While COVID-19 is wreaking havoc on the vulnerable, the economy and society as a whole, it is also generating – by necessity – some new and innovative ways of working. DDN reports.
With the UK’s lockdown now in its second month, everyone has had to adjust to the ‘new normal’. However, in much the same way that COVID-19 can be far more damaging to people with weakened immune systems or pre-existing conditions, so it has the potential to cause disproportionate damage to sectors already depleted by year after year of shrinking budgets. Whether the inevitable recession that comes in its wake will lead to greater austerity, or whether renewed respect for health services and – perhaps – a different attitude to society’s most vulnerable might see the drug and alcohol sector get off relatively lightly (DDN, April, page 7) is yet to be seen.
In the meantime treatment services, like everyone else, are having to get by as best they can. Substance misuse staff have been designated as key workers eligible for COVID-19 testing if they display symptoms and for school-based care for their children, which means the sector is able to function better than most. Arrangements have also been made to try to ensure people can get their substitute medication, and organisations have also been able to move elements of their support online.
The government published its guidance for treatment services and commissioners on 15 April (see news, page 4) which – alongside instructions to minimise face-to-face contact, scale back hep C testing and defer detoxes – recommends increasing provision of harm reduction measures including naloxone, and encourages services to increase stock held by NSPs and allow people to take more equipment. The guidance also advocates new ways of working, such as by phone or video call, something most organisations were already doing.
‘I do think that the drug and alcohol sector were getting on with it ourselves because of the very nature of what we do,’ director of health, care and wellbeing at the Calico Group, Nicola Crompton-Hill, tells DDN. ‘But I think what the guidance did was offer reassurance. One example was that staff were recognised as key workers. That alone really helped me and the management teams realise we’d be able to manage staffing levels and safeguarding better.’
‘We were heartened to read the guidance, especially as WDP had already implemented the overwhelming majority of it,’ agrees WDP chair Yasmin Batliwala. ‘The guidance is sensible and comprehensive but will of course need to be updated to suit the ever-changing situation, particularly as lockdown restrictions are eased and we begin the return towards normal service operation – albeit with stringent protection measures in place.’
WDP has moved support to online resources, videoconferencing facilities and phone appointments where it’s considered safe for the service user, although it also continues to safely operate in-person appointments. ‘Our IT department has also rolled out a large amount of equipment and support in a short space of time, for example a desktop phone system used on tablets to allow staff to make and receive calls using the usual service number,’ she says.
It’s possible that one of the long-term impacts of all of this might be a shift towards more online support and counselling generally, although clearly there are areas where this will be far from ideal. ‘We’ve been adapting the model and the programme where we can to offer virtual support and virtual counselling,’ says Crompton-Hill. ‘Some staff in our residentials aren’t used to working digitally so I’m really proud of how quickly that culture’s been adapted, and we’re starting to think about how we can enhance services going forward. Given that when we come out of the actual crisis we may be left with a reduction in funding, can we do more in the style that we’ve had to adapt to? But there are lots of mutual aid groups operating virtually at the moment and what’s key to mutual aid is actually going out there and socialising with people in similar situations – having that connectedness and those one-to-one chats. So although people have done their very, very best, those sort of things will be really impacted, so it’s just trying to get the balance right. I think we’ve just got to hope as a sector – and fight a bit – to try to get back to where we were in terms of our offer and delivery.’
The unprecedented operating environment has meant that organisations have needed to come up with other alternative ways of working. While the lockdown has inevitably forced the partners who provide the rewards for WDP’s Capital Card scheme (DDN, February 2019, page 6) to close, the organisation is securing a free-of-charge arrangement with a national delivery company to deliver essentials like clothing and hygiene products from Capital Card shops – normally located in services – direct to service users’ doors. While keen to return to normal operating models, WDP will ‘certainly be able to boost our offer with a lot more home participation for service users in the future,’ says Batliwala. ‘This should really help the momentum of recovery journeys between in-service appointments.
Although it’s been a period of rapid change, the local authorities commissioning WDP’s services have been ‘extremely supportive, which has been a big help’, she adds. ‘It’s been a real two-way process – there’s been a real sense of really wanting to help us with PPE, for example, which has been really welcome,’ agrees Crompton-Hill.
‘We’re proud of the way all WDP staff have risen to the challenge with both dedication and innovation,’ says Batliwala. ‘To say thank you to them doesn’t seem nearly enough. The fact that we’ve managed to still provide both an in-person and remote service in all areas has been a huge success. We’ve maintained very regular communication, guidance and encouragement to staff throughout, and have done whatever we can to boost morale in small ways such as pizza lunch deliveries and ‘fresh fruit Mondays’. We have also vastly expanded our online support for staff, including workouts, weekly wellbeing webinars and tips for effective home-working and coping with lockdown in general.’
What no one knows, of course, is what the long-term financial impact of all this is going to be on the sector. ‘A lot of the work we’re doing at the moment is looking at the “what if?” and factoring in the financial implications of that as a business,’ says Crompton-Hill. ‘I think what we need to try to do as a sector is use what we’ve learnt over the last month to see if we can step up to what those financial challenges might be, for example can we do more digitally so we can see more people? We don’t want to have to do that because a lot of our services run on being able to come together, but we may have to.
‘One of the things I’m proud of is the staff and their resilience, and their ability within a very short time frame to adapt their everyday practice,’ she continues. ‘We’ve been specifically helping with homelessness. We looked at all the beds we had available and with every service that had a bed it was, “can we help?” Everyone mucking in together has been a real theme over the last month.’
Another thing that the crisis has reinforced is the vital importance of effective communication. ‘Really open and transparent communication has been key,’ she states. ‘I’ve had that from the local authorities we work with, and we’ve done that with all of our clients in treatment, all of our staff, partners – it’s really helped us through this. I’ve never had as much communication coming through, and I’ve never sent as much out. But I think that helps people feel fully informed, and it’s been a real key thing for me. You’ve not felt alone in the process.’