Phase 3: Looking to the future and recovery

Summary

In this final section we draw on the third and final phase of the stories project. At the end of 2020, we recorded interviews with eight of our storytellers. We invited individuals from diverse sectors (health, social work, third sector, education) and roles (staff involved in direct support, team leaders and senior managers) to contribute. We asked them to reflect on key messages from their earlier stories, learning and hopes for the future. Then, early in 2021 we hosted a workshop for PON members – 30 attended and contributed to this resource and added some of their own experiences of the pandemic, which are also included here. This section combines stories from phase 3 and findings from the wider project with suggestions about what needs to be built on and the importance of a trauma informed response to recovery.

On reflection, the stories tell us that the pandemic challenged previously fixed ideas of what is possible, as well as assumptions about the capacity and resilience of the workforce and people accessing support. It put a spotlight on existing issues which were thrown into sharp relief and exacerbated by the crisis; particularly social isolation, poverty, inequalities, mental health and the digital divide. There were also disproportionate impacts on people from black and ethnic minority communities, including high numbers working in health and social care. Equally, it highlighted untapped reserves of kindness, common humanity, relationships, trust and extraordinary responses within local communities. What matters to people, captured by personal outcomes, takes on new salience with striking similarities between the outcomes important to supported people, unpaid carers and staff.

Acknowledging mixed experiences

In the introduction we identified that we had sought out examples from practice of where people were managing to keep a focus on outcomes during the pandemic. Although our storytellers identified diverse challenges, they all had some sense of having been able to achieve good outcomes. During our workshop with PON members in February 2021, we shared themes from this resource with a wider group of practitioners and managers, wanting to check whether the messages were more broadly representative. We found that on the whole, the messages resonated and to some extent the positive impacts were amplified, but there were frustrations too. Starting with positives, in the following example a manager reflects on people using services benefiting from a very different approach to their support:

I’ve been amazed how people with learning disabilities have adapted, especially given that some people we work with really like routines and predictability. Staff going out to do home visits since the day centres shut has changed the balance of power. Some people have really enjoyed staff going into their homes to see them. It would be good to keep some of that flexibility when day centres open back up.
PON member, Feb 2021 workshop

This example bucks the trend of removal of home visits for most, to a shift towards home visits being a very welcome adaptation in this case. In another area, staff from one service area had thrived on very new roles in direct support to very young and older people:

I’m interested in how so many preconceived ideas have been overturned over the past year. We have had staff who worked in leisure services being re-trained and moving into support work in children’s homes and care homes. I love the idea that many of their expectations have been challenged and some staff have found the work so rewarding that I’m not sure they will want to go back to their old roles. I don’t want to sound like Pollyanna but there is hope
PON member, Feb 2021 workshop

However, as we had expected, the positive experiences were not universally shared. Some staff had struggled to engage meaningfully with the people they supported, particularly where restricted to online contact only: ‘I really worry about some of the families who we are not hearing from at all’. While the people who contributed stories in phases 1 and 2 had freedom to innovate, respond and be creative, this was not universally experienced. We also heard from people involved with adult and child protection who had found the online experience of the process inadequate and stressful compared to being in the same room.

The importance of feeling valued was a strong theme in phases 1 and 2, and in our workshop it was identified that who was valued during the pandemic did not always feel equal. The need for careful communications around this was evident, with a sense that

social care staff feel less valued, this was also highlighted with reference to different groups within the population of supported people, and the relevant staff:

Our staff are tired, sore and frightened. We went from having few cases to significant numbers later than most areas and that set everyone back. I don’t think people with learning disabilities have been given the same voice as some other groups. At the same time the staff have gone above and beyond but I’m not sure they feel recognised
PON member, Feb 2021 workshop

While the care home sector had been at the forefront of media coverage throughout the pandemic, there was a need to ensure that the focus on managing risk did not result in a regression to care homes as clinical settings rather than people’s homes. There was a need to focus on what matters to residents:

We need to take care because it’s not all been progressive. Some of us have worked hard for a long time to get care homes out of a medical model. That progress has been stripped back and a clinical approach is dominating. We can’t let care homes become mini hospitals and personal outcomes can help with that. I feel so sorry for people in care homes
PON member, Feb 2021 workshop**

We can’t draw conclusions based on stories we didn’t collect, and although there was a positive account of social work practice in the workshop, it was a concern that we struggled to get stories from social workers. Where we did finally reach social work practitioners, they didn’t want to be named. There was a sense that there was less room for creativity and limited room for relational practice in face of crisis interventions.

On balance what emerges from the project is a story of very significant change and of some changes impacting in ways that could not have been anticipated. Storytellers reflected on how this crisis propelled us forward in many ways. There’s a sense that we can’t unlearn what we’ve learned and go back to how things were before. To do so would waste the valuable learning alongside the losses that have come from living through COVID-19.

What practice and approaches need to continue?

Storytellers highlighted the new ways of working, new ideas and approaches seeded in the early days of the pandemic, that allowed outcomes to be achieved for people. In the first phase, the outcomes were determined by a shared sense of the need to keep people safe, well and connected during the initial crisis response. In the second phase, it was clear that increased emphasis was being placed on more personalised outcomes, based on learning from phase 1 and in response to additional efforts to engage directly with people through phase 2. Collectively the stories identify key features that should continue to be nurtured:

• Supporting creativity and flexibility in practice
• Blending use of technology - capitalising on benefits of reaching new audiences while rebuilding face-to-face contact for the many people who prefer and need this
• Meet the challenges of digital exclusion and inequalities
• Flexible working and working from home
• Keep the pace of change - quicker decision making and easier access to funding
• Keep bureaucracy to a minimum
• Build on collaboration and partnership working - at all levels
• Prioritise relationships and trust
• Keep the ‘shared experience approach’ which builds on our common humanity and vulnerabilities
• Organisations modelling an outcomes approach
• Prioritise staff support and wellbeing and put in place mechanisms to assure this
• Be more effective communicators
• Connect Scottish Government with practitioners to reshape performance measures
• More direct access to resources and more autonomy for the Third Sector
• Schools being places where wellbeing and resilience have parity with attainment

Many of the items that feature in this list are echoed in the findings of the Independent Review of Adult Social Care (Scottish Government, 2021). Focusing on personal outcomes; flexibility; collaboration; valuing lived experience; developing trusting relationships; partnerships without competition; and shifting attitudes towards technology and data sharing, are all identified as vital to reimagining models of support.

A shared experience

In Sandy’s story the concept of a ‘shared experience approach’ captures the fact that the barriers between staff and supported people became much lower during the pandemic. The fact that we are all vulnerable and interdependent at various times in our lives became much more apparent; we all faced similar risks, restrictions and responsibilities in the face of a silent and invisible, but powerful threat.

Transcript for Julie: Strength and courage is in being vulnerable

The core personal outcomes captured in our wordcloud were equally relevant to supported people, unpaid carers and staff, albeit to varying extents and at different stages of the crisis.

Collective trauma responsive approach

The stories reflect an understanding of the intensified challenges as identified above that the workforce will be responding to as we move through the crisis; including social isolation, poverty, mental health, social inequalities and the digital divide. Catherine reflected in her interview that the crisis was rekindling previous experiences of distress and trauma for people, and that her team had a role in supporting individuals in working through the feelings this generated. Given the shared sense of threat, crisis, bereavement and loss experienced by the workforce and supported people, there is a need for meaning making, healing and integration of losses into our collective future. Being trauma-informed includes seeing behind behaviours to understand the emotions people might be struggling with, and having this lens was identified as being important in engaging with staff, as well as people using services:

Transcript for Catherine: It’s about being more open minded about how people react to things

A trauma responsive approach offers a way to think about recovery and the need for humanising systems, and supportive and reflective organisational practices. The idea of post-pandemic growth suggested in John’s story (and further explored in this PON webinar) is adapted from the concept of post-traumatic growth or transformation following trauma. This is highlighted by Keir in his work with people whose lives have been affected by suicide:

People touched by suicide want to share their learning in helpful ways to improve the experience and outcomes for others. They want their difficult and often traumatic experiences to make a difference to others. Once they have got through the early and most sometimes most difficult phase after a suicide, being supported to sharing their story can be cathartic and support healing.
Phase 3 interview

We need to acknowledge and build on the positive adaptations within communities, recognise the strengths demonstrated by supported people and practitioners, while responding appropriately to new fragilities. Part of the solution lies in refocusing on personal outcomes and on use of stories.

Reflections on storytelling and recovery

As well as the core aim of finding out about and sharing practice examples during COVID, the importance of stories as a way of connecting and engaging with and finding out what mattered most to people was an additional theme that emerged from this project. The multiple benefits of stories was identified in the following feedback from the workshop:

The interviews and feedback from our workshop in phase 3 confirm the importance of taking the opportunity to pause and reflect, and how this enabled people to clarify purpose and prioritise at different stages of the pandemic. That sense of using difficult experiences to help others was reflected by Keir’s story on the importance of the voice of lived experience but also by staff hopes to make things better for others, now and in the future. At the workshop storytelling was seen as very important for both people being supported and staff. For supported people and unpaid carers the importance of ‘time to let people tell their story in their own way’ was emphasised. For everyone, stories were seen as a way of people being able to be ‘seen, heard and feel connected.’ Several people wanted more support with storytelling skills and techniques, to promote recovery and wellbeing in their own settings. Storytelling has an important contribution to make in achieving outcomes for everyone. There are, in turn, benefits to be gained from the listener or the reader of the stories in others, as one PON member described her response to the story collection:

Reflecting on the stories, what strikes me is the change in energy levels over time. At the start there was so much energy and a collective sense of ‘right, let’s do it’. And it’s different now, especially with the latest shock of this further lockdown since before Christmas, and I think about what we really mean by resilience. I wonder if we now think of it more as about enduring and that we all have to recognise when our reserves are low, and adapt accordingly. That’s how the stories resonate with me
PON member, Feb 2021 workshop

Conclusion: Hopes and learning

Hopes for the future

Storytellers in phase 3 expressed their hopes for the future. These focused on a range of areas, again reflecting the diversity of the perspectives shared through the stories. For example, Wilma, (Transcript) talked about her hopes that teachers become better understood and respected as a result of their role during the pandemic. Don’s hopes, (Transcript) centred around an increased effort to support carers and give them access to the breaks they need. Keir, (Transcript)described a future with a more blended approach of online and face-to-face engagement and Julie, (Transcript) talked about a post-COVID world where barriers and boundaries between people have not been resurrected.

In conclusion, we give the final word to our storytellers who described their key learning from the pandemic, with a selection included below:

I’ve learned that a crisis like this can galvanise change and bring out a flexibility in the way we practice that benefits the families we work with. Barriers have quickly been overcome to achieve positive outcomes and working relationships have been strengthened. I’ve learned that we can be creative about the way we work and want this to continue so that it becomes embedded.
Kate

I have learned that funders, statutory organisations can move quickly and have the resources to commit if they wanted to.
Fatima

Inequalities are deeply entrenched in our society. COVID-19 has brought to the surface what is worst and what is best in our community.
Alexandra

We have learned that people are what actually matters at the end of the day. Paperwork is important, I agree, however this should not be given more recognition or made more important than the delivery of care. The compassion, the way care is delivered and the special relationships that staff develop with the people they care for all need to come first.
Theresa

I’ve learned again that necessity is indeed the mother of invention. I’ve learned that I don’t want to wait for the next global crisis before thinking to myself, I wonder if we could do this differently?
John