Earlier this month, together with the Welsh Government, we held our fourth Regulatory developments and the Welsh context seminar. This event is an opportunity to review recent health and care regulatory policy developments in Wales and across the UK, and to provide an update on current issues and challenges influencing Welsh Government policy. While we did miss the opportunity to visit our colleagues in Cardiff, and to network over the course of a full day as opposed to just two and a half hours – what this remote format did offer was ease of access. This led to our highest turn-out yet, with 90 colleagues dialling in from across the UK.
The session aimed to examine the impact of the Covid-19 pandemic on different parts of the system. As noted in the opening remarks by the Minister for Health and Social Services in Wales, Vaughan Gething, professional regulation has had to be flexible and reflect that the scope of practice for many healthcare professionals has changed and extended beyond traditional boundaries. This need to change can lead to improvements, but it is vital that we don’t lose sight of patient safety.
Adapting to the pandemic
Education and training had to innovate to adapt to lockdown measures. Angela Parry from Health Education and Improvement Wales (HEIW) outlined how they had responded to the crisis, and how digital technology became central to this. Annual Reviews of Competency Progression (ARCPs), exams, interviews, GP modules, and professional support all had to be provided virtually, as did planned work to develop and approve programmes and carry out strategic reviews. At the same time, many professionals have had to move to providing care and support to patients and service users online. This presents new challenges for both the professionals and the public. Efforts to support health literacy and digital literacy therefore have and will continue to play a huge part in ensuring genuine co-production of services into the future.
David Pritchard from Social Care Wales explained their approach to flexibility, which included making all of their work, including hearings, available online. For example, piloting an approach to fitness to practise to take context into account to reassure registered social care professionals that the unprecedented demands put on them were being considered. Other processes included: setting up temporary registers, establishing new rules for manager registration to help cope with absences, and the use of multidisciplinary teams. This demonstrated how important adaptability and the need for transferrable skills which go beyond clinical and professional abilities are to meet workforce requirements.
The seminar also looked at how mental health has been supported throughout the pandemic. Tanya Leonard and Gary Catterall from the Association of Child Psychotherapists gave their perspectives on moving therapeutic work to online forums and phone calls. Some groups of patients responded more positively to this than others – while it caused concern for some children and young people, it also made services more accessible and useful for others. It has been important to make sure face-to-face support can continue where there is an urgent need. Practitioners have been creative, taking advantage of new ways of working where possible – for example, by making new links with colleagues to ensure that service users in need are flagged quickly.
The need for effective communication
In a crisis, communication becomes paramount to responding effectively, and can be the most challenging part of the process. Speakers explained how they worked together with stakeholders and the wider workforce to react in a cohesive and timely fashion, and how this has highlighted the greater need for collaboration beyond the pandemic for the future.
For HEIW, liaising and collaborating between the four nations and the regulators was essential to ensure education standards were maintained when emergency standards were introduced. Angela also noted how they worked to support the wider workforce and the system, by providing access to resources in areas such as compassionate leadership, health and wellbeing, critical care, and remote clinical decision-making, among others. Simulation based education (SBE) and other tools have been used to facilitate experiential learning in a time where it has been impossible to do so normally.
Social Care Wales stressed the need for regulators to engage and work together, develop better relationships with employers, engage in wider legal debates, and communicate directly with workers on the front line. The regulator facilitated peer support networks and provided data and information on the workforce to Government and others. They suggested that going forward, the UK Regulators must continue to work together across the nations.
David added that while virtual hearings work and are popular, they do present challenges – suggesting that better support is needed for those undergoing fitness to practise investigations, with an understanding of their impact on newly qualified social workers. Attendees also discussed how lockdown has highlighted the need for more meaningful personal communication with patients, and that decisions needed to be made with rather than for them. Examples of this included seminars on the remote fitness to practise guidance.
According to the ACP, a move to virtual has made professional connection more efficient for many Child and Adult Psychotherapists, with meetings and discussions being made easier to arrange and access. As Tanya and Gary explained, the all Wales Child and Adolescent Psychoanalytic Psychotherapy (CAPPT) group has developed and continues to have more contact with organisations, who can work in partnership when resourcing the workforce for children and young people with mental health difficulties. The ACP are talking to HEIW about the development of an infant mental health diploma and a standardised training for clinicians. They are also working with colleagues in Welsh Government to discuss developing the profession to help improve access.
While bringing together services and working across the system, organisations need to also reflect on what has and has not worked. Re-deploying staff, stabilising services, and delivering robust interventions were all actions taken to meet the needs of the population and to keep young people safe and protected. With this comes a need for effective risk management, safeguarding and education.
Learning for the future
The Authority has been working on its own analysis on Covid-19’s impact by carrying out a learning review. The review is due to be published this Spring. Douglas Bilton gave an update on how regulators had responded during the first wave of the pandemic until July 2020. For the review, we asked regulators and stakeholder organisations what measures, new policies, new approaches or key decisions they considered to have been the most effective in responding to the pandemic, and where these have had a particular positive or negative impact. They were also asked whether there had been any unintended consequences of these changes, as well as if the crisis had highlighted any gaps in regulation. The report identifies various themes and sets out provisional recommendations for further review, including the value of establishing temporary registers, set against the risks and costs; the experiences of temporary registrants, and whether other regulators who did not have powers to set up temporary registers should have had this power, as well as how the pandemic had impacted collaborative working.