In March 2020, when the virus first reached the Isle of Wight (IOW), there was a large amount of government guidance issued geared towards assisting care providers, when responding to the COVID-19 outbreak.
It soon became apparent though, that care providers including those working in care home settings, would benefit from increased support to make sense of government guidance while at the same time grappling with the burgeoning and complex challenges the outbreak presented them in their daily practice.
Myself and colleagues responded by forming an ‘ethics task and finish’ working group or multi-disciplinary team (MDT), which included representatives from the safeguarding adults board, the Clinical Commissioning Group, the care partnership, and a CQC representative seconded to IOW. This small MDT initially looked at the social distancing and ethical framework set out by the government, as well as other guidance emerging from central government. They worked to quickly distil key messages for those working in various care settings, producing a range of quick reference guides for care providers in order to give managers and their staff tangible pieces of information to ‘hang’ there practice on.
Implementing a rapid response
This process opened a dialogue with registered managers across the island, who were understandably struggling to cope with the impact of coronavirus in their services – this included services supporting adults’ with autism, complex learning difficulties and dementia. Ethical questions and new practice dilemmas emerged as a result of the outbreak including how staff might now manage the care plans for people who historically had always spent a lot of time in the community, in order to meet their needs. How should staff manage the sudden curtailment in the freedoms previously enjoyed by the people they supported, and how best could they support people to understand the sudden changes?
In responding to these key questions, the ‘task and finish’ MDT needed to ensure that they were nurturing and enabling best practice, while ensuring that statutory responsibilities were met, amidst the changing landscape of the pandemic. The team began by mobilising a response which aligned with the ethical framework issued by the government, and in so doing, began to gather good practice stories from providers on the island, and recirculated them across the sector, as part of a daily bulletin.
The daily bulletin enabled the MDT to disseminate key information and updates. However, it soon became apparent when the team were ‘checking-in’ with managers that they were facing a unique set of highly complex, often traumatising, challenges as the virus took hold. Many were tearful and exhausted, as they worked hard to continue to manage services against the backdrop of increased staff sickness levels due to COVID-19. Staff were also anxious about returning to work, for fear that they would spread the virus to the adults’ they supported. Most of all, many people sadly lost their lives, as staff and carers coped with the unforeseen deaths of several of the people they supported; lives lost too early, and of people that they had known over a long period of time in many cases. These huge and unprecedented losses understandably took their toll on the staff and managers working during this time.
Centring the wellbeing of those working in care settings
The increased rates of bereavement and loss across care settings on IOW due to COVID-19, reflected the national picture, and prompted the ‘task and finish’ MDT to develop a separate coordinated wellbeing resource, to support workforce resilience. This was so that managers were themselves supported, but also better equipped to support their teams; a response which would operate in tandem with the guidance issued in relation to practice.
The MDT subsequently devised a straightforward, accessible three-tier resource for staff and managers, aimed at fostering better self-care; this ranged from tools managers could use with their teams, to one-to-one counselling sessions for staff, with trained professionals. Crucially, this response centred the work and input of the island’s Mountbatten Hospice, who were instrumental in delivering the wellbeing package. The resources were developed in consort with two clinical psychologists from Mountbatten along with the representative from CQC and included support for debriefing after a difficult conversation; ways to manage daily anxieties, as well as grounding techniques when feeling out of control or overwhelmed.
Recognising and valuing the vital role of those working in care settings
The work in care homes during the outbreak has been unparalleled, intense, and fraught with challenges, as staff have worked to curb the spread of the virus and care for those they support. Indeed, the pandemic has brought into sharp relief the vital and complex role carers and care staff do across a range of settings; a segment of the workforce too often undervalued and overlooked across the country. The taskforce decision to not only support staff in care settings, but also to acknowledge the challenges they face and the emotional impact working during times of COVID-19 has had upon them, has been crucial to the rapid cross-island response. It reasserts that this part of the adult social care workforce are not forgotten; that they are seen, and that they are valued.
For managers, the resources provided an important set of tools they could deploy when managing during a time of crisis. The resources encouraged managers to model empathy, foster connections with their teams, and make space for debriefing, during a tumultuous time for the whole workforce. The work of the taskforce was not to replace the measures that managers and providers already had in place themselves, but rather to complement, bolster or refresh what they were already doing, and to provide an additional set of tools to use, regardless of what part of the system they worked in.
Supporting staff and managers
Feedback and looking forward
The new resources were disseminated across the IOW and were discussed during two webinars with attendance from managers across the island, totalling around 40 people at each. The webinars provided an important space to share experiences during the outbreak and the feedback was very positive with many people reporting feeling reassured that there were others ‘in the same boat’ as them. In total 66 providers were involved in the roll-out of the taskforce’s coordinated response; 16 of which were contracted by IOW Adult Social Care, but all providers across the island were included.
Looking forward; the MDT aim to continue the webinars for providers, and to keep the wellbeing and resilience focused conversations going well into the future. The MDT team will also continue to convene their meetings, albeit with less frequency, as the Island moves towards a post-lockdown phase. This transition will undoubtedly bring new challenges for everyone concerned, two prime examples being, the new government guidance issued around care home visits, as well as the complexities of swab testing for adults’ with fluctuating mental capacity – both of which will constitute key concerns for the ethics taskforce in the coming weeks and months. The team will continue to work with the hospice, as they grapple with the emergent and future ethical challenges. Indeed, while the pandemic has undeniably brought huge sadness and loss, it has also accelerated a more cohesive, multi-agency, response across a range of key actors across the island, which is to be applauded.
The second phase of the wellbeing and resilience toolkit will expand to include informal and formal carers in the community. This stems from a recognition that many of the support and advice mechanisms previously available to carers in the community, are now no longer available, due to COVID-19. This has left carers – our unsung heroes – dealing with complex care issues on a daily basis, without the support they need to do the vital work they do, but also to ensure that their own mental health and wellbeing is appropriately supported.
The ethics task and finish working group was made up of the following people
- Ann O’Brien – Service Manager & Strategic Commissioning Lead
- Daron Perkins – Service Manager Integrated Learning Disabilities Service
- Elaine Cockerham – Head of Education & Training Mountbatten Hospice
- Emma Coleman – SAB Coordinator
- Ginny Smith – DOLS Group Manager
- Jane Hazeldine – Director of Psychosocial & Spiritual Care Mountbatten Hospice
- Maggie Bennett – Isle of Wight Health Care Partnership
- Sara Frost – QCQ Inspector