Written evidence submitted by Independent Age (COV0038)

About Independent Age

We offer regular contact, a strong campaigning voice, and free, impartial advice on the issues that matter to older people: care and support, money and benefits, health and mobility. Our mission is to ensure that as we grow older, we all have the opportunity to live well with dignity, choice and purpose.

For more information, visit www.independentage.org. Registered charity number 210729.

Summary

This submission addresses question 2 of the Committee’s inquiry and focuses on the group of people who have been designated ‘clinically extremely vulnerable’ and those who fall outside of this group.

Clinically extremely vulnerable group

Independent Age welcomed the Governments proposals to provide free food parcels to the 1.5 million clinically extremely vulnerable people in the high-risk category, who were being asked to self-isolate for 12 weeks. However, we have identified some concerns and gaps, which include:

• Delays in food parcel provision putting older people at risk of having to skip meals or go hungry until their next delivery.
• People falling through the cracks if they have not received the initial letter from the NHS. They have struggled to register for food parcels and/or do not know who to contact when they have concerns.
• A discrepancy in the composition of the food parcels with a lack of healthy foods in some cases
• A ‘one size fits all’ approach to food parcels which does not take into account individuals’ medical, dietary or religious requirements.

People outside the clinically extremely vulnerable group

We are concerned about the people who fall outside of the clinically extremely vulnerable group category, who are struggling to access food. This could be because:

• They cannot afford to purchase food. This could be due to being unable to pay delivery costs, or cheaper products that they usually buy currently being out of stock.
• They are stringently self-isolating as they were informed by the government they are in the ‘at risk’ group. For example, people over 70.
• They relied on services to access food before the pandemic that they now cannot access easily due to increased demand. For example, online delivery.

The Department for Environment Food and Rural Affairs (DEFRA) have been engaging with charities about this issue following a joint letter sent to the Secretary of State on Wednesday 15th April. We welcome this continued engagement but feel that solutions to this urgent problem are not moving quickly enough. Many of our recommendations below were set out in the joint letter and have not yet been actioned.

We have conducted an online survey of our supporters around access to food, some the results of which we have included below. The survey has been running since Wednesday 22nd April, and as of 28th April has 1777 respondents. The survey is UK wide, but most of the respondents are located in England. The majority of respondents are 65+. While accepting the limitations of the data, we believe it gives a valuable insight into the people’s experiences and concerns. We are happy to share the full results with the Committee on request, and are happy to provide oral evidence.

Independent Age represents the 65+ age group however we recognise that many of these issues apply to younger age groups, particularly to working-age disabled people, and to younger carers. We therefore urge that these issues be considered in the round, rather than focusing on specific age demographics. 

Summary of recommendations

Clinically extremely vulnerable group

• The Government should work with local authorities to better coordinate distribution of food parcels to ensure that those at risk are not exposed to unnecessary delays in their food provision, and are never left having to skip meals or go hungry until their next delivery.

• Follow up information must be sent to all those identified as clinically vulnerable, who have opted in to receive food parcels or have not replied to the initial letter, including advice and information about who they can contact if they have any questions and FAQ documents.

• The composition of the food parcels across the UK must be revised to ensure that they include a healthy mix of foods, including fresh produce.

• Modifications must be made to the food parcels to ensure they meet individual medical, dietary or religious requirements at no extra cost to the recipients.

People outside the clinically extremely vulnerable group

To ensure people outside the clinically extremely vulnerable group get access to the food they need, the Government must undertake the following:

• Set out a timetable of urgent action to support the worst affected.

• Involve charities in the work it is undertaking to identify those in need, to prioritise them for home deliveries or support getting food supplies, keeping them healthy and protecting the NHS from avoidable admissions.

• Set out a definition of the ‘non-shielded vulnerable group' so that those who are struggling to access food get the food they need. It should be inclusive to allow for flexibility on the part of referrers, but be specific enough to allow clarity of communication and easier triaging. 

• Continue to engage with supermarkets, and assist in building up their delivery capacity.

• Provide clear information about alternative sources of support for people in vulnerable circumstances who cannot access supermarkets or a home delivery because of demand, and reassurances those alternatives will be safe.

• Echo messaging from several supermarkets, encouraging those who do not need home delivery to shop in store instead, to reduce demand on what is a stretched and limited service.

• Set up a central hub where all the supermarket information about their COVID-19 response and policies is coordinated and kept up to date, which is widely promoted and accessible to all.

• Work with supermarkets to ensure customers that are digitally excluded are aware of support systems and they can place orders by phone. This service must be advertised in various accessible ways at a local level.

• Clearly communicate with those in need what support is available and ensure that local authorities are identifying people in need quickly and effectively. Charities that have the capacity to do so must also be empowered to identify those in need, and fast track them for support.

• Together, the Government and local authorities should closely engage with charities to ensure that communication about what support is available to people struggling to access food does not inadvertently lead to self-exclusion.

• Supermarkets should also engage with charities to ensure that their in-store policies do not make it harder for people who are disabled, or have formal or informal carers, to access food.

Section 1: Clinically extremely vulnerable group

1.1 Access and communication

In late March, letters were sent out to the households identified as being clinically extremely vulnerable, to ensure that they had access to sufficient food, essential household supplies and medication. The letters contained a telephone number and website address for individuals to effectively opt in or out to receive food parcels.

Our recent survey – which remains open for responses – identified 82 respondents, over the age of 65 who are in receipt of food parcels. 89% of these individuals had received a letter from the NHS informing them of their clinically extremely vulnerable status. However, our helpline has received calls from people who have not received the letter and believe that they should have been identified as part of this group, such as cancer sufferers who at the time were worried about the availability of food when their stocks inevitably ran low.

Independent Age has also heard from older people who have been surprised to find a food parcel left on their doorsteps with no apparent communication from the NHS or their Local Authority.

‘I hadn't realised I had ticked the box asking for a food parcel.  I don't need one and it took some time to get it cancelled.  I'm very glad I don't have to rely on it.’ – survey participant

Although well meaning, this kind of practice can cause confusion and anxiety about the contents of the parcel, especially at a time when everyone is being advised to be cautious about cross contamination during the pandemic. If the individual is also unsure if they were the intended recipient with no one to contact to confirm this, the contents may be wasted.

We also have concerns for those living alone with no one to advocate on their behalves. We have heard from individuals who have tried multiple times to contact the dedicated telephone number on the letter from the NHS but have been unable to get through – this may have been during the first few days of the letters going out. If no further communication is made with individuals who did not respond to the initial letters, then a proportion of those in need will slip through the cracks. This also applies to those living alone with a cognitive impairment or fluctuating mental capacity to make decisions relating to their clinically vulnerable status, whose care and support may have been negatively impacted due to the pandemic. These people are left with no one to organise the provision of these parcels on their behalf.

Through our recent survey we have also heard about discrepancies in the timeframes people are having to wait to receive a food parcel. Early indications from our survey have shown that a small, but significant proportion of people have been waiting longer than a month for their first food parcel which raises serious concerns for their safety and welfare and if they have had to go hungry. Other respondents have shared that they are not aware of when the next parcel will come meaning their control of the situation has been removed and they are being told to stay at home with no other means of getting supplies into their households other than to wait and hope. Early results from our survey have shown that 29% of respondents getting a food parcel do not believe that there is enough food in the parcel to sustain them until the next one arrives.

‘Only had one food parcel not had one for 2 weeks.’ - survey participant

We have further concerns about the proportion of people in receipt of food parcels who do not know who to contact if they have questions related to their parcel. Just over 51% of those in receipt of a food parcel said that they do not know who to contact if and when they have queries. This can contribute to feelings of unease in an already disquieting time.

‘I didn’t know it was coming and didn’t know who to contact about it and tell them I do not require it.’ – survey participant

1.2 Nutrition, choice and sufficiency

During the introduction of the food parcels plan, the Communities Secretary Robert Jenrick MP stated that over time they hope to refine the food parcel service so that it is more tailored to individuals’ needs.[1] At a time where access to sufficient, healthy food is paramount for those who have been identified by the NHS as ‘clinically extremely vulnerable’ it is very problematic that some individuals have shared via our survey that due to specific health reasons, such as being a coeliac or having a restricted diet due to diabetes, a proportion of their food parcel is unable to meet their needs or puts their health at risk.

Currently, our survey shows that 23% respondents feel that their dietary needs have not been met. An example was given where someone was left with no choice but to consume foods that have a high sugar content despite their diabetes diagnosis.

‘I am a diabetic and some foods have sugar in them. There is no fresh food.’ – survey participant

‘I am a coeliac and an insulin diabetic, so l have a restricted diet, in my food parcel l receive lot of fruit and veg and tins of corned beef, but it would be of a help if l received gluten free flour...’ – survey participant

Initial results from our survey also indicate that there is disparity in the nutritional value of the composition of the parcels, with some people receiving fresh fruit and vegetables and others only receiving what they describe as ‘manufactured foods’. When these are being distributed to people with cancer, heart problems and other respiratory conditions, a well-meaning plan could have the opposite effect if it negatively impacts a person’s health and immunity.

‘The contents seem random and very low in nutritional value.’ – survey participant

Section 2: People outside the clinically extremely vulnerable group who are struggling to access food

2.1 Timetable for urgent action

We are very concerned by the large numbers of people who are struggling to access food due to the COVID-19 pandemic. Although some are relying on friends and family to get food for them, this isn’t an option for many older people. 1.5 million older people are living without children[2] and 17% of older people report they are in contact with family, friends and neighbours less than once a week[3].

This echoes what we are hearing from callers to our helpline and from the people we support in the community. While we welcome DEFRA’s engagement so far, this issue has been ongoing for several weeks and there has not been any meaningful support offered to people outside the clinically extremely vulnerable group.

‘Lockdown doesn`t bother me. Access to food does. I’m only just over 6 stone now, & having to ration it…I don`t know where it will all end, but if Coronavirus doesn`t get you, starvation will.’ – survey participant

‘My husband drives me to the supermarket and I have to queue on my own, it’s a struggle but I have to do it or we’d go hungry.’ – survey participant

Key statistics from our survey

• 48% of respondents outside the clinically extremely vulnerable group said they had had problems accessing food. Of these respondents:
• 56% said they couldn’t get food as there were low stock levels at the supermarket.
• 34% reported that they were skipping meals, reducing the amount of food they ate, or cutting down on the essentials.
• 35% said they are relying more on other people to get their shopping.
• 76% of respondents said that trying to access food during the pandemic had made them feel more, or much more, anxious than normal.

2.2 Defining this group

If we are going to help this group access support, we will need to define who they are. Currently there is a lot of confusion about who can access support, and when they should do it. As support becomes available to help people in need access food, there needs to be clarity on who can access it.

The definition should be inclusive and flexible, but also specific enough to communicate clearly and provide clarity to referrers and those who need support. It should include, but not be limited to, recipients of

• PIP.
• DLA.
• Attendance Allowance.
• Carer’s Allowance.
• ESA support group.
• UC limited capacity for work.
• Access to Work.

It should also include:

• Blue Badge holders.
• People receiving social care.
• People that are on the ‘at risk’ list because of their age and/or underlying health conditions.
• Unpaid carers of any of the groups listed above.

26% of respondents to our survey said they were a Blue Badge holder. Blue Badge holders were significantly more likely to say that they were struggling to access food and relying on other people to do this.

Respondents to our survey shared their concerns about not being identified as someone who needs support with access to food, despite facing challenges which means they can’t access it.

‘I feel I've been forgotten about. I'm not in the super-critical group, but I am in the vulnerable "old group", but I've been left to fend for myself. I don't want to go shopping where people are ignoring the social distancing rules.’ – survey participant

‘I have a daughter with severe learning disabilities and who is unable to walk and needs lots of personal care. Both my wife and I have had cancer operations a year ago and are concerned about difficulties of getting check-ups. The risk that I will catch the virus shopping is very worrying, or that I bring it home. Individually we are vulnerable, as a family we are even more vulnerable, but not on the list to get online shopping’ – survey participant

‘The school boy next door gets me some things but he is also shopping for his mum so can only get a certain number of fruit for example. I think I should be able to give him something like my passport or bus pass to show he needs to shop for 2 different people. He still wouldn’t get loads anyway as he has to walk and carry the shopping home’ – survey participant

2.3 Shortage of online delivery slots

The COVID-19 pandemic has put incredible pressure on supermarkets. For those who are self-isolating, or have been informed they are in the ‘at risk group’ but not the ‘clinically extremely vulnerable’ group, it is very hard to access food by visiting the supermarket[4]. For those with mobility issues there are additional difficulties getting to the supermarket and having to stand in a queue. As a result, many are relying on online shopping. The resulting strain on the system has been something that has come through very strongly in our survey and conversations with older people.

‘I had groceries delivered but once a month only. I had to place my Online order at 2.00am, when vacant delivery slots appeared. Limit: 80 items.’ – survey participant

‘We have managed to get only 2 delivery slots but we have great neighbours so we are managing. We don`t want charity, we can pay our way, but the system is just not working.’ – survey participant

It has been great to see so many volunteers stepping up to help people at risk, and the development of the GoodSam app. However, we are concerned that proper vetting and safeguarding is not always in place for local groups, and the criteria for getting help from the GoodSam app with accessing food is not currently very clear.

Key statistics from our survey:

• 35% of survey respondents outside the clinically vulnerable group used online shopping to access food within the last fortnight. Of these, 52% did not use online shopping before the COVID outbreak.
• 69% of respondents who are not classified as clinically extremely vulnerable are struggling to access food because they can’t get an online shopping delivery slot or register for an account.

2.4 Lack of consistency between supermarkets regarding COVID-19 policies

At the moment, every supermarket has different rules in place and this has been confusing for many older people. For example: the days and times people can shop there; which groups can shop in the ‘protected hours’; or whether people can be accompanied or not.

‘Waitrose has identified me as an 'at risk' person, Sainsbury's tell me I'm not? Tesco, who I've been told are the most aware in this area haven't even mentioned it. Still can't get a slot!’ –survey participant

Currently, charities are collecting information from supermarkets and putting it on their own websites, or signposting people. It is crucial that there is a central resource where charities and local authorities can direct people, that shows all the supermarkets and the rules they have in place. DEFRA have indicated that this should be run by charities, but we do not agree. This should be the responsibility of supermarkets to keep up to date, using DEFRA as a host for this central resource.

‘It took me ages to find a company to supply basics on a regular basis. A list of companies from local council would have been of great help and less stressful’ – survey participant

Supermarkets must also improve their in-store policies, as some are negatively impacting groups in need. For example, many supermarkets have introduced a ban on accompanied shopping. This has made it harder for those with mobility issues who may require support, those with learning disabilities who require a companion, and those with carers to access food.

Key statistics from our survey:

• 51% of respondents who shopped at multiple supermarkets said supermarkets have had different rules and procedures.
• Respondents who said they were Blue Badge holders were significantly more likely to say that the ban on accompanied shopping was a barrier to them accessing food.

2.5 Solutions must be accessible, including for those who are not online

Access to food via online delivery is a large barrier to people accessing food and alleviating that would help many people. However, there are many who do not use online shopping, for a variety of reasons. It is important that they are not digitally excluded, and that support is put in place for them, for example access to ordering food by phone.

According to ONS, approximately 53% of people in the UK aged 75+ do not use the internet, which is an estimated 2.5 million people[5].

Respondents to our survey have shared their concerns and challenges about online shopping:

‘There are 3 of us and it takes a lot of time and knowing how to use a computer and only luck on getting spots- we've been online looking for local companies who are delivering’ – survey participant

‘I don’t know how to shop online, I only know how to receive emails and send emails, a 9 year old boy taught me on this iPad which is 11 years old and keeps going off, it was given by my friend when she got a new one. Wish I knew how to do more. He was just teaching me to do Messenger, but I am not very good yet.’ – survey participant

2.6 Dissatisfaction official communication of what support is available

One point that came through strongly on our survey, and on calls with people we support, is a feeling that communication about what support is available to non-clinically extremely vulnerable groups has been lacking. Charities are having to fill this information gap, with the risk that people in dire need are sent on a wild goose chase around local authorities, supermarkets, and mutual aid groups. The Government must take the lead in this issue and provide clear effective communication on what is available that charities can help disseminate.

‘There seems to be little or no information about accessing food from Government or TV etc I used to get food from a local foodbank before the pandemic but I have received no information.’ – survey participant

‘The elderly were the first group advised to self isolate/lockdown and yet no priority has been given to this group regarding access to food. To date I have not had one leaflet from my local council.’ – survey participant

Key stats from our survey

• 43% of respondents said the Government should provide clearer information and advice about how people can access food across the country.
• 63% of respondents said they disagreed, or strongly disagreed, that the Government has communicated well about how people can access food.
• 55% of respondents disagreed, or strongly disagreed, that their local council has communicated well about how people can access food.
• There was some evidence of geographic variation. Respondents from the North East were significantly more likely than any other English region to ‘strongly disagree’ that their local council has communicated well about how people can access food.
• 43% of respondents said charities should be allowed to notify the Government if they feel someone needs access to support.

2.7 Reluctance to ask for support

The reluctance of many older people to ask for help, even when in dire need, was one of the main findings from our recent research report In Focus. We have found this with our helpline as well, where often older people will call us up about a single issue, and once we have helped them with that issue, they raise a series of other issues they have been reluctant to seek help with.

‘Some people would not ask for help as they are too proud. My neighbour only let me help when they needed prescriptions and then began to be more receptive to offers of help’ – survey participant

We have seen this play out with the access to food issue as well, with many survey respondents expressing reluctance to seek help, feeling that they ‘shouldn’t complain’, and feeling anxious that relying on others for support may impact their independence. The Government and local authorities therefore must be very careful about the language used when communicating what support is available, and the criteria for access. Using the terminology of ‘vulnerability’, ‘emergency’ and similar language can have an excluding effect. Many people in serious need will not necessarily self-identify as vulnerable or as being in an emergency situation.

‘The friend who has been getting food for me works in an organic vegetable shop so she brings me fresh fruit and veg that is more expensive than the supermarket, but I don't wish to put her in any danger by asking her to go to the supermarket for me. So I have now run out of things like milk. I have also not been able to go to the pharmacy to collect the blood pressure pills recently prescribed for me. I wouldn’t ask anyone else as the queues outside are very long I'm told.’ – survey participant

‘What I cannot get I go without. Having spent 3 years in Buchenwald concentration camp as a child…I know that somehow I will survive.’ –survey participant

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