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

13. Support needs as Scotland emerges from lockdown

Looking ahead to future need, respondents continued to stress all of the issues mentioned above as areas of greatest need:

Practical concerns, such as food, pharmacy, and finances; 

Mental and physical health (including help to regain mobility and deal with frailty and falls risk, help with longer-term and new health conditions, and help with the impacts of isolation and bereavement); 

Isolation and vulnerability (rural location; poor public transport; living alone; being lonely; being less mobile); 

Older people needing particular support; 

Those with disabilities also needing particular support; 

Digital connectivity, skills, and inclusion (free broadband for all suggested as a partial solution, as well as improving connectivity in island communities); 

Dealing with existing and developing poverty; 

Getting those shielding back to normal life; 

Carers and caring (respite for unpaid carers being mentioned as an urgent need, but also increased training and better conditions for professional carers; PPE);

A range of needs around children, young people and families^[3] (mental health; strained or volatile family relationships; domestic abuse and child abuse; care leavers; homelessness; concerns about restarting school, further and higher education, and starting or returning to employment in difficult times);

People also continued to stress the need for clear and accessible (accessible for those with disabilities and in terms of the content and language used) communication, information, and advice.  

The third sector organisations show that they are creatively considering how to deal with certain concerns and support those in need: 

‘We have issued questionnaires to our 120 clients to determine what support is needed going forward. Early feedback indicates around 30% as still at risk and we will continue to support them as much as possible, 30% want us to keep in touch and may attend our lunch clubs and community activities once they reopen, 30% are feeling confident that they will now be able to cope and are very appreciative of support. Quote from a client today: "This has been a lifeline due to my PTSD and muscular dystrophy, I was worried about my situation. D (volunteer) phones and comes round with food and gives me support and encouragement...I thought I would be lonely, isolated and hungry. I was none of these thank[s] to D - supplying me with crosswords, jigsaws, DVDs, his conversation and phone calls. For someone like myself who doesn't have a big social circle this has been invaluable. I thank all at the [  ] a true community hub. And a huge thanks to now my friend D, a real decent, giving person in my community who helped me when I wasn't able to help myself – indebted”. (male age 44 yrs - referred by his housing association)’

‘Domestic abuse - One of the things we set up… was a weekly activity pack for families that included an activity using natural resources and a baking activity. The main reason for this was to give a parent a reason to leave the house weekly and gave us the opportunity to chat to them about how they were. The thinking behind this was that we know domestic abuse has risen during lockdown and that parents and children weren't getting their normal outlets i.e. work, school, groups etc. At least this was an opportunity if one was needed to raise a concern or welfare issue. This has been incredibly successful and still runs but I feel that families are going to need ongoing support to encourage positive relationships and engagement with children.’

Organisational concerns were also mentioned.  Responses were strongly focused around future sustainability: there were calls for more direct funding to the third sector, funding for more of the ‘smaller players’ in the third sector, and greater recognition of the work that is being carried out by these organisations.  Many were concerned about their funds, their ability to pay staff, and worried about the pool of volunteers dwindling as people return to work.  Some responses noted that their volunteers were vulnerable/at risk due to age or ill-health and may not be able to contribute as they had before the pandemic, while others had become economically vulnerable/at risk during the pandemic due to job and income loss, and may need their support in future.  

The third sector organisations who responded were clear in their sense that demand for services would continue and was likely to rise.  Some had excellent examples of their creative working and solutions to support their communities (see above quotes), and some demonstrated their thinking around how to support themselves in uncertain times, but the overall message was one of concern for the sector moving into the future.  Services say they are having to manage expectations about what they can provide and some will start having to use waiting lists for support.  

Services may need to be adapted to continue to work and there were calls for support from local authorities and the Care Commission in managing this work.  Good partnership working was seen as important moving forward – between third sector, local authorities, and government.  This includes creating sustainable funding models, good communication, better use of available space and resources, and greater equality in funding to reach smaller organisations and beyond the central belt:

‘Safe Spaces - our sector has very little physical capacity around Scotland.  Your intermediary organisations are only based in Edinburgh or Glasgow and there has been no investment of ScotGov cash outside the central belt.  We urgently need a framework to help us work collaboratively to build on ALL our community assets in every corner of the country to provide physical spaces to organise and to deliver services safely.’

‘Council and Care Commission need to allow providers to use imagination to adapt their services to allow people to attend safely – i.e. outreach or smaller groups or longer opening hours. However there might be an additional cost which needs to be paid for.’

‘Funding goes to Third Sector not Local Authorities as the Third Sector has shown that it is more agile and able to offer flexible and responsive services better than local government.’

‘Financial security to continue delivering their services. Normal fundraising has ceased and groups/organisations are eating through their reserves. However the funding packages have been so focused on COVID activity that there is now an existential threat to many Third Sector groups and organisations because of it. Subsequently the support network for service users is being threatened because of the short term nature of the available funding sources.’

Beyond these there were a whole range of other support needs that respondents could see emerging as Scotland moves out of lockdown.  The range of responses was large and sometimes an issue might be touched on in only one or two responses – given this, these needs have had to be prioritised for inclusion here and will be discussed briefly below.

Confidence to return to normal life was raised numerous times and across groups and demographics, as people are described as afraid to go out of their homes again.  Some organisations were concerned that fear was compounded by reliance on support and, in their words, ‘free food’.  For those with disabilities, getting back to routines may be particularly significant.  Third sector organisations who provide activities were keen to get these restarted as soon as possible.  Good, accessible information, safe activities, and clear guidance about behaviour in particular settings were all recommended as ways of regaining confidence.

Longer-term health harms were considered a significant future need.  Such longer-term harms are referred to as the ‘long tail’ of Covid-19, and include the mental impact and trauma of the pandemic and its consequences, which might reach beyond health and into social and economic harms.  There were calls for consideration of how to deal with these needs and support them in a consistent manner.

There were also specific concerns related to the restarting of health and social care and the need to do this safely, and to return professionals to their original roles as soon as possible.  These responses reflected concern for the general functionality of the health and social care system, with one noting that the pandemic has only highlighted problems that already existed.  People’s needs, it was felt, should be reassessed at this stage to ensure they get the right support, as needs will have changed through the pandemic.  A concern for those in residential care was also raised, as this was felt to be an area with its own concerns and particular issues that require support and help to reconnect with the wider world:

‘Support for people in residential care must also be considered and an appropriate compassionate plan for ensuring they are able to reconnect with their families.’

‘The importance of restarting health support: Loss of Allied Health Profession services needs to be rebuilt and ensured for those not returning yet to school or day services.’

‘People’s health needs will have changed so this needs reassessment.’

‘This pandemic has not caused, but has highlighted the significant gaps in our health and social care system. There is clear evidence of a disproportionate impact of this crisis on people with dementia, their families and carers. There are an estimated 90,000 people living with dementia in Scotland . There is an urgent need to respond to the changing and increased needs those living with dementia and a commitment to ensure that dementia is a priority in national and local recovery plans and reform.’

Though connected with a number of other issues raised throughout this report, the issues of transport and unemployment were topics of concern when thinking about the future. Some third sector organisations are concerned that there is not enough good public transport across the whole of Scotland, leading some people to be more isolated and dependent upon support than others (a rural/urban divide), but also that many of their clients and members have concerns about safe use of public transport to access work or social contact (the latter particularly for older people): ‘Transport is our main issue, older people need accessible transport’.  An overhaul of public transport and risk assessments to ensure it is safe were recommendations.

Unemployment was also of deep concern as it is seen as a developing need, which is likely to only get worse over the coming months.  There were calls for more funding for employability schemes and greater support for young people to access jobs: ‘Support around employment (particularly for young people)’.  This issue also related to benefits and ensuring people get all the support they can, particularly as furlough ends.  The furlough scheme and benefits are reserved issues, but SG was clearly seen to be responsible for ensuring the wellbeing and economic survival of its citizens in both matters.

Responses also called for SG to consider inequalities in greater detail going forward and there were responses reflecting on the divides of inequality created, highlighted, or exacerbated by the pandemic:

‘Inequalities will be further exacerbated if we fail [at] being proactive [in] reaching marginalised communities. We have identified so many unmet needs where people are struggling with managing tenancies; no cooking appliances; boarded windows and doors; no gas or electric. What support will be in place when shielding ends as the same needs will remain?’

‘We support BAME people and refugees in need of English language learning.  If you can't speak the language, you don't have a voice, you cannot participate in community events and you are isolated.  During the crises, we provided daily lessons or support meetings for various levels of English and various ages, including 'story time' for children in the afternoon.  As we move out of lockdown, we might be able to provide more face-to-face meetings, however, online lessons/support will have to continue.’

This concern for inequalities extended to legal and immigration advice for refugees and those seeking asylum.

Reprioritisation of ‘normal’ issues was also seen as significant.  People are seeing the return of everyday concerns and need to return to the work they were doing previously, while still supporting need resulting from the pandemic.  Such areas for reprioritisation were: community safety; transport and road planning (with an equalities focus – there were concerns that those with disabilities have been forgotten about in the move to create more space to walk in towns and cities, which has left areas hard to navigate for some); criminal justice provision; advocacy services; transport for health appointments; services and support for new and breastfeeding mothers; moves to equalise service provision across postcodes.

Finally, there were numerous calls for a local response going forward with third sector organisations feeling the pandemic had shown how important local work is and that it is only at this level that need is really understood.  Some of these responses reflected on funding in particular, seeing local mechanisms for distributing funding as successful and useful models: 

‘Financial support coming directly into our communities to enable facilitation on the ground and support those in most need, only local communities themselves know what individuals locally need.’

‘By being able to receive direct funding almost immediately through the Supporting Communities Funds was invaluable.’

‘As a community development trust we are very experienced with supporting our community and using funding to do this, we need to be trusted that we can do this with direct funding rather than via local authorities.’