Phase 1: Response to crisis

Summary

The stories gathered in the spring and early summer of 2020 took a snapshot of the initial crisis response to the COVID-19 pandemic. Storytellers were asked to highlight how they had kept a focus on what mattered to people at this early stage; what they had to do differently and what made this possible. 39 stories involving 40 people were collected in this phase.

This section outlines the key changes that took place in the early months of the pandemic including changing roles, redesigning services, support to work online and the associated pros and cons of using technology. Ultimately, these changes were required in order to continue to focus on outcomes for people (highlighted in the text). At this stage, there was emphasis on ensuring that people supported by services had access to food, medicines and the essentials required to maintain health and wellbeing. A key concern was how to maintain this provision in ways that were safe to both supported people and staff. An additional concern was how to maintain human contact and avoid isolation. There was also recognition within teams, organisations and communities of the need for interconnection and collaboration within and between agencies, and with the public in order to achieve these key outcomes. The emotional impact on storytellers and those they supported is also explored.

Key changes to systems and processes

Role change

The stories describe the ways in which roles had to change as people responded to the crisis. Some management roles became more operational (Alison), workloads from other roles were picked up (James and Joanna), and some staff were redeployed (June, Lesley). In one case, within the general hospital environment, there was a shift in focus to staff wellbeingand support in preparation for the expected influx of COVID patients (Catherine). To meet increased demand caused by the pandemic there was a focus on recruitment and training (Alice, Iain) and in some cases extending service hours (Mark). For some, the crisis provided an opportunity to try out new approaches to rapidly training staff:

We developed a new face-to-face component of induction ‘Fundamentals of care’ which we had never had the resource to develop and deliver. COVID-19 working provided a golden opportunity to trial this in small groups using social distancing guidance
June

The most prevalent key change commonly described in the stories was moving to remote and home working. Alongside the shift online was a concern to maintain two-way communication in order to keep people informed, and of finding out what mattered to people.

Transcript for Wilma: My role has been so different

Addressing barriers and staying informed

For many, urgent priorities were addressing the ‘extra barriers’ to do with access to technology (Wilma) and information and communication (Lorna). Storytellers described developing tipsheets (Hilda), signposting (Rachael), writing advice and tools to support good conversations (Lorna), and setting up a new national helpline (Hamish) to help meet these challenges. Other priorities included keeping informed about people’s needs through research and consultation (Claire, Donna) and evaluation (Katy), and the importance of being led by lived experience (Keir, Hilda, Will). For others who were not pressured by an immediate need to respond, they were able to take time at the start of the pandemic to see where gaps and needs emerged rather than ‘rush in’ (Anne-Marie).

Rethink, redesign

The pandemic meant quickly accelerating digital plans to keep people connected and the crisis response was characterised by shifting from face to face / in-person support to relying on communication technology, namely the internet and phone. A key feature of this shift was that support had to be redesigned to fit with remote ways of connecting. The stories describe how a range of aspects of service delivery had to be rethought including: engagement and outreach (Keir, Will, Donna); counselling sessions and evaluation (Paula); advice services (Hamish); work programmes (Fatima); and practice learning and assessment for students (Gillian). Policies and procedures to provide a framework for practice also had to be redeveloped and quickly shared (Kate). Personal outcomes were a key driver. For example, the ‘Help the helpers’ programme described in John’s story focused on how to help people (workers and community members) ‘articulate and name their desired outcomes and wishes’. It was noted that the adaptation required to develop new systems and structures brought a lot of extra work and demands (Keir, Donna).

One of the key reasons for switching to online was to facilitate the mass adaptation of people across sectors working from home, which was met with mixed responses from staff.

Transcript for Alison: I lot of what we did changed overnight

Challenging assumptions about technology

The shift online challenged a number of assumptions and fears to do with practitioners' ability to use the technology, what kind of support might still work virtually and how receptive or otherwise those accessing support would be to engaging online. With caveats, most storytellers could see benefits and were at least partly reassured:

Given the emotive nature of our work, digital meetings had not been considered before. COVID required completely changing our approach to engagement… There was fear to start, partly because of my lack of tech skills but also fear about being able to genuinely engage, being able to make eye contact, reading non-verbal communication…
Keir

The fast pace of switching to using technology was in contrast to the traditional slow and steady approach to gradually onboarding staff and those receiving support (Lisa). It meant that some felt ‘thrown in at the deep end’ (Paula) and ‘a bit lost’ (Donna), although for others this shift also slowed time down (John Paul, Paula). Some practitioners were pleasantly surprised, finding that they could not only adapt quickly to the technology but, importantly, engage meaningfully even when dealing with sensitive issues.

This COVID lockdown has actually really boosted my confidence in using different methods to counsel people. Turns out it’s nowhere near as daunting as I thought it would be!
Paula

… I have found it relatively easy to form meaningful connection and trusting relationships online with people on a face-to-face communication over Zoom - when the technology works!
John Paul

We are supporting people who are sharing traumatic experiences. It is not a substitute for face-to-face engagement. But for now key learning is that it is possible to learn and share safely online
Keir

With regard to their own sense of connectedness, most storytellers viewed the switch to online as necessary if not ideal. Technology meant that they didn’t feel isolated (Paula) and it provided a ‘lifeline’ to other colleagues (Children and families worker). While we go on to consider some of the limitations identified with providing services online, practitioners identified many ways in which online access was helping with reaching supported people.

Transcript for Keir: Providing that safe online environment has been absolutely indispensable

Benefits of technology - accessibility and staying connected

A benefit of using technology during this time meant more easily reaching those in rural and remote areas (Claire, John), people with disabilities (John), some carers including young carers (Mark), and increased engagement with patients where there are physical, practical and psychological barriers (Lorna, Joanna and James, Hilda). The role of technology to help address social isolation (Claire) and to support remote learning (Wilma) was more important than ever.

Some storytellers noted better engagement and more confidence from those they supported (Bryony, Mark) and increased interest in virtual group work over face-to-face sessions (Kate). It was also identified that people took more care to take turns in conversations, as speaking over each other was less feasible in a Zoom meeting than it would be sitting round a table (Will). Some stories included examples of where people with lived experience enjoyed the new opportunity to take part in informal social sessions alongside work meetings (Keir, Mark).

The stories described efforts to ensure internet access and equipment was provided for supported people and for staff (Bryony, Mark, Kate, Julie). Media coverage also played an important role in raising awareness of particularly excluded groups and was linked to donations and pro bono legal support.

[Media coverage] has highlighted the significance of digital exclusion… This has resulted in tangible changes taking place quickly such as installation of internet access in refuge accommodation and provision of equipment…
Kate

At this stage, it was identified in one area at least that the deaf community was supported by the interpretation, electronic note taking and other communications support community, who volunteered time, skills and technology to make real-time note-taking and verbal communication accessible and fast (Rachael). This same storyteller appreciated that the implications of mask-wearing for lipreading were widely recognised.

Challenges of technology: inequalities and exclusion

The pandemic put a spotlight on ways in which some groups were further excluded from participation and accessing support because of a lack of hardware, outdated software and/or lack of internet access with concerns about how to address this (Will, Catherine). In the school context, there was concern to find ways of making sure that parents for whom English is a second language were not excluded (Wilma).

Although not a strong theme at this early stage, it was already emerging that for some, engaging online was not working as well as for others (Hilda, Brony):

These are extremely stressful and confusing times for any child, however for Seal’s children who have autism and other social and emotional needs, a change towards a virtual world has been a lot more challenging
Bryony

Although internet technology dominated many of the narratives, the stories also emphasised the importance of using the phone to keep in touch with more isolated groups, including the welfare call service described in Katy’s story and the thousands of wellbeing calls made by the volunteers in Alison’s story. Yet concerns remained about people who had not yet been reached (Catherine, Alice).

Transcript for Wilma: I’m conscious of the digital divide Covid has exposed

Priority outcomes for people

There were variations in the stories about the outcomes practitioners focused on. This prioritisation was partly associated with existing roles and remits of the relevant organisations. It was also largely shaped by a collective sense of what mattered most in a crisis situation. At this early stage, systems were changing to keep up with the unfolding pandemic, practical and emotional impacts were being navigated and staff were being equipped to work remotely. In this context, immediate health and wellbeing were predominant concerns.

We already touched on the need to ensure that people were informed which involved significant efforts for many organisations, and which was necessary to ensure that people were able to understand risk and associated precautions, including use of protective equipment to continue to stay safe during a pandemic. Beyond this, there was a resurfacing of Maslow’s hierarchy of needs in social media, with an understanding that attention needed to be paid to the fundamentals of life, as well as the more relational aspects of staying connected.

Practical support to maintain health and wellbeing

As identified above, a key priority was making sure the essentials of life required to stay healthy were available to those who were socially isolating and/or who were already dependent on services to access food and medicine for example (Alison, Muriel, Alice). In the statutory sector this focus on essentials extended to emergency support issues and ‘base level’ needs such as electricity and gas (local authority social worker), although early concerns about increased poverty was also mentioned. In one service which was set up specifically in response to the pandemic, efforts were made to ensure that practical help for older people – shopping, prescriptions, hearing aid batteries – was offered pro-actively to people who were identified as potentially being in need of support (Katy). In one area, an existing community based project ‘Compassionate Inverclyde’ which is run by volunteers switched from providing ‘back home boxes’ for people going home from hospital to direct provision of nightwear and toiletries to people admitted to hospital (whose relatives couldn’t visit). They also redirected efforts to provide isolation boxes for those people unable to get out and about and to collect prescriptions (Alison).

While most of our stories were from the third sector, we also had examples of NHS provided services re-directing efforts to ensure people were supported to maintain their health through provision of online options alongside essential face-to-face provision (Lorna, Joanna and James). Some of the storytellers identified specific roles with regard to provision of PPE (Anne-Marie).

Keeping a focus on connection

The practical focus on delivering food, medicines and maintenance of utilities to make sure people were able to stay physically well provided points of connection with people. Some practitioners who were delivering these core resources also provided wellbeing parcels or boxes including a variety of contents such as activities, flower seeds and kindness cards for example (Maggie, Alison, Muriel), with others also providing these goods (Alice, Bryony).

Whether the connections with people were made remotely by phone and/or online (Paula, Keir, Sally, Hilda) or a combination of the former with some deliveries or face-to-face meetings (local authority social worker, Alison, Maggie), practitioners always took the opportunity to check in on people and make sure they were well in a wider sense.

The impact of ‘every interaction and conversation’ was more apparent and conversations, a cornerstone of a personal outcomes approach, were prioritised:

Doorstep conversations are now part of my working week and in some ways, they have helped me get to know families better, and conversations have turned to what really matters in the here and now…
Maggie

In the school and higher education settings, the importance of staying connected to support the wellbeing, as well as the continued learning opportunities of pupils and students, were identified as key priorities (John Paul, Wilma, Gillian). This emphasis on keeping connected and mitigating isolation was a broadly identified priority (family support worker 1, Alice, Katy); with some storytellers identifying that they quickly harnessed the opportunities identified by social media (Bryony, Claire, Donna, Hilda).

Denise, an unpaid carer, provided a personal perspective which illustrated how the pandemic and the first lockdown presented a new caring situation for her. She described how her mother usually visited from London for three weeks at most. Because of the crisis, Denise’s mother Betty’s stay was extended to over three months. Although Denise herself has MS and can become fatigued, at this stage the situation was manageable because Denise’s young adult offspring were furloughed and able to share the care.

Relationships in practice and changing boundaries

Relationships were prioritised differently depending on the context practitioners were working in. A local authority social worker felt relational-based work had to be ‘scaled back to ensure financial worries are kept as the priority’ (LA SW) while Theresa, working in a care home, found ‘relationship care has been the priority at this time’, made easier due to the reduced footfall through the home. Some storytellers identified new opportunities to engage with and build relationships with families, as well as the people they usually supported, and that this was facilitated by online engagement in family homes (Bryony) and care homes (Theresa).

Between staff and supported people there was a sense that boundaries had begun to blur between the personal and professional (Maggie, Sandy). In continuing a programme of work on reducing gambling harm, it was noted that the power dynamic between managers and people with lived experience was flattened in online meetings, as suits were no longer worn and clothing differences reduced (Will).

Transcript for Sandy: It’s affected us all

Making a contribution and community connections

Some storytellers identified that people they supported were keen to make a contribution to others in need at this time. The stories praise the response and reciprocity of communities and volunteers in meeting the needs of people through the pandemic (Muriel, Alice, Katy, Theresa). Some community-oriented services were identified as having reached further into ‘communities relatively disconnected until now’ (Alice, Fatima) as a result of the pandemic. There was a sense that skills and confidence had been enhanced in communities, with services users more able to ‘help, contribute and run things for themselves’ (Fatima). There’s also an awareness that communities have changed and ‘part of the job, moving forward, is going to be researching how our community works now’ (Carla).

Community groups and service users have been saying for a long time that grassroots organisations can make a real difference to service delivery and have the ability to respond to seismic problems at a local level. It’s good that the evidence is there to show this
Fatima

Working together

The stories describe the pandemic as a shared experience which changed dynamics and challenged traditional hierarchies within some organisations, as well as reaching across existing boundaries. The stories evidence that for many storytellers, common humanity, kindness and shared vulnerability were put at the forefront of practice at this time.

Teams

There’s a strong narrative across the stories of people working more effectively together in teams to support each other through uncharted territory. Team working was identified as a key enabler of being able to work differently in the COVID landscape. Some storytellers reflected on the irony of improved communication and team relationships at a time of social isolation and remote working, perhaps speaking to previous assumptions about virtual communication. They describe ‘solidarity’ between colleagues as ‘the most pivotal aspect’ and of having to ‘collectively think about how social work is run’ (local authority social worker). Storytellers notice colleagues are ‘taking more time with one another’ (Hamish) and that ‘everyone asks for each other’s welfare’ (Sandy).

Some practitioners had moved to different parts of the system and were performing different roles and engaging with new colleagues more closely:

Prior to COVID-19, I was so caught up with the daily tasks and demands, there was little time for reflection…I have a strengthened appreciation for my colleagues who work permanently in the community care duty team. Their depth and breadth of knowledge and capacity to carry out complex, often challenging pieces of work is amazing
Lesley

The team of people I found myself working closely with; all have a strong sense of integrity and believe in ‘doing the right thing’ no matter the situation. All held true to this in what were difficult and stressful times
June

Technology also helped maintain togetherness and cohesion for teams, reducing feelings of isolation for those working from home (Paula, family support worker 2), being a tool for clinical supervision (James and Joanna) and for daily ‘team cuddles’ (Don). Also, crucially, technology facilitated communication which was frequently highlighted as enabling effective partnership working at all levels.

Transcript for Don: We’re a close knit team

Wider shifts within organisations

The stories document ways in which staff were supported by their management and organisations during this time. There was a recognition that ‘support for staff is needed more than ever’ (Kate) and online forums for staff to connect and share with each other were highly valued (Sally, Claire). The vastly changed landscape called for new ways to support staff and to value their work:

We now meet weekly, have a buddy system, support staff with resources to help them work at home, offer flexible hours, additional pay / vouchers and counselling services
Fatima

In terms of leadership, effective communication, permission and trust were highly valued by staff. They appreciated communication from senior leaders and managers that was regular, clear, honest and acknowledged the stresses. The stories highlighted examples where permission was given to take time for self-care (Lorna) and staff were trusted to find a work / life balance (Don). Again, it seemed that shared humanity was at the forefront of staff support from their leaders at this time:

I have found communication with my management team and the bigger organisation very supportive…The language has embraced a very human and personal touch including self-disclosure.
Lorna

Where decision-making and autonomy was further devolved to staff working directly with the public, this supported staff to focus on outcomes for people with increased flexibility and creativity:

During the early phase of COVID in particular there was more flexibility with using our budget to support families with small items, Netflix cards, internet etc. These were items which would have not been freely available previously
family support worker 2

…a lot of work is centred around processes and decision-making, based on fixed criteria…There are numerous blocks in the system and the work can be demoralising at times… Since COVID-19… our approach has been often more reactive and creative.
Lesley

Transcript for Don: Put that rule book aside

Transcript for Julie: Information was relatable and human

Transcript for Alison: You have to have trust and courage

Transcript for Don: Two words that spring to mind are energy and horizons

Across agency boundaries

Partnership working changed in a number of ways, driven by a ‘stark but unifying purpose’ (Sandy). Notable were the ‘speed and willingness of all to work within and across organisations’ making redesign and redevelopment possible (June); barriers were ‘quickly overcome to achieve positive outcomes’ (Kate); and ‘quick decision-making processes from funders’ enabled staff to ‘pilot, try out and be creative in responding to need’ (Fatima). Storytellers described ‘truly coordinated’ responses (Alice) and working more strategically with partners (Fatima). Some stories could draw clear lines between partner support and a focus on personal outcomes:

The excellent support and information from NHS Fife psychological services have supported an ethos of connecting with people, being kind, listening well. I think these additional tools and learning opportunities will support staff to have better, more outcome-focused conversations with patients and colleagues.
Lorna

This new landscape for partnerships seemed to foster more equal relationships with ‘no hierarchy, no competition’ (Alison) and an increase in the ‘accessibility of government’ (Claire).

When we have suggested measures to support carers and carer support organisations we have been listened to and many of our suggestions have been implemented swiftly…I believe we have been treated as expert partners at this time, more than at any other time
Claire

Several stories (Anne-Marie, Katy, Alice) described that approaching information sharing and governance differently enabled effective partnerships and the development of services to better meet people’s needs at this time. Further, the de-prioritisation of bureaucracy was also identified as enabling partnerships to work more effectively (Theresa, Claire, Fatima, Rachael).

Transcript for Alison: The relationships were there before

Emotional impact on staff

Proud, valued and useful

The stories aimed to capture a picture of how it felt to be part of a workforce responding to the pandemic. The response was in many cases surprisingly positive with storytellers describing a range of feelings including appreciated, validated, hopeful, humbled, confident and energised.

I feel useful - that the work we’re doing is helping at this very challenging time
Don

Common sources of pride and confidence included new ways of working together and adapting quickly to using technology. People felt hopeful about building on partnerships and ‘increased collaboration in the future’ (Alice, Wilma, Fatima).

For those practitioners who found that they were able to be creative and agile as they quickly designed new services and adapted current ones, there was a strong sense of pride. For some this involved learning new opportunities:

I have really enjoyed being able to use my wider skills to improve outcomes for people. My current role has allowed me to actively undertake practical tasks and often advocate for people in various situations… I feel more energised and excited by my work and look forward to the new challenges and learning opportunities.
Lesley

Staff positivity and confidencewas also considered to have impacted people accessing support, for example in lifting the ‘spirits of the residents’ in a care home (Theresa).

Tiredness and worries about supported people and staff

Although many of the emotions described are positive, there are unsurprisingly also negative experiences and emotions such as information overload (Claire); staff exhaustion and isolation (Fatima); and feeling overwhelmed (Gillian).

Despite significant efforts by these storytellers to find ways to continue to do a good job for the people they support, fear about the future for those people is also apparent, with concerns about financial impacts on families (Wilma); their jobs, health and relationships (Hilda); long-term anxiety and mental health (John Paul, Hilda); and the lasting effects of grief and ill health (Carla).

Rachel’s story is one of several which combines personal and professional impacts of the pandemic. Based on observations in both contexts, she identifies gender issues in that ‘women have shouldered the burden of ensuring families get through COVID with their wellbeing intact’:

… there is the extra work with managing COVID risks for family members of different ages, maintaining contact with people through diverse routes, and trying to keep a three-year old entertained and well. My husband contributes in his own way and we share parenting but I still carry most of the mental load… I would love to see more men and partners do more.
Rachel

Alongside worries about the impact on the public, the stories evidence the emotional toll taken on staff and challenge assumptions about taking resilience for granted:

I think in health and social care there can be too much expectation that staff absorb emotionally challenging events and just keep on without a chance to process things. It has taken a global pandemic to put a spotlight on this but it needs to continue.
Catherine

What helped

What supported the storytellers was self-care (Mark, Donna, Keir), as well as relying on values and integrity to help them navigate during this time.

…during such unprecedented times it is even more important to be clear on your purpose and live your values. That’s what keeps you anchored and able to steer a course through the complexity of it all.
Julie

I have learned that staying true to my integrity and what I believe is ‘right’ is vital and helps drive me through stressful times
June

While self-care and maintaining values was identified as a key part of staff strategies for survival, the importance of team and organisational support as identified above also played a very significant role in this.

Transcript for Keir: ‘Who cares for the carers?’

Transcript for Julie: I feel like I’m fully living the values