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Reflections on management during COVID-19

As breathing space begins to edge slowly in, Raina Summerson reflects on what has happened, where we are now and what we can hope for in the future.

The battle against coronavirus has just about taken all the energy the sector has.

Since March and the start of the COVID-19 pandemic, life in social care has become even more challenging than usual. Many times in the past weeks, my colleagues and I have asked ourselves what we did before ‘the crisis’, as every part of our days, like many others’, have been overwhelmed with managing the management of coronavirus.

Three months in, there is finally some space for reflection and consideration of the issues raised for the social care sector and how it might change the future for us. Could it be the catalyst for the major social care reform that has been so long awaited? Or will we go back to being on the side-lines, an area just too big and complex to address?

Underlying system issues have certainly been brought to the fore during the pandemic. A lack of understanding of the sector, a lack of funding and ongoing struggles to communicate effectively with the sector have all been evident. Alongside this, there has been some increased recognition of the key workers playing an essential role in frontline care delivery, we have seen the sector react fantastically to fast-paced and emerging needs with the innovation, responsiveness and positive attitude it is known for by those who understand it, and we have seen amazing personal commitment from many people who work within it.

Recognising the impact

For those of us who live and breathe social care and the ups and downs that come with it, none of the above was a surprise. However, the start of the crisis changed our working days into structured routines of daily director briefings, endless conference and video calls with internal teams and external networks, lobbying on essential issues, communication pieces with our teams and visits to our locations – to stand outside offering moral support whilst feeling pretty useless compared to the activity going on inside, being dealt with so admirably by our direct care team members.

Remote working was introduced quickly where possible, whilst maintaining daily support processes, which meant IT resources and support needed deploying rapidly and new systems needed setting up. A full-time team focused on securing PPE, and we had daily realities of juggling rapidly escalating costs with unknown and unreliable funding streams, whilst managing the expectations, anxieties and queries of our teams and people using our services.

Daily-changing government guidance, often issued at five o’clock and with the really game-changing issues often on a Friday, meant little rest as interpretation and communication of this was needed immediately.

The issues and unknowns contributed to many sleepless nights, mostly caused by concern for our teams out there working and how we could best support them to keep themselves, and those we provide care and support to, safe.

The weekly calls and updates provided by the United Kingdom Homecare Association (UKHCA) were invaluable as a sounding board with other homecare leaders, but also gave critical and timely insight from the wider Care Provider Alliance perspective and enabled us to give direct and key data provision back into central government, the Local Government Association and the Association of Directors of Adult Social Services (ADASS).

New ways of working

Some great projects emerged to support communities, reminding me of how nimble and responsive our social care teams are at all levels. Homecare operations put together dedicated teams and working processes to help with hospital discharge into people’s own homes as well as ‘care hotels’, working closely with health colleagues. They adapted and expanded ‘welfare calls’ for people who were worried about visits or frequency of visits and they used their community links to support in multiple ways.

Our existing live-in care project work developed to flex with our health colleagues’ demands, whilst also seeing fantastic commitment from team members who remained in one-to-one placements with those they support in order to give continuity of care and minimise risk of cross-infection. Complex care services for younger adults continued to provide a safe haven for those we support, though with added flexibility to accommodate a wider range of needs and support critical situations caused by the pandemic.

As reflected in the media coverage, our care homes have been impacted the most of all our services in this time, with changed working practices, often to aid both hospital discharges and prevention of people into hospital. In some cases, this required rapid changes to registration, installation of new equipment and new ways of working; not least in the essential communication and daily support of people with a dementia while wearing enhanced PPE and with a lockdown on visits from families and friends.

The way the teams have responded to this, managing outbreaks of COVID-19, whilst dealing with all of the usual care, reassuring and supporting people, managing visitors for end of life care and using different ways of ensuring social connection and activity, has been amazing.

Our support functions have also responded brilliantly, dealing with rapid implementation of new commercial agreements, local authority payment queries and new processes, tracking costs to each location for local authority funding purposes, and the frustrating world of PPE procurement and distribution.

Training and recruitment had to adapt overnight, implementing processes to accommodate increased recruitment interest and ensure robust processes for interviewing, starting and inducting within streamlined procedures. Human resources, quality and marketing have dealt admirably with increased communications, support and information flow. New things have been tried across all of our services and teams and with some great learning and outcomes to take forward beyond COVID-19 times.

From a wider perspective, teams across social care have seen recognition of their roles beyond anything we have seen before. ‘Clap for our carers’ every Thursday and thoughtful donations and communications from local communities into so many care locations have meant so much in keeping up morale, and seeing this recognition and resulting pride shine through our teams, amidst anxieties and tiredness, has been one of the joys of this time for me.

At times, it has still felt like a battle to get our teams recognised along NHS colleagues; supermarkets and discounted offers being one area that was far more problematic than it should have been.

Will the future be bright?

In terms of impact on the future of social care, what can we hope will change? We can hope that the calls for social care reform – real, proper system change, not just tweaks – don’t fade away as they have so many times in the past. Proper long-term funding has to be a key part of that.

We can hope that the collective recognition and appreciation of our social care workforce, and indeed of the range of organisations who employ them across the sector, will continue and gain momentum. We can hope that the adults and children who require social care support at times in their lives will get the support and care they need from a more joined up system that recognises the value of both social and health care, and that working together is more effective. Structurally, we can hope that society and organisations have learned that streamlining processes, focusing on essentials and minimising red tape procedures can make ‘the system’ flow so much better and enhance the experience for all of those in it.

Questions are rightly being raised about the support afforded to older people, the protection of people living in care homes, and the range and depth of our homecare provision to do so much more, as well as how as a society we want to pay for and receive support when needed.

Whilst we wait to see if we get a second spike of outbreaks, we are already talking about ‘normal things’ again: winter pressures, perennial funding issues, local authorities who have still not given uplifts for this financial year and, of course, social care workforce terms and conditions.

However, these conversations are happening against the backdrop of a severely challenged economic background and a world of enhanced infection control and PPE use, COVID-19 testing, higher levels of team absences and increased costs for the foreseeable future. The ‘new normal’, as people like to refer to it.

Beyond the end of June, most providers who work with local authorities and clinical commissioning groups have no idea about where any additional support for these inflated costs of providing care are to come from. The fall out of this, in particular for smaller providers, is likely to hit in coming months.

Expressed support for the sector from central government, local government, NHS, the public and the media has been welcomed during this period, despite some fundamental failures in the actual ‘on the ground’, practical delivery of some of the rhetoric.

However, we are already starting to see the usual business strains emerging. Less mention of social care in daily briefings, a lack of trust and partnership in dealings with local authorities, vagueness in future planning and worst of all the finger of blame being pointed at the sector for perceived deficiencies or judgments made, often in the absence of knowledge about the realities of managing care at any time, let alone through a global pandemic.

Issues remain with points-based immigration, with quarantine requirements not covering social care professionals and off-the-cuff comments about ‘unskilled’ workforce still being made by senior politicians and the media.

Let’s hope for all of our sakes that the commitment and care shown by our teams during this time is not forgotten and that we see this extraordinary time as one that impacted real and positive change for the sector.

Raina Summerson is Group Chief Executive of Agincare. Email: raina.summerson@agincare.com Twitter: @Agincare

How have you coped with managing a service through COVID-19? What do you think the future holds? Let us know in the comments area at the bottom of this page.

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