Coming together to respond to Covid-19: Evidence of ‘What Works’ in a Multi-Agency Response
Report produced for the Home Office preparedness for Covid-19 (coronavirus) call for evidence (January 2021).
Louise Davidson1, 2, Holly Carter1, John Drury2, Richard Amlôt1, S. Alexander Haslam3, Matthew Radburn4, Clifford Stott4
1 Behavioural Science Team, Emergency Response Department Science & Technology, Health Protection Directorate, Public Health England, United Kingdom
2 School of Psychology, University of Sussex, Brighton, United Kingdom
3 School of Psychology, University of Queensland, St Lucia, Queensland, Australia
4 School of Psychology, Keele University, Staffordshire, United Kingdom
1. The Covid-19 pandemic presents a unique set of challenges for UK emergency responders due to the scale and complexity of the response required. The emergency services and partner agencies across the UK have come together within their Local Resilience Forums (LRF) to put a response in place. These usually independent teams have been required to work collectively and interdependently to achieve the superordinate goal of reducing harm and saving life. However, previous research has consistently highlighted that coordination between responding agencies is a key challenge that hinders effective response, leading to a call for a greater understanding of how these teams work together.
2. Within the field of psychology, the Social Identity Approach can be applied to help understand the way in which responders from different organisations came together to work with each other in the response to Covid-19. This approach suggests that a shared identity within a group can facilitate coordination and cooperation between group members because they share the same norms and goals, thus increasing the ability of the group to work more effectively together. To understand how responders at the local level came together in the response to Covid-19 and to identify any challenges that they faced, we conducted interviews with responders from across the UK from the Police, Fire and Rescue, and Ambulance Service involved in the response at a strategic or tactical level. Our findings are organized under two key themes: (i) horizontal intergroup relations which refers to the relationship between organisations within the LRF partnership, and (ii) vertical intergroup relations which refers to the relationship between LRFs and national government agencies. Based on these findings, we have identified a number of evidence and theory-based suggestions of ‘what works’ in a multi-agency response to support the ongoing development of good working practice in the response to Covid-19, as well as to inform improved understanding of multi-agency working and enhance preparedness for future incidents.
3. Five suggestions of ‘what works’ in a multi-agency response are provided in this report:
(1) Providing new partners with a full briefing of the purpose of the LRF and the structure of meetings they will be attending to ensure new partners have a full understanding of the LRF and are able to work collectively with its partners.
(2) Chairs of strategic and tactical coordination group meetings continuing to emphasise the shared goal of the response to maintain a shared identity between partners and promoting responder resilience.
(3) Using a name such as ‘stabilisation phase’ to describe the period between response and recovery to help keep the shared purpose of the group salient, facilitating the effective working of the group.
(4) Ensuring communication channels between local and central government remain open by continuing to feed messages upwards through the local government liaison officer to help facilitate the development of shared norms and values, and to build trust between the national and local levels of response.
(5) LRFs actively communicating and sharing information with other LRFs to ensure that local level responders have as much information as possible to allow them to carry out an effective response.
4. The Covid-19 pandemic is unprecedented in living memory, owing to the scale, longevity and complexity of the response that it requires from the UK emergency services and partner agencies. The coordinated response of Local Resilience Forums (LRFs) across England, Wales, Northern Ireland and Scotland has brought together partners from a range of different agencies, including the Police, Fire and Rescue, and Ambulance Services, the NHS, local authorities, and the voluntary sector. These partners have been required to work together collectively and interdependently in responding to Covid-19. Response activities have included the management of personal protective equipment, mortality planning, understanding and implementing test and trace, and responding to changes in lockdown measures. Poor coordination between response agencies has been consistently highlighted as a key challenge hindering effective response (1). This can lead to asynchronous action between responders (2), misallocation of resources, duplication of effort and the sharing of unnecessary or ambiguous information (3). Because of this, it is important to gain a greater understanding of the factors that affect the collective working of responding agencies in the context of this health crisis to support the ongoing development of good working practice.
5. The Social Identity Approach is a theory of social psychology that can be applied to better understand the way in which people work together both within and between organisations and therefore offers insight into the factors affecting collective working between response organisations during Covid-19. It suggests that people have both personal identities and social identities that are based on group memberships (4). Different social identities can become salient in different contexts (5). When people identify as a group, this affects the way they interact, both with members of their own group, and with members of other groups. Shared identity within a group facilitates coordination and cooperation between group members because this leads to an increased sense of inter-connection and common purpose, and greater capacity for mutual social influence. The emergence of shared norms and goals also increases the ability of the group to work more effectively together (6, 7), as well as fostering trust in other group members (5). For two different groups to be able to work effectively together they need to have some form of shared identity at a superordinate level (e.g. a sense that they share higher-order goals). Therefore, in this research we examined whether and when different group identities were salient between emergency responders in the Covid-19 response and how this affected coordination between them.
6. The research discussed in this report used the social identity approach to understand interoperability dynamics at local and national levels and to identify how the evolving situation affected strategies, practices, and outcomes over time. We carried out regular interviews with responders at strategic and tactical levels across the UK in order to identify good working practices that engendered effective multi-agency working and examined the extent to which these contributed to effective outcomes, particularly harnessing collectivism and solidarity among responders. We used the data we collected to produce regular evidence assessments and analyses which were fed directly back to responders, as well as being published online at Crisis Response Journal to help support the development of good working practices in the response to Covid-19 (8, 9, 10). In the longer term, evidence collected in this research will be used to inform improved understanding for multi-agency working in the future.
7. We are submitting this research as part of the Home Office preparedness for Covid-19 (coronavirus) call for evidence because within our research we identify a number of challenges faced by responders at the local level when working collectively in their response to Covid-19. We demonstrate how actions taken at the national level by central government agencies often exacerbated these challenges for local responders and show how responders managed these challenges. We applied our findings to relevant theory to identify suggestions of ‘what works’ in the response to Covid-19, in order to support the ongoing response and to enhance preparedness for future incidents.
8. To understand how different organisations worked together through the LRF in the response to Covid-19, we conducted a series of interviews with responders at the strategic and tactical levels of response between 13th April 2020 and 27th July 2020. Ranks of responders included Superintendent, Chief Fire Officer, and National Inter-Agency Liaison Officer.
9. Responders involved in the interviews were from each blue light service and included representatives from England, Wales, Scotland and Northern Ireland (Police, N=8, Fire and Rescue, N=7, Ambulance, N=2). Six responders took part in one interview, four took part in two interviews, three in three interviews, one in four interviews and three took part in five or more interviews (total number of interviews, N=52).
10. Interviews focussed on understanding how the different organisations in the LRF partnership came together in the response to Covid-19, any key challenges responders faced and how they overcame these challenges. In the first interview, the questions focussed on roles and responsibilities in the response, multi-agency working, and any key challenges faced. Subsequent interviews examined any developments or changes that responders faced since the previous interview. Our findings are organized under two key superordinate themes: horizontal intergroup relations and vertical intergroup relations.
Horizontal Intergroup Relations – this refers to the relationship between organisations within the LRF partnership.
11. In our initial interviews (April 13th, 2020 – May 14th, 2020) responders described a key strength of the response being how well everyone came together in such uncertain circumstances in order to put a response in place. Responders credited pre-existing relationships between partners as being a key facilitator in the group coming together due to trust already being established and providing the ability to get straight on with the job. However, some responders discussed difficulties in the range of partners that were involved as there were a number of guest agencies involved who would not ordinarily be involved in the LRF structure. This created challenges with new partners being initially hesitant to bring problems they were facing to the table because they were not familiar with the LRF, leading to delays in resolving them. Furthermore, some responders made a distinction between the blue light services who are used to 24-hour crisis management, and other organisations who tend to work ‘9-5’ and described how this created some initial tensions. We therefore suggested the importance of partners understanding the purpose of the LRF and what is required of them in order to be able to work collectively with each other. What works: Providing new partners with a full briefing of the purpose of the Local Resilience Forum and the structure of the meetings they will be attending.
12. In later interviews (May 15th, 2020 – June 12th, 2020) responders highlighted that challenges in the response arose when the initial ‘peak’ of Covid-19 passed, and pressure from an individual’s own organisation competed with the ongoing demand from the LRF, which included preparing for a potential second spike and how this might link with winter pressures and the flu season. While the existing team ethos within the LRF was still present, pressures from work that had previously been stalled because of Covid-19 were beginning to re-emerge. One way some responders explained they were managing this challenge was by the chair of the meeting going over the group’s key goals at the beginning of each meeting. This was important in encouraging collaboration between partners and ensuring all partners understood what they were working towards and continued to maintain a shared situational awareness, which can help keep the shared identity salient. Research suggests that maintaining a shared identity within the LRF can promote responder resilience and reduce the impact of this challenge on multi-agency response. What Works: Chairs of strategic and tactical co-ordination group meetings continuing to emphasise the shared goal of the response.
13. In our final stage of interviews (June 13th, 2020 – July 27th, 2020) responders discussed challenges when trying to understand what the move out of the initial ‘response’ phase looked like and what it meant for the strategic and tactical coordination groups (SCG’s and TCG’s, respectively) continuing to meet. There was some disagreement between organisations on when was the right time to step down the SCG and TCG’s, due to differing views on the state of the response. For example, one responder explained that some partners were more nervous than others about stepping down the SCG and suggested this was due a fear of no longer having access to the support and resources that the SCG provided. However, this responder explained that the meetings could re-start at any time if needed. This demonstrates the importance of partners having a shared understanding of where they are at in the response, what others partners current risks are, and what the SCG/TCG are doing to mitigate these risks. One responder explained that the current LRF set up outlines two stages that the partnership would be in: ‘response’ or ‘recovery’, however, they were not in either which caused confusion. To address this, one LRF moved into an ‘in-between phase’ after the initial response phase, and before the recovery phase, which they called the ‘stabilisation phase’. The reason behind this was to remind partners that whilst they were not in an active response phase and not meeting regularly anymore, the SCG was still there and ready to stand back up if, or when it was needed again. This was important in helping to provide a shared understanding between partners of what stage of the response they were in. Providing a name for this new ‘in-between’ phase was important in helping keep both the shared identity and the shared purpose of the group salient, facilitating the effective working of the group, even when they were no longer meeting. What Works: Using a name such as ‘stabilisation phase’ to describe the period between response and recovery.
14. Initially, a key challenge consistently highlighted by responders centred on communication between national and local level. Responders experienced difficulties as a result of receiving key announcements at the same time as the public. This left them with limited time to understand and respond to any new information, putting them at an operational disadvantage and interfering with their ability to provide a timely response. Responders expressed mixed opinions as to why this occurred. Some believed that they were told information at the same time as the public to prevent leaks, while others suggested that it was because those in more central roles were also receiving delayed information, impacting the speed at which they could make decisions and pass on information. This highlighted not only the importance of local responders understanding the communication processes from a national level and why they might not receive information when they need it, but also the importance of national government agencies understanding what local responders need from them and how delays in information sharing can impact the response at a local level. Local responders feeding messages to central government through their local government liaison officer can help facilitate the development of shared norms and values, and to build trust between the national and local levels of response which can help to provide a joined-up up approach between the two levels. What Works: Ensuring communication channels between local and central government remain open by continuing to feed messages upwards through the local government liaison officer.
15. In later interviews, whilst communication challenges between national and local levels was still prevalent, some responders reported being less reliant on information coming down from central government to guide them in their response and were utilising a much more local-level approach. An approach that seemed to work well was the development of connections with other LRFs in the region which facilitated a common regional approach. This allowed organisations to compare and discuss what actions were being taken in each region, to share relevant information, provide updates on what was working well and provide a vital coordination role between regions. In an incident such as Covid-19 which has a nation-wide impact, these regional ‘lesson-sharing’ opportunities helped to ensure that local-level responders had as much information as possible to allow them to carry out an effective response. Responders were therefore able to use their horizontal intergroup relationships as a solution to a challenging vertical intergroup relationship. What Works: LRFs actively communicating and sharing information with other LRFs.
- Providing new partners with a full briefing of the purpose of the Local Resilience Forum and the structure of the meetings they will be attending.
- Chairs of strategic and tactical co-ordination group meetings continuing to emphasise the shared goal of the response.
- Using a name such as ‘stabilisation phase’ to describe the period between response and recovery.
- Ensuring communication channels between local and central government remain open by continuing to feed messages upwards through the local government liaison officer.
- LRFs actively communicating and sharing information with other LRFs.
16. The findings from these interviews are presented in briefing reports, alongside relevant theory, to generate the evidence and theory-based suggestions of ‘what works’ in the Covid-19 response. For more details of the research and results discussed here, the reports can be found online at the Crisis Response Journal (8, 9, 10).
17. The research discussed in this report highlights some of the challenges local level responders faced when responding to Covid-19. Further, this research highlights how factors such as delayed information sharing from a national to local level can exacerbate challenges and hinder the ability of responders to provide a timely response to the incident. As demonstrated here, a key solution that responders implemented in response to the challenges with the vertical intergroup relations was forming wider horizontal intergroup relations. Whilst it was clear that responders felt they would have benefitted from an improved information flow between the national and local level, the strong horizontal intergroup relationships between members of different organisations were critical to the responders being able to effectively work together to minimise the negative impact of Covid-19.
18. This research forms part of a wider PhD project which is being undertaken by Louise Davidson and supervised by Dr Holly Carter, Professor John Drury, Professor Richard Amlôt and Professor S. Alexander Haslam. The research discussed in this report was conducted in collaboration with Professor Clifford Stott and Dr Matthew Radburn. The project is jointly funded by the Fire Service Research and Training Trust and the University of Sussex. John Drury, Holly Carter and Clifford Stott were supported by a grant from UK Research and Innovation (UKRI), reference ES/T007249/1. Holly Carter and Richard Amlôt are funded by the National Institute for Health Research, Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response (EPR) at King’s College London in partnership with Public Health England, and in collaboration with the University of East Anglia and Newcastle University. Louise Davidson is also affiliated to the EPR HPRU. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care or Public Health England.