Director of Standards and Policy, Christine Braithwaite, reflects on the impact the pandemic has had on the health and social care workforce, as well as how the Authority intends to use learnings to respond to the ongoing challenges.
A physical and emotional toll on registrants
For registrants, it has meant a myriad of difficulties. Nurses in intensive care used to caring for one patient at a time are suddenly caring for several patients. In this crisis the ethical decisions they make have taken on a new speed, intensity and significance. Who to attend to first, and in what order should normally routine tasks now be performed? When the timing of an intervention can be critical, these are hard choices to make. Then there is the anxiety of clinicians being moved to unfamiliar clinical areas, dealing with the sorts of conditions they may have covered briefly during their early training, but no longer experience within their current specialty. For many it’s managing the sheer volume of patients requiring complex Covid-related interventions, and having to speculate, in the early days at least, rather than having the comfort of knowing, what the best combination of treatments might be. And when they are tired, possibly distracted, anxious for their own safety or their colleagues, some separated from their own families or worried about family members – there there are knock-on effects for the care they provide to other patients.
Then there is the emotional toll of more patients dying than usual and having to tell their families. The role conflict which many felt when they had to deny families access to their dying family member – speaking through glass, or on the telephone, unable to touch or comfort them. And the unfamiliarity of caring for patients and not knowing if they were putting their own health, and possibly that of their family, on the line. We expect our armed forces to risk their lives. Not so much our doctors, nurses, paramedics, pharmacists, social workers and their brave colleagues. We cannot – and do not – underestimate any of this, and are in discussions with the regulators about the best way to take account of the Covid context in investigating and responding to any concerns.
How the regulators responded
Regulators too have had to tread unfamiliar ground. They responded quickly, opening emergency registration to allow retired professionals to return to practice, publishing guidance, and moving hearings to virtual platforms.
We set up a Covid risk log, tracking new risks as they emerged to help us identify whether we or the regulators we oversee might need to take action to stem them. The sectors where we identified potential risks included patient care, education of health and care professionals, safeguarding, workforce, freedom to speak up, regulators and social care. In each of these areas we checked to see what action regulators were taking; for example, making changes to placements for students or the arrangements for accelerating second and third years students’ entry to the workforce to support their qualified colleagues. Regulators also made changes to their revalidation requirements and issued guidance for registrants on speaking out during the pandemic when some raised concerns about feeling silenced.
As a result of our monitoring, we consulted, and then produced, guidance on virtual hearings for regulators on holding hearings remotely, which we issued to help them achieve a consistent approach. We tracked the issues surrounding personal protective equipment (PPE) and the impact of Covid on BAME staff, noting that regulators gave clear guidance to employers to undertake risk assessments to ensure their employees were protected – and we continue to monitor it. We tracked reports of the blanket imposition of Do Not Attempt Resuscitation Orders. Regulators responded promptly, putting out guidance to their registrants not to do so, but we were unclear whether any that had been imposed had been lifted. We subsequently wrote to the Department for Health and Social Care. We are pleased to see that the Care Quality Commission are following this matter up through their review, now they have resumed inspections.
Other aspects of regulators work have involved changes to their educational requirements, particularly practical ones, to allow for the fact that this may be difficult for hospitals to manage in the pandemic. On fitness to practise matters, they concentrated initially on the urgent cases – identifying the cases which needed interim orders or reviews.
How the Authority adapted
We too altered our activity by limiting our performance reviews and adapting our timescales to ensure that regulators had the space to undertake their urgent work. We also sought clarification from DHSC about the practising status of practitioners on Accredited Registers, resulting in clearer guidance for the second phase of lockdown, and an adjustment to our accreditation process to take account of the impact of Covid.
We all hope this pandemic will be a unique event in our history. But it may not be – and so later this month, we will publish a report on learning from the early period of the pandemic. It will include a series of case studies from the regulators, learning from their experiences of regulating during a pandemic. We hope this will be useful, not just in continuing to manage this pandemic and to sustain the gains made by the rapid way in which the regulators have responded and innovated, but also in making ready for any future challenge.
Read our guidance on virtual hearings or find out more about how we have adapted our processes and are working through the pandemic here.
We are also publishing a series of guest blogs looking at the impact of the Coronavirus pandemic across the four nations of the UK: