Coronavirus (COVID-19): supporting people at higher risk - qualitative research

Executive summary

Policy Background

The Scottish Government introduced a number of measures to protect people at most risk from Covid-19, including a £350 million package of support for communities affected by Covid-19 that was available to local authorities, third sector organisations and others. The Scottish Government also established the National Assistance Helpline on 14^th April to support those who are not shielding, but are nevertheless at higher risk. The National Helpline provides a central point for people across Scotland to call and access their local authority who will support them to receive the essential services they need.

The Scottish Government was keen to develop understanding (collectively with local government) of how the local response to the Coronavirus pandemic is supporting those at higher risk but not shielding, to inform consideration of future support options.

Research Aims and Methods

In order to provide in-depth evidence, in-house qualitative research was undertaken to explore who in the 'non-shielded at risk' group (NSAR) is contacting local authorities for Covid-related support (whether via the national helpline or local authority numbers), what support they are getting and how this is provided locally. The NSAR group is commonly referred to as 'at risk' and this is how this group will be denoted throughout this report.

To reflect the diversity in populations and geographies, 16 LAs were selected, including a mix of cities, areas with higher and lower population densities, and islands. Local authority officials who had detailed knowledge of helpline operation and/or Covid support were invited to participate. 16 interviews with a total of 27 officials were conducted between 21^st May and 18^th June 2020 by phone or videoconference, each lasting 45-60 minutes and following a semi-structured topic guide (see Annex A).

Findings –

Call Handling

These LA interviewees report a variety of ways that people can contact them to access essential services. Alongside their phone numbers many of the LAs offer an online referral form or email service, and in some areas walk-in centres are available.

The customer contact hubs used to deal with calls coming into local authorities were either established specifically to deal with Covid-related support queries or expanded from existing customer support teams. There are varied numbers of staff operating helplines both across and within LAs in response to demand. Most LAs now operate a Monday-Friday helpline service, with an out of hours voicemail system and emergency number. At peak demand, LAs were often operating 6 or 7 day services.

In some LAs, call handlers who handled advice and assistance calls before Covid were supplemented with redeployed staff from across the council. Others were drawn from specialist teams, such as social work staff. At times call handlers have to deal with sensitive and emotional calls. These interviews did not gather feedback on the extent to which call handlers are trained to cope with these kinds of issues.

LAs had a Covid support system in place before the National Assistance Line was developed, meaning this has provided an additional route to support. LAs reported concerns about resourcing going forward as Test and Protect picks up and redeployed staff may be needed to work on the recovery or return to their day jobs.

Data collection and management

The majority of LAs interviewed use a template developed by Scottish LAs for collecting data from Covid helpline callers^[1], though some have made tweaks to reflect local customer needs and priorities. Local authorities have worked to build in SG and COSLA requests for data where possible: updating call scripts and data management processes and systems. Some felt it was unnecessary to collect all of the data requested or that it was not appropriate to ask certain questions of people who may be anxious or at risk.

Many of the LAs discussed the software they have been using during the crisis to manage the data around the helpline. There were mixed views on the capability and usefulness of these systems. Most noted the importance of an effective data management system and, with the benefit of hindsight, many would have liked to get a good system in place more quickly.

Many of the LAs found the various data requests burdensome. Some referred to frequent changes – 'it was constantly changing at the beginning' – and pointed out that when changes are made they need time to update systems and processes. Some of the feedback suggested need for closer alignment of SG and COSLA data requests.

Callers

All of the LAs that participated in this research strongly believe that the helplines are there to support everyone who may be in need due to Covid, particularly those without a support network; they focus on need and not on specific categories (i.e. shielded, non-shielded) or on demographics.

LAs receive calls from people who are shielding looking for help in understanding and applying government advice to their specific circumstances. They also receive a lot of calls from people (particularly people aged 85+ and those with various medical conditions) who think they are or should be on the shielding list, looking for clarity or requesting support.

Although LAs receive calls from people in the original target group for the helpline, those who call extend well beyond this. Many were not known to the LAs before this crisis and are experiencing some challenges for the first time. LAs also noted that the helplines act as a route to support for those who have accessed local services regularly before. Some LAs reported that, whilst calls had initially come from mainly older people and people with long-term health conditions, the profile of callers had widened over time to include more families and other groups.

LAs reported only a small number of marginalised groups, such as homeless people, calling. Some say they have specialist teams who will contact those they know from these groups directly about their needs and the support available during the crisis.

Support Needs

LAs talked about the range of assistance and support that callers need; most report food and medicine being the main requests, followed by befriending and financial assistance. Many needs are interlinked: financial issues and inability to obtain food, for example. LAs provide help as required, wherever reasonable.

LAs tend to work with food partners from the third sector to provide food directly or support people in accessing food. If a need is very urgent, LAs may provide food themselves or go shopping for the caller and deliver it to them. LAs report regular requests for specific types of food (e.g. vegan, halal) or calls about the content of the SG-arranged shielding boxes or LA-arranged food support. Some LAs have a system of call backs to those receiving food boxes recurrently, to discuss ongoing needs and sometimes ask whether support is still needed.

Pharmacy delivery is also a frequent request, though there is some variation by LA. Some pharmacy deliveries – such as methadone – involve particular access procedures and have been delivered by emergency services.

LAs receive calls from people struggling with loss of income, looking for advice on employment, support with benefits and grants for businesses. LAs also receive calls from people unable to pay energy bills or requiring pre-payment meter top-up cards.

Participants report that isolated, distressed or anxious callers sometimes need a befriending service, but often they just need to talk to somebody. Some do not currently need any support, but are keen to know that should they need support in the future, it will be there.

LAs are supporting people with a wide range of other needs during the pandemic including: problem substance use; mental health or other health problems; delivery of baby and sanitary products; dog walking; delivery of replacement hearing aid batteries; fixing TVs and broadband; fixing front doors; toenail cutting; delivering samples to GPs; and transport to hospital appointments.

Participants also report that not all callers know what they need when they call and it might take a conversation to get to the wider picture of need, particularly for wellbeing or isolation issues. However, some callers do know what they want or need, and may also know what support is available through the council; these calls tend to be much shorter and more direct.

Delivery of Support

Response times are reportedly swift, usually the same day. LAs assess the level of urgency of any request in their triaging process. Some LAs keep very urgent work in-house; these are often requests for food (for access or financial reasons) and LAs have teams set up to deal with this.

The more remote and rural LAs tend to have more dispersed delivery mechanisms, making use of community hubs and third sector relationships. Cities and more densely populated authorities tend to have more centralised delivery processes to cope with larger volumes, though working closely with third sector and other partners.

LAs provide a range of support from their own specialist teams such as welfare, finance, mental and emotional wellbeing, social work and social care support. Callers are referred to these teams as required.

LAs report positive relationships with partners. The crisis has led many LAs to develop or enhance links with the third sector and they are more aware of what each other does, with increased mutual respect and a hope that these ways of working continue.

Overall reflections on support provided for people at higher risk

The LAs interviewed were confident that support is reaching the right people and has made an impact on alleviating distress, need, and worry. They recognise that they may not have reached everybody who is at risk, but say they have made extensive attempts to do so, both through promotion of support available and outreach.

There were many reflections on how fast and intense, but nevertheless successful, the response to the crisis had been. Work had necessarily been at pace and under pressure. There was pride in staff being able to adapt and change to the ongoing circumstances and be agile in responding to customer requests and handling new partnership working.

Many LAs wish they had had more time to plan at the beginning – to develop guidance and processes, establish data collection systems, clarify expectations with partners, and so on – whilst recognising it often was not possible due to the pace of change.

Some LAs say they have learned more about their local population and the challenges for many of them. This could help them to better understand need going forward.

LAs report having received positive feedback from partners and also from the public. Many described the response from the public as relieved and 'grateful'.

Most LAs we spoke to are concerned about sustainability going forward, both in terms of their own resources and the re-emergence of business as usual demands. They are concerned about their partners' ability to continue to deliver, particularly the third sector, and whether the model in place will be sustainable.

Some LAs are concerned about the development of a reliance on the support offered during the crisis and how they can move people away from this as support is wound down. This concern related to both the working population and older people.

Reflections on those Shielding

Whilst those shielding were not the focus of this research, a lot of LAs interviewed have one model for supporting everybody whether they are shielding or not, so points about shielding arose in all of the interviews. These have been fed back to SG colleagues responsible for shielding. The evaluation of the shielding programme is scheduled to be published in early 2021.

Reflections on working with SG and what could be improved

LAs recognise that, due to the emergency situation, everyone has been working at pace and learning as we go. One LA described it as 'quite a good response all round, everyone pulling together'. A number of LAs said that the things that could have gone better were at least partly a reflection of the pace of change.

There were, however, some points for the SG to consider for future working:

• More streamlined data requests and more notice about new requests.
• More advance communication on potential policy changes.
• Working with LAs more to test processes, policies, and procedures before they are put in place.
• Thought given to less digitally-focused solutions.
• Consideration given to ending the distinction between shielded and non-shielded.
• Some steer on how long support will be needed and the sustainability of the current model.

Conclusions

This research has provided in-depth evidence about the ways in which LAs operate their helplines and provide support to local people who are at risk in a time of great need.

The LAs we spoke to were proud of the efforts they had made to respond to the unprecedented crisis situation quickly. LAs worked at pace through an intensive initial period to set up systems and processes to support people in a variety of ways. Many staff were redeployed to new roles and ways of working, including many working from home. LAs feel that they reached most people in need, including many who experienced new vulnerabilities related to the pandemic.

LAs noted a significant increase in partnership working locally, with voluntary and community groups as well as local resilience partners. Many hoped that these new ways of working would continue and were considering how this could be achieved.

There are concerns about sustainability going forward, relating both to internal resources and capacity of partners. LAs made useful suggestions about how national and local government can work together going forward