How health and social care is adapting to the COVID-19 crisis - RSA

How health and social care is adapting to the COVID-19 crisis

Blog 1 Comments

  • Health & wellbeing
  • Institutional reform
  • Public services
  • Social care

Everyone is adapting to the impact of most of us being at home.

In the last week, I’ve set up a WhatsApp group for my street this week, watched a livestreamed comedy show, done a yoga class over Zoom and arranged for some food to be delivered from a local café.

Local communities, businesses and individuals have rapidly deployed technology to connect, communicate, share and survive. It’s inspiring.

In contrast, the health and social care system is struggling to adapt as quickly. That’s because the system is too inflexible.

Rigid management styles are hampering the social care system’s response to the crisis

Of course, we have seen incredible community spirit and resilience from people working in the care sector. But the crisis has shown how much the system lets them down. Next Stage Radicals has highlighted some strategic changes that are happening to make the system work more efficiently and they highlight the opportunities it can take to become a more Human, Learning, System.

But health and social care services in response to the crisis are struggling with:

  • Lack of investment
  • Shortage of staff
  • Rigid commissioning and contract restrictions.

Contracts and commissioning may be less well known to the public. But they are having an impact on the sector’s response.

I was talking to a service provider this week who cancelled a planned group session after the Prime Minister’s press conference on Tuesday, only to receive an email from their commissioner asking ‘Why? I haven’t given permission to cancel. This is the service I pay for!’.

That sort of attitude puts people at risk. It also illustrates a wider problem: we’re not letting workers get on with their jobs. Too many are micro-managed.

This makes the system too slow to respond to changing needs. Another example: a friend told me recently that their family member in a care home cannot get access to wi-fi, despite the home now being closed to visitors.

Across the entire sector, there is more reliance on telephones than you’d expect in 2020. Phone - more often than not a landline number - is still the only option to contact many community social workers, care providers and health services.

Positive ways social care could change

The health and care system can use the learning that will come from this crisis to create a better system for the future - everyday and in crisis. Key to change is giving workers more flexibility. There are positive signs of the system recognising the need to adapt.

Acute hospitals in particular will see radical change, with its structures requiring swift response and adaptation. This can already be seen with rotas being updated and the “weekend go-slow" ending.

Services need to embrace and accelerate the use of data sharing and technology that creates connectivity across the system.

This also allows citizens to link with professionals more easily (and crucially remotely). This is a crucial area for change. Social work, home care and community nursing teams are often isolated away from the communities they serve. If they were locally based - working with and in the same spaces as local community organisations - a more holistic, swift and less disjointed response could be provided in times of emergency (and everyday).

In times of crisis, we often don’t have the time to ask for permission from a number of managers or committee. We need to enable professionals to use their skills and abilities to respond rapidly to the needs of their clients.

I’ve written before about the principles of self-managing teams, a strucutre that can meet this need – both during and after a crisis.

Learning hard lessons for the care sector

The health and social care sector won’t look the same after COVID-19.

The RSA has already highlighted opportunities that build bridges to the future, focusing on health and social care this could include:

  • Our public services have already shown enormous reserves of agility and resilience. They should be supported further.  
  • Additional funding and deliberate ring-fencing of preventative services such as home support and care, public health, early stage mental health, youth services, children’s centres and police community support services. These services should receive support now with investment in remote communications including staffing to enable them to serve vulnerable groups and communities during self-isolation. 
  • Begin to invest in ‘agile’ self-management approaches for community and care workers, learning from adaptation in the crisis period to regularise supported self-management. 
  • Encourage and support local services to tap into the flood of community volunteering in the past few days through a single, curated information hub. Share innovations, resources, technological tools and approaches to tapping into the new volunteer force. Where civil society responses such as Covid-19 Mutual Aid are emerging they should receive emergency financial support. 

One sign of the change already happening: A local social care training organisation (delivering health and safety and moving and handling courses) has seen an exponential increase in demand for courses as a huge increase in care workers flood into the market.

We must make sure that the sacrifices that health and social care staff are making now aren’t in vain.

The system and those who control it must learn from these hard lessons. To do that, it can’t just commission some learnings afterwards - it needs capture the innovation as it happens.

We must be brave to offer a new service that we all need, whether it be in times calm or in times of crisis.

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  • One group that often gets forgotten in these kinds of conversations is direct payment users: people who are funded by the local authority to employ their own care. Theoretically, councils are supposed to support direct payment users to be good employees. The current crisis has created some very significant difficulties for us as employers. We cannot furlough our staff as we still need them, but we need to stay safe (and we might have several people coming into our house and going back into their own families, other care environments and public spaces). Even more importantly, if we contract the virus, we need to keep our staff safe. Local authorities currently seem to have no plans to support us to do this. I have had a rather obscure letter from my local authority telling me to continue 'paying invoices' but that assumes that I either employ agencies to provide my care or self-employed people. Many direct payments users employ their staff directly. It would be good to think that, when we emerge from this crisis, the needs in any future crisis of those of us who employ our support staff directly would be considered carefully and lessons learned. But I fear this won't be the case and we will be pushed even further to the margins.