Written evidence submitted by MHA (WBR0106)
Evidence submission to the Health and Social Care Committee’s inquiry into workforce burnout and resilience in the NHS and social care
By MHA (Methodist Homes), October 2020
About MHA (Methodist Homes): MHA is the largest charity provider of residential care for older people in the UK. We have over 75 years’ experience in creating communities that care with one of the highest quality ratings in the sector. Through our 90 care homes, 70 retirement living communities and 60 community support schemes our 7,500 colleagues and 4000 volunteers provide care and support to over 18,500 older people across England, Scotland and Wales.
Our CEO, Sam Monaghan, would be delighted to give oral evidence to the Committee about the experience of our workforce at your convenience.
1. How resilient was the NHS and social care workforce under pre-COVID-19 operating conditions, and how might that resilience be strengthened in the future?
Our workforce of over 7,500 people is the lifeblood of the care we provide. We are proud of the skills, compassion and dedication of our staff and put staff wellbeing and resilience at the heart of our people plans. In addition, we are proud that we have been paying every member of our staff the real living wage or more since 2018.
At MHA, we are confident in the leadership skills of our care home managers and those staff that support them. We encourage an inclusive and supportive culture, placing great importance on nurturing the mind, body and spirit of those we care for, their families and friends and our colleagues. Despite this, we recognise Covid-19 has put immense strain on our colleagues. Below we have outlined how we have responded to support their wellbeing needs during the pandemic along with how it has affected them.
Before the pandemic, as across the adult social care sector, we faced challenges in recruiting and retaining staff, in particular nursing staff - we consistently have around eight nurse vacancies at any one time, despite our rate of pay being above average and our competitive suite of enhanced benefits. This is in the context of a general social care workforce under significant strain with 112,000 vacancies across the sector and staff turnover rate of 30.4%[i]. MHA’s overall staff turnover rate is only marginally less than this at 28.6% (September 2020).
We have long argued that the social care workforce needs to be recognised and valued for the dedicated and skilled work that they undertake every day. We will only address the recruitment and retention issues across the sector with a national People Plan that ensures a fair wage for all staff in the care sector, training opportunities, career progression, professional recognition and parity of esteem with NHS colleagues.
2. What has the impact of the COVID-19 pandemic been on resilience, levels of workforce stress, and burnout across the NHS and social care sectors?
Our staff are all facing unprecedented challenges due to the pandemic and outbreaks of Covid-19 in some of our homes, and they have stepped up with commitment and professionalism. Many have provided more end-of-life care than ever before and taken on additional clinical tasks. All staff have swiftly adopted new and changing rules on infection prevention control and given ever-more compassionate care and friendship while people cannot see their loved ones. This is in a context of personal risk and too-often grief. We are acutely aware that these pressures bring increased risk of anxiety, stress and burnout.
Our care home managers have gone above and beyond, to protect residents and support their staff demonstrating unparalleled commitment, teamwork and support for each other.
To understand more about their experiences over the last six months, we have undertaken a ‘lessons learnt’ exercise with our care home managers, giving them a chance to reflect and be candid about their feelings. We have included some of their stories below, to illustrate and emphasise the emotional, physical and mental impact Covid-19 has had for staff working in our care homes.
Keeping homes running
Care homes are busy places at the best of times, but we recognise that during the pandemic workloads increased:
“In the absence of family we became everything to our residents. I can’t believe what we fitted into a week.”
“I have been in nursing 42 years and this is the first time I have had unknown level of stress. The workload has really intensified. Priority for the residents, relatives and staff. I learnt a lot about my resilience. It took investment and work, keeping the team together and I found inner strength.”
“It was very sad but didn’t have much time to think. I had 14 staff off sick, I had four on annual leave, four on other leave, deputy home manager off and admin manager off, so very busy juggling rotas, arranging tests and all the paperwork involved in anything, very sad about the deaths, but concentrating on keeping the home ticking as it was so busy.”
“Staff including myself have worked long hours, cancelled time off, worked as a team, and supported each other emotionally and professionally.”
Coping with increased deaths
While our care homes are used to dealing with the death of residents, the arrival of Covid-19 intensified the experience, with many deaths occurring in quick succession in a number of our homes. For many members of staff, they were losing people from their extended family who they had cared for, often for a number of years. In addition, MHA was also saddened to lose three colleagues during the first wave of the pandemic, which had a great impact on staff:
“We saw 13 of our residents die in a two-week period. What was sad was there was nothing we could for them. It wasn’t like normal end-of-life care, it was heart-breaking. The symptoms were not always typical. We knew they were struggling. District Nurses couldn’t always come… The staff were devastated. Many of the residents had lived with us for years. It’s a relatively small home and staff and residents were close.”
“I said to D that they’re just dying and I can’t do anything. Those of us who didn’t get it [Covid-19] and were here throughout have come out of it more emotional, I cry more easily than I did before.”
“I have witnessed Managers break down on Zoom meetings at the loss of life in their homes. I have heard fear in those voices and saw it on the faces of people I have worked with, I have lost many hours of sleep with a deep fear I would miss something or cause the death of someone by not being cautious enough and at times I have felt alone, vulnerable and forgotten.”
“We had approx. 22 staff off sick, approx. 10 deaths and worse was yet to come. The team were terrified… I was alright, tired but alright. We had lost [a colleague] by this time… this was extremely traumatic for the staff now that they had lost a colleague. G had also been admitted into hospital… and quickly transferred to ICU and remained there for some weeks.”
Hospital discharge
The majority of our care home managers felt intense pressure to take Covid positive patients from hospital, and there was a lack of understanding from health colleagues when this was refused:
“We were asked to take residents from the hospital with Covid-19, I felt guilty that I could not take anyone but I needed to protect my residents and staff.”
“I remember having heated conversations with the managers on the [hospital] wards because we wouldn’t have residents back and they were accusing me of bed blocking. They were trying to admit back in after three days and Government guidance at that point was seven days and they wouldn’t do tests – it made us all very angry.”
Keeping up with guidance
As well as the day-to-day running of the home, there was the need to read, understand and cascade guidance as it changed, all having an impact on staff:
“I definitely lost sleep thinking I had missed something important. It was information overload of the worst kind.”
“I remember feeling like the staff might not trust me, as I was continually changing the information I had provided.”
“The guidance being sent from MHA, Government and PHE became all-consuming at one point and certain days it appeared not to be changing daily but within the day. My thoughts and feelings on some days with the information being cascaded - I was fearful, worried of passing on the wrong information or making a mistake. Had I done enough to keep the residents and the team safe?”
Impact of limited access to testing and PPE
Lack of access to testing and PPE in the early days of the pandemic, presented additional pressures to life within care homes:
“The peak of the outbreak, I was doing 18-20 hours a day and slept in the building as the agency was letting us down. After two weeks things got better. If there had been more access to testing at this time, the impact on staff would have been far less.”
“Staff were all very frustrated because they had seen it on the news and they were coming to me as if it was my personal responsibility that we didn’t have the tests, I had to continually tell them I was doing everything I could to get the testing, as was MHA.”
“Trying to get PPE, I felt like a second class citizen, we got told [that the] priority was the NHS. The worry was awful. It was hard as I couldn’t share my worry with the staff as I needed to be supporting them.”
Staff wellbeing
Care home managers have done a tremendous job of supporting their teams in the most difficult of circumstances:
“Staff didn’t want to take a break if that meant the resident would be alone. I arranged for pizzas and drinks to be delivered into the home. It was a case of quickly grabbing something to eat.”
“I checked up on my staff everyday and ask if any of them are poorly in any way, because we know it doesn’t fit into that neat little box of a cough and a temperature. If anyone is unwell I want to know about it and take precautionary steps. We wouldn’t survive another outbreak like the first. We just wouldn’t survive.”
“We all struggled with not being able to cuddle people, especially when someone was upset and needed a hug.”
“I was feeling tired and feeling stressed worrying about the staff keeping them supported, I felt drowned. It made it harder for me as I had to be strong and I had to support them.”
“There were a lot of staff self-isolating with minor symptoms, as they were scared. One member of staff was taking her own temperature three times a day, as she was so concerned.”
“We had our first case… the worst day of my career and I will never forget this day. I cried and I was so worried. I was so upset. I felt I was going to leave care at this point because I felt so helpless. I remember telling the area manager, and [who] said you’ve been amazing, I’m here if you need me. I felt I had failed, I remember thinking ‘oh it’s ok’ It isn’t my fault.”
“We had a rollercoaster with the staff on their feelings and their insecurity about coming to work, concerned they were going to get the virus.”
“Everyone was just stunned. When it’s one of your own it really brings it home. We had four of our team in hospital. We were right in our peak then… Reassured that we have our own chaplains for those who lost loved ones.”
“What was equally more time consuming was reassurance to staff as people were getting more worried, it was health worries and financial worries as the Government started to say to restrict travel and work from home.”
“Staff have carried each other in waves - when one person feels down another picked them up. The team are interactive and have played a part in allowing individuals to have a bad day.”
“I’d listen to my staff; a lot about reassurance. I encouraged them to write things down, and that has all gone in our Covid book. You have to be everything to everybody and sometimes the unpredictability can be hard.”
“I remember feeling a bit begrudging of the NHS, I felt we didn’t get the recognition. We were the heroes, what about us?”
“Staff morale was OK, we kept each other going. We made sure we had activities in the home, I was buying extra treats-KFCs, chocolates, I had a big basket that I filled with treats, I bought them all a present of a keyring… inscribed on the keyring, “May you be proud of the work you do, the person you are, and the difference you make”
“Having open conversations with each other in the home has helped as well, tears, cups of tea and biscuits and some laughter as well has helped us all to support each other. Our team is stronger now and they know who they can rely on, they are closer.”
Relatives and friends
As well as caring for residents and staff, care home managers spent much of their time reassuring relatives:
“The phone never stopped, the families were worried , we had to spend time explaining how we were managing the virus.”
“There was a lot of insecurity with relatives and they were wondering how long our homes were going to be closed.”
“We were all very wary about letting visitors back in since we had been Covid free for a few weeks. We felt like we had our bubble of protection and we didn’t want it to be infiltrated.”
“A relative complained because she couldn’t have a visit after 5pm, this would have meant me working even later than I was doing and I simply didn’t have the energy. Having someone yelling at me that it wasn’t fair that I could see my family but she couldn’t see hers, except I haven’t seen family or friends this week.”
Clearly our colleagues have had an immense workload to cope with and in response we have prioritised creating internal support mechanisms, as well as tools and resources to support the wellbeing of our staff. You can see examples of some of these on the Wellbeing Page on our website. These include:
- Wellbeing Toolkit – with a range of resources
- Care First - our Employee Assistance programme, where we saw an increase of 79% in usage during April – June 2020 compared to the same period last year.
- Leadership resources – including topics such as ‘burnout’
- Provision of a range of manager and staff wellbeing webinars that have focused on a number of topics to include anxiety, resilience and leading remotely.
- Partnerships with a counsellor to provide group sessions for our frontline colleagues to have the opportunity to reflect on their experiences during Covid-19 and look at coping mechanisms and ways to move forwards.
- Coronavirus Welfare Fund - MHA set up a special fund to assist colleagues who were experiencing short term financial strain in relation to issues such as transport to and from work and day-to-day bills, including food shopping.
- Chaplains – providing a chaplaincy service has been a core service since MHA was first established and has always been available to residents and staff, with most homes having a dedicated chaplain.
- PTSD identification of symptoms and follow up support
- Wellbeing survey
- Mental Health First Aid Champions.
As previously stated, it is the invaluable skills of care home managers, who have stepped up to support their teams within their homes, but also their peers.
“I looked at the wellbeing sessions. We were getting a lot of support from each other. I was also supporting other homes who had symptomatic residents. Colleagues would ring me text me every night to check in. We supported each other locally.”
However, we are being very careful not to be complacent and recognise that staff fears about what the second wave will bring are very real.
“I don’t think the easing of restrictions was particularly helpful as the environment we work in we have to be very careful. All staff are still trying not to visit pubs and restaurants. Our lives are still on hold because the risk to the residents and staff is too great.”
“I am tired and feel drained, there is that fear that the virus is still out there and we could see it spike at any time and then we will have to start all over again”
“This has been and still remains a challenging time for all involved in our care homes. I am happy how the staff have taken on board all the new challenges, albeit frustrating at times. We have all had moments when we have been anxious about how Covid-19 will or could affect us, and we have been there to support each other.”
We are currently planning for a MHA Managers conference in November, “Leading through uncertain times”, to focus on how best we can support our colleagues, already weary from the first wave of the pandemic and now facing into the second.
3. What further measures will be required to tackle and mitigate the causes of workforce stress and burnout, and what should be put in place to achieve parity for the social care workforce?
As a priority, the government must maintain regular testing and access to PPE for care homes. Anxiety remains amongst staff, but these two things give the staff confidence and reassurance that the risks of infection are reduced. We also need government policy to provide this reassurance by extending it to those who come into contact with care homes. For example, the policy not to test CQC inspectors and other health professionals before they visit, only increases worries about increased risks of infection and outbreaks occurring.
Like many other sectors, our (predominantly female) staff rely on vital infrastructure, such as schools and childcare services. As a priority these must remain available and accessible to reduce the pressure and stress on staff and enable them to be available work .
Prior to the pandemic, we had been working hard to reduce administrative burdens, however Covid-19 has brought a seeming increase in these – through daily updates for the capacity tracker, audit trails for the Infection Control Fund and existing administration for local authorities and clinical commissioning groups.
“I do think it felt like all day we read about Covid. Some of the guidelines were very long and you also were receiving material from LA and other sources. It felt like information was constantly changing. You would get your head round something and then it would change.”
“I’ve allocated a person who does all testing and paperwork. I’ve got the luxury of freeing her up to do that. And [she] updates the trackers. It’s very time consuming, I know other homes have struggled. A lot of people have complained to the CCG about how much time it takes.”
The case for a national strategic People Plan for the social care workforce has never been more evident. This should be fully funded and include:
· Registration of care workers to build respect for profession
· Recognised career pathways and training, aligned with NHS pay scales and accreditation
· Parity of status with healthcare professionals including pay, benefits, access to subsidised housing and transport for those starting out
· Full bursary for nurse training and modules or specialisms included for care home nursing
· Care workers on shortage occupation list and ‘points-based system’ to allow care workers to be recruited
· Access to anti-body tests and priority access to a vaccine as and when available.
Health and social care integration – we need people to be able to work across health and social care systems, who can understand the pressures across all services. As our managers expressed, there has been great anger and frustration with a feeling of being dictated to by the parts of the NHS, rather than effort to work together with a shared understanding.
“I went home and said to my partner I feel we “care homes” are dumping grounds where the NHS can just return residents home without tests. I really felt that the NHS were not working with us but working against us.”
[i] ‘State of the adult social care sector and workforce in England’, Skills for Care, October 2020
November 2020