‘Recovery will need to be the creation of a future’

On 1 May 2020, we spoke with Dr Rowena Hill, then seconded full-time to the cross-governmental C19 National Foresight Group. We caught up with her again on 12 October. To complete the trilogy we heard from her in March.

What's the deal with the C19 Foresight Group now? 
The group has been decommissioned. We were full on for those ten months we were active and have produced 40 reports on our work and findings. Given the amount of foresight we have offered on the impacts and consequences of Covid-19, we can come to our end. We also had a number of people seconded full-time to that group who needed to return to their substantive roles, including myself. 

Our aims were to save lives, relieve suffering and support the communities across the UK through providing evidence-based foresight on the short-, medium- and longer-term impacts of the Covid-19 pandemic. We achieved this through supporting local strategic decision-makers. So yes, I am really happy with the extent to which we achieved our aims. 

Part of our effectiveness was Nottingham Trent University's expertise and leadership in analysing large amounts of established and emerging evidence and synthesising it into relevant, accessible, consistent outputs. The other part of our effectiveness was the insightful way our Chair (Shaun West) sought to disseminate our work through government and resilience structures as well as through other innovative methods.    

Has vaccine development made this stage of the pandemic less 'psychological', aside from addressing vaccine hesitancy?
The current vaccines, although clearly medically elegant and societally important, are not the whole answer. The expectation is that they will prevent the most extreme outcome – death – but only with the current mutations. And the evidence is still not solid on whether they prevent transmission. Whatever the UK strategy was – to reduce transmission, to protect our national health service, to limit deaths – then vaccines are just a step on the way to an answer. 

From what I have seen and learnt over the last year, unless we develop the vaccines to be agnostic of mutation/variants of C19, we cannot fully open up society. If we do without that agnostic vaccine, I do not see any other outcome than the next mutation needing as much proactive management as the other mutations have. This will be with us in some form for the next few years at least. 

So what will it take to get to a whole answer?
Behaviour change, updating our norms longer term, changing our expectations on what it means to maintain our health and safe health behaviours, updating our understanding of how engineering and systems can contribute, re-thinking societal priorities and acceptable ways of conducting civic life and contributions. The answer lies with acceptance of C19 needing to be managed in a much longer time frame, and what each and every one of us is willing to sacrifice and change in order to make that the most successful it can be… not in an equal way, but in an equitable way. Accepting that this will continue to be, at its core, a philosophical shift from a narrative of 'Covid-19 safety' to an expectation of 'Covid-19 mitigation'. The assumptions and expectations have to fundamentally shift to be able to meaningfully engage with that.

An uncertain future, then.
The future has felt uncertain for a while now. I'm not sure if we are getting more practised at living in uncertainty, or if our tolerance of uncertainty is depleting. However I feel we will continue to live in uncertainty for a longer period yet.

And it's worth remembering that what I've said is an insular position so far. It only considers the UK perspective. It does not contextualise the globe and other societies, their rights, responsibilities and response. This is not a geographically bounded issue… in years to come, we are only ever as 'safe' from Covid-19 as the most impoverished, unsupported community on the planet.

When we first spoke, you talked in terms of phases of response, adaptation, stabilisation and recovery… does it surprise you that we seem to still be managing all of those phases simultaneously? 
No it doesn't surprise me. We live in a big, connected world… as I said when we first talked a year ago, this is everywhere in the world, affecting everyone in some way. The impacts on individuals, families, communities and nations is significant and will continue to compound through time. They are also painful impacts, as well as some positive things. Some families are missing someone. Some families have shared experiences they would not have previously had. Some communities have seen significant cohesion, some have seen significant division. Some sectors of employment will never be the same again, some have been born from the needs of the pandemic. 

In that context, on a global level, we are all on a similar journey. Just because we have a vaccine programme, it doesn't mean all the other things don't exist, we still need to support each other through the job losses, through the bereavement, through the family strains, through the impacts on education and training of our young people. Nor does it mean Covid-19 is eradicated out of the UK. We continue to live in a world full of people trying to navigate as successfully as they can through the pandemic, just the same as us, we're just taking different paths through the same journey.

So in terms of the different phases I mentioned last year, we're still in 'response' and we may see further waves once winter approaches again. We also continue to need to adapt, by using longer-term collective efforts of moving in and out of a range of interventions to minimise the transmission of the virus. We see the impacts of economic insecurity today, but they will continue to impact for decades to come. In this way, stability isn't about recovery of the economy. I argued back then, and I continue to hold the position, that the economic structures and leadership at national and organisational levels will need continue to respond to the social and health needs (for example long-term policies of hybrid or home working patterns), but also to accept recovery to what we were is not possible. It's not about restoring what we had. Once that is accepted, we need to work through what significant changes we need to innovate in order to structure our economic policies going forward. 

Recovery following Covid-19 will need to be the creation of a future. We need to create new norms which accommodate adaptation and stabilisation phases. We need to do that for the next 2-5 years until we learn to successfully live alongside Covid-19 and manage it as best we can, so we will continue to be in all four stages simultaneously for the next few years. Then we can move with more certainty to the new future. 

That's a lot to take on, psychologically…
The psychological demands of all of this are not to be underestimated. One person living with uncertainty is painful enough. Not being able to plan against assumptions, not feeling in control of you're here and now or future, not feeling you have agency or sovereignty. That's quite a fundamental need. We talk a lot in interventions and emotional wellness of sitting with uncertainty, but we're asking people to engage with uncertainty as a necessity and try and live successfully with it. At national policy level all anyone wants is consistency – that allows people, organisations, communities, sectors to plan. This isn't 'over', and we can't say when it will be 'over'. 

We can say that there are stages that have been moved through (for example the initial stages of identifying and intelligence creation about the virus and the impacts), but that isn't what people want to hear. They want to know when they can have their friends over for dinner, or gather their family, or hold a celebration, or gain support face-to-face. They want to know that they can manage the uncertainty in their own lives within a perception of certainty in the world. But that simply isn't possible. So the psychological demands of being in, and managing, uncertainty, or wanting to return to a more normal way of life, is instead replaced with the messaging that we consistently need to readjust to living with the virus… to take this and use it to create a new future. 

Can you give me an example?
Because of the pandemic, the different domains of our lives have opened up and overlapped. We have been forced to be more integrated and holistic rather than context/domain defined. We've seen into our colleagues' homes, and our families may know more about our work through hearing snippets of meetings as they've passed the door to the bathroom or seeing notes which would ordinarily be on the office desk. They may have acted more frequently as a diffuser as the kitchen conversations with colleagues and commute decompression hasn't happened. And from the experience of home schooling, our relationship with the education of our children within communities may significantly change.

So to me, the true energy and blend across our work and home domains needs innovation and a different approach. How can we truly achieve a healthy work life balance, rather than treating everything as a relentless 'to do' list? This would also offer learning to sectors and roles which cannot work from home too. The psychological challenge to gather and focus enough energy, flexibility and agility to look at all the current and future adaptations we will need to make, and the creation and move to a new future, is also a great psychological challenge. Do we have enough left in the tank after everything we continue to go through to do it with kindness, equity… and to do it well?

Tuesday 23 March is a National Day of Reflection in the UK. I guess that's an important part of building this new future?
Absolutely. Memorialisation, including marking anniversaries and permanent memorials, is now considered by society as a quintessential human right of all people, a behavioural and emotional need/right allowing us to process our grief, mourn and to preserve memories of those that we have lost over many years to come. The National Foresight Group briefed on this.

- You can find our huge range of perspectives from the last year here, and the BPS resources and guidance here. Find resources on bereavement and grief here.