|
| Theme | Issues reported | Examples |
|
| (1) Increasing visibility and support for the sector |
| (i) Lack of public recognition for adult social care workers compared to colleagues working in the NHS
(ii) Huge sacrifices being made by individuals in order to keep colleagues and residents safe with little or no recognition and/or support (e.g., pay rise and incentives.) | “I think it has been really, really difficult for a lot of our carers (…) because quite often they’re short staffed and so they’re having to work harder and they’re exhausted and they’re picking up extra shifts and I think it’d be nice for them to have a little bit more recognition than they get.” (RM1)
“I think a lot of the focus has been on the NHS, but I really do think they should be definitely expanding that” (RM1)
“We made ID cards for every single staff member that worked within the service to allow them access for priority shopping. One of our staff was refused entry to waitrose because he worked in a care home and not for the NHS” (RM2)
“We don’t get paid enough for what we do. And the government has just put a pay-freeze on care workers for the next three years. That’s nice isn’t it?” (RW1) |
|
| (2) Impact of negative messaging about the sector |
| | (i) Concerns that there is not enough positive publicity about the sector and that the main image of care home is uncontrolled outbreaks | “(What) would be good to come out of this, is some kind of positive messaging that we as care providers, did the best we could with the resources that we had” (RM2) |
|
| (3) Feelings of isolation |
| | (i) Feelings of isolation and lack of moral support from other health and care colleagues/bodies
(ii) Domiciliary care staff predominantly working alone, and in general, only engaging with colleagues online | “I remember my clinical lead saying to me, just after one of our registered nurses died, “everybody says that we’re all in this together but not one of them [in the CCG] has set foot in this building”“(RM 2)
“I think for the managers, erm, it would nice if they had that phone call from the CQC or social services or just, you know someone to let them know that actually ... they do a really good job. “ (DM1)
“Since COVID it almost seems like I’ve been isolated, in a way”(DW1) |
|
| (4) Accessibility and usability of guidance |
| Dissemination | (i) Guidance often released on a Friday afternoon, with an expectation for implementation by the following Monday(ii) Guidance released by several different organisations, and uploaded to several different sites | “Sending out the same document from ten different sources does more harm than good” (RM2)
“It’s a bit like now the lateral quick testing they give it all out, say “start using it on Monday” but don’t give you the information until Friday and then suddenly we’re all meant to have done the training and able to support this” (RM4) |
|
| Format | (i) Guidance was very lengthy and wordy and managers often had to create flow charts, diagrams, posters, and videos to communicate guidance effectively to staff and those receiving care | “If there was a set time or a day that you knew it would come out and not on Friday at ten to five (…) it would be fantastic” (DM1) |
|
| Suitability | (i) Guidance is difficult and laborious to implement (ii) Lack of specific guidance for domiciliary care | “If you read the guidance around the use of masks it’s like 20 pages long, but actually you can make it look cool but give the same message in a page, a page sized poster and that was, that’s what I mean about accessibility. “(RM2)
“Everything they send out, I read it from the beginning to the end, I print it off, and I put it in the COVID file. And then more stuff will come through, so you read it. And you can’t retain all that information, so I think sometimes it’d be really good if they picked up on the key points” (RM5)
“I know it’s got to be done [lateral flow test], but i don’t think they’ve thought about it properly, you know. (...) the recording of the testing is just a nightmare” (RM5)
“I think the care homes have had a lot of guidance, a lot more, sort of structure. Yeah we’re just sort of finding it out as we’re going along (...) any policies coming out [for care homes] we could readapt [to homecare]” (DM1) |
|
| (5) Social care staff as agents in producing and sharing good practice |
| | (i) Many examples of staff creating and using flow charts, posters, and videos to help colleagues, residents, clients, and family members understand and follow guidance | “[The office team put a video together for staff] so at least they could have a visual of what was expected in the reality of actually going to someone’s house, getting out of your car. Wiping down keys, little things that would go alongside that PPE” (DM1)
“Other ones have, like, done it with pictures, so they’ve, like, sent pictures of how to do it. And they’ve just done lots of “easy reads” really, for people to access things, so I think that’s really helped.” (DW1)
“[We made] this flow charge process, erm, and it’s across two organisations so it’s exactly the same in every service and it is basically if you receive a positive result you do this, you do that, you call PHE, you call your regional manager, you write your letter, you send it to all of your relatives, you let all of your residents know and you tell all the other staff.”“(RM2) |
|
| (6) Managing expectations and the impact of conflicting messages in media |
| | (i) Families can have expectations that are not consistent with guidance, often due to conflicting information from the news and social media | “The reason that we didn’t watch the news was because the guidance that was going out to members of the public and guidance that was specific to us working like in care homes were two completely different things.”(RM2)
“It’s trying to manage the staff, the members and the families” expectations that when they hear the news, you’re constantly having to say to them “yes I know they’re saying that but it’s not happening” and I’ve felt that we’ve had to do this all the way through” (RM4)
“During various stages people hearing different things from newspapers, news articles, online from this source, etcetera, erm, meaning that they question (…) the guidance we officially have” (RM3) |
|
| (7) Improving communication with hospitals |
| | (i) Information on testing and isolation provided by hospital staff to residents and families was inconsistent with social care guidance
(ii) Unclear responsibilities in liaising with other services (e.g. ambulance services) | “My second outbreak in October was one of my members being discharged from hospital untested and came back here with COVID” (RM4)
“The manager at the ambulance service rang me and shouted at me because the ward had booked the transport, but the ward had failed to tell the ambulance crew that it was cancelled, so the ambulance crew then ring me and shout at me for booking an ambulance for someone who wasn’t going to be returning home” (RM2) |
|
| (8) Problems early on in the pandemic |
| | (i) Difficulty getting guidance or advice on infection control limited supply of PPE
(ii) Limited or no testing in place
(iii) Track and trace not working/delays | “At the time PHE were like, well you do what you think’s best, like if it’s safe then that’s fine, if it’s not, then we don’t know what to tell you, so I ended up having a couple of very strongly, strongly worded conversations with some discharge coordinators” (RM2)
“(At the beginning of the pandemic) I couldn’t get the visor, it just took forever to come, um, I think I waited something like eight weeks for it, or maybe even longer” (DW2)
“(At the beginning) it was really hard to ... you know, all our suppliers you’d go to and there would be backlogs, gloves weren’t coming through. We didn’t have the PPE either (DM1)”
“(Up to May, I would call PHE on a daily basis about testing) I wasn’t signposted for any support” (RM4) |
|
