Meals on Wheels for the 21st Century: A report exploring meals on wheels services in London before, during and after COVID-19

This report from Sustain and London Food Link, funded by Trust for London, explores meals on wheels services in London before, during and after COVID-19, showing that many incredible community services have emerged during the crisis but that they need urgent support or older people risk going hungry.

This report looks at how services that ensure older adults can access meals in their homes are run, both before the Covid-19 pandemic and during it, across London. In the capital, adequate provision of meals on wheels services where not in place prior to lockdown. Where these exist, many face the possibility of being cut, annually. New, innovative services were being established in a few locations even before Covid-19, demonstrating that viable, affordable and effective solutions exist that could improve lives for thousands of older and disabled adults. During the lockdown, many innovative community solutions arose, which show great promise for the future if they are supported and funded.

• Meals on wheels services are one important aspect of a comprehensive adult social care system which facilitates health, independence, connectedness and wellbeing.
• Meals on wheels are not a requirement for all older adults or disabled adults; where heightened independence is possible, services such as lunch clubs are more suitable. Meals on wheels are essential for those who are least able to prepare or cook meals for themselves.
• Meals on wheels can be paid-for, subsidised or free-of-charge. Viable models exist for making the service affordable for government and local authorities, especially where this involves social enterprise and integration with social services.
• Meals on wheels are an essential preventative service that alleviate stress from other parts of the adult social care and healthcare system: for example they allow hospital patients to be discharged at an earlier stage of their recovery; they facilitate improved health and strength, thus decreasing the number of GP visits or emergency service call-outs; and they enable frailer adults to remain in their own homes, rather than having to relocate to care homes. Consequently, meals on wheels services are cost-saving when looking at public spending holistically.
• Meals on wheels services bring about the benefits described above because of the nutritional value of the meal, but also because of the social, relational and psychological value of regular visits from well-trained delivery staff. Robust meals on wheels services include welfare checks and social interaction, and are linked in with the adult social care services.
• Overall there was a hugely inadequate level of meals on wheels provision in place in London before Covid-19. The community responses that have emerged to meet real needs will struggle to continue without funding and support. Malnutrition and social isolation experienced by many by older adults and disabled adults requires urgent examination by local authorities and national government, who need to come forward with a robust plan to sustain meals on wheels provision. This should include funding, policy and other support.

• Implement national legislation that puts a statutory obligation on local authorities to ensure all adults can access at least one good meal per day, accompanied by funding to fulfil this requirement.
• Use multiple metrics to monitor and evaluate meals on wheels services
  to assess their benefits, including: employment figures and quality of jobs; levels of supported employment; health and wellbeing; sustainable and local food supply lines; meal quality; dignified service provision; cost-saving across multiple budgets including both adult social care and healthcare.
• Commission, fund and support meals on wheels services, lunch clubs, social prescribing and shopping services from adult social care and healthcare budgets.
• Finance the social security system and local authority welfare assistance programmes to enable household food security.

• All London Borough Councils commit to ensuring that every older adult in their borough is able to access at least one good meal per day.
• Create a streamlined referral pathway standardised across London, learning from good practice elsewhere.
• Create a range of various meal choices with standardised prices, ensuring that dietary requirements, cultural requirements and tastes can be catered for.
• Establish a pan-London service and/or several multi-borough services so that boroughs work together to reach appropriate economies of scale and can benefit from collaborative purchasing and wholesale prices.
• Pay the Real London Living Wage for all jobs in this sector; provide secure contracts with additional benefits, such as sick pay.
• Buy food from sustainable, local supply lines wherever possible, supporting local businesses and the ethical priorities and values of the Mayor of London’s Food Strategy; avoid using surplus and donated food.

• Launch a London-wide inquiry into food access for older adults and disabled adults by the end of 2020. This could begin with a London-wide conference on aging, disability and food access.
• Help food delivery hubs that have been established or supported during Covid-19 to continue and build on the systems established. Council staff can coordinate the hubs and referral systems, whilst community kitchens are built into these hubs and chefs and delivery staff are employed.
• Set up training and shared learning sessions that help newer services to professionalise and establish sustainable, robust models and structures.
• Provide funding to the responses that have the best chance of being sustained in the long-term and those that provide ‘more than the meal’. Support them to professionalise and become integrated with the social care system, with funding arrangements that encourage services to include, or be working towards incorporating:
  Essential: Welfare checks, including full training for staff on how to complete these properly
  Essential: integration with adult social care and hospital discharge systems
  Essential: meals are healthy and aligned with the NHS EatWell plate
  Essential: basic meal choices are available including culturally appropriate meals and meals meeting specific dietary requirements
  Desirable: extended choice of meals
  Desirable: employment of staff on Real Living Wages rather than reliance on volunteers
  Desirable: Use of local, sustainable food and support for local businesses
• Self-referrals and relaxed eligibility criteria should be maintained alongside any integration with the adult social care system.
• All roles that are essential to keep services running are paid roles.
• Parking fines are not applied to delivery staff.