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Pandemic disruption offers opportunity to do things differently

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The Certitude-led, Fulfilling Lives programme in Lambeth, Southwark and Lewisham

(LSL) has seen unexpected opportunities for people accessing our social care and health systems during lockdown restrictions.

The programme works with people who are sometimes labelled as ‘being hard to reach’. We believe no person is hard to reach – but systems can be hard to access. Fulfilling Lives LSL works with people in a joined-up and person-centred way, identifying new and innovative ways to support those who might have a combination of needs, including mental health, substance dependency, experiences or risk of homelessness and offending histories. It aims to embed co-production into existing systems and look at how these systems can improve to enable people to live more fulfilling lives.

Lockdown shakes things up

In recent months, the Fulfilling Lives team have witnessed how the coronavirus pandemic has

provided a surprising opportunity to shake up how support is traditionally delivered. Organisations and services came under pressure to react quickly, dynamically and with a more joined-up approach than usual because of the national restrictions.

Virtual and remote working enabled a greater level of contact between groups of professionals

supporting individuals. A more collaborative approach emerged, where professionals and services contacted each other more often. Link workers reported that contact with services improved with more positive conversations, leading to a feeling that our team members were more included in the joint care of people we support.

One person commented: “I feel that I am being listened to, they are more involved and keeping in touch with me more than before. They [services] should carry on like this. When this is over, they should pull their finger out.”

People were already experiencing isolation

We found that many people we work with through the Fulfilling Lives programme reacted calmly to the pandemic and quickly accepted the change in circumstances.

A team member noted: “People we support have experienced isolation, limited access to services and difficulty in getting essential items before social distancing and other measures came into play. In some ways, these people are coping better with the situation than the general population.”

Moving things online or replacing face-to-face contact with phone calls also worked better for some people, with feedback suggesting that people enjoyed not having to attend in person and that it reduced the sense of stigma. People have reported that GP assessments by phone were both effective and supportive. Women say they preferred not to have to “spend hours hanging around” in male-dominated environments waiting for prescriptions or assessments. For many, the new way of working felt safer.

Changes to accessing drug treatments

Although drug treatment services were seriously impacted by the lockdown, benefits were also noted by people impacted by this. As appointments were suspended and treatment shifted to phone or online, one woman commented:

“There are less problems, I get to speak to the person I need to quicker – before I would have to keep calling, waiting until I heard back from them.”

Detox treatments were suspended during the pandemic and the majority of people on medication were given longer take-home prescriptions. Early indications show that trusting people to self-manage their medications for longer is enabling people to take greater ownership and responsibility of their own drug use.

Someone due to enter detox just before lockdown said: “At the last minute everything changed and I couldn’t go into detox. But it has enabled me to look at my health and I have been able to cut back on alcohol. I have turned it into an opportunity to try not to drink anymore. I will keep on going until the services are back open. I may stop drinking completely and may not need to go back to detox.’’

Not all positive effects

It’s important to note that some groups were disadvantaged by the changes forced by lockdown.

With traditional safety nets removed, victims of domestic abuse were at greater risk of coercion and control. People were forced to access phone support while the perpetrator of the violence was in the home. In these cases, not being able to meet people outside their home posed a huge risk.

Head of Programme, Diane Smith, believes the pandemic has provided valuable learning for providers and the public:

“This pandemic has highlighted the barriers some people face and given people a greater

understanding of their challenges. It feels as though there has been a shift in how people who face multiple life challenges are perceived.

“It has been widely reported that the health impact of the virus and the economic consequences of the national restrictions are likely to hit the most disadvantaged in society the hardest. I hope that increased support for the NHS, a new professional respect for support and care workers, we all pay attention to the structural inequalities that exist in society and now act through support for the Black Lives Matter campaign, and the positive responses to the ‘Everyone In’ homeless strategy suggests a public readiness for a more caring, kind and compassionate society as we move out of national restrictions.

“This has been a challenging time for everyone, but I know the valuable lessons we have learned – both about the positive impact of joined up, dynamic support and the way restrictive living poses challenges to certain people – will inform our programme’s recommendations for the future.”