By Samrina Bhatti, Manager, and Krissie Ferris, Research Analyst, Deloitte Centre for Health Solutions

The silent pandemic
Prior to the COVID-19 pandemic, loneliness was already recognised as a significant public health issue with government publishing the world’s first strategy to end loneliness, ‘A connected society: a strategy for tackling loneliness’ in October 2018.1 According to the Campaign to End Loneliness, there are nine million lonely people in the UK, four million of whom are older people.2 Throughout the pandemic, measures such as lockdowns, shielding, and limiting contact with others while essential to help stop the spread of the virus, have left millions more dealing with loneliness, social isolation and lengthy separations. This week’s blog therefore, explores how COVID-19 has influenced the scale and extent of loneliness and the actions needed to help improve future health outcomes and reduce demand on health and care services.

Loneliness and the COVID-19 pandemic

Loneliness, is a feeling of being either socially, emotionally, or existentially disconnected from others. Feeling lonely is also strongly associated with high anxiety and has been linked directly to poor physical and mental health.3 Loneliness is also a predictor of increased morbidity and mortality, with evidence of worse outcomes in cardiovascular disease, increased risk of Alzheimer’s disease, type 2 diabetes and poor mental health.4

People who are lonely, especially older people, tend to rely more on health and social care services, independent of illness. The April 2020, seventh annual survey report by Cogora, ‘Primary Concerns 2019, State of Primary Care’, found 94 per cent of GPs and 86 per cent of pharmacists who responded said they ‘sometimes’ or ‘regularly’ treated patients who had no medical conditions, but who visited them simply because they were lonely. Moreover, loneliness was seen as a much bigger problem compared with ten years ago.5

Research undertaken during the pandemic found that individuals who felt most lonely prior to the pandemic in the UK now have even higher levels of loneliness after the introduction of lockdown measures.6 More specifically:

  • Analysis by the Office of National Statistics conducted between 3 April and 3 May 2020, found five per cent of respondents felt lonely ‘often or always’, suggesting around 2.6 million people across Great Britain are chronically lonely. During the same period, 30.9 per cent said their well-being had been affected through feeling lonely in the past seven days, equivalent to around 7.4 million people across Great Britain (14.3 per cent) suffering from ‘lockdown loneliness’. Working-age adults living alone, and those in ‘bad or very bad’ health, in rented accommodation or who were single, divorced or separated were at greater risk of chronic and lockdown loneliness7
  • A COVID-19 Social Study by the What Works Centre for Wellbeing (WWCW), an independent collaborating centre that develops and shares evidence on wellbeing, working in partnership with UCLA, surveyed 70,000 people between March and July 2020. It found that adults most at risk of being lonely have one or more of the following characteristics: they are young, living alone, on low incomes, unemployed, and/or have a mental health condition. Prior to the pandemic, the WWCW found 8.5 per cent said they were often or always lonely, this increased to 18.5 per cent during lockdown, with the loneliest becoming lonelier.8

Current strategies and actions to address loneliness

The Governments January 2020 progress report on the Government’s Loneliness strategy identified that somewhere between 6 per cent and 18 per cent of the UK population often feel lonely and highlighted the importance of a whole society approach to tackling loneliness, working across government and in partnership with other sectors.9

The WWCW considers that well-tailored interventions that take into account things like access to technology, people’s interests and where they live, can help alleviate loneliness. However, it also highlighted the findings from the Covid Social Study that, between March and May 2020, ‘none of the protective social factors, such as having better social support, moderated the relationship between mental illness and loneliness as might have been expected, which may have been due to the difference in how people have experienced social support during lockdown, with more virtual and less physical interactions’.10

Actions adopted across primary care include social prescribing and referral schemes. Research by Nottingham Trent University found that social prescribing can improve the health related quality of life for people suffering with loneliness or social anxiety.11 As can referrals of lonely and vulnerable patients by GPs, practice nurses and community link workers to the NHS Volunteer Responders scheme - a partnership between NHS England and NHS Improvement and the Royal Voluntary Service. Volunteers offer patients daily telephone calls and general advice on keeping themselves well.12

Technology solutions have proliferated during the pandemic

During the pandemic, on-line services for shopping, banking social interaction have proliferated as have digital first services for accessing health and care advice and support. However, accessing digital services is dependent on the availability of, and an understanding and confidence in using digital technologies and having adequate Wi-Fi and broadband connectivity. So although digital technologies are keeping many of us connected, digital exclusion is a key driver of social isolation for many more. Indeed, the ‘digital divide’ tends to disadvantage the same groups of people who are most at risk of social and health inequalities (people from older age groups, low income, low education, low literacy, ethnic minority groups, and socially marginalised and underserved groups).13 Individuals with a lack of access to technology can find their loneliness exacerbated as they are unable to leverage the benefits of connecting to others virtually.

Technology solutions aimed at addressing loneliness, particular for older people, include:

  • NHSX distributed 11,000 iPads, to thousands of care homes across England since September 2020. The iPads enable care homes to connect residents with loved ones remotely, and access healthcare services including video consultations with medical professionals and reorder medications.14
  • In the US, virtual companionship service Papa connects older people with volunteers who can provide companionship and assistance with daily tasks.15
  • Assisted living provider Alcuris, is supporting vulnerable and older people through tele-care products.16
  • QuarantineChat provides a free service connecting isolated individuals through phone calls, aiming to accelerate human connections and reduce social isolation.17
  • Caremark Gloucester is trialling ‘Genie’, a voice-activated robot which offers connectivity and support to older people. The GenieConnect® service provides free video calling, welfare video monitoring with alerts, entertainment and access to online shopping and remote medical support.18

 Opportunities for the future

The COVID-19 pandemic has exacerbated the extent and impact of loneliness and exposed the need to address it more effectively. It has also accelerated the use of digital technologies, including apps and wearables, which in some cases has led to people feeling more empowered to improve their own health and wellbeing but for those who are digitally excluded, is likely to have exacerbated loneliness. Our research reports, Shaping the future of UK healthcare: Closing the digital gap, and Realising digital-first primary care, identified the need to improve digital inclusion which the above evidence on loneliness reinforces still further.

While actions by healthcare organisations and local health authorities working closely with partners, such as voluntary and community sector organisations have helped deliver some important improvements, there is a need for a stronger national public health system targeting high risk groups using population data and evidence based interventions to help alleviate loneliness and promote good health outcomes. This includes using behavioural science and digital technologies to tackle health inequalities. Clearly the Government’s Loneliness Strategy has an important strategic role to play, however, refreshing the commitments and prioritising future actions in the wake of the pandemic will be important, as will scaling the adoption of the actions and technology solutions highlighted above.

If you’re interested in exploring further how smart technology and cutting-edge digital platforms can help older people register for the next instalment in our Deloitte Health Tech Catalyst webinar series to answer the question - How can technology help us care for the elderly? Taking place on 28th January 2021.

Samrina Bhatti IMG

Samrina Bhatti, MRPharmS, PGDipGPP, Manager

Sam is a national award-winning pharmacist with local, national and international experience. Prior to joining the Centre, Sam was working alongside the Chief Pharmacist at Bart’s Health delivering trust-wide projects in service development and implementation. Prior to this Sam was the NHS England Chief Pharmaceutical Officers’ Clinical Fellow at Specialist Pharmacy Service, where she led various national projects on medicines use and digital healthcare. Sam is part of the global commonwealth health partnerships, an NHS England Clinical Entrepreneur, and a pre-doctoral fellow at Health Education England undertaking a PGCert in Healthcare Research Methods. Sam is also an associate of the Faculty of Clinical Informatics and Institute of Healthcare Management and has a Master of Pharmacy from King's College London and Diploma in General Pharmacy Practice.

Email | LinkedIn

Deloitte-uk-krissie-ferris

Krissie Ferris - Research Analyst, Centre for Health Solutions

Krissie is a Research Analyst at The Deloitte Centre for Health Solutions where she combines her diverse work background with her research skills to help find solutions for the challenges impacting the healthcare and life sciences sectors. Prior to Deloitte, Krissie worked initially in the NHS’s mental health sector before joining a health tech start-up. She has a MSc in Neuroscience from King's College London and a BSc in Psychology.

Email | LinkedIn

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1 A connected society: a strategy for tackling loneliness - GOV.UK (www.gov.uk)
2 campaigntoendloneliness.org/about-the-campaign/
3  https://whatworkswellbeing.org/wp-content/uploads/2020/08/COVID-LONELINESS-2020.pdf
4  National Academies of Sciences, Engineering, and Medicine. 2020. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, DC: The National Academies Press. https://doi.org/10.17226/25663.
5  The State of Primary Care Report - Cogora News
6  https://whatworkswellbeing.org/resources/loneliness-lockdown-and-covid/
7  Coronavirus and loneliness, Great Britain - Office for National Statistics (ons.gov.uk), See also: https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/bulletins/coronavirusandlonelines|
8  COVID-LONELINESS-2020.pdf (whatworkswellbeing.org)
9 Loneliness Annual Report: the first year - GOV.UK (www.gov.uk)
10  COVID-LONELINESS-2020.pdf (whatworkswellbeing.org)
11 Social prescribing can help patients manage loneliness and anxiety post-Covid -Management In Practice
12 Patients: Supporting the lonely, isolated and vulnerable - May - Pulse Today
13 https://ec.europa.eu/health/sites/health/files/expert_panel/docs/022_digitaltransformation_en.pdf
14 https://www.nhsx.nhs.uk/news/care-homes-benefit-tech-help-residents-keep-touch-loved-ones/
15 https://www.joinpapa.com/
16 https://www.alcuris.co.uk/#focus
17 https://quarantinechat.com/
18 https://www.inyourarea.co.uk/news/gloucestershire-home-care-provider-trials-robots-to-combat-loneliness-and-isolation-among-customers/

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