COVID-19 resources

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Recommendations for welcoming back nursing home visitors during the COVID-19 pandemic: results of a delphi panel

Journal of the American Medical Directors Association

Objectives: Nursing homes became epicenters of COVID-19 in the spring of 2020. Due to the substantial case fatality rates within congregate settings, federal agencies recommended restrictions to family visits. Six months into the COVID-19 pandemic, these largely remain in place. The objective of this study was to generate consensus guidance statements focusing on essential family caregivers and visitors. Design: A modified 2-step Delphi process was used to generate consensus statements. Setting and participants: The Delphi panel consisted of 21 US and Canadian post-acute and long-term care experts in clinical medicine, administration, and patient care advocacy. Methods: State and federal reopening statements were collected in June 2020 and the panel voted on these using a 3-point Likert scale with consensus defined as ≥80% of panel members voting "Agree." The consensus statements then informed development of the visitor guidance statements. Results: The Delphi process yielded 77 consensus statements. Regarding visitor guidance, the panel made 5 strong recommendations: (1) maintain strong infection prevention and control precautions, (2) facilitate indoor and outdoor visits, (3) allow limited physical contact with appropriate precautions, (4) assess individual residents' care preferences and level of risk tolerance, and (5) dedicate an essential caregiver and extend the definition of compassionate care visits to include care that promotes psychosocial well-being of residents. Conclusions and implications: The COVID-19 pandemic has seen substantial regulatory changes without strong consideration of the impact on residents. In the absence of timely and rigorous research, the involvement of clinicians and patient care advocates is important to help create the balance between individual resident preferences and the health of the collective. The results of this evidence-based Delphi process will help guide policy decisions as well as inform future research.

Last updated on hub: 10 December 2020

What people are telling us: a summary July – September 2020

Healthwatch England

This report forms part of the regular updates for NHS and social care service leaders about the key issues that matter to the public. It covers the period July - September 2020 and is informed by 38,082 people’s experiences of care. The update looks at the specific issues people have raised in relation to: accessing NHS dental care; the support provided in care homes; getting COVID-19 tests. The report also provides an overview of the online advice and information the public are seeking from Healthwatch England and feedback on how people feel about their care by health and social care service area. More than 7 in 10 people (73%) found it difficult to access help and support when they needed it compared to just over 1 in 10 (11%) who could access care easily; and more than half of people (51%) expressed negative sentiments about dentistry compared with 1 in 25 (4%) who said something positive. Care homes have faced incredible challenges during the pandemic, with coronavirus disproportionately affecting residents. An ongoing concern for many remains the process for arranging visits to and from care homes for residents. The restriction in visits to and from friends and family is leading to increased isolation, loneliness and the physical and mental deterioration of care home residents. With some residents not receiving any visits at all since March, it is more important than ever that the health, welfare, rights and wellbeing of residents are prioritised.

Last updated on hub: 10 December 2020

The courage to be kind: reflecting on the role of kindness in the healthcare response to COVID-19

Carnegie UK Trust

Findings from reflective conversations of a cluster of doctors in leadership programmes on the experience and new ways of working as a result of the pandemic. The five participants in the project were able to reflect on the COVID response from roles within Scottish Government, local health board management, hospital medicine, emergency department and general practice. This report presents a thematic analysis of what was heard across these reflective conversations. It is structured chronologically and, in doing so, it tells a story of people’s experiences of change across the NHS through three distinct phases: lockdown (April-May), lifting lockdown (June-July), and remobilising (August-September). Each phase is broken down into key themes, with the voice of participants woven between. The report finishes with a discussion that summarises what has been learnt about kindness and relationships in the first six months of COVID, and considers what this might mean for the future. Although they reflected shifting dynamics, pressures and emotions, the three phases of conversations present a clear focus on what is important, and an indication of what should be valued and prioritised in health and social care renewal, in order to build a system that looks after the wellbeing of patients and staff: a meaningful conversation about staff wellbeing – too often the individual can be overlooked in conversations about the system; sustaining a common purpose – the clear focus on COVID-19 demanded and enabled a more relational approach and, more widely, kindness became a feature of interactions among staff and leadership; shifting the emphasis on targets – the experience of COVID-19 may open up a much wider conversation about how best to fit targets to a system in a way that delivers the best for both patients and staff.

Last updated on hub: 10 December 2020

Ever more needed? The role of the Leeds Neighbourhood Networks during the COVID-19 pandemic

Centre for Ageing Better

This report draws on the findings of a ‘real time evaluation’ (RTE) of the Leeds Neighbourhood Networks (LNNs) during the pandemic, as a way to understand and share learning about their response. The LNNs aim to support older people to live independently and participate in their communities as they grow older, through a range of activities and services that are provided at a neighbourhood level. The networks have developed over the past 30 years and there are now 37 of them covering the whole city of Leeds. The form, function, activities and services of the networks are diverse, but they share some key characteristics, such as running with the involvement of older people. Prior to the COVID-19 pandemic there was a city-wide ambition for a symbiotic relationship between the LNNs and the health and care sector. This was linked the city’s strategic vision to make Leeds the ‘best city in the UK to grow old in’ and recognition of the need for a ‘left shift’ of resources toward prevention and the development community-based resources and assets. Although the outbreak of the COVID-19 pandemic meant that this progressive policy agenda was placed on hold out of necessity as city partners focussed on addressing the acute needs brought about by the crisis, the pandemic also provided an opportunity for the LNNs to demonstrate their value by being part of this response at a city and neighbourhood level.

Last updated on hub: 10 December 2020

The multiple conditions guidebook – one year on

Richmond Group of Charities

This report revisits seven of the case studies featured in The Multiple Conditions Guidebook to find out how things are progressing in the year since their original publication. Conversations detailing the impact of Covid-19 on people with multiple conditions, and the practitioners and services supporting them, are set out in this report with case study updates from the Black Country (employment support), British Lung Foundation (peer support groups), Cornwall (self-management), Gateshead (GP health reviews), Luton (specialist exercise trainers), Southwark (social prescribing) and Yorkshire (medication reviews). Across all the case studies revisited the Taskforce heard how: there is fear and anxiety from the increased risk to life from the virus for people with pre-existing health conditions and for some a sense that these health conditions mean their lives are less valuable in the face of Covid-19; the restrictions in place to keep people safe mean that people’s health conditions are, more than ever, affecting their ability to go about their life as normal; the disruption to the health and care services that many rely on to keep well not only causes stress and worry but also a deterioration in people’s health.

Last updated on hub: 10 December 2020

Destitution in the UK 2020

Joseph Rowntree Foundation

This report examines the scale and nature of destitution in the UK, updating similar studies undertaken in 2015 and 2017. It is based on in-depth case studies on destitution in 18 locations, including a user survey of 113 crisis services and in-depth interviews with 70 destitute respondents. The user survey was conducted in autumn 2019, and captured the scale of destitution in the UK before the COVID-19 pandemic hit the UK in early 2020. The qualitative interviews, undertaken in spring 2020, enabled in-depth exploration of the experiences of destitute households during the UK lockdown that started in March 2020. The report estimates that more than a million households were destitute in the UK at some point in 2019, with these households containing 2.4 million people, of whom 550,000 were children. There was a significant increase in the number of destitute households over the two-and-half years between the 2017 and 2019 surveys. There were also signs of a growing intensity of destitution for some, with more households experiencing both multiple deprivation of essentials and a very low income, and more households with zero income or less than £70 a week. Chapters cover: the scale and distribution of destitution in the UK in 2019; the impact of the COVID-19 crisis on UK nationals with experience of destitution; the impact of the COVID-19 crisis on migrants with experience of destitution; and the impact of the COVID-19 crisis on people with ‘complex needs’ with experience of destitution.

Last updated on hub: 10 December 2020

Measuring and mitigating child hunger in the UK

Social Market Foundation

Food insecurity, and particularly child hunger, has been a source of growing social and political concern for the best part of a decade. There are fears that COVID-19, and the economic shutdowns brought in its wake, will make it even worse. This report provides initial findings on the level of food insecurity in the UK, as well as the impact of the pandemic. It is based on a survey of 1,000 parents, the report finds that: levels of child food insecurity in the UK are high – one in four children, 3 million in total, have faced some form of food deprivation in the six months following lockdown; children in families hit worst by the pandemic have suffered most – very low food security is more common and rose significantly for children with parents working in hospitality and leisure, retail and construction, all sectors badly hit by economic shutdown; existing support schemes appear to have made a difference, but have not been adequate to address the problem – reported usage of food banks rose from 8% before the crisis to 11% since, but reported take-up of free school meals went down slightly from 22% to 20%. The study also modelled levels of very low child food security by local authority, producing a national ‘heatmap’. It finds that rates are highest in London, where just under one in five (19%) of children face very low food security, as well as in the South West. In fact, the top three local authorities for estimated child food insecurity are in the East of the capital: Redbridge (25.5%), Tower Hamlets (24.7%) and Newham (23.9%).

Last updated on hub: 10 December 2020

Social distancing in a social therapy environment

Therapeutic Communities: the International Journal of Therapeutic Communities

Purpose: This paper aims to describe the impact of the COVID-19 pandemic on a prison-based therapeutic community (TC). Design/methodology/approach: The paper takes the form of a case study where the authors reflect on their current practice, using the findings of research on social isolation and the overarching TC principles to explore the effect of the pandemic on the TC at HMP Grendon. The authors consider how the residents and staff adjusted to the change as the parameters changed when the social distancing rules were imposed and how they adapted to the prolonged break to therapy. Sections in the paper were written by a resident and an operational member of staff. The authors conclude with their thoughts on how to manage the consequences the lockdown has brought and start to think about what returning to “normality” might mean. Findings: The paper describes the adjustments made by the residents and staff as the UK Government imposed the lockdown. The authors, including a resident and an operational member of staff comment on the psychological and practical impact these adjustments had. The thought is given to the idea of “recovery”, returning to “normality” and how this study can be best managed once restrictions are lifted. Research limitations/implications: At the time of writing, there are no confirmed cases of COVID-19 at HMP Grendon. The measures and commitment from all staff and residents in the prison to keep the prison environment safe may in part account for this. This paper explores the effects of lockdown on the emotional environment in a TC and highlights the consequences that social isolation can have on any individual. To the authors’ knowledge, there is currently no research undertaken on the impact of lockdown/social isolation on a TC. This research would be useful, as the authors postulate from reflections on current practice that the effects of the lockdown will be greater in a social therapy environment. Originality/value: HMP Grendon started in 1962, as this time there have been no significant events that have meant the suspension of therapy for such a sustained period. It is, therefore, important that the impact of such is considered and reflected upon.

Last updated on hub: 09 December 2020

“Act-as-if you are infected and infectious”: what has the global therapeutic community movement learnt from COVID-19?

Therapeutic Communities: the International Journal of Therapeutic Communities

Purpose: The purpose of this paper is twofold: to reflect upon what the global therapeutic community (TC) movement has learnt from coronavirus and to consider how TCs will continue to adapt and evolve in a post-pandemic climate. Design/methodology/approach: This is a viewpoint paper based on the authors’ participation in an international learning event whereby speakers from TCs from around the world spoke about how they adapted their services to overcome adversity. Findings: The findings are usefully thought out as shelter, creativity, reintegration and employment, technology and roots. Based on the material discussed in the learning event, it would seem that the global TC movement has engaged in a process of looking to the past to move forward by drawing upon founding principles and prescriptions of the TC tradition, rooted in humanistic and indeed humanitarian responses to staff, client and sociocultural needs. Originality/value: According to the author, this paper is one of the first attempts to capture how TCs from across the globe have responded to the threat of coronavirus.

Last updated on hub: 09 December 2020

Safeguarding adults practice and remote working in the COVID-19 era: challenges and opportunities

Journal of Adult Protection

Purpose: This exploratory paper aims to examine the literature on the impact of COVID-19 on safeguarding adults practice. Design/methodology/approach: A literature search was carried out in recently published articles to locate literature relating to COVID-19 and safeguarding adults in the UK and internationally. This included policy guidance and law, to describe the existing knowledge base, gaps in practice and areas that may require further research. Findings: The findings suggest that measures to curb the spread of the COVID-19 pandemic gave rise to remote working and virtual safeguarding practice. The findings highlight the need for empirical research into the impact of virtual safeguarding adults assessments and effective ways to support the needs and outcomes of those who may be at risk of or experiencing abuse and neglect while shielding, socially isolating or when working in an environment where social distancing is required. Research limitations/implications: The paper is based on a review and analysis of published documents and not on other types of research. Originality/value: Little is known about effective safeguarding adults practice in the era of shielding, self-isolation, social distancing and remote working. The paper adds to the body of knowledge in the field.

Last updated on hub: 09 December 2020