Coronavirus (COVID-19): supporting people at higher risk - survey of third sector organisations

12. Greatest need

The greatest number of comments focused on practical needs: food, medicines, financial concerns and fuel poverty.  A selection of these comments reflect difficulties with payment methods in the early stages of the crisis:

‘Practical support e.g. medicine delivery and food.’

‘Making sure that people have access to shopping and food.  At first the local [supermarket] only offered payment on delivery so this was a major problem for some, we had to make sure drivers were happy to take cash to these people and received either a cheque or money will be paid back when the clients are able to attend the bank themselves.  Many clients do not use contactless or even cards so this was a big problem.’

‘Financial support to access food, utilities, internet, etc.’

Food support was of particular concern in rural areas where people living in more isolated areas, and shielding or isolating, could not access online shopping initially and where supply chains could be more fragile.  One response noted that often a single supermarket supplies a reasonably large area and this creates a lot of pressure:

‘In a rural area, access to food and medicines - but especially food. Before the supermarkets sorted out their online shops for high-risk and shielding people, for those unable to get out this was extremely worrying. Luckily there are good local village shops who have gone out their way to help the community, but not being able to be sure that you will get enough food for the week was a big stress.’

‘Food supplies have been the greatest need initially. The reliance on a single small supermarket – [supermarket] – made things very difficult at first for the island and [supermarket] was less than helpful nationally in sorting out the supply change.’

It was suggested that prescription delivery needs a long-term solution and that, given the various schemes already in existence to deliver medicines, there may be scope for better advertising and expansion of existing services.  

Such practical concerns link with other areas of need such as ongoing poverty and isolation, but also struggling with new restrictions, furlough, and loss of normal routines:

‘Financial. Many of our parents earned the minimum wage and when furloughed the drop of 20% caused many financial worries. Several also lost jobs and are worried about how they will gain employment soon. Some parents had to sign off work due to caring responsibilities and struggled to pay bills.’

‘Food poverty has been very clearly a result of low income[,] loss of income and rural locations not being able to access transport etc.’

‘Food support to those on low income, furlough, unemployed or waiting for Universal credit.’

Other responses mentioned the concern that these needs may only increase as the pandemic continues and/or the effects of it are felt with increased unemployment and income loss: ‘The need for food is likely to continue as more people become unemployed and the cost of living increases.’

A very small minority of responses were concerned about the potential for some people to become overly reliant on crisis support: 

‘I am alarmed at the amount of free food that has been distributed when before COVID people paid for the shopping.  That's the reason why we charged the customers the cost price for all the food we delivered.’

‘We are concerned of the amount of dependency that has been created.’

Though a minority, these responses are mentioned because they tie in with concerns raised by some local authorities in our previous research, suggesting this is a more widespread concern.

Beyond these areas of practical need, the significant issues of isolation and mental health were also raised.  These needs may have developed only after practical needs were dealt with or could have existed from the very beginning.  Isolation and mental health were often mentioned separately, though some responses linked the two.  Concerns about isolation were both geographical and social – often the two were felt to be linked, as those living in rural, island and isolated communities may struggle to access services and stay in touch with others due to their location or their location may have meant they were already socially isolated and this was exacerbated by the pandemic:

‘Vulnerable people who live on their own, don’t have access to the internet, unsure of who to ask for support.’

‘Social isolation was a huge problem as people couldn’t get to talk and access appropriate support.’

‘People are isolated and have low mood.  Mental health has deteriorated.’

‘Lockdown has resulted more directly in need around social connection and mental health.’

Isolation and related loneliness, along with increased vulnerability were also seen as a part of rising mental health concerns.  Those shielding or isolating were also of acute concern, as were carers and those they cared for.  Some responses reflected their worries that mental health problems will only increase as time goes on and the full impacts of the crisis are felt:

‘I feel there will be a lot of people of all age groups who will be suffering from anxiety and loneliness and this will become apparent throughout the easing of lockdown.’

‘Mental health has been a huge need during this crisis and it will continue to be so on an ongoing basis.’

The importance of befriending and listening services was highlighted to help tackle these needs, but responses were concerned – as noted in the quotes above – about potential demand in future and how third sector organisations might cope.

Cutting across concerns about practical needs, isolation, and mental health were the needs of those shielding – some responses felt this group had been the most in need during the pandemic and supporting them was the most significant part of their work:

‘Getting food & prescriptions for people who are shielding or isolating for 14 days.’

‘The social isolation of people who are shielding leading to carers hitting crisis points.’

Across the survey there were responses questioning the make-up of the shielding list and wanting to know why certain groups were excluded.  There were concerns about whether this group had been properly served and the longer-term impacts of shielding.

The last quote above leads into another significant area of need according to responses – unpaid carers, though also the needs of those cared for.  The main issue raised was the lack of respite for carers and the impacts of this on their physical and mental health.  Responses were calling for more support for carers and short breaks, the reopening of day centres and respite care, and increased professional care services in the home.  There were also concerns raised about how care packages would be reinstated once safe to do so and whether everyone would receive the same level of care as before:

‘I feel that the isolation and centres being shut has caused a greater need for carer respite and the people themselves are needing out of their surroundings as this is causing them to be failing physically and mentally.’

‘Once past the practical and immediate support needs of food, pharmacy, financial and emotional support, PPE etc. carers mental health and physical wellbeing are the main concerns going forwards. We are really concerned about the impacts of the social isolation imposed by the lockdown and shielding  (whether that was formal or informal shielding, the impact is the same). The support needed to help carers through this and into the future must address the challenges of coming back out into society while preparing and supporting for a possible 2nd wave. We must focus on tackling carer exhaustion and avoiding carer burn out. In terms of preparation for the 2nd wave, unpaid carers need to be a much higher priority for government. If they burn out now and are unable to protect the people they care for in another round what will be the cost then?’

‘…We also hear of carers who cancelled carer packages at the start of lockdown as they didn't want other people coming into their homes as they were scared of what they may bring in with them. There are concerns now that these care packages will not be reinstated or reduced packages offered as we start to come out of lockdown…’.

Another group of people specifically raised as being in greatest need, was older people.  The third sector organisations responding to the survey felt that older people were potentially vulnerable, isolated, digitally excluded, and suffering from physical and mental health concerns.  Some noted that some older people might not know about or want to reach out for support, feeling others were more in need or being ‘too proud’ to seek help.  Other responses noted that some older people might have interpreted the guidance very literally and only shopped for absolute essentials, meaning they often had little to live on and limited stocks of food and essential supplies in their homes.  Older people might also rely on public transport to get their shopping and with services limited or suspended this decreased their ability to access shops and essential supplies:

‘Older people and those with long term medical conditions.  We have found that loneliness and social isolation has increased.’

‘…in the initial stages people were told only essentials but this message went on for a long time and some elderly were not making an effort to get enough of what they needed as they thought they were not entitled.  With help from community groups and others they did eventually get stocked up.  However there is a limit to how long you should only be buying bread and milk!’

‘Our community has a large proportion of over seventies, many of whom no longer drive and who could not access supermarkets because the bus service was suspended… With the order and delivery service we provided they had contact with the outside world even if it was by phone or waving through the window to the volunteer delivery person. Helping folk feel less isolated has been very important.’

One response noted that, though no group was in greater need than any other, their organisation had seen an increase in the needs of the over 65s.  Those over 65 were noted as being ‘pleasantly surprised’ that support was out there when needed:

‘The greatest need was giving reassurance to people that help was at hand and that we would be delivering the food parcels to their home address.  There was no one group that needed more help than others, the group we did see an increase from normal was over 65's who had never needed help or [sought] help in the past, I think they were pleasantly surprised that help was there when needed and the Foodbanks referral system was easily [understood].’

Many of the quotes above show the work third sector organisations have been doing to try to address some of the problems older people have faced during the pandemic. Other responses referred to schemes and programmes in development, for example:

‘…we are planning a service to hopefully help get the elderly back out and safely socialising using our volunteers as "buddies".’

Numerous responses also raised those with disabilities as being in greatest need during the crisis.  People who normally cope well have had routines disrupted, lost support services, and found themselves facing increased physical and mental health difficulties.  Many have felt alone, with one response using the word ‘abandoned’ to describe the feelings of their clients, as they have felt the general population has been supported while their needs have been side-lined.  This response was strong in pointing out the equalities and human rights legislation in this area, ensuring those with disabilities are included and catered for – their sense was that this had not been attended to in enough detail during the crisis.  Both practical and emotional support are cited as needed by those with disabilities and their carers:

‘Those with a disability. This is both physical and mental health. It has been a worrying and stressful time for people who are unsure how to carry out their “normal” routines, we have supported a lot of people who have been worried about themselves or people they care for who cannot cope with lockdown.’ 

‘Emotional support has been the greatest area of need for those we have supported.’

‘The isolation and loneliness of people with learning disabilities and their family/carers - many feel abandoned and that the needs of the general population were always prioritised over them.’

Some responses also discussed the issue of poverty, stating that the pandemic has exacerbated the problems those in poverty already face.  They felt that this could cut across practical and emotional issues, be connected to geography and connectedness, prior health status, and so on.  Responses in this area also noted that the pandemic has meant many people have found themselves newly in poverty and struggling, with little idea of how to access support:

‘The greatest area of need has been in relation to supporting those living in poverty or experiencing financial hardship.  These people are already disadvantaged and they have suffered disproportionately because they don't have the same “safety nets” as people living in more comfortable circumstances… There has also been a high number of people who have lost their jobs as a result of Covid-19 and this has resulted in new needs arising within the community.  People who were previously able to support themselves and their families have found themselves in dire need of support.’

Connecting a range of the above concerns was the issue of digital exclusion.  Responses reflected on the unprecedented move to digital information and support, due to face-to-face services having to reduce or stop in the earlier stages of the pandemic.  There was a lot of concern about the impact of this on clients, members, and service users.  Digital exclusion was flagged as an area of serious need and one that would be made worse by either inequalities or vulnerabilities.  Older people, those with disabilities, those living in poverty, those with limited or patchy access to internet, and those with limited confidence or digital skills were also seen as particularly at risk of missing out on support because they may be digitally excluded.  Skilling people up, providing devices, providing full internet coverage, and providing other means of accessing information and services were all suggested as ways of managing this area of need.  Digital exclusion was also connected to isolation and mental health concerns:

‘It has brought digital poverty and social exclusion sharply into focus.’

‘Upskilling and equipping those not digitally connected.’

‘I think that making sure everyone is digitally connected in some way has been the greatest need.  Some people are suffering by being forced into isolation without enough outside contact which is causing major mental health issues.’

One lengthy, but important, quote shows the level of impact such exclusion can have on groups who may already feel marginalised.  This quote reflects on those with learning difficulties:

‘Digital exclusion is overwhelming in this community and so hardware, connection and ongoing support for learning and maintaining a digital connection are required to change that.  Across the national membership of this organisation (1100+) that digital exclusion takes many forms.  It can be due to where and what type of setting people live in; what, if any social care or other support they receive and their income, which is almost universally low and benefit based.’ [Full quote at Annex B]

Children, young people, and families were also raised as groups in particular need.  There were concerns that vulnerable children would not have had the oversight of adults outside the home during lockdown and may be in serious need in terms of child protection concerns.  It was recognised that the family might be living in tense or potentially explosive situations because of lockdown restrictions.  Children and young people with additional needs may also be suffering from the lack of routine and changes in their support services (as might their families and carers).  There were more general worries about the impacts of home schooling on families, the mental health impacts of lockdown, and, for young people, the impact on jobs and education.  Some respondents have found young people harder to engage than normal.  Other responses were particularly worried about how single-parent households are coping:

‘Support for one parent families, particularly with children who have additional needs, this has led to financial difficulties and also contributed to increased [difficulties with] mental health.’

‘The removal of routine and predictability has been very difficult for children and young people with learning difficulties.’

‘Some children and young people are at risk when they do not have regular contact with vigilant adults from outside the family.’

Further to the range of needs outlined as greatest for those the organisations support, a variety of organisational concerns and issues were also raised.  These focused in the main around funding, with many already facing financial worries and others concerned about the future, as government support diminishes.  The third sector respondents stressed their feelings that demand will only increase as the longer-term impacts of Covid-19 are felt:

‘Community based third sector organisations offer a grassroots solution to many of the problems that our Scottish society faces – this we knew – but during COVID 19, when many centralised public services closed, ours along with many others worked creatively and harder to ensure that emotional/ mental health services were open, and accessible.  We have the knowledge and the skills to provide a service that meets the needs of the people of our locality, but we do not have the funding to do it [at] the level we believe we can.’

‘Our Charity has applied for funding and it all takes too long to complete application and wait on notification if [you’re] successful. We are trying to do our best but with fears for our charity’s future is a pressure we could do without, we have lost our income for people visiting our community house.’

There were also some comments on working with partners and communication:

‘Coordination is the one thing which has been massively missing - whether that's HSCP, local authority, NHS etc.  The Third Sector in our area has not been well communicated with since the beginning of lockdown - we may have been able to shape our services to meet whatever need may have been identified.  Perhaps the illness was not as widespread in our area...we just don't know.  At times, apart from working with other 3rd Sector partners and one or two specific local authority colleagues it has felt like operating in a vacuum.’

Communication, information and advice needs were also raised as serious.  A number of responses noted that communication from government was not always clear, accessible, or easily digestible.  One comment noted that using the SG website should be easy, but the person often found accessibility issues:

‘Accessible information both in print and on television.  It is a major priority especially in areas [ ] which has a high proportion of older people.  Being told to look on the internet and such is not and never will be especially when faced with this:-

• Coronavirus (COVID-19): Scotland’s route map 
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Unfortunately this was true in each case.

All of the above is a requirement under the Equalities Act 2010.

I do appreciate that lots of things had to be done in a hurry, but if it becomes the norm to always give details in large print of how to get a copy in a different format on printed material, if I am honest, there will be a lot less hassle from people like myself!’

Communications were also flagged as not easy to read for those who may find reading difficult or have more limited comprehension skills – there were calls for more accessible, easy read versions of all information:

‘The expectation that everyone can read and comprehend government guidelines too has stressed some of our participants greatly.’

Beyond this, some responses noted that more information is needed on how people access support and who they can talk to about their needs – some were left behind simply by not knowing what support was out there.

Finally, there were also smaller numbers of responses around area of greatest need about domestic abuse; migrants; quality of housing; and that needs have changed over time or are hard to disaggregate from each other.  It is clear that need has been wide-ranging and that third sector organisations are working hard to meet demand, while attempting to consider the future needs of those they support as well.