COVID-19 and the Liverpool Health Commission

Project Manager Gerry Diver reports on the impact of COVID-19 on one of LJMU's flagship health and social care projects.

LJMU's Liverpool Health Commission led by Professor Valerie Fleming aims to improve health outcomes for children and mothers, focusing upon the 'first 1,000 days of life' (from conception to age two) and is arguably one of the most significant projects of its kind undertaken by the university.

These first 1,000 days are recognised as the key period in human development when the foundations for optimum health, growth and neurodevelopment are established. As poverty in the UK continues to climb - and with Liverpool itself being ranked as the fourth most deprived local authority in the UK - too many children are already disadvantaged by the close of those 1,000 days.

While the UK's provision of free antenatal care for pregnant women has seen some of the lowest mortality rates in the world, it still remains the case that one of the most significant barriers to accessing developmental opportunities (such as antenatal and postnatal care and advice) is poverty and its associated conditions. Now "routine" antenatal care has been suspended in many parts of the country and this may have a negative impact on some of the already most disadvantaged families. 

The project is also significant in terms of being the first investigation by the Liverpool Health Commission (LHC), an independent panel established by LJMU in May 2019, to investigate and analyse health care policy issues across the UK. The LHC aims to make practical and realistic recommendations to assist policymakers and help improve the lives of people across the Liverpool City Region and beyond.

Prior to the arrival of the Coronavirus, the commission had spent seven months gathering oral evidence from professionals working with mothers and infants and from mothers themselves. Looking at practices in England, Wales, Northern Ireland (with Scotland soon to follow), the investigations have focussed on accessing key support services and identifying the barriers—real, potential, chronic, or acute—to achieving good health and wellbeing. Some of the obstacles highlighted have included financial, social, and cultural matters, related to the realisation of the generic 'right' to health, against a backdrop of inherent vulnerabilities. 

Arguably, a number of the systemic rights failings uncovered in the pre-COVID-19 data might well be exacerbated, post-pandemic.  The continuing work of the commission seems set, therefore, to offer a useful time-capsule analysis of health inequities 'before and after' the pandemic, as its work moves into, perhaps beyond, 2020.

Some of the preliminary findings are not unexpected given ongoing austerity: the question of how best to allocate finite resources is a perennial issue, as the pandemic so clearly indicates. The levels of socio-cultural 'blockage' revealed have been both nuanced and telling, however, at times suggesting ingrained, systemic biases against some of the most vulnerable groups, not least in terms of their ability to access key services and social supports. For example, one young mother could not afford the bus to bring her child to a children's centre and free car parking was denied to some midwives providing essential postnatal visits. 

The psychological aspects of such exclusions are far-reaching and inter-generational in terms of harms and, potentially, human rights infringements. As one participant observed, promoting good health was only one aspect of her work, with several of the girls in her group having already faced the loss of one or more of their newborn babies either to coerced adoption or to the care system.

With more work ahead, further findings (not least from Scotland, the final report, albeit delayed) will be of interest to a wide range of stakeholders from health professionals, psychologists and social workers, to legislators and non-governmental organisations.

The commission is reviewing its timescales now but hopes to have a final report published by the end of 2020. We expect it to command widespread, national interest, especially from policy-makers across the four nations of the UK.

The commission is comprised of 12 highly experienced, authoritative commissioners who are recognised experts in their field.

Gerald Diver has written about the project in a blog for the BMJ.