Coronavirus (COVID-19) care home outbreaks - root cause analysis: progress report November 2020 to September 2022

8. Leadership

Leadership roles within care homes, particularly care home managers, as in other sectors are vital and are recognised as being one of the key factors in the successful running and the quality care and support ^{[27] [28] [29]}These roles, are particularly complex and demanding, but have been especially so through the intensity of the COVID-19 pandemic. Staff have had to deal with grief and loss on an extraordinary level as well as adopt a range of measures to keep people safe. Management organisations, structure, size and degree of staff specialism can vary depending on care home, bringing added complexity.

The high pressure, turbulent and high-risk nature of the pandemic has put significant strain on the resilience of care home managers. This is recognised within the RCA report, citing the need for managerial organisations, regardless of size, to act and provide support allowing managers to successfully undertake their role.

The RCA report recognises the diverse range of backgrounds and skills among care home mangers whilst identifying the desirability of access to; enhanced leadership training, mentoring and local leadership networking. The report acknowledged that managers with professional nursing backgrounds are more likely be registered with the Nursing and Midwifery Council than they are the SSSC. Care home managers who are also registered nurses are not, therefore, mandated to obtain a leadership or management qualification.

Recommendations:

8.1 Organisations should take steps to ensure the emotional wellbeing of all staff, with a particular focus on care home managers, through providing access to support and signposting to the range of resources currently available.

The RCA report recognised the immediate need to support the emotional wellbeing of care home managers, as they and their staff grapple with resilience in dealing with the pressures created by the COVID-19 pandemic. These included; police investigations, being the focal point for family members concerns; as well as coping bereavement, grief and loss on an unprecedented level were noted as key challenges to resilience and wellbeing.

Progress

Recognising the pressures facing health and social care staff and in particular care home staff a range of national and local wellbeing programmes have been developed.

In May 2020, a partnership was launched with National and local professional bodies for looking after the emotional and psychological wellbeing of health and social services workers, providing support relating to the emotional and physical wellbeing of staff. This is now a partnership initiative between the Rivers Centre for Traumatic Stress and Scottish Government Health and Social Care Directorate. This was done with the support and engagement of key partners – NHS Boards, Health and Social Care Partnerships, Trade Unions, professional bodies and associations.

The emotional wellbeing of staff has been in focus for the SSSC. They have undertaken work to ensure support such as being an active member of national wellbeing focus groups; providing support for the 'Wellbeing Champion Network; promoting the 'Coaching for Wellbeing Programme'. They have also provided leadership development, supervision, coaching and mentoring materials via the SSSC 'Step into Leadership' resource.

Along with CCPS and Scottish Care, the SSSC carried out research in Spring 2021 to establish what kind of wellbeing support was required by managers, frontline workers in care homes, housing at home and care at home workers. Using the feedback received, the SSSC delivered peer support, reflective support and leading in crisis sessions in the early part of 2022. Despite attendance being lower than expected, due to service pressures, feedback was positive.

The Kinharvie institute developed and delivered similar sessions for senior leaders supported by Scottish Government funding and in close collaboration with the SSSC. Similarly, to the previously mentioned courses, despite positive feedback, attendance was low with service pressures being the cause.

To support staff during the pandemic, the CI operated 7 days a week, providing advice and support to managers and staff on managing large outbreaks. Along with this support they also dedicated a part of their website to staff wellbeing resources linking both the Scottish Government and SSSC content. This was in conjunction to delivering wellbeing webinars and establishing a reference group to engage with staff on pandemic experiences. Wellbeing was also included as part of the inspection methodology used by the inspectorate, something they introduced from May 2020. In addition, the Safe Staffing Programme (SSP) delivered 24 stakeholder events which included staff wellbeing.

Locally NHS and Local Authority partners came together to ensure support for staff wellbeing, making use of national resources such as the National Wellbeing hub. This was done in range of ways for example through regular peer forums where staff come together to discuss and share issues as well as the provision of individual wellbeing support for staff. One example was an initiative in NHS Lanarkshire led by clinical psychologists: 'The Care Home Wellbeing Group – in the corner for care home staff'. Recognising the significant impact of the pandemic on care home staff wellbeing and resilience, work was undertaken to gain a better undemanding of the challenges staff were facing to tailor support for all staff regardless of role or employer/ owner. Staff indicated that they found the support from each other to be beneficial so a peer support network was established for staff and managers. A campaign was launched to attract in-house wellbeing supporters in care homes with psychological first aid training provided and access to experienced clinical psychologists. This was complimented by providing information on wellbeing resources and access to support as well as regular newsletters. NHS Lanarkshire developed a video^[30] about the work.

8.2 Consider access to enhanced leadership training, mentoring and leadership networks

Recognition of the diverse range of backgrounds and skills among care home managers was acknowledged within the RCA report. However, particularly given that 41% of managers were still to achieve the required SSSC management qualification, it was identified that access to enhanced leadership training, mentoring and local leadership networking was desirable. Irrespective of background, it is important that managers possess the skills and abilities to support the workforce in challenging times, undertake their role successfully and be supported to do so by the managing organisation.

Progress

Scheduled for launch in October 2022, development of the Leading to Change (L2C) (formerly known as the National Leadership Development Programme (NLDP)) is underway. This will provide a variety of leadership development offerings and support for social care and social work staff. This endeavour is supported by the SSSC who work closely with the Scottish Government in the programme development. Various L2C subgroups have been established, including groups that are social work and social care specific.

NES and SSSC co-designed 'Leadership Links' seminars, with NES hosting. These complimented Project Lift/ L2C leadership community events throughout 2021/22. Staff have been encouraged to attend these events.

The SSSC's promotion and support of Wellbeing Champions as well as the 'Coaching for Wellbeing Programme' have contributed to the advancement of this recommendation along with the delivery of peer support, reflective support and the leading in crisis sessions in early 2022.

The SSSC's Step into Leadership resource has provided social service workers with access to a range of leadership development learning resources and activities including a (360 degree) leadership capability feedback tool for frontline workers. It shares examples of good leadership in practice. It is structured around six leadership capabilities which have been adopted by for a similar resource, hosted by NES on the TURAS dashboard. The SSSC's leadership logic model provides an illustration of what good leadership looks like in social services and can be used to provide focus to leadership development discussions.

As part of the Healthcare Framework implementation, the Scottish Government has funded 5 places for care home managers on the Person-Centred Practice (Advancing Care Home Practice) PGCert programme run by Queen Margaret University (QMU)^[31]. This is a newly developed programme specifically designed and tailored to suit leaders, both clinical and non-clinical, working within a care home setting. It consists of three modules (Theory and Practice of Person-centred Health and Wellbeing; Leading Person-centred Practice for Health and Wellbeing and Advancing Care Home Practice). There will be a focus on leadership, promoting autonomy and experimenting with a range of methodologies, including quality improvement and practice development, to create person-centred cultures that improve the experiences of residents, families and teams in care homes.

8.3 A national information campaign should be considered for care home staff to ensure information is well understood in relation to how personal behaviour can impact on their role whilst at work, to include social distancing, cigarette breaks, car sharing, and remaining vigilant to risks at all times

Progress

The recommendation was written in the height of the COVID-19 pandemic to address concerns at the time including social distancing, personal hygiene etc. This was included in subsequent guidance from ARHAI and PHS in support of the pandemic needs.

The Kind to Remind campaign, developed as part of the CNRG COVID-19 behavioural insights sub group work, was approved at the IPC subgroup on 9December 2021 and ran until it was rebranded as 'COVID Sense' in May 2022. The aim of the initial campaign was to inform health and social care staff behaviours that prevent and limit infection and transmission such hand hygiene, ventilation, quality mask wearing, risk of gathering during break times, being distance aware and car sharing. To support conversations, posters and social media tools called "kind to remind" were produced and issued to the sector.

Launched in May 2022 'Covid Sense' Healthcare Workers Stakeholder Toolkit was published to demonstrate the impact of positive behaviours on individuals and those around them. This includes a campaign film "Because I care" supporting staff in IPC excellence. More campaign links can be found at Scottish Government Marketing News^[32]. The CI has shared this with the social care sector and will continue to share this kind of information and updated guidance with the sector.

Going forward

• The Scottish Government with the sector will continue to recognise the importance of investment in leadership, support and wellbeing. SSSC will provide peer support, reflective practice and leading in crisis sessions to allow staff, who could not attend the early 2022 sessions the opportunity to do so.
• Supervision and learning resources are to be revised by SSSC – including how supervision can be used as wellbeing support for workers.
• The Safe staffing Programme at the CI to support the sector to prepare for enactment of the Health and Care (Staffing) (Scotland) Act 2019. Part 1, the guiding principles, includes staff wellbeing to ensure safe and high-quality services.
• The Scottish Government will continue to support the development and promotion of the national wellbeing hub for health and social care staff.
• NES and their delivery partner, HULT Ashridge will deliver the Developing Senior Systems Leadership programme to the first cohort in September 2022 – a further two are also planned.
• 'You as a collaborative leader' programme is scheduled for late 2022. This is a product of the leadership of integration activity between NES and RCGP Scotland and the SSSC.
• Queen Margaret University is creating a course that is centred on nurses, enhanced leadership training. This includes 'business in care' and 'kindness - person catered framework for organisations.