Category: COVID 19

Cracks in the system – Part II

Fulfilling Lives South EastLeave a comment

In April 2021, FLSE  published a blog about concerns in how the healthcare system responds to people experiencing multiple and complex needs (MCN). These concerns were logged between January and March 2021, and then reviewed by our client-facing specialist workers together with the Systems’ Change team as part of the OOPS (‘Overcome Obstacles, Provide Solutions’) Project.

Following Up

This blog article captures our learning on this topic between April-June 2021 and acts as a follow up to our first reflection in March. this feels timely for our specialist workers because our front line support services come to a close at the end of June and even though our workers have championed the needs of our clients, there’s still improvements that can be made to the system to ensure people with MCN receive appropriate access to and support in healthcare services.

Similar to previous OOPS project learning, the last three months have shown that people experiencing MCN fall through the gaps and during the ongoing challenge of the Covid-19 pandemic, are missing out on valuable support services.

Concerns raised

Between April and June 2021, the following five concerns were raised by our specialist workers:

  • Dentist registration– a client who wasn’t yet registered with a dentist in East Sussex wasn’t able to be taken on as an NHS patient to get emergency treatment in local dentist surgeries, so needed to access A&E instead

  • Lack of mental health support– one client was really struggling with their mental health and took an overdose on prescription medication. The client wanted to discharge themselves but was kept in the hospital under the Mental Health Act. A mental health assessment took place, but it was decided that the client wasn’t fitting the criteria to be sectioned. Unfortunately, this meant that the case was closed without a referral for further mental health support in the community. So, the client left hospital and continues to struggle with their mental health. 

  • Prescriptions– during the last 3 months, one of our clients was released from prison but sadly, their prescribed medication was not prepared or organised prior to their prison release. Suffering from seizures due to anxiety, and being relocated to a new area, the client would need to see a neurologist to get these prescriptions. This had not been arranged as part of the release planning and the client did not have access to the necessary medication on their release. Shortly after release, the client had seizures. One of the seizures caused a fall, which led to a broken hand. Due to mobility impairments, the broken hand contributed to the client not being able to wash themselves. Unfortunately, another incident occurred and they broke their leg too.
    The client’s past traumatic experiences of hospitals have been overlooked by the prison medical team. The client is now in supported accommodation. Staff at their supported accommodation are trying to encourage them to go to hospital but so far unfortunately weren’t able to convince them.
    An official complaint has now been submitted to the Lewes Prison medical team.

  • Access and communication with GPs- One client was asked to book a GP appointment by phone to discuss a recent diagnosis. This diagnosis was communicated to the client by letter, without warning or preparation. The client wasn’t aware that his illness has progressed to a terminal stage which came as a surprise. This has meant that the client found out their terminal diagnosis via letter, not in person. Unfortunately the surgery wasn’t able to take their call to find out more because the phone line was busy and so the client asked the Fulfilling Lives specialist worker for help. This particular GP surgery’s rules didn’t allow the worker to make an appointment. Even the client’s social worker got involved and made numerous calls to the surgery to insist on making the appointment on the client’s behalf. The Social Workers persistent calls paid off and an appointment was made. The client then attended their appointment with support of the Specialist Worker.

Worker Reflections

FLSE has delivered client facing support for 7 years and during this time our workers have engaged with healthcare support systems and engaged with feedback and complaints systems. They have concerns about the effectiveness of these mechanisms to serve our client’s feedback and experiences. Two of our workers share their reflections below.

‘The NHS is really good at single issue solutions but when it comes to more complex/ dual diagnosis it’s a different story. Complaints processes need to be more personal, not one size fits all… because if the NHS isn’t fit for purpose for our clients, where can our clients go? They can’t afford to go private. (…) It is necessary for complaints systems to be simple, accessible and standardised. The current systems, such as PALS, doesn’t have the resources to deal with the number of complaints- especially if they are complex. Advocacy services also seem to be understaffed to help our client’s voices being heard. Resourcing is a big issue.’

‘A personalised approach is needed in which clients are supported to reflect on their experiences in their own words. The complaints’ systems are very fragmented, and our clients unfortunately seem to be bouncing around a lot.’

One of the Solutions

In our experience at FLSE, even if specialist workers understand the process of escalating concerns and are equipped to navigate the system, they often feel that the process is bureaucratic, ineffective, time consuming and slow. There is a sense of distrust that the complaints process has the welfare of patients at the heart.

Experience has shown that our Specialist Workers and clients prefer to solve problems right there and then in an informal way. Unfortunately, informal issues or complaints don’t get recorded and it is difficult to demonstrate impact or changes to the wider complaints system using these informal channels. PALS in Hastings was also identified as difficult to access during Covid-19 because there were no phone numbers and complaints needed to be made in person in the hospital office.

We have asked our Specialist Workers what difference it would make to their clients, if the official systems to challenge and escalate unsatisfactory responses and care would be easier to access.

The answers were pretty clear:

If there’s a simplified and standardised complaints system, that is fully resourced and trained to deal with a multitude of people, it would help clients with MCN to take control of their own care and support. It would empower them to demand better services and give them a voice to share their experiences with the system.

If you would like to hear more about our work in healthcare, then please do get in contact with Michaela and Rebecca in the FL team:

Michaela Rossmann, Systems Change Officer: michaela.rossmann@sefulfillinglives.org.uk

Rebecca Rieley, Systems Change Lead: rebecca.rieley@sefulfillinglives.org.uk

Joint Working: The Power of Collaboration

Fulfilling Lives South East3 Comments

Throughout the COVID-19 pandemic and lockdown, many services (statutory and third sector alike) stopped all face-to-face contact with service users and started working remotely. This shift in support was especially difficult for clients experiencing multiple and complex needs (MCN), including learning disabilities (LD), where the right type of communication is vital for understanding.

This article is about the importance of collaboration between services and an example of good practice when supporting women with MCN and LD through care proceedings.

We, at Fulfilling Lives South East (FLSE), together with Brighton & Hove Speak Out (BHSO) are currently working with the same mother, who has MCN and a LD. This mother’s child is subject to care proceedings and is currently living in foster care. This collaboration has highlighted some obstacles in the system for the mother from a front-line perspective, as well as advocacy point of view.

The FLSE Women’s Specialist Worker and BHSO Advocate agreed that it was much harder to build a trusting relationship remotely, and that effective communication was impaired

Whilst FLSE continued face-to-face support throughout the pandemic; the BHSO Advocate and Specialist Adult Social Worker were only able to offer remote support. When reflecting together, the FLSE Women’s Specialist Worker and BHSO Advocate agreed that it was much harder to build a trusting relationship remotely, and that effective communication was impaired. In some instances, the client’s mistrust of professionals and their misunderstanding of her and her partners’ behaviour, led to them making assumptions, which the FL Women’s Specialist Worker needed to challenge.

During the client’s pregnancy and post-birth, all Children’s Services meetings were held using video-conference facilities. Court hearings, parenting assessments and support, were also remote during this period. Children’s Services enabled digital access for some of the meetings at their premises; at other times the FL Women’s Specialist Worker had to provide equipment in alternative locations. Where the physical equipment was available, the FLSE Women’s Specialist Worker supported the client to use the technology, and to understand, communicate, and regulate their emotions. The BHSO Advocate was able to support the understanding of information before and after each meeting and feed the client’s voice back into the process. Without FLSE’s support, the client risked complete exclusion from the care proceedings.

Unfortunately, digital inclusion does not always reach the most marginalised people, including people experiencing MCN. The push for digital inclusion when providing essential services, for example health care appointments, adult social care support and court proceedings, has demonstrated just how many vulnerable adults do not have easy access to laptops and the internet. Even when digital access is available, communication via this method offers challenges to all participants. Non-verbal communication is much harder to recognise, multiple voices can be hard to follow, and a large number of participants can be intimidating. This type of communication is additionally difficult for those with a LD who have additional communication and processing needs and requirements.  With the parenting assessment and support also being conducted on-line, this again creates a further barrier for those with MCN.

FLSE would like to call for a person-centred approach for key meetings, to enable professionals to meet clients in a safe way to reduce the impact of exclusion and reduce the infliction of further trauma

FLSE would like to call for a person-centred approach for key meetings, to enable professionals to meet clients in a safe way to reduce the impact of exclusion and reduce the infliction of further trauma. In this case, the Local Authority applied for the child to be removed from the mother’s care at birth. The FLSE Women’s Specialist Worker supported the mother at hospital just after her birth, to make sure her voice was heard in meetings, medical exams and at the virtual court hearing. As the mother had a diagnosis of LD, she had access to a Specialist Adult Social Worker who was able to arrange this support and other reasonable adjustments whilst she was on the ward. Without this collaboration between the Local Authority, NHS and FLSE, the event of having a child removed at birth would have been even more traumatic for the mother.

When reflecting with BHSO, we agreed that the child protection process is very child focused – and rightly so. However, we would like to see an improved understanding and implementation of the communication and support needs of parents with LD, at the start of Local Authority interventions. Easy read documentation of the processes, key reports and assessments are rarely made available by children’s professionals, yet they are essential for the vast majority of MCN and LD mothers, as is, allowing additional time for processing and understanding information. Advocacy at the earliest opportunity is also essential within the tight child timescales, along with referral to adult services and other 3rd party support as needed.

FLSE and BHSO, would also like to see specialist support for parents with LD going through child protection and care proceedings. This includes conducting parenting assessments in a more LD friendly way, focussing on what parents can achieve, rather than just their struggles. Where support needs are identified, commissioners should ensure that services are available and accessible. This includes longer-term parenting support options, (such as Shared Lives- a scheme that matches someone with care needs to an approved carer), relationship safety support and awareness, and a holistic approach as provided by FLSE.

The right support and a trauma informed approach with the time and care put in at early stages can have a lasting positive effect on their recovery and reduce the likelihood of another pregnancy

We know that women who are going through child protection processes and care proceedings are likely to be experiencing MCN and LD. These parents often face increased stigma, and without advocacy to challenge professional behaviours, this will continue to exacerbate harm. However, the right support and a trauma informed approach with the time and care put in at early stages can have a lasting positive effect on their recovery and reduce the likelihood of another pregnancy.

Throughout our client’s journey and together with BHSO, peer support between the FL Women’s Specialist Worker and BHSO Advocate was appreciated and this collaboration has shown that a flexible and trauma informed approach can lead to positive relationships, not only for organisations but most importantly for the wellbeing of the mother.

Authors: Michaela Rossman, Gemma Harfleet & Nicola Johnson

Cracks in the system?

Fulfilling Lives South East2 Comments

A deeper look into concerns about the healthcare system’s response to people with multiple and complex needs

Our learning so far

Fulfilling Lives (FL) is committed to supporting Systems Change in Healthcare services and structures for people with multiple and complex needs (MCN). We recognise that it isn’t an easy task to influence large systems like the NHS  but at the same time we would like to encourage workers from all organisations and services to feel confident in escalating concerns about the healthcare system on behalf of their clients as we see this as an opportunity to bring about positive change: it is a way to log learning, share it and look to explore resolutions That is why one of our goals is for ‘Workers who support clients with MCN will be informed and empowered to use official systems to challenge and escalate unsatisfactory responses and care.’

Over the last six years, our specialist workers have supported numerous clients in Brighton and Hove, Eastbourne and Hastings to access primary and secondary healthcare services, including psychological healthcare services.

According to our workers, it has been clear that our clients have low expectations when it comes to healthcare support. This includes how they expect to be treated by staff. Sadly, some of our clients’ experiences only reinforce these low expectations.  For example, one client was transferred from temporary accommodation into a care home setting. Within 24 hrs, the client’s GP cancelled the daily prescriptions without giving the new GP and pharmacy time to transition his care effectively and get the prescription ready. Other examples include stigmatising practice observed by the specialist workers and challenges for clients to access the care they need. Not all our clients’ experiences are negative. On a different occasion, one of our support workers encouraged a client to make an appointment at a GP practice – something they were fearful of doing. On arrival at the surgery the client was reluctant to check in with the receptionist, but with some persuasion he did. In contrast to his expectation the receptionist welcomed him and understanding his anxiety stated we could wait in the quieter areas of the waiting room and she would come and get us when he was called in. Then, the nurse and GP saw this client as a person (not just a file) and this whole experience gave the client the confidence to return for the follow up appointment and make and attend several more.

How we are responding and why bother?

We value our specialist workers and their role to not only find solutions to healthcare issues faced by our clients on a daily basis but we also appreciate their role in advocating on their behalf and raise concerns when they observe concerns. But we needed more data to check if concerns are isolated cases or whether these concerns are more frequent across the local areas and pointed to something more systematic. That is why FL has launched the internal ‘OOPS’ (overcome obstacles, provide solutions) Project in December 2020, where specialist workers can log observed concerns, get peer support through regular Sub Group meetings and identify trends of concerns and solutions to these concerns together.

The Systems Change Team was keen to understand better the concerns that our Specialist Workers have when it comes to supporting clients through healthcare issues. These concerns might not always be about writing an official complaint to a healthcare professional, but to observe daily obstacles within the system. This might range from not being able to make an appointment with a GP on a client’s behalf, to keeping track about hospital discharges happening on a Friday afternoon for those who are homeless. Usually, these frustrations aren’t recorded but we see them as small cracks within the wider healthcare system. 

The OOPS Project launched in December 2020 and between then and early March 2021 we recorded 7 key concerns in Brighton, Hastings and Eastbourne.

Concerns raised

Here are the type of concerns raised:

  • Health provision in prison – Not being able to get an appointment with the mental health assessment team to review our client’s treatment.
  • Access to pharmacies and dispensing during Covid 19 – Dispensing bulk prescriptions, such as methadone, during lockdown instead of individual dosages.Another client has been banned from most pharmacies and the only one our client can access is 2 hrs drive away.
  • Transitions between GP surgeries – One of our clients has been transferred into a care home in a different area which meant that the GP has cancelled all prescriptions within 24 hrs of the move due to being out of area.
  • Access to the perinatal mental health team – One of our clients has had a child removed after giving birth and the perinatal mental health team can’t support the client as they only work with mothers who keep their children.
  • Support staff response to client engagement challenges – A client with a coexisting condition of substance use and mental ill health was referred to SPFT for mental health support. The worker tried to contact the client 3 times but wasn’t able to reach them which resulted in a frustrated email to our specialist worker. However, the client did leave a message for SPFT but the message wasn’t followed up on. 
  • Hospital discharge and follow on rehab – Our team felt there has been a lack of effective joining up of services for a client being discharged from hospital due to alcohol cirrhosis and the rehab services. After the detox in hospital, the transition was not as smooth as it could have been – consuming alcohol could have fatal consequences and this was a high risk.

Raising concerns in the context of the pandemic

It’s now been a year since the pandemic hit the UK and in March of 2020 there was a push to get the homeless communities into emergency accommodation, which created its own issues and problems. Some organisations blanket prescribed a two-week supply of methadone to recipients but ceased face to face appointments, testing and offered limited phone contact.

With most services suspending all face to face interactions with people and an emphasis placed on the wider use of digital devices and phone contact, those with MCN have been left to manage with minimal or no support from the statutory and many non-statutory health services. This has meant that clients and services often relied on FL specialist workers who continued face to face support to escalate concerns and advocate on our clients’ behalf. The pandemic has shown the health inequalities in our society and people experiencing MCN fall through the net. Raising concerns, when resources are thin on the ground, involves having emotional energy and lots of patience as well as time to get them resolved. With FL client-facing work ending in June 2021, FL specialist workers continue to focus on the best outcome for their clients, which in some cases means circumnavigating the system because complaints’ systems are felt to be slow and difficult to navigate.

One of our Specialist workers said: “The NHS closed everything from GP surgeries to wards, with their focus on Covid-19.  Initially it was impossible to contact any NHS services and as time went on this did not get any easier, again there was a desire to make everything online.  I found accessing my GP, virtually, easy but then I have access to a computer and the internet, as do many other people but many of our clients do not have smartphones or access to the internet, many are not computer literate and some find having a conversation by phone to be very distressing.  I supported a client to make an appointment to see his GP, yet despite me speaking with the surgery about the difficulties he experiences when talking on the phone, the surgery arranged a phone consultation, which resulted in my client feeling he had wasted everyone’s time and he did not discuss what he wanted to with the doctor. The media also created fear and a sense that the NHS was not to be disturbed, so many clients and members of the public in general ignored health issues.”

Useful resources when making a complaint

Obviously, sometimes an official complaint needs to be made and there are different guidelines on how to make a successful complaint. We’ve listed ways to do this below to help client-facing workers have a useful summary of the existing support and guidance to do this.

Local hospitals have a Patient Advice and Liaison Service (PALS). This service can give you information about the hospital’s complaints procedure.
It is important that you complain directly to the person or service (such as your GP or dentist). 

A challenge is often finding out what a services complaints procedure is, obviously there is a generic NHS complaints policy.

As a worker or individual, you can also complain to your local Clinical Commissioning Group (CCG), who funds the local healthcare services. This would be after all other options have been exhausted.

The Advocacy People (formerly SEAP) is the commissioned health complaints and advocacy service for East Sussex.  During the Covid-19 restrictions making referrals has become more difficult and at times communication with the service has been limited.

If the above has failed, then there’s also the option to contact your local MP.

Your local Citizen Advice Bureau or Healthwatch can support you and guide you when making a complaint.

The Ombudsman can also help if a complaint is first logged with the provider directly but the outcome hasn’t been satisfactory. They can make independent and impartial decisions on complaints and they have created a useful leaflet with the top 10 tips on making a complaint to the NHS England.
Tips on making a complaint to the NHS in England | Parliamentary and Health Service Ombudsman (PHSO)

What next?

We plan to continue with the OOPS project for a further 3 months and use this learning to further inform our understanding of the gaps and barriers in the healthcare system facing people with MCN. However, we hope to pair this learning with conversations with partners to explore how we can shed greater light on key concerns and start conversations about how we can collaborate to resolve them.

If you would like to hear more about our work in healthcare, then please do get in contact with Michaela and Rebecca in the FL team:

Michaela Rossmann, Systems Change Officer: michaela.rossmann@sefulfillinglives.org.uk

Rebecca Rieley, Systems Change Lead: rebecca.rieley@sefulfillinglives.org.uk

Why Women with Multiple Complex Needs deserve our attention during the passage of the Domestic Abuse Bill 2020

Fulfilling Lives South East1 Comment

The Domestic Abuse bill of 2020 will massively impact people with multiple complex needs, the below includes our response and thoughts on the subject.

Response to the third reading of the Domestic Abuse Bill

In June 2020, the South East Fulfilling Lives team responded to the call for evidence by the government on the draft Domestic Abuse Bill 2020[1]. In response to the third reading of the Bill that was passed in the House of Commons on 6 July 2020, we are disappointed that there is little in the Bill that directly references women with multiple complex needs.

Why do women with multiple complex needs deserve focus and legal protections?

More than half of every one in 20 women who experienced extensive physical and sexual violence and abuse across their life course have a common mental health condition, one in five have experienced homelessness, and one in three have an alcohol problem[2]. In December 2018, 93% of the women on South East Fulfilling Lives’ own caseload had experienced domestic abuse. Of these women, 76% were homeless (rough sleeping/in temporary accommodation/sofa surfing/in hostels), 96% had both substance misuse and mental health needs when we began working with them, 88% had histories of offending, and 72% had disabilities.[3]

Why should the complex needs of domestic abuse victims be named and defined?

Domestic abuse takes place in a wider context and not all women experience similar levels of domestic abuse nor possess similar privileges or resources to get the right support at the right time. Women facing multiple disadvantage are some of the most marginalised victims of domestic abuse and an unequal society, and are often ostracized from society and support services. They are more likely to present with a history of extensive violence and abuse, have complex and overlapping needs such as high rates of mental health problems, substance misuse, contact with the criminal justice system and homelessness. They are also more prone to victim-blaming by professionals in statutory services or being labelled non-engaging or non-compliant by essential services[4].

Having a one-size-fits-all response to domestic abuse that fails to acknowledge different levels of vulnerability creates a culture around “worthy” and “unworthy” victims of domestic abuse. Therefore, we believe that the complexities of some of the most vulnerable victims’ lives should be named and adequately defined in order to provide more targeted support as well as legal protections. Whilst we welcome the widening of the statutory definition of domestic abuse to include emotional, coercive or controlling, and economic abuse, we also reiterate our call for the Bill to include a clear definition of ‘Multiple Complex Needs’.

Reconsidering New Clause 23: Commissioning specialist domestic abuse services

We are disappointed that a majority of MPs voted against the new Clause 23 which seeks to establish a statutory duty on relevant public authorities to commission specialist support and services to all persons affected by domestic abuse[5]. Women with multiple complex needs, who use the independent and women-led specialist domestic abuse services seldom respond well to traditional forms of service delivery models and access routes to support.

Our own project learning revealed that women with multiple complex needs are harder to reach, less visible to services and under-represented in statistics[6]. Research carried out by AVA and Agenda found that out of 173 local areas in England and Wales, only 19 had access to support for women facing multiple disadvantage that could address all of the following issues: substance use, criminal justice contact, mental-ill health and homelessness.[7] Survivors with complex needs and their children often require additional services and higher levels of support and outreach by trusted professionals who have the social skills and gendered understanding of how perpetrators operate and who can empathetically support them on their path to freedom and recovery.

In our experience, the response to domestic abuse continues to be siloed, with little joint work between the police, probation services, substance misuse services, children’s services and health practitioners and the specialist charities working supporting women. Victims of domestic abuse with complex needs require a holistic, comprehensive and whole-systems approach to tackling domestic abuse which includes partners in housing, health, relevant public authorities and statutory services in addition to the Bill’s sole focus on criminal justice and crisis response. This means an integrated cross-government response, rather than individual departments publishing separate guidance and being provided with separate funding arrangements.

Furthermore, those experiencing domestic abuse and complex needs may access a range of public services, such as their GPs, who are often the first point of contact.These non-specialist services play a crucial role in early intervention by identifying complex needs and recognising signs of abuse. Yet, women frequently do not receive a service which reflects an understanding of the complexities, dynamics and risk issues of domestic abuse or receive a trauma informed response, due to a lack of understanding. Thus, we urge for specific training duties for non-specialist domestic abuse services to be established in the Bill and embedded within the implementation plans. This echoes Agenda’s #AskAndTakeAction campaign, which places a duty on public authorities to ensure all frontline staff make trained enquiries into domestic abuse, which is crucial to ensuring victims get the support they need at the earliest possible opportunity [8]. 

We also hoped to see the Bill pave the way for new forms of accommodation that can provide emergency rapid-access accommodation that is self-contained and dispersed within communities, where wrap-around support is provided, and to include Specialist Multiple Complex Needs Refuge Accommodation as an option as often additional complex needs, such as substance misuse, excludes women from accessing the current refuge models, meaning many are being forced to return to their partner and abuser or being placed in non-specialist accommodation settings.

For the Domestic Abuse Bill to be truly transformational in its intent and also its outcomes, it is vital that no victim is left behind, and all victims feel heard, safe, and valued. Although many improvements have been made to the Bill, there are still holes in the protection the law provides to some of the most marginalised victims of domestic abuse. As the Bill is in the process of being scrutinised by the House of Lords[9], we hope further amendments will be tabled to ensure the scope of its protection is extended to all victims, especially those who have complex needs, and face multiple disadvantages and vulnerabilities simultaneously.

This post has been authored by Aditi Bhonagiri, with valuable contributions from Emily Page, Sandra Sylvester and Rebecca Riley.

If you have any questions after reading this piece, please feel free to get in touch with the author at aditi.bhonagiri@sefulfillinglives.org.uk

For more information on what we do, download our reports and resources please visit https://www.bht.org.uk/fulfilling-lives/

1 https://publications.parliament.uk/pa/cm5801/cmpublic/DomesticAbuse/memo/DAB86.pdf

2 http://weareagenda.org/wp-content/uploads/2015/11/Hidden-Hurt-full-report1.pdf

3 https://www.bht.org.uk/wp-content/uploads/2019/11/Fulfilling-Lives-Manifesto-for-Change.pdf

4 https://www.changing-lives.org.uk/wp-content/uploads/2019/03/Too-Complex-Evaluation-Final-Nov-2018.pdf

5 https://www.theyworkforyou.com/debates/?id=2020-07-06e.780.0#g781

6 Sarah Robinson, Oct 2016, Where are the Women?: Supporting Women with Multiple Needs. Cached at: https://wy-fi.org.uk/?mdocs-file=2277

7 https://avaproject.org.uk/resources/mapping-maze-full-report/

8 https://weareagenda.org/askandtakeaction/

9 https://services.parliament.uk/bills/2019-21/domesticabuse.html

Behind Closed Doors

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Kate is a Playwright,  and Project Consultant Assistant with Fulfilling Lives. In this piece she writes about her experience of domestic abuse and what services have been being doing to combat it during the current pandemic

No one knows what goes on in people’s lives behind closed doors, but what is known is that there has been a sharp increase of domestic violence during the Coronavirus outbreak, with us all having to live our lives in lock-down. For some, trying to live in an abusive relationship can be traumatising, fearful and shameful. What I mean by shameful is that it can be something that people do not want to talk about in case they are not believed, or they are frowned upon. They might have been made to believe it is their fault, and even be frightened to think that what they might share could get back to the person who is abusing them.

I say this as someone who has lived most of my life in violent, controlling, coercive relationships and it’s not just as easy as getting up and leaving or talking to someone about it. The amount of times I wanted to talk to someone, especially after I had taken a beating. That hand around my throat, strangling me. That knife held to my throat, in front of my children. That trainer that is just about to stamp on my head. Oh and how can I forget the line “I didn’t mean it, it won’t happen again, I promise, I love you”. Unfortunately, time and time again, I believed that line and believed it was love. What I should have believed in more is the saying, that actions speak louder than words. This is exactly what has been happening in many communities during Covid-19.

Government and Services Response to DV

The government and services have been acting. There have been some fantastic campaigns raising awareness of domestic abuse, here are some examples:

  • Numerous organisations have created information posters and leaflets with key guidance for ‘non-specialist services”.
  • Pharmacy schemes with the launch of the “safe space” initiative where Boots, Superdrug, and Morrisons have allowed their consulting rooms to be a safe space for women experiencing domestic abuse. Go to the healthcare counter and ask to use their consultancy room. The pharmacist will you show you to the safe space and once inside you will have access to all specialist domestic abuse information and be able to make the call safely. https://uksaysnomore.org/safespaces/.
  • There is printed information of the national domestic abuse line on pharmacy bags and at the bottom of Tesco’s shopping receipts.
  • UK says no more has the #listeningFromHome campaign. Encouraging members, friends, colleagues, and neighbours to be aware of and to report signs of domestic abuse whilst in lockdown. If you are concerned you can help by following these guidelines:Check in with victim but be mindful communication channels maybe monitored or call the police.
  • If you are feeling unsafe the best thing to do might be to call 999 and get support from the police. You can do this silently if you are worried about your partner knowing. When dialling 999 from a mobile listen to the prompts from the operator, then cough or tap. The operator will then prompt you to press 55 this will transfer your call to the police, pressing this only works from a mobile and does not allow police to track your location.  
  • “At home shouldn’t mean at risk” logo has been added on the specialist domestic abuse services and if you are experiencing domestic abuse you don’t need to stay at home. Police response and support services remain open for help and support visit https://www.gov.uk/guidance/domestic-abuse-how-to-get-help  #YouAreNotAlone campaign.
  • The sanctuary scheme provides an alternative to relocation away from family and friends with vital support networks and key services through installation of enhanced security measures in your home. It’s voluntary, free and available to both homeowners and tenants who meet certain requirements. The scheme is funded by members of the Hastings and Rother Domestic Violence forum which has reps from CGL, Sussex Police, HomeWorks, and Optivo. If you would like to request sanctuary in your home call the CGL Domestic Abuse Portal service on 01424 716629 or housing options team on 01424 451100.  
  • East Sussex refuges are still accepting referrals. You can self-refer or enter through Hastings, Eastbourne, Lewes and Wealden and Rother councils or alternatively through East Sussex Police or the Portal. Also, through health services and social care website http://www.refuge.org.uk
  • Fulfilling Lives also played an essential role in trying to influence the content in the Domestic Abuse Bill for women with Multiple and Complex needs.


I really hope that this great work and national/local campaigns that has taken place during the coronavirus pandemic, has encouraged women experiencing domestic abuse to open their doors and walk free from the abuse that can happen behind closed doors. I know if these nation-wide campaigns were taking place when I was living this traumatic life then I would have felt safer to step forward, speak up and flee the violence, a lot sooner than I did.  So, let’s try to keep these conversations going within our communities not only to encourage, support and make people feel safe, but to also reduce the stigma that can occur around domestic abuse. Long may these campaigns against domestic violence continue after the coronavirus pandemic eventually ends.


Useful Contact Numbers

  • Emergency accommodation outside of Hastings Borough Councils working hours 01424 451999
  • Portal’s helpline 0300 323 9985 or 01323 417598 for Eastbourne, Lewes and Wealden or 01424 716629 for Hastings, Rother and Rye or alternatively online at https://theportal.org.uk
  • Women’s aid email info@womensaid.org.uk or helpline@womensaid.org.uk
  • Rise helpline 01273 622822 or general enquires 0300 323 9985 or https://www.riseuk.org.uk
  • National Domestic Abuse helpline 0808 2000 247 or https://www.nationaldahelpline.org.uk
  • Penny appeal Domestic Abuse support helpline 0808 802 3333 or http://www.pennyapp eal.org/
  • Rights of women.org.uk offer free advice in family, immigration, and criminal law 020 7251 6577
  • Men’s advice line 0808 801 0327
  • National LGBT+ 0800 999 5428
  • Karma Nirvana 0800 5999 247 Honour based abuse and forced marriage
  • Shelter give advice if your homeless and fleeing Domestic Abuse

https://england.shelter.org.uk

  • Hastings and Rother Samaritans 0330 094 5717 or call 116 123 free from any phone


Fulfilling Lives – Good practice for DA clients

We would like to share with you this Fulfilling Lives South East Partnership Good Practice document on the subject of supporting women with complex needs who are experiencing, or at risk of, domestic abuse during Covid-19 restrictions.

During May and June 2020, people with lived experience of multiple and complex needs interviewed local client-facing staff and researched organisations’ responses to Covid-19 before bringing together the information presented in this document.

We hope you and your colleagues find this a useful tool in your work and if you have any feedback or suggestions about the document please do contact us.

Good Practice Document: https://www.bht.org.uk/wp-content/uploads/2020/11/Best-Practice-T2-COVID-Document-V12.pdf

If you have lived experience of multiple and complex needs and are interested in working or volunteering with us, please contact Nelida at nelida.senoran-martin@sefulfillinglives.org.uk. 

Living in Lockdown: Tips on Managing Your Mental Wellbeing

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Life in lockdown can take its toll on our mental and emotional wellbeing. Ian Boyle, Specialist Complex Needs Worker, shares his top tips for self-care during this challenging time.

Accept that it is very different to our ‘norm’ and the pace of life has slowed down; why not embrace this?

Most of us are working from home, so it is more important than ever to create clear boundaries between work and personal spaces.

“Take a walk outside—it will serve you far more than pacing around in your mind.”

Rasheed Ogunlaru
  • At the start and end of the day go out for a walk to simulate the commute from before lockdown, allowing you to help separate work from home.

  • Take breaks, especially if you are sitting at a computer all day; in video calls and writing up notes.

  • Ensure that you eat and drink enough during the day, as it is easy to forget.

  • It is very easy to start a bit early, cut out breaks, miss lunch or eat at the desk/table and work a little bit later, DON’T.  You are no use to anyone if you get ill.

  • Don’t be a hero, if you are stacked up ask for help from colleagues and delegate tasks.

  • Speak to colleagues, friends or family, it is not healthy to bottle things up, eventually the bottle overflows.

  • If you don’t complete all yours tasks today, remember tomorrow is another.
  • Smile at others as it is contagious 🙂

This week…

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As we enter May FLSE continues to extend the scope of its response to the COVID-19 pandemic.

In addition to continuing our day-to-day provision of support for clients and progressing our systems change projects, we have focused our attention on increasing our contribution to the wider community response to COVID-19.

Practical responses include making reusable face masks, putting together wellbeing packs for people in temporary accommodation, donating sandwich packs, and offering our assistance to partners in Brighton, Eastbourne and Hastings.

At a strategic level, FLSE have been closely involved with the wider charity and voluntary sector as we look to plans for life ‘post-lockdown’. Opportunities to influence lasting change with local authorities are emerging and we are looking to have a critical role in this process.

We also continue to research the impact of COVID-19 on our clients, staff and volunteers. This week saw the planning stage for a survey that will be shared with our Project Consultants and Volunteers (experts by experience of multiple and complex needs), and our Systems Change team. As well as looking at the impact of COVID-19 on wellbeing, we will be concentrating on how the current situation has impacted ‘co-production’ – the meaningful involvement of service users, or people with lived experience in all stages of service design and delivery.

Weekly COVID-19 Briefing

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Prime minister Boris Johnson announced lockdown at 8.30pm on 23rd March. It is now 24th April, and for some lockdown is starting to feel like the new normal. For others however, it continues to pose significant challenges – having enough to eat, accessing health care, staying in touch with friends and family, staying mentally and emotionally well, and coming to terms with serious economic uncertainty.

We can be confident in anticipating that COVID-19 will have a disproportionately greater impact on the wellbeing of the Fulfilling Lives client group – people with multiple and complex needs. Since the gravity of COVID-19 became apparent, FLSE has worked with determination to ensure that our clients continue to receive that best support possible. We have also been working hard so that our work to bring about lasting positive change in the systems and services that people with MCN rely on can progress despite the challenging circumstances, and that this work continues to be co-produced with our Service User Involvement team.

Our Response So Far

Client-facing work has been significantly affected by the COVID-19 response measures. Face to face work with clients has been reduced and is now on an ‘as necessary’ basis, ensuring that social distancing is observed. Where possible work is being conducted remotely and both workers and clients have had to utilise technology to stay in
contact. Clients have been supported to use phones and internet to stay connected with their workers and wider support networks.

Client-facing workers have reported that most of their time has been taken up with finding ways to meet their clients basic physical needs, however they have still found creative ways to connect with support the emotional and mental wellbeing of their clients.

All our non-client facing teams (Service User Involvement, Systems Change, and Learning and Impact) have made the transition to remote working and are finding creative ways to maintain communication, support for one another, and keep vital project work moving forwards.

Research and Learning

As a research and learning project we want to understand the impact of COVID-19 on people with multiple and complex needs, as well as on those working directly to support them. A survey was conducted with all specialist workers and area leads in FLSE and the findings from this survey were summarised in an initial impact report that was published on 15th April.

The impact report has been shared internally, and is being used to inform practice within the client facing delivery teams. It is also being used to inform the direction of our Systems Change projects in the coming weeks and months. The report has also been shared with our extensive network of stakeholders, including Fulfilling Lives National Evaluation, National Lottery, MEAM, and the Frontline Network.

So far we have received very positive feedback from our stakeholders. Some have used the survey as a model for conducting their own research, and many have expressed interest in the findings of the report.

A partner at Homeless Link said ‘Really great work and absolutely essential to capture the impact of what is going on right from the start. We are currently collating information and intel on how landscapes are changing and the impact of Covid-19. We definitely would like to include your findings in the report’

Next Steps

We will continue to research the impact of COVID-19 on people with multiple and complex needs and on the systems and services, which they often depend on. We will continue to gather feedback from our teams; share learning with (and learn from) our network of stakeholders; and review and adapt our Systems Change work to the ever-changing situation. Our key next steps are the following:

– Survey the impact of COVID-19 on our Service User Involvement teams’ ability to continue co-production work with the wider project.

– We will collate and share examples of best practice from across the wider network, in particular form our key partner organisations.

– Share key learning and reflection on this blog and webcasts with contributions from staff and volunteers.

– We will conduct client interviews remotely with the support of the Service User Involvement Team.

COVID-19 Initial Impact Report

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As with the rest of the world, we at Fulfilling Lives have been significantly impacted by the coronavirus outbreak that took hold in March. Our teams have had to rapidly adapt to new ways of working, which has been especially challenging for the client-facing teams. Due to the speed at which the Coronavirus pandemic has escalated, and the degree of uncertainty of its ongoing impact, we have had to act quickly to formulate an appropriate response. Part of our response has been to try and capture client and worker experiences ‘on the ground’, and to gain insight into:

  • The challenges our clients are facing in this difficult time and how they are adapting and coping.
  • The challenges that front-line workers are facing in adapting to new ways of working, often remotely.
  • The ways support systems have changed and the gaps and barriers in service provision that appear to have a disproportionate impact on people with multiple and complex needs.
  • Examples of successes, creative solutions and good practice, as we seek to understand what good or even best practice looks like, in this highly challenging situation.

To begin capturing this data a survey was conducted with all specialist workers and area leads in FL SE (Brighton & Hove, Eastbourne, and Hastings). The initial findings from this survey are summarised in this report and will feed into further research, evaluation, and shared learning

The full report is available to download below:

Initial Impact of Covid19 April 2020Download

Statement from Fulfilling Lives South East on COVID-19

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This is to briefly update you on how the Fulfilling Lives South East teams are responding to the pandemic and how you can get in contact with us.

Client facing local service delivery teams continue to operate. We are continuing to support the people on our caseload across Brighton & Hove, Eastbourne and Hastings who have multiple and complex needs. We are obviously concerned about the health and wellbeing of our clients during this outbreak – many of them have physical health problems which makes them at higher risk of serious illness should they contract the Covid-19 virus. We are finding ways to provide support to clients without meeting face to face if possible; or limiting contact to brief interactions. We are working closely with partner agencies  to share information and ensure  clients have somewhere safe to stay and are able to meet their basic needs. We are also working with Homeless Link, frontline network and other frontline support agencies to contribute to the national frontline worker response to the pandemic.

Our service user involvement and coproduction work has been reviewed and will continue to enable those with lived experience to engage with the project. Local Action Groups across Brighton & Hove, Eastbourne and Hastings are continuing remotely, via video call and WhatsApp. All Fulfilling Lives’ volunteers have been contacted within the past few days. We are mindful of the potential negative impact of isolation on wellbeing and are looking at creative ways to help our network of great volunteers to stay well.

Our systems change and research work continues, and we are confident the majority of our planned work can continue remotely. We are mindful of the pressures on statutory services and will be slowing down some projects for now so as not to over-burden these systems; and will be bringing forward other areas of work that are better suited to remote working. We will ensure our work remains useful and if you feel the project’s system change team could support you with a new piece of work during this time, please do get in touch with us – we are keen to think creatively and respond flexibly.

If you would like to contact us:

Brighton & Hove – Lindsay Horler 07469 147576 lindsay.horler@sefulfillinglives.org.uk

Eastbourne – Jake Alexander 07712 528483 jake.alexander@sefulfillinglives.org.uk

Hastings – Laura Torrance 07712 528498 laura.torrance@sefulfillinglives.org.uk

We have been really heartened by colleagues, volunteers and partners’ responses offering help and sharing useful information – thank you.

With best wishes

FLSE