PLAIN TEXT - Briefing 16: Rapid research COVID-19: Community responses to COVID-19: Connecting communities? How relationships have mattered in community responses to COVID-19

Local Trust commissioned in-depth research in communities across England into how they respond to COVID-19 and how they recover.

These are places where:

• residents have been supported over the long term to build civic capacity, and make decisions about resource allocation through the Big Local programme.
• residents have received other funding and support through the Creative Civic Change programme.
• areas categorised as ​‘left behind’ because communities have fewer places to meet, lack of digital and physical connectivity and there is a less active and engaged community.

The research, which includes extensive desk research and interviews across England, is undertaken by a coalition of organisations led by the Third Sector Research Centre. The findings will provide insight into the impact of unexpected demands or crisis on local communities, and the factors that shape their resilience, response and recovery.

This briefing is the 16th in a series seeking to understand how communities across England respond to COVID-19 and how they recover. Briefings were published throughout 2020 and will continue through 2021 and 2022 to share findings and learn from others exploring similar questions.

Authored by Angus McCabe (TSRC), Angela Ellis Paine (TSRC), Asif Afridi (brap), and Eleanor Langdale (Renaisi).

Published January 2022.

The COVID-19 pandemic has made all of us think about our relationships, whether at home, work, or in our community. While some people feel more connected, others have experienced extreme isolation. The importance of relationships has been highlighted in the ways communities have responded to the pandemic – indeed, we suggest ​‘relational working’ has been key. Approaches which rely on relationships to work, but also pay attention to the importance of relationships to the people that community groups engage with and support, can enhance both individual and community wellbeing. However, working in a relationship-centred way requires time, effort and emotional energy, which has placed immense pressure on some people. Relational approaches can also risk being exclusionary, through favouring those closest or most similar to you, exacerbating rather than easing existing divisions. The important learnings about relationships that have emerged from the pandemic will shape the way community groups approach their work in the future, including how to develop new ways of engaging groups that have previously been excluded from their work. 

• The pandemic has amplified the significance of all our relationships, whether we have experienced greater connection or increased isolation.
• Relationships have underpinned many of the responses to COVID- 19 at a community level: community groups have relied on relationships to be effective, while seeking to nurture new connections for the people they support.
• Relational working can enhance individual and community wellbeing. However, the time and effort it requires can also create pressure on people, and the approach can risk being exclusionary.
• Learning about relationships will shape the way community groups approach their work in the future, from recognising the importance of self-care when caring for others to developing new and diverse means of engaging previously excluded groups. 

In 2018, Julia Unwin argued: ​“Human relationships matter and they matter enormously in times of change and challenge” (Unwin, 2018, p. 8). It is hard to think of a time, in recent memory, of greater change and challenge. The pandemic has made us think more about, and amplified the significance of, all our relationships: family relationships, work relationships, community relationships. As Abrams et al (2021, p. 5) argue, the pandemic has “…profoundly impacted our social relations”. 

Many of us have had to stay closer to our immediate family members, while being physically distanced from friends and colleagues. We have often orientated ourselves more towards those who live closer to us. Long et al’s (2021) review of evidence found that relationships with neighbours were more likely than other types of relationships to be reported to show net gains in quality (Fancourt, 2020), and that this was often built through the spontaneous interactions that developed between community members as they came together to respond to the crisis, in turn increasing levels of ​‘community spirit’ (Cook et al, 2020). 

Changes in our social relationships, however, have been experienced differently. While some people feel more connected to other people within their local communities through the pandemic, others have experienced extreme isolation. Indeed, Lawrence (2021) talks about it being a pandemic of two halves: there has been both renewed connection and renewed loneliness. Carter and Clarke (2021) highlight how, despite lots of talk of communities coming together during the pandemic, statistical data from the UK Household Longitudinal Survey shows that perceptions of community cohesion fell during the pandemic, especially in deprived communities: ​“many communities moved further apart, with even fewer opportunities for common experiences and even less access to shared spaces” (p. 9). 

What is clear is that many of us have experienced some kind of a change in our relationships and re-evaluated the importance of relationships in various aspects of our lives. It is important to consider how this has played out in the ways in which communities have responded to the pandemic: how and why have relationships mattered, and changed, in and through community responses to COVID-19? Through exploring these questions, we can begin to identify important learning for the future. 

This research briefing draws on evidence gathered from 26 communities throughout the pandemic. This includes approximately 800 learning conversations and a series of online workshops with community activists, workers and policy makers. We consider first how relationships have mattered in community responses to COVID-19, before turning our attention to what has helped and hindered relationship building within communities during the pandemic. We then introduce the idea of ​‘relational working’ as a way in which we can understand the unique potential of communities to respond to needs within times of crisis, whilst also recognising the challenges that this brings. We finish by reflecting on the lessons learned by community activists about relational working through their experiences of responding to the pandemic. 

Relationships have underpinned many of the responses to COVID-19 at a community level. Within our research, this has been evident in two ways. Firstly, many community groups have relied on relationships to enable them to respond to the crisis and provide support to those who have needed it. This includes: 

• Relationships amongst individual local residents, who have come together – often informally, and on a hyper-local level – to provide support.
• Relationships between community groups and organisations who have needed to work together to ensure residents’ needs are met, whilst reducing the risk of duplication.
• Relationships between community groups, local authorities and others (such as NHS Trusts and, national voluntary organisations) who each have different roles and responsibilities when it comes to providing support – creating relationships of interdependency, which are not without challenge (see Rapid research COVID-19 briefings 9 and 10 (Macmillan, 2021 and Wilson et al, 2021a respectively)).

These relationships have mattered in many different ways. For example, the local knowledge which comes through the depth of such relationships, based more on information gathered during everyday interactions than through statistical data, has been integral not only to rapid responses to the pandemic but also in the ability to adapt rapidly to changing circumstances. 

Where these relationships did not already exist, community activists and workers have generally sought to build them. Overall, our research suggests that relationships within communities have strengthened over the pandemic, although this is far from universal, and is also not static or linear. Within some communities the opposite appears to be true. During the first lockdown in the spring of 2020, initial responses to COVID-19 were often organised on a street, or micro, level (see Rapid research COVID-19 briefings 2 and 3 (McCabe et al, 2020 and Macmillan, 2020 respectively)). This often relied on previous relationships, but – as one resident described – also involved ​“actively looking out for people I did not know … but knew they were on their own”.

In the majority of the 26 areas involved in the research, including ​‘left behind’ areas (‘left behind’ neighbourhoods are 225 wards across England that were identified through research conducted by Oxford Consultants for Social Inclusion (OCSI) for Local Trust in 2019 (OCSI, 2019)), these informal sets of relationships may have waxed and waned the longer the pandemic has lasted, but have often been sustained (see Rapid research COVID-19 briefing 14 (Ellis Paine et al, 2021b)), and sometimes translated into more formally organised community action. As one resident explained: ​“At the start of COVID you’d see people on the street and sort of nod. Gradually you would stop and that turned into conversations and that still happens – so that is a big change round here”. 

In many of the communities involved in the research it was recognised that relationships have often developed amongst individuals and groups which had previously been divided: 

“The pandemic has broken down historic barriers between people and to a certain degree between organisations in the community.” (Community worker) 

Secondly, community responses have also paid attention to the importance of social relationships to those they have supported and as such have worked in ways which seek to nurture people’s social relationships even while meeting more immediate needs. This has become particularly so over time. As Robinson (2021, p. 9) points out, and our research confirms: ​“A lot of community activity started out as tackling ​‘single issues’ (e.g., food poverty), and became more about relationships”. We frequently heard about how delivering food quickly became as much about the doorstep conversations as ​“just dropping it [food] on the doorstep and ringing the bell” (resident).

During the first lockdown, in the spring of 2020, community groups and other agencies were acutely aware of social isolation amongst older people and invested time, energy and resources to addressing this – through, for example, doorstep visits or developing telephone support and buddying schemes. As COVID-19 has evolved, however, there has been a growing awareness that isolation has not been confined to older people. Children, young people and families have also suffered and have been a growing priority in terms of mental health support for a number of community groups in this study. Even with the easing of restrictions over the summer of 2021, there were those residents and workers who noted that some people remained ​“reluctant to come out of their house … to mix with others … they have lost their mojo”. Responses have therefore been adjusted, for example through providing activity packs for children and young people, and the formation of support groups, to meet changing needs (see Rapid research COVID-19 briefing 15 (Wilson et al, 2021c)) in ways which recognise the importance of social relationships to health and wellbeing.

It is clear that, while community responses to COVID-19 have both relied on and sought to develop relationships, these are neither uniform within or between communities or over time. Relationships and relationship building seem to be ​‘easier’ in some communities, and amongst some groups and organisations, than in others. What then has helped, and hindered, relationship building within communities during the pandemic? Table 1 summarises some of the key, often inter-related factors that were identified through this research.

Table 1: Factors that have helped and hindered community relationship building.

Table shows a list of factors under headings ​‘Helped’ and ​‘Hindered’, as follows:

Helped:

• Recognition of common cause/​agenda.
• Strength of existing relationships.
• Trust.
• Availability of time and energy.
• Reasons and opportunities to come together.
• Spaces to come together.
• Continuity of key activists and workers.

Hindered:

• Lack of resource.
• Lack of trust.
• Rigid/​bureaucratic approaches.
• Pressure and stress.
• Duration of pandemic.
• Technological challenges.
• Historic competition and distrust between community groups.

Out of all the different factors that were identified as facilitating relationship building within communities, trust was highlighted as one of the most significant. Trust was important in building and maintaining working relationships, facilitating individuals and groups coming together to provide and coordinate support. It was also important to those who were being supported – accepting help relied on being able to trust neighbours, community groups and other organisations to provide support, often in terms of very basic needs such as food. As Abrams et al (2021, p. 9) remind us: ​“Trust is a vital component not just of social cohesion. Trust lies at the heart of a functioning democracy and so declining trust constitutes a significant challenge”. Where trust was lacking, this sometimes led to tensions, resentment and other barriers which hindered relationship building within communities, particularly between different groups and organisations, and in turn hindered responses to the pandemic: 

“Not much local partnership work to be honest. It was disappointing that the [community space] next door wouldn’t work with us, which was built for [the community]. It was badly managed and no one was ever there. So it didn’t work and then a charity took it on, but they know the roof was weak and didn’t do anything about it. We were hoping to sell our building and move over there. It’s a shame.” (Community worker).

Indeed, our findings suggest that where there has been a previous history of distrust between groups and agencies, responses have, in some instances, been more limited. Rather than co-operating and collaborating, groups have acted in isolation. There has been competition amongst community groups for resources and kudos within the community, which has exacerbated previous tensions and made it harder to sustain responses over time.

Overall, however, our research and other more quantitative studies (Abrams et al, 2020; 2021) – indicate that, whilst levels of trust between groups may fluctuate over time, during the pandemic higher levels of trust have been experienced at the hyper-local community level.

Whilst important, trust is not sufficient on its own. There have been other factors which have helped support relationship building. Access to resources has been crucial to enable the building of relationships for and through community responses to the pandemic. This applies not only to the availability of flexible funding, which could be used in responding to immediate community needs, but also to resources within communities: the skills and knowledge of local actors, the diversity of their existing networks and relationships, and the ability to directly link access to financial and human resources to local needs.

This access to resources also applies to spaces and places that bring people together within a community. As Long et al (2021, p. 3) argue: ​“A key ingredient for well-being is ​‘getting together’ in a physical sense. This is fundamental to a human need for intimate touch, physical comfort, reinforcing interactional norms and providing practical support. Emerging evidence suggests that online ways of relating cannot simply replace physical interactions.” They conclude by arguing for investment in green spaces, which encourage social interaction, and long-term community building.

In our research, we have seen that community hubs have been vital, at a very practical level, as spaces which have brought people together to provide and receive support (see Rapid research COVID-19 briefing 13 (Langdale et al, 2021)). As the pandemic has evolved, this has also applied to green and open spaces. Community events, when possible, often moved from physical buildings to parks and other open spaces in the community, creating opportunities to bring people together and nurture social relationships when gathering indoors was not possible. Indeed, community meetings were themselves increasingly recognised as opportunities to build relationships:

“In the past [our] network meetings were about sharing information but now they are about the relationships between people. The level of conversation is different – about the impact COVID is having on workers – there is a better sense of collegiality.” (Community worker).

Consistency within and stability of key actors involved in community responses has also been important: ​“What has worked well is the continuity in the workers who are local. They are there for the long term which is key” (resident). COVID-19, however, has disrupted or altered many job roles as staff, particularly in statutory agencies, have been moved from established roles into dealing with emergency responses to the pandemic, which made it harder to sustain relationships between groups, particularly when they have in the past been reliant on personal relationships between key individuals: 

“It’s hard to sustain relationships [with external agencies] when staff keep leaving or their roles keep changing because of COVID.” (Resident).

Technology has also been important for relationship building. On the one hand, when technology has worked well, and when people have had access to it, it has facilitated community relationships – enabling individuals and groups to come together, despite social distancing, in ways which only two years ago would have felt impossible. However, the move from face-to-face to online has been a challenge for some. This is not just that some activists have been reluctant to access Zoom and other forms of online communications – some have been unable to do so because of issues with local broadband speeds and the affordability of devices and data. Most people we have spoken to have described missing aspects of meeting in-person that help to sustain relationships, such as informal discussions and having fun in face-to-face conversations. Some said it was particularly difficult to resolve any tensions or disputes that arose within groups when limited to online meetings. 

It is clear that, in responding to COVID-19, communities have both been reliant upon and facilitated the development of social relationships, although this has not always been easy. This, we suggest, is clear evidence of relational working and, what is more, that relational working has been fundamental to the strength of community responses to COVID-19. This has been identified in other studies of community responses to COVID-19 earlier in the pandemic too (Cook et al, 2020). By relational working we mean working in ways which both rely on relationships and the development of those relationships to provide support/​welfare/​development, but which also pay attention to relationships and the importance of relationships to the people we engage with and support. Prior to the pandemic, greater attention was beginning to be paid to the importance of relational working within welfare provision, particularly associated with the work of Hillary Cottam and the growing currency of her concept of relational welfare. As Cottam explains: 

“… at the heart of these new approaches to health, work, to growing up and to ageing is a switch from a 20th century transactional approach – let me pass you the sticking plaster – to a 21st century approach that stands beside you and works with you to help you grow. Relational Welfare supports people to grow their own capabilities, the most important of which turns out to be the human bonds between us: our relationships.” (See: Hilary Cottam, n.d.).

Links can also be made to a growing emphasis on co-design, or co-production in the design and delivery of public services (Durose and Robinson, 2017). Relational approaches are held in contrast, and hoped to provide a counter-balance to, transactional approaches which tend to focus on specific tasks, treat everyone the same, and focus on performance measurement and management: ​“exchanges between static actors and systems with fixed properties” (Bartels and Turnbull, 2019, p. 1338). Instead, it is increasingly recognised that: ​“It’s relationships that matter, like having a chat over a brew” (Richardson et al, 2019, p. 171). Respondents within our research made their own direct comparisons between the ways in which they had responded to COVID-19 and what they see as other, more transactional, approaches: 

“[I’m] most proud of maintaining the support sessions, giving people who live alone the opportunity to meet safely and have a sense of normality. People say all their [other] conservations were transactional…” (Community worker).

Relational approaches can lead to positive outcomes. As Firman and Robinson (2020, p. 7) argue: 

“… everything works better when relationships are valued. Schools nurture happier, more successful students. GP practices achieve better, more cost-effective health outcomes. And businesses have more loyal customers and staff.” 

Our research confirms the positive outcomes associated with the relational working that underpinned community responses to COVID-19, and which go beyond the meeting of basic needs. It has been apparent, for example, that relational approaches have contributed in some areas to a breaking down of traditional identities, roles and relationships that have kept people apart: between donors and recipients, for example, and between workers and clients. We heard how role boundaries had shifted: clients could also be volunteers in the same community organisation; recipients of food could, with changing circumstances (for example, returning to work from furlough), become donors of goods and services. As one resident noted: ​“There are kids with nothing delivering (food) to people that won’t come out”. 

Perhaps more fundamentally, working in this way can enhance levels of wellbeing for individuals and communities. As Julia Unwin’s report on kindness in public services notes: “… kindness and everyday relationships can effect change and support the wellbeing of individuals and communities” (Evans, 2018, p. 2). Abrams et al (2021) found that volunteers have fared better during the pandemic than non-volunteers, perhaps in part due to the relationships which are inherent within the act of volunteering. It was widely recognised amongst those we spoke to in our research that working in ways which nurtured relationships, whilst also meeting basic needs during the pandemic, had helped to stave-off some of the worst effects of isolation and had helped to build wellbeing, in ways it was hoped would continue into the future: 

“They [residents] have done a lot of BBQs and things down there. All that started with COVID and they have made a lot of new friendships. That will continue, they will keep on doing things.” (Community worker).

Relational working is not, however, without its challenges. Just as this research has highlighted the positive outcomes associated with such approaches, it has also highlighted the risks. Firstly, it is clear that this is work: it requires a lot of time, effort and emotional energy: 

“We are here for people and it’s around that, that flexibility and working responsively that’s really important … you do open the doors. It’s taken a long time to get to the point where you get the hard-to-reach people walking through the door for a cup of coffee, you know, it’s […] not just something that has happened, it’s been a lot of work and relationship-building over the years.” (Community worker).

Boundaries can also become blurred in relational working, in terms of being able to separate out home and work/​community life, with it being hard to know when or how to stop and step back, but also how to manage risks, such as knowing when or when not to go into someone’s home, or when it was safe to physically bring people back together. As the pandemic has evolved, some community activists have become ​“tired, exhausted and worn out” (McCabe et al, 2021). This applies in particular to those areas where there was a heavy reliance on a relatively small number of individuals, or a heavy reliance on a single, again usually small, anchor organisation. For some people it has proved too much: the intensity of these relationship-based approaches to community action has been emotionally exhausting, to the point of having to withdraw, particularly when relationships have been tense. This reflects a wider increasing awareness of the risk of burn out and the toll that the emotional labour of activism can have (Anderson, 2017). 

A potential darker side of working largely, or purely, through relationships and pre-existing networks should also be acknowledged. Networks and relationships may be inclusive (Gilchrist, 2019) but they can also exclude. They may favour those with pre-existing access to resources, to the detriment of more vulnerable or marginalised groups (McCabe et al, 2013). They may further entrench rather than transform existing, unequal, power dynamics (see Rapid research COVID-19 briefings 11 and 12 (Ellis Paine et al, 2021a and Wilson et al, 2021b respectively)). In some of the communities involved in this research it has been apparent that a tendency to rely on existing patterns of relationships has meant that some people appear to have been favoured, whilst others have been marginalised from community responses. As one resident explained: 

“I think wider faith groups such as ours tend to just serve their own community and don’t necessarily branch out further. I mean they don’t necessarily work with other groups of the same faith. I think the pandemic has changed some but not all. If our community isn’t inclusive to itself, then how can they be inclusive with others?” (Resident).

In some cases, a tendency to rely on existing patterns of relationship has amplified rather than reduced existing divisions within communities. This, highlights the importance of reaching out beyond existing networks, and challenging the assumptions and biases which many of us hold about who is more or less deserving of our time and help (see Rapid research COVID-19 briefings 11 and 12 (Ellis Paine et al, 2021a and Wilson et al, 2021b respectively)). This becomes more important given that the pandemic has itself had a disproportionate effect on certain groups: loneliness, for example, has disproportionately affected young people, women, and Black, Asian and minority ethnic communities (Lawrence, 2021), suggesting extra efforts are required to ensure relational (or indeed any) approaches are inclusive. 

Finally, some community groups are questioning the ability, and indeed the appropriateness, of their efforts to meet the scale of the challenges that lie ahead for communities. The number of relationships that people can develop and sustain are arguably finite and relational working can be resource-intensive. This suggests that community-based relational approaches may need to sit alongside a range of other forms of investment, support and structural change. This could help to address what has been referred to as ​‘austerity localism’ (Jupp, 2021, p. 780) and the longstanding structural inequalities in fields like the labour market and access to healthcare, which have been shown in stark relief and further exacerbated through the pandemic. 

We asked community members to reflect on what they had learnt about relationships and relational working from the pandemic, which they would take forward with them into future community action. They highlighted three key lessons. 

Firstly, relationship building takes time and effort, and the outcomes may not be realised for several years. The time required is not only about identifying or creating connections but also building and then sustaining trust. As Abrams et al (2020) note, trust can easily be broken and perceptions of who can be trusted shift over time. Building trusting relationships, particularly between residents and organisations in marginalised communities, requires a consistent investment not only of financial resources but of time and emotional energy. For individual community activists/​workers, it has become clear that while looking after others they also need to look after themselves: ​“we need to think about our relationship with ourselves as well as others” (community worker). This applies to taking care of their own mental wellbeing, the ability to take time out to recover and acknowledging that ​“you can’t be 100% all of the time” (resident). 

Secondly, community activists told us they have learnt that it is critical to go beyond pre- existing relationships to effectively respond to community needs. This risks those relationships being effectively ​“networks of people like us” (resident), becoming exclusive and exclusionary. Community activists and groups in a number of research study areas had taken time to reflect on their relationships with the wider community, to consider who was ​‘in’ and who was ​‘out’, and why. The result was often a greater focus on active outreach work, which they will continue into the future. As one worker described: ​“We just take a chair, take a Thermos, and go and sit down by the duck pond on the green, just so we can see people face to face, really”. 

Thirdly, and relatedly, community groups said that there were lessons in how to ​‘flip’ the methods of relational working, from face-to-face to online via Zoom and other communications technologies. This applies at the informal neighbour-to-neighbour level with the expediential growth in the use of social media (Statista, 2021) to keep street and neighbourhood connections going (or, in some cases, to spread disinformation, Allington et al, 2021). For community groups and other agencies, the pandemic resulted in moving governance, management and often services online. Whilst this has been welcomed by some as presenting a more flexible way of working, others have struggled – either because of unfamiliarity with the technology, limited fast broadband access (particularly in rural case study areas) or finding the data unaffordable. This also reinforces the importance of being reflexive within community activism, asking, for example, who is digitally connected, who is excluded (Watts, 2020) and how do we reach those who are not online, both in terms of ongoing community engagement but also, crucially, access to basic services and benefits such as healthcare and welfare? 

Carter and Clarke (2021, p. 4) paint a pessimistic picture of communities, and society more widely, post-COVID-19: 

“Our research has consistently shown how, during economically tough periods, resentments and frustrations can brew, and people look for someone to blame. When people have little hope for their own chances in life, it is much harder for them to show openness and compassion for others. And it [is] easier for opportunists to exploit real fears with hatred. The post-pandemic landscape therefore poses enormous challenges for community resilience, and for hope.” 

What has emerged from our research is both more nuanced and more hopeful. We see narratives with two tales. On the one hand, there are those individuals and groups that have become more isolated as the pandemic has evolved. On the other hand, there is evidence of greater connection and collaboration – between neighbours, community organisations and external agencies. For some, information technology has been invaluable in staying connected. For others, those technologies have only highlighted digital divides and the exclusion of those without access either to the equipment or affordable data (see our second research report, ​‘Now they see us: Communities responding to COVID-19’ (McCabe et al, 2021). There may, in some sections of society, be a willingness to find blame in others for causing or spreading COVID-19 (Xun and Gilman, 2021), but in other instances the pandemic has promoted a greater understanding of the impact of poverty and exclusion on people’s everyday lives and a building of empathy. 

The ways in which communities have responded to COVID-19 have highlighted the importance of relationships and relational working, in terms of enabling individuals and groups to mobilise at speed. They have also shown that this way of working requires time and investment, in building the trust between individuals, groups and communities which facilitates collaboration and appropriate, tailored responses to needs at a time of crisis. 

Perhaps, as the pandemic continues and new variants of COVID-19 emerge, we are reaching a critical transition point. One future might be where we return to an ​‘old normal’, which reinforces pre-pandemic inequalities and more transactional modes of working. 

Another might be where what has been learned during the pandemic, about the importance of investing time and energy in relationships in the face of crises, offers a more equitable, humane, future (Parker, 2020). Such learning may offer a pedagogy of hope that counters the fears of Carter and Clarke. 

That is not, however, to deny that there remain questions over the potential of community action, and relational ways of working in general, to address the sheer scale of the pandemic, or other crises such as climate change. Is ​‘scaling up’, or even replicating, relational ways of working sufficient as a response to the national and global crisis of COVID-19? Do we need a mix of approaches and ways of working, if we are to address the entrenched inequalities which our communities face? National governments have struggled to address the immediate economic, social and health needs of their citizens over the past 18 months – never mind local authorities and community groups. This requires structural changes and different approaches to welfare provision that go beyond simply building ​‘better relationships’. 

Yet, transactional ways of operating have been shown to be insufficient too. What has been valued by communities during COVID-19 has been relationships. Through this research we have also heard about the significant time and investment required to work in relational ways at hyper-local levels during the pandemic and the effort required to sustain those relationships. What might the future hold in terms of balancing or reconciling large-scale, transactional working (for example, in the purchase of vaccines), necessary to respond ​‘at volume’, with the relationships that have underpinned what people have valued during the pandemic? 

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