Understanding the financial impact of COVID-19 on the UK care home sector - implications for businesses and the workforce

Lead Research Organisation: University of Warwick
Department Name: Warwick Business School


This project addresses the impact of COVID-19's on the care home sector including the consequence for the workforce and users while assessing its financial viability, as well as requirements for recovery and resilience.
The UK depends on the financial sustainability of the mainly privately-owned care home sector, which cares for over 400,000 older people. Prior to the pandemic, the Competition and Markets Authority 2017 report highlighted the financial fragility of the sector. It is clear that COVID-19 has exacerbated financial pressures on care homes, potentially leading to highly disruptive closures.
Although there is a growing understanding of the additional costs to the care home sector attributable to COVID-19, there is a lack of knowledge about the implications for the financial sustainability of the sector as a whole, as well as for different types of organisation (e.g. large chains, charities, family-run care homes). Yet, it is essential for policy makers to comprehend these financial impacts if they are to design effective interventions to ensure the stability of care home provision, maintain safe standards of care and deliver good quality services. This new research will complement the analysis of care costs being undertaken by other relevant research conducted by the ESRC Sustainable Care programme.
According to the 2019 report produced by the Skills for Care charity, the 600,000-strong care home workforce is characterised by low pay, high staff turnover and vacancy rates, and reliance on migrant labour. Given the difficulties in recruiting and retaining care home workers prior to the pandemic, policy makers also need to understand and address the financial impact of COVID-19 on staff experiences and efforts to retain staff.


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Description Care homes provide an essential public service to hundreds of thousands of people and employ over 600,000 people across the UK. Their financial stability matters: poor financial health can put pressure on staff and managers, lead to deteriorating service quality, or cause home closures, which can lead to severe disruption for residents and staff and reduce the overall amount of care homes available to meet the population's growing need.

Therefore, the financial health of the UK's 8,700 care homes for older people - 80% of them provided by for-profit companies - is a significant matter of public interest. Although many residents in the UK's care homes are required to pay for their own care, public funding still makes up half of the sector's annual income, and so the functioning of the care home sector is highly dependent on financial support from the government, particularly during a public health emergency.

Ensuring the financial viability of the care home sector and the well-being of the care workforce must therefore be a key part of any pandemic response, particularly given the highly vulnerable nature of people living in care homes.

This report examines how the UK's care homes for people aged 65 and over have been affected by the economic shock caused by the COVID-19 pandemic. It reviews the extent and effectiveness of government support prior to, during, and after the peak of the pandemic, as well as the way care home companies responded to this challenge.

It also explores how staff experienced these financial impacts regarding their workload, their well-being, and the quality of care they could deliver during the pandemic's various phases.

In general, our research finds that even though there was strong evidence that the financial impact of a pandemic on the care home sector meant that it would prevent care home services from functioning effectively, there is no evidence that the government had any plans to address this challenge. For-profit and not-for-profit providers of care home services to people 65 and over (referred to as care home companies) did not know how much financial support they could expect or how it would be administered, and this added avoidable burdens of stress on care home operators and managers at a time of significant trauma.

Financial support provided by the government during the first year of the pandemic mitigated its worst effects on the financial viability of the care home sector. However, the decision by the government to end financial support for care home companies after the peak of the pandemic had passed likely contributed to the current financial and operational difficulties experienced by the care home sector, with wider consequences for older people and the healthcare system.
The financial viability of the care home sector was partly dependent on care workers working harder and longer. However, their remuneration for extra hours worked during the pandemic was at a regular rate, resulting in a loss of benefits for some and a resulting overall loss of income. Very little of the government's additional financial support for the care home sector was dedicated to supporting staff and improving their health and well-being, despite the immense pressure at work and in their personal lives. Therefore, it is unsurprising that the care home sector has struggled to recruit and retain staff since lockdown restrictions were removed and the broader economy re-opened.

Detailed findings

Our research found the following:

Finding 1) Although care homes were financially fragile before the pandemic and the likely impact of a pandemic on their financial viability was well known, the government failed to plan for the economic shock which hit the sector in March 2020.
• It was highly predictable that a pandemic affecting the older population would significantly impact the finances of the care home sector; revenue would decrease due to higher deaths and fewer people being admitted to care homes, while costs would increase due to the introduction of enhanced infection control measures, such as cleaning and the provision of PPE, and additional costs associated with covering for sick or absent staff.

• Based on the pre-pandemic financial situation of the UK care home industry, we estimate that a 5% increase in costs and a 5% decrease in revenue caused by a pandemic would mean that companies operating over 60% of all care home beds would be at risk of significant financial distress.

• Despite this, we can find no evidence that the government planned for this in their pandemic preparedness strategies. Due to poor data collection, the government had limited knowledge of the overall financial health of the care home sector for older people or how much public funding might be required to avoid significant financial difficulties.

• Government also lacked effective mechanisms to deliver funding, meaning that extra funding was slower to reach care homes, more burdensome to administer, and less precisely targeted than it should have been.

Government financial support for the care home sector came with more restrictions than for the NHS and other businesses.
• Despite providing a critical public service, care home companies had to comply with complex rules on state subsidies and other accounting restrictions to receive financial support, and some care homes had to employ staff to apply for it.

• A chief focus of the government's Infection Control Fund (ICF) was not to support the financial viability of the care home sector or to support care workers but to enable care home companies to comply with infection control regulations.

• In contrast, financial support for the NHS and other businesses was provided much more swiftly and often without conditions.

Finding 2) Government financial support worth over £2 billion meant that the sector avoided financial collapse during the peak of the pandemic

Because of government financial support, the overall income for most care homes in the first year of the pandemic remained broadly the same as in the previous year.

• In total the governments in England, Scotland, Northern Ireland, and Wales across the UK provided the care home sector with an estimated £2.1 billion in support during the first year of COVID, worth around £5,900 per bed. This support included financial support from local authorities and the devolved governments as well as the Infection Control Fund and the Coronavirus Job Retention Scheme ('furlough').

• Despite an estimated reduction in occupancy of around 8% during the first year, this additional income, along with some increase in fees from private payers, meant that in both the for-profit and the not-for-profit sectors overall revenues remained the same; for more than half of care home providers (60%) total revenues increased.

To ensure their viability, some care home providers reduced their operating costs, including staffing costs, although there were significant variations across the sector.

• At an aggregate level, total operating costs across the care home sector were reduced. About half of all companies in the for-profit sector reduced their total operating costs, compared to 40% in the not-for-profit sector.

• Because around 11% of the care home workforce is employed on zero-hours contracts, it was possible for some care homes to reduce staff numbers as bed occupancy declined over the course of the pandemic. This meant that for some care homes, spending on staffing fell.

• In the for-profit sector, aggregate expenditure on staffing as a percentage of total revenue fell from 65% to 62%, and the total number of staff employed fell too. 27% of providers accounted for this reduction in the proportion of income spent on staff.

• In the not-for-profit sector, staff expenditure as a percentage of revenue increased from 66% to 69%, with three-quarters of not-for-profit care home providers increasing spending on staff. 38% of not-for-profit care home providers saw a reduction in the proportion of income spent on staff.

Profitability for most care home providers improved marginally during the first year of the pandemic, although some companies increased dividend payments.

• The aggregate operating profit margin of the for-profit sector increased from 5% to 8% - a total increase of £215 million. Aggregate pre-tax profits increased by £117 million compared to the year before the pandemic.

• 64% of for-profit companies saw an increase in their total operating profits, and a similar percentage saw an increase in their operating profit margins.

• While there was an overall aggregate operating loss for the not-for-profit sector, this loss was reduced by £21 million, and 52% of not-for-profit companies saw an improvement in their total operating profits and operating margins compared to the previous year.

• The total amount of dividends paid out by for-profit care home companies increased during the first year of the pandemic. 122 (27%) of the 460 companies we analyzed paid out a total of £120m in dividends, an 11% increase compared to the year before the pandemic.

• The sector's overall financial risk profile improved over the course of the first year of the pandemic, with fewer companies at risk of financial collapse. At the same time, their liabilities as a proportion of their assets also fell.

Finding 3) In the later phase of the pandemic, a financial crisis hit the care home sector due to workforce shortages, inflation, continuing infection outbreaks, and the removal of government financial support.

• As of winter 2022, care homes were still affected by COVID, with outbreaks restricting new admissions. This has continued impacting occupancy rates, which remain below pre-pandemic levels even though the pandemic peak has passed.

• Care home companies faced unsustainable increases in insurance costs and, in particular, energy bills, with estimates in the autumn of 2022 that the average annual energy cost of a care home bed would rise from £660 to over £5,000.

Since the pandemic's peak, staff shortages have also driven up agency staff spending, jeopardizing nursing home provision and risking the quality and safety of care.

• One large care home provider reported that expenditure on agency staff increased from 6% of its wage bill in 2020 to nearly 23% in late 2021.

• As a result of nurse shortages and a nursing staff turnover rate of 38.2% (compared to 8.8% in the NHS), several senior home managers said they might cease to provide nursing care for older people, as it was unaffordable.

• Staff shortages have also begun to affect the safety and quality of some care homes. Around one in twenty care home providers formally flagged that they were at significant risk of being unable to meet their duty to provide safe care due to challenges to their agreed safe staffing ratios in the first five months of 2022.

• Despite these ongoing challenges, financial support from the government in England for the care home sector (including the provision of enhanced sick pay for care home staff) ended in March 2022. Enhanced sick pay for care home staff in Wales ended in August 2022 and was terminated in Scotland in October 2022.

Finding 4) Many staff reported personal financial problems during the first year of the pandemic.

• More than four in ten survey respondents reported financial problems related to working in care during this period in the context of low pay, restricted sick pay, and the broader impacts of the pandemic on households.

• The benefits system financially penalized some staff for covering absences to keep services running; where their pay increased as they took on extra hours it reduced their eligibility for benefits and resulted in a net loss of income that pushed them into greater hardship.

Finding 5) Staff pay was largely unchanged during the first year of the pandemic, except for a bonus for some and limited changes to sick pay, despite the extra funding for the sector and a significantly increased workload.

• The vast majority of the £2.1 billion of support for the care home sector provided by the governments across the UK during year one of the pandemic - including furlough support - went to ensuring the financial viability of care home businesses and preventing the spread of infection, rather than supporting care workers financially. Despite longstanding concerns over low pay and staff shortages, and the additional pressures of the pandemic, there was no general uplift in pay aside from the uprating of the minimum wage.

• Care homes could use some state funding to support workers by improving their terms and conditions. We heard examples of employers offering increased pay, internal bonus schemes, improved benefits, and broader changes such as more flexible working and expanded well-being support.

• Care homes received funds to cover enhanced sick pay for staff during the pandemic, which was important for many of them. However, in contrast with the sick pay rules for staff in the NHS, this funding only covered the period when staff were legally required to isolate under the COVID regulations and not the duration of any COVID-related illness, which could often last much longer. Even the more limited policy for this funding was not always adequately implemented, with widespread reports of staff receiving less than full pay being recorded in our research and in other surveys.

• Scotland, Wales, and Northern Ireland followed a slightly different approach to that of the government in England. In these countries, care workers were also provided with a direct bonus of £500 and pro rata for part-time staff.

• Some English local authorities offered additional funding to support employers in paying their employees a bonus. However, the administrative burden, complicated implementation, and varying policies made it difficult for care companies operating across different areas to treat all their staff consistently.

• However, although the impact varied between different staff groups and types of organizations, our survey showed that large majorities of all staff remained dissatisfied with their pay.

Finding 6) Workloads for care home staff increased - often to levels described as intolerable, with significant impacts on their health and well-being.

• Working hours increased for 82% of survey respondents, and 95% reported an increase in workload.

• For many these longer hours come on top of a typical 12-hour shift for care workers and on top of additional unpaid care for their families during the pandemic. This often affected respondents' work-life balance, health, and well-being.

• Care staff were already working at high intensity before COVID-19 in roles that, although often rewarding, were physically and emotionally demanding.

• Interviewees often said they had been struggling with their health and well-being and feeling burnt out due to increasing workloads and other stress factors during the pandemic.

Finding 7) The financial impacts on staff varied by ownership type and size.

• Compared to not-for-profit homes, staff in care homes owned by for-profit companies were more dissatisfied with their sick pay and reported higher work increases.

• Staff in not-for-profit care homes were also more satisfied with their manager's support than those in for-profit companies' care homes. This may have been due to differences in the financial resources available (e.g., charitable reserves), business models (e.g., paying dividends to investors vs. reinvesting surplus in the service), organizational values, and whether or not senior leaders had a background in front-line care work.

• Homes that were part of bigger chains fared worse in staff satisfaction with workloads, pay (including sick pay), ability to offer good care, and support from their managers and organizations.

Finding 8) Care staff raised concerns about the quality of care delivered during the pandemic.

• More surveyed staff were satisfied with their ability to offer good care (42%) than were dissatisfied (30%).

• However, half of the survey participants reported that their ability to meet residents' needs worsened during the pandemic. Many interviewees commented that they had less time to 'care' due to staff shortages and pandemic-related tasks.

Finding 9) Staff valued in-person support from colleagues, managers, and external professionals, but such support was not accessible to all.

• There were many examples of employers seeking to support and retain staff by offering hardship funds, extra leave, length of service awards, increased regular pay and overtime, and small tokens of recognition. Many also sought to help staff access well-being support and counseling.

• However, these measures were widely constrained by organizational capacity, including finances, and were not universal. Workplace support was often felt to be insufficient, especially for support staff and agency workers.

• Staff were more satisfied with colleagues' support than managers or their organization.

• Senior managers with experience in care, and a commitment to offering in-person support to staff and sharing risks, were viewed positively.

A report entitled: 'Bailed out and burned out? The financial impact of COVID-19 on UK care homes for older people and their workforce', will be launched on the project's website https://ficch.org.uk/ in April 2023.
This report is based on interviews, a survey of care workers, and an analysis of company accounts filed with Companies House before and during the first year of the pandemic. We examined all the publicly available financial data for care home companies, including all the publicly available financial data for accounts of 401,300 care home companies across the UK, providing 377,856 beds for people aged 65 and over. The data is drawn from accounts filed with Companies House by various organizations providing care on for-profit and not-for-profit bases, all described here as 'companies'.

The report also draws on a survey of 605 care home staff across the UK conducted between October 2021 and April 2022. Our survey sample was sufficient to produce statistically significant results. Still, given the diversity of the care workforce and care homes around the UK and the complexity of the issues at stake, our results should be treated only as indicative. In-depth qualitative data comes from interviews with 43 care home staff, including workers, managers, and senior managers, between December 2021 and April 2022.
Exploitation Route Based on these research findings, we make the following FIVE recommendations for policy makers and those working within the care home sector.

Recommendation 1) As part of its plans for future pandemics, the government should significantly improve its understanding of the financial situation of care home companies, model the potential impact of the virus on the financial viability of the care sector, and ensure that any extra funding is adequate, spent in line with public priorities, and easy to administer.

• To provide timely support and offer greater certainty to care homes in the event of an economic shock such as a pandemic, the government should set out plans on how extra funds will be delivered. Insights from people using care services, staff, and employers, should be used to inform these plans and should consider the following issues:

• The extent to which care home providers are expected to bear losses in the event of a pandemic or another economic shock and under what conditions they should receive public funding to maintain their financial viability.

• How financial risk should be shared - between fee-paying residents, care home companies, and the state - so that those paying privately are not required to bear unfair additional costs.

• The extent to which the state should pay for the additional insurance and indemnity costs imposed on care homes by a public health emergency, as happened in other areas of healthcare provision during the pandemic.

• As a condition of receiving financial support from the government, care home operators should provide full financial data on how their businesses operate, including how their income is allocated between staffing, facilities, rent, debt repayments, and profit, and the government should consider limiting financial support to those companies which are fully tax registered in the UK. This would ensure that any government funding goes to supporting frontline care workers and residents rather than other financial stakeholders and that taxpayers' support does not go to paying out dividends, bonuses, and other payments involving the extraction of value from the sector.

• Because many care home companies operate across the UK and across local authority boundaries, there should be a coordinated approach to managing the financial consequences of a pandemic between central and local government and between the Westminster government and the devolved nations.

• Emergency financial support, and public funding for care in general, should take account of evidence showing varying outcomes by ownership type and should seek to promote forms of provision that offer both good quality care and good quality jobs.

Recommendation 2) Government should learn from the experience of COVID-19 that the worst financial impacts of the pandemic on the care home sector occurred after the first year. Preparations for future pandemics affecting the care home sector should ensure that adequate planning and funding are in place for restoring services to their pre-pandemic level after the pandemic's peak has passed.

• Given that the worst financial aspects of the pandemic occurred after the first year of the pandemic, the wisdom of removing emergency financial support in 2022 remains to be seen. But there are clear indications that reduced occupancy rates due to COVID outbreaks, reduced profitability, and workforce shortages due to burn-out have meant that the care home sector has thus far been unable to provide the critical frontline service to care for older people or to provide optimal help to the broader healthcare system as it recovers from the peak of the pandemic.

• Emergency planners should learn from this experience and consider what additional funding and workforce support is needed to restore care home services to their full functionality and to support their financial viability.

Recommendation 3) In any future pandemic, the government should improve pay, sick pay, and benefit entitlements and provide support for unpaid caring responsibilities for care staff.

• During a pandemic, there is good reason for the state to contribute directly to hazard pay, enhanced overtime, and significant 'recognition payments' for care home staff where employers are financially unable to do so. Such measures reduce turnover and show societal recognition of the value of care home workers' risky and challenging tasks.

• To avoid the recruitment and retention difficulties currently facing the sector in the latter stages of the pandemic, everyone working in social care in the UK, including ancillary staff, should, as a minimum, be paid in line with the real Living Wage, as is now happening in Wales and Scotland. There is a strong case for pay and conditions to match those of staff in the NHS to avoid recruitment and retention difficulties in care homes.

• Sick pay entitlements for social care staff during a pandemic must provide adequate compensation for the loss of income due to becoming ill (including being affected by a post-viral syndrome such as long COVID) and not just for the period of self-isolation. There is a strong case for enhanced sick pay for care home staff, in general, to protect vulnerable residents from infection, support staff health, and make employment conditions more attractive. Because of the extraordinary nature of a pandemic, it is legitimate for these additional staff costs to be borne directly by the taxpayer.

• Given the likely need for staff to work extra hours during a pandemic, the benefits system should not financially penalize those care staff who are able and willing to do so. As a result, the government should ensure that the rules relating to in-work benefits (Universal Credit) do not disincentivize care staff from taking on extra hours and should consider whether these rules might be altered during a pandemic or otherwise to help address emergency staff shortages.

• With the pandemic triggering a need for additional unpaid care (for example, due to school and nursery closures), the government and providers must offer support such as access to key worker services and funds for extra-paid care. This is particularly important in social care, where the workforce is predominantly female.

Recommendation 4) The government should develop plans to tackle staff shortages, including emergency staffing.

• General improvements to the terms and conditions of work in care homes are needed to address longstanding staff shortages. Future pandemics will again put additional pressure on staffing, and the government should plan for this.

• The government should support the development of a standby emergency social care workforce with proper training, support, and equipment.

• Local authorities should work with care homes on plans to redeploy furloughed staff into care with proper training and support, safety measures, and full pay.

• Plans to address workforce shortages should not be left to individual care home providers, as appears to have happened over the past two years, - and should instead be coordinated at national and regional levels.

• Greater oversight and regulation of employment agencies is needed to ensure fair pricing and good practice.

• To ensure that any future planning for a pandemic fully takes into account the role of the care home sector in the emergency response, care home providers need to be much more integrated into the new NHS Integrated Care Systems in England and into local decision-making regarding emergency planning in other parts of the UK.

Recommendation 5 ) Government should support care home providers to enhance the overall well-being of care home staff both during and outside a pandemic.

Good working conditions underpin mental health and wellbeing, but targeted support is also needed to help care home staff deal with the experiences of the pandemic.

Governments should work with social care organizations to:

• Promote a better understanding of how care staff experience their working lives, through the regular collection of data such as, for example, via an annual national workforce survey like that conducted by the NHS.

• Ensure adequate personal, professional, and clinical support is accessible to social care staff, particularly during a pandemic. For example, social care staff should have access to the same mental health support available to NHS staff.

Employers should build on existing efforts to:

• Facilitate peer support among staff in different roles (including managers) by providing time and space for group reflection, action learning, and other activities within their home and promoting access to networks across different homes where appropriate.

• Identify and reflect staff preferences regarding the further support provided, such as one-to-one sessions, helplines, or digital resources, and ensure that staff can access them in a timely fashion.

• Monitor employee experiences of support from managers and other sources, with regular positive dialogue to help build a culture of appreciation and shared endeavour.
Sectors Communities and Social Services/Policy,Government, Democracy and Justice

Description Financial Impact of Covid on Care Homes- Implications for business and the workforce: Existing evidence and new research
Geographic Reach National 
Policy Influence Type Contribution to a national consultation/review
URL https://ficch.org.uk/resources/policy-briefs/
Description Programme Report Parliamentary Meeting
Geographic Reach National 
Policy Influence Type Contribution to a national consultation/review
Description Derya Ozdemir Kaya presented research findings at the PPE Webinar On 11th October 2022, organised by the independent think tank Public Policy Exchange (PPE). Tackling the Crisis in Care Homes: Rebuilding Social Care Capacity After the Pandemic, Meeting Funding and Staffing Shortfalls and Protecting the Most Vulnerable 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact On 11th October 2022, Dr. Ozdemir Kaya, Research Fellow on the project, spoke at a webinar organized by the independent think tank Public Policy Exchange (PPE) along with policymakers, sector representatives, and experts. Drawing on the project research, she presented the financial impacts of the pandemic on the care homes for older people and their staff and discussed long-standing and more recent challenges the sector faces.

Tackling the Crisis in Care Homes: Rebuilding Social Care Capacity After the Pandemic, Meeting Funding and Staffing Shortfalls and Protecting the Most Vulnerable

Date of Event: Tuesday, October 11th 2022

Time of Event: 9:30 AM - 1:00 PM

Place of Event: Webinar

Key Speakers

Neil Eastwood, Founder and CEO of Care Friends

Mike Padgham, Chair of the Independent Care Group

Dr. Kayonda Hubert Ngamaba & Dr. Cheyann Heap, Research Fellow & Research Associate at the University of York

Nadra Ahmed OBE, Executive Chairman of the National Care Association

Michael Voges, Chief Executive at ARCO (Associated Retirement Community Operators)

Dr. Derya Ozdemir Kaya, Lecturer in Work and Organisation, University of Sussex

Dame Caroline Dinenage MP, Chair for the All-Party Parliamentary Group on Carers


Discuss government spending strategies for adult social care and their adequacies for the challenges that face the sector over the next decade
Explore the impact of the Covid-19 pandemic on adult social care sector, and discuss what opportunities this may provide for reform
Assess how care providers can address spiralling costs in care homes equitably
Examine the roots of the staffing crisis in the adult social care sector and how to address it, including recruitment and retention strategies of care home staff
Learn how to improve collaboration between key stakeholders including local authorities and care home providers
Learn about the growing role of private equity and hedge funds in care homes, and how that has affected the level of care and what this means for the sector's future
Address the skills gap in the care home sector
Explore avenues for ensuring that the most vulnerable receive the social care they need
Assess means for coordinating quality care amongst the four nations
Analyse the impact of Brexit on recruitment and retention of adult social care workers
Consider how the use of technology can facilitate better services
Year(s) Of Engagement Activity 2022
URL https://publicpolicyexchange.co.uk/event.php?eventUID=MJ11-PPE
Description Researchers recently briefed parliamentarians on the emerging findings 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact The research team for the Financial Impact of Covid-19 on Care Homes presented the project to parliamentarians on 28 April. Members of the All Party Parliamentary Group on Adult Social Care heard about the research aims and methods from David Rowland, director of project partner Centre for Health and the Public Interest.

The National Care Forum, an organization of non-profit care home providers, organized the meeting. It allowed parliamentarians to discuss how emerging research findings - due to be launched later this year - could contribute to future policymaking.
Year(s) Of Engagement Activity 2022
Description Stakeholder Event 6 May 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact We have already conducted a Stakeholder Workshop with key stakeholders to discuss the first step in the financial analysis. This included stakeholder groups focused on the cost of care.

We have further plans for the engagement of policy makers and All Party Parliamentary Group in June and July and a stakeholder group 6 May.
Year(s) Of Engagement Activity 2021,2022