During the Covid-19 pandemic, the Government Outcomes Lab had an extensive network of leaders across sectors providing valuable insights into how services delivered through cross-sector partnerships are coping with the Covid-19 pandemic. Here, we provide a summary of these insights, to help the entire community learn from one another on how to adapt and respond.
We looked at a range of topics:
Please note the responses described here are anecdotal. They may not reflect general or widespread practice. They should not be taken as an endorsement of any particular approach.
Most services went fully remote when the UK government announced the restrictions on movement. A few services have since been put on hold indefinitely.
Services that have moved to remote delivery are having to work through the practicalities of this. Management patterns and styles are having to change. Technology needs to be provided, not just to frontline workers who don’t already have it, but also in some cases to service users. Even where service users have a device, they may not have the requisite data connection or sufficient data allowance to be able to use it.
Services that delivered one-to-one interaction have found the shift to remote working more straightforward than services which delivered to groups of people (e.g. school-based services). These have the additional challenge that the group is dispersed, so either delivery needs to change to one-on-one – considerably adding to the resource requirement – or one-to-many has to be attempted virtually, which can be even more challenging for vulnerable groups. Staff are being creative with the type of activites they set that can be done alone in the home.Some places are investigating whether qualifications can be delivered through remote learning.
Generally services feel that remote contact with service users is less effective than face-to-face, and expect outcomes to be worse as a result. Relationship development between staff and service users in particular is harder when done virtually. But some services are reporting that for certain groups it can be more effective e.g. young people.
In many cases the reduction in face-to-face contact is being compensated for by an increase in the total amount of contact – either increased frequency or increased duration (which is now made remotely, of course). This can create an additional resource burden.
Some services have retained a limited face-to-face service alongside a remote offer:
Continued face-to-face working creates a need for organisations to supply appropriate Personal Protective Equipment [PPE] to their staff).
Some services have had to face the additional challenge of ensuring safe social distancing from other service users – for example, residential care services, sheltered accommodation or daycare services.
In some places it seems frontline workers are reducing their reliance on the usual processes and trusting their own judgment. They may be doing this of their own accord, or may be called upon to do so.
Similarly, some licensed services which demand a high degree of fidelity to a pre-determined model are being given more flexibility to innovate – this includes a move to remote support, of course, with other types of innovation encouraged to ensure ongoing engagement of service users.
Some services are being called upon to provide additional services not part of their usual offer. Services whose usual service is closest to the new needs arising are able to adapt the quickest.
Referrals patterns into services for vulnerable people are changing, but not in a consistent way. Some services are seeing falling referrals, while others are seeing heightened demand (but sometimes for services which fall outside the usual scope of what is provided). Some services have decided to stop taking on new referrals altogether at this time.
Closure of schools may be causing a drop in referrals in some cases, but this does not necessarily mean needs are decreasing. Similarly, many people with long term conditions are not able to go to hospital at present, potentially exacerbating needs even as referrals decrease. Where referrals are made from other parts of the system which are under strain, referring users on may not be a priority even when there is a need.
Some providers are working with their commissioners to simplify referral processes or establish new referral sources from other groups who may be in need at this time. Where demand is increasing, providers and commissioners need to agree on funding for increased volumes of service.
For housing-related services, the moratorium on evictions may in fact reduce demand for homelessness support services. But a similar effect may also trap people in undesirable domestic situations e.g. with an abusive family member.
There is a lot of concern amongst services who anticipate a huge increase in demand once social distancing measures are lifted.
Many vulnerable service users struggled to access food or medicines during the lock-down, and had limited social networks to step in. The mental wellbeing of many groups was already a concern.
During this time, there was a concern that some service users might try to turn to overstretched health services as a result, even though their needs could be addressed outside of primary care – so there was a need for services to step in to protect the health services.
Domestic Violence and ‘Edge of Care’ services were already reporting spikes in demand in some places.
Substance abuse recovery services was considered less effective when delivered remotely, which potentially led to these service users to regress.
Highly vulnerable populations such as rough sleepers were at heightened risk. Some people in these groups who may have relied on day-to-day activity in the wider economy to sustain themselves and were no longer be able to do so. Public spaces that they may have made use of during daytime for shelter or personal hygiene were closed.
There was some concern that amongst the many sources of information, vulnerable service users would access poor quality services or be unable to access the most relevant sources of information for their situation. There were many practical questions such as whether families could still access free school meals, how the ban on private evictions worked, and who was eligible for the 80% salary subsidy.
Some service users chose not to engage at all during the period of lockdown.
Sickness absence increased. Some services trained additional staff members to be able to deliver their service, so as to be able to provide cover if needed.
Some services saw staff redeployed onto other aspects of coronavirus response (such as food delivery), so had to deal with the additional burden of reduced staffing.
Staff mental wellbeing was a concern.
Many frontline staff have a lot of questions about sickness pay, lone working, whether it is possible to work from home (and how to be protected from the virus if not), and whether they are considered to have key worker status and therefore whether they should continue to work at all.
Some providers provided virtual training on how to manage remote teams, and maintain employee wellbeing. Other produced information packs to provide clear guidance to their staff on the above issues.
Some services suggested that it is possible that the impact of reduced time spent travelling between client sites resulted in teams being able to work with higher volumes of service users.
Some services were already looking ahead to the easing of restrictions and the impact on staff who would already be overwhelmed and fatigued and therefore unprepared for an anticipated huge increase in social needs following long periods of isolation.
Some services started to collect additional information about service users to try to more accurately determine risk levels.
Forms of data collection that required face to face meetings (e.g. for a medical test) or signatures for accountability purposes were relaxed for the duration of the COVID-19 emergency situation.
Some places adapted by launching or co-ordinating new services.
Some services saw a huge and sudden demand for emergency support. In some cases this was provided directly through the re-direction of existing resources. In others it was referred on to others to provide.
Voluntary action increased. In some places community groups were delivering, but these efforts were often uncoordinated and the usual attention paid to issues of safeguarding vulnerable people not not always adhered to.
Some examples of the type of new initiatives that were seen include:
Like many businesses, providers of services were concerned about their financial viability.
The providers whose situation we had some awareness of were either seeking ways to continue to provide their service remotely, or adapting their service to the changing circumstances and needs. In many cases they were doing this despite ongoing uncertainty around their future funding sources, but did not expect to be able to do this indefinitely. Voluntary sector providers were concerned about a loss of donations now and in the future.
Certain types of contracts had payment structures based on volume of service or outcomes achieved, such as outcomes contracts or operating under social impact bonds structures. These services had to additionally consider how the disruption will negatively affect their ability to provide the service and therefore achieve target outcomes. Even if adequate contingencies could be made for service delivery (such as remote provision), in some cases it was still impossible to gather the required evidence of outcomes achieved remotely.
There were different options being explored by different services. The provider’s preference in some cases was to continue providing services but to put the outcomes contract on hold, and shift to grant or fee-for-service payments for at least the duration of the lockdown - based on agreed amount that covers the cost of the service. This amount could either be deducted from the total expected contract value, or the contract could be extended so that it could “pick up where it left off” when things returned to normal. Not all commissioners were expected to agree to this shift to fee-for-service, though providers (and social investors backing them) were concerned they were being asked to bear too much risk otherwise.
The alternative was to negotiate changes to the payable outcomes themselves – either changing the definition of some or all of the payable outcomes, adding entirely new payable outcomes that better aligned with the current priorities for the service users, or increasing payment amounts to secure service viability. These types of changes could be used to accommodate the shift to virtual support, or changes to the type of support offered – for example, virtual learning could cover different topics to in-person learning, or the type of accommodation that someone could be provided with during that time was different from what was anticipated.
For social impact bond contracts that had the involvement of an investor carrying some or all or the risk of outcomes not being achieved, there were additional considerations. These depended on how the contracts were structured. It meant providers needed to delay repayment of capital. Or, where investors carry all the risk and pay the providers on a fee-for-service basis, it meant re-assessing any performance bonuses and penalties imposed on providers in the light of the reduced likelihood of meeting targets.
Commissioners in general seemed to be willing to discuss options, but also had to re-direct some of their time and resources to support the wider system, as people who weren’t particularly vulnerable before the crisis were now extremely vulnerable.
The risk profile of contracts may have increased after the end of the crisis. The legacy economic effect was expected to create increased demand for services for vulnerable parts of the population long after the end of the period of lockdown. It also made outcomes harder to achieve for certain services, for example those aimed at increasing employment if there is a recession and fewer jobs. (Some services already reported job offers being withdrawn and redundancies being made for their service users). These factors meant providers / investors wished to negotiate targets downwards more permanently, or requested extensions to the contract to give longer to achieve them.
Some projects that were nearing contract signing have been put on hold, either by the commissioner or provider (and / or investor in the case of a social impact bond). Others that were still in the mobilisation phase (i.e. gearing up to delivery) have had their start delayed until the end of the social distancing / lockdown period. Those yet to launch were considering whether to launch with adjusted service offers, or using a different type of contract that might be more suited to the current scenario.