been denied relationships that were essential to their lives, and were outraged or saddened by this.

As a result of Covid-19 policies cutting off these usual social support networks (and formal social care), there has been an emergence of a kinwork and care deficit. Households, and in particular women within them, have had to fill this deficit by absorbing greater care burdens. As a result, particular categories of people with multiple caring responsibilities or managing multiple households are experiencing immense pressure.

Moreover, the isolating impacts of the restrictions have been felt across a diverse range of vulnerable groups: single-parent households; a ‘squeezed middle’ of middle-aged women - women who are providing both physical and financial care to their children and parents, sometimes while continuing as essential workers themselves; children with disabilities; and single men experiencing financial stress, to name but a few. Being more isolated from sources of emotional, financial and physical care has taken a real toll on mental health and wellbeing.

Formal care deficit

Formal care refers to primarily free or subsidised facilities provided by councils or NGOs and engaged with at local level by the household. These may include, but are not limited to: day care centres used by disabled and elderly household members, midwife services, family planning clinics, women’s refuges, nurseries and schools. Usually, these kinds of organisations would absorb part of the household’s care burden or offer care and shelter in the absence of this within the household itself.

Many formal care facilities utilised by the household are closed to face-to-face visits, are no longer accessible, or have been lost touch with, due to lack of communication to convey they are still running. Though some services have reopened, their ability to conduct outreach or run drop-in centres are severely constrained.

This decrease in access to formal care, combined with the intensification of informal care because of smaller social networks as discussed before, has added a formal care deficit to already burdened households.

Elderly households and households with young children and disabled members have experienced the formal care deficit most intensely. They have considerable difficulty accessing care services and everyday necessities including groceries. Some local charities, local counsellors and NHS volunteers have been phoning to ensure their elderly and disabled users are in good health, although many of these are running on tight resources and good will as temporary services.

While existing ‘support bubble’ arrangements have provided assistance and companionship to people who are structurally isolated (living alone), they remain unavailable to people relationally isolated, for instance people who live with and care for a severely disabled relative or spouse, who themselves are in need of support but do not qualify.

Communicating vulnerability

Our report examines how a lack of scientific knowledge, clear official communication and population-level evidence has resulted in processes of stigmatisation and blame as people and policy makers speculate as to the drivers of transmission.

The fear of exposure to the virus, of rising case numbers in particular geographic areas, class groups and ethnic communities, is manifest in the apportioning of blame in ‘hotspots’ of transmission, or the accusation that certain ethnic, cultural groups or age-groups are ‘vectors’ of transmission.

Most importantly, Government advice, communications and policy decisions can perpetuate and introduce some forms of stigma, where, for instance, the lockdown of particular ethnic areas or prohibition of certain religious activities serve to cement them as potential sources of infection in the public imagination.

Some of these new relations of stigma that we have observed include: (1) stigma against essential workers, both during the lockdown as they continued to work, and as lockdown has eased, as they were excluded from social bubbles and alienated from some social networks; (2) stigma against multi-generational households; (3) stigma against young people, where young people are considered dangerous due to their ‘reckless’ behaviour, the fact they socialise without being socially distant with a range of people, and may be a-symptomatic if they contract the virus; (4) stigma against black and ethnic minority people, where multigenerational households and key workers are conceived to be mainly BAME, these groups are seen as non-adherent or unable to understand Government guidelines; (5) stigma against low income or deprived communities, considered to have poor hygiene practices and cramped living conditions where the virus could spread easily.

In order to combat these processes – and thus lower transmission rates – it is necessary to build a fuller picture of how the virus is spread and how it is impacting people’s lives; how they are responding to guidelines and perceiving risk.

Nuanced national and local communications that give clear explanations for transmission in particular environments rather than ‘within communities’, and that combat blame narratives are required.

Please do let me know if I can provide any further information, and again I would be more than happy to send the full report to the Committee, should you wish to read our research in greater depth.

Professor Laura Bear

COVID and Care Research Group Principal Investigator