Blending online and face-to-face provision in community wellbeing services ROSA ROBINSON & MIKE CORCORAN with ROSIE HAVERS, JOSH COLES-RILEY & HANNAH DURRANT

Pre-pandemic, organisations were on a delivery trajectory that they believed met their communities’ needs and fitted their organisations’ delivery capacity. Some organisations were delivering exclusively face-to-face, others were moving slowly towards a blended approach, while others were on a journey to predominantly digital delivery. The Covid-19 lockdowns necessitated a rapid move to online, which organisations managed with varying degrees of success. Organisations discovered a great deal about themselves and their communities during this period. It was a time of deep learning and, in many cases, a catalyst for transformation.

For those already delivering some aspects of their services digitally, the pandemic accelerated the transition; it was challenging but manageable. The lockdowns and the wholescale move to digital engagement was easier to navigate for those service users already geared up and confident to engage online, but also identified new groups who struggle to engage in person and for whom the fast-paced opening up of online access offered a more inclusive and accessible option for participation. It created demographic shifts across service user groups, with previously rarely-heard-from groups seeking help via new service routes.

However, many organisations whose service relied entirely on face-to-face support, found themselves unable to reach their communities online. Providers reported that some service users, who usually accessed services in person, lacked access to appropriate devices or sufficient data to get online, or lacked the skills and confidence to engage digitally. Some simply did not want to go online. For those organisations whose services had been in-person only, the pandemic meant that people unable or unwilling to engage online often experienced loneliness as well as reduced support. As face-to-face delivery returned, providers were aware of the need to mitigate future risks of social isolation but were unsure what they could do.

Recognising that some service users didn't want to engage online was only part of the challenge. Organisations reported that, initially, several staff were equally reluctant and needed support and training to enable them to integrate digital provision into their support role.

Blended provision is now widespread across Wales. It is being done differently across different organisations and places, and happening at different scales: from individual projects to whole-service and whole-organisation approaches.

In practice, blended delivery looks different from organisation to organisation, depending on its service offer, community, resources and staff or volunteers. As well as the use of video calls, practitioners highlighted the importance of telephone, text and social messaging apps, such as WhatsApp and Facebook Messenger, in delivering a blended service. The extent to which organisations are integrating online and face-to-face provision also varies, from multi-channel provision with little or no integration (e.g., sending voice notes over WhatsApp instead of sending letters for people with conditions like dyslexia, or using in person or telephone interaction to develop and support capability and confidence to engage online) to fully integrated services offering parity of experience for service users across multiple overlapping channels (e.g., following up in person interaction with online or telephone offers to extend support).. Often, the ability to blend or integrate depends on infrastructure and resources.

In other cases, blended approaches were carefully designed and planned to create a streamlined experience for both those engaging online and in person. For example, streaming online talks and courses into community venues so that people could feel fully part of the event and the community whether attending in-person or online.

The pandemic lockdowns highlighted new inequalities in service provision, and the cost-of-living crisis was amplifying barriers to access to both in-person and online engagement for different groups.

For example, organisations identified that people with caring responsibilities, unable to leave their homes for any amount of time, had often been unable to engage with in-person services before the pandemic.

When the world moved online during the lockdown, their world opened up. But people unable to get online had been left out in the cold. Post-lockdown, organisations recognised an urgent need to offer blended services to meet their communities’ different needs and preferences to create better outcomes for them.

For others, the reasons for blending were more reactive. Practitioners described the integration of digital into predominantly face-to-face services as a natural consequence of pursuing other connected objectives—including widening digital participation and improving equality, diversity and inclusion (EDI) practices—and seeing other services offering blended delivery with success.

Service providers report that blending delivery brings many benefits for service users, improving access to services and offering responsivity, flexibility, and choice. It enables people without data, devices or digital skills, and those in need of in-person support, to access face-to-face services and creates opportunities for people who struggle to get to physical spaces, lack the confidence to engage face-to-face, or have caring responsibilities that limit time away from home, to access services and appointments from the comfort of their home.

In addition to the commonly reported benefits of providing alternative delivery channels to enable access and inclusion, we heard about novel benefits stemming from blended approaches that promote transitions across channels and empower people to participate in multiple, overlapping ways. These benefits explain why the integration of channels described above was considered important (offering parity of experience for service users across multiple overlapping channels).

The ability to move fluidly between online and face-to-face was identified as particularly important for some groups. For example, one practitioner supporting deaf people told us that the deaf community often prefer face-to-face meetings but sometimes struggle to get to them due to poor mental health. Offering flexibility in how people access services and enabling them to switch channels reduces the risk of them missing appointments altogether and enables them to access support and be part of a community on their terms.

Flexibility and choice of access were highlighted as particularly important in the cost-of-living crisis. Practitioners spoke about people facing new barriers to access, depending on their personal circumstances, location and resources. They told us that blended services were vital for ensuring that nobody was excluded and left behind and gave examples of people facing different barriers to accessing online and offline services: those who can’t afford to travel to in-person services (particularly those in rural areas), and the other side of the coin, those who can’t afford data to get online—or can’t get online because local internet infrastructure is patchy.

While blending delivery facilitated cost savings and increased efficiencies, freeing-up staff time, these efficiencies sometimes came at the expense of staff wellbeing. Having allowed services to increase the reach of their work to existing and new groups in need, certain efficiencies associated with digital provision – e.g., reduced travel time - had lead to an increase, rather than decrease, in caseload and stress.

For most practitioners we spoke with, the move to blended delivery was responsive rather than strategic. Consequently, organisations found themselves without sufficient resources to deliver blended services effectively.

Interestingly, post-pandemic, some organisations also found they needed to offer training and support to help staff reintegrate in-person support into their support provision.

While organisations recognised the need to create services that are both equitable and optimal, practitioners on the ground often felt that there was a lack of interest in the ‘how’ of blended delivery from leadership teams, which meant that managing the double-sided coin of benefits and challenges to deliver an equitable service was, as one practitioner described, like spinning plates.

Overall, despite these challenges, practitioners believe that blended provision is more inclusive of a wider set of user needs, widens reach, improves participation, encourages organisations to ask service users what they want and need and, in turn, enables more people to influence the design of services they use.

Practitioners also told us that early signs suggest that blended approaches can empower service users by enabling them to access services on their terms, which improves participation and, in turn, creates opportunities for meaningful connection. However, practitioners also recognise the urgent need to move from reactive to strategic delivery and to evaluate what works for whom in order to refine services and evidence impact.

Practitioners also recognise the urgent need to move from reactive to strategic delivery and to evaluate what works for whom in order to refine services and evidence impact.