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

Key findings

At risk groups supported by 3rd sector organisations during the crisis:

• 57% of responding organisations support particular sections of society whilst 43% provide support for anybody in need in their area.
• Responding organisations have been supporting all of the groups defined by SG as particularly at risk due to Covid, including people who are isolating (57% of respondents), have higher health risks from Covid (75%), were advised to shield (69%), have barriers to accessing essentials (73%), are financially at risk (59%) and marginalised groups (49%).
• Within the higher health risks group, responding organisations have been supporting people aged over 70 (84% of respondents), who are disabled (76%), who require mental health services (70%), who receive an annual flu jab (51%), and who are pregnant (26%).
• Other groups supported by responding organisations include children and young people, parents and families, carers, survivors of domestic abuse, other third sector organisations and volunteers, businesses, community resilience partners, socially isolated people and people affected by multifaceted issues.

Types of support provided:

• More than two thirds of responding organisations (68%) have provided befriending and isolation support, almost half have provided food support by supplying food boxes (45%) or arranging for delivery of food (48%), 39% have delivered medicine, a quarter have provided financial support and a quarter have provided support with energy bills and meters.
• Almost half of respondents (49%) have provided other support including:
• o Support and services to individuals and households such as information and advice, transportation, digital support, mental health support to help with anxiety, resources for carers including Personal Protective Equipment (PPE), activities for children, gardening and dog walking. 
• o Supporting other organisations such as intermediary bodies helping smaller third sector organisations and other third sector organisations supporting businesses, offering use of their community spaces, and seconding staff and volunteers to emergency response groups. 
• o Supporting key workers with childcare and summer camps, provision of PPE including masks, and bicycle maintenance.
• While it’s unclear how much of this is new since Covid, some respondents highlighted adaptations to their support services or expansions in their capacity: 

‘All of our support services have been transformed during this crisis to provide alternative support utilising telephone support, online groups, information, activity packs, helpline support, telephone befriending etc.’

Working with local authorities

Not all responding organisations have worked with local authorities during the crisis, but those who have describe working together on local coordination and emergency response groups, taking referrals and delivering support, sharing and contributing to information, guidance and intelligence, receiving funding and identifying need - ‘We have been working alongside the local hubs and schools trying to identify anyone that may be in need but not entitled to any of the government handouts.’ 

Many describe the third sector providing the initial response to support people in their community, then later working with LAs - ‘We pre-empted the local council and established a coordinating group linking those providing food and essential supplies. We operated alone in this role for a month before the council were ready to take over this activity.’ 

Respondents’ assessments of working relationships with local authorities were mostly positive (70%) or neither positive nor negative (23%), with only 6% judging the relationship as negative. Much of the positive feedback highlighted enhanced collaborative working - ‘I feel we have worked well and felt included more than usual. We have been receiving referrals and been referring back to services.’ There was negative feedback about lack of engagement and an imbalance in the relationship - ‘Tends to be one way - they refer’. Other respondents highlighted the variable quality of relations – ‘This has been patchy, depends on the local authority’.

Working with the Scottish Government

Just under a quarter of respondents had worked directly with SG (24%) and a large majority of those considered the relationship to be positive (93%). The positive feedback highlighted provision of funding, listening and consulting, and communicating and collaborating - ‘There has seemed to be a genuine willingness to work collaboratively as far as possible and a massive effort was undertaken to try to keep everyone on the same page.’

Where there was negative feedback, the main issues highlighted were around funding mechanisms, lack of engagement, engagement at the wrong geographical level, and SG staff capacity - ‘As the pandemic broke other staff were redeployed into [ ] who of course were working under pressure in new roles.’

Overall effectiveness in supporting people at risk locally

A large majority of respondents (83%) believe that people at risk were effectively supported in their area. Reasons for this include: 

• The rapid initial response by the third sector within communities - ‘Third sector were responding within a few days of lockdown and continued throughout’.
• Collaboration with local government.
• Adaptation by the third sector and others locally - ‘We were challenged to re-purpose our core activities and move from one to one and group workshops and learning opportunities to delivering remote support to people with little or no digital resources or internet access.’
• Community support and pulling together - ‘It has been a massive call to arms...’
• Collaboration locally - ‘Charities etc... that don't usually work together have formed new and lasting relationships.’
• Communications, funding and coordinating activity by agencies and intermediaries.

Although only 4% of respondents felt that people at risk in their local area had not been supported effectively, there were many comments pointing to factors which respondents felt resulted in ineffective support being delivered. Reasons included: 

• The impact on carers and families, particularly where social care became limited. 
• Difficulty in accessing essentials - ‘I believe that some people may have experienced more hardship than they needed to, just because they didn't know where to go for help.’
• Duplication and poor coordination - ‘It has not been well co-ordinated in the voluntary sector - too many people trying to do similar things instead of sitting down together early on and agreeing a plan…’
• Insufficient protection of older people in care homes and restricted access to them for loved ones.
• Digital exclusion - ‘Some people, particularly those in isolation, are not aware of the help which is mainly promoted on social media’.

14% of respondents were unsure how effective support had been for people at risk in the area and this was due to variable support provision, the difficulty of answering the question accurately, and uncertainty about the future – ‘Support was great at the start, but no exit strategy has been developed’.

Reaching Everyone in Need

Almost half of respondents thought that not everyone in need has been reached (47%) while 28% thought everyone has been reached and a quarter didn’t know. Those who answered ‘no’ or ‘I don’t know’ provided a large number of reflections on why, some of which intersect. The main themes were:

• Digital exclusion.  Many highlighted that the Covid-19 response – in terms of information and support due to face-to-face restrictions – has been very digital and this had excluded certain groups - ‘Most of the support we were able to give was online or over [the] phone. I suspect that if people did not have access to internet/gadgets then they would not have been able to easily access support.’
• Underserved groups including: older people; disabled people; unpaid carers and those who have lost professional care support; those who are isolated (geographically and/or socially); those with mental health issues; those with physical health issues or long-term health conditions; rural and island communities; those living in poverty or with limited means; and those with English as a second language and/or who are asylum seekers or refugees.
• Organisational failings and resourcing.  Some pointed to funding and resource constraints. Others had negative comments about Health and Social Care Partnerships and local authorities. Communication issues had prevented some inter-organisational working, including information sharing barriers caused by GDPR and confidentiality agreements.
• The impossibility of reaching everybody when many are ‘too proud’ to ask for help or don’t know where to go for help.

The greatest area of need

Respondents highlighted a range of areas of greatest need which may reflect the people they have been helping during the crisis: 

• Practical needs such as food, medicine, financial concerns and fuel poverty. Food issues included difficulties with payment methods in the early stages, access for people in isolated areas and supermarket delivery capacity. Loss or reduction of income led many people to struggle financially and become anxious.
• Isolation and mental health. Concerns about isolation were both geographical and social. ‘Lockdown has resulted more directly in need around social connection and mental health.’
• The needs of those shielding. Some responses questioned the make-up of the shielding list and there were concerns about longer-term impacts.
• Unpaid carers and the needs of those cared for. Issues include a lack of respite for carers and the impacts on their physical and mental health.
• Older people who were potentially vulnerable, isolated, digitally excluded, and suffering from physical and mental health concerns.  
• Those with disabilities.  People who normally cope well had routines disrupted, lost support services, and faced health difficulties and reduced social contact.  
• Some felt that the pandemic had exacerbated problems for those in poverty.
• Digital exclusion relating to the unprecedented move to digital information and support, due to face-to-face services having to reduce or stop.
• Children, young people, and families. There were concerns about vulnerable children, tense family situations during lockdown, access to services for children and young people with additional needs, and general pressures for families. 
• Organisational concerns and issues around funding, sustainability of services as the crisis continues and local coordination.
• Communication, information and advice needs including views that government communications were not always clear, accessible or digestible. 

Support needs as Scotland emerges from lockdown

Respondents continued to stress all of the issues mentioned above as requiring ongoing attention.

Beyond these there were a whole range of other support needs that respondents could see emerging as Scotland moves out of lockdown including:

• Confidence to return to normal life particularly for people with health risks and disabilities, and those who may have become dependent on the crisis support offering. Information and guidance were highlighted as important to help with this.
• Longer-term health harms including the mental impact of the pandemic and its consequences, which might well reach into social and economic harms.
• Restarting of health and social care quickly and safely. 
• Ensuring good, accessible public transport across Scotland.
• Unemployment: calls for more funding for employability schemes and support for young people to access work and benefits.
• Calls for SG to consider inequalities in greater detail.
• Reprioritisation of ‘normal’ public services.
• Calls for a greater emphasis on local responses going forward.

Concerns about supporting those in need as the pandemic develops

When asked whether organisations have any concerns about supporting those in need in the future, responses were quite opposed, with some organisations providing specific and detailed concerns and others indicating that they did not have any concerns to mention at the time of the survey.

Key concerns raised were:

• Funding: lack of funds and the difficulties of meeting demand or providing alternative services with social distancing. Clarity was sought on public funding.
• Volunteer numbers and training. Some are returning to work or may be less able to provide support.  Volunteers may need training for future service needs.
• Burnout.  Staff and volunteers were considered to be at real risk of burnout, risking their ability to provide for others. Many report needing a break whilst worrying that demand for services often increases during colder months.
• Adapting services to meet new needs and to respond to physical distancing and safety guidance, whilst remaining connected with clients and members.
• Future planning and coming to terms with the new context. A need for guidance on how to look after staff, clients and members, and help finding new premises.
• Technology and improving digital inclusion.
• Relationships between the third sector, local authorities and the NHS - calls for closer and in some cases more productive working.