COVID-19 resources

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COVID-19: what people are telling us: a summary, April-June 2020

Healthwatch England

This report provides NHS and social care leaders with a summary of key issues the public faced because of the COVID-19 pandemic, and how this affected their experiences using health and social care. The feedback covers primary care; secondary and urgent care; mental health services; social care; and community and other services – including patient transport, equipment services and charitable or voluntary services such as the National NHS Responder Scheme. This report covers the period April–June 2020 and is informed by 19,717 people’s experiences of care. In relation to social care, people raised concerns about access to testing and PPE in care home settings, as well as for home care workers and informal carers. People’s feedback highlighted that while family and friends were unable to visit their loved ones in care homes, timely and regular communication from care home staff really mattered – especially surrounding discussions about advance care planning or if the resident was approaching the end of their life. In addition, families and carers have faced huge challenges due to the closure of respite and day centre services during this time. The report finds that factors such as loneliness and social isolation, bereavement, employment and financial stress, and anxiety about both COVID-19 and other health conditions have all had a negative impact. There has been an increase in positive experiences of urgent and emergency care services – with the amount of positive feedback increasing to 45%, compared to 36% last quarter. Only 22% of respondents reported positive experience of social care services while 46% said they had a negative experience.

Last updated on hub: 10 September 2020

The Health Foundation COVID-19 survey: second poll: a report of survey findings

The Health Foundation

This new polling data looks at the public’s attitudes towards the Government’s handling of COVID-19 and the measures it has taken to tackle the outbreak so far. The data shows a significant change in the public’s perceptions on these issues since May this year, when the first round of this polling by Ipsos MORI was carried out. The public are more critical of the Government’s handling of the coronavirus outbreak. A majority (56%) now believe that the Government has not handled it well, significantly more than in May (39%). The survey shows that the clarity of the Government’s current official guidance varies. Nearly four in five think the guidance on wearing face masks on public transport is clear (78%), but less than half (44%) think official advice on who and how many people you can meet is clear (54% think it is unclear). The survey also shows that overall public confidence in using NHS services is returning, with around three-quarters (77%) of people reporting they would be comfortable using a hospital – a significant increase from 52% in May. However, concerns about using hospitals is greater among some of the groups worst affected by COVID-19, with more than one in four (28%) people from black and minority ethnic backgrounds and more than a third (34%) of people with a disability saying they would feel uncomfortable about using their local hospital, compared with just over one in five overall (22%). The majority of the public (77%) would support a social care visa for people living in the EU to come to the UK to start working in social care.

Last updated on hub: 10 September 2020

Making evidence and policy in public health emergencies: lessons from COVID-19 for adaptive evidence-making and intervention

Evidence and Policy

Background: In public health emergencies, evidence, intervention, decisions and translation proceed simultaneously, in greatly compressed timeframes, with knowledge and advice constantly in flux. Idealised approaches to evidence-based policy and practice are ill equipped to deal with the uncertainties arising in evolving situations of need. Key points for discussion: There is much to learn from rapid assessment and outbreak science approaches. These emphasise methodological pluralism, adaptive knowledge generation, intervention pragmatism, and an understanding of health and intervention as situated in their practices of implementation. The unprecedented challenges of novel viral outbreaks like COVID-19 do not simply require us to speed up existing evidence-based approaches, but necessitate new ways of thinking about how a more emergent and adaptive evidence-making might be done. The COVID-19 pandemic requires us to appraise critically what constitutes ‘evidence-enough’ for iterative rapid decisions in-the-now. There are important lessons for how evidence and intervention co-emerge in social practices, and for how evidence-making and intervening proceeds through dialogue incorporating multiple forms of evidence and expertise. Conclusions and implications: Rather than treating adaptive evidence-making and decision making as a break from the routine, we argue that this should be a defining feature of an ‘evidence-making intervention’ approach to health.

Last updated on hub: 09 September 2020

To what extent does evidence support decision making during infectious disease outbreaks? A scoping literature review

Evidence and Policy

Background: Infectious disease outbreaks require decision makers to make rapid decisions under time pressure and situations of scientific uncertainty, and yet the role of evidence usage in these contexts is poorly understood. Aims and objectives: To define and contextualise the role of scientific evidence in the governance of infectious disease outbreaks and to identify recommendations for overcoming common barriers to evidence-informed decision making. Methods: A scoping review and an expert workshop to provide additional input into recommendations on enhancing evidence uptake during infectious disease outbreaks taking place in European settings. Findings: Forty-nine records reporting on multiple decision-making processes during infectious disease outbreaks of the past ten years were included in the study. Decision makers prioritise expert advice, epidemiological data and mathematical modelling data for risk characterisation and management, but tend to be challenged by scientific uncertainties, which allow for conflicting interpretations of evidence and for public criticism and contestation of decision-making processes. There are concrete opportunities for optimising evidence usage to improve public health policy and practice through investment in decision-making competencies, relationship building, and promoting transparent decision-making processes. Discussion and conclusions: It is not necessarily a disregard of evidence that puts a strain on decision making in health crises, but rather competing interests and the lack of clear, unambiguous and rapidly available evidence for risk characterisation and effectiveness of response measures. The relationship between science and public health decision making is relatively understudied but is deserving of greater attention, so as to ensure that the pursuit of evidence for decision making does not challenge timely and effective crisis management.

Last updated on hub: 09 September 2020

Visits to care homes: guidance for providers

Welsh Government

This guidance provides advice for care home providers on facilitating outdoor visits; indoor visits when the level of COVID-19 at a local or national level allows; indoor visits in exceptional circumstances including end of life; and people going out into the community and visiting family and friends. The guidance sets out an ethical framework to support people living and staying in care homes to reconnect safely with families, friends and professionals, consistent with the requirements of the wider coronavirus restrictions. The ultimate decision on whether, and in what circumstances care home visits take place rests with the individual provider, and some providers will find it more challenging to facilitate visits than others. However, this guidance is intended to support providers to enable visits to take place, and providers are expected and encouraged to facilitate visits wherever possible. [First published:25 June 2020; Last updated:10 November 2020]

Last updated on hub: 08 September 2020

Wellcome Monitor 2020: Covid-19 study

National Centre for Social Research

This report presents the results of the fifth Wellcome Monitor study. It looks at findings around the British public’s experience of the Covid-19 pandemic and their views on health information during lockdown. Findings are based on a survey of 2,651 people across England, Wales and Scotland, carried out between 29 March and 26 April 2020. Topics include: people’s experiences of the coronavirus pandemic and lockdown restrictions; trust in different sources of information, including scientists and government; the clarity of information on staying safe and minimising risk; the perceived effectiveness and uptake of prevention measures. The analysis finds that the levels of concern about the effects of the coronavirus epidemic were not evenly distributed across the population. People finding it more difficult financially and people from BAME groups were more likely to be very concerned about the impacts of coronavirus on both their physical health (particularly Black and Asian people and key workers) and mental health, as well as on their personal finances and the education of their children (these latter two especially so among the Black population). Most people reported receiving clear information on what to do to minimise their risk of catching or spreading coronavirus. The majority also trusted the information they received from health-sector sources and, to a lesser extent, government sources. Overall, this report suggests the BAME population and those finding it difficult financially were not just more concerned about the effects of the pandemic and finding the restrictions more difficult to follow. They were also less likely to receive information about staying safe from coronavirus that they find clear or that they trust.

Last updated on hub: 08 September 2020

What now for social care?

ARK

This brief paper paints a picture of social care systems and the workforce struggling to cope under significant pressure as a result of the COVID 19 pandemic. It argues that many of the now highly visible problems relating to social care are not new; the pandemic has just brought to public attention serious problems resulting from years of under-funding and political neglect. Even in Northern Ireland where health and social care provision has been structurally integrated since 1973, a clear fault line exists between universal health services and means tested social care. There are inequities driven by how services are funded, how needs are assessed, how individual contributions are assessed, the fragmentation of the provider market and variation in care standards and quality. The paper focuses specifically on the fragmented provision and variable standards; the social care workforce; and the integration of health and social care in Northern Ireland. It observes that the experience of NI has shown clearly that structural integration does not in itself lead to parity between health and social services. That can only be achieved by reform of the funding and delivery of social care.

Last updated on hub: 08 September 2020

Decision making in a crisis: first responses to the coronavirus pandemic

Institute for Government

This report examines the government’s initial response to the Covid-19 crisis, including the implications for the social care sector and workforce, and the decisions made in three areas: economic support, Covid-19 testing and the lockdown. It suggests that the response was hampered by the absence of a long-term strategy, lack of clarity about who was responsible for what and its poor use of evidence. The report also identifies how: the government needed to be clearer about the role of science advice and its limitations, particularly in the early stages of the crisis when it looked to its scientists to generate policy, not just advise on it; government decisions were influenced too much by concerns over NHS capacity rather than by controlling the spread of the virus; senior officials distanced themselves from the decision to reach 100,000 tests a day, and it was unclear who was responsible for different aspects of the testing regime, which made it difficult to assign responsibility for remedying gaps and failures; the government did not think about some of the most important aspects of how it would implement its policies until after it had announced them, leaving many public services, in particular schools and the police, playing catch up.

Last updated on hub: 08 September 2020

Deprivation of Liberty Safeguards: annual monitoring report for health and social care 2018-19

Care Inspectorate Wales

This is the annual monitoring report of Care Inspectorate Wales and Healthcare Inspectorate Wales on the implementation of Deprivation of Liberty Safeguards (DoLS) in Wales. The findings show that the total volume of applications received by local authorities increased by 6% in 2018-19 - however, for health boards, the number of applications has remained relatively stable for the last two years; roughly three quarters of applications sent to health boards are for urgent authorisations; the majority of DoLS applications are for individuals who are aged 65 or older; the vast majority of the applications that were refused were on the grounds of mental capacity – the authoriser required further evidence that the person lacked the mental capacity to make the decision in question before the DoLS application was accepted; most standard applications were not completed in 28 days – supervisory bodies are unable to assure themselves that people’s human rights are not being breached by being deprived of their liberty unlawfully; very few people were referred to Independent Mental Capacity Advocates (IMCAs) or referred to the Court of Protection.

Last updated on hub: 08 September 2020

What does the impact of Covid in social care mean for the NHS? 5 questions, 10 actions

iMPOWER

Based on findings from interviews with directors of adult social services, this paper focuses on five critical areas that will set the direction for social care to bounce forward from the Covid-19 crisis. These are: structural integration and a national funding solution; the right balance between acute hospitals and local communities; re-shaping the provider market; developing enabled, embedded, multidisciplinary work across pathways; and a paradigm shift in the value and importance of social care. The paper identifies ten actions, setting out practical steps that support going beyond recovery through winter and into next year – to drive an inclusive vision for health and care systems. These include: assure the adult social care financial position is accurate in system models before the end of summer and reviewed through autumn; ensure there is dedicated agenda time on key pressures for local government; identify named neighbourhood change leads and encourage them to collate and share barriers to delivery; invest time in understanding the true baseline for local people plans; support health and care colleagues to undertake case reviews so that the Covid-related change to demand is evidenced; ensure VCS representatives are present at discussions on the design of new models of care; work with public health colleagues to ensure delivery is based on behavioural science; set clear joint expectations of how colleagues will work and make decisions at an ICS level; understand what is working, and what could work even better by having a named evidence lead; and build a bottom-up change plan, not a top-down one. These actions sit under a broader checklist, included in this paper, to assess how well systems are partnering at the moment.

Last updated on hub: 08 September 2020