Covid-19: Charity cuts could put the NHS under even more pressure

Social prescribing

An important link between the NHS and charities comes in the form of social prescribing, a term used to describe the referral of patients from primary care to a wide range of local non-clinical services, from choir groups to financial support. These connections have been formalised in recent years with the introduction of “link workers”—people in the primary care team whose sole role is to take on patients from GPs, assess their needs, and signpost them to services that could help them.

A large proportion of the services that link workers engage with are led by charities. Sam White, a GP link worker for Carnforth and Milnthorpe primary care network, says that she would be lost without local charity services. “A lot of the organisations we refer to are charities that have been massively affected by covid-19, and most have lost 70% of their funds due to fundraising being unable to go ahead. I worry that if we didn’t have these groups I would be lost, as they all do such amazing work.”

Nick Grundy, a Teddington GP and chair of the representative group GP Survival, says that he relies on charities, often referring patients to them for mental health support, bereavement, and homelessness. Like many general practices, Grundy’s also pays a charity, through its GP federation, to provide its social prescribing link workers.

He says, “I’m worried that, without investment, the charities themselves will cease to exist. That was a concern pre-covid from some of the primary care network pilot sites, and more so now.” He adds that clinical commissioning groups need to be prepared to put money into charities where there is increased demand as a result of primary care network referrals or covid-19.

Less money, more work

One charity that Grundy often refers patients to is RUILS, a group based in Richmond, London, that supports disabled children and adults, as well as elderly people. The charity has worked hard to continue providing normal services—such as its befriending scheme and family support service—while also setting up pandemic services such as providing personal protective equipment (PPE), running a mobile food bank, and delivering prescriptions.

For the RUILS staff, the pandemic has been one of their busiest times. During lockdown they have delivered over 1500 food parcels, made over 1300 phone calls, and delivered PPE to GP surgeries throughout the borough.

However, while the group says that it can manage this financial year, it has concerns about what will happen after March 2021. Cathy Maker, its chief executive, says, “Our community fundraising—which includes quizzes, concerts, band nights, and participation events such as marathons—have all been cancelled. We raise about £55 000 per year, which funds our counselling services and our befriending for young people.”

Similarly, Marie Curie relies heavily on donations from the public, and the pandemic has significantly affected its fundraising. Wells says, “We have our big Daffodil Appeal in March, and that was cancelled; all of our face to face activity, our events, have been cancelled.”

Fragile system under pressure

Marie Curie provides frontline services for patients with terminal illness and their families or carers. Around the UK the charity has nurses working in the community, nine hospices, and a telephone helpline for patients, families, and healthcare professionals.

Patients are referred from GPs, district nurses, or hospitals, and the NHS holds contracts with the charity—but the services are only partially NHS funded, and how much the NHS contributes varies between areas.

Wells explains, “Every hospice has a different level of contract, so one may get 80% of their funding from their local clinical commissioning group and another one may get 20%. It’s really inequitable. There needs to be a huge overhaul . . . It’s a very fragile system that is really going to be tested now.”

Tom Nolan, a GP and BMJ clinical editor, says that he has already seen the impact on patients when charities can’t provide services face to face, such as choirs and support groups, and he worries about what will happen if they are financially unable to reopen.

“The charity and voluntary sector provide so much value support to patients, particularly in terms of the psychological, social, and practical aspects of living with long term conditions,” he says. “I think we’ve come a long way in primary care in the past few years in linking patients in with this support, and now so much of it isn’t available.

“I have several patients who I’ve tried to refer to charitable sector organisations, where I think their input would make a huge difference to them, but the charities haven’t been able to offer support. The demand is still there and it’s increasing, but now the supply has crumbled.”

Tough decisions ahead

With so much demand and so little money, charities are having to look at what they can continue doing. Wells says that Marie Curie, even as a large charity with more resilience, is going to have to make “tough decisions.”

“Those smaller charities, smaller hospices, and cancer charities—I think there are going to be a lot of closures,” she says. “I think there needs to be a more robust funding mechanism for charities providing end of life care. As a charity we want to keep collaborating with the NHS on this, but it needs to be sustainable.”

She says that Marie Curie expects a huge backlog of patients who have been unable or too scared to access healthcare during the pandemic, especially those with cancer, chronic kidney disease, heart failure, or chronic respiratory diseases.

“It’s all coming. The patients we are seeing out in the community, some of the conditions are very disturbing,” she says. “They have missed out on treatment over the last few months and they’re frail and vulnerable; they are going to be more prone to flu and other winter pressures.

“All of that backlog is going to see a huge surge in the requirements for our services.”