REVOLVING DOORS AGENCY – WRITTEN EVIDENCE (PSR0090)

About Revolving Doors Agency

  1. Revolving Doors is a national charity that has been working for over 25 years to change systems and improve services for people in the revolving door of personal crisis and crime.  People in the revolving door are characterised by repeat low-level, nonviolent offences, such as theft and minor drug offences, linked to multiple underlying problems, including mental ill health, problematic substance use, homelessness and domestic abuse. Their health, care and offending-related needs go hand in hand with persistent poverty, long-term unemployment, trauma, experience of racism and discrimination, and social exclusion.
  2. We bring independent research, policy expertise and lived experience together to support effective solutions to end the revolving door. We work with policymakers, commissioners, local decision-makers, and frontline professionals to share evidence, demonstrate effective solutions, and change policy,
  3. We involve people with direct experience of the problem in all our work through lived experience forums based in London, Birmingham, and Manchester. We also convene the National Expert Citizens Group (NECG) as part of the Big Lottery funded Fulfilling Lives Programme, which delivers support services to people with multiple needs throughout England.

Our response has been informed by research conducted in the following areas

  1. Over 120 people with lived experience of multiple disadvantage consulted through:

4.1.                     A recent survey of 48 people in the revolving door and how they have managed during the lockdown imposed by Covid-19. 

4.2.                     Three consultation sessions run with over 40 NECG members to better understand the positive service responses for people with multiple needs.

4.3.                     Two sessions with 21 Lived Experience Forum members to understand the potential impact of the Covid-19 related operating models in prison.

4.4.                     Three sessions with 39 Lived Experience Forum members to discuss probation reform more widely, of which aspects relate to the Covid-19 related operating models in probation.

Survey respondents

  1. A summary of sorbet respondents: 48 people responded to our survey, all have repeat contact with the criminal justice system, and experience a combination of homelessness, mental health and substance misuse; 53% male, 45% female, 2% prefer to describe gender as something else; 35% of respondents were aged 26-35, the second most-common age group to complete the survey were those aged 36-45 (31%); A large majority of respondents were White British (80%). 10% were Black/ African/ Caribbean or Black British and 8% were from multiple or mixed ethnic groups; More than half of respondents considered themselves to have a disability or long-term health condition (55%)

 

Response to inquiry questions

Question 1: What have been the main areas of public service success and failure during the Covid-19 outbreak?

  1. Covid-19 resulted in unforeseen, sudden, and large-scale changes to the services and system supporting people experiencing multiple disadvantages. Reports from the sector shows the myriad of ways in which services have innovated under pressure. However, it is less clear whether these innovations have been welcomed by people accessing these service.
  2. This situation is developing at such a pace that current good practice may appear outmoded in the near future. It is likely that the negative impact of Covid-19 for people living with severe disadvantage and multiple needs is likely to increase with time, particularly its impact on mental health, associated trauma and bereavement, the health implications for those that contracted Covid-19, and the impact on the local economy and labour market (especially in areas of significant pre-existing deprivation). 
  3. People facing multiple disadvantage told us that the main successes in public services, according to our consultations appear to have been increased flexibility, choice of how to engage, the use of technology, fast tracking and simplifying referral process, increased collaboration and reducing unnecessary bureaucracy, more outreach and services being proactive and creative. This has resulted in several innovations, including prescribing services speeding up access and providing longer prescriptions, residential rehabilitation removing barriers to access, probation services have increased outreach visits and have implemented more regular contact.
  4. The main failings of public services appear to have been caused by pre-existing low capacity of services, lack of investment in technology, under-developed partnership working with other public services and other local services (including charities). This is highlighted by a number of examples, such as a high demand for mental health services that could not be met, inability to connect family and friends with those in prison due a lack of historical investment in technology to facilitate virtual visits, and the difficult of co-ordinating responses between agencies where pre-existing partnership work was not well-established.  
  5.         One of the critical oversights made by government policy and public sector services is an inability to jointly support people and families suffering from severe disadvantage and with multiple needs. Services are generally not geared towards addressing the overlapping issues of public health, criminal justice, poverty, discrimination, and trauma that run deep in communities up and down the country. Of the people we surveyed:

10.1.             32% were unemployed and looking for work, 30% were unemployed and not looking for work because of disability or long-term health condition, only 7% of respondents were in education or training. Of the 28% that were employed just under a quarter (23%) considered themselves to be a key worker.

10.2.             Over half of respondents (53%) reported that it had either been very difficult or difficult to pay for their living costs in the past two years;  a third 30% said their ability to pay for their living costs had  worsened since 1st March.

10.3.             More than half of respondents had used a foodbank before and after the lockdown (57%), an additional quarter of respondents reported using a foodbank since the lockdown had been introduced. Of those who had started using a foodbank since the lockdown was introduced, more than 91% were in receipt of Universal Credit. 82% of those who had started using a foodbank since lockdown considered themselves to have a disability or long-term health condition. 

10.4.             Just under a quarter of respondents said that they were drinking more (24%) since 1st March; compared to 12% of respondents gambling more and only 2% of respondents increasing their drug use.

10.5.             40% of respondents had difficulty exercising – alone or in groups.

10.6.             41% of respondents explained that they had felt lonely some of the time since 1st March, just over a quarter felt lonely often or always (27%) – regardless of how many people that were in their household. Loneliness has a significant negative impact on mental health and wellbeing.

10.7.             12% had Covid-19, 35% reported 1-3 family members or friends had it, and 2% reported that between 4-6 family members or friends had COVID-19. Of these respondents 44% explained that their family members or friends went to hospital.

10.8.             Just under a quarter of respondents had reported a crime to the police since 1st March 2020 (23%).

  1.         In order to address these needs effectively it requires more targeted support that reaches into communities and actively supports people to access the services they require. Currently there is no joined up way of delivering this sort of support in our communities, unless it is provided by charitably funded services such as the National Lottery Community Fund Fulfilling Lives programme (supporting people experiencing multiple disadvantage). 

 

Question 3: 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?

  1.         It was clear from respondents that many services struggled in terms of capacity in three areas. Housing, mental health, prison and probation.
  2.         Housing: People with lived experience welcome the govt investment and the councils’ rapid response to offer temporary accommodation to those who are sleeping rough during the pandemic. Some of the people who have been housed would inevitably be those with previous histories of criminal justice contact, or those who have recently been released from the prison. However, it remains the case that people are being released from prison homeless, and prior to the lockdown 25% of all people leaving prison after a short prison sentence are released homeless. It is absolutely essential that we meet the needs of this population both during the lockdown, and invest in affordable alternatives such as Housing First. The Ministry of Justice should continue to invest in the development of accommodation services, and create a justice-led solution to housing prison leavers and those at risk of homelessness under probation supervision.
  3.         Mental Health: although we heard accounts of remote mental health support, it was clear from our survey that mental health services are inaccessible for many. Just over half of respondents to our survey (51%) reported having difficulty getting medical advice from a GP and accessing mental health support. In our consultation we found that mental health needs have increased during lockdown, for example 41% of our survey respondents say they felt lonely some of the time since 1st March, just over a quarter felt lonely often or always (27%) – regardless of how many people that were in their household.
  4.         Prison and Probation: It is common knowledge that the prison system has ambitious targets to recruit and train new prison officers, the probation service has also had similar issues in retaining and recruiting new probation officers. Feedback from our lived experience forums suggests that neither prison nor probation staff have enough time or resources to properly focus on the rehabilitative needs of their service users. For example, when discussing probation many said that they only received 5 to 15 minutes with their probation at each meeting, leaving little or no time for rehabilitation.

 

Question 5: 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

  1.         We have identified three changes that provide some important lessons as to how we could better support people with multiple needs.
  2.         Prescribing Services: Faster access and longer prescriptions. People talked positively about changes in opioid substitute treatment prescribing services. There has been a more positive approach to risk. Many prescribing services have moved from daily prescriptions, consumed at the pharmacist, to weekly, fortnightly, or even monthly ‘take away’ prescriptions. Services were described as becoming more ‘speedy and flexible’, red tape was said to have been removed and home deliveries provided. An example was given (London) of several women accessing scripts for the first time with the whole referral process completed over the phone. The benefits of longer prescriptions were stated to be; reduced stigma, responsibility, trust and enhanced recovery. Trust and responsibility were strongly linked to promoting and driving individual recovery. The risks of longer prescriptions were said to be being well managed by services providing extra support; regular phones calls, provision of naloxone, lock boxes, advice and education. A phone buddy system for people collecting scripts (Blackpool) was said to have been crucial in people considering rehab as an option.

Quotes from NECG members:

‘Supervised consumption is horrible for everyone.’

‘Responsibility and getting empowerment back are key to recovery. It’s about dignity’ Give trust it comes back 10-fold, it’s saving lives’

‘People are felling less stigmatised and have more responsibility’

 

  1.         Residential Rehabilitation: Barriers Removed to Enable Access. An example was given, from Blackpool, of it being easier to access services such as drug rehabilitation.  This has been enabled by the removal of the criteria that people must complete a course before a referral can be accepted. This was celebrated as a good example that eased access.

Quotes from NECG members:

‘Best thing for me in Blackpool, managed to get people into rehab and they haven’t had to go on courses for 6 weeks, without red tape, we’ve fast tracked’

‘I never got into rehab because I could never complete the courses. We got people into rehab who were really chaotic, we wouldn’t have done that before’

 

  1.         Probation Services: Outreach visits and more regular contact. When we heard examples of good probation practice it was often linked to regular calls, officers giving out mobile numbers to reach them on, checking in regularly, and offering support out of hours and signposting to other activities and services that were not part of the sentence plan or licence conditions. Regular telephone conversations were seen as very useful, but often only when used in combination with in-person meetings to help develop a good relationship and create regular communication. The more proactive outreach ‘door-step’ visits practiced during lockdown by probation staff have been positively received.
  2.         A downside of telephone contact was a practical concern that people could not afford the data to access voicemails. As an alternative. text messages were often preferred. Others also stressed that people in crisis, especially in relation to physical health issues, may be able to tell probation officers they are doing great on phone but, as one forum member stated,  “face to face you would see the reality”.
  3.         Our survey results showed a mixed picture on probation telephone supervision. A quarter found it extremely useful, another quarter found it useful; and another quarter found it somewhat useful. 17% found it not so useful and 8% found it not at all useful.

 

Quotes from NECG members:

“Understand, people don’t always have [phone] credit”

“It’s so different from going to horrible probation office. It’s taken out stigma and anxiety”

“Probation have stepped up, they used to decide between once a week or monthly, everybody is seeing everybody once a week. Coming out to houses, so much easier”

“[On doorstep visits] Professional but more personable. I feel I’m more relaxed, and I feel they are more relaxed”

 

Question 7: 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?

  1.         One of the main issues for people we work with was digital exclusion. The fact that some services and support became virtual, or online, meant that many relied on access to the internet and a device upon which to utilise it. That was not readily available for many. In particular those leaving prison, access to a telephone with credit, and access to the internet, a device that can connect, and the data to be able to access the internet are not a given and can act as a significant barrier to engagement. In many instances prison leavers were provided with simple mobile phones, this represents progress in the right direction. Other charities described how they had provided re-conditioned smart phones to allow service users to be contactable and access online resources.
  2.         A lack of technology in the prison estate meant that for many the lockdown was a solitary and isolating experience. With very limited contact with family or support services. This combined with a 23-hour lockdown imposed in the youth and adult (male and female) prison estate, should be cause for serious concern. The short and long-term impact on mental health should be closely monitored across the estate as a result.  However, the prison estate has made swift strides to bring technology into the prison estate, showing what is possible in a short space of time. We recommend that this momentum is not lost and that the Ministry of Justice seize the opportunity to embed modern communication and technology across the secure estate.

Quotes from NECG members:

“Giving phones out is a small cost to enable people to engage with a service”

“The regular contact is stopping me from triggering. The counsellor rings once a week, that is a massive help. I can text if I’m not feeling up to it, there’s no pressure, it just eases the pressure in your recovery”

 

Question 8: Have public services been effective in identifying and meeting the needs of vulnerable groups during the Covid-19 outbreak? For example, how have adults with complex needs been supported?

  1.         Revolving Doors convened he National Expert Citizens Group (NECG), which consists of representatives from the Fulfilling Lives services (supported by National Lottery Community Fund) and provides a national voice to people with lived experience of multiple needs; enabling them to identify positive improvements made to services. Over June we held three regional and one national meeting with members to assess what positive changes had been made as a result of the Covid-19 outbreak. 
  2.         People who have experienced severe disadvantage and multiple needs have often been defined as ‘hard to reach’ or labelled as being unable or unwilling to engage. The NECG saw this as a myth, disproven by the response to Covid-19. Previously, it was felt, that people had to engage with the service on the service’s terms; at the office, set appointment times, always in person, via referrals and bureaucratic processes. This created anxiety. One NECG member described missing an appointment as ’terrifying’.

Quotes from NECG members:

“Whole myth of non-engagement is dispelled if they take a different approach”

“Those traditionally described as hard to reach have been engaged”

“There was complacency from services and pressure on person to engage”

“There’s more flexibility with services. It’s levelled the playing field it doesn’t feel like you are talking to authority”

 

  1.         We have found that some services have become more flexible and enabled people to engage with them more easily. The NECG explained how accessing traditional and more rigid services can be difficult. Expressing that engaging remotely was less stigmatising and felt more informal. Heightened levels of anxiety were consistently mentioned as a significant barrier to visiting services.
  2.         Waiting areas within services, and the journey to them, were described as potentially dangerous. There is a risk of meeting people you want to avoid – dealers, people you used to use with, perpetrators of domestic violence and people who might exploit you. These reasons, combined with underlying anxiety, can make attending appointments extremely difficult. The dangers associated with attending appointments were expressed more strongly by women.
  3.         The positive is that, out of necessity, different approaches have been taken; services have responded by becoming more flexible, offering choice, options and using technology creatively. People have been able to access support from their home. Choice is key. There are limitations to support provided by phone or video calls and valid concerns that this will not always enable contact with the most vulnerable.

 

Quotes from NECG members:

“Sometimes if you’re anxious you don’t feel like going to appointments”

“Hard to attend lots of physical appointments in a day. Sometimes you don’t feel like leaving the house’.

“Found out how rigid they were before – services realising how creative, adaptable they can be, outreach, in reach – variety – we are more creative than we give ourselves credit for”

“It’s difficult getting to services when you’ve got kids in tow”

“Services should find out what people prefer – phone or face to face. People will engage, they just need the right format”.

‘Flexibility needs to come into play, it being person centred, telephone works for some but will not work for others, that transpires for all services. It can’t be led by a stringent tick boxing approach. Decisions need to be based on a person by person basis.’

 

  1.         There was evidence of phone and video calls enabling more support to be provided and freeing people from the difficulties of “trekking” to offices. People appreciated the regularity, and increased frequency, of phone calls saying it was now easier to engage with services. Numerous services have been proactive in providing the hardware – smart phones, tablets, laptops – to enable engagement. However, the use of technology must be balanced with outreach approaches.

 

Quotes from NECG members:

“Normally you go in, rush off, they are so busy. Drugs team asking if I want help with the kids. More personal, more humane… Drugs workers now phone up for catch ups, wouldn’t have happened before”

“’Zoom meetings are really good for some people, those settled in flats, but what about people on streets, those who are really vulnerable?”

“NA [Narcotics Anonymous] Zoom meetings, really helpful, but sooner they were face to face. I find it really difficult to share on a zoom meeting.”

 

  1.         The removal of red tape was consistently mentioned as a positive change making it easier and quicker to access services. Referral processes appear to have been made simpler and are often completed over the phone. Examples were given by the NECG members of quicker access to prescriptions, GP appointments, drug rehabilitation, and mental health services.
  2.         The reduction of bureaucracy appears to have been supported by increased collaboration between services. Multi-agency approaches were said to be more difficult when dependent on face to face office appointments, but video meetings allow people to meet more frequently and easily.
  3.         Multi-agency working was said to work best when co-ordinated by a lead worker (or navigator) directed and guided by the person receiving support.

 

Quotes from NECG members:

“Rapid response has been the biggest change”

“Removal of bureaucracy has been fantastic, we need to transition to keep that”

“NHS have stepped up with mental health. Started ringing people…Services are stepping up and talking to each other”

“Getting people on scripts for first time - over the phone!”

 

  1.         A consistent observation was that workers appeared to have more time to offer support. In addition to the regular phone contact already mentioned, there appears to have been the development of a proactive outreach approach and more creative ways to interact. People said this has resulted in a more humane and personal approach that was greatly valued.
  2.         Outreach into hotels, for people who had been sleeping rough, to offer ‘wrap around support’ was sighted as a positive development. Housing officers are visiting hotels to support people complete applications and linking in with other services. Nurses have been visiting to ensure easy access to primary healthcare.
  3.         Substance use services were also cited as implementing outreach approaches including home deliveries of ‘support packs’ which included medication and health information.

 

Quotes from NECG members:

“Had two calls from the mental health team, hadn’t spoken to me in a year!”

“Outreach approach is working… services are now coming to people”

“More outreach from drugs services. Needle exchanges can be dangerous places, people you want to avoid are there.”

 

 

 

Question 9: 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?

  1.         During our consultation we were unable to uncover any specific work that related to BAME groups and the Gypsy, Roma and Traveller community, despite some the fact that some of the aforementioned changes in support services may have inadvertently supported increased access to services. We have been concerned that despite clear evidence of poorer outcomes for people from BAME communities in relation to Covid-19, we have seen limited focus or strategy from central government to pro-actively support these communities with bespoke approaches.

 

Question 12: 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?

  1.         As part of our evidence gathering, we worked closely with the Fulfilling Lives projects across England. These services already work closely in partnership with a range of local partners to address the multiple needs of people experience severe disadvantage. As a result, we believe we have highlighted a disproportionate amount of good practice which we do not believe exists across all areas. 

 

Question 17: 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?

  1.         Too many people are being pulled into the cycle of crisis and crime because of the lack of early intervention and prevention. It is a fact that the criminal justice system has become a ‘service’ of last resort that ends up trying to support people with a range mental and physical health issues, substance misuse, homelessness, poverty and assorted childhood abuse and trauma. That service is ill-equipped to manage these issues effectively. A better solution would be to divert people into relevant services.
  2.         A prime example of a successful diversion service is the national roll out of Liaison and Diversion services, which showcases how we can intervene earlier and do it in a systematic way. Liaison and Diversion services need to have strong links with local mental health, learning disability and other relevant support services, including specialist services for children, women and for people from black and ethnic minority backgrounds. communities. They also need to have links with wider support for example with housing and welfare advice. They need to have the confidence of the criminal justice system to inform decision-making and ensure vulnerable people are appropriately diverted away from custody as early as possible or offered effective support quickly if they stay within the criminal justice system
  3.         Similar national approaches should be embedded into local services to spot need before it reaches crisis-point. Other areas for development could include Police-led diversion in the community and in custody, increasing targeted community sentences such as Community Sentence Treatment Requirements, rolling out alternatives to custody that focus on treatment, and better services that focus on rehabilitation and preparation for release from prison. 

July 2020