Understanding how COVID-19 impacted on people who use drugs

Authors

Dr Joanna Kesten, Research Fellow, Bristol Medical School, Bristol Population Health Science Institute, Health Protection Research Unit. 

Professor Catriona Matheson, Professor at the University of Stirling, and Chair of the Ministerial Drug Death Task Force for Scotland.

When the COVID-19 pandemic hit the UK in early 2020, there was concern about its impact on vulnerable groups in society. In this blog, Jo Kesten, Research Fellow at the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol and Catriona Matheson, Professor at the University of Stirling and Chair of the Ministerial Drug Death Task Force for Scotland, discuss the findings and wider policy implications of two independent research projects to investigate how people who inject drugs were affected. Both studies interviewed people who use drugs in the first national lockdown in 2020 to understand how the pandemic impacted on them. In Scotland, data from online forums, surveys and the police were also used to examine changes in the drugs market.

 Key points

  • Service innovation can happen quickly in a crisis
  • Digital inclusion is important if services are to continue with remote contact
  • Many people struggled with the loss of connection with others
  • There were fewer infections among interviewees than may have been predicted
  • Drug markets were more resilient than we had thought
  • More research needs to be carried out on changes to drug treatment medication policies as our studies recorded slightly different experiences

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Creative Industry Paradoxes: New business models and spaces of change

This blog was written by Malu Villela Garcia & Alice Willatt, researchers at the University of Bristol working on an IEI Bristol+Bath Creative R&D project.

The creative industries are not short of paradoxes. A culture of flexibility, self-management and creativity exists alongside precarious working conditions, excessive working hours, and a lack of inclusion and diversity. In the past months we’ve spoken with ten representatives from alternative organisations in the Bristol and Bath region to explore whether their business models are more effectively tackling the challenges faced by the industry. Here we discuss our main findings and propose some solutions.

‘Alternative’ business models

What do we mean by ‘alternative’ business models? These are businesses which put social and environmental goals alongside or before profit through democratic ownership and governance structures. They are referred to as ‘alternative’ because of how they seek to distinguish themselves from traditional shareholder-led, profit-driven, mainstream types of business. But the extent to which they manage to move away from this traditional model lies in a spectrum. Towards the more democratic and socially-oriented end, we see cooperative and employee-owned models, whereas towards the more commercial end we can find social enterprises and mission-led businesses (such as B Corps). Continue reading

Levelling-up: using the language of the government to maximise policy engagement opportunities

This blog was written by PolicyBristol’s Nathalie Goodsir and Simon Russell who both work for PolicyBristol. Nat is the PolicyBristol coordinator, and Simon is the Associate for Science and Engineering.

Though it began as yet another snappy campaign slogan, it is clear that ‘levelling-up’ remains a central theme of the current government’s policy agenda. In a speech in July, the Prime Minister once again reiterated his ‘mission’ to level-up the country. While the keynote address had promised to define and refine this somewhat amorphous vision, talk of ‘magic sauce’, ‘the ketchup of catch-up’ and ‘jam-spreading operations’ may not have provided the desired clarity. However, researchers and policy engagement experts can, and should, respond to the situation at hand – even a large-scale governmental vision still short on substance can present opportunities.

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The freedom to love: Mixed-immigration status couples and the immigration system

This blog post was written by Dr Candice Morgan-Glendinning, University of Exeter & Dr Melanie Griffiths, University of Birmingham. Their report from the Deportability and the Family project was launched in June 2021. You can download the project report, Policy Bristol policy briefings and other outputs from the webpage.

“If you are a British citizen then falling in love with someone who is not British isn’t allowed to happen basically.”

In the last decade, a series of changes to immigration policy have significantly affected the family lives of people living in and coming to the UK. These have restricted not only the private lives of immigrants but also thousands of British citizens, with implications for their wellbeing, prosperity and sense of national identity.

Shifting policy

A wide spectrum of changes to family migration rules were introduced in July 2012. This included dramatic increases to the minimum income required by Britons seeking to bring a foreign spouse to the UK, to a figure well above the minimum wage. There were also changes to the entry requirements for family members and lengthened probationary periods, as well as increased – but unevidenced – suspicion over so-called ‘sham marriages’.

As well as affecting the arrival and settlement of foreign family members, concurrent policy changes have curtailed the relationships of people already in the UK. In particular, Article 8 of the European Convention on Human Rights (the right to respect for one’s private and family life) became considered increasingly controversial and suspect. The response has been to make drastic changes to the interpretation of Article 8 and the threshold needing to be met by families, particularly in removal and deportation cases.

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The ‘New Plan for Immigration’: a further curtailment of rights

This blog post was written by Nadine Finch, Honorary Senior Policy Fellow in the School for Policy Studies at University of Bristol. 

Over the past three decades I have linked my practice as a human rights lawyer in the UK with research and policy development in the migration field and I will draw on this experience in my new role as an Honorary Senior Policy Fellow in the School for Policy Studies at Bristol. It will take the totality of this experience, and more, to address the formidable challenges posed by the immigration legislation recently proposed by the UK government. The New Plan for Immigration needs to be placed in the context of repeated attacks on ‘activist lawyers’ and plans to limit the discretion of judges in immigration and asylum appeals and to reduce their powers in judicial review.

It is not just international law norms that are not respected in the wake of Brexit. There is also a growing disregard for the parts of the UK’s unwritten constitution that assign the judiciary a role, as important as that of the executive and parliament, when it comes to domestic law. The enormity of the possible consequences for migrants and the professionals who support and assist them is still not fully comprehended by many in civil society. The gradual and disparate extension of the ‘Hostile Environment’ over the past three decades has been mitigated to some extent by local authorities and legal challenges and this has lulled many into a false sense of security that there are certain lines that will not be crossed. As have the continuing invitations to take part in consultations and working groups.

The UK has legislated to control immigration on numerous occasions since 1905, when the Aliens Act first gave responsibility for matters concerning immigration and nationality to the Home Secretary. The very fact that responsibility was allocated to this particular minister indicated a belief that it was imperative to ‘protect’ existing British residents from those seeking to enter from abroad. Since then, on many occasions, legislation has been introduced – and supported by the mainstream media – to protect the ‘majority’ from migrants who are perceived to be seeking employment and support, to which they are not entitled, and who are said to be responsible for a varying degree of criminality. In the populist climate following Brexit and the repudiation of the human rights norms underpinning much EU law, these claims can be more blatant and fact-free.

(Image: DDP on Unsplash)

The main targets for this legislation can be refugees and migrants fleeing from civil war and economic and social degradation, which is rooted in the history and economic policies of the very states in which they are compelled to seek protection. Attempts have previously been made to deter asylum seekers from accessing protection but the main principles underpinning the 1951 Refugee Convention have been honoured. The New Plan for Immigration is in many ways a radical departure.

The Immigration Rules relating to this New Plan do not provide a safe and legal route for an asylum seeker to enter the UK as a refugee. A person seeking international protection cannot seek sanctuary and assistance at a UK diplomatic post abroad. Instead, they can only apply for asylum once they have reached the UK’s home territory. Some individuals do manage to circumvent this restriction by initially entering as a student or a visitor. But this is only possible if they can meet a series of onerous financial and evidential conditions before leaving their own state. A person fleeing persecution is unlikely to have the economic resources, the freedom of movement or the time to do so. In addition, if they mention a fear of persecution in their application for a student or visitor visa it will be refused as they will not be able to show that they will return to their country of origin after their limited leave to enter and remain as a student or visitor. But if they do not mention it, this failure will damage the credibility of any subsequent refugee claim.

Therefore, asylum seekers have to employ whatever means are available to enter the UK, whether on flights and Eurostar trains or dinghies to the southern and eastern seaboards of England. In response, the Government has funded defensive walls and fences in northern France, posted immigration officers in airports in many states abroad and is now patrolling the Channel. An individual travelling alone is unlikely to be able to penetrate these defences: this is a major factor that has led to their need to employ smugglers to assist them to enter the UK. The emergence of these ‘criminal networks’ is better characterised as a response to the barriers faced by refugees than a reason for their arrival.

If adults do manage to enter, but illegally, and are deemed to have passed through or have a connection with a safe third country, any application for asylum is deemed inadmissible and they will face removal. If they cannot be removed, and even they are found to be entitled to international protection, they will only be given a lesser and temporary form of protection, will have no recourse to public funds unless they are destitute and their immediate family members will not be permitted to join them. This creation of a two-tier system for international protection does not meet the requirements of the Refugee Convention and has been severely criticised by UNHCR.

It is also planned to set the test for qualifying for international protection at a significantly higher level than that recommended by UNHCR in its Handbook. In a series of seminal cases the UK’s highest court has also recognised the severe challenges facing asylum seekers asked to provide evidence of detention, torture or ill-treatment, when their persecutor is a repressive regime, witnesses and family members may have been killed or imprisoned and they may have fled without any possessions, let alone documents, to prove their case. An individual’s ability to provide evidence will also be curtailed by the fact that on arrival they will be transferred to proposed reception centres or camps. This will limit their access to legal advice and representation as well as medical and other expert reports. It is also likely to increase any trauma previously experienced in their countries of origin and during their journeys and render them less capable of providing a cogent account of their persecution.

It is still not clear whether these centres and camps will accommodate any children accompanying adult asylum seekers, as was the case in the 1990s before it was accepted that the detention of children in such circumstances breached the UN Convention on the Rights of the Child. However, children wrongly assessed as being adults will be detained. It is also likely that proposed changes to the age assessment process will increase the risk of mistakes being made. In particular, the proposal to establish a National Age Assessment Board staffed by social workers, contracted to the Home Office, would remove the process from the direct oversight of local authorities who have the training and skills to maintain necessarily robust and regulated child protection processes.

The core elements of the New Plan were included in the Queen’s Speech on 11 May 2021 and it is expected that the proposed bill will have its Second Reading before the parliamentary summer recess. It is likely that much of the detail of the Plan will not be on the face of the Bill but that the Government will give itself wide regulatory powers. This will be addressed in a policy briefing that I am writing on the Plan and the Bill, which will be published by Policy Bristol in the autumn.

Nadine’s primary areas of research and policy development relate to children on the move in the UK and Europe. She is also an associate at Child Circle in Brussels. Between 1992 and 2000 she was a barrister at 1 Pump Court Chambers and then Doughty Street Chambers and from 2000 she was a barrister at Garden Court Chambers.

This blog was originally published by Migration Mobilities Bristol. You can find the original blog post here

 

How scientists and policymakers collaborate towards sustainable Bristol

This blog post was written by Dr Ola Michalec, a social scientist based at the University of Bristol, researching regulation in the domain of digital innovations for sustainable energy. Ola also serves as a member of the Bristol Advisory Committee for Climate Change and is a member of the Cabot Institute for the Environment.

In the world facing increasingly complex and interdisciplinary challenges, our job descriptions expand to account for new collaborations, duties, and types of knowledge to engage with. Civil servants are now expected to ground their policies in evidence, while scientists are required to translate their findings so that they’re useful to the citizens, industry practitioners or politicians.

Climate action is no different. It comes to life at the curious intersection of activism, political will, market incentives, democratic mandate and, of course, scientific knowledge. As a university researcher, I am on a mission to ensure academic knowledge serves Bristol’s transition to the sustainable city.

An effective collaboration across the worlds of science and policy requires some professional unlearning. Convoluted and jargon-filled academic writing style is not going to cut it if we’re serious about influencing ‘the real world’ (sorry). Similarly, our traditional output formats are simply too long to be accessible for policymakers. I also firmly believe that we ought to advance public debates, rather than solely our respective disciplinary conversations; for that matter we need to invite a broader set of discussants to the table.

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Modernising the Mental Health Act: Will more rights lead to less wrongs?

This blog post was written by Judy Laing, Professor of Mental Health Law, Rights and Policy, University of Bristol Law School. 

The government published a White Paper in January 2021 outlining proposals to reform the Mental Health Act in England and Wales.  The government has consulted on these proposals and the consultation period closed a few weeks ago on 21st April 2021. We now await further announcements on the government’s plans following this consultation process. I am currently engaged in a parliamentary academic fellowship, working with Lizzie Parkin (a University of Bristol alumna) in the House of Commons Library Social Policy section. The Library offers an impartial research and information service for MPs and their staff. Part of my role involves working on research briefings to inform Members of Parliament on business in the House of Commons. Mental health law reform will no doubt be debated in parliament in the coming months and I have developed a detailed research briefing on the proposals in the White Paper to assist parliamentarians with that process.

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Westminster, an inside account

Engaging with policymakers, especially those in Westminster, can take many forms. Dr. Maria Pregnolato shares her recent experience and identifies how to improve the interaction between research and policy.

The what and when:

In April 2021, I was part of a ‘Pairing Scheme’ organised by the Royal Society with the ambition to, ‘give policymakers and research scientists an opportunity to experience each other’s worlds’.

Scientists with at least two years postdoctoral or industry research experience across STEMM (Science, Technology, Engineering, Medicine and Maths) are eligible to apply (details here).

Typically, some 250 applications are shortlisted to 60 candidates from which 30 will be paired with Parliamentarians or Civil Servants. The selected researchers see first-hand how research findings can help inform policymaking, and how they can be involved.

Due to current circumstances, activity was online, beginning with a virtual ‘Week in Westminster’. This included a number of presentations, including ‘How Parliament Works’ given by the Parliamentary Office of Science and Technology, and ‘How Select Committees Work’ hosted by the (Commons) Science and Technology Committee.

We also got to quiz the Chair of the Science and Technology Committee, Greg Clark, MP and hear from keynote speakers like Prof. Paul Monks, the Chief Scientific Advisor to the Department of Business, Energy and Industrial Strategy (BEIS). Our roundtable discussions included an exploration of the role for research and innovation in ‘levelling up’ the UK and in a ‘politics live’ session we watched Prime Minister’s Questions.

What else?

I was paired with Chi Onwurah, MP. She studied electrical engineering and was Head of Telecoms Technology at Ofcom before entered in Parliament in 2010. Chi brings her prior learning and experience to bear in her role as Shadow Minister for Digital, Science and Technology. I had previously met Chi when I was selected to present my research at ‘STEM for Britain’ in 2016 when a PhD student at Newcastle University, since she was, and still is, the MP for Newcastle.

I particularly enjoyed the Q&A session with Amanda Solloway, MP, the Parliamentary Under Secretary of State (Minister for Science, Research and Innovation) at BEIS. She was very keen to stay in touch, to reach out as much to the research community(“please give us information”) and she spoke of a vision to give funding without complex process of grants, “which perhaps give no justice to good research not well-written”.

What did I learn?

  • Policymakers rely on experts and have scientists in the background to inform them.
  • When scientists inform, the responsibility is not on them: politicians make the decisions.
  • To have policy influence – communication is key: engage early and be persistent, and sharp, e.g., concise specific messages and tangible recommendations, three sentences max, and have examples that are easily understood.
  • MPs are more open and available than you might imagine.

What might improve the interaction between research and policy?

There are a few barriers between policy and research, notably:

  • The timeframe (years vs. days).
  • The language used.
  • Not enough opportunities like this scheme, and
  • No formal pathways of engagement.

Though if scientists and researchers embrace the opportunities that exist and seek to create other chances to make contact with policymakers, building networks, then relationships are established so that collaboration is easier – even at pace – so that research can inform both policy development and implementation.

Was it worthwhile?

Absolutely yes. I am grateful to Royal Society for this opportunity, and I very much recommend that anyone interested in impactful research considers an application or seeks to engage with policymakers in other ways.

To make science reproducible, focus on prevention not cure

This post was written by Marcus Munafò, University of Bristol, Malcolm Macleod, University of Edinburgh, they are on the steering group of the UK Reproducibility Network and Malcolm Skingle, director of academic liaison at GlaxoSmithKline. 

Improved upstream quality control can make research more effective, say Marcus Munafò and his colleagues.

Science relies on its ability to self-correct. But the speed and extent to which this happens is an empirical question. Can we do better?

The Covid pandemic has highlighted existing fault lines. We have seen the best of scientific research in the incredible speed at which vaccines have been developed and trialled. But we have also seen a deluge of Covid-related studies conducted in haste, often reflected in their less-than-ideal quality.

Peer review, the traditional way of assessing academic research, occurs only after work has been done. Can we identify indicators of research quality earlier on in the process when there is more opportunity to fix things? And if we did, could scientific knowledge be translated into societal benefit more rapidly and efficiently?

In many ways, the cultures and working practices of academia are still rooted in a 19th-century model of the independent scientist. Many research groups are effectively small, artisanal businesses using unique skills and processes.

This approach can yield exquisitely crafted output. But it also risks poor reproducibility and replicability—through, for instance, closed workflows, closed data and the use of proprietary file formats. Incentive structures based around assessing and rewarding individuals reinforce this, despite the welcome shift to team-based research activity, management, dissemination and evaluation.

Lessons from industry 

Research needs a more coherent approach to ensuring quality. One of us has previously argued that one way to achieve this would be to take the concept of quality control used in manufacturing and apply it to scientific research.

Pharmaceuticals are one R&D-intensive industry that has worked hard to improve quality control and ensure data integrity. Regulatory frameworks and quality-assurance processes are designed to make the results generated in the early stages of drug development more robust.

Indeed, some of the early concerns about the robustness of much academic research—described by some as the ‘reproducibility crisis’—emerged from pharmaceutical companies.

For regulated work, major pharmaceutical companies must be able to demonstrate the provenance of their data in fine detail. Standard operating procedures for routine work, and extended description of less common methods and experiments, makes comparisons between labs easier and improves traceability.

Data constitute the central element of robust research. The integrity of the systems through which data are collected, curated, analysed and presented is at the heart of research quality. National measurement institutes, including the UK’s National Physical Laboratory and National Institute for Biological Standards and Control have a role to play, sharing best practice and developing protocols that contribute to international standards.

How well these systems perform depends on many factors: training in data collection and management; transparency to allow scrutiny and error detection; documentation, so that work can be replicated; and standard operating procedures to ensure a consistent approach.

Red-tape review

Academic researchers are increasingly keen to learn from industry, and vice versa—to identify best practice and ways to implement higher standards of data integrity. University and industrial research are very different, but academia can learn lessons and adopt working practices that might serve to improve the quality of academic research in the biomedical and life sciences.

Learning from other sectors and organisations is a central theme of the UK Reproducibility Network. The network, established in 2019 as a peer-led consortium, aims to develop training and shape incentives through linked grassroots and institutional activity, and coordinated efforts across universities, funders, publishers and other organisations. This multilevel approach reduces the cost of development and increases interoperability, for example, as researchers move across groups and institutions.

Given the likely future pressures on the UK’s R&D budget, effective and efficient ways to bolster research quality will be essential to maximising the societal return on investment. Simply encouraging, or even mandating, new ways of working is not sufficient—many funders and journals have data-sharing policies, for example, but adherence is uneven and often unenforced.

A coordinated approach will require a clear model of research quality; buy-in from institutions, funders and journals; infrastructure; training; the right incentives; and ongoing evaluation. Coordinating all these elements will be challenging, but it is essential to improving research quality and efficiency. We need to take a whole-system approach.

This also applies to the independent review into research bureaucracy recently announced by the UK government, charged with identifying how to liberate researchers from admin. This is laudable—academia should certainly not be regulated in the same way as the pharmaceutical industry—but the review should recognise that an ounce of prevention can save a pound of cure.

Developing and deploying systems that improve research quality might increase efficiency and reduce research waste, as well as securing greater value for our national research effort.

This blog post was originally posted on Research Fortnight, you can read the original article here.

To address ethnic inequalities in COVID-19, we must acknowledge the multifaceted influence of racism

This blog post was written by Dr Saffron Karlsen, (Associate Professor in Sociology, University of Bristol). 

The evidence of ethnic inequalities in the number of COVID-related infections and deaths in the UK is compelling – yet discussions about how to address them remain somewhat simplistic. Dr Saffron Karlsen discusses five key issues that must be acknowledged if we are to establish a more complete picture of these inequalities and their drivers.

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