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Protecting and supporting the clinically extremely vulnerable during lockdown

Today’s report from the National Audit Office (NAO) finds that the shielding programme was a swift government-wide response to protect clinically extremely vulnerable people against COVID-19. However, at the start of the pandemic there was no way to quickly identify all those who needed to shield, with the full list of those eligible for support not stabilising until May.

On 22 March 2020, government urged clinically extremely vulnerable (CEV) people to shield themselves for 12 weeks and not go out for shopping, travel or leisure. Government recognised the need to offer food, medicines and basic care to those CEV people shielding to help meet its objective of reducing the number of people suffering from severe illness and dying from COVID-19. It quickly set up the shielding programme (the Programme), led by the Ministry of Housing, Communities & Local Government (MHCLG), to provide CEV people this support.1

Several problems arose when compiling the shielded patient list (the List). Hospital data, while immediately available, was seven weeks out of date and did not always specify sufficient detail of people’s medical condition, meaning some were unnecessarily advised to shield. The time taken to identify CEV people was largely down to the challenge of extracting usable data from different NHS and GP IT systems. 

By 12 April, 1.3 million people were identified as formally eligible for the Programme’s central support offering of food boxes and medicines delivery. Of these, 870,000 were identified using hospital, prescribed medicines and maternity data. GP patient data was used to identify an additional 420,000 people.

By 7 May, a further 900,000 people were identified as CEV and formally eligible for support through the shielding programme. This was as a result of GPs and trusts adding or removing people from the list based on their clinical judgement and local patient records.

Expenditure on the Programme up to 1 August was £308 million.This included a total of£200.2 million spent on food box deliveries to CEV people, £34.3 million on the medicines delivery service and an estimated £54.4 million spent by local authorities on basic care and other support to CEV people.  A further £18.4 million was spent on a shielding contact centre, run by the Department for Work and Pensions.

From 28 March, the shielding contact centre started to call those who had not registered for support while shielding. It was unable to register 815,000 CEV people, of these, around 375,000 could not be reached because of missing or inaccurate telephone numbers within NHS patient records. From 28 April, the Government Digital Service started passing details of the people that could not be reached to local authorities to follow up.

The regular food box deliveries to CEV people started on 27 March and by 1 August, food boxes had been delivered to over 510,000 people.  The Department for Environment Food and Rural Affair’s surveys found peoples’ satisfaction with the food boxes ranged between 79% and 83%. However, charities and local authorities were critical of aspects of food boxes such as the quality of fresh products and culturally inappropriate items.2

While the Department for Health and Social Care (DHSC) is confident that shielding has had a positive impact on protecting CEV people, separating the impact of shielding from other factors, such as the impact of general lockdown, as well as individuals changing their behaviour, is extremely difficult. DHSC is therefore unable to say whether shielding led to fewer deaths and less serious illness in CEV people than would otherwise have been the case, although it is likely to have helped.

In August, the government conducted an early lessons learned review of the Programme, which concluded that the context and speed at which it was developed meant that it was largely offered universally – resulting in poorly targeted support and inefficient use of funds. The government has applied many lessons learned from the Programme, for example, introducing a system so people could register their needs more easily for the second national lockdown.

To improve the timeliness of support provided to those people advised to shield, the NAO recommends that DHSC should ensure there is easy, but secure, access to healthcare data, and that it sets out the key data needed for a future pandemic or civil emergency. By April 2021, MHCLG should review the effectiveness of the National Shielding Service System.

“The shielding programme was an important response to support clinically extremely vulnerable people asked to shield. It provided support to many of those most at risk from COVID-19, and delivered food to just over 500,000 people.

“However, challenges pulling together data meant it took time to quickly identify those needing to shield, and therefore eligible for support. Government has learnt lessons from this programme and is better placed should this type of support be required again.”

Gareth Davies, head of the NAO

Notes for Editors

1. The Ministry for Housing, Communities & Local Government had overall responsibility for the shielding programme, the Department for Health & Social Care was responsible for determining who should shield and for issuing clinical advice, and the Department for Environment, Food & Rural Affairs led on providing food. The Department for Work & Pensions provided a national shielding contact centre. NHS Digital was responsible for producing the list of people who were to be advised to shield and working with GP systems' suppliers on any required changes. The Government Digital Service (GDS) was responsible for creating and running the digital service, which consisted of a website, an automated telephone helpline and other services required to collect, store and share information on the support needs of CEV people.

2. Local authorities have criticised the quality of emergency bulk food supply provision in particular noting that the food was of poor nutritional value, seemingly random selections of provisions and catering-sized food and drink containers which were impractical for individuals and difficult to repackage into food box portions.

3. Press notices and reports are available from the date of publication on the NAO website. Hard copies can be obtained by using the relevant links on our website.  

 

About the NAO

The National Audit Office (NAO) scrutinises public spending for Parliament and is independent of government and the civil service. It helps Parliament hold government to account and it uses its insights to help people who manage and govern public bodies improve public services.

The Comptroller and Auditor General (C&AG), Gareth Davies, is an Officer of the House of Commons and leads the NAO.

The NAO audits the financial accounts of DWPs and other public bodies. It also examines and report on the value for money of how public money has been spent. In 2019, the NAO’s work led to a positive financial impact through reduced costs, improved service delivery, or other benefits to citizens, of £1.1 billion.

Contact

NAO Press Office
+44 (0)20 7798 7400 or email pressoffice@nao.org.uk