LLOYDS BANK FOUNDATION FOR ENGLAND AND WALES – WRITTEN EVIDENCE (PSR0011)

House of Lords Select Committee on Public Services: Lessons from coronavirus

Inquiry submission from Lloyds Bank Foundation for England & Wales

Summary

• All services to the public were already under pressure and have been under intense strain during the pandemic, stepping up to deliver differently and more. Charities of all shapes and sizes have been crucial to this response, particularly those embedded in local communities. They have been key partners to local government, the NHS, communities and individuals themselves.
• The pandemic has required rapid transformation of services and for silos between and within organisations to be broken down. The importance of person-centred, locally rooted, flexible and holistic services has been central to effective public service responses.
• Charities have been never more needed yet much of their activity has occurred under the radar. While ‘public services’ engender visions of those provided by government, in reality many of the essential services for the public are, and have been even more so during the crisis, delivered by charities.

• Local charities, embedded in communities, have had a particularly important role in delivering holistic, person-centred public services and there is evidence to suggest that in some places this has been increasingly recognised during the pandemic. Their agility enabled them to adapt quickly so that services could be continued under lockdown and their connections have enabled them to catalyse and mobilise activity, bringing together volunteers, businesses statutory agencies and mutual impact.
• The best service responses have seen improved partnerships between government and charities, shifting away from a contractual focus on KPIs and payment by results, learning from the expertise of local charities and involving them in planning and strategic decisions as well as working with them and assuring payment as they adapt delivery approaches. They have demonstrated that commissioning can be done differently and this practice needs to be further built upon.
• Cabinet Office procurement guidance has helped to empower some commissioners to relax performance targets and enabled process to follow need. In some areas the pandemic has accelerated long-overdue culture change. This guidance needs to go further and be strengthened to support further long-term shifts in approaches to ensure services better meet the needs of people.
• Some commissioning authorities have failed to support adaptation and partnership working, leading to a poorer and unsustainable public service response. Where commissioners have refused payment because delivery mechanisms have changed or shut down communications, services have struggled to continue effectively.
• The demand for public services will continue to increase, with many services anticipating surges in demand as lockdown continues to ease. It is critical that sufficient funding is in place to enable services such as charities to respond – which includes securing sufficient funding for local authorities. People need access to services, but these services cannot exist operate without funding.
• While the shift to remote delivery has enabled many public services to continue, and improved access for some, it has also increased the digital divide. It is vital that digital approaches do not become the new default, but are further developed alongside face-to-face services.
• Where local charities are delivering public services with by and for the communities they serve, they have been well placed to address inequalities. However, these organisations have been marginalised through funding processes. Public service commissioners need to better recognise the needs of different communities and enable specialist services to work with those communities to meet needs effectively.
• Despite better practice in some areas. the pandemic has highlighted many fundamental flaws in the commissioning of public services more broadly. Whether by disincentivising partnerships or encouraging top-down centralised contracts that fail to reflect local needs and assets, the worst responses to the pandemic have continued these patterns.
• There are clear examples of how public service commissioning can shift to processes that allow services to respond to needs and how they can be best met. In most cases, better responses evolve from more localised approaches that engage local organisations.
• As needs and the external environment continue to shift, there is a growing urgency to adopt more grant making in public service delivery, to drive innovation and enable services to adapt. This should be accompanied by a greater emphasis on the importance of social value.
• As we emerge from lockdown we need to learn from those areas that have best responded, building stronger links with local charities and shifting away from contractual relationships that fail to meet needs effectively and instead strengthening relationships and working together to meet needs.
• Keep it Local, an approach to improve collaborative working between local authorities and local organisations offers a framework for how learning about the best responses to coronavirus can be further expanded.

Introduction

Lloyds Bank Foundation for England & Wales partners with small and local charities to help people overcome complex social issues. Through long-term funding, development support and influencing policy and practice, the Foundation helps those charities make life-changing impact. The Foundation is an independent charitable trust funded by the profits of Lloyds Banking Group.

The local charities supported by the Foundation provide a range of services to the public, such as supporting those with learning disabilities, helping people to overcome mental ill health or managing addiction or dependency. Many of these charities are involved in delivering public service contracts directly – such as local contracts for domestic abuse or homelessness, for example. Even where they are not directly receiving public sector funding, charities are delivering support which relates directly to public services. They are often providing support to people who do not meet the threshold to access statutory services, or which will prevent them from having to access statutory support at a later date – such as providing counselling. They may be providing additional wrap around or more flexible support, or helping people to navigate and access the statutory services that they are entitled to – such as providing advocacy or support with welfare benefits.

Throughout this response we use ‘public services’ to refer to all those services delivered for the public – services that people need and that are often delivered by charities of all sizes and across all areas. While this response focuses on the experience of small and local charities, many of the themes identified throughout resonate across the charity sector; a sector that has been central to the pandemic response yet which is facing significant funding gaps. Importantly, the services that these charities provide are people-focused services, supporting people to overcome complex social issues. During the coronavirus pandemic, these services have become even more important than before- the people who they support were already facing challenges before the crisis, and the pandemic has exacerbated issues such as mental ill health or domestic abuse, at a time when other sources of support are harder to access. Similarly, those delivering services were already under pressure, with rising demand funding increasingly difficult to access. The pandemic has intensified many challenges that already existed.

General

What have been the main areas of public service success and failure during the Covid-19 outbreak?

Since the outbreak, charities, particularly those that are small and local have stepped up to ensure services are delivered to people who need them most. They have adapted their services at speed to be able to continue delivery, shifting services online and by telephone. For example, a charity supporting people facing homelessness in the North West highlights:

“Our primary focus has been on continuing to support the homeless and precariously housed individuals we work with… we have been able to continue casework with all current clients and support new clients we are engaging through our emergency accommodation hostel work.

They have also developed new services to meet emerging needs, such as delivering food and other essentials to people who do not have the means to purchase their own and to help people self-isolate safely. In many cases government has relied on such organisations to reach into communities and identify people who need support. As the same charity goes on to describe:

“In addition to our usual case work much of our work over the last 5 weeks has focused on supporting vulnerable service users to self-isolate and social distance appropriately. Many of the people we work with have significant underlying health conditions and compromised immune systems and fall into the category of people the government has recommended self-isolate or shield. However they tend also to be the most chaotic and are finding isolating and social distancing extremely difficult (if not impossible). Our work with these clients is very practical and immediate, ensuring they have access to food parcels, medication, scripts etc. liasing with other health and social care professional to ensure they continue to receive statutory support, while also providing ongoing emotional support.”

For a number of these charities, their response and ability to continue delivering public services has been supported by local commissioners, such as local authorities. Successes can be seen where local authorities have embraced the Cabinet Office procurement guidance[1], introducing more flexibility and working with local charities to ensure services can be delivered effectively. For example, a mental health charity in Derbyshire was able to continue delivering services as the county council confirmed they would still receive payment despite a change to way in which support was delivered. A homelessness charity in the East Midlands has also reported how the council has shifted their payment by results model to a block contract in recognition that what they deliver and how they deliver it has had to change – but that they are still addressing the same issue and supporting people facing homelessness.

In another example, a disability charity in Cornwall describes how the council has worked collaboratively with local partners to ensure needs are met effectively:

We are part of a coordinated response working with other VCS organisations and the Council, mapping services, support and volunteers. We are working with our partners on a Council commissioned 'Inclusion Matters' contract and have changed elements of it to enable us to respond with helping people with shopping, collecting prescriptions etc. The dedicated helpline is also central to the response efforts of which we are a delivery partner. [The Council’s] Access Team are also referring people direct to the service as they are unable to meet volume of demand.

This example also highlights charities’ role in supporting public service delivery ecosystem more broadly, developing additional services to complement traditional ‘public services’ and to reduce demand on other services. As a sexual abuse charity in the North East acknowledges:

“our interventions save money and increase the local economy with people returning to work and/or education and therefore require adequate, commissioned funding to continue our work and minimise the impact on GPs, IAPT, Prescription Medication, Substance Misuse Services, A+E, CAMHS, MH Services, etc”

Local authorities have reported how the pandemic has encouraged them to shift away from a focus on KPIs and instead adopt a partnership approach to meet needs. They have seen charities step in and adapt to meet needs, without requiring a detailed specification and contract to detail what they should do and how they should do it.

As Andrew McCartan, Commissioned Services Manager at Wirral Council has said in a report for Locality:

“Traditionally, we’ve been a very KPI, performance-driven organisation. During the crisis, we’ve seen organisations do things well without this level of process and a greater degree of trust and collaboration.”

Similarly, in Bristol, another Keep it Local Council, the council took swift action to suspend or relax performance targets, instead encouraging suppliers to prioritise services that would meet needs.[2]  Allowing process to follow needs has been critical to securing a good public service response, rather than the approach that we have seen too often for years which has prioritised processes that do not meet the needs of the services.

Local charities have been able to respond rapidly this because they are embedded in communities and understand local needs. Such a partnership approach between local authorities and local charities has long been heralded as a more effective way to operate, as promoted through Keep it Local[3], an initiative led by Locality and the Foundation – but the severity of the pandemic has accelerated the approach in some areas. It has strengthened relationships, with the expertise from local charities used to help direct strategy as well as delivery which has further consolidated partnership approaches, as highlighted by a charity supporting people facing homelessness in London:

“We are fortunate that we operate in two boroughs with enlightened councils that are eager to partner with the third sector. Because of this, we are invited to have a high level of input into decisions around housing and treatment. Therefore, we feel we are part of an approach where we are equal partners in the provision of housing and treatment services.”

Cabinet Office’s procurement note has helped to empower local areas to embrace new, more effective approaches.  As Locality have identified,

“This has helped them get money out the door quickly to local small and medium-sized enterprises and voluntary and community sector (VCS) organisations during the crisis, which has in turn demonstrated to commissioners and procurement officers that high quality, credible solutions can be found locally. This shift has raised ambitions around the “art of the possible”: to not return to designing complex procurement processes based on the principle of creating fair competition to invite tenders from across the EU.”[4]

Where councils have been able to provide some assurance that payments for delivering public services will be maintained at least in the short term, this has been valuable in ensuring people can continue to access vital services. For example, a charity supporting people with learning difficulties in Norfolk reports:

“Norfolk County Council agreed to maintain funding for 12 weeks initially (to mid June) with the understanding that providers will support their own service users remotely as much as they can and also be ready to support other people in other settings should the need arise. The charity has adapted well to this situation but new challenges will arise as we look to open up reduced services that maintain social distancing and as we try to plan for an uncertain period ahead. Negotiations with the County Council continue to be very positive and encouraging in these respects.”

Such approaches from enlightened commissioners recognise the need for services to still be available after lockdown restrictions are lifted. One such example can be seen from Derbyshire County Council which, early on in the crisis, confirmed that if people were not going to attend the homelessness service during the crisis, they would continue payments to the charity to hold the places for when the lockdown eased.

However, these successes have not been universal. In other areas charities have struggled to engage with commissioners, leaving them without any knowledge of whether their payments will continue despite adaptations in delivery. As a homelessness charity in the East Midlands reports, their commissioner has completely shut down, leaving no continuity for the service while another charity supporting people in the North East points out:

“a lot of our commissioned services may well be in jeopardy after June 2020… At the moments though it’s a waiting game like so many other charities.”

This creates a level of uncertainty and potential unsustainability that threatens the continued delivery of public services. In other instances commissioners are refusing to honour payment by results contracts where needs are now being met in new ways. Over half of charities already subsidise public service contracts with income from other sources[5], and their unrestricted income has been hit by falls in fundraised and traded income, with expected shortfall of £12.4bn of funding this year[6]. Services in these areas are increasingly under threat as charities cannot continue to deliver without funding – it is not about the continuation of charities for charities’ sake in this regard, but a recognition that funding is necessary to ensure people can access the support they need.

Challenges have been further intensified where councils have delayed decisions on competitions that were already underway. For example, a domestic abuse charity in the East Midlands was expecting a decision on future refuge funding in April but this has been delayed. Charities delivering essential services such as those for survivors fleeing abuse cannot continue these services without resources. In one example, the council had recently moved to a Unitary authority which further delayed payments for public services at a time when charities were facing concerns over cashflow.

In another example, problems have arisen due to a government body halting referrals to contracted services. In this case, the service was contracting through a spot purchasing arrangement to support domestic abuse perpetrators to tackle their behaviour through both one-to-one and group work. Since the onset of the crisis the charity provider has shifted its delivery so that all support is provided one-to-one remotely. The group work element cannot continue safely. The commissioner is continuing to pay for those accessing the service who were referred before the crisis, recognising that the alternative approach still provides effective support, yet they have ceased all future referrals because the contract cannot be delivered as it no longer includes the group work intervention. As a result, perpetrators in the area cannot receive an intervention at a time when domestic abuse is on the rise, until group work can resume (which is not expected to happen for a prolonged period, until people feel safe attending group activities). This will lead to a surge in need when group work can commence, and will intensify challenges because people have not been able to access to support for a long time.

While in general, responses and collaboration with local charities seem to have been better in areas where there were already strong existing relationships, there have been some instances working together has improved despite challenges before coronavirus. As a charity working with people in the criminal justice system in the West Midlands acknowledges:

“There is a real sense of collaboration. [The] Council who took so long to agree our Exempt accommodation (they are renowned for this regionally with the prisons), offered support for us to apply for Homelessness Grant funding.”

What remains constant in these examples is the importance of building relationships – an element which too often been lost in a shift to competitive tendering and increased pressures on commissioning teams due to a lack of resources. While we have seen examples of new and existing relationships flourishing between charities as public service providers and commissioners at a local level, we have not seen similar evidence of this where central government is the commissioner. For example, we are aware of specialist organisations in the criminal justice sector approaching the Ministry of Justice with offers of how they could support the response to Covid-19 (drawing on the organisations’ own independent income). Yet these offers have been met with refusal to engage by the Ministry of Justice or rejection for fear that it could impinge on the MoJ’s existing contractual relationships. This focus on contracts rather than a partnership approach has led to missed opportunities and a poorer public service response in some areas.

Where good practice has emerged, it is critical that this good practice is built upon. A charity supporting people with a learning disability in the East Midlands reported that they work across two local authorities, with one being highly supportive to ensure continuity of public services while the other local authority takes the opposite approach making it much harder for the charity to continue delivery in their area. We must take examples of improved collaboration and more trust-based partnership approaches and apply this is in all areas to improve the delivery of and access to public services for people facing complex social issues.

Resource, efficiency and workforce

Did resource problems or capacity issues limit the ability of public services to respond to the crisis? Are there lessons to be learnt from the pandemic on how resources can be better allocated and public service resilience improved?

Flexibility has been key to ensuring resources reach those who need them. The rigidity of pre-existing public service contracts did not naturally lend themselves to adapting to emerging needs. This has been a demonstration of how grants can be more effective than contracts, particularly in terms of delivering services to people facing complex social issues. As outlined by Grants for Good[7], grants enable charities to deliver services in the most effective way and to adapt to changing conditions and needs, rather than tightly defining how a service can be delivered. They give services the ability to innovate – which has been of critical importance in responding to the pandemic – whilst still allowing the commissioner to be discerning and allocate funding based on the service’s ability to deliver safely.

The pandemic has highlighted the urgent need to adopt the resurgence of grant making that was outlined in government’s Civil Society Strategy[8]. The impacts of the pandemic will be felt for a prolonged period and public services will need to continue to adapt so that they meet needs effectively. A shift to grant making enables and encourages this flexibility and will help services to be more resilient during difficult times, as promoted by Keep it Local.

Lessons can be learnt from where charities have worked closely with government to ensure resources are targeted in the most effective way. Charities that have formed part of local Gold Command centres, such as Cellar Trust in Bradford have been able to pool local knowledge with local government agencies to ensure effective coordination and targeting of support. This collaborative approach to meeting needs demonstrates how government and local charities can work together effectively to maximise limited resources – it is not just about charities delivering public services, but partnerships between charities and government agencies to understand the best way to allocate resources to meet needs.

In Bradford, the Chair of the local VCS Assembly has been on the District Gold and Silver Command with the CEO of the main local infrastructure charity. They have also been involved with the other command structures. They have been able to negotiate for commissioned charities through the CCG and the council to be paid up front for 12 months to support cash flow and provide some security for the continuation of public services.

By bringing charities together with council partners Bradford has been able to redesign the volunteer infrastructure, establishing a new single point of access and launching a new app to register and plot volunteers and boost the coordinating teams long before any national scheme was announced. The national scheme came far too late and was hardly used in Bradford due to the great local response in place. A plethora of other new services and approaches were developed in a rapid timescale including a Pharmacy Delivery Scheme, working strategically with Community Pharmacy West Yorkshire members, the fire service and SSE (drivers) and using redeployed staff from charities to manage the process. They were able to link up community anchor organisations with smaller charities to respond to calls for support, while food distribution was redesigned through a collaboration of existing food banks, a new food hub and street kitchens. Again, the success came from a multi-agency team which included charities, the council, the main local social housing provider and faith organisations, as well as engaging with local businesses. Grant agreements were put in place with existing food banks at pace to facilitate this response.

The council has been able to work with the CEO of the local infrastructure organsiation to set up an engagement programme on Test & Trace as part of a multi-agency response and has also led on community production and distribution of face coverings. As the CEO of Bradford and Craven CCG, Helen Hirst, has said:

The VCS in Bradford District and Craven has been embedded within the system leadership and governance arrangements within the health and care system for a number of years.  I have seen this be strengthened in the last two to three years to one where the sector takes their seat as an equal with others, had real and direct influence over decisions and has developed the response of the sector to meeting needs and expectations of partners.

During the recent management of the coronavirus the investment the health and care system has put into effective relationships has come into its own, none more so than in the VCS.   From the first raft of projects set in train to respond, the VCS has been involved in both delivery and decision making.  One would expect the VCS to be leading the support to communities, food distribution, shielding support etc.  One would not ordinarily expect the VCS to be at the heart of the coronavirus governance and decision making.  Deciding with partners what action to take, what to prioritise.   What this brings is a diversity of view to problem solving, reaching beyond traditional thinking and a creativity that those who understand communities best have.

Where the VCS are already embedded within service delivery and care models this has provided additional resilience to services as the sector is much more able to pull from a wider range of resources to maintain services than the statutory organisations are.

Learning from these excellent examples is critical because it cannot be assumed that the worst is over for the delivery of public services. For many people and services, we will be moving to the next stage of the crisis rather than out of the crisis. Many charities are predicting further rises in demand. For example, people who have experienced abuse during lockdown will have more opportunities to reach out for help as restrictions ease. People will be dealing with the compounding impact of isolation on deteriorating mental health. More people are likely to face redundancy as the furlough scheme comes to an end and the recession kicks in. Services that have had to prioritise those in greatest need during the pandemic will see rises in demand as the challenges people face have been left to intensify. This is likely to happen at the same time as charities’ reserves run dry, matched by a similar situation for local authorities’ own funds. We are already seeing local authorities having to consider issuing section 114 notices[9].

Charities were already overstretched going into this crisis[10] having seen continued rises in demand for services over consecutive years. The ongoing delivery of vital services is under threat if government does not secure further funding for charities – and indeed local authorities who are responsible for the delivery of vital services.

Did workforce pressures preceding the crisis, such as difficulties in the recruitment or retention of workers, limit the ability of public services to meet people’s needs during the lockdown? How effectively, if at all, have these issues been addressed during the Covid-19 outbreak? Do public services require a new approach to staff wellbeing?

Charities had reported challenges with staff and volunteer recruitment and retention in grant monitoring reports submitted to the Foundation before the pandemic. Core reasons for this included:

• increased pressures from austerity and changes to welfare reform which leave individuals with fewer opportunities to volunteer
• increased pressure within services, often driven by austerity and welfare reforms, which has increased demand on services both in terms of numbers of people needing support, and complexity of the issues they face, which in turn takes a significant toll on staff and volunteers who are at increased risk of burnout
• short contract cycles which fail to value the expertise of staff and offer very limited job security.

“The majority of our grants and contracts are for a maximum of 1 year. We can't innovate and plan with insufficient funding over a period of at least 3 to 5 years.”

(a mental health charity in the East of England)

Charities delivering public services have faced significant challenges around staffing as a result of the pandemic because:

• Staff have faced increased caring responsibilities of their own
• Many volunteers are vulnerable themselves so had to shield – particularly in local charities tackling complex social issues, where many of the volunteers used to be service users themselves.

For many charities, they had to shift from group work to one-to-one support, with an increased need to check-in on clients more regularly due to their heightened vulnerability. Services therefore faced a higher workload with fewer resources. This has been exacerbated by the furlough scheme which encourages charities to stand staff down in order to survive financially, at a time when they need to be ramping up their services to cope with increased demand.

Charities have reported growing concerns around staff wellbeing. The increased pressure on remaining staff and volunteers has been intense, and does not look set to decrease. Charities are increasingly concerned about staff burnout. This is a primary concern for the ongoing delivery of public services because these services are only ever as good as the people delivering them. For charities delivering services to people facing complex social issues, this is particularly pertinent because the effectiveness of delivery is built on trusting relationships and expertise.

Why have some public services been able to achieve goals within a much shorter timeframe than typically would have been expected before the Covid-19 outbreak – for example, the increase in NHS capacity? What lessons can be learnt?

Government agencies working with local charities have been supported to adapt more quickly due to the distinctive features of small and local charities. As highlighted in independent research led by Sheffield Hallam University (Value of Small[11]), small charities are embedded in communities and are able to understand how to meet local needs. Their size makes them agile so they quickly adapt. Where public services are delivered through these locally embedded charities, they have been able to ensure that changing local needs are met. This is clearly illustrated by a specialist local domestic abuse charity in the South East which, while not receiving statutory funding, was able to better respond to Covid-19:

“small and independent charities like [us] are innovatively picking up the slack of the large and inaccessible [public] services. COVID is making this more obvious - … the … Council integrated service only shared their information for victims this week (week 8) - when the rest of us shared information about access points for support in week one - because we were prepared, with less red tape to get through. COVID has illustrated that small and vital charities are able to respond quickly to the particular needs of local people.”

The speed at which charities have been able to respond has enabled government to meet their objectives. Homelessness provides perhaps the clearest example here, as a charity supporting people facing homelssness in Manchester describes:

“A huge area of work for us over the last 6 weeks has been supporting the new Covid-19 rough-sleeper emergency accommodation hostels the city council has opened in the city. On Sunday 22nd of March the government issued an ‘Everyone Inside’ directive to all directors of homelessness. The council moved to open emergency accommodation for the city’s roughsleepers but had neither adequate accommodation or the people to staff it. We stepped in to support the council and immediately provided staff and volunteers to cover the night-shifts at 4 of the 10 new shelters the council had to open. In addition we put a call out for new volunteers to come forward to support this humanitarian effort. To date we have recruited over 45 people to assist with night cover across the city. Without our efforts there would have been a very significant delay in the getting emergency accommodation up and running. To date 331 rough-sleepers have been offered emergency accommodation.”

Technology, data and innovation

Has the delivery of public services changed as a result of coronavirus? For example, have any services adopted new methods of meeting people’s needs in response to the outbreak? What lessons can be learnt from innovation during coronavirus?

Charities have had to rapidly adjust how they operate, turning services and support that were rooted in social contact into something online and remote. Changes that before coronavirus may have taken months if not years to implement were introduced in days or weeks. For some charities and some client groups, this shift has helped more people to access their services – this has been particularly evident for charities delivering services to young people who have embraced online support. For others, it has been more challenging.

While the speed at which services have shifted online is commendable, it must be recognised that the move has increased the digital divide, leading to exclusion of particular groups of people. For example, engaging with public services delivered online has been particularly problematic for:

• those delivering services to older people, many of whom have not typically engaged online previously
• people who do not have access to devices or digital skills. Charities have often supported people to access public services through online portals by attending their centres and providing one-to-one support. Social distancing has made this impossible
• people who may have devices and skills but do not have internet access or enough credit to engage in services online. For example, some rural communities are still without internet access, while those in asylum accommodation do not have access to the internet.

Charities are now looking at how they continue to deliver services going forward. They are using the learning they have gained from shifting to a predominantly online service to understand how this can complement face-to-face services going forward. Social contact and face-to-face services are reported to be particularly important for some services such as counselling – for example, to ensure people have the space to talk away from abusive partners.

It is critical that services do not simply default to remote operations going forward. Online delivery offers many opportunities but it is not effective for all needs, so government must ensure that it isn’t seen as a quick cost-saving measure to retain all services online.

Did public services have the digital skills and technology necessary to respond to the crisis? Can you provide examples of services that were able to innovate with digital technology during lockdown? How can these changes be integrated in the future?

Many of the local charities funded by the Foundation have had to rapidly learn new digital skills. Accessing hardware has been particularly problematic for charities whose resources were already stretched. The Foundation has supported 117 charities to access repurposed laptops through Computer Recyclers UK so that they are able to move services online. We have also provided consultancy support to help charities adapt their delivery.

In many cases, this has seen a shift from face-to-face support to video or telephone calls. For example, a charity supporting people with addiction/dependency has shifted to provide courses, groups and activities online, as well as encouraging people to upload their progress to keep them motivated and engaged. Many charities are checking in frequently by phone with individuals who are most in need of support or are living in the most challenging situations. Some charities have reported that young people in particular have been most able to engage with shifting services such as counselling online, given they may be more digitally literate.

Inequalities

Have public services been effective in identifying and meeting the needs of vulnerable groups during the Covid-19 outbreak? For example, were services able to identify vulnerable children during lockdown to ensure that they were attending school or receiving support from statutory services? How have adults with complex needs been supported?

Local charities have played an important role in helping government to meet the needs of vulnerable people, particularly those with complex needs. Their existing relationships and reach in communities meant that they were often already working with people who needed support. Their expertise was particularly important for the delivery of public services due to their deeper understanding of ‘vulnerability’. At the start of the outbreak ‘vulnerable’ quickly became a synonym for ‘older people’ or those with a physical disability. However, far more people faced increased risks and were ‘vulnerable’. For example people tackling dependency with compromised immune systems, people with underlying mental health difficulties, people with a learning disability or people with little or no English for example – all of whom often access public services through local charities.

Local charities are well placed to deliver public services to people facing complex needs because they are person-centred, providing holistic support and recognising that the challenges people face are overlapping. Looking at needs holistically has been particularly important during the crisis, with charities stepping in to develop new services where new needs have emerged. For example, mental health charities have delivered food parcels to clients who have been unable to access supplies. This person-centred approach is a characteristic of small and local charities[12] but it has not typically been enabled effectively through rigid and siloed public service contracts. Much can be learned from how charities have adapted to deliver and how funding structures should be adapted to allow for ongoing flexibility and a needs-led approach.

It should be recognised that the rigidity of contracts is not a new issue that has emerged as a result of the crisis – but the issue has been intensified. Charities, particularly those that are local, have picked up the pieces of failed contracts for years but the growing demand and lack of funding makes this unsustainable, risking more people falling through the gaps. As a grant holder working with people in the criminal justice system in Yorkshire illustrates: 

“we often get referrals from the large agencies as their contracts are limited in so many ways, either in terms of level of support or eligibility”

Were groups with protected characteristics (for example BAME groups and the Gypsy, Roma and Traveller community), or people living in areas of deprivation, less able to access the services that they needed during lockdown? Have inequalities worsened as a result of the lockdown? If so, what new pressures will this place on public services?

Charities led with, by and for the communities they serve are typically better able to support groups with protected characteristics. Being from the same community enables local charities to have a deeper understanding of the needs of the people the charities serve as well as the links into communities to reach them. However, it is these services that faced particular difficulty in accessing financial support even before the crisis. Research by The Ubele Initiative has shown that 87% of small BAME led organisations could soon face closure.

Coronavirus has amplified inequalities. The stark reality of this is highlighted by the data on coronavirus, with higher mortality rates amongst people living in more disadvantaged areas[13]  as well as amongst BAME groups[14]. People in overcrowded housing have faced more difficulties. It has been even harder for people with little or no income to access food and other essentials. Those who were most marginalised before the crisis have become even more marginalised because of it. There is an urgent need to ensure that public services adapt and respond so that they better serve different groups and communities. Local specialist services are well-placed to support this – rather than one-size-fits-no-one services, they are able to deliver support in the way that is tailored to the needs of the community. Doing so requires commissioners to adapt their approaches, breaking down contracts into smaller lots and adopting alternative approaches.

For example, the Foundation has been supporting Capacity: The Public Services Lab to work with Wirral Council and local organisations to improve commissioning and engagement with local charities. Through this work the Community Matters Partnership was developed as part of Wirral Metropolitan Borough Council’s Early Help offer. Through this work contracts were broken down so that now seven smaller, local providers have been commissioned to work together alongside existing council teams, using a joined-up approach so that families get the help they need to improve their daily lives. This new way of working is making it easier for families to access the services they want and need and creating stronger links between council teams and voluntary community groups to deliver effective support.

In supporting marginalised communities, it is particularly important for public services to recognise the growth in the digital divide that has characterised the coronavirus response. For example, while counselling services or advice provision might be able to shift online, this is not accessible for those with either limited digital skills, such as those with learning disabilities, or those who may not have digital devices or credit, such as refugees and asylum seekers, so are unable to access support online or by phone.  Public services need to look at how those without access to online services can continue to be supported. Charities have long advocated for more specialist support, recognising that different people have different needs and this will continue to be the case. It’s important that online delivery does not become the default option for delivering services that are seeking to support people facing complex social issues.

The medium to long term impact of Covid-19 presents a significant threat to people who were already marginalised before the crisis. For example, a grant holder in the West Midlands highlights: 

“We are concerned that the current crisis will have a long term detrimental effect as resources are driven towards managing the immediate impact of risk to health and the requirement to be physically distant from others as well as the economic impact of job losses and business closures. Some consequences will be harder to spot and disproportionately felt by the most vulnerable in our society. For example, the introduction of the Coronavirus Act 2020 which dilutes the requirement of local authorities to assess and meet the needs of vulnerable people due to increased pressure on time or resources because of coronavirus. This is a huge concern to us as over the past ten years we have already seen numerous services cut and eligibility criteria raised so that only those with the highest need are eligible for support. If the local authority are no longer even required to make an assessment of need then we are fearful that many people with learning disabilities, particularly those with a mild to moderate learning disability will be pushed further to the margins with little support available to them facing greater inequality and disadvantage.”

It needs to be recognised, however, that fewer charities exist in more deprived areas[15], where there is often a lack of infrastructure and spare capacity to grow charities. Investment is needed in these communities to support people to develop community-led solutions to ensure that public services best reach the people who need them most.

Are there lessons to be learnt for reducing inequalities from the new approaches adopted by services during the Covid-19 outbreak?

Shifting to remote delivery has enabled services to continue meeting needs and in some cases has opened up access, especially for those delivering services to young people or those who feel uncomfortable leaving the house. There is an ongoing need to monitor the effectiveness of these different delivery models to more fully understand how they might be able to better reduce some inequalities. However, in other ways the shift to online delivery has heightened the digital divide, as outlined above.

Once again we have seen the importance of specialist local organisations in delivering public services which both can reach into different communities and provide support in the most effective way. Too often these organisations have been marginalised by commissioning processes and this has to be addressed if public services are to better serve all who need them. We need to see the end of large scale generic contracts for the delivery of services for those facing complex social issues and instead recognise the plethora of needs that emerge in different ways in different communities and can be best served by engaging in more trusted and long term relationships with organisations from those communities.

Integration of services

A criticism often levelled at service delivery is that public services operate in silos – collaboration is said to be disincentivised by narrow targets from central Government departments, distinct funding and commissioning systems, and service-specific regulatory intervention. Would you agree, and if so, did such a framework limit the ability of public services to respond to people’s needs during the Covid-19 outbreak?

Commissioning practice has too often disincentivised partnerships. It has long been recognised that the shift to competitive tendering has damaged relationships and partnership working between charities[16]. Small and local charities in particular have felt the impact of working within a system that is set against them because of their size. The shift to large scale contracts that has dominated public service commissioning over the last ten years has also discouraged holistic support. Many of the charities supported by the Foundation receive some funding from statutory services to deliver public services. This typically accounts for around 20-25% of their income. Charities have sought to overcome the flaws in public service contracts by ‘topping up’ to provide wrap-around support with services funded through other means, such as independent trusts and foundations, fundraising from individuals and trading. Yet this alternative income is now disappearing.

Commissioning public services in silos comes at a cost – both financially for the public purse and emotionally and physically for those accessing services. The tendency to commission tightly defined public services, even where delivered by charities, can limit services’ ability to fully address the underlying issue that is driving the need for support. Payment by results contracts encourage services to focus on the easiest cases, rather than incentivising work with people who need support the most. Ultimately, this is likely to result in higher costs to public services due to people not getting the right support they need at an earlier stage. Even where attempts are made to reduce silos, by pooling budgets, too often this has resulted in ever larger contracts that are out of reach of specialist local charities that might be best placed to deliver the service.

The difference we have seen in some areas on the back of the pandemic is a growing realisation that this is not the most effective way to deliver public services. Alongside this has been the recognition in the importance of local organisations in delivering effective public services. For example, in Locality’s latest report:

“Head of Procurement at Bristol Council, Steve Sandercock laid out the shift this represents: “The council encourage suppliers to prioritise things that will meet the community’s needs and trusts that details will be dealt with in relationships between contract managers and suppliers.”

To address the challenges that underpin siloed working, government’s approach to commissioning and procurement needs reassessment and shifting towards a system that supports the development and supply of effective public services. Too often public services have been treated as goods – yet delivering services to people is vastly different to procuring objects, and the processes used to source them need to reflect the aim of the service and their impact on people’s lives.

Working with other infrastructure bodies, such as Children England, NCVO and Locality, we believe the adoption of seven core principles could radically improve public service delivery and overcome many of the commissioning challenges highlighted throughout this submission:

• Placing relationships at the centre. Commissioners need to develop long-term relationships with organisations that can deliver the services people need in the way communities can access them. There is a vast difference between the delivery of services to people and purchasing inanimate objects.
• Measuring meaningful outcomes. Targets and KPIs have been shown to be ineffective in driving high quality services – the pandemic has highlighted how they can stifle innovation and adaptation. Outcomes should be set in dialogue with those accessing the services.
• All payment-by-results contracting should be suspended and renegotiated, as recommended by the Public Administration and Constitutional Affairs Committee following the collapse of Carillion.
• All decision-making by any public officials regarding potential commissioning and procurement, its conduct and the appropriate eventual recipients of public funds, should be conducted in compliance with the 7 Nolan Principles for Public Life (selflessness; integrity; objectivity; accountability; openness; honesty; leadership), and should hold all organisations (charities, social enterprises or private companies) who are recipients of public funds to the same ethical standards 
• Competitive tendering for public services should be used as a last resort, not the default setting for public spending with independent organisations 
• Wherever volunteer capacity or charitable funds contribute to public-benefit work, public funding of it should always be pursued through grant-funded partnership agreements, not competitive tendering for contracts.
• Reliance on cash or in-kind subsidy by voluntary sector organisations in order to provide any statutory service is unsustainable for both the organisation and the taxpayer - and should be avoided at all costs. Ensuring full cost recovery on contracts should be as important to public commissioners as it undoubtedly is to commissioned organisations.
• Social value should always feature in any criteria for deciding between tenders for all public supplier contracts (including those that would not be considered public services), and no tender should give more than 50% weighting to price.​

Were some local areas, where services were well integrated before the crisis, better able to respond to the outbreak than areas where integration was less developed? Can you provide examples?

Coronavirus has amplified many things that existed before the crisis – both positive and negative. Keep it Local councils, those that have signed up to Keep it Local principles[17], had already started to look at how they could better work with local organisations. This gave them a much stronger base on which to develop their pandemic response. Charities have reported that where commissioners have responded positively, this has often developed from existing relationships with the commissioner. Where such relationships did not pre-exist, the response from commissioners has more often not been as positive.

For example, Calderdale Council has acknowledged that they were able to respond quickly to the pandemic due to the existing partnerships, networks and understanding that were in place – which in part had already been established due to recent flooding.[18]

This emphasises the need to facilitate good relationships, built on trust. Keep it Local offers a way for local commissioners to improve their working with local charities to transform lives through improved services. As the country looks to build back better, approaches such as Keep it Local offer way forward that builds on strengths in communities and enables public services to best meet needs.

While the pandemic has been a tremendous shock to the country, many predict that such a shock will not be a one-off event and that we need to better prepare so that services can better respond next time. Looking at public service commissioning is one element of this - adopting approaches that encourage collaboration and trusting relationships, working closely with local community organisations to understand local needs.

The Coordinated Community Support Programme[19], supported by the Foundation, is a pilot programme looking at how to improve the response to people facing immediate financial crisis. The programme, which brings together local councils with local charities to reduce duplication and promote a more coordinated response has shown how stronger coordination between the voluntary sector and local authority can enable a better response to crisis. In the pilot areas, relationships had already begun to develop over the first six months of the programme, and this coordinated response has been accelerated during the crisis, as both local authorities and voluntary sector have had to step up quickly to meet immediate need. As the pilots progress over the coming months, they will offer important learning for how other areas can best respond in a coordinated way to crisis need.

Are there any examples of services collaborating in new and effective ways as a result of Covid-19? Are there lessons to be learnt for central Government and national regulators in supporting the integration of services?

Improved communication between organisations and councils has helped to improve collaboration during the crisis. This has been supported by a shift away from strict contract approaches and towards a partnership approach. An example of this can be found in Swindon. Harbour Project for Swindon Refugees and Asylum has shifted its approach to public service delivery since the onset of the crisis, so that all face-to-face support has moved to phone-support, with additional services developed to meet needs such as delivering food parcels and providing wifi routers and low costs tablets to allow people to access online classes. They were able to do this because Swindon Borough Council confirmed at the outset that their contract payments would be unaffected by the changes. This has been supplemented by weekly calls with the commissioning team about the borough’s broader response plans. The approach has again highlighted the importance of relationships. While the collaboration has helped to reduce duplication and ensure needs are met effectively, it has also facilitated honest conversations about both short and longer term challenges for service providers which charities and the council will need to address together.

The core lesson emerging from this is that relationship-based approaches to providing person-centered services are more effective. The emphasis that we have seen on competitive procurement practices over the last decade have continually eroded trust and damaged the relationships needed for effective collaboration. Both government and charities have shared objectives in terms of ensuring that people can access the support they need. The Covid-19 crisis has demonstrated how much more can be achieved where these sectors can more effectively work together instead of focusing on a contractual relationship.

What does the experience of public services during the outbreak tell us about services’ ability to collaborate to provide “person-centred care”?

As outlined throughout this response, small and local charities are experts at delivering ‘person-centred’, holistic support[20]. In many cases, this is in spite of rather than because of how public service contracts have developed.

The depth of need and urgency of response has seen many charities improve partnership working, not only to ensure holistic support but also to ensure the best use of limited resources. A range of collaborations have developed. In some cases this has built upon existing strong local infrastructure, or the strength of local charities’ networks. In other instances it has developed informally and the key question will be around how this collaboration continues. As a grant holder in Bradford describes:

“With the red tape lifted, we have been able to move mountains and change things which would have taken months or even years … We always work closely with the council and NHS but this has taken our partnership working to another level.”[21]

Local infrastructure that supports such collaboration has been underfunded for years, but it has an important function in bringing different organisations together. Many local infrastructure organisations had turned to trading to survive financially but this income has now disappeared due to lockdown. This is important because it highlights that supporting good public services is not just about funding service delivery – but supporting the infrastructure that enables good public services to be delivered.

The relationship between central Government and local government, and national and local services

How well did central and local government, and national and local services, work together to coordinate public services during the outbreak? For example, how effectively have national and local agencies shared data?

The scale of the coronavirus outbreak required both a local and national response, but too often this reverted to a centralised approach that failed to make best use of local networks and resources. The pandemic has shone a spotlight on the importance of local organisations. NLGN’s latest Leadership Index revealed that 95% of respondents think the role of community groups in responding to the pandemic was significant or very significant[22]. This reflects patterns that were evident before the crisis but again have been amplified during the response: locally-led approaches are often more effective than centralised top-down contracts.

The response to the pandemic in different areas has been adapted to the local context – the needs of local people and the resources available to respond. Yet the central government approach has overlooked the importance of locally-led responses. Councils, on the ground in the areas they serve, are typically best placed to ensure public services meet the complex needs of local people by working with local charities – but they need access to the funds to support this. There are a number of examples where the public service response to the pandemic has been driven by top-down centralised contracts, from the supply of food parcels for those who are shielding and free school meals support to our approach to testing. In each case, devolving approaches to the local level would have enabled more tailored responses which better mobilised existing networks and support.

For example, working with the Children’s Society Coordinated Community Support Programme, Mulberry School in Tower Hamlets quickly identified 320 families likely to be most in need of immediate support, and mobilised a food bank offer from their school. With the help of additional funding from the Coordinated Community Support programme and a charitable grant, this provision was extended to support other families, providing emergency food parcels (tailored for dietary or religious requirements), baby/early years parcels, books and textbooks and other household essentials. They have also built links with local advice agencies, referring around 10 families per week for specialist support.

Key to the local level’s ability to respond is the availability of funding for public services at a local level. Rather than supporting and empowering local areas to respond effectively, central government has backtracked on funding promises to support local authorities at a time when councils already faced uncertain financial futures[23].

There are of course some areas in which a strong central government approach is needed however – such as a well-resourced and effective national social security system, which would mean fewer people would need to turn to foodbanks or local charities for emergency support. Similarly, adequate and fair national funding is needed to support local authorities to play their role.

Even before the pandemic, communities that need the most support had seen the biggest cuts to services in their local authorities[24]. The pandemic has hit already marginalised communities hardest and there is a growing need for funding redistribution. Local authority funding has shifted away from redistribution, requiring local areas to generate their own income but this fails to recognise that more deprived areas face greater demands on public services yet have fewer opportunities to generate income. If Government is committed to its levelling up agenda, it has to ensure that local authorities have the resources to meet needs.

Can you provide any examples of how public services worked effectively with a local community to meet the unique needs of the people in the area (i.e. taking a “place-based approach” to delivering services) during the Covid-19 outbreak?

One example can be seen in Locality’s latest report, We Were Built for This. The report describes how Knowle West Alliance was set up by a group of community organisations to enable better partnership working and a more collective approach for the local area. In response to coronavirus, they were keen to set up systems that would enable people to access advice and support:

“KWA reflected that their existing good relationship with the council – based on mutual trust – enabled them to respond quickly. On top of this, the way council and community have been working together during the crisis has strengthened these bonds further. This included collaborating together to build an app that links volunteers with requests for help.”[25]

A further example is evident in Halton. A fortnightly call, initiated by the local sector infrastructure organisation brings together the local CCG, borough council, Halton and St Helens Voluntary and Community Action and numerous local charities has helped the area improve collaborative working. The approach has helped to coordinate access to PPE and enabled organisations to help each other. They have been able to ensure that food offers are not duplicated and have directed clothes and food donations to refugees who needed support. It is a space where people can highlight a need they have identified or give an update. The opportunities and relationships the call has helped to develop are driving its continuation, with the intention to shift it to an ongoing forum to further develop relationships after lockdown.

Would local communities benefit from public services focusing on prevention, as opposed to prioritising harm mitigation? Were some local areas able to reduce harm during coronavirus by having prevention-focused public health strategies in place, for example on obesity, substance abuse or mental health?

For years, charities have been reporting rising demand for support – both in terms of number and complexity. As one sexual abuse charity in the East of England highlights, even before the impact of Covid-19:

“Over the last year, we experienced a significant increase in demand for our services - 28% over the last year and almost 300% since 2015.”

While a domestic abuse charity in Yorkshire reports:

“We have seen an increase in clients with complex needs being referred into our services, thus requiring more intense and longer- term support.”

The financial constraints of austerity have forced local areas to take difficult decisions which too often has seen disproportionate cuts to prevention budgets, driving increased costs for crisis interventions. For example, a study for the Foundation by New Policy Institute found that local government spending on disadvantage in housing fell 13% over five years and, within this, spending on preventative services (enabling people to stay in their homes) have been cut by 46%, while crisis spending (primarily on temporary accommodation) has increased by 58% over the same period.[26] In this case, the cost of cutting prevention is an increase in homelessness.  Grant holders, such as a local charity in Yorkshire, also report challenges as councils have to cut back on prevention and early intervention:

“Because of the funding cuts to local councils their early help workers have dramatically reduced and they are also covering wider area of the district”

The levels of need that we now see, as a result of pushing people further into crisis before they are able to access support, can only be stemmed if more people are supported before they reach crisis, with more focus on prevention. However, the level of immediate need cannot be ignored in favour of prevention – both responsive and preventative services are needed side-by-side. Again this comes down to funding. Charities have reported an increase in the intensity of support needs, particularly around mental health. The threshold for accessing support has risen, meaning people with lower level needs cannot access support at an earlier point when they might have benefitted from a lower level intervention – and when they are eligible, they face long waiting lists until they can access support. As one of our grant holders describes:

“The waiting times can be six months to a year when young people are in urgent need of support and treatment. This leaves support organisations, like us, supporting young people who have acute mental health needs, because there is a waiting period for them to access therapy. This causes a real strain on non-mental health organisations, as these cases can take up most of support workers capacity and time.”

This has again been amplified by the pandemic, as charities have faced increased resource constraints so have been forced to focus on those with the highest needs. Preventative investment is critical so that services can access the funding to address needs earlier.

Role of the private sector, charities, volunteers and community groups

What lessons might be learnt about the role of charities, volunteers and the community sector from the crisis? Can you provide examples of public services collaborating in new ways with the voluntary sector during lockdown? How could the sectors be better integrated into local systems going forward?

First and foremost, charities, particularly those that are small and local, have played a critical role in the response to the crisis. Their connections in communities and agility has enabled them to pivot their services to continue delivering support as well as understanding emerging needs and developing responses accordingly.

The connections that charities have in communities has been essential for mobilising support. Independent research has shown that small and local charities are often the ‘glue’ holding services and communities together and we have seen charities draw on these skills during the crisis. This has been particularly noticeable around volunteering. For example, a local organisation in Hackney worked with the council and local CVS to identify roles in which to place newer volunteers from across the borough.[27]

Local charities like those supported by the Foundation support people facing complex social issues – typically the people that services delivered by bigger agencies find difficult to reach. These charities have helped to ensure services reach those who need them most, precisely because they were already operating in these communities. The pandemic has solidified the importance of these charities – public services cannot reach into communities without them. Such charities have also helped councils to ensure people receive accurate information too. In one example, a domestic abuse charity in the South West has helped to set up a Covid-19 Domestic Abuse Taskforce and

“have supported the Local Authority and the CCG with Comms advice and information and advocated for harmonised and accessible information to be available a cross platforms and services, to ensure victims know that they are allowed to leave their homes to seek help, and where that help is available.”

Charities’ existing connections have also been important for allocating support from businesses. For example, a grant holder in the South West is working with Wessex Water to coordinate food for vulnerable people. Wessex Water’s head office catering team is producing 100 meals a day twice a week for people in the local areas.  The charity was already working with other local community organisations so has been able to build on this to make sure that the food reaches those who need it most, with other community groups able to refer people into the charity.

Agility has been a key characteristic needed to respond to the crisis – and is a feature of small and local charities. Their size enables them to adapt quickly and respond to emerging needs. Their size also means they often serve a particular community in which they are deeply embedded. These charities have been well placed to continue delivering public services and to ensure they reach people facing complex disadvantage. A key lesson to draw from this is how more of these charities can be supported to deliver public services, shifting away from large scale generic contracts.

Through the crisis it has become even more clear that services supporting people facing issues such as homelessness, domestic abuse or mental ill health need to be able to adapt and provide person-centred support. To enable this, there needs to be a greater emphasis on alternative approaches to commissioning. This could involve alliance contracts, breaking down contracts to smaller lots or making more use of grants for example. As the impacts of the crisis continue to be felt, the need for services to work together (not against each other through competitive tendering) and to build in the flexibility to continue to adapt will be increasingly important.

The ‘everyone in’ policy to provide accommodation for everyone facing homelessness is a clear example of where some local authorities and charities collaborated effectively to ensure public services could deliver.

“COVID19 saw the local councils having to provide emergency accommodation to rough sleepers over the lock-down period and we worked closely with them to achieve this. The desire for the local authorities and [our charity] is that we will not put those currently housed in the hotel provided by the council, back on to the streets once the lock-down is over. [Our charity] is working hard with local authorities to gain more affordable accommodation to achieve this.”

Maximising the value of charities in delivering public services depends on two core elements:

• Involving charities in strategic decisions about what support is needed and how it can best be delivered. The examples of where charities have formed part of the council’s Gold Command system, such as the Bradford example highlighted above, have demonstrated how partnerships can work effectively to bring together different partners to ensure services for the public are delivered in the best possible way and are complemented by the additional services that charities provide. Such partnership work requires infrastructure resource which needs to be invested in.
• Funding needs to be available to ensure public services can continue to be delivered. The Foundation is concerned that charities are increasingly reporting delays to tenders being issued / awarded or government drawing back the funding for the service. Charities are facing extreme financial pressures and do not have the resources to continue delivering public services without adequate funding. This relates both to the quantum of funding made available by central government and its distribution at a local level.

Key to improved public services going forward will be building on the partnerships and collaboration that have flourished in some areas. Charities are eager to see such new ways of working continue, as highlighted by a local charity in the West Midlands: 

“We have had wonderful co-operation, in recent weeks, from Shropshire Council, West Mercia Police and many other local organisations. We hope that level of co-operation will continue.”

Getting this right is of vital importance because so many charities are predicting further surges in demand as lockdown restrictions ease. As a specialist service supporting survivors of domestic abuse describes:

“It is the calm before the storm as referral rates have reduced, some clients have disengaged preferring to wait for face to face therapy. We are expecting that when restrictions are lifted there will be a surge on demand for the organisation.”

In another example a charity delivering specialist services for people with eating disorders in the East Midlands saw fewer referrals at the start of lockdown as adults were choosing to wait until face-to-face support was available – leading to a bottleneck in demand further down the line. In this example referrals for children and young people also reduced at the start of lockdown as with children stuck at home, agencies had fewer opportunities to pick up cases. Whilst these specialist referrals went down temporarily, referrals for more generalist mental health support increased and in this example, were supported through the local CCG.

There are clearly many lessons to be learned about how public services can be better delivered, how why and how public service commissioning needs reforming and the critical role of charities in delivering services for the public. Charities and public services more broadly will continue to face extreme pressures going forward, but it is critical that we maximise the gains that have been made where good examples have emerged and ensure that sufficient funding is made available for the ongoing delivery of essential public services that is accessible to the local charities that are central successful delivery. 

31