Phase 2: Continuity and endurance

Summary

The 20 stories in phase 2 of the project were collected in the autumn of 2020. Prior to this period and since the first stories were collected, the regulations had been relaxed over summer – some people had experienced more freedom, and infection rates had reduced. In late autumn, it was clear that infection rates were rapidly rising and different parts of Scotland were experiencing varying levels of restrictions according to local circumstances. For this second phase, storytellers were asked what was helping to keep a focus on what mattered to people during the pandemic and whether any changes were slipping back to old ways of doing things.

At this stage, there was a sense that to a significant extent, key systems and processes were in place with regard to technology and access to PPE, although still were by no means universally available. While in limited organisations there had been some more face-to-face contact with people using services and to a lesser extent, carers during this time, many people were still socially isolating and a large proportion of services were still operating online. Because of the continued limitations on direct contact, concerns were increasing about reaching those who remained out of contact, and the psychological impact of increasing infection and death rates was resulting in heightened emotions in staff.

This section provides a summary of how early changes were continuing as described in these later stories. It also provides an update on key themes and priorities identified in phase 1 including technology, working together and emotional impact.

Continuity and endurance in services

A sense of endurance

Stories from this phase include the impact on services and how they are affected in different ways. By this stage, there was also a sense of adjusting to an understanding of the pandemic as a longer-term presence (John, Donna). Some services were experiencing increased demand after the first lockdown was lifted and with it, pressure to develop new ways of working to meet this demand (Maggie). In some areas, demand for support had increased ‘as services have returned to normal’ and staff ‘adapt to new ways of working’. However, with this came a concern about balancing core work with staff needs in the face of a second wave (Catherine).

In terms of priorities and key concerns, these remained similar to those in phase 1: poverty, rights, relationships (Maggie); and social isolation for supported people (Katy, Alison) and staff (Sally):

The common humanity underlying relationships and connection of the earlier stories is still prominent:

People have responded positively to the shared experience approach and this helps diffuse some of the anxiety that we have all had to bear for the last seven months.
Sandy

Transcript for Catherine: What we’re seeing is more staff distress

Technology

During this second phase, some services were blending remote ways of keeping in touch with people, with limited face-to-face contact (Joanna and James, Catherine, Maggie). All services continued to use technology to stay in touch and what remained the same in the phase 2 stories was recognising both the benefits and limitations of using technology. The benefits of increased accessibility continued to be built on, but the risks of inequalities and how to engage those being left behind were persistent concerns.

With few exceptions most of our storytellers were still engaging with their colleagues online and while there was an appreciation of being able to stay in contact, there is a pervasive sense that many are starting to ‘miss being part of a team with a physical location’ (Sandy) and finding it ‘challenging and exhausting being online all the time’ (Donna). There was also an increasing concern that for some people with the most complex needs, the online environment was not good enough:

But it is not satisfactory to us because a lot is lost in translation
Catherine

Transcript for Catherine: There’s a huge assumption that people have the technology required

Priority outcomes for people

Essentials for staying safe and healthy

There was increasing concern to ensure that people’s basic needs were met so they could stay safe and wellgiven many were still socially isolating and receiving services online.

In some settings, internet technology was a key enabler, facilitating communication for self-management (James and Joanna). There were, however, concerns about people not connecting with the relevant services until their health conditions had significantly deteriorated (Hilda, Catherine). Early anxieties about poverty were amplified in the later stories. Food poverty (Donna, Alison), fuel poverty (Alexandra) and managing through the winter (Wilma, Paula) were key concerns:

I feel like we’re returning to a less hopeful situation (compared to the start of the pandemic) where job insecurity, inequality and division between people are all on the rise
Paula

In addition, there were concerns that while food banks played an important role, that quality, variety and freshness of food (Donna, Maggie) needed to be attended to:

I see people needing this support weekly and not just an occasional delivery in a crisis. I would like to see more shopping vouchers to give people fresh ingredients to cook with or a small local shop for cheap fresh items as the food bank items are all non-perishables Maggie

While by this time there had been a concerted effort in the care home sector to reduce the infection and death rates, this had come at a price of family contact, with many family members having had limited or no opportunity to visit relatives in care homes, in many cases at the end of care home residents’ lives. Sally described a project where wooden doves and butterflies were sent out to people to decorate and send on to loved ones who would have previously attended the hospice day services. She extended the project to care homes she was supporting:

We have shared this work with our Care Home community, who have adapted the [wooden doves] project to connect residents and families in their own settings
Sally

Concerns about carers were increasing, with so many usual services for supported people being closed for the duration, with limited options for short breaks or respite. Denise, who has MS described the impact of her mother moving in for a second period at this stage:

I was finding looking after mum intense and when she is here, I get little time to myself and because all the family are busy, I have been missing their full attention and help with mum, that full lockdown afforded. My own symptoms have been getting worse
Denise

In this case, Denise was able to negotiate her mother moving back to stay with her sister in London, with immediate improvement in Denise’s own symptoms:

I have learned quite forcibly that the connection between mind and body is stronger than I had understood before
Denise

Accessing and listening to the voices of people

Now that the initial crisis response was over, there was a concern to find ways to engage with people to find out what matters in enduring the longer-term impacts of the pandemic. There was reference to gathering and acting on feedback from patients (James and Joanna) and stories from those accessing support to focus on what matters to people (Julie, Hilda, Alexandra, Sally, Alison), including school pupils (Wilma). A focus on being informed by lived experience remained a priority (Keir, Hilda, Will), with linked impacts on staff wellbeing.

The calls we are making now offer a really person-centred approach, are based on paying attention to what people have told us so far
Katy

Being able to do something tangible, to hear people feeling better and sharing how more able they feel to cope, keeps us grounded and positive that we can come through this
Hilda

Another example of the impact of the second wave of COVID is in the primary school, where children were described as having enjoyed being back in the school and having developed a stronger attachment to the school as the main location for mixing with peers.

I think the children feel they have more of a voice than before… They decided they wanted something to replace Halloween…It’s like that Hygge they have in Scandinavia, except we are calling it a Coorie-in week
Wilma

In supporting people working in the community in an impoverished part of Glasgow, work by the Violence Reduction Unit sought to ensure that the support was informed through first conducting focus groups:

In working in] one local community in Glasgow that faces many challenges (eg poverty, organised crime, violence and an elevated need for food banks). The purpose of these focus groups was to invite people to tell us what they needed and have open conversations about what effective support in the recovery from the effects of COVID-19 would look like for them
John and Kirsty

Transcript for Wilma: Can the school support our social life?

Transcript for Wilma: We all walk through that door with the same risk

Mental health and wellbeing

From an early stage, and particularly following the immediate crisis there was a burgeoning of online courses, resources and associated materials to support mental health and wellbeing, resilience and recovery in response to the impact of COVID-19. Many of these resources were designed to support behaviour change, self-management, and the development of individual self-care.

For Catherine, supporting people with alcohol addiction was ‘busier than before’ due to the impact of lockdown on isolation and loss of family support. New drinking problems were emerging for people using alcohol as a coping strategy.

Again, storytellers reflect that virtual communication is no substitute for face-to-face:

Text and phone calls / video calls are great for keeping in touch but the most powerful support and most difficult conversations I have had have been face-to-face in people’s closes, gardens, swing park, car park
Maggie

What seems to be clearer in the later stories is knowing that no-size-fits-all when it comes to communication (Sandy) and how vital it is to offer flexible options to keep people connected, particularly for those experiencing crisis and severe threats to wellbeing (Catherine, Will, Sally).

Working together

Teams

The importance of team cohesion remains a priority for staff in being able tostay wellduring this period (Hilda, Sally) and close working with colleagues continued be a source of pride(Joanna and James, Alexandra)

For ourselves we were always a cohesive team and we are now more so. We have supported each other through work and home related struggles so we are stronger in facing what might come next. There is a resilience there
Catherine

Wider support within and between organisations

The importance of organisational culture and clear and careful communications between managers and staff within organisations was still emphasised (Wilma). There was also recognition of organisations modelling an outcomes approach with their staff, demonstrating permission to be vulnerable (Maggie) and ‘walking the talk’ bylistening to and responding to staff concerns (Julie).

…staff are highly motivated due to the great support we received from management. This, in turn, has led to everyone seeking creative solutions to ensuring young people get the services they need right now.
Paula

There was also evidence of continuation in improved communication and strengthened relationships between organisations (Katy). A sense of ‘camaraderie’ was identified in feedback to one programme which brought together organisations within one locality (John and Kirsty). The sharing of regular updates from local and national government remained important to sustaining a collective understanding of levels of risk and current regulations (Sandy, Don).

Transcript for Don: It’s connected up all these organisations who must feel isolated

Persistent barriers linked to funding processes

In this phase, a return to competitive tendering and its associated impacts on insecurity and uncertainty for affected organisations was very evident. A couple of our original storytellers communicated regret that they could not contribute a second story at this stage because all efforts were being invested in tendering exercises which could determine their survival. The implications of competitive tendering were highlighted:

..the silo mentality is still very much entrenched, and maintained by the ongoing competition for resources/funding. Funding streams need to acknowledge their role in creating this division in the community and address this attitude
Alexandra

We worked very closely with voluntary sector organisations during the first stage of the pandemic. With the funding situation being uncertain for many, that has changed a bit, but we want to keep those links going where we can
Wilma

Emotional impact on staff

Continuation of pride and feeling valued

The stories gathered in the autumn reflect a continuation of some of the same positive feelings of pride, confidence and achievement, particularly around the adaptation and use of technology and working together. There is still at least some sense of hopefulness in the stories, with most people finding that some of the more positive working conditions and team cohesion associated with staff wellbeing have endured.

Emotional toll

On the other hand, as many people’s lives had narrowed, in that their direct social contact, opportunities for travel and attendance at events of all kinds remain limited, there was also a pervasive sense of ‘groundhog day’, with the days and weeks rolling into each other. Further, the emotional toll is more apparent in the later stories with a strong sense of fatigue, of focus slipping (Muriel) and of ‘continuing to be on the hamster wheel’ (Julie).

The adrenaline of the early crisis had given way to exhaustion, and this was apparent in different contexts, including in the hospital where the harsh reality of loss of life was evident:

I would say that everyone still feels fragmented and burnt out…There is a collective denial going on. The numbers are awful and deaths are increasing but it is hard to take it in and people are detached… It is such unknown territory. There is a continuing state of confusion and uncertainty
Catherine

In the school context, the anticipation of children and staff being re-confined to their homes raised concerns, even though accepted as necessary:

You are constantly adapting to the latest circumstances of the pandemic… it can feel a bit like climbing a Munro at times. You are trying to see what is coming round the next bend
Wilma

The latter two examples were from managers. A further issue collectively identified by several managers in the project was the challenge of juggling and re-juggling the needs of different groups of staff, people using services and their families. Some referenced the need to attend to the changing needs of their own families (Catherine, Wilma, Don, Hilda).

Emotions were closer to the surface. Storytellers described colleagues crying in team meetings (Julie), crying with people who use services (Maggie), and the recognition that ‘allowing vulnerabilities to be shared is crucial’ (Catherine). Perhaps because of the continued emotional toll of the pandemic, there was more emphasis on the importance of self-care in the later stories (Maggie, Donna, John) as a way to avoid being ‘sucked into a black hole of burnout’ (Alexandra).

Transcript for Catherine: Every now and again you feel overwhelmed