The LEAP response to COVID-19: two months into lockdown

Carla Stanke, Public Health Specialist at LEAP reflects on the impact of COVID-19 on BAME communities, and the next steps in rebuilding support.

My first COVID-19 blog focused on the efforts involved in reorganising the entire LEAP programme in light of physical distancing requirements. Two months into the UK lockdown we are reflecting on a range of different issues:

the disproportionate impact of the virus on BAME people
the effectiveness of digital interventions and learning how best to embed key principles into service delivery
understanding the emerging needs of the LEAP community and considering how our programme needs to be reimagined for a changed world.

We are deeply concerned about the emerging evidence showing that BAME communities are disproportionately affected by COVID-19. Recent analysis reveals that black people are twice as likely as white people to die from COVID-19 (1, 2), and there are different reasons that may explain this stark inequality in outcomes. People from ethnic minorities are more likely to:

have underlying health conditions that make them more vulnerable to the virus
work in roles where they are exposed to COVID-19 (e.g. public facing occupations like public transport drivers, nurses and carers)
live in conditions in which it is more likely to spread (e.g. in overcrowded housing) (3).

This means that a substantial part of the difference in COVID-19 mortality between ethnic groups is explained by the different circumstances in which people of those groups live, e.g. in areas with socio-economic deprivation (1). Another UK study recently revealed that 55% of women admitted to hospital with coronavirus were from BAME backgrounds (4), another troubling reality of the pandemic.

The implications of this for our LEAP families are enormous; our programme is delivered in some of the most deprived wards in Lambeth, an ethnically diverse borough. As we think about how we need to re-shape LEAP in light of the pandemic, this sobering reality reminds us that many of our families are now facing new and extremely difficult circumstances and likely to have different needs than we previously understood.

Like organisations around the world, we have quickly shifted to digital delivery wherever we could. Now that the dust has settled somewhat, we are turning our attention to ensuring our services are delivered in line with the best possible evidence to support optimal digital engagement with our families.

A recent report summarised the evidence, challenges and risks related to virtual and digital delivery of interventions (5); we are now considering how best to implement these principles so that we can deliver services to our families in the safest and most effective ways possible, in the face of probable ongoing cycles of lockdown.

The ultimate goal for LEAP is to move seamlessly between face-to-face and digital delivery, as needed; most of our services were designed to be delivered in person so careful thinking is needed to determine how best to move back and forth between delivery styles in the longer term.

From the beginning of lockdown, our strand leads have gathered insights about the effects of COVID-19 on the LEAP workforce and on the families we work with. While some outcomes have been positive (e.g. less waiting time to speak with a GP), data analysis has revealed rich insights about the following broad themes:

Housing (e.g. overcrowded and insecure housing)
Finance and employment (e.g. job insecurity, unemployment, income loss)
Food insecurity and family nutrition (e.g. access to food and free school meals)
Parenting (e.g. lone parent households, access to educational resources)
Family relationships (e.g. domestic violence and parental conflict)
Parental mental health (e.g. overall anxiety, isolation, ante- and postnatal worries)
Child health, wellbeing and welfare (e.g. mental health and safeguarding)
Workforce and services (e.g. changes to the way primary care is delivered and increased workloads)
Inequalities (e.g. increased vulnerabilities, digital exclusion)

Several concerning issues have emerged from this exercise, and we are now planning research to help us further understand and meet the changing needs of our community.

Public health programmes that focus on the very beginning of the life course are more important than ever. What happens during pregnancy and early childhood can have physical and emotional impacts into adulthood, and the challenges that are part of the coronavirus response - e.g. fewer face-to-face midwife and health visitor appointments and suspended children’s centre activities - underscore the continued importance of engaging with families early, albeit in different ways.

With the uncertainty about how our lives will change for the longer term as a result of the virus, it is crucial that we listen to the voices of our communities and bear witness to their stories as we adapt our work so that it continues to be relevant.

Carla Stanke is a Public Health Specialist at LEAP in Lambeth

References

About A Better Start

A Better Start is a ten-year (2015-2025), £215 million programme set-up by The National Lottery Community Fund, the largest funder of community activity in the UK. Five A Better Start partnerships based in Blackpool, Bradford, Lambeth, Nottingham and Southend are supporting families to give their babies and very young children the best possible start in life. Working with local parents, the A Better Start partnerships are developing and testing ways to improve their children’s diet and nutrition, social and emotional development, and speech, language and communication.

The work of the programme is grounded in scientific evidence and research. A Better Start is place-based and enabling systems change. It aims to improve the way that organisations work together and with families to shift attitudes and spending towards preventing problems that can start in early life. It is one of five major programmes set up by The National Lottery Community Fund to test and learn from new approaches to designing services which aim to make people’s lives healthier and happier

The National Children’s Bureau is coordinating an ambitious programme of shared learning for A Better Start, disseminating the partnerships’ experiences in creating innovative services far and wide, so that others working in early childhood development or place-based systems change can benefit.

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