Written evidence submitted by Bournemouth University (WBR0026)

Written evidence submitted by Professor Lee-Ann Fenge, Emily Rosenorn-Lanng and Tilia Lenz on behalf of Bournemouth University, to the Health and Social Care Committee call for evidence on workforce burnout and resilience in the NHS and social care.

Professor Lee-Ann Fenge is Professor of Social Care at Bournemouth University, Director for the Centre for Seldom Heard Voices, and research lead for the National Centre for Post-qualifying Social Work (NCPQSW) at Bournemouth University. She is writing in her capacity as a researcher with a track record of research concerning the social care workforce. She has an interest in those individuals and groups who are marginalised and disadvantaged within society and whose needs are often overlooked. She is a registered social worker and has published extensively about the social care workforce, marginalised identities and safeguarding.

Emily Rosenorn-Lanng is a Research Project Officer within the National Centre for Post-qualifying Social Work at Bournemouth University, specialising in undertaking bespoke impact evaluations, working closely in partnership with organisations and local authorities, to empirically demonstrate and validate impact and efficacy in practice.

Tilia Lenz is a Lecturer Practitioner Consultant working for the Pan-Dorset and Wiltshire Teaching Partnership and based at Bournemouth University.

Both Emily and Tilia are working with Professor Fenge on research into the impact of COVID-19 on social work practitioner wellbeing.

Professor Fenge is available to provide further detail and give oral evidence as needed.

EXECUTIVE SUMMARY

1. Prior to the pandemic the social work profession was already facing challenges due to issues with staff retention, large caseloads and cuts in resources which have led to high levels of staff burnout and stress.
2. The impact of COVID-19 across the population has been enormous, but frontline social care practitioners have faced a particular challenge as a result of their role in supporting some of the most vulnerable members of society during the pandemic. Despite the lockdown, and a move to remote working from home, these practitioners have continued with their statutory duties whilst often being concerned about their own safety and inadequate access to PPE. In a survey conducted by Bournemouth University (BU) during the first 6 months of the pandemic social workers reported feeling overlooked in comparison to their health colleagues and felt they were facing additional challenges as a result of needing to maintain contact with service users in the community without adequate access to PPE or testing.
3. The stresses experienced by frontline social workers are different depending on whether they work in Children or Adult services. For those in children services, there were concerns about the mental wellbeing of children and families during lockdown, and the invisibility of children not in school who may be experiencing abuse within the home environment. For those in adult services increased stress was caused by the need to deal with early discharge from hospital, and a lack of access to community support for vulnerable adults during lockdown.             
4. Working from home reduced practitioner access to peer support and face-to-face supervision with managers and peers, leading to feelings of isolation, disconnection and frustration which increased stress. Respondents to the BU survey indicated a willingness to use online supervision, but it was felt that new models are required to support critical reflection on cases rather than a brief focus on case management. This poses a challenge as traditional models of supervision occur face to face and include consideration of non-verbal communication and cues which are more difficult to capture online. Further research on how to replicate a good supervisor/supervisee relationship online is required to promote practitioner resilience in the future.
5. There is some evidence from the work of BU and our teaching partnership during the pandemic that digital communities of practice may promote practitioner well-being and resilience. The large numbers of practitioners accessing these free online learning events during lockdown suggests that there is an appetite and demand for such a resource. For those working remotely, online learning events provide connection to other practitioners and current practice issues. Online learning may hold great promise for supporting socially distanced social work practitioners to support their wellbeing and resilience but more research is needed to fully build this potential future CPD resource.

The impact of COVID-19 on social care practice

6. COVID-19 and the lockdown that followed continue to exert a major influence on public services and wider society. Working remotely with less face to face contact with service users and colleagues has had an enormous impact on social work practice. Even before the COVID-19 pandemic, research suggested that frontline social work practitioners experienced high levels of stress and burnout[1]. High pressure working environments, the impact of austerity, resource constraints and a workplace ‘blame culture’ has resulted in high levels of staff turnover, presenteeism and low job satisfaction[2]. The adoption of hotdesking and ‘agile working’ in many local authorities has also had an impact on the wellbeing of practitioners who have experienced reduced access to a team environment or peer support[3]. The new challenges created by home working, social distancing and working without access to personal protective equipment (PPE) may have increased the stress experienced by frontline social work practitioners, although home working may also have increased practitioner autonomy and control, promoting improved wellbeing outcomes for some.
7. Access to PPE has been a major concern during the pandemic for all practitioners working in health and social care settings. A recent online survey by Community Care found that although 76% of respondents were satisfied with how their employer reacted and adapted to the initial lockdown, 40% reported their ability to meet statutory responsibilities had been compromised due to increased demand for services or colleagues getting sick or self-isolating, and 55% reported carrying out duties that caused them anxiety due to infection risk, lack of satisfaction of access to PPE[4]. The British Association of Social Workers (BASW) has contacted the Prime Minister to raise concerns about the access that frontline social works have to PPE. Social workers continue to need to visit service users in their own homes, sometimes seeing up to a dozen or more service users a day. Guidance and access to PPE is required as the pandemic continues into the winter months and BASW have called for the inclusion of social workers in the list of priority groups who should be given regular coronavirus testing to support practitioner wellbeing[5].
8. Social Work supervision is a key element to promote safe social work practice. A good supervisor/supervisee relationship should provide an interactive space to engage in critically reflective practice to support the development of professional skills and knowledge. A strengths-based relationship between supervisor and supervisee can build rapport and understanding and can act as a model of good practice with service users and carers. Prior to the pandemic, supervision occurred on a regular (often monthly) basis between practitioner and team manager and is essential to support critical reflection and promote sound professional judgement. COVID-19 has increased working from home and reduced the opportunity for face-to-face supervision. Practitioners and managers have had to adapt their supervision practice to support online delivery. Early research findings from a recent survey by the Pan Dorset and Wiltshire Teaching Partnership and Bournemouth University show that 78% of practitioners continued to receive supervision and for 98% this took place remotely. Practitioners report that online supervision is of shorter duration and more task focussed with less space and time for critical reflection on cases.
9. Currently there is little research evidence exploring how to best create digital communities of practice for social workers to promote practitioner well-being and resilience. During the pandemic the Pan Dorset Teaching Partnership and Bournemouth University have sought to offer practitioners on-going learning activities and wellbeing support through regular webinars and digital learning events In June, July and August 2020 590 practitioners joined 5 online events specifically designed to meet the needs of front line staff in Social Work, with the latest event discussing Stress, Trauma and Self-care during COVID-19[6]. Early analysis of feedback suggests that participants value the flexibility of accessing the webinars online, revisiting the subjects at their convenience through recordings on the Teaching Partnership website[7] and appreciating the variety of themes offered. The Teaching Partnership website has seen an increase in traffic by 184%. Although online learning may hold great promise for supporting socially distanced social work practitioners to support their wellbeing, more research is needed to fully build this potential future resource. Challenges may include the lack of good internet connectivity for those living and working in rural areas.
10. Research by the NCPQSW and Teaching Partnership team at Bournemouth University recently identified a range of key factors which contributed to practitioner wellbeing and resilience during the current pandemic[8]. The NCPQSW research team and the Pan-Dorset and Wiltshire Teaching Partnership collected responses from over 140 front-line practitioners between May and September 2020. The online questionnaire was designed to capture the direct impact of COVID-19 on the social work workforce and implications for services users.

• 145 front line practitioners responded to the survey, across three Local Authorities. The sample was mostly frontline practitioners but included some managers, senior managers and students. Two thirds of respondents were qualified for six years or more and both Adult Services and Children and Young Peoples Services were represented.
• Initial findings indicate a feeling of disconnection and frustration felt by practitioners, underpinned by a sense of isolation from both colleagues and service users. Practitioners shared concerns related to the need to maintain face-to-face contact with service users whilst being concerned about personal safety and well-being due to the risk of catching COVID-19. This illustrates the challenges faced by all front-line practitioners at this time related to access to adequate PPE and personal safety, however, social workers reported feeling overlooked in comparison to their health colleagues and felt they were facing additional challenges as a result of needing to maintain contact with service users in the community.
• Practitioners working in Children and Young Peoples Services highlighted increased concerns about the mental wellbeing of children and families during the pandemic, and additional stress linked to potential safeguarding concerns not being referred as a result of children not being in education during lockdown.
• Practitioners working within Adult Services reported increased stress as a result of early hospital discharges to empty hospital beds early in the pandemic. Practitioners experienced extra challenges due to limited technology available across health and social care system, and concerns that they were not able to achieve the best outcomes for service users due to the lack of available care services at this time.
• Work-life balance was a frequently highlighted as a challenge during lockdown as a result of working remotely from home. Extra work stress was created by the need to adapt to new and updated practice guidance during the pandemic which increased workload pressure. Social workers also had to adapt to new ways of remote working, alongside disrupted patterns of interaction with service users and colleagues. Many reported the need for greater clarity to ensure the appropriate prioritisation of workloads.
• 78% of practitioners reported receiving their normal pattern of supervision, with 98% being able to receive supervision remotely. 35% of respondents reported that their supervision had changed as a result of COVID-19. It was often of a shorter duration and online supervision was felt to lack depth and a focus on critical reflection compared to face-to-face supervision sessions. There are strong indicators of a willingness to engage in online supervision from both practitioners and managers. However, consideration is required as to how online supervision can offer practitioners a safe space in which to engage in reflective and critical thinking rather than just case management. Effective communication is key to supporting the mental well-being of practitioners, and respondents repeatedly emphasised the positive impact of good reflective supervision and team interactions as part of this. COVID-19 and the lockdown increased practitioner isolation and engagement with peer support from a team environment. Pre-existing peer networks which were able to continue remotely during lockdown were recognised as being beneficial to practitioner well-being.
• Although many practitioners adapted well to remote working during this period and were confident using new technology, others were more stressed by the sudden change in working patterns and would have liked additional support and guidance. Individuals with prior experience of working remotely were better placed to adapt, and this highlights the learning needs of other members of the social care workforce if new models of working persist into the future. This highlights the need for continuing professional development (CPD) as the workforce adapts to new ways of working as an impact of COVID-19.
• The survey results indicate that working from home has had both positive and negative impacts on practitioner wellbeing. Working from home has allowed practitioners greater flexibility in their time management, improving attendance at meetings and reducing stress related to travel times. However, negative impacts reported relate to the impact of isolation and working from home on mental wellbeing, working with service users who have experienced increased stress as a result of the pandemic, and changes in supervision and peer support which are essential to promote practitioner resilience and wellbeing.

Contact information:

Lee-Ann Fenge

Professor of Social Care and Director of the Centre for Seldom heard Voices
Faculty of Health and Social Sciences, Bournemouth University                           
Staff profile http://staffprofiles.bournemouth.ac.uk/display/lfenge

Emily Rosenorn-Lanng

Research Project Office, The National Centre for Post-Qualifying Social Work
Faculty of Health and Social Sciences, Bournemouth University
Staff profile: https://staffprofiles.bournemouth.ac.uk/display/elanng

Tilia Lenz

Sept 2020