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Health and Social Care
Textbooks, monographs and policy-focused books on our Health and Social Care list push forward the boundaries of teaching, theory, policy and practice. The list covers areas including global health, health inequalities and research into policy and practice.
Key series include Transforming Care which provides a crucial platform for scholars researching early childhood care, care for adults with disabilities and long-term care for frail older people, and the Sociology of Health Professions, offering high-quality, original work in the sociology of health professions with an innovative focus on their likely future direction. Our leading journal in the area is the International Journal of Care and Caring.
In response to COVID-19, many care homes closed to visitors and new ways for carers and residents to stay in touch were tried. This UK study employed an online survey to explore carer experiences of staying in touch from a distance. The research highlighted: the importance of ongoing connections (through visits and remotely); diverse approaches to maintaining contact; and concerns about safeguarding and well-being. Findings underscore the importance of developing personalised approaches to staying in touch during future care home closures and for those who require an ongoing approach to remote contact due to distance, illness or additional caring responsibilities.
‘Shielding’ and ‘isolating’ were the strictest forms of staying home. Four million people who were particularly vulnerable were asked to ‘shield’ at home for months, initially to protect the health service and latterly for their own protection. At least 12 million who had COVID-19 or suspected COVID-19 were required by law to ‘isolate’ at home to protect others (at least those outside their household). A quarter of shielders and isolators lived alone and became a new category of dependent people. Those who lived with others had to try to avoid infection at home. People on lower incomes were more likely to have to shield or isolate, but they and ethnic minorities were less likely to have a spare bedroom to do so properly, which must have contributed to inequalities in infection and death. Shielding and isolating were only partially successful.
In 2020/21, there were 28 million or 18% fewer hospital appointments than before the pandemic. Millions were providing healthcare for household members with COVID, while trying to avoid infection, or conditions that would normally be treated in hospital. Some 34% more people than usual died at home. This placed extra responsibility on sick and vulnerable people, their households and homes.
This chapter introduces the book. Everyone on earth has views about the COVID-19 pandemic. It was unprecedented and multi-dimensional. It has been seen as a test of resilience, as casting a spotlight on inequality, and potentially as a turning point for policy and society.
The most important policy used to control COVID-19 infection in the UK – and all around the world – was ‘lockdown’, requiring large proportions of the population to stay home. This resulted in mass changes in the way in which homes were used, experienced and paid for, with their own knock-on inequalities. When the pandemic hit, many felt that the UK housing system was in ‘crisis’, but suddenly the unsatisfactory system became the official national refuge. The pandemic provided an unfortunate natural opportunity to learn about the UK housing system under unique pressure: its flaws, its inequalities and its resilience. This book uses a wide range of special surveys carried out in 2020–21, including studies of people aged 19, 31, 50, 62 and 74 in 2020 when the pandemic began, to analyse its impact on people, households, homes and the housing system in the UK.
The COVID-19 pandemic shut down or disrupted large parts of the UK labour market. By May 2020, almost half of the population had lost at least 10% of their income.
Most people turned first to their savings and to friends and family, but in March 2020, the UK government invented new jobs support, benefits and housing policies, which were relatively generous compared to the pandemic policy in other countries and to the normal welfare safety net. A total of 12 million UK people were ‘furloughed’ on 80% of pay for some months at a cost of £70 billion. Universal Credit claims increased by 1.1 million or 39%. At least two million mortgagees took a payment ‘holiday’. A moratorium meant an almost complete halt to legal evictions and repossessions until at least 2022. Overall, median income fell and partly as a result, relative poverty reduced slightly. However, some people experienced stable incomes, reduced costs and increased savings, while others lost income, spent savings and borrowed. Three million people lost income but were ineligible for schemes. Job and income loss affected renters and outright owners more. Mortgagees and private renters experienced worsening affordability and increasing arrears. Renters had no ‘holiday’ scheme. There will be lingering and unequal effects on savings, debts, housing security and ability to buy.
UK policy sought to minimise the impact of the pandemic on the housing market, which was viewed as essential to sustaining economic growth. Home construction and marketing paused only for seven weeks, construction workers received £15.9 billion of pandemic support and at least £4.7 billion was spent on a cut in stamp duty (transactions tax). While completions, transactions and lending reduced in 2020, they soon recovered. In contrast to expectations, house price growth continued at 11% a year throughout 2020 and 2021. This contributed to inequalities in access to home ownership and to wealth.
The UK had three waves of COVID-19 infections and deaths between January 2020 and the start of 2022. ‘Age-standardised’ death rates were among the highest in Europe, although lower in the second and third waves. By January 2022, there had been 390 million recorded tests, about 20 million infections and 620,000 hospital admissions, and 52 million had had at least one dose of the vaccine. A total of 148,000 people had died within 28 days of a positive COVID-19 test. The increase in deaths was enough to reduce life expectancy at birth. Deaths were very unevenly distributed by age, gender, pre-existing health conditions, disability, region, neighbourhood deprivation, ethnicity and occupation.
On 23 March 2020, UK government required most of the population to stay home, and measures were among the most stringent in Europe. However, locking down a week earlier would have saved an estimated 20,000 lives and might have allowed less stringency. Later lockdowns were also delayed. A House of Commons report in September 2021 described early policy as ‘one of the most important public health failures the United Kingdom has ever experienced’.
Most people in the UK obeyed most of the restrictions on leaving home and mixing with other households most of the time. In the first national lockdown, most were at home for 23 or more hours a day and 41% were entirely at home for five or more days a week.
The UK birth rate fell, international migration fell and the death rate increased, meaning the total population reduced, against previous trends. The trend of growth in the number of households paused, as people moved in with others to reduce costs, loneliness and infection risk.
Home occupancy, overcrowding and time at home increased. People spent more time on sleep, childcare and leisure, and less on work outside the home, housework, personal care and travel. About 40% of employed adults worked from home. Experienced varied widely. There were difficulties in fitting multiple people and activities into congested home space, and in being home alone. Homes acted as refuges from the virus, but had to be defended from it. For some, the meaning of home was enhanced. Others felt home was no longer quiet, restorative or private. For many, home became a ‘prison’.
Staying home avoided exposure to COVID-19 and any other risks outside the home, but increased exposure to any harms at home. Scientists recognised early on that home was a major site of infection, with higher risk for larger, overcrowded households, or those with members working outside the home. In the UK, homeless people were provided with self-contained emergency accommodation to reduce risk. However, in contrast to some other countries, there was little policy or support to prevent infection at home in private households, where 98% of people lived, even where they contained infected or vulnerable people.
People responded by following rules strictly, by cleaning more, by moving people between households or by giving up work. However, the ability to respond was limited and unequal. Infections at home could have caused 26–39% of all UK pandemic deaths, or 38,000–58,000 deaths within 28 days of a positive test by the start of 2022. They certainly contributed to inequalities in deaths.
The COVID-19 pandemic has dramatically exposed weaknesses in UK housing’s relationship to the labour market and welfare system. Inequalities in household type, home occupancy, housing cost and security have contributed to the unequal impact of the disease.
Comprehensively charting fast-moving and inter-linked policy developments, Becky Tunstall assesses the position of housing and home in public policy, health and in peoples’ lives, and documents the most immediate responses to the pandemic in one convenient resource for students, scholars and practitioners.
Household and home were central to the experience of the COVID-19 pandemic, and its impact on physical and mental health, living standards and security. UK pandemic policies overlooked the risk of infection at home, which accounted for an estimated 26–39% of deaths. Home size, facilities and costs affected the ability to stay home, and to shield and isolate. Housing inequalities contributed to the marked inequalities in deaths.
Household and home size, occupancy, facilities, affordability and cost affected the wider experiences of staying home. Housing tenure and affordability affected the impact of income loss on living standards and risk of repossession. Policies to mitigate pandemic income loss had significant limitations.
By early 2022, pre-pandemic inequalities in housing and overcrowding, unaffordability, insecurity and homelessness remained or had worsened, while house price rises continued. Despite the great disruption, and policy innovation including housing homeless people and reducing poverty, in early 2022 things were building back the same, not better. The pandemic highlighted the role of family and friends as supplements to the state and market in providing income, material help, care, support and housing, and as a key source of the overall resilience of the UK.