Safe Delivery of face-to-face Services

We spoke to Brushstrokes to find out how they adapted their health and safety for safe delivery of services.

Organisation Profile

We found out more about how Brushstrokes’ adapted their health and safety procedures for returning to face-to-face delivery

What have you learnt during the lockdown about the delivery of your services and the needs and capabilities of your service users? 

At the start of the lockdown, in order to prevent homelessness and destitution, we decided to focus on providing urgent advice and food provisions to vulnerable individuals. 

Whilst we have seen that telephone and online advice works for some types of enquiries (our immigration, welfare benefits and housing advice has worked well as an online/ video call offer), face-to-face services remain essential for those at greatest risk. From the first week we saw a steady stream of individuals who were homeless and destitute. It was clear that face-to-face support was required to resolve their urgent, complex issues, either because people lacked access to mobiles, data or wifi to receive remote support and/or because they needed to provide additional, written supporting evidence. We worked in our car park, socially distancing, to provide advice and support for these clients. 

Moving to an appointment-only system means staff must make difficult judgement calls about who can be seen and what issues are considered urgent. Clients don’t always understand this.

We have had more referrals from organisations or departments that would not routinely direct clients to us for help. The recognition of our work providing specialist advice and practical support for migrants on a range of issues has been one positive outcome. 

The willingness of some individuals to volunteer to help others has been another positive. Existing clients have helped us connect to other members of their community. On a street some distance from our office, where there are five units of asylum accommodation, an existing client of ours with young children, who we had started delivering food to spoke to the other households who were also in need and referred them into us. 

What have been the biggest needs of your service users during the lockdown period? 

As the only place that remained ‘open’ (with people on site) we saw a significant increase in referrals and people dropping into the car park for urgent advice. In particular these were homeless or destitute asylum seekers and refugees, migrants with NRPF, and also EU nationals who had lost work and were unable to claim benefits.

Service users have needed information on health and staying safe in the face of COVID-19, how to access food, destitution support and accommodation. 

We have seen an increase in referrals of people who have been refused asylum or who have had NRPF conditions for several years. This has created opportunities for some to receive immigration advice and secure short-term accommodation. 

For our IELTS, OET and many of our higher level ESOL learners, moving to online classes has been a real positive. However, the lack of access to wifi/ data and low IT skills means our pre-entry learners have had a greater challenge sustaining engagement in ESOL.   

How have you re-introduced the safe delivery of face to face services?

Having recognised that face-to-face was still required (and happening in a socially distanced manner in our car park), we looked at what was possible with our current building. 

We are fortunate to have 4 access points into the building, with the option of isolating parts of the building to maintain safety. We created a proposal for restricted access to one room in the building, that would enable 2 metre socially distanced appointments to be held. 

We shared our proposal with our local Public Health team. Getting confirmation that they felt we had taken all reasonable steps to mitigate risks of infection was an important step for staff and our management committee. They advised that all clients should be asked to put on gloves and masks on entry to the building.

We provided perspex screens across advice desks and gloves and masks for staff and clients. We provide hand sanitizer and a set of PPE for each client, and they are instructed by staff how to put this on before they are seen for the appointment. 

All staff involved in the potential delivery of face-to-face appointments were asked individually if they were happy to see people in this capacity, we are not making staff see people if they do not feel safe. All staff were provided with detailed guidance on the process of using PPE on site and the specific procedure which needed to be followed if they were seeing clients face-to-face. 

We only see individuals with what we consider to be urgent issues. Individuals are triaged prior to an appointment being made, questioned about COVID-19 symptoms and then an appointment is made.

We started off with one appointment slot an hour and then reviewed it with the staff and chair of our management committee after two weeks. Three weeks ago we moved to two appointments concurrently per hour and from 29th June we will reconfigure the room we are using to allow for three advice booths - with 2 metre social distancing measures so we can go up to three appointments concurrently per hour. 

We have had to stress to clients that we only have safe space for a single adult, couple or lone parent and young child to be seen in this room at present. In cases where there would be more than three adults/ children in the advice space we would restrict the appointments available for that time down to one to ensure safety.  

What were the main factors you considered when making this decision? 

  • Need of clients
  • Staffs willingness / concerns about seeing people face-to-face
  • Staff capacity for different volumes of appointments
  • Available space and on street access directly into the room we were planning to us
  • Availability of screens and delivery timescales
  • Availability of PPE and delivery timescales

What guidance and advice did you find useful?

We made use of the Working safely during coronavirus - Offices and Call centres guidance

Discussions with Public Health in Sandwell and the Chief Exec of the Refugee and Migrant Centre in Wolverhampton about the steps they were taking to manage re-opening of face-to-face services were useful and important in my conversations with the management committee to gain approval for starting on site appointments. 

What steps did you take?

  1. Identifying number and size of screens and ordering
  2. Securing supply of PPE
  3. Discussion with RMC and Public Health 
  4. Undertook risk assessment for advice room and management of COVID risk 
  5. Developed clear guidance for staff
  6. Held discussion with staff to clarify if they were happy to see clients face-to-face
  7. Provision of guidance to staff on correct use of PPE, social distancing and management of face-to-face appointments
  8. Weekly review with staff on how appointment process is working, opportunity to identify concerns and consideration of when to move to next phase (increased number of appointments per hour etc) 

What challenges have you encountered?

The current demand for face-to-face support is still exceeding our capacity to safely deliver through socially distanced appointments. We still have service users dropping into the car park who are in need, so we have tried to keep a few appointment slots free for emergencies each day. For a number of our homeless or destitute clients who don’t have credit on their phones - we have purchased some basic Pay as You Go phones to give to these clients and topped them up to aid communication. 

The cost of PPE and screens has also been an issue. We were proactive in ordering well in-advance of starting up on site advice. We have secured supply via Father Hudson’s Care (Brushstrokes is part of Father Hudsons Care who also provide residential care services so had access to PPE supplies already). 

We struggled to cope with the additional need for additional IT equipment and mobile phones (both for effective home working and use in the new advice area). 

As the only service in our area offering face-to-face appointments for urgent cases we have seen increased referrals for support.  The kinds of cases - homeless, destitute, Section 4 applications etc. are all more complex and also take more time to resolve.

What feedback have you got from clients?

Securing benefits, accommodation, Section 4 support, providing food and restarting applications for EU settled Status are making a real difference to our clients. 

Clients have been really appreciative that there is still a place to go for help in this time of crisis. Our advice team have reported how clients appreciate being able to get an appointment when all other services are closed. People are grateful that they can actually see an adviser. There is a real difference in being able to see someone in person to resolve your advice and support needs in contrast to trying to deal with this over the phone. 

There has been some disappointment when people have turned up expecting to be seen without an appointment, as in pre-COVID times, and have to be told that they cannot be seen, we are still trying to do some emergency triaging of individuals in the car park. For most there is an increasing understanding that appointments need to be made.  

When Mussab gained his LTR during the COVID-19 lockdown and he shared that ‘…if Brushstrokes was not here, I would not know how to open a bank account as everywhere was closed & Lukano helped me to apply for benefits, which I am happy for’.

A homeless client we assisted to apply for section 4 accommodation and secures temporary housing via ‘Everyone In’

“You have helped me so much – with food, clothing and even money for bus fare. You also helped me to live in accommodation. I feel at home with you; you are people that really care about us and your team cares about everyone.”

What practical advice would you give to other organisations?

Think about your own context. What is possible with the building you use? Can you isolate part of the building and maintain the current 2 metre social distancing measures?

What specifics about your client group and service make face-to-face essential? Consider how you can communicate what is urgent vs what can wait, when is phone or video advice possible and when is it not, and how can you get clients to understand this?

Complete a risk assessment and keep this under review as the situation changes. Work with the staff team to ensure they understand how you are mitigating risk, what procedures you need them to follow to keep themselves, their colleagues and clients safe. Set clear regular review times with the team to check how the service is going, raise concerns and communicate at what point and on what criteria you might move to a further expansion of services / have more clients on site.

Talk with any other local agencies and find out what they are doing, how they have or are going to manage re-opening of face to face services. 

Identify what volume of PPE / Screens etc. you are going to need to deliver the service. Ensure you have a supply chain in place. Explore if there is an opportunity to club together with other local advice providers to jointly bulk purchase PPE.

Ensure your trustees/ management committee understands and supports the steps you propose to take. 

Don't try to do everything at once! We are working on a phased incremental increase in services, taking account of client demand, staff and building capacity and government guidance.