SVL0020

Written evidence submitted by British Red Cross

British Red Cross submission to the Public Accounts Committee

Covid-19: Supporting the vulnerable during lockdown

February 2021 

1. About the British Red Cross 

1. The British Red Cross has more than 19,600 volunteers in the UK and nearly 3,900 staff. We are part of the world’s most wide-reaching humanitarian network, the International Red Cross and Red Crescent Movement, which has 17 million volunteers across 191 countries.

• Before Covid-19, we responded to an emergency every four hours, from house fires to terrorist attacks. We provide practical and emotional support when it is needed most, and support individuals and communities to prepare for, respond to and recover from emergencies. 
• During Covid-19, we have reached over 1.5 million people in the UK since March 2020, providing food, medicines, emotional and wellbeing support, transport to and from hospital as well as providing a range of education resources online.
• The British Red Cross Hardship Fund provides one-off, small cash grants to people facing financial hardship due to Covid-19. Since March 2020, we have distributed over £2.4 million in cash assistance to more than 10,000 people.
• We run a free Covid-19 support line open 7 days a week. Since the start of 2021 we have seen an increase in calls coinciding with the return to lockdown. The most common reason for calling is needing food.
• We are the largest independent provider of support to refugees and people seeking asylum in the UK. Since March 2020 we have supported over 32,000 people across 58 different cities and towns, including people who are being accommodated in hotels and military barracks.
• We collaborate with voluntary and community sector partners, such as through the Voluntary and Community Sector Emergencies Partnership[1] which the British Red Cross co-chairs, and with statutory partners to provide holistic support to communities during and after a crisis strikes.

The contents of this submission are based on our operational experience, insights from our partners as well as British Red Cross research exploring people’s needs during Covid-19.

2. A summary of British Red Cross recommendations

2. The British Red Cross continues to call on governments across the UK to fully meet the humanitarian needs of the individuals and communities most vulnerable to hardship under Covid-19 restrictions.

3. As in any emergency, everyone living under Covid-19 restrictions should have access to clear and accessible information, financial support, shelter, emergency food, psychosocial support and social connections. To achieve this, the UK government and its partners should:

• Ensure everyone can afford basic essentials, such as food, toiletries, warm clothes, data and heating under Covid-19 restrictions – local or national. This should be achieved by investing in and promoting discretionary emergency support, such as Local Welfare Assistance scheme, and where possible, using a cash-first approach.[2] The Department for Work and Pensions (DWP) should invest at least £250 million per year in local welfare assistance over the longer-term to give local authorities the confidence and certainty they need to develop an effective local welfare offer.
• Prioritise reaching people in the most vulnerable situations so they can access the support they need. Active outreach should be undertaken by practitioners who provide practical and emotional support, with a focus on reaching individuals not currently in receipt of help, when additional restrictions are put in place in local areas.
• Ensure those with the greatest mental health and emotional needs can access the support they need to cope and recover from Covid-19. This should include targeting support towards those living alone, the clinically vulnerable and clinically extremely vulnerable, as well as their carers and households.
• Tackle digital exclusion and proactively enable people to connect with others either in-person or virtually. Government should continue to work with local government, the telecommunications industry, the voluntary and community sector and isolated people themselves to rapidly address digital isolation. At the same time, policies that allow people to meet outdoors and that allow people from single person households to form support bubbles should continue as long as it is safe to do so.
• Establish effective early warning systems for local emergency response partners, including local authorities, health bodies, the voluntary and community sector – and specifically the Voluntary and Community Sector Emergencies Partnership (VCSEP) – in areas that are about to enter into new or additional restrictions to better enable an effective and well-planned human-centred response.[3]
• Provide accessible, clear and consistent information about local restrictions at a local and national level. Government guidance on the rules, restrictions and support available during the coronavirus pandemic should be provided in multiple languages, as standard.

[Detailed recommendations sitting underneath each are explored in Sections 3 - 6].

3. Defining vulnerability

4. Throughout most of the pandemic, government’s definition of vulnerability has primarily focused on people who are clinically vulnerable or clinically extremely vulnerable (CEV). This refers to people who are at high risk of severe illness from coronavirus and is linked to specific medical conditions and treatments.[4][5]

5. At the British Red Cross, we recognise that many people experience vulnerability for a range of different reasons; clinically, linked to a specific medical condition, or economically and socially (i.e. loneliness and social isolation).

6. We believe it is important to apply a wider understanding of vulnerability, focusing not only on those who are clinically vulnerable but considering social and economic vulnerability as well as wider health and wellbeing needs too. From our services, we know that a wider cohort of people are vulnerable and are being left unsupported, and all too often fall into hardship:

• Around a fifth of calls to the British Red Cross support line come from areas facing high levels of deprivation, and we are hearing from more people with complex or multiple needs.
• In addition, 36% of those receiving British Red Cross Hardship Fund payments have No Recourse to Public Funds (NRPF), while others face issues including delays to benefits, homelessness, or domestic violence. Around half of those receiving the Fund identified as being from a Black, Asian and minority ethnic (BAME) background. These groups are falling through the gaps of support and highlight significant inequality.

7. Within this submission, we consider vulnerability to encompass clinical, social, and economic factors, as well as wider health and wellbeing needs. This is rooted in our research and on the ground delivery providing practical and emotional support when it is needed most.

4. A summary of the impact on people and communities of Covid-19 lockdown and local restrictions

8. Since the pandemic began, the British Red Cross has published multiple pieces of research exploring the experiences of people in vulnerable situations. These include:

• Life After Lockdown: tackling loneliness among those left behind, June 2020[7]
• Access to Food in Emergencies: learning from Covid-19, July 2020[8]
• Lonely and Left Behind: tackling loneliness at a time of crisis, October 2020[9]
• 590 people’s stories of leaving hospital during Covid-19, October 2020[10]
• The Longest Year: life under local restrictions, February 2021[11]

9. The Longest Year: life under local restrictions, explores the experiences of people and organisations living and working in areas that have been under tighter local restrictions across the UK, with a focus on those in particularly vulnerable situations. This research is particularly relevant to the Committee’s inquiry and provides recommendations of how to provide targeted local support.[12]

10. This research found that living under restrictions has, over time, affected people’s livelihoods and mental health. We’ve spoken to people worried about losing their jobs and people who are unemployed and struggling to find work. In some cases, people are facing impossible choices between buying essentials like food, heating, or clothing for their children. A prolonged lack of in-person contact has made others feel lonely and depressed, made worse by a notable drop in support from friends, family, neighbours and statutory organisations since the initial national lockdown. Some have felt “trapped” and like “prisoners in their own homes”, and many don’t know where to turn to for help.

11. The support, information and advice offered under tiered restrictions has often felt different in comparison to that offered under national lockdown, and ultimately lacking. To summarise, people are:

• Struggling more financially[13] and, in some cases have not been able to access essentials, such as food.[14]
• Struggling with their mental health and loneliness, which is reducing people’s individual resilience and ability to cope.[15]
• The pandemic has both exacerbated inequalities and pushed new people into hardship.

12. Key findings from our latest research, The Longest Year, include:

• Many people are reluctant to reach out to organisations for support, particularly those who are struggling with their mental health. More than half of UK adults (55%) find it hard to talk about their problems when so many people are having a difficult time.
• People struggle to distinguish between national lockdowns and local restrictions, meaning for most under local restrictions, lockdown has felt “never-ending”. 75% of people say they find it easier to limit how much they leave their home than to keep up with changes to restrictions.
• Some people feel support under local restrictions is less readily available than under the national lockdown in March 2020, and people don’t know where to go for help. Two fifths of UK adults (40%) say they are not confident about where to go to access financial support and more than a third (36%) were unsure how to access emotional support.
• People have been struggling financially under local restrictions and, in some cases, are having to choose between buying essentials like food, heating, or clothing for their children. 39% of people who said that financial support for essentials such as food, clothes and toiletries would be helpful for them were not able to access this support (this represents 5% of the total UK population), and 43% of people who said that financial support to self-isolate would have been helpful to them were not able to access this support (this represents 4% of the total UK population).
• A lack of social contact with others, and the negative impact this is having on people’s mental health, is one of the biggest challenges associated with local restrictions. While the majority of UK adults (66%) said they are confident they can cope with changes to their life that may be caused by the Covid-19 pandemic, and that they will be able to recover afterwards, a significant minority of 10% disagree. People with a disability are more likely to feel they cannot cope (16%) compared to those without a disability (8%), as are females (13% say this, compared to 7% of males). Of those who feel they can’t cope or recover from the impact of the pandemic, mental health (71%), missing friends or family (62%), lack of social contact (60%) and households finances (44%) were cited as the biggest challenges.

5. Mental health and loneliness

13. The short and long term social and economic impacts of Covid-19 have and will likely continue to exacerbate mental health and loneliness, presenting new challenges for people and services.[16] Our research, The Longest Year, exploring the impact of local restrictions suggests that the biggest impact of living under continued restrictions is on people’s mental health.[17] While this has impacted people of all ages and from all backgrounds, participants living alone, those who are clinically vulnerable or CEV, and

those caring for others felt particularly isolated and despondent.
 

14. The short and long term social and economic impacts of Covid-19 have and will likely continue to exacerbate mental health and loneliness, presenting new challenges for people and services.[18] Our research, The Longest Year, exploring the impact of local restrictions suggests that the biggest impact of living under continued restrictions is on people’s mental health.[19] While this has impacted people of all ages and from all backgrounds, participants living alone, those who are clinically vulnerable or CEV, and

those caring for others felt particularly isolated and despondent.
 

15. Many had stuck with the routines they had begun during the first national lockdown which meant they have continued to isolate at home, even when the rules allowed them to get out and about. This means that some people, and especially the clinically vulnerable and

CEV, have, in effect, been shielding since March.
 

16. Previous British Red Cross research, Life after lockdown, published in June 2020 found some communities have been at greater risk of loneliness than others:

• people from BAME backgrounds,
• parents with young children,
• young people aged 18 – 24 years old,
• those living with long term physical and mental health conditions,
• people on lower incomes and
• those with limited access to digital technology and the internet.
   

17. Our report, Lonely and left behind, published in November 2020, explored the experience of people shielding and isolating during Covid-19. It found:

• Feelings of loneliness have remained high or worsened for many vulnerable people throughout the pandemic, especially as those who continued to shield as the rules relaxed in Summer 2020 watched others resume their social lives.[20]
• People who are lonely feel less able to cope. There was a sharp rise in the number of people who said they felt too lonely to cope with the Covid-19 crisis from May to September 2020 (from 19% to 39%), and two in five UK adults told us loneliness is having a negative impact on their mental health.
• People often don’t know how to help themselves and others with loneliness. The pandemic and lockdown restrictions have had a significant impact on people’s strategies for managing loneliness and many find it too difficult to talk to others about their feelings.
• People were worried further lockdowns and winter risked entrenching feelings of loneliness.
   

18. To tackle the worsening impacts on mental health and loneliness, the British Red Cross recommends that:

• The Department of Health and Social Care (DHSC), working with the new cross-government group of ministers established to consider and address the longer-term impacts of the pandemic on mental health and wellbeing, should ensure local health systems have the capacity, resources and skills to meet the mental health and emotional support needs, including loneliness, of those most at risk.[21] This should include those living alone, the clinically vulnerable and clinically extremely vulnerable, as well as their carers and others in their household.
• Emergency response partners, including local authorities, the NHS and the voluntary and community sector, should work together to offer psychosocial support[22], including support with loneliness, to anyone being advised to shield, take extra precautions or self-isolate.
• The Ministry of Housing, Communities and Local Government (MHCLG), DHSC, and DWP should work together to attach psychosocial support to other public services that are likely to encounter those most in need (such as those accessing mainstream benefits, and local authority emergency food support).
• MHCLG, Department for Digital, Culture, Media and Sport (DCMS) and DHSC should support local authorities to promote advice and information about how to overcome loneliness and support friends and family members that may be struggling emotionally. This should always be published alongside communications and correspondence about restrictions in place locally and should include information about support available in the local area.
• DCMS and DHSC should ensure that local restrictions guidance continues to allow support bubbles for single person households, and meeting an individual from another household outdoors, as long as it continues to be safe. These exceptions should be promoted clearly in guidance and wider communications to ensure people do not restrict themselves from permitted interactions that could have significant benefits on their mental health.

6. Financial insecurity
    

19. The exacerbation of financial insecurity under Covid-19 has been widely reported. While those who were already in a precarious position before Covid-19 are worse off, many more people have been pushed into financial hardship as a result of Covid-19, creating a ‘newly vulnerable’ group.[23] Throughout 2020, unemployment rose while the number of people

claiming Universal Credit doubled between February and November.[24]
 

20. Our research into local restrictions, The Longest Year, found those on benefits or low income have struggled with an increase in household bills as a result of staying at home more, and with the costs of essentials, such as food. Others who had recently been made

redundant or been placed on furlough struggled with a drop in income.
 

21. We saw that those experiencing financial insecurity during local restrictions are broadly unaware of where and how they might be able to access financial support; two fifths of UK adults (40%) say they are not confident about where to go to access financial support.

22. Many of those that are aware of how to access support either feel they will not be eligible for the support on offer even if they are, or have attempted to access this support and found they are not eligible.

• 39% of people who said that financial support for essentials such as food, clothes and toiletries would be helpful for them were not able to access this support (this represents 5% of the total UK population).
• 43% of people who said that financial support to self-isolate would have been helpful to them were not able to access this support (this represents 4% of the total UK population).
• We also found that levels of financial need appear to be higher among younger age groups (aged 18-24 year olds, and 25-34 year olds).

23. People seeking asylum. Many people seeking asylum find it difficult to make their asylum support payments of £39.63 per week stretch to cover their living costs. Asylum support payments were increased by £1.75 per week in June 2020, and by a further 3p in October 2020 (totalling £1.78), a significantly lower increase than the £20 uplift to Universal Credit. Asylum seekers’ ability to spend this money is also restricted as the ASPEN card, which is how asylum support payments are made, cannot be used online, and in some cases

cannot be used to take out cash, either.
 

24. People who are Clinically Extremely Vulnerable. For people who are CEV, there is an increased risk of financial vulnerability, especially for those who are unable to work from home; research from Citizen’s Advice found that 1 in 2 people who are CEV (48%) are facing redundancy.[25] Independent Age have also reported weaknesses in financial support

for people unable to work because they are shielding.[26]
 

25. In order to support those in severe financial crisis, the British Red Cross recommends that:

• The UK government should ensure emergency financial support is available and promoted through Local Welfare Assistance schemes, with appropriate investment across the four nations. These should be made available to people who have No Recourse to Public Funds. In England, DWP should invest at least £250 million per year in local welfare assistance over the longer-term, to give local authorities the confidence and certainty they need to develop an effective local welfare offer.
• The Home Office should increase Asylum Support rates in line with the £20 per week increase to Universal Credit and enable ASPEN cards to be used online.
• When people who are clinically extremely vulnerable are advised not to go into work and they cannot work from home or be furloughed, the government should provide adequate financial support to them and their households, to ensure that they do not fall into financial hardship.[27]

7. Barriers to accessing support
    

26. The Longest Year found that access to both statutory and voluntary support varies depending on how much contact people have had with support systems before the Covid-19 crisis. For those who were not receiving support before the pandemic, there is a lack of awareness about where they could go for support, or what options are available in their area. Positively, however, those who were receiving support before the pandemic noted

how well organisations have adapted their schemes to be socially distanced.
 

27. Access to Food in Emergencies, found that those most at risk from food insecurity include lone parents, large families, those with disabilities or health problems, those who are or were self-isolating, free school meal recipients, people from Black, Asian or minority ethnic backgrounds and unemployed people. While national and local government support has been prioritised to those on the official shielding list, our research identifies that there are

many vulnerable people who remain unable to access the support they need.[28]
 

28. At the British Red Cross, we have continued to see support needs rise. On the first day of England’s third lockdown, 5 Jan 2021, we received 118 calls to our support line, the highest daily rate since August 2020. The biggest ask was around access to food. This insight highlights the need for continued food and financial support throughout the pandemic,

particularly for those most vulnerable to impact of Covid-19.
 

29. People who are Clinically Extremely Vulnerable have seen a reduction in support. Under local restrictions our research identified a reduction in support from central government for those who were previously advised to shield, for example, the food parcels that were available under the first national lockdown. However, many of the people we support and spoke to for our research have continued to remain at home as much as possible and in effect continued to shield throughout the period even when the rules had eased.
     
30. Support, including for food, for people who are not considered CEV, such as the clinically vulnerable and others experiencing hardship, has not always been tailored to meet people’s personal requirements and looks different from place to place.[29]

31. Our research, The Longest Year, also found that many people are reluctant to reach out to organisations for support, particularly those who are struggling with their mental health. This is due to a number of factors, including: feeling they should be able to cope or that others ‘have it worse’ than them, stigma around asking for help, reluctance to use certain support channels and a feeling they would not be eligible. We found that more than half of UK adults (55%) find it hard to talk about their problems when so many people are having a difficult time, and more than a third (36%) were unsure how to access emotional support.
     
32. To resolve barriers to accessing support, the British Red Cross recommend:

• DWP, MHCLG, DHSC, and local authorities should better identify areas and individuals most at risk to target support. This should be achieved by partnering with the voluntary and community sector and local communities, using tools such as the British Red Cross’s Covid-19 Vulnerability Index.[30] When additional restrictions are put in place in local areas, practitioners should attempt active outreach to individuals not currently in receipt of support.[31]
• MHCLG should ensure that those living under additional restrictions receive a level of support tailored to meet their individual needs, addressing both the access and cost implications for those who are vulnerable. This should specifically support those struggling to afford essentials, such as food, and those who take the decision to shield.
• Going forward, as part of its 2021 review of the Civil Contingencies Act 2004, the Cabinet Office (CO) should consider creating a statutory duty for national government and Category One responders to fully meet the humanitarian needs of their communities, including making the provision of accessible, nutritious food a statutory requirement in emergency response.[32]
• MHCLG should ensure that all local authorities are fully resourced to continue to support the clinically vulnerable, clinically extremely vulnerable and non-shielded vulnerable, with access to essentials such as food. Emotional support, such as for loneliness, should also be attached to this provision.
• DHSC, DCMS, MHCLG, DEFRA and HMT should resource the voluntary and community sector to continue to support people with their practical and emotional needs during Covid-19 and in recovery.

8. Accessing and understanding information
    

33. Due to a lack of information and perceived availability of support, our recent research The Longest Year, found that under Covid-19 restrictions, people were reluctant to reach out for help, and many feel left alone to manage their own situation.[33] While some people have found information through their local authority helpful, others don’t know where information on local restrictions and local support could be found. While our UK polling found that the majority of adults say they have found it easy to get clear information about local restrictions (58%), there is a significant minority of over a third who have not (37%). Thirty-three per cent of adults are not confident they fully understand the coronavirus restrictions in their local area, and half of UK adults (50%) said they find it difficult to keep up to date

with the latest coronavirus restrictions in their local area.
 

34. Language barriers are preventing some from understanding information about the rules and support available. For people that do not speak English as their first language, information regarding the rules around restrictions is particularly confusing. Most are not aware of information being available in other languages. While most non-native English-speaking research participants had a good grasp of English, many still said they have struggled to understand certain aspects of the restrictions, for example the different tiers.[34]

This has led to increased anxiety around breaking the rules.
 

35. There is a lack of tailored information for the clinically vulnerable and clinically extremely vulnerable under tiered restrictions. For people who were told they were CEV and asked to shield in March, information regarding the local restrictions in their area and guidance on how to protect themselves is of particular importance as they are at the highest risk

from Covid-19.
 

36. We found that those who were clinically vulnerable, and CEV, continued with the same routines during local restrictions as under the national lockdown because of a fear of contracting Covid-19. However, under local restrictions few from these groups received specific, tailored information from central or local government, or their GP, about the new rules and what support they might be able to access to protect themselves and maintain

their health and wellbeing.
 

37. While identifying those who are CEV was a major objective during the first national lockdown[35], under local restrictions there seems to be confusion around how those who are CEV should protect themselves, and whether they should continue to shield. In some instances, it had also not been made clear to people why they have been classed as vulnerable or that they were classed as vulnerable.

38. In particular, the ‘clinically vulnerable’ group has lacked support and information throughout the pandemic. For example, one of our research participants and his wife and two sons, one of whom has cerebral palsy, isolated throughout the Covid-19 crisis. While they did not receive a letter to confirm that his son was CEV, cerebral palsy is included on the list of clinically vulnerable conditions, so they made the decision to shield themselves throughout local restrictions to avoid any of their family members contracting Covid-19.
     
39. In practice, this meant that some people who had been classed as CEV or identified as clinically vulnerable had interpreted the same information and advice around local restrictions differently to each other, reflecting the ambiguity in the rules and the ways in which they were communicated. One professional we spoke to as part of the research from Leeds City Council said it had often been necessary to follow up with central

government to clarify what the rules meant.
 

40. The changes in advice for people classed as CEV during local restrictions has also been difficult for local authorities to keep up with. In some cases, local authorities began to request weekly updates from government as to whether the advice for people classed as

CEV had changed.
 

41. To improve information received by individuals, The Longest Year, found information should simply state what is and is not allowed, and include links to information on local support.
     
42. Our research participants expressed a preference for tailored, localised content, stripped of analysis or opinion, and communicated as simply as possible. They thought that a simple list of what is allowed and what is not allowed would be the easiest format to interpret.
     
43. We found that, often, people wanted tailored information to come directly to them from one source that they felt able to trust. Our UK polling found that 50% of UK adults trust the NHS or public health bodies to provide accurate information about Covid-19 local restrictions. 34% trusted the news on television or radio, 31% trusted the UK government, and 31% trusted their local council. Professionals we interviewed also found that sending information to people by text can be beneficial and allowed them to consistently communicate with people who are

clinically vulnerable or clinically extremely vulnerable.
 

44. A few of those who were struggling emotionally and financially would have liked to have received information on local support they could access alongside information about restrictions.
     
45. To improve overall communication and access to information, the British Red Cross recommends:

• The Prime Minister should keep tiered or level systems as consistent as possible to avoid confusion and motivate people to follow the rules.
• MHCLG should support local authorities to ensure any guidance on the rules and restrictions during coronavirus is provided in multiple languages, as standard. This should be based on an assessment of local language use and be funded appropriately by central government.

• Local authorities should regularly disseminate information both online and offline that is easy to interpret and tailored to the local community. This should set out clear advice for clinically vulnerable and clinically extremely vulnerable people about what they can do, while staying safe. To complement this, local authorities should work with voluntary and community sector organisations, including grassroots organisations and community members, to proactively target information and advice to people who are digitally isolated, clinically vulnerable and clinically extremely vulnerable, and who speak English as a second language.
• CO, DHSC and MHCLG should establish effective early warning systems for local emergency response partners, including local authorities, health bodies and the voluntary and community sector, in areas that are about to enter into new or additional local restrictions, in order to enable an effective human-centred response.
• CO, DHSC and MHCLG should ensure they provide timely and easy to understand guidance on Covid-19 and local restrictions to those with a disability, impairment, or sensory loss, in line with the aims of the Accessible Information Standard. [36]

February 2021

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