Tweet about this on Twitter Email this to someone Share on LinkedIn
logo-ivar

How we set up a social prescribing service during lockdown

As in many areas, the Social Prescribing Link Worker role is new in Lytham St Anne’s Primary Care Network. Two link workers were employed in March 2020, and in the midst of us learning the role, the country almost immediately went into lockdown due to the COVID-19 pandemic.

Working from home with restrictions on face-to-face meetings had an impact on the way we were able to reach patients, and the closure of local groups made it increasingly difficult to carry out the usual objectives of this kind of role.

Like many areas, Lytham St Anne’s saw an incredible response from local volunteers who were keen to help their neighbours, particularly the elderly, vulnerable and those advised to shield by the government.

We had access to the list of shielding patients and worked alongside primary care colleagues to contact each of these patients by telephone for a supportive chat, finding out what additional needs they may have during lockdown. For those that needed help with shopping, collecting medications or dog walking, we were able to signpost or refer to local mutual aid volunteer groups, as well as to NHS volunteers.

For patients who were found to be especially isolated or lonely, or struggling with their mental health, we provided regular check-up calls, in addition to signposting to telephone befriending services.

We found that patients were appreciative of the calls, even if they had no additional needs; they were grateful that they hadn’t been forgotten. Others chose to receive a weekly wellbeing call from us and reported that this helped them to get through the difficult months of lockdown.

Inevitably, a major challenge of this period has been the lack of active community groups and services to prescribe to patients. While some groups have gone online to hold virtual meetings, the large elderly population in Lytham St Anne’s faced barriers to accessing these groups. Age UK Lancashire provided tablets on loan to people who were without the relevant technology and there were volunteers available to teach people how to access apps such as Facetime or Zoom. Despite this, many patients proved to be reluctant to make the move online, and others do not have access to the internet at all. Furthermore, we found that many local groups did not create an online presence, and have simply been waiting to be allowed to meet again in person.

One prominent local group, Just Good Friends, usually provides regular meetings including dancing, quizzes, musical entertainment and exercise sessions. During lockdown, the group leaders kept in touch with their members via telephone and once guidelines lifted to allow people to meet outdoors in small groups, members began to meet in a local park in socially distanced “pods” of up to six. They have recently started some chair-based exercise sessions in the same pods. We have been able to refer new members to this group.

Although groups and services have been restricted during the pandemic, we have been able to build relationships with local group leaders, establishing a good network of contacts which will be invaluable as the community comes to terms with the “new normal”. We have also started seeing some patients for face-to-face appointments and hope to see more and more groups opening up following lockdown, depending on further restrictions that may arise. Drawing from our learning and the need to work more across sectors, we are looking at developing a local Social Prescribing Network in Lytham.


Sign up for our virtual Transforming Healthcare Together Conference to hear more stories about cross-sector partnership working during Covid. We’ll hear from some amazing speakers who will offer local, national and system perspectives.

Covid-19 in 50 languages

So, you’re feeling ill, it’s the middle of the Covid-19 lockdown, you don’t speak English and your mobile phone is 12 years old. How do you manage?

 

That’s when you need an organisation like Sussex Interpreting Services (SIS), a registered charity that has been supporting people’s access to public services for over 25 years. Just before the virus hit, SIS was delivering around 1500 interpreting sessions a month for people whose first language was not English. The Covid-19 crisis added a whole new level of complexity to that. Overnight.

 

The average monoglot Brit who struggles to say ‘oui’ and ‘non’ on a weekend in Paris might think everyone in the UK speaks English. Yet, as Alice Evans’ report for the BBC suggests ‘four million people in England and Wales do not consider English to be their main language’ while there are ‘over 800,000 people who speak little or no English’ and 88 languages other than English are used as a principle language.

 

This points to the importance of voluntary action by organisations like SIS which, with 15 employees and a pool of 100 sessional linguists, delivered services in around 50 languages last year – sometimes in emergency situations. Their situation during the Covid-19 crisis mirrors some of what we’ve been hearing elsewhere. Services have had to re-adapt fast, funding was required quickly, with the minimum of fuss, and statutory partners had to be flexible.

 

Getting close up

 

But what’s the inside story? Let’s get granular. We spoke to Arran Evans, an SIS Director, about the challenges for the people they support, the design and funding difficulties SIS faced, and the flexible ways they responded.

For people with difficulties in English, obtaining GP appointments remained extremely difficult until the beginning of July. Many of SIS’s service users would normally drop in at the doctor’s surgery. However, the (understandable) growth of automated phone services – as an access point for public services – created barriers for certain groups. SIS worked alongside people who could not understand the correct selection to choose in the complex series of options offered by automated phone services.


Arran pointed out that ‘if people cannot understand the instructions and the system – they do not get access’. For mental health services, for example, it could take over 40 minutes in English to go through all the questions. One of SIS’s tasks was to explain the service users’ access needs to statutory services to which they were entitled.

 

Linkage to statutory services

 

In the early stages, strategic statutory partners were slow to respond. For example, GP surgeries closed, but people still needed their necessary or regular appointments. The consultation that a SIS interpreter would attend, alongside the service user, stopped overnight.


‘We can’t do what we do without collaboration with hundreds of people’
says Arran. SIS estimates that they lost 85% of work because appointments were cancelled, the translator had to go home, while, crucially, the person in need did not get diagnosed or treated.


Information needs presented another important dimension. Although every local community is different, large sections within BAME communities have stayed at home during the Covid-19 crisis. Language difficulties have meant that it was sometimes easier for them to obtain information about Covid from family members outside the UK. However, by the time such news arrived here the message may not have been clear, correct, or up-to-date. Arran explained that:


‘We spent lots of time auditing information – adapting it and posting it on our pages and translating – and distributing it to the council … The very best and useful information was what we got from
Doctors of the World, not government at large which had done little on this issue.’

 

Agile organisational adaptions

 

In the midst of the Covid-19 crisis, Arran said, SIS had to fundamentally re-design their whole service almost overnight including the web site and phone service.‘We had to be very creative. We don’t have enormous resources.’

 

They designed a free platform that was working well with interpreters online. But there were still access challenges: many of SIS’s users did not even have an up-to-date working phone. SIS developed important and collaborative links to the Clinical Commissioning Group and doctor’s surgeries in cases where it was necessary for people to be shielding for medical reasons.

 

Arran pointed out:

 

‘The interpreters have been magnificent but SIS is now about half the size it was … It is exhausting to gain income from contracts. Funding dried up. We had to significantly use our reserves.’

 

Funding

 

Most funding streams that appeared during the crisis were exhausted before SIS could even apply. Meanwhile, some funders even thought SIS was not a voluntary organisation as their work was concerned with people’s access to statutory organisations!

 

Overall, Arran acknowledged that:

 

‘It has been emotionally draining in our team. We’ve been supporting people facing domestic violence or asylum seekers who are destitute or with long term illness.’

 

Dealing with this has had long term affects on staff and interpreters.

 

‘We’re not machines! And we’re not together physically like usual. We’re isolated at home and some colleagues are working and sleeping in one room. It’s very tough!’

 

Challenges

 

It was hard for a relatively small organisation like SIS to get local strategic partners to respond. However, as Arran explained:

 

‘We’re so proud of what we’ve achieved. But you can’t do that forever… It’s very draining. Do local authorities, government funders get it?’

 

This points to the vital role of independent voluntary organisations like SIS in identifying, and acting upon, social disadvantage. SIS have developed – and adapted – a model of working based on their closeness to the people they work with over the long term. And their small team have been agile in re-designing their entire service, in a national emergency, at short notice.

 

As Arran indicates: ‘We’ve worked right through the crisis. It’s been very tough. Really tough.’

Peer support for charity leaders

We are running free 90 minute zoom sessions for up to 12 charity leaders at a time:

 

‘It’s good for mental wellbeing and to have the opportunity to talk and share with others in similar situations’. 

 

You’ll hear how others are adapting to Covid-19 and have a safe space to offload any challenges you face: 

 

‘I am able to share things that I can’t share with my Chair or staff’. 

Sign up here. 

 


Who is this for?

Leaders of charities, community organisations and social enterprises. Over 300 people from across the UK have taken part so far. Their organisations are active in 17 fields including the arts, criminal justice, education, equality, infrastructure and migration. 


What kind of space is it?

The precise focus of conversations is generated by the participants, who can shape what this needs to be, to ensure that the sessions are useful for them. Past attendees have valued hearing other leaders’ experiences, having a safe space to offload and time to pause and reflect.

 

‘It was really powerful to be part of one of these sessions … incredible to hear about the wide range of experiences and challenges faced by colleagues and to identify together commonality within that diversity.’


When are the sessions?

The online sessions last 90 minutes and will continue running until March 2021. Dates for drop-in sessions are currently available to December 2020, and groups can choose to continue meeting on a 6-weekly basis. 

 
How do I sign up?

By visiting calendly.com/ivar-social-change. You will be asked four questions:

  • What is your registered charity number?
  • Can you tell us in 1-2 lines how this crisis has affected you and those your charity supports (to help with the facilitation of the session)?
  • How did you hear about this?
  • Do you have any access requirements?


The facilitators

 
Please note:

 

The online support sessions are not information or advice surgeries. They are facilitated peer support spaces.

Based on what we hear in these sessions, we are producing regular briefings on the challenges faced by VCSE leaders. This is a by-product and does not require any action on the part of attendees.

Acting locally in the Covid-19 era

Covid-19 has been like a viral version of globalisation. It’s the import and export of a deadly virus that pays no respect to national borders. So what’s local community action got to do with an international pandemic?

At a national level, of course, we have needed to mobilise the public sector, most notably the NHS. At a personal level, social media has provided ways for us to communicate with friends, family and colleagues across continents. But has the pandemic either stimulated – or stifled – local community action?

At one level, helping a neighbour with shopping; waving through the window to someone in isolation; sticking up a poster about a Mutual Aid scheme; all represent important contributions to our local communities. We could think of these as individual civic acts. Alongside this, mobilising our contacts with voluntary, community and co-operative organisations in our towns and villages has also been crucial. Local community action has an important complementary role to play in the current crisis but it also faces challenges.

Vulnerable people hardest hit

First, it’s important to note that community groups were already providing frontline support to people before the crisis. For example, they may have offered support or advocacy to people who were homeless or living in overcrowded temporary hostels; to undocumented migrants who encountered barriers to accessing health care; and to people on low incomes who relied on food banks to survive.

Second, it’s worth recognising that local groups have encouraged the associational life that is so important for mental wellbeing and local engagement. Over the last months most community centres have necessarily remained closed. These were places where people might learn yoga, drama or juggling; or organise and advocate for local needs; or provide places to socialise and meet friends. These are not frontline emergency services. But they may be vital locations for fostering mutual support and wellbeing.

Practitioner Voices

Let’s take two examples. At one community centre, in a densely packed neighbourhood in the south, volunteers have been regularly cleaning the garden as a convivial social space. Janet, one of the trustees, pointed out that the centre’s normal activities had ceased following government guidance several months earlier but ‘we have kept the garden open for local residents with strict rules on social distancing’. They rely ‘purely on room hire and fundraising activities’. At present ‘there is no income coming in’ and ‘we don’t get grants’. 

Meanwhile, a community centre on a new-build estate, have been operating an independent food bank. Sam, a committee member, underlined that health, housing and food were ‘the most basic aspects of life’. In this locality, ‘most people coming to food banks are on universal credit’ and, according to Sam, they are ‘self employed on low incomes that aren’t sufficient to cover their costs’. Their policy was that there would be no means test. Meanwhile, donations of money are preferred – rather than odd combinations of non-nutritious items – so that quality food can be distributed.

For him, the reason that Covid-19 had been such a disaster was because ‘for many people affordable secure housing, sufficient nutritious food and decent access to health services was already not part of their world’.

These two vignettes illustrate some modest but important examples of responses to the effects of Covid-19 by local community groups as well as indications of their own organisational fragility. Certainly, Public Health England’s (2020) [1] examination of the pandemic points to the higher risk faced by older people, Black, Asian and Minority Ethnic groups, as well as for those living in deprived areas or in medical and menial employment roles. Local community action groups work closely with many of these groups.

The Outlook

It seems a different era since headlines on the 31st January 2020 read ‘First case of Corona virus confirmed’ [2]. For analysts such as John Gray [3], the arrival of the virus did not represent ‘a shift to small-scale localism’ however he argued that ‘…the hyperglobalisation of the last few decades is not coming back either.’ Gray’s analysis holds echoes of Paul Hirst’s [4] ideals of a local or regional associationalism that sought democratised private and public agencies.

The important support roles of local community action can easily be overlooked. Their multiple voices need to be heard in any post-Covid reappraisals of our social and economic structures. Their practical, social and convivial roles remain a vital contribution at the local level.



References



[1] Public Health England (2020) Disparities in the risk and outcomes of COVID-19, London: PHE publications.

 

[2] Burgess, K. (2020) ‘First case of Corona virus confirmed’, The Times; 31 Jan, 2020. https://www.thetimes.co.uk/article/world-health-chiefs-declare-coronavirus-is-global-emergency-9pc9jkkfk.

 

[3] Gray, J. (2020) ‘Why this crisis is a turning point in history’, New Statesman; 1/4/2020.

 

[4] Hirst, P. (1994) Associative Democracy. New forms of economic and social governance. Cambridge: Polity Press.

NB Names of those interviewed are anonymised at respondents’ request.

Six ways VCSE leaders are adapting to Covid-19

Over the past 11 weeks, we’ve hosted peer support sessions for over 180 VCSE leaders across the UK. We’re publishing regular briefings about the challenges they are facing; we’ve also heard much about how these are being overcome.


In celebration of Small Charity Week, we wanted to share six ways in which VCSE leaders are adapting.

  1. Actively managing staff and volunteer welfare, by encouraging them to:

 

  • Take some time off
  • Build self-care into the working day
  • Find opportunities for social connection (e.g. daily quizzes, sharing a favourite book or photo weekly)
  • Keep a diary
  • Adopt a more flexible working pattern
  • Introduce a buddy system across the team to ensure people have someone they can check-in with regularly

 

In cases where staff have been furloughed, finding ways to include them so that they remain motivated and are aware of key organisational decisions/changes:

 

  • Inviting them to take part in remote team meetings
  • Rotating furloughed staff to reduce the emotional impact of not being at work
  • Swapping furloughed staff between peer organisations for skill sharing and volunteering purposes – informally or through Furlonteer, which has been set up to connect furloughed staff with charities who need their expertise and time

 

  1. Setting boundaries


Continuity of service provision – now or when restrictions ease – is the intended goal for most organisations, along with responding to the increasing needs of their beneficiaries. However, VCSE leaders are trying to set clear parameters when it comes to service adaptation to ensure they do not step too far away from their original mission, and that they have the appropriate capacity and skills to deliver: ‘Focus on what you’re good at and do as much of it as you can’.

 

For some, this is clear cut. Others are finding themselves ‘tip-toeing’ into new or altered activities (e.g. evening and weekend shifts), leading to deeper questions about organisational boundaries and, at times, the need to review charitable objectives: ‘We had one trustee say “you can’t do that”.  But we said “we have to do this to support people”. This might be something people have to think about – changing charitable objects’.

 

  1. Scenario planning

 

As things remain unclear and are constantly changing, many leaders are turning to scenario planning as a way of fulfilling their dual role of strategist and visionary. This ensures that long-term implications are being acknowledged without committing to a particular course of action, continuing to ‘take each day as it comes’

 

‘It’s important to not be over-planning for the future as we are still in uncertain times. Planning for what’s important for now, and what’s pointless for now is also as important.’

 

  1. Working together

Leaders are recognising that, by coming together to collaborate with partners, they can effectively coordinate services and strengthen the sector’s voice to highlight the impact of Covid-19 on organisations, communities and individuals:   

 

‘A natural reaction is to focus internally, but from experience, partnership working is a lifeline and will keep us afloat.’

 

 ‘All of this needs to be done with the thinking and humility that we’re all in the same boat and none of us have the perfect answer.’

 Examples include:

 

  • Signposting to alternate provision
  • Advocating for the needs of particular groups (e.g. the homelessness sector working with the Greater London Authority to address housing need)
  • Supporting people who they wouldn’t usually, because they know that the organisation who normally does this is inundated

 

  1. Listening

Some are investing time in actively listening to the changing needs of their beneficiaries, either through specific surveys or via ad hoc interactions.  This intelligence is being used to help shape organisations’ own responses as well as to ‘actually see what’s happening so that we have some data we can go back to government with … and say “some of the solutions you need to put in place are xyz”’.

 

  1. Talking to funders

VCSE leaders are having honest, open conversations with funders about what can and can’t be delivered, and what impact this will have on outcomes for existing grants and contracts.  While much of this has been initiated and enabled by funders themselves, it feels important to note the courage and clarity it requires from VCSE leaders to be able to make these decisions, and to articulate what is possible when under extreme pressure.

 

__________

 

For the foreseeable future, VCSE leaders will be called on to continually review and reshape their work – in line with shifting government guidance and increasing understanding of what existing and prospective beneficiaries need: ‘No one knows how to feel or respond at the moment. There is no right or wrong way to support people’.

 

In this context, VCSE leaders are remaining steadfast: holding their nerve; making clear, resolute decisions; balancing optimism with realism; and doing everything possible to protect the welfare and motivation of their workforce to ensure they can continue to deliver high quality – albeit slightly altered – services to those who need them most.