The impact on health and social care staff

As the pandemic gathered pace, health and care staff across all roles and services showed huge resilience in the face of unprecedented pressures and adapted quickly to work in different ways to keep people safe. They had to learn at pace about the new disease and how to care for people with COVID-19.

In hospitals and care homes, staff worked long hours in difficult circumstances to care for people who were very sick with COVID-19 and, despite their efforts to protect people, tragically they saw many of those they cared for die. Some staff also had to deal with the loss of colleagues to COVID.

It took a substantial emotional toll on care staff, concerned as they were not only for the wellbeing of their patients and residents but also for their own families and loved ones, as they worked to understand the nature of the disease and protect people to the best of their ability.

For the first time ever, the NHS stopped the majority of its non-emergency services. The need to adapt quickly to manage demand and keep people safe became imperative. This was seen, for example, by the NHS responding to feared capacity issues with the rapid opening of five emergency, or Nightingale, hospitals. Two core services, critical care and end of life care, were at the forefront of managing the most seriously ill patients.

Emergency departments were reconfigured into streams to separate COVID and non-COVID patients; clinical expertise at the ‘front door’ increased, with improved access to face-to-face specialists; and there was closer working between departments, such as emergency department and radiology.

Through the height of the crisis, our inspectors contacted more than 80% of adult social care providers – more than 20,000 care homes – to better understand the impact of COVID-19, and to offer support, advice and guidance. We heard that care staff had to suddenly cope with a whole range of new tasks and take on aspects of care that they had never had to do before. The lowest paid staff had an enormous burden put on them. They had to care for large numbers of people faced with a new and complicated illness, understand complex guidance, and often be the only one to be with the person as they died, sometimes relaying families’ messages of comfort to the dying person.

Adult social care staff themselves were additionally vulnerable: data from Skills for Care showed that a quarter of staff (340,000 people) were aged 55 or over, and 1.4% (18,500) of staff were aged 70 or over. Data collected by Skills for Care showed that 7.5% of working days were lost to sickness (including self-isolation and shielding) up to August 2020 during the COVID-19 period, compared with 2.7% pre-COVID-19.

GP practices and other primary care services have made a rapid transformation in response to the pandemic to continue to support the needs of people in the community. We saw:

• a fall in the number of face-to-face GP appointments and a rise in those conducted remotely, especially by phone and email
• digital systems becoming more available, including ways for patients to send information to practices as well as arrangements for video consultation
• urgent dental care centres established across the country to provide care for people with urgent and emergency dental problems.

Among the many challenges faced by providers in recent months, services have had to make sure they had enough employees with the right skills to cope with new and increased demands. Strategies included the redeployment of existing staff, for example staff moving from one area of a hospital to another, commonly to critical care, while minimising the risk of transmission. Some people were redeployed to another sector, such as hospital and community staff with appropriate clinical skills moving to care homes.

There was significant interest from the public in volunteering and supporting their local communities, although there were also concerns about the coordination of volunteer strategies and how recruited volunteers might be best used.

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The impact on people