LONDON BOROUGH OF HACKNEY – WRITTEN EVIDENCE (PSR0098)

House of Lords Select Committee on Public Services | Public services: lessons from coronavirus

London Borough of Hackney response to the Committee’s call for evidence

We welcome the opportunity to give evidence to the Committee about this important work, and we have set out detailed answers to these questions below. We would be happy to give oral evidence or submit further evidence to support the Committee’s work.

Hackney has made a long term investment in our data analytics capability because we believe that effective use of data has a critical role in the services we deliver to our residents. As part of this we place a high value on data standards and master data management, for example ensuring that the unique property reference number is used for all address information held in our business applications so we can use address data consistently and effectively. The data from these systems is used in our data warehouse platform, joined and visualised using a range of tools. The Council's data and insight team works closely with subject matter experts across our service teams to understand what the data means and how we can use it to inform effective business decisions.

In this context, the Council was able to link records to identify residents with certain characteristics that might make them more vulnerable to Coronavirus and the impacts of lockdown - for example, if the family was in receipt of free school meals, entitled to Council Tax reduction or living alone. This was then presented in an accessible interface to enable different Council services to design interventions accordingly (such as housing officers targeting proactive phone calls to vulnerable tenants).

When vulnerable residents needed additional support we used this data to design appropriate interventions and test different approaches to matching them with longer-term help (eg a referral to the food bank).

Our more detailed response focuses on the London Borough of Hackney’s involvement in the support for extremely vulnerable people during the initial phase of the response to the Covid-19 pandemic (including people who were advised to ‘Shield’). Whilst it is currently too early to tell, it appears that many of these experiences might be repeated in the logistical arrangements to set up the national ‘Test and Trace’ service so we hope that sharing our experience can be useful to inform improvements to future aspects of the national response to Covid-19.

We are responding to the Committee’s questions relating to:

●       Technology, data and innovation

●       Integration of services

●       The relationship between central and local government

It was our experience that, in a time of unprecedented need for clear leadership, cross-organisational working and intensive support for the most vulnerable in society, central Government demonstrated a lack of:

●       Capability to understand service delivery

●       Willingness to embrace partnership working with local authorities

●       Diversity in decision making or sufficient care for equalities

●       Consistency in approach towards funding

Together these combined to produce inefficiency, considerable rework and delay, and jeopardised the political commitments given by Ministers.

We have used principles from the Government’s Service Standard as an objective framework to explore the strengths and weaknesses of public service success and failure through this part of the response to Covid-19.

Understand users and their needs

The Government anticipated that users who were advised to Shield would need help accessing food and other essential supplies as they would not be able to leave their homes. It used its scale to create a national offer for food delivery and contact channels via letter and GOV.UK to alert citizens. It then created the NHS volunteers service to leverage the NHS’s national brand to create capacity to provide local support.

Our experience at a local level was that there were significant weaknesses in the approach that the Government took.

The service appears to have given little or no thought to the cultural sensitivities of our diverse communities or the sustained health needs of the population. Food packages did not cater for cultural or other dietary needs (the GOV.UK form asked about these, but they were not catered for in the food that was provided by the Government service) and the service did not include help to take food inside where residents were physically unable to. It was also a national delivery model delivered by private contractors, that lacked the ability to connect well into wider parts of the public sector including local government.

The service appears not to have anticipated the other needs associated with the immediate breakdown of informal care and the vulnerability of this group. For example, paying bills where the users didn’t have online banking, the provision of prescriptions, washing and cleaning, and support with household chores. The expectations of local government were unclear and councils were left to guess what types of service they would need to provide to fill the gaps in the central Government service.

By comparison, at a local level we were able to use our data and insight capabilities to work rapidly to develop a picture of needs in the borough and use this to design a more comprehensive response. This included consideration of potential clinical vulnerability, disability, isolation and the impact of the pandemic on people’s financial situation.

From an early point in the pandemic, Hackney also created a community impact assessment which considered the knock on ways that communities and individuals were likely to be impacted. This was informed by what services and communities were telling us as well as national data sets, such as an increase in Universal Credit claims, our own surveys, and survey data and service data from partners. This gave us a more strategic assessment of vulnerability that we were able to check against our service data and has helped us consider our response from the perspective of those who might not be contacting us, who might not be reached by our communications and also who might not already be using our Council services. As the pandemic has disproportionately impacted on ethnic minority communities and created a level of vulnerability amongst those who might not have had reason to use our services before, this impact assessment has been very important. Later in the process we used this to develop a set of equality considerations which are now informing our evolving response.

Central Government’s failure to understand users and their needs effectively has been repeated in the early stages of the ‘Test and Trace’ service. For example:

●       The online form to book a test slot required a vehicle registration number but the majority (70%) of people in Hackney do not have a car. So for the Dalston testing centre, users had to enter ‘WALKING’ in this field to be able to book a test - but there was no notification on the form to advise that this is what someone who was not driving to the test centre needed to do. Indeed this local hack ensured hundreds of people were able to access a test locally, and at the time of writing has yet to be fixed.

●       NHS Test and Trace is not providing details to local authorities of people who are vulnerable and need support to self isolate. Instead, those people who are identified as vulnerable during their interaction with the service are provided with a link so they can find the support page on their own local authority's website. People will identify as vulnerable and in need of support for many reasons, including that they may have learning disabilities or physical disabilities (including visual impairment) that prevent them from self isolating without support and would also make it very difficult, if not impossible, for them to access a website to ask for support. This is not to mention language needs.

Solve a whole problem for users

The Government’s food delivery service did not solve a whole problem for users, even on its own terms. It was providing food, in weekly boxes, to people that had been advised to stay at home because they were extremely vulnerable to Covid-19. But this food would only be delivered to a ground floor door. We believe that around 80% of residents in receipt of this support were social housing tenants, the majority of whom would not be living with a separate front door on the ground floor. Government advised that local authorities should organise volunteers to take the food to the person’s property, but couldn’t provide any data about the day or time when the parcel would be delivered, leaving councils with no ability to plan.

These logistical constraints were compounded in the early weeks of the service. Initially, local government was asked to provide the infrastructure to deliver food to all of the people on the Shielding scheme who asked for it (although central Government was not able to indicate how many people this was likely to be) and to establish a phone line to enable vulnerable people to ask for support. In response to this we used the data we hold to assess where people in need might be located across the borough and then identified and staffed a warehouse to receive this food, setting this up to be operational throughout the weekend as we understood the first delivery would arrive at any moment. When the delivery was made, Hackney was provided with food to meet the basic needs of 44 residents. Over 120 people who were self-isolating and unable to access food had already contacted the Council directly asking for help (some of whom were on the Shielding list and others of whom had serious health concerns but had not received Shielding letters at that point).

The basic supplies in these consignment would not have met the basic nutritional needs of a single person for two days, included large volume bottles of double concentrated squash and low quality meat based ready-meals (inappropriate for the dietary or cultural needs of a large number of our residents). The Council then sourced food directly from local businesses to meet the shortfall. Several days later, the Council was able to clarify that the central Government delivery was for emergency parcels only, not intended for delivery direct to residents.

In Hackney, many of the vulnerable residents who contacted us directly had other needs - such as the collection of prescriptions, help with debt or accessing essential services online. The design of the central Government service meant that this provision was highly fragmented, meaning that we could never provide reassurance to residents about how the ‘whole problem’ would be solved. For example, the Council might organise for the prescription to be collected but didn’t know when the resident would receive food from the Government service.

Hackney received multiple phone calls each day from residents in receipt of central Government food parcels with queries such as ‘when will the box be delivered?’ ‘Can I opt out of the box?’. The central Government service did not provide any channels to handle these queries - either for residents to contact directly or for the Council to follow up on their behalf. We later learnt that users who wanted to opt out had to repeat the registration process online, this time requesting not to receive food parcels. The lack of effective communications in the box meant that there was no way for the recipient to know what would happen next or even who to contact about the delivery.

By comparison, the Council’s ‘I need help’ service which we set up rapidly for Hackney residents was designed to meet the complex needs that we had identified through our analysis of the data. This provided online and telephone access to support, backed up by a service that went well beyond meeting needs for food, delivered by a team who were trained in ‘Make Every Contact Count’ so they could make the most of each conversation and provide the best support possible to each person they spoke with. We established a multi-disciplinary team of professionals who were able to follow up where residents reported complex and acute needs, including referral for social care support where needed. Close collaboration with local community sector partners (building on long-standing and effective partnership working) also played a vital role in our response, including delivery of food while we established a larger scale operation that could meet the rapidly growing demand. Our housing service was also able to use the contacts made through this service and our data tools to identify residents at risk of isolation and make proactive befriending calls. Feedback from residents who were contacted in this way was that this provided a vital lifeline and reassurance at a time of great anxiety. We were able to iterate and develop this service quickly as we learned more about the needs of the residents who needed our help.

The failure to think about the whole service shows signs of being repeated through ‘Test and Trace’. For example, at the time of writing, the Government cannot provide details of who has been tested, and when.

Provide a joined up experience across all channels

The people who were assessed to be ‘extremely clinically vulnerable’ discovered the Government's support service because they received a letter from the NHS, were asked to register online and were then phoned up to 10 times by a central Government call centre. Government initially also asked local councils to call all of these residents directly - although the purpose and advice that should be provided beyond the calls that the Government’s call centre had already made was unclear. Subsequently this scope was revised to ask councils to contact people who weren’t in receipt of central Government support. The ‘extremely clinically vulnerable’ list was populated through inputs from GPs, who also had a role in contacting this group proactively.

Given the number of actors in relation to this cohort, the lack of clarity about the role of each, the changing ‘ask’, and the failure to provide adequate tools to users (such as the facility to view recent communications or receive alerts when something was going to happen), a huge amount of effort will have been expended by a large number of agencies, with vulnerable and frightened people left confused and unclear about where they should expect to receive support from.

In relation to track and trace, the 119 telephone line for accessing testing doesn't avoid the need for online or mobile access, since callers are asked for an email address or mobile number when booking a test via this route. The only way to get round this is to nominate a trusted person's email or mobile phone number, which could cause problems for advocates who are supporting several people to access the test and have only one email address or phone number. This is not to mention the confusion that most people experience about the different services that are provided via 119 (book tests and follow up results only, with no clinical advice) and 111 (clinical assessment and advice, leading to testing, if appropriate).

Locally, our response was based on close partnership working from the very start. We knew that our residents would rely on support from a wide range of partners (including health and the voluntary sector) and we knew that co-designing the response and using our experience of Agile delivery would be essential to minimise confusion and wasted efforts (noting that the urgency and pace of developments meant that normal levels of coordination and planning would not be practical).

Make the service simple to use

All evidence we could see indicates that central Government did not give adequate focus to achieving simplicity:

●       Local authorities were asked to create an online form and set up a dedicated phone line so that vulnerable residents could seek support, whilst central Government then appeared to also provide the same service centrally

●       The NHS Volunteers service was set up to appeal for volunteers whilst also asking local government to appeal for volunteers (and continued to hold the NHS Volunteers list centrally, rather than directing them to local councils who would then have been able to connect them to a coordinated local response)

●       Local authorities were asked to contact the group of Shielding people, without being provided with funding, whilst central Government funded a DWP contact centre to do the same

●       The majority of people who indicated on the central government form that they had a care need had to be then contacted by the local authority where, typically, a further conversation revealed that they didn’t - and one reason was a lack of understanding of what the question meant

The sign-up form on GOV.UK was simple to use for the people in our digital team. However, too little thought was given to the particular needs of much of the target audience, which included:

●       People over 70 years old and/or those with dexterity issues

●       People without English as a first language who may not have understood the language (Q1 asked if you’ve been told by your doctor to ‘Shield’)

●       People who did not know their NHS number

●       People who could not use the Internet

Locally, our ‘I need help’ service has been designed to simplify support to the greatest extent possible. We made sure that none of the service was dependent on Internet access, our contact team were trained to be able to provide advice across the full range of support needs (indeed we extended the range of services that were provided directly by our contact team), and our multidisciplinary team model was designed to ensure that vulnerable residents received the specialist support they needed without any delays due to process or bureaucracy.

Make sure everyone can use the service

As noted above, there appears to have been minimal or no consideration of the needs of non-internet users or people with dietary or cultural needs as part of the Government’s food provision. This left councils needing to fill the gap, but without the information needed to plan how to meet those needs.

As we have described above, Hackney’s response took a very different and more comprehensive approach. We also knew that further targeted effort was needed to meet the needs of all of our communities. For example, as part of our collaborative approach we chose to fund local community groups in the Orthodox Jewish community directly (who typically do not have Internet access) to provide a service that mirrored the provision available to other groups but designed to meet their specific needs.

Have a multidisciplinary team

Central Government’s approach to what was correctly identified as an urgent need did not represent multidisciplinary working between central Government, their private sector partners and local councils.

The Government expected that each local authority would create its own service to enable vulnerable residents to request help and sign up local volunteers to offer their help. And where central work took place the data provided to councils was either non-existent or of extremely variable (and often poor) quality.

Councils lacked the data, clarity about expectations and feedback channels to support the effective delivery of the Government’s plans. We were also left needing to make guesses on the gaps that our own local services would need to fill. Fortunately, our multidisciplinary and partnership working at a local level meant that we were able to respond rapidly and ensure that people who contacted our ‘I need help’ service received the support they needed.

Use and contribute to open standards, common components and patterns

The failure to incorporate structured address information (using the well established Local Land and Property Gazetteer standard) as part of the sign-up process created hours of avoidable work for local authorities to match the data with their own records, and in many cases data could not be matched. To explain this in layman’s terms - postcodes often split across borough boundaries, so cannot be used as a reliable way to determine which borough an address is in.

The failure to validate NHS Numbers also created further issues matching data, preventing coordinated delivery of support.

As shown in our analysis of needs in Hackney, effective use of data standards allowed us to link data to develop a clearer picture of the needs that we would need to respond to. This was vital to the effectiveness of our response.

9 July 2020