COVID-19: What did we learn?

“As a volunteer food courier supporting vulnerable people in my area, I have visited community centres I had never been to before, cycled down roads I had not been down before, and met people I would not have met otherwise.” (PPL)

The University of Hull’s research on caring from a distance found that while a personalised approach is needed, and staff support is essential, digital technology, phone calls, socially distanced visits and creative approaches – photo gifts to stimulate memories – all had the potential to help maintain connection and interaction. Alternative approaches were necessary while care homes closed to visitors, and these lessons are important to support “distance carers”.

SCIE’s report on learning and sharing following the COVID-19 lockdown found that at Boudicca Court residential service, in Norfolk, staff had the idea of holding an outdoor socially distanced movie night. To achieve this, they needed a projector and screen and so put out a Facebook message to the local community to see if anyone could help. Members of the public enthusiastically responded and generously provided both items brand new, allowing the show to go ahead.

Volunteers were actively recruited to socialise with residents in care homes, while Independent Age’s report on lessons from befriending in the time of Covid-19 found that befriending was “the frontline as well as the last line in tackling loneliness”.

Of course, none of this should become a way for the state to ‘pass off’ its responsibilities on others – and any developments need to take place with great care and conscious balance.

“Most of our communications have been through digital channels such as social media platforms and our web pages. This highlights opportunities for us to consider networks of communication with our most vulnerable adults in future, offering a blended approach rather than the default; the pandemic has demonstrated the art of the possible in relation to technology.” (North West ADASS)

During the pandemic, our understanding of what was possible with digital technologies such as Zoom and Teams technology really increased. At their best, these helped to remove some of the barriers imposed by travel restrictions, while also saving time and money. Digital tech also allowed for ongoing communication with family and friends during the pandemic, alleviating some of the effects of loneliness and enhancing social support through the running of social activities.

A more blended approach was needed where digital technology wasn’t appropriate or accessible. Other solutions included developing phones that were preloaded with contacts and didn’t rely on Wi-Fi, providing signal boosters, and providing training and support through peer-to-peer ‘digibuddies’.

Technology worked best when its use was co-designed with people drawing on care and support, to help service providers understand whether digital solutions were appropriate and met people’s needs.

Going forwards, some of what we learned about technology might help in terms of our relationships and connections, and supporting people to lead chosen lifestyles (although only if part of a broader approach). Alyson Scurfield, Chief Executive of the TSA said “technology-enabled care should be considered as part of an overall package of care tailored to an individual”.

“Having the voice of people that use services alongside the Director and the clinical leads was really beneficial for us. Not only hearing about the difference in the statutory services but hearing the voice of people who used services and what was happening to them [which] grounded the work we were doing” – Alan Sinclair, Director Adults and Communities, Slough Borough Council (Think Local Act Personal)

North West ADASS’ review of lessons learned during COVID-19 found that person-centred services gave people who draw on care and support a say in how services were delivered during the pandemic.

Speakers on The Future of Direct Payments webinar, for instance, described some very positive experiences where “some councils adopted a more pro-active approach to self-directed support and enabled people with direct payments to take decisions to give themselves the best chance of staying safe and well. In these ways, the pandemic was a chance to think differently; to trial other approaches and build an evidence base of ‘what works’ to help promote further flexibility in self-directed support”.

IMPACT has been doing lots of work on choice and control, including around increasing uptake of direct payments for people from minority ethnic communities, use of Individual Service Funds/managed budgets and more co-operative models.

In lots of areas of the country, the urgency of the pandemic brought different groups together, including commissioners, care providers, the voluntary and community sector, government, IT suppliers, people and communities.

Many of these approaches were ‘place-based’ – bringing together all the key people locally to focus on specific communities, respond to health inequalities, share information and do whatever was needed to make a difference.

Often, traditional barriers and divisions went temporarily out of the window, as people tried to pull together to focus on what really mattered in the midst of a crisis.

Responsive and supportive leadership with a focus on outcomes rather than ‘rules’ was sometimes evident during the pandemic. The Parliamentary Office of Science and Technology (POST) innovation in adult social care briefing found that less risk averse leadership can increase levels of innovation. Responding to POST’s call for evidence, the Midlothian care co-ordination team, who provide a single access point for dementia services, said that “distributed, empowering leadership” has underpinned improvements in care.

Paradigm’s report, “Don’t ever call us unskilled again!” Learning from the experience of Support Workers during Covid-19, found that – pre-pandemic – some of our rules, policies and regulations restricted natural and creative ways of being and working.

North West ADASS’ review of lessons learned during COVID-19 found that “strong, decisive leadership and moral courage inspires change”. In the absence of usual restraints (financial, regulatory or statutory), leadership had a unique role to play and “in most cases created a culture of responsiveness, clear purpose, ‘permission to act’ and a trust in the expertise of staff and partners.”

In a crisis, there could also be something of a “we are all in it together” approach. For example, research into the experiences of nurses working in care homes emphasised the importance of peer and emotional support, as well as making recommendations in terms of approaches to ensuring future well-being. In other sectors, the Queen’s Nursing Institute asked nurses working in community and social care settings to share how they adapted during the pandemic and produced a collection of case studies of innovation.

The Director of Strategy at Blencathra said that they “put in place fortnightly BAME [Black, Asian and Minority Ethnic] and Allies meetings. So, every fortnight all of our staff who identify in that group have a support mechanism where they can bring their stories, share their information about the impact of COVID on them, and do that with executive directors in the room.”

“It has taken a pandemic for the general public to realise the contribution we are making on a daily basis, caring for vulnerable adults. before during and after the pandemic. It’s a privilege to work in health and social care.” (Paradigm)

In an emergency, very rapid and meaningful change was possible when staff were freed up to be innovative. Frontier Economics found that the removal of barriers to innovation, the need to act quickly and as one, as well as the receiving of extra monies, allowed staff to feel more empowered to make rapid decisions and to work in new ways. Support workers told Paradigm that lockdown brought the opportunity to “reconnect with the soul of their work – to be in relationships with individuals and figure out how to make the best of life”.

A report from BASW on learning for the future found that as long as it was safe, staff continued with home visits, blending existing practices with new ways of working, upholding professional standards and seeking opportunities to develop their knowledge and skillsets, whilst at the same time providing peer support to combat isolation and loneliness.

The pandemic also brought an increased appreciation of the social care sector. A report on learning from the impacts of COVID on care homes found that social care staff, who were often overlooked, were now seen as “keyworkers” who were highly valued (by some at least). They were also recognised for their thoughtfulness and skill during the hardest of times as staff took on new roles and responsibilities – blurring traditional boundaries and doing whatever was needed to look after those in their care.

This was often only patchy at best, and arguably hasn’t continued – and there are many more examples of social care staff being under-appreciated, ignored and overlooked. Moreover, lots of people who draw on care and support, carers and care workers died from COVID because they were exposed to fatal risk – and nothing can ever take away from this. However, we also learned that some things can change when people are freed up to focus on what matters and when we try to support each other better.