Shielding in Wales
BASW Cymru join with charities to call for clarity for the most at risk groups
BASW Cymru co-sign open letter to Mark Drakeford, First Minister of Wales calling for clear advice and support for people who are shielding:
Dear First Minister,
Shielding in Wales
We are deeply concerned by the impact on the wellbeing of people who are shielding or being asked to take particular care when social distancing. In Wales our charities represent many thousands of people who are shielding and have been advised to stay home as much as possible because they are at a significantly increased risk of severe illness from Coronavirus. This includes many adults and children with long term health conditions who ordinarily lead full and active lives.
Following the updated shielding guidance published on 1st June by Welsh Government, we have concerns over the clarity of information being provided to the most at risk groups. Current restrictions have been eased to allow the shielding group to exercise and meet with others of another household outdoors. With the advice stating that a measure of ‘reasonableness’ must be applied when adhering to the new guidelines, a confusing burden is placed on those people in at risk groups who will now need to work out how to balance out these new guidelines while still being asked to continue to stay away from work, shopping and collecting medicine. This potential confusion must be addressed.
The manner and timing of the shielding changes between England and Wales has led to some confusion and anxiety. As a group of charities supporting many of those people who are shielding, we would have welcomed advance notice to provide information and support over the weekend.
We would very much welcome further information about the rationale for how Welsh Government reached the decision to depart promptly from the existing guidance in place and why it eased the shielding advice around exercise further than in England. A clearer understanding of these issues would help us with the advice and information we are offering those in the shielding group.
Whilst changes to the shielding guidance will provide welcome alleviation from the issues of isolation, we believe there are some further positive changes that could take place to better support people in the shielding group:
Be clearer with communication
There needs to be urgent and direct communication with those who are at risk, especially those who have been advised to shield.
There will also need to be clear communications with health and care professionals to ensure consistency of advice given to those who are at risk. This communication should include charities and voluntary groups who can support and cascade information.
Over 130,000 people in Wales had previously been shielding for a twelve-week period and are waiting for guidance as to what happens when this period ends on 15th June. This affects not only them but their parents, partners and children who have had their ability to lead a normal life severely curtailed while they ensure that their loved ones are safely shielded.
The updates to the guidance released over the weekend alongside the statement made on 1st June, create cause for concern around the clarity of communication. It is also imperative that clear guidance as soon as is possible and that every effort is made for the information to arrive to the correct recipients.
Asthma UK & British Lung Foundation have conducted surveys during the Coronavirus period. Respondents were asked in two successive surveys as to whether they received a shielding letter. Recent results indicate that in all other nations other than Wales, 48% of the respondents confirmed that they had received a shielding letter. In Wales only 37% of the respondents confirmed that they had a letter, this is 11% behind the other UK nations average, an increase from 7.7% in the last survey.
We are aware that the next phase of guidance for shielding is being actively reviewed for Wales. We recommend that Welsh Government notify health charities, advice lines and medical professionals in advance of future guidance changes in order to adequately prepare us for queries that follow as we are often the first port of call for many of the people affected, providing vital sources of information and support.
Ensure clear leadership
We recommend the identification of a lead minister within Welsh Government to develop a detailed strategy to protect the quality of life of people who are at risk to Covid-19, coordinating consistent departmental policy on support to those that are shielding or reducing contact with people as much as possible.
We would like to see the Welsh Government set up a Reference Group of key stakeholders, including third sector representation, to feed into the development of a new strategy, on new guidance and on relevant policy decisions impacting high risk individuals.
With the establishment of a reference group, there should be substantial input from relevant medical professionals, charities and those who are being advised to shield or stay home.
The issues that relate to shielding and extended social distancing are broad and relate not just to clinical care but also to financial vulnerability, mental and emotional health, food, work, education and families. It is imperative that next steps are developed in an open and transparent way with insight from those who are affected and the charities that support them.
A new strategy would need to address a wide range of concerns across all of the areas mentioned above, but some central pillars should be:
Impact on mental and emotional health
The change to the guidance over the weekend may help many with the mental health impact of shielding, however we remain deeply concerned on the impact of isolation and loneliness which can be profound. Many people will also be anxious that due to underlying health conditions they will not be a priority for treatment should they contract Coronavirus.
A recent survey of a respiratory shielding group in Wales by Asthma UK and British Lung Foundation found that a high number of respondents had concerns around their fitness and mental wellbeing, especially those who live on their own. With many finding it difficult to distance themselves from others in their own household socially and concerned about not seeing their family and friends.
We understand that at least one council in Wales has proactively reached out to shielding people about whether they need access to mental health support. Local authorities will have a key role to play in providing preventative mental health services at a population level and must be supported to do so. There will need to be capacity within NHS mental health services to deal with immediate and longer term impacts on the mental health of those who are shielding.
Protect physical health
It is important to continue to find ways to replace crucial ongoing health support that people who are shielding cannot access, in particular physiotherapy, occupational therapy and rehabilitation services that depend on physical contact. Those who are shielding or at risk need to be prioritised for other clinical support as they become available and services that allow people to stay safely at home and support their health and wellbeing must be enhanced.
Current guidelines still prohibit those who are shielding from shopping and collecting medication, however, does not clarify whether they now arrange crucial appointments which have been delayed.
Support for carers and families
Policy to support those who are shielding needs to support the whole household to keep those who live with them safe. There needs to be paid leave for carers who are supporting somebody who is shielding or at risk and where necessary PPE must be made available to unpaid carers. Providing access to testing for family carers and other unpaid carers even when they are asymptomatic will give them assurance that they can provide support to those at risk people.
Importantly, there needs to be robust guidance as to how children and young people with complex needs, who are also being shielded, can safely return to school.
We would welcome a meeting to discuss these matters in more depth.