‘It’s everyone, everywhere, everything… There’s nothing that’s untouched’

Tell me about joining the cross-governmental C19 National Foresight Group. How did that come about?

I haven't had time to ask anyone specifically, but I suspect it came about from the range of relevant work I had done previously. Including myself and a team of eight other psychologists and other academics at Nottingham Trent University we have been completing research and policy work around disaster and emergency management for a few years now. I also sit on a number of national groups and organisations relevant to the emergency services, as well as at regional level. I have also worked for a number of years connecting academic work with sectors, and sectors with academic work. So I think it was a combination of those factors.

I was approached directly and was initially asked if I could be seconded full-time from Nottingham Trent University. I'm the only full time seconded academic on the group. NTU have made a commitment of ongoing support until next summer, which I'm really proud to be able to say. 

Although C19 was initially a health emergency, it is a societal wide experience. It's everyone, everywhere, everything. There's nothing that's untouched. It's remarkable. In a very sad, collective way we're all in this together. The societal wide approach needs new ways of working and a longer-term look. So this cross government departmental group was established.

That's such a big commitment, for the government to be looking that far ahead in terms of your time. It suggests they are taking it seriously and know they're in it for the long haul.

Essentially, there are a few different time periods we are considering. One is up until, or if, we've developed a vaccine. We are going to have to live alongside the virus until a vaccine is developed. Until then, if the virus is anywhere in the world, it's our problem to manage. Looking forward after the initial physical distancing and lockdown stage we are beginning to see the language around 'restart', particularly around opening up NHS services which have had to be paused. But then we need to be looking further ahead to phases of recovery. We're hoping to see as many academic findings as possible contributing to evidencing the ways forward and framing those phases, sharing with us the academic research and foresight that studies are suggesting we need to be considering. 

Beyond the initial 'response' of trying to bring the R rate down, we might think in terms of 'adaptation' and 'stabilisation' phases within that umbrella term of recovery. Adaptation refers to social interventions that we need to apply; for example, physical distancing, school closures, shop closures. I use the word physical rather than social, for reasons that psychology has been very good at articulating. Then the stabilisation phase is a way to frame and think about our economic management of what we might have to do in the future… this pandemic has a long tail. Partnerships at local level are already thinking about the economic implications and what the nature of those impacts will be on their local economies, encouraging commerce, management of services to enable the economic stability of a region. 

We know that recovery isn't restoration; it isn't 'return back to where we were'. We can't do that financially or socially. Instead we need to consider what is that normality we can establish, even if it's not familiarity in the fullest sense. And then, eventually, it will become recovery once we've hopefully got the vaccine, and we no longer need to do those societal behavioural adaptations and economic stabilisation has been achieved. 

Presumably there's a recognition within government that those adaptations might be economic, social, structural, but the psychological is intimately tied with all those things. 

Yes. My role is to feed psychology and the range of relevant academic subjects, to the Foresight Group, to make the most sensible use of academia in the wider sense and enable it to be evidence and data based, to be useful to decision makers. We focus on the longer term, rather than the here and now interventions, the foresight. 

So how do you begin to get a handle on that?

Well, we've started to frame our thinking in a few different ways. There are the primary impacts of Covid-19 and these include impacts from the measures we've had to put in place. Then we know there are going to be secondary impacts, as a consequence of the primary impacts. So we're trying to work with academic outputs and keep our eyes on rapid and systematic literature reviews. We then feed that in responsibly to the Foresight Group to inform the potential longer-term social, economic and psycho-social impacts. 

For example, there are areas such as academic denial: that missed education, people who haven't been able to sit their exams, the possible effect of unconscious bias on student outcomes which academia is trying to understand in order to mitigate… how that plays out in the longer term for a whole cohort of students who have missed out on learning, achieving and celebrating. Then there are the impacts of physical distancing and isolation, something that psychology has been really active in feeding into: how we can cope with that, the longer term effects, the secondary impacts. And there are wellbeing issues: as a community how have we stayed connected even when we physically distance, what are the impacts of financial precarity as experienced as a greater collective within society, how can we understand the experiences of our communities and families who are caring and working differently, what are the impacts of collective adversity? 

What about beyond lockdown?

We are trying to gain a forward look to see what the challenges are within the changes we have made and continue to make. For example those who are bereaved, what are the impacts of not displaying grief through typical expressions of rituals, the probability of complex grief, and the experience of a higher level of death in the community, how can we help. When we're relaxing the measures, will we see a surge in seeking access to healthcare and wellbeing support? Will we see a surge in domestic violence reporting; there are suggestions at the moment from charities that rates are increasing, but that's not necessarily coming through in reporting figures, perhaps because people aren't in a position to access those reporting mechanisms and support. 

From an emergency services point of view, who are already stretched and fatigued, and living with the consequences of what we've been through, how will they manage those consequences as a collective group? 

So I think Foresight is about everybody needing to think about everybody's future. Health, education, transport, social care, all sorts of different government departments coming together and thinking through what communities and society are needing in the future in a joined up and considered way. Things were changing so quickly in those early stages. Everybody from Government departments to organisations across all sectors were trying to manage the emerging enormous task that was in front of them. The people who brought the Foresight Group together realised that they needed to get together a group who could have the headspace to take that longer view: not just what happens in the coming weeks, but months, years ahead.

When you talk about the evidence base on that, is there a danger that much of what we have isn't relevant to 'unprecedented times', and what is being set up now isn't ready or might not end up being the most rigorous because it's being done quickly. Are you finding gaps? 

At the start of April there was hardly anything… a lot of academics were taking the time to rewrite entire courses and put them online, so of course there was a delay. The structure we have at NTU to support this work spans across a range of academic subjects, and across those subject areas we saw professional bodies and think tanks start to brigade research topics to Covid-19. Things are starting to come through now which are Covid-19 focused.  

In my role, on behalf of the group, one of the big challenges is the consistency of findings. We just don't have that yet. I'm very careful in how I convey how confident I am about inferences and taking work between contexts or applications. We just don't have the numbers – but that's across the board. We don't have the numbers for the epidemiological modelling yet. We don't have the numbers for many different areas. It's a big challenge for scientists of all disciplines. We've got this mass of information, published material that's got integrity, but how much can we extrapolate sensitively and with enough confidence to make 'good enough' decisions? It's uncomfortable for us as academics and researchers, but that's the realm that governments across the world are working in – do we have reasonably enough confidence to make this decision, the best decision we can make at the time? When you lay the political contexts on top of that, it becomes even more complicated. 

Psychologists sometimes feel that they are lower down the scientific hierarchy at least in part due to the complex, messy nature of our subject matter. But if you're saying that actually applies across the board at the moment, you're not getting policymakers saying, 'Come on Dr Hill, we need confidence, we need black and white answers on this!'

I think we're quite comfortable as scientists understanding the weight of evidence around a phenomenon and then taking a position on it. My position and my interpretation might be different to yours. But as an embedded scientist in this group, I see the challenge has perhaps been an expectation that academics and scientists will agree. But we're not trained to get a consensus of opinion. We're trained to get a consensus of approach, and perhaps a consensus of findings. And that's really different. We're trained to critically evaluate, to explore and be curious, and just because you're then asked to be in that governmental environment, it doesn't mean you turn off all those skills nor should they lose their value.

Do you think that makes it hard for the government response to genuinely, honestly be 'led by the science'? Or is it still possible to be led by the science, when the science that's being presented to them is nuanced? 

I think so. Because the science is supposed to be leading, it's not supposed to be the decision making process, right? Otherwise, we'd be voting for scientists not politicians. Ultimately, the politicians are the decision makers and they need to take a view on that science.

Good point. A lot of your research in the past has focused on critical occupations and frontline staff. It sounds like the scope of the Foresight group is wider than that. But have you retained that particular interest in this situation?

Yes, alongside this I've been involved in a small team that have been developing resources. And I've been pointing people very loudly to the British Psychological Society sites: for those of us who were looking around to the different disciplines for evidence based resources and having a collection of voices, the BPS response really impressed me.

So yes, I work with people who lead those emergency services, but my focus on the consequences for the relatives of emergency responders also becomes increasingly relevant. The consideration of the families of emergency responders has come up frequently across my existing roles with national bodies. Mostly the concern is related to the risk of passing on the virus to their family. The reality of what our emergency services are doing… the NHS of course, but also the rest of our key workers, who aren't necessarily getting as much attention and support – is humbling. They really are seeing the true horror of this, the experience of more death and the impact it may have. The emergency responders, body handlers, faith leaders, those who work in social care, refuse workers, people who work in crematoriums who are working really hard at the moment. We know that many people are working in very adverse conditions, with shifts that have been rearranged or roles refocused. We know as psychologists, if you take somebody out of one role and put them in another, that might be a little bit fuzzy because it's an interim role, it's evolving, it's somebody else's area of business, that can become a stressor. Think of an NHS worker being deployed to another part of the NHS, or Fire Rescue Service taking on responsibilities of ambulance workers to get people to hospital. Then they're coming home and having to wash their uniforms in pillowcases and leave their shoes outside and be a daughter, dad, sister, grandad, friend, neighbour whilst trying not to pass on the experience of what they have been doing all day. It has involved whole lifestyle and work changes for them and their family, as well as it being an adverse situation in a more general, wider sense.  

How do you think you will adapt to the 'new normal'?

What an interesting question. I think of everybody else's foresight, but perhaps not mine. 

Part of it is around seeing how I can usefully develop this role: how I can continue to take academic conversations both into the national conversation and to support local strategic decision makers. I take that really seriously. And how can we, as an academic group, start talking to other disciplines more to start to build a more comprehensive, integrated foresight for those strategic leaders at national and local level to use? 

For me on a personal level, it's figuring out how can I see my parents again. They're about half an hour away, they're shielding and they will be for the foreseeable future. At the moment I deliver their shopping and give them a hug and a kiss through a double-glazed window. I miss being physically next to them, to be able to show my love and affection for them. I find that hard.

We got my mother-in-law a Portal, for video calls… just that small technological change has made a big difference. 

To what extent do you think the country, the world, is going to be fundamentally psychologically changed by all this? Might we look back on this as a time of huge personal loss, but also a blip where things did go back to something like before, but with more video meetings?

I think it's likely to be a big shift and C19 will continue to challenge us through the impact on the economy and budgets. I'm really pleased that as a world and as a nation we've decided, 'we're going to stop being as economically viable in order to save lives'. I love that we've done that, that we've placed humanity before money. But we have to live with the consequences of doing that. We won't be able to return to where we were, because we haven't got the economic position that we had. That drives things like spending on public sector services, how much multi-agency early intervention support we can put in place, things that are generally unnoticed when they are there, but missed when they go because they support our social fabric. 

And individual and community resilience can only go so far…

Yes. It's conservation of resource theory. It's emotional, social, spiritual and financial support. And when you draw from it, you need to replace it. And I'm not yet quite sure how we're going to fill it back up again and in what time frame.

I don't think anyone is under any illusions over how difficult it is going to be to figure out a 'new normal'. Psychology must surely play a major role in that… but I do still come across many psychologists who feel that our evidence-base is not 'crisis ready', that we must exercise caution in our attempts to embed psychology in policy and politics, even that we need to 'stay in lane'.  

I understand caution of confidence in findings, but this is a societal wide issue, it's a societal wide approach. We need to work with other disciplines who are just as cautious and some who are very confident to add value to that approach to move forward. My ambition is that we try to somehow, pretty damn quickly, figure out a way that's much more sophisticated than 'here's the Psychology aspect of this economic consequence'… we need to be working with other subjects and thinking past 'this is our answer, this is their answer'. With Covid-19 it's all so tied up together that those different lanes can't work… we all need to figure out how we pool together.  

- Watch Dr Rowena Hill as a discussant in our webinar, 'Towards the new normal, and beyond'

Editor's note: This interview was originally posted online on 2 June 2020.