Covid recovery: learning from person-centred approaches

2. What are the key features of the Person-centred approaches that were used in Scotland during the Covid-19 pandemic?

During the Covid-19 pandemic the delivery of public services was significantly disrupted due to social distancing, staff absences (due to illness, shielding and self-isolation) and the re-deployment of some front-line staff. At the same time many people experienced an increase in 'demand' for support due to a deterioration in physical and mental health, a reduction in income and the loss of informal support. ^[20]

Evaluations from interventions introduced during the pandemic are considered in this section. ^[21] These indicate that some public and third sector services adopted more person-centred approaches in order to:

• Address the multiple and complex needs experienced by individuals, families, and communities, and
• Identify new and creative approaches to meet the needs of people and overcome the constraints associated with delivering more traditional face to face services.

There is also evaluation evidence that some of the organisational barriers to delivering person-centred services relating to restrictive and narrow funding and detailed reporting requirements were relaxed, giving organisations greater autonomy and flexibility to respond. However, there were also many examples of paternalistic, inflexible, and non-person-centred approaches primarily introduced to reduce infection rates and protect the public from Covid-19.

The section below discusses some of the key features of person-centred approaches used in Scotland during the Covid-19 pandemic, these include:

A more holistic and relational approach to addressing needs

Evaluations of interventions introduced during the pandemic identify a number of ways services sought to understand the needs of people by looking at the overall package of support that was available to them. This involved seeing people in the context of their informal networks (e.g, family and friends) and the resources that were available to them within the household and community. A study examining service provision for migrant and minority ethnic populations in Scotland during the Covid-19 pandemic, for example, concluded that a holistic approach addressing needs broadly was far more effective than a remit-based approach focusing on single needs.^[22]

Some areas of service provision such as youth work were able to address the needs of young people and their families. A good example of this is the work done by Food Punks – a social enterprise focused on teaching young people how to cook fresh local food. During the pandemic they moved their model online on a Friday afternoon. Young people were sent weighed and bagged ingredients with a recipe and any equipment and kit that they needed before the online session. This initiative not only helped young people learn cooking skills, but created fun activities that connected them with other young people. The food parcels also helped to address food poverty in a dignified way by providing enough ingredients to feed the young person and their family.^[23]

Another example of holistic working relates to efforts to address homelessness in the early stages of the pandemic. The Scottish Government provided £1.5m to local authorities and third sector partners to acquire emergency accommodation, provide daily hot meals and emergency food, give enhanced independent living support to young women who are homeless and have experienced sexual assault, and support the basic needs of people with No Recourse to Public Funds.^[24] As a result of this co-ordinated response from local authorities and their third sector partners rough sleeping was almost eradicated as many 'entrenched' rough sleepers accepted the offer of temporary housing, showing what a more personalised approach with a clear message of care and dignity can achieve.

Building relationships and trust through improved communication

The review 'Addressing the needs of Scotland's migrant and minority ethnic populations under COVID-19', found that voluntary organisations showed great creativity in tailoring public health messaging - simplifying, translating, and sharing it in an accessible way. Many communicated using videos in native languages (often subtitled) and others used visual symbols to support communication. Charities broadened their outreach as much as possible contacting people by text, email, video or voice messaging and social media. Organisations were also mindful of the digitally excluded, sharing key information in written or visual form in public spaces such as community noticeboards and shop windows. ^[22]

In phase 1 of the Connecting Scotland programme ^[25], digital devices were issued to people shielding during the COVID-19 outbreak or who were otherwise vulnerable, to alleviate the effects of social isolation brought about, or exacerbated, by the national lockdown. End users receiving devices were also offered support from a 'digital champion'; a nominated person who provided digital skills support and help with using devices. The evaluation demonstrated the positive impact of increased access to digital services, including increasing digital skills and confidence and the support (around social connection and with mental health) it gave those shielding to cope with the severe social restrictions resulting from COVID-19. ^[26]

There is also some evidence that relationships between organisations were strengthened.^[23] This is apparent in the report on youthwork during the pandemic which highlights how during Covid-19, youth workers developed new and deepened existing partnerships. As one youth worker shared: "There has been a fundamental shift towards collaborative work across services due to the pandemic". Local authority and third sector youth workers worked closely with social work, education, and other agencies and this led to an increased understanding of the value of youth work.^[23]

A recognition of the importance of choice

Assessing and weighing up different risks was a key feature of Scotland's response to the pandemic. The Scottish Government developed the 'Covid-19 framework for decision making – assessing the four harms'. ^[27] This involved assessing and weighing up different health, economic and social risks when making policy decisions. This challenge of weighing up and assessing different risks was also apparent at an individual level in relation to a number of policies implemented during the pandemic.

The Shielding Programme is a good example of how public services evolved over time, to take a less paternalistic and more person-centred approach to risk. The evaluation of the Shielding Programme ^[28] found that 'the shielding programme placed a stronger emphasis over time on enabling people to make an informed choice to shield as much as was optimal for them. In contrast, early shielding materials advised people on the list to stringently follow the guidance' and this was found to be insufficiently person-centred and 'disempowering for some'. ²⁹

As noted in section 1 'choice' is often an attribute of person-centred approaches. This includes the person choosing their priorities, the level of service provision, and from whom support is received. A significant feature of choice is positive risk taking. Understanding a person's values and their hierarchy of priorities (for example, anxiety about the risk to their physical health from Covid-19 being in tension with their desire to see their families) is crucial to engaging meaningfully with this aspect of person-centred approaches.

Greater flexibility and responsiveness

Evaluation evidence highlights a number of examples where organisations were able to act with greater flexibility and responsiveness during the pandemic. On occasion this may have been facilitated by a 'light touch approach to funding' to ensure that funding reached those most in need communities quickly ^[29] (e.g. the Supporting Communities Fund). As a review on learnings from the pandemic for supporting migrant and minority ethnic communities found, 'The emergency funding worked well because of its flexibility, which allowed both charities and third sector organisations to go beyond the usual constraints of funding streams and take a more holistic approach'. ^[22]

There were also examples of greater risk taking and a loosening of accountability in the early phases of the pandemic where local authorities and community partnerships were given greater autonomy to take risks and do what they felt was best for individuals and communities. Some broader constraints were also loosened. For example, GDPR legislation was relaxed so that different organisations could share data between them more freely, allowing for more targeted and person-centred local interventions.

Partnership working and co-ordination at a local level

Interim findings from a study on Local Partnership Resilience in the Covid-19 Pandemic found that partnership working at the local level provides numerous examples of very fast and innovative adaptation to the challenges and demands of the Covid-19 pandemic. At the institutional level, 'silos' have been broken down and previously insurmountable hurdles have been overcome. ^[30] A review of innovation and creativity in the third sector also found thatsome pre Covid-19 cross-organisational barriers to service provision were overcome during this time. The study found that setting aside the usual procedural hurdles enabled service provision to be more adaptable, enabling aspects of person-centredness to emerge more clearly, effectively demonstrating how the concept of 'no wrong door' may work in practice. ^[31]

This study found that groups, described as 'hyper-local', were able to be responsive to needs within the community. During the pandemic, the crisis motivated members of the public to get involved; a sense of purpose and belonging helped to galvanise this response. Third sector mutual aid groups were set up very quickly, comprised of local volunteers. At this hyper-local level there was significant community solidarity, adaptive capacities, and cross sector collaboration which helped to facilitate a much stronger person-centred approach. ³² Voluntary organisations working with migrant and minority ethnic groups were also found to have adapted to meet the needs of their service users, working flexibly, setting up mutual collaborations, and changing or expanding their remit. ²²

The lasting legacy of Covid-19 in driving more Person-centred approaches

There is mixed evidence in relation to the extent to which the Covid-19 pandemic in Scotland actively supported a move towards more person-centred approaches.

There is some evidence that whilst the public and third sector experienced fewer procedural barriers to service provision during the pandemic, once restrictions were lifted these hurdles returned. ³¹ Some cultural barriers between statutory and third sector organisations resumed, with the third sector reporting a reluctance from the public sector to continue collaborative working. It could also be argued that the risk taking adopted during the pandemic to keep people safe has been replaced by a return to risk aversion and concern about lines of accountability and reporting that lie with service providers. Furthermore, there is some evidence that the urgency of reacting to the pandemic detracted from efforts to embed and promote preventive approaches. ³¹

There were, however, some examples of person-centred innovations which have continued beyond the pandemic. The Distress Brief Intervention, previously rolled out as a pilot, and positively evaluated^[32] was extended across Scotland, facilitated by the increased use of digital technology. Similarly, at HMYOI Polmont, the use of virtual visits and the introduction of in-cell phones brought in to mitigate the effect of a pause on in-person prison visits had the effect of facilitating increased contact with family and friends continued once restrictions were lifted. ^{[17] [18]}

Finally, the pandemic resulted in a much stronger recognition of the importance of person-centred approaches in supporting Scotland's recovery from Covid-19 as evidenced within the Covid Recovery Strategy^[8] and the emergence of new 'person-centred' policies that have been developed over the last 2 years.