The Welsh NHS Confederation response to the Equality, Local Government and Communities Committee’s inquiry into the impact of COVID-19 on the third and voluntary sectors in Wales.

Contact:

Nesta Lloyd-Jones, Assistant Director

Date:

3 November 2020

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Introduction

1.    The Welsh NHS Confederation welcomes the opportunity to respond to the Equality, Local Government and Communities Committee’s inquiry into the impact of COVID-19 on the third and voluntary sectors in Wales.

 

2.    The Welsh NHS Confederation represents all the organisations that make up the NHS in Wales: the seven Local Health Boards, three NHS Trusts and Health Education and Improvement Wales (HEIW). We also host NHS Wales Employers.

 

3.    Since the beginning of March, our priority has been supporting and representing our members to respond to COVID-19. Our engagement with members has focused on the active support of Executive Director Peer Groups’ response to COVID-19, including NHS Chairs, Chief Executives, Assistant Medical Directors and the Workforce and Organisational Development (W&OD) Directors.

 

4.    In addition to supporting members, we have been working closely with partners across the health and care system to ensure we can provide a ‘whole system’ perspective. Throughout this time, we have continued to engage and work with our stakeholders, including Royal Colleges, third sector and social care organisations, to respond to the pandemic so that we can highlight any issues and offer potential solutions to Welsh Government. We held bi-weekly remote meetings with members of our Policy Forum, an informal network of over 60 health and care organisations, including third and voluntary sector organisations and the Wales Council for Voluntary Action (WCVA). These have proven to be invaluable to share intelligence, discuss updated Welsh Government guidance and establish shared strategic priorities.

 

5.    The Welsh NHS Confederation Policy Forum recently published Delivering a sustainable seamless health and social care system: Our priorities for the next Welsh Government, which was endorsed by over 30 health and social care organisations, including several third and voluntary sector organisations. The briefing emphasises the important role that the third and voluntary sector plays in protecting the health and wellbeing of the communities they serve and the vital role of the sector to the delivery of NHS and social care services.

 

Background

6.    The challenges posed by COVID-19 are considerable. Since March, the health and care system has experienced unprecedented demand on its services. NHS organisations have shown flexibility and innovation throughout this period by delivering a remarkable response to COVID-19. This response could not have happened without the excellent partnership working across Wales with local government, the voluntary sector, and the private sector. The response to the pandemic has accelerated partnership working, bringing together service delivery in a much more integrated way. To date, the Welsh NHS Confederation has published six briefings to highlight just some of the partnership working across Wales to support the response to COVID-19. From increased digital services to support people to stay at home and maintain social relationships with friends and family, to providing meals to frontline staff and vulnerable people, and providing vital frontline support and expertise within the NHS and social care settings, partnership working and collaboration is an essential component to supporting the NHS and its services.

 

7.    NHS leaders have always valued the significant contribution the third and voluntary sector makes to supporting the health and wellbeing of the population. NHS leaders recognise that third and voluntary sector organisations are mutual partners who work hand in hand with them and have the skills and expertise to improve patient and service user experience and outcomes. All NHS organisations in Wales work in partnership with the third and voluntary sector by commissioning the sector to deliver health and social care services. As highlighted by the WCVA, nearly 100,000 people are employed in the third sector in Wales across 32,000 organisations and more than 8,000 registered charities.

 

8.    The influence and reach of third and voluntary sector organisations is not limited to supporting the delivery of health and care services. The sector also plays a vital role in the prevention and wellbeing agenda through: supporting the provision of health and care information; patients and service user advocacy; enabling people to maintain their independence, health and wellbeing in their own home and in their community outside of NHS settings; and improving people’s quality of life and community cohesion by supporting volunteers and volunteering opportunities.

 

9.    The third and voluntary sector also plays a significant role in engaging with health and social care services when the NHS, and other public sector bodies, consult on new services or service change. Within Welsh Government’s long-term plan for health and social care, A Healthier Wales, there is a clear emphasis towards community-based models of health and social care that cuts across traditional organisational boundaries. This has enabled third and voluntary sector bodies to take on a more enhanced role in supporting people and communities in their area, including through engaging with Regional Partnership Boards (RPBs) and Public Service Boards (PSBs).

 

10. Since the outbreak of the COVID-19 pandemic, the role that third and voluntary sector organisations play in supporting people to stay safe, healthy, and active has been further evidenced. A number of new community groups across Wales have been set up and thousands of additional hours have been provided to support communities, especially the most vulnerable. From supporting people shielding or vulnerable groups with daily amenities like food shopping and picking up prescriptions, to supporting and arranging homecare visits and providing advice around benefits and wellbeing support, the work of the sector has encapsulated a spirit of community and togetherness that NHS leaders are committed to building on in future.

 

How the third and voluntary sectors have worked in partnership with the NHS

11. This year has seen innovation and service delivery carried out by third sector organisations in different ways to ensure that communities and individuals continue to be supported.  In our briefing, Cross-sector partnership working to support the response to COVID-19 in Wales, we highlighted some of the ways that NHS Wales organisations are working with other sectors, including the third and voluntary sectors, to support people to stay active, healthy, and safe. Below are just three examples that we have highlighted in our briefings. We are aware there are many other examples we could have included to highlight how the sector has provided significant support to the NHS and people across Wales.

 

Volunteers recruited to deliver Age Cymru’s ‘Friend in Need’ service

12. Age Cymru launched the ‘Friend in Need’ service to help tackle loneliness and isolation among the over 70s due to social distancing, self-isolation and shielding during the COVID-19 pandemic. Older people can connect with a trained and vetted Age Cymru volunteer for a free weekly friendship call. Funded by the Welsh Government, and with the support of the WLGA and Volunteering Wales, the service was launched during Volunteers’ Week in June.

 

13. The initiative also supports friends or neighbours who are providing informal help to older people and others who are social distancing, self-isolating, or shielding with activities such as shopping or collecting prescriptions. Since the beginning of the Spring lockdown, the charity has made more than 10,000 calls to older people who are lonely or isolated and handled more than 3,000 enquiries to its advice line.

 

14. Potential volunteers are interviewed by telephone, asked to submit two references, and to forward a DBS check if they have one. Age Cymru provide online training, then match the volunteer with an older person for a 30-minute weekly telephone conversation. The charity also provides ongoing support to the volunteer.

 

Volunteers working to improve outcomes for patients on hospital wards

15. Royal Voluntary Service (RVS) volunteers are working closely with clinical teams to improve outcomes for older patients on hospital wards. In clinical settings, they help with exercise and activity sessions, and in the community they support a prevention-based service which focusses on nutrition, physical wellbeing, and social connectivity.

 

16. At St David’s hospital and Llandough hospital in Cardiff and Vale University Health Board, volunteers are supporting patients with chair-based exercises to build strength and mobility. Exercise sessions focus on building muscle strength in the core, arms and legs while replicating the day-to-day movements that older people may struggle with. Group sessions also aim to reduce anxiety and loneliness. So far, 61 volunteers have contributed 1,180 volunteer hours (the value of this, as estimated by the Kings Fund, is £12,980) supporting 158 patients over 16 months.

 

17. During the spring lockdown, the service implemented a contingency plan. Both aspects of the service, on the ward and in the home/community, have been adapted to provide a telephone befriending service. Support has also been offered to other hospitals and other organisations, such as Care and Repair. Volunteers and staff have been assisting clients with wellbeing phone calls and the offer of shopping/delivery services.

 

18. RVS has secured funding for this work until 2021 from The People’s Postcode Lottery. It is recognised as a ‘seed and scale’ project which has the potential for wider adoption across the UK.

 

The Swansea Voluntary Council Service

19. Through the Swansea Voluntary Council Service (SVCS), volunteers have been delivering prescriptions on behalf of pharmacies throughout the pandemic. Amy Meredith-Davies, Health and Wellbeing Partnerships Manager for SVCS, said: “We’ve worked in partnership with 4x4 Response South Wales, a volunteer force operating throughout South Wales. They have been truly amazing in delivering prescription medication along with numerous other requests that they have been dealing with during this COVID crisis, such as delivering food parcels.”

 

Volunteers

20. Our members welcomed the co-ordinated approach that Welsh Government took, through Volunteers Wales, to develop a volunteering environment that is right for the NHS and Welsh communities. Across Wales a significant number of volunteers were recruited and deployed into health and care roles at the beginning of the pandemic. This involved a considerable amount of work to set up the procedures and protocols between, and across, the third and statutory sector to enable this to happen.

 

21. In relation to volunteering within NHS settings, volunteering supports build NHS organisations capacity, improves patient experience and patient outcomes and develops career pathways. Across NHS organisations in Wales there are volunteering teams who have a variety of volunteer approaches and opportunities which have made significant contributions distinctive from those made by the NHS workforce.  

 

The impact of COVID-19 on third and voluntary sector organisations in Wales

22. Our members recognise the COVID-19 pandemic has brought about acute challenges for third and voluntary sector organisations in Wales. Organisations with a high reliance on traded income (sale of services, tickets, or retail through their shops) or voluntary income from individuals (including individual donations, events, and community fundraising) have seen income fall dramatically. This has led to a reduction in service provision in some cases, workforce pressures due to staff shielding/ isolating, furlough or redeployment of employed staff and uncertainty about their organisation’s future and possible job losses.

 

23. In addition, at a time of decrease in income, the third and voluntary sector has had to manage and invest in infection control and social distancing, deal with increase in enquiries, exponential growth in volunteer requests and multiple new volunteer groups being established to help respond to the pandemic. Third sector organisations in Wales mobilised very quickly to support the emerging needs of a changing community and support staff and volunteers in this new and challenging time.

 

Impact on income and expenditure

24. We are aware that third sector organisations who are involved in the front-line response to COVID-19 are reporting increased costs due to additional work or the need to adapt established premises to ensure safe delivery models e.g. funding the supply signs, sneeze screens, PPE, gel dispensers and hands-free bins

 

25. Many third sector organisations have had to furlough staff or redeploy staff to areas of work that came under the greatest strain to respond to COVID-19, including dealing with enquiries, sourcing PPE and working on implementing and communicating Welsh and UK Government guidance, which has been very complex and difficult to navigate, especially as this became increasingly divergent post the initial UK wide lockdown. Many organisations initially lost their long-standing volunteers due to them having to shield and thereby losing volunteer hours. This has meant many established pre-COVID services have not been available and in some circumstances, there has been delays in starting planned projects and services, causing increased anxiety, disruption, and uncertainty for service users. However, redeploying staff to deal with the overwhelming enquiries has enabled some organisations to swiftly answer the growing demand of public enquiries.

 

26. Many organisations have missed out on funding opportunities due to staff being furloughed, while others have been able to gain more funding as they have had more free time to write bids and seek available resources. Third sector organisations with a strong reliance on grant funding are typically finding themselves the most financially secure. Those in receipt of grant funding are reporting ongoing support from funders, including the ability to apply discretion to change funded delivery models or programmes to meet the challenges of COVID-19.

 

Impact on service users

27. Like many other sectors, staff working in the third and voluntary sector have had to work from home and change the way they work to keep services running. Organisations have had to adapt how they engage with people, clients, and their families, switching from visiting people face to face in either hospital or their home to telephone consultations.

 

28. In many cases, the use of virtual methods of delivery facilitated even greater numbers of users supported and across a greater geography, with none of the usual travel and transport difficulties that can be experienced in rural parts of Wales. This often exceeded the contracted levels of activity, at no extra cost, providing greater value and leverage of public monies.

 

29. While for many technology channels have been more convenient and flexible, some organisations have found that virtual delivery does not fully meet the needs of their clients/ service users, such as those providing support for mental health or advocacy. This is partly because they depend on a person’s capacity to adequately explain their current situation orally, but mainly because they rely on self-reporting. Often a home visit for one issue reveals many more, either through conversation with the client or using a caseworkers’ expertise to spot where additional help might be needed. Similarly, telephone consultations are not always appropriate for people with hearing difficulties, or other disabilities, which is an additional barrier to access.

 

30. In addition, there have been challenges with supporting people to live in their own homes independently due to the home adaptations not always being available. The pandemic has exacerbated problems associated with unsuitable housing for an individual’s needs that already existed before the pandemic. Organisations supporting people to live independently in their own home have been unable to address any risks or hazards in the person’s home due to significantly reduced capacity and the inability to connect with people face-to-face. Going forward, the backlog this has created will create additional strain on organisations’ caseworkers and agency staff.

 

31. There has also been a record number of enquiries from the public asking for support with shopping, collection of prescriptions, or someone to call them as they are lonely and anxious. This has been difficult for some third sector organisations due to staff being furloughed, as highlighted above.

 

Funding available for third sector organisations

32. Funding is a prominent issue for the third sector as fundraising activities were curtailed. Our members welcome the financial support provided by the Third Sector Resilience Fund and the Voluntary Services Emergency Fund. The funding has enabled staff and volunteers to continue to play a vital role in Wales’ COVID-19 response, enabling people to stay healthy at home.

 

33. Where funding was routed locally, it enabled greater co-ordination and built on the existing collaboration and partnerships in place locally. It helped to join up the service delivery and develop networks, acting together to respond across communities and providing greater value for the public purse. However, with the number of external funding sources available for the third sector to access, it led to significant demand on staff time and has been resource intensive to complete different application processes and monitoring requirements, detracting staff from service delivery.

 

34. While the financial support outlined above is welcomed and will undoubtedly enable the continued operation of many third and voluntary sector organisations in the short to medium term, we share the concerns of the WCVA around the lack of certainty about the level of financial support from April 2021 onwards. Even for relatively stable organisations, the longer-term impact of the decrease in fundraising revenue will likely lead to an increased dependency on financial reserves at a time when demand for third and voluntary sector support is likely to be high. It will be increasingly important to have a long-term funding strategy for third sector organisations to ensure the sustainability and resilience of the sector going forward.

 

The important role of third sector in devolution

35. The third and voluntary sector has a key role to play in devolution and in influencing policy, legislation and services in Wales. Through engaging with Members of the Senedd and public sector bodies, including the NHS, they ensure the needs of the people they support are met and campaign to improve service provision.

 

36. Third sector organisations’ activity is a vital part of Welsh democracy. Without the contributions made by public affairs professionals working within third sector organisations, Welsh Government policy and the legislation passed by the Senedd would not be as effective as they have been. Third sector organisations provide a key role in ensuring that underrepresented groups in society are given a voice through their public affairs, campaigning, research, policy, and communication work in Wales.

 

37. There has been several instances where public affairs professionals working within third sector organisations, either as individual organisations, as part of alliances or task and finish groups, have worked with Welsh Government and Senedd officials to develop and improve policy and legislation. For example, the Social Care and Wellbeing Advisory Group, which consisted of a group of 20 organisations representing thousands of children, older and disabled people who rely on social care, provided significant support and insight to the Health and Social Care Committee when the groundbreaking Social Services and Well-being Act 2014 was proceeding through the then National Assembly during the Fourth Assembly.

 

38. Third and voluntary sector organisations also act as a champion for vulnerable people whose voices might otherwise go unheard. With significant experience of addressing complex needs and providing preventative support through person-centred approaches, the sector is well placed to support NHS Wales organisations, Local Authorities, and communities to redesign and deliver devolved public services and campaign and influence for change.

 

39. Due to the ongoing financial constraints as a result of COVID-19, we are aware of many UK wider organisations who are restructuring, with staff working in Wales being made redundant. We are aware of one UK wide third sector organisation’s fundraising income being reduced by 40%, with the impact being felt in the devolved nations with senior roles in Wales being removed and the roles and responsibilities being transferred to one individual in Scotland covering Wales, Northern Ireland and Scotland.

 

40. This is an important point to consider within the context of greater powers being devolved to the Senedd in recent years and the uncertainty that stems from the UK’s departure from the European Union (whether a deal is struck or the UK leaves without a deal in place). In addition, as political parties are currently developing their manifestos for the 2021 Senedd election, third sector organisations are key to provide information, research, knowledge and intelligence which enable political parties to put forward calls and pledges that will improve services for the people of Wales.

 

Conclusion

41. Our members recognise the significant contributions third and voluntary sector bodies have made and continue to make in responding to the pandemic. There are many benefits for statutory partners in having a well-resourced, strong, sustainable third sector and we hope the essential nature of third sector services and the value they bring will continue to be acknowledged.