Why Covid Recovery Needs Our Attention

Why Covid Recovery Needs Our Attention

This briefing provided a prompt for discussions for IPPO’s work in 2023 and 2024 on COVID Recovery across the UK. In this year and beyond, there are likely to be serious stresses across many parts of society – and governments – as the after-effects of the pandemic combine with high energy prices, likely recession, a cost-of-living crisis, and buckling health services.


A brief scan of UK Government and parliamentary publications considering aspects of COVID Recovery reveals discussion across a wide range of often interdependent policy areas. These range from a consideration of public services, such as the provision of family and children’s services, to a strong focus on health and social care. Our healthcare systems need to address record backlogs, improve staff recruitment and retention, increase their mental health provision, rejuvenate the quality of primary and community care settings, reduce health inequalities, and manage the long-term impacts of Long Covid on our most vulnerable populations. All of this means building resilience into healthcare planning.

Other key areas of focus include reforming our labour markets to help tackle low growth and future-proof our economy, building social capital in our communities, encouraging wider digital inclusion, and reforming our democratic systems, such as our governments and justice systems, to ensure their trust role at the heart of society.

In Scotland, the priorities are similar, albeit with a greater focus in some areas including seeking to build greater resilience to future economic shocks with a focus on accelerating the transition to Net Zero and developing a wellbeing economy. The Scottish Government’s Covid Recovery Plan identified ambitions to address systemic inequalities; advance a ‘wellbeing economy’ and develop inclusive and ‘person-centred’ public services. The Scottish Parliament’s Covid-19 Recovery Committee will focus on Covid Recovery in 2023, particularly the NHS Recovery Strategy and health inequalities.

Many local, regional and national governments have developed recovery plans that cut across a range of policy areas and seek to address other policy challenges, including tackling inequalities, health and wellbeing, and transition to Net Zero. This demonstrates the complexity and interdependencies inherent in Covid Recovery but also provides a useful framework for capturing long-term policy goals.

In Northern Ireland, the absence of an executive since the May 2022 elections has inhibited the development of strategic recovery responses, with political leadership coming from the Secretary of State for Northern Ireland and associated ministers in the Northern Ireland Office (NIO), while the Northern Ireland Civil Service (NICS) leadership is now tasked with management of public services. The cost-of-living and health crises are particularly acute in the absence of local political leadership, and no budget has been set for 2022/23 or 2023/24, with current budgets over-running by up to £1 billion. Ambitions to develop anti-poverty, childcare and infrastructure strategies under the New Decade – New Approach plan from January 2020 have not witnessed much progress. And the recent Winter outlook report by the Ulster University Economic Policy Centre predicts an economic contraction during 2023 followed by recovery into 2024. However, there is progress on local initiatives such as the ongoing roll-out of the Belfast Region City Deal and some recent allocation of money as part of the UK Levelling Up plan.

The impact of COVID and the public sector response to the same is a central driver of Welsh Government priorities, and scrutiny of the same. As at the UK level, there is a focus on health and care: addressing the backlog while managing unprecedented levels of demand; trying to support social care through a workforce crisis, while also pursuing a reform agenda; and greater recognition of mental health and health inequalities.

Outside of health and care, a focus on inequalities through the pandemic has shifted to a focus on cost of living. The same households who experienced the worst impacts of the pandemic are those who are now most vulnerable to cost pressures. In the absence of major tax and social security levers, the Welsh Government continues to focus on mitigating the impacts and reducing costs (e.g. roll out of free school meals for all, and an extension of childcare offer). Similarly, a priority around skills and lifelong learning that was emphasised through the Welsh Government’s response to the pandemic has been maintained but is increasingly being linked to ambitions around Net Zero.

Where has COVID left the UK’s Health?

While the mortality rate for COVID-19 in the UK has plummeted because of the worldwide vaccination programme and remains at a low level, the number of people with coronavirus in the UK currently continues to rise. A factor that contributes to extreme and ongoing pressures on health and social care. 

More than 1.4 million people in the UK, about one-in-45, were infected in the week ending 9 December, 2022.

In January 2023, COVID patients filled around 7% of occupied hospital beds in England, 11% in Northern Ireland and COVID-19-related illness represented around 11% of all hospitalisations in Wales.

There were also 460 deaths involving COVID-19 registered in England, Wales and Scotland in the week ending 30 December 2022 (4.3% of all deaths). Of these, 397 were registered in England, 32 in Wales and 21 in Northern Ireland

Outside of acute services, around 1.9 million people in the UK say they have symptoms of Long Covid, according to the latest ONS report. There is no test for Long Covid – now defined by the WHO as the continuation or development of new symptoms 3 months after the initial infection – and it has wide-ranging symptoms, of which fatigue continues to be the most common self-reported symptom followed by difficulty concentrating, shortness of breath and muscle ache. A study of Long Covid in Scotland found that nearly 1 in 2 people infected with COVID-19 reported feeling only partially recovered between six- and 18-months following infection. 

Since COVID-19 reached the UK in early 2020, more than 500 million tests have been reported, more than 9 in every 10 people aged 12 years and over have received at least two vaccinations, and more than 150,000 people have died. Vaccinations are estimated to have averted 19.8 million COVID-19 deaths worldwide in their first year.

Where has COVID left our Mental Health?

The pandemic triggered an increase in the incidences of mental health problems across the globe and exacerbated the unmet need for mental health services. In Northern Ireland, a dedicated Mental Health Champion has taken up office and engaging in a range of assessments and activities across public service and other organisations, and the Scottish Government is consulting on a new mental health and wellbeing strategy.

Research shows that social and economic inequity guaranteed pandemic-related stressors, such as severe illness, hospitalisation, death, economic strain, job loss, housing insecurity, hit people with minoritized racial/ethnic identities and sexual and gender identities harder than wealthy, white, cisgender and heterosexual people. These effects have been found in all four nations of the UK.

Poor mental health among young people (aged 16 and 17) has increased by more than a quarter since 2017, according to new research by UCL and the Sutton Trust, using the COVID Social Mobility & Opportunities (COSMO) study. The research highlights that 68% of those who had reported high psychological distress say they are now less motivated to study and learn because of the pandemic, compared to 37% who had not reported distress.

Recent work by IPPO suggests that scaling up mental health interventions would require consideration of the following options:

  • Increase access to services across time and place by digitising interventions and making them available online
  • Expand the workforce by task shifting or task sharing from specialists to non-specialists
  • Use technology and online provision to train non-specialists and speed up workforce availability
  • Enable self-referral and make mental health interventions more open access

In January 2023, IPPO commissioned a team from the Oxford COVID-19 Government Response Tracker, led by the Blavatnik School of Government at Oxford University, to investigate what kinds of non-clinical new or scaled-up policies have been initiated to respond to population-level mental health needs in school-aged youths because of the COVID-19 pandemic.

Where has COVID left our Education?

Many students missed a large amount of school time during the pandemic, even after schools had reopened nationally. And many young people feel they have fallen behind due to the pandemic, with 36% saying they have fallen behind their peers. School attendance has not yet returned to the pre-pandemic average (this includes staff absences as well as pupils).

Where has COVID left Employment Levels?

Demand for labour has recovered faster than labour supply since the pandemic and Britain’s labour market is suffering from severe staff shortages. Almost a third (32%) of businesses with 10 or more employees reported they were experiencing a shortage of workers, with the human health and social work activities industry (private sector businesses only) reporting the highest proportion of businesses affected, at 51%.

Where has COVID left Vulnerable Communities?

The COVID-19 pandemic has had a catastrophic impact on the 1.5 million people with learning disabilities in the UK. Not only were they more likely than the general population to contract COVID-19, and to experience poorer health outcomes and mortality but their services and support networks were greatly disrupted. For those who are immunocompromised, the risk of infection remains a constant threat. Vaccination is not suitable for those who are unable to raise a sufficient antibody response.

Where has COVID left our Transport?

A sustainable recovery from the pandemic involves in part confronting changed transportation patterns. While walking and cycling in London are now at levels higher than before Covid, tube use remains at 82% of pre-pandemic levels, as hybrid working arrangements see commuter travel in large cities often concentrated on Tuesdays, Wednesdays, and Thursdays. These altered patterns have a knock-on effect on the finances of transportation providers as revenue drops, in addition to posing further questions on longer-term questions of resources and service design. In short, how do you plan, design, and run a network which is likely to only be at full capacity three days a week?

Underlying the interconnectivity of current challenges, the need to reduce operating expenditure against the backdrop of both reduced revenue as well as increased costs related to, among other things, the war in Ukraine, takes place against the backdrop of the need to encourage modal shift as part of the pursuit of Net Zero goals.

In past due to the challenges arising from Covid, Scotrail was nationalised in April 2022.

Where has COVID left our Cities and Towns?

Urban planning and design in the aftermath of the pandemic face two separate but interconnected challenges: responding to the accelerated changes that the pandemic brought about, as well as responding to broader, more open questions as to the priorities and organisational principles of city life. 

Hybrid working models raise questions as to the viability of the traditional urban core, particularly as large businesses and institutions seek to downsize their real estate footprint. The increased availability of (former) office space co-exists with an acute affordable housing crisis in many large cities, suggesting that creative approaches are required to connect these two issues into potential solutions.

The viability of many businesses in the urban core built on a model of a 5-day a week commuter workforce is also threatened by these changing working and commuting patterns. One challenge for policymakers will be to ensure that independent businesses can continue to connect with consumers in these new realities, rather than custom simply moving to large corporations such as Amazon.

While debates over the Paris-inspired 15-minute city prove a welcome attempt to confront these issues, faster fixes for the urban spatial fabric are also required to allow cities to weather the current storm[GR1] . Nevertheless, the experience of the pandemic provided a re-invigoration of normative debates as to who the city should be for, as well as suggesting the limits of data-centric, top-down, master planning as a panacea for urban life.

In Scotland, there is ongoing planning to introduce more resilient, 20-minute neighbourhoods, an idea that is also being promoted in Wales by the Future Generations Commissioner. In addition, the Welsh Government has a remote working strategy that aims to reach a target of 30% for remote working and deliver tailored hubs for this model in communities, as well as an associated town centre regeneration programme.

Covid Recovery Policy Responses from around the World

Responses to the pandemic can be seen at all levels of government and encompass multiple policy areas, including employment, healthcare and Net Zero. Here are some global examples. 

Multilateral Responses

The EU’s Recovery & Resilience Facility, introduced in February 2021, provides financing to Member States (a mix of loans and grants totalling €723.8 billion) to support Covid Recovery from December 2026. Investments must address EU priorities and country-specific recommendations under the European Semester framework of economic and social policy coordination, with a particular focus on climate neutrality by 2050 and digital transition.

The City Climate Finance Gap Fund was introduced by the World Bank and the European Investment Bank to help cities in developing and emerging countries develop low-carbon plans in the context of pandemic recovery. By September 2022, the fund had supported 95 cities in 36 countries and identified a target of 40 further cities to be supported in 2023.

National Responses

Income support: New Zealand’s COVID-19 Leave Support Scheme is available to employers, including self-employed people, to help pay their employees who must self-isolate because of COVID-19 and can’t work at home during that period. It includes money for urgent costs or bills, as well as connecting affected individuals to help from a community organisation for practical support such as delivering food or medicine. Singapore introduced the COVID-19 Recovery Grant (CRG) in January 2021 to provide financial assistance to lower to middle-income employees and self-employed persons (SEPs) who experience involuntary job loss, no-pay leave (NPL) or significant income loss for at least three consecutive months. Macroeconomic uncertainties, such as recessionary fears in Europe and the United States, continue to weigh on the economy. Individuals impacted by job loss, NPL or income loss may face greater difficulties in coping financially. On this basis, the government decided to extend the CRG application period by another year, until 31 December 2023.  

Support for businesses: New Zealand’s Small Business Cash Flow Loan Scheme provides loans to small businesses, including sole traders and the self-employed, impacted by COVID-19 to support their cash flow needs. In the UK, the Recovery Loan Scheme (RLS) will run until the end of June 2024 to support small businesses looking to access finance as they recover and grow.

Health and social care: The Australian government has pledged record investments for a stronger health system over four years: $132 billion in 2022–23, increasing to $140 billion in 2025–26, with a total commitment of $537 billion over the next four years. The aim is to provide access to improved healthcare across regional and rural health settings, with improved health outcomes. This includes dedicated funding to continue protecting Australians against COVID-19, through improved telehealth services, supply and access to safe and effective vaccines, alongside treatments and support for health workforce in primary care, aged care and hospitals. Dedicated support for the aged care system includes funding to provide eligible aged care workers with bonus payments worth up to $800 and to extend the Aged Care Preparedness Measure assisting providers to manage COVID-19 if they experience an outbreak. Additional funding to support more aged care nurses to access infection prevention and control (IPC) leadership training, ensuring nurses are responsive to COVID-19 outbreaks in aged care facilities.

In December 2022, the UK launched its New Elective Recovery Taskforce to help unlock spare capacity in the independent sector to reduce the COVID-19 backlogs and waiting times.

Urban Responses

Repurposing public spaces: In Delhi, neighbourhood pop-up stores of big retail brands were introduced to make it easier for people to access them, whilst generating additional business income. In Ethiopia, temporary markets were introduced to address overcrowding. Melbourne is redesigning part of its Central Business District to provide more outdoor activities. Tirana in Albania developed urban regeneration projects to improve areas for residents, which also helped to support the construction sector.

Greening the city: Bogota and Medellin in Colombia have both introduced significant expansion of cycle lanes. Initially, as an emergency measure, it has now been made permanent and incorporated into further expansion plans. Freetown in Sierra Leone introduced a campaign to plant 1 million trees over 3 years from 2020, which also provided employment for citizens who were paid to plant the trees.

Housing: Washington DC has offered tax relief to turn offices into residential buildings. In Scotland, proposals are underway for a Housing Energy Retrofit programme, part of Glasgow City Region’s economic response to Covid Recovery.

Cross-cutting recovery plans: The London Recovery Programme (developed through the London Recovery Board and convening London’s anchor institutions) has identified 9 missions to support economic and social recovery. These are: green new deal, robust safety net, high streets for all, new deal for young people, good work, mental health and wellbeing, digital access for all, healthy food, healthy weight, building strong communities. Its ambition is to make London a ‘fairer, more equal, greener and resilient city’. Implementation has taken the form of dedicated action plans encompassing multiple targeted policy interventions.

For example, the Economic Recovery Implementation Plan identifies 5 priorities (jobs, business, thriving neighbourhoods, connected city, global London) with specific policy initiatives for each. These include support for creative industries (eg Creative Workforce Development Programme); skills and employment (eg London Careers Hubs, Good Work for All programmes), small business support, support for high streets (eg £4m High Streets for All challenge; High Streets Data Service), climate interventions (eg retrofit accelerator; local energy), and digital access for all.  Alongside this, there are a range of sub-London cross-cutting plans, such as the South London Partnership Economic Recovery Action Plan or the Central London Forward Recovery Plan.

Potential Topics for a COVID Recovery Rapid Evidence Reviews

IPPO is likely to commission a deeper dive evidence review on COVID Recovery.  We are seeking inputs on what topic would be most useful for policymakers. These are some of the options:

1) What interventions can address learning loss from school disruption?

Evidence from reviews on school-based education programmes (including summer school, tutoring programmes) to address disadvantaged students from school disruption suggests that there is limited evidence investigating the impact of school-based educational programmes to address learning loss from school disruption, including in the context of COVID-19. The evidence mostly comes from high-income economies. Further research could:
• Explore how to develop effective, accessible, inclusive provision for disadvantaged students that are appropriate to local settings.
• Gain understanding of key stakeholders’ perceptions and acceptability of school-based educational programmes such as views from parents, teachers, or learners. Although we identified qualitative research from mixed methods studies, there is a lack of rich data that could provide an in-depth understanding of the contexts, circumstances, or factors that can facilitate and improve programme implementation
• Explore the impact of community-based summer schools, summer reading interventions, online summer programmes, private tutoring, and online tutoring to address learning loss from school disruption and improve academic outcomes for marginalised students.
• Explore impact on the impact of school-based interventions science literacy and physical literacy (most of evidence is focusing on maths and reading skills)

2) What are the benefits and challenges to working patterns in different sectors?

The COVID-19 pandemic has disrupted and changed working patterns globally. Periods of national lockdowns have resulted in hybrid working becoming more acceptable and desirable, with a significant rise in the number of working days undertaken from home, and governments are looking to better understand how remote working may impact economic activity. Companies have also reconsidered flexible working as a way of engaging and retaining employees. Yet, concerns have been raised about flexible working not being accessible to all or available in all sectors, and the possible detrimental effects for some such as increased feelings of isolation or lack of opportunities to grow a network for the younger employees. The so-called “future of work”, widely discussed at the start of the COVID-19 pandemic, is now a reality. Evidence about emerging working patterns, as well as benefits and challenges of such patterns, need to be identified and synthesised to inform the industry and policymakers.

• How different industries have adapted to flexible/hybrid working.
• The impact of flexible/hybrid working on productivity, adaptability, and cost-effectiveness.
• Which sectors are benefiting from flexible working hours/hybrid working the most and how, and who is being left behind?
• The fiscal incentives for both companies and employees.
• The interactions between changing ways of working and impacts upon transport, the future of cities and housing
• The perceived advantages and disadvantages of flexible working for young employees/graduates.

3) What measures would best facilitate a ‘green and sustainable’ COVID Recovery that improves health, wellbeing and economic outcomes?

The post-covid recovery phase provides opportunities to review, reset and transform the UK’s socio-economic landscape. In Scotland, there is increasing emphasis on restoring nature and investing in natural capital, led by the Green Party, for example. This systematic review of reviews of interventions suggests that building new infrastructure such as cycling and working routes, outdoor gyms, parks and playgrounds to encourage physical activities can be effective at improving health and well-being (although, the impact of such interventions on disadvantaged groups remains unclear). Green innovation and recovery measures also have great potential to secure biodiversity, while enhancing the resilience of societies through economic growth. Possible areas to explore
· The role of green infrastructure/green innovation in employment, health and well-being, particularly to support inclusive transition for vulnerable populations
· Barriers and facilitators of accessing and using green spaces and green infrastructure
· Drivers or social determinants of green innovation adoption
· Community impact on engagement and activity levels

Potential Synergies with Other IPPO Themes

Many Covid recovery plans, at different levels of government across the UK, take a cross-cutting approach, and include actions to addressing inequalities and advance the transition to net zero. The pressures of the current cost of living crisis is exacerbating the impacts of Covid and hampering recovery efforts – making ‘levelling up’ a key issue for Covid recovery. This also highlights the importance of recognising intersections between current challenges and identified policy goals.

Net Zero

The unprecedented disruption caused by the pandemic provides an opportunity for proactive change to pursue Net Zero goals. This can take the form using the reflective opportunity that the crisis provided to encourage individual behaviour change, as well as embedding Net Zero components within economic recovery strategies, such as the Department of Business, Energy and Industrial Strategy’s ‘Build Back Greener’. Embedding some of the societal changes wrought by the pandemic – for example, greater walking and cycling, also provides an opportunity for “quick wins” in the pursuit of a carbon-neutral future. Also, in trying to address the ‘scarring’ of the pandemic, there is an opportunity to close the skills gap between different socio-economic groups by increasing access to Net Zero professional skills training, and ensuring post-16 education and training reflects the needs of Net Zero

Levelling Up/Cities

The pandemic exacerbated existing regional inequalities. However, the economic impact of the pandemic in the UK did not follow a traditional north/south divide pattern, and “levelling up” requires more long-term structural shifts than simply repairing the economic fall-out from Covid. Nevertheless, innovative approaches to recovery involving boosting productivity such as City innovation Districts provide a potential pathway in which the dual challenges of pandemic recovery and combatting regional inequality can jointly be met.


The pandemic highlighted and exacerbated violence against women and girls. A great deal was learned during this period about how to respond effectively to this issue, but carrying forward the learning to implementation of new policy and strategy is at different stages across the UK and in some areas requires further evidence synthesis.