Staffordshire as a place to live

The true impacts of the pandemic are continuing to unfold and may not be fully evidenced for some years, however national research suggests:

A worsening of existing social inequalities and increased negative health outcomes for disadvantaged groups, increased importance of local communities and voluntary organisations in providing assistance and support, pressure on revenue streams across the wider economy e.g. hospitality and leisure and increased unemployment rates and changed labour market demands.

COVID-19 impact on outcomes

Although Staffordshire’s response to the COVID-19 pandemic has been identified as best practice, mortality in Staffordshire is slightly higher than the national average. This is partially due to the older population in the country. As of 23 July 2021, there were a total of 2,723 deaths where COVID-19 had been recorded on the death certificate, 1,911 more deaths compared to the average for the previous five years. COVID-19 has also significantly impacted outcomes in Staffordshire regarding infant and parental health, educational attainment, excess weight, mental health and economy and employment. This section provides an overview of the national and Staffordshire-specific outcomes and trends.

An analysis of the impacts of COVID-19 has been undertaken regarding its: direct impact, indirect impact, outcomes and experiences below.

Direct impact of COVID-19

Cases and mortality in Staffordshire

• By 19 July 2021, nearly 73,800 people in Staffordshire had tested positive for COVID-19 and over 2,350 people had died.
• Deaths rates per 100,000 population in Staffordshire are higher, partially due to the older population in the county.
• Highest case rates were Tamworth and East Staffordshire, with East Staffordshire also experiencing the highest death rates.
• Severity of the disease varied by age - for Pillar 1 average age was 59 years 5 months and for Pillar 2, 38 years 1 month.

Understanding excess mortality

Excess deaths is a better measure of the pandemic’s overall impact on mortality. In Staffordshire there were over 1,900 more deaths than the previous five-year average – 73% of COVID-19 related deaths were in hospitals. Care homes have seen the biggest increase in deaths since the start of the outbreak (ONS, 2020).

Cases to 19 July 2021 / deaths from start of pandemic to 23 July 2021.

To 23 July:

• 2,356 deaths within 28-days of a diagnosis of Covid-19
• 2,723 deaths where Covid-19 had been recorded on the death certificate
• 1,911 more deaths compared to average for previous 5 years

Cases and mortality – at risk groups

• The pandemic has further highlighted pre-existing health inequalities and in some cases believed to have increased them, influencing exposure and vulnerability to COVID-19.
• Cases and mortality impact disproportionately on the elderly, partly because they are more rigorously tested – deaths in ages 80+ accounted for 62% of COVID-19 deaths. Also, high case rates are also among young adults.
• East Staffordshire has experienced both the highest case rates and mortality rates, even after accounting for differences in the age structure of its population.
• Case rates were seen to be much higher in Black, Asian and Other ethnic minority communities. This could result from factors associated with ethnicity such as occupation, population density, household composition and conditions. Also, pre-existing health conditions that increase the risk of severe infection are more common in BAME groups.
• Mortality rates among Black African males was 3.8x higher than those of a White background, and for Black African females 2.9x higher. (ONS, 2020)

Indirect impact of COVID-19

Healthcare system changes

Reductions in Acute Care

• COVID-19 has led to radical changes in the way people are using NHS and social care services. In Staffordshire, comparing Mar-Dec 2020 to the same period in 2019:
• 53,800 (39.4%) fewer elective (planned) inpatient admissions
• 23,900 (24.9%) fewer non-COVID emergency inpatient admissions
• Maternity admissions fell by 1450 (9.8%) over the same period
• Sharp reduction in hospital activity between March and April 2020.
• Emergency inpatient admissions and elective volumes have partially recovered but remain well below 2019 levels.
• Reductions more notable in Black and Asian communities and younger people (Economic and Social Research Council).

Impact on hospital waiting lists

• The reduction in acute hospital care has led to a substantial increase in waiting lists for routine hospital work.
• COVID-19 impacted on day-to-day management of hospital wards, leading to a fall in the number of available beds. Coupled with staffing issues related to COVID-19 this has led to a reduction in hospital capacity.

Changes in primary care

• Reduction in GP consultations leading to concerns about care of non-COVID patients, those with long-term health conditions and delayed diagnoses.
• GP consultations in Staffordshire during 2020 lower than England rate (using experimental data).
• For 2020 40.9% of GP consultations in Staffordshire took place remotely, compared to 9.6% in 2019. This was higher than seen nationally (36.0%).

Support for those most vulnerable

• 62,371 clinically extremely vulnerable (CEV) people were identified in Staffordshire and contacted with an offer of support.
• Support included emergency food parcels, help with essential domestic supplies and medication, and befriending.
• The Voluntary sector played a key role in providing support to those most vulnerable, with Staffordshire experiencing a rise in social action.
• 4,675 referrals for support were made by statutory public sector organisations to voluntary sector ‘anchor organisations’.

Experiences of COVID-19

Stakeholders experience

Key themes:

• Partnership working and relationships: Led to positive action and impact; faster hospital discharge, minimal bureaucracy and timely decision making.
• Impact on children: Missed development opportunities, education disruption, working with schools to remain open, supporting vulnerable children key.
• Impact of national systems and guidance: Disconnect between national strategy and local implementation, implications of rapid changing guidance.
• Community response and support: People assets, focus on personal impacts, particularly mental health effects in young people and communities.

Key risks:

• Inequality for some; long COVID; mental health risks for children and young people; care home instability.

Future innovations:

• Digital to help people connect; real time data surveillance; use and promotion of local assets; voluntary sector opportunities.

Impact on economy and employment

National

• Significant impact on the UK economy and employment, with young people most impacted. Those aged under 25 more than twice as likely to work in sectors forced to close. (The Health Foundation, 2021)
• Some industries have been severely affected, including transport, travel agencies and tour operators, accommodation and creative, arts and entertainment activities. (ONS, 2020)
• One third (32.66%) of UK adults say they are worrying about their finances, such as bill payments and debt. (ONS, 2020)

Staffordshire

• Despite COVID-19, unemployment rates are well below national and regional averages at 3.6%.
• Younger people likely to require ongoing support with their employment and financial situation, with support packages in place (Ignite, Kick-start).
• There has been job growth in some industries related to the COVID-19 pandemic such as in e-commerce, delivery and social media.
• Supporting businesses to adapt and transform will be key – especially given more residents are in lower paid, manual and routine jobs.

Impact on education

National

• Lost education time has widened the gap between disadvantaged pupils and their peers, particularly for children eligible for Free School Meals. (Rising Stars)
• Impact on KS4 remains unknown as national studies have focused on primary-aged pupils. (Coronavirus and higher education – ONS)
• Life satisfaction scores for students (5.8 out of 10) are statistically significantly lower than the adult population (7 out of 10) (ONS, 2021).

Staffordshire

• Lost education time likely to have detrimental effect on mental health of children and young people, as well as education attainment.
• The impact on KS4 is unknown, but with the lowest KS4 attainment (36.9) amongst peers, there is a risk of declining performance.
• The effects of wider inequalities and low levels of attainment will likely widen in key areas. (Cannock Chase, Newcastle, Tamworth). Already seen over 4,800 pupils becoming eligible for Free School Meals since the first COVID-19 lockdown.
• Growing number electively home educated - since September 2020 671 children have become EHE compared to 350 the year before (92% increase).

Impact on excess weight

National

• Carrying excess weight was a risk factor for dying from COVID-19 - 7.9% of patients critically ill with COVID-19 had a BMI of over 40. (BMJ, 2020).
• The way people exercise changed during COVID-19 - while an estimated 1.9 m people stopped using a gym regularly, numbers of people exercising at home increased significantly (Sport England, 2021).
• Many people found managing weight difficult due to access obtaining healthy food, increased snacking at home, comfort eating and less exercise. (Slimming World).

Staffordshire

• Potential to increase child excess weight levels – already is a key issue locally pre pandemic, with 1 in 3 children active for less than 30 minutes a day and inactivity potentially increased during remote schooling.
• Obesity related hospital admissions in Staffordshire on an upward trend, from 563 in 2013/14 to 2,886 per 100,000 in 2019/20.  More recent unpublished data shows that Staffordshire obesity related hospital admissions fell during 2020/21 due to COVID-19.

Impact on infant and parental health

National

• In-person visits from health visitors stalled during lockdown - only 1 in 10 parents with children under 2 years had in-person visit, compared to 1 in 4 before lockdown. (Parent-Infant Foundation).
• Having COVID-19 while pregnant was a significant risk factor (50%) for women having complications during the pregnancy, and infants were almost three times more at risk of severe medical complications. (Nuffield Dept of Women’s & Reproductive Health at the University of Oxford, 2021).

Staffordshire

• Significantly more mothers expected to have had virtual appointments with health visitors, meaning opportunities for support may have been missed.
• Local efforts ensured two thirds received in person antenatal contact with a Health Visitor at 28 weeks, and new birth visits also increased (83%, 2020/21).
• Potential widening of health outcomes for deprived mothers and infants. Pre-pandemic 50% of infant deaths came from the most deprived 28% of Staffordshire.

Impact on mental health

National

• Anxiety and depression rates often higher among young people, those with lower household income, those living with children and living in urban areas. (UCL COVID-19 Social Study).
• Around 1 in 5 (21%) adults experienced some form of depression in early 2021; more than double that before the pandemic at 10%. (ONS, 2021).
• Despite increasing rates of depression, diagnoses by GPs fell by almost a quarter, suggesting access to mental health care is in decline. (Health Foundation, May 2021).

Staffordshire

• Partnership focus on mental health in light of rising self-harm admissions, increases in mental health referrals among young people, as well as a rising trend in GP recorded depression.
• Local survey reported half of respondent’s mental health had been affected, which could result in pressures on voluntary and NHS services.
• Likely future increase in demand for support services, particularly among younger groups as a result of lost education time and reduced social contact.
• Potential social anxiety going back into public - 11% (279) of local survey respondents cited confidence and safety concerns when going out.