A Reflection on Supporting People with Complex Needs during the Pandemic

Arron Zaib, Managing Director of Komplex Care Telford, reflects on supporting people with complex needs during the pandemic.

January 2020, with the chimes of Big Ben in our ears we were all looking forward to the new year and our plans for the future. Only a few understood the magnitude of what lay ahead. Pre-pandemic the care of people with complex health needs had been challenging for all health care providers. Working with clinically diverse people with multiple conditions, Komplex Care are one of the few specialists’ providers who care for individuals that require home ventilation. Spinal Cord Injury, Muscular Sclerosis, Motor Neurone Disease are some of the conditions we can support people to live at home. The care packages that we deliver are individual to the client’s specific needs with both clinical and operational oversight. We employee registered nurses to train and clinically manage our care packages for both adults and paediatric clients.

As a specialist provider we can deliver care packages for a range of complex conditions. From the outset, our clients with impaired respiratory function were particularly vulnerable if they were to contract Covid 19. As the Pandemic has progressed through its various stages another hurdle to over come was how we manage the use of PPE in the care packages where clients have Complex Mental Health needs. The wearing of masks meant some behavioural changes were observed, to alleviate this we were able to access transparent masks. Having a team that are solution based in there thinking has helped us through the many challenges we have encountered.

Working in complex care requires planning and managed processes to ensure the safety of our clients and staff, as we entered February providers like ourselves were in full planning mode and drawing up contingencies on how the pandemic may affect us. Our orders of PPE were made well in advance and our stock levels looked healthy. Our infection control policy was reviewed by our lead clinicians and redistributed amongst our workforces. Our clients and staff were concerned, we were at the front line and seeing healthcare professionals in other countries without PPE contracting Covid-19 and becoming seriously unwell and in some cases dying, this was heightening all our anxieties. We had attempted to cover as many bases as possible.

As the prime minister announced that the United Kingdom was going into Lockdown all hell broke loose. Ours PPE suppliers cancelled our orders guidance changed daily we were unable to get clear guidance from Public Health England and we as providers were attempting to manage clients who were by the nature of their conditions extremely vulnerable to this disease. One of our challenges was appropriate masks, FFP2 FFP3 KN95 these were products most had never heard of and obtaining them had become next to impossible. Most complex services are commissioned by the Clinical Commissioning Groups, and I know providers sought guidance and support, but they were in the same position and could only guide us to local resilience forums that were hit and miss and varied in their ability to help in different areas of the country. We were worked closely with the Care Quality Commission, they were always willing to support when needed.

The working from home guidance raised more issues, a considerable proportion of our workforce had children and with schools now closed had no childcare provision in place and were unable to attend work, once the essential worker list was implemented the impact of this greatly reduced.

The dedication and commitment shown by the care workforce has been underestimated. As frontline care workers supporting some of the most vulnerable in our society, they took a heavy load and reduced the pressure on the NHS during the pandemic. For too long over multiple governments a division has been created between NHS staff and its perceived lesser cousins working in health and social care, this was again highlighted with the initial clap for the NHS, I was so pleased to see this adopted for all frontline Key workers. The CARE badge was meant to help with the levelling up between Health and Social care and The NHS, although the idea was positive in reality this was merely a gesture, I wear mine daily with pride, “My badge of Honour” as an ex- Health Minister coined. This led to an urgent question in Parliament on the matter by Lord Rogan. In total 15,000 were distributed before supplies ran out. In the United Kingdom we have 1.5 million care workers, giving only 1% of care staff access to one. Until Health and Social Care and the NHS are treated equally the divide will remain.

During the Pandemic at Komplex Care we took the decision that keeping our clients and staff safe was the priority, we did not actively look take on new business. This was not the same for all care providers. Recruiting staff in all areas of care is a challenge but finding resolute and committed people that want to take the level of responsibility required to care for our clients is exceptionally hard.

Recruitment of fresh staff declined during the pandemic. This led us to only commit to our current client group. We initially had an influx of applications from candidates that had never worked in care those inspired to help others and those that had unfortunately lost an income and were not entitled to government support schemes. The recruitment of new care staff during the lockdowns proposed new questions, how can we deliver training? A whole new training plan and how we would deliver it was devised to equip our workforce with the appropriate skills to deliver high quality care. We also embraced technology, Zoom Teams, and the like, but we have gone even further forward, digital care planning E-mar, Virtual assessment, and web-based recruitment. Implementing technology gives us a greater oversite and flexibility for our clients in the delivery of their care. This has also reduced our carbon Footprint; we are doing our bit!

Our clients and their families have all seen Covid in different ways, just the same as the rest of the UK and the world! we have some clients that have been and remain very cautious, those that were advised to shield but decided against it, some that think its and over reaction. The one constant has been their understanding that we were dealing with a threat that no one had the full facts and our guidance and advise was and remains likely to change. When the PPE supply chains eased, it went from one extreme to another. The operational and logistical skills demonstrated by my teams would rival some of the multinational delivery companies, I can see the picture now of our staff fully kitted in personal protective equipment transferring other kit into each other’s cars in supermarket car parks and lonely motorway services.

The long-awaited white paper on the future of social care “People at The Heart of Care” was published by the government in December 2021. The paper proposes just as many questions as it has attempted to resolve. All staff either working within Health and Care must be rewarded appropriately. The costs associated in delivering care have risen during the pandemic, it is not only staff pay that needs to rise a commitment to care providers is required so we are able to offer better terms and conditions.

As we came out of Lockdowns, Komplex Care have received many enquiries for our services, this is obviously a good thing for our business, however we have heard from some of these new enquiries they have not received a good standard of care, which is extremely sad to hear in our industry. At Komplex Care we ensure ‘care’ is at the heart of everything we do, it must be safe, and it must be the best for our clients. Commissioning Teams are inundating us with referrals, they are really struggling to find care provision. Our ability to take on new business is driven by recruitment, whether it be, nursing assistants, support workers, registered nurses, operational support, and even recruiters, Healthcare is not an easy industry to work in and with the new variant of Omicron this may potentially get worse before it gets better. The compulsory vaccination for our sector will also have an impact. We take this into account with all new applications and have seen candidates withdraw when advised it will be a requirement. Many of our client group will not accept staff if they have not received the Covid – 19 vaccines. At Komplex Care we promote choice and look to support our clients and staff. The uptake of vaccine has been high with our current workforce, and we have worked on providing factual information for any of our staff and clients that required any additional advice. I think the communication on the benefits and reasoning why we vaccinate the health and social care frontline workers would have been a far better way to keep all healthcare staff engaged and committed to the vaccine role out.