Dealing with the turmoil wrought by Covid-19 has been like sprinting through a marathon, says Mandy Crowford, who reports on keeping services going during lockdown
As I write this, I am mindful that we have a way to go yet we have achieved so much already, and I wonder what my reflection will look like in a month or a year from now.
I am fortunate to work for an incredible organisation – the Westminster Society for People with Learning Disabilities – which is truly values based, not only in words but also in actions. Most of the senior team had worked together during the H1N1 influenza pandemic and we started our Covid-19 journey with a business continuity plan firmly established and a level of confidence that told us that we would be OK and we knew what we are doing.
I began my marathon run in mid-March. The reality of what was coming had started to hit home. The idea of social distancing was a vague notion coming from overseas. Our first week of planning was spent in our meeting room with the senior management team of six working through our Covid-19 organisational risk assessment and challenges we could face.
This came to a halt on Friday, when one of the team felt a bit “off”. One Covid-19 positive director and, five weeks on, we have seen each other daily using teleconferencing and continued in this way, planning and troubleshooting our way over new hurdles as they appear.
Seeking ‘legitimate’ PPE
The lack of personal protective equipment (PPE) soon became the thing that kept me awake at night and meant that I had to hit the organisational credit card hard for anything that looked legitimate. It was also very difficult to navigate PPE supply processes via clinical commissioning groups and local authorities as each had their own systems.
Our lack of a central purchasing system worked to our advantage and meant we had to spread purchasing across the whole senior team, which allowed us to set up multiple accounts and secure a wide range of suppliers within the supply chain. We centralised the storage and distribution of PPE. I am writing this sitting at my new desk in what was once an activity room; it is now our store room where I issue PPE to our services as needed. From here, I can monitor use and get PPE out to where it is needed quickly and efficiently.
The advantage of central distribution is that I and other members of the senior team have become our couriers. This means we are out and about and visible to all our services. This connection with the teams has been welcomed and reassuring for morale.
On the Easter weekend, chief executive Gabby Machell and I were out delivering PPE. This was a practical demonstration of solidarity as well as meeting a need. We also had to manage constant requests for information from absolutely everyone, including housing associations, the Care Quality Commission, clinical commissioning groups and local authorities, all wanting information in a variety of formats and by different deadlines. Our pleas for a single system were met with sympathy but were rejected, and we continue to struggle with this every day.
Securing food
Battle number two was for food supplies. Usually, the people we work with do their own shopping and make their own choices, with support from staff as needed. As the lockdown began, all of this went out of the window. We bought second hand chest freezers and set up a food bank. We stocked this with donations from local businesses, hotels and a West End casino. We also established links with catering suppliers and wholesalers. We delivered food to services every day.
We noticed a change in some eating habits, especially as a result of the casino donation, which meant many people had a change from their usual meals and were eating lobster and duck à l’orange instead.
As lockdown bedded in, we realised supermarkets were not recognising the social care workforce. We contacted all the major stores, going directly to their chief executives. We contacted all our local branches too, arguing the case for our staff and the need to get food supplies to people living in our services. We had some successes and matters have improved.
Keeping staff safe
Getting the right information out to our staff about the pandemic and how to protect themselves and the people we support was a priority. In the early days, the lack of information was a real problem. Using our internal contacts, we secured the support of a senior nurse working in a London hospital who helped us think through the issues.
This resulted in a social-care friendly training video on donning and doffing PPE for staff and guidance and instruction leaflets. We set up PPE and hygiene stations in services, using camping tables, which were a perfect and creative solution to minimising cross infection in our very small, homely care services.
Our lack of PPE made us more creative. We sourced protective eye goggles from building contractors, sterilising fluid from a home brewing company and gloves and aprons from the motor industry. Our training department set up daily contact with services, working through infection control issues and ensuring the information got through.
Our senior managers set up daily contact schedules with those managing services to troubleshoot emerging issues and ensure all the right procedures and working practices were in place. We assessed each service for critical levels of staffing required to ensure the health and wellbeing of the people we support. Our HR team set up systems to support and track staff with symptoms or who needed to self-isolate and/or shield.
Some of our staff in high-risk groups were required to self-isolate for 12 weeks while others were able to work from home. This group of staff have taken on delivering
telephone support to people with learning disabilities living on their own or in the family home. They also provide daily telephone teleconferencing contact with support, activities and resources for people struggling with the lockdown.
Some staff members were naturally anxious about coming to work so our HR team talked through their fears and concerns and, in many cases, these issues were resolved. The numbers of staff off work were updated daily and communicated to the senior team. This meant we were able to send out daily updates to services about staff availability and, as a result, could allocate staffing when and where needed.
First case
We then had our first confirmed case of Covid-19 in a service user. We were devastated. Then, two more people were confirmed to have the disease in another service plus a further three had symptoms. Sadly, one person died in hospital. This had a huge effect on the people he shared his home with, the staff team supporting him and the organisation as a whole. As part of our weekly teleconference meeting with our managers, we shared the sad news and, even though we were communicating this to faces on a screen, the effect of the news was palpable. This horrible thing was now a reality.
Over the next few weeks, our service users with Covid-19 began to recover. Two returned to their homes from hospital and we set up a recovery/convalescence service in an empty property for a person who was so traumatised by her experience that she needed time and support before returning home. 
The visibility of our senior team and our ability to communicate with people across the organisation have been vital. Teleconferencing has been good for morale and motivation. Seeing teams putting procedures, systems and working models into practice and the care and dedication shown to the small number of people who have been sick with this virus fills me with pride.
Most of our staff have been incredible. We are finding heroes in our teams and managers every day, and it makes things a little better for us all when we know that we are in this together. Letters of thanks from our chief executive to staff and gift packages for workers and homes from charitable donations have given morale a much-needed boost. Our weekly updates with managers are the times we know if we are getting it right or not. We have many moments of joy and pride at how people are keeping things going, which spurs us on for another week.
However, our work is not all pride and joy. Frustration and anger are also part of the daily yo-yo of emotions we all go through. All of us are frightened and worried at times, and confident and optimistic at others. It would be untrue to say that everyone has been on the same page throughout. We have seen some staff behaviour that does not fit with our values (but these are definitely the few exceptions). The vast majority of our staff have been wonderful. On my food and PPE delivery runs, the level of optimism and commitment from staff and the people using our services has been a pleasure to witness.
Care sector proves critical
Thankfully, testing our staff and people using our services for the virus has become a government priority. However, we did have to deal with pressure to admit people to our services without prior testing and isolation. Our insistence to the NHS and commissioners that this was not acceptable did, we hope, save lives.
In addition, along with our care and disability partners across the country, we pressurised decision makers to ensure the care sector was recognised as critical to shielding the NHS and the country as a whole and therefore our staff deserved equal status with our NHS colleagues.
However, managing the additional information flowing from the government and our local authority and health partners, which includes government policy changes, continues to be difficult. Most of this information and guidance does not really reflect learning disability services, supported living models, or the use of language, settings and imagery. This has meant we have had to interpret what is being said and convert the information into something that makes sense to our staff. This has added to our workloads enormously.
So, like everyone else in the country, we wait each day for the government’s daily briefing. This triggers a flurry of thinking about its impact and an agreement on the actions we need to be taking as a result. Each week, something new is conveyed and we are back to the early days of our planning through organisational risk assessments to make sure we think through each change and how it affects us as an organisation as well as our workforce and the people we support.
Anticipating the exit
We are starting to think about the exit and what this might look like in the coming weeks and months: the staff vacancies that still need filling, the training we still need people to access, the voids we need to let, the tender that is going live and will need writing and hopefully delivering on, the incidents that need investigating, the funds that need to come in, our social media presence to keep us visible and part of the conversation, the reduced lockdown and increased risk of infection, and the funeral for the one person we have lost that needs organising.
I wonder: can I carry on sprinting when we have come so far but still have so far to go? I am not the only one sprinting – this whole organisation is running at top speed and we are all having our personal and professional moments of struggle.
We will need to take a break soon. We all will. How and when is not yet clear. What we will be like in six months is hard to anticipate. What I do know is that our organisation has put people first and I work with a team who share the work ethic and commitment needed for this sector.
That is why the cancelled leave, and weekends and evenings spent working are worthwhile. I will do the same tomorrow and the next day and the day after that until we are through this and the finish line is in sight.
● The Westminster Society for People with Learning Disabilities: www.wspld. org.uk. The society is changing its name to London Living
