Ensuring sufficient health and care skills where they were needed

 

We looked at how workforce and staffing across health and social care have been affected during the pandemic: how have providers worked together across systems to ensure staffing capacity, and how have providers tried to make sure there are enough employees with the right skills to cope with new and increased demands? Also, how have providers worked together to keep staff safe?

Strategies to manage staff and resources across sectors and partnerships were inconsistently navigated, causing varied success of collaboration within systems. Initiatives to manage professional skills capacity across providers was managed well in some areas, with demonstrable impact

There were numerous strategies for making sure the right professionals and skills were available where they were needed to care for people. Across our reviews, we heard about collaborative working between providers, commissioners and other system partners, including local organisations and national bodies such as NHS England and NHS Improvement and Public Health England. There was a focus on workforce planning and monitoring, recruiting and redeploying staff, training, COVID-19 testing, and wellbeing initiatives.

However, understanding of shared strategies for staffing was mixed across the systems we reviewed. Although we spoke to people in all systems who were aware of shared strategies, we also heard from those who said they were not.

We heard many examples of workforce planning and sharing staff at organisation, provider and sector level. However, we were told how staffing plans and initiatives did not always extend to all sectors, for example adult social care. We heard about the challenges of transferring staff between health and social care settings, and how barriers were created by issues such as organisational boundaries, a lack of existing relationships and indemnity.

We were also told about the complications and time commitments of setting up the necessary arrangements to facilitate cross-sector working, meaning support was not always available when it was most needed in the early stages of the pandemic. Some providers had reservations about system-level working because it was not well established and contained a number of uncertainties, and felt it was important to develop and implement their own organisational strategies. We also heard about the difficulties of bringing in new staff to some services at short notice, because specialist skills and training were needed.

Coordinating staff support could be a challenge – some areas were not able to attract large numbers of people back to work, and some small providers struggled when senior staff were ill or isolating.

We heard how learning was in place across systems, particularly in London and Sussex, including virtual learning networks and learning from areas that experienced peaks of the virus earlier than others.

There were some specific challenges and successes in different places. In Lincolnshire we heard that the transfer between health settings was easier than transfer from health to social care settings due to indemnity issues. A memorandum of understanding was agreed to mitigate this issue and allow flexible transfer of staff between settings.

Also in Lincolnshire, there was the implementation of a ‘workforce cell’. We heard there were many conversations about redeployment of clinical staff and sharing clinical staff between providers. HR directors worked together to make unanimous decisions for consistency of information reaching staff. We heard this did not involve social care, but that rapid support would have been offered if needed. The rapid redeployment and upskilling of staff by acute trusts was described as a big success.

Health and social care staff worked above and beyond, with a shared drive to look after people well and keep them safe

Across our reviews, we found that a range of approaches were initiated by providers and systems to ensure sufficient capacity and skills to meet demand. This included upskilling existing staff to take on additional responsibilities, former employees returning to work, using bank and agency staff, medical students joining the team, and recruiting new staff and volunteers.

Across the systems, we heard praise for the contributions of staff and their willingness to support and adapt to changing circumstances. Positive examples included care home staff volunteering to reside at the service when needed, and teams moving from a five-day to a seven-day working pattern. It was clear that the goodwill of staff had been a key factor in enabling organisations to cope during difficult times.

Levels of staff sickness were different in different places, as were the numbers of staff and volunteers in groups or needing to shield at home. Some providers said they were reliant on using agency staff, but this resource could be difficult to access and was costly. There were also concerns about the risks of virus transmission if staff moved between services. We heard about staff, including part-time and sessional staff, working extra hours and restrictions being placed on annual and study leave at certain times in some services.

In the Black Country and West Birmingham, we heard how the trust realised very early on they would need a new cohort of volunteers. They recruited new volunteers and made use of them in all areas – they said this was something they wanted to invest in for the future.

From Devon, we heard how a home care provider developed a fast-track recruitment system for other home care providers in the system. They said this was successful and crucial for supporting gaps in the workforce – and that they were trying to keep this innovation.

In Frimley, we were told how some staff were supported to train for skills they did not have before. Receptionists were trained in phlebotomy to ensure there was enough staff to carry out these roles.

A wide range of measures were introduced to keep staff safe, although implementing them caused challenges

Keeping staff as safe as possible throughout the pandemic was quickly acknowledged to be critical to ensuring people accessing health and care received the best care possible. We heard from many providers and systems about the impact the pandemic was having on their staff – the levels of staff anxiety were described as unprecedented. There were worries about the supply of PPE, particularly early in the pandemic.

Employees were afraid that they might pass on the coronavirus to their families and others. There was high anxiety about accessing COVID-19 testing, and examples of poor communication about local testing sites and challenges accessing them for staff who do not drive.

Our reviews found a range of measures to ensure staff were kept safe during the pandemic. This was primarily at organisation level, rather than system level. There were examples of frequent communication from leaders and managers, information and training for staff to ensure they could keep others and themselves safe, changes to the physical layout of health and social care settings, infection prevention and control protocols, and mental health and wellbeing support.

Organisations carried out individual risk assessments for staff in high-risk groups, including people from Black and minority ethnic groups, and supported those who needed to shield. Opportunities were created so staff who were shielding took on alternative jobs so they could work from home.

We were told how staff were provided with appropriate PPE and guidance to use it – with some providers acting quickly (prior to government advice) and, where staff had concerns, providing higher levels of protection than those recommended. Some organisations introduced COVID-19 testing for staff early in the pandemic.

There was a range of approaches implemented to support employees’ mental health and wellbeing. These included ensuring regular breaks during shifts, taking annual leave when possible, having dedicated spaces for staff to take time out and ‘de-stress’, sharing positive stories and feedback, and the use of mindfulness activities and apps. We were also told about ‘debrief and reflective practice sessions’, access to mental health first aiders, employee assistance programmes, confidential helplines, talking therapies and bereavement support.

In Gloucestershire, the workforce hub established in 2019 had its hours increased to 24 hours a day, seven days a week, to offer support to staff. We were told this was a single point of access for staff who could be signposted and offered support and advice on a range of issues – childcare, counselling, goodie bags from the community. ‘Wobble rooms’ were established, providing a safe place for staff to use.

From Lancashire and South Cumbria, we heard that in care homes where there were outbreaks and deaths, staff were traumatised. Realising this was a significant risk, a counselling service was commissioned and there was group work via Skype.

However, while some systems had providers with leaders and managers viewed as approachable and caring in their support for staff, we heard this was not the case everywhere – some providers told us that leaders were not visible. In addition, in several local areas, there was concern that the ongoing pressures and stress faced by staff might impact on future workforce capacity and resilience.

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