COVID-19 resources

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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

Leave no-one behind: action for an age-friendly recovery

Older People's Commissioner for Wales

Drawing on evidence from 16 engagement sessions held with older people and those who work with and support them across Wales, this report considers what, in the wake of Covid-19, an age-friendly recovery may look like, setting out both short- and longer-term actions. The Covid-19 crisis has laid bare the systemic inequalities and discrimination that exist – especially the disproportionate impact that the pandemic has had on particular groups, such as people from BAME communities. It has also revealed the ageism that exists in societies and the devastating consequences that can flow from this. The report explores the aspects and implications of an age-friendly recovery in relation to: social care and health services in Wales; the economy and older people; stopping the abuse of older people; strengthening communities; and improving communication and inclusion. With specific reference to social care and health service, the long-term actions identified in this report include: establish a major healthy ageing programme focused on supporting older people and helping people to age well; expedite work to reform social care funding and ensure long-term investment in the social care sector; improve engagement with older people in the development of services; appoint a Chief Social Care Officer in the Welsh Government to act as the head of the profession in Wales; and conduct a review of spending on social care to determine whether the allocation of social care resources is age discriminatory, and take action on the findings.

Last updated on hub: 08 September 2020

Digital innovation in adult social care: how we've been supporting communities during COVID-19

This report is intended to share learning and offer practical considerations for councils, their partners and national bodies on how best to support greater digital innovation and adoption across the adult social care sector. It draws on engagement with councils both before and during the adult social care COVID-19 initial response. It looks at what local authorities have done to support the use of technology for connection, wellbeing and bringing communities closer together; it assesses what we have learned about the factors which lead to successful digital; and considers what next if we want to keep up the momentum and sustain new learning, approaches and ways of working. Findings are grouped into the following four themes, although these are not mutually exclusive and are enablers of each other: promoting wellbeing and independence; flexible and enabled working; digital for everyone; and working together with partners. The report finds that local authorities made greater use of technology to help people of all ages and in all settings get connected and stay connected, independent and well; they adopted digital technology to keep vital services up and collaborated with others to adopt digital technology at pace and scale. Key lessons and messages include: simple technologies can help people with daily activities and reduce isolation; digital transformation requires strong leadership and a culture shift; it’s not just about the kit, but about enabling outcomes for people and communities; and sustainable and meaningful change needs strong partnerships and commitment. To sustain the momentum, the report recommends using technology preventatively to support self-management; investing in people to achieve digital change and transformation; investing in local and co-produced digital approaches; and investing in digital to support longer-term adult social care reform which is coproduced with key stakeholders and communities.

Last updated on hub: 07 September 2020

The rapid learning initiative into the transmission of COVID-19 into and within care homes in Northern Ireland

Northern Ireland. Department of Health

This report provides the findings of the Rapid Learning Initiative with regards to the transmission of Covid-19 into and within care homes during the first surge of the pandemic, and makes recommendations on the way forward prior to further potential surges of infection. It details the findings of each of the four sub-groups, which considered: the experience of residents, families and staff; symptom monitoring, interventions and testing; infection prevention and control; and physical distancing, reduced footfall and restricted visiting. The initiative identified three overarching structures and processes that will need to be established to support the delivery of outcomes and bring about a learning system that works across Heath and Social Care (HSCNI), including the independent sector and Trusts: at strategic level, the collaborative partnerships established for the purposes of the Initiative should continue and develop further to support future development of Strategy and Policy; a regional learning system should be developed and include key quality indicators for Care Homes (led by frontline staff) using real-time data that can for continuous improvement; and a quality improvement learning system should include building the capability and capacity within Care Home staff to use continuous improvement methodologies to implement operational improvement as a system.

Last updated on hub: 07 September 2020