Feeling like Cannon Fodder – researching the challenges of frontline doctors in the response to Covid-19

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By Dr Liz Jenkinson, Senior Lecturer in Health Psychology and Co-chair of the UWE Bristol Healthy University Group

With a new variant pushing healthcare capacity to its limits, understanding the challenges of responding to Covid-19 on the frontline is pivotal. As a Health Psychologist, I am driven to inform and develop evidence-based policy and practice in healthcare. I have been working with Jo Daniels and Sophie Harris at the University of Bath, Edd Carlton (University of Bristol/Royal College of Emergency Medicine) and Tom Roberts (North Bristol NHS Trust/Royal College of Emergency Medicine) to capture the scale of the challenge faced by healthcare professionals responding to the pandemic. Despite the popular media narrative of healthcare workers being our Covid-19 heroes, our research documents that many simply do not feel that way in terms of how they are being supported. The research highlights how frontline healthcare workers are angry at being treated as ‘Covid cannon fodder, not Covid heroes’ after responding to the virus for nearly two years.

‘It’s been ugly’: A large-scale qualitative study into the difficulties frontline doctors faced across two waves of the COVID-19 pandemic’ is the first study of its kind to capture the views of over 1,300 doctors in the UK and Ireland responding to Covid-19 since early 2020. The study was published in the International Journal of Environmental Research and Public Health this week and featured in the Sunday Times, BBC news and beyond.

Despite working at ‘100% capacity, 100% of the time’, the frontline healthcare workers told researchers of their frustrations at those not following public health advice, and towards Government for ‘failing in so many ways to support us.’ Doctors said they felt ‘expendable’ and left traumatised by events. The dual issues of a worrying lack of support for doctors’ basic needs (e.g. insufficient places to rest, food to eat, and relentless shift patterns), and a significant lack of appropriate psychological support to help them decompress was also highlighted.

Participants recruited for the study comprised frontline doctors who worked in emergency medicine, anaesthetics, and intensive care medicine in all parts of the UK and Ireland. All genders, ethnicities and seniority levels were represented in the sample of 1,379 participants who responded to a longitudinal survey asking them to answer freely: ‘What has been most difficult about the pandemic?’

Clinical psychologist at the University of Bath, Dr Jo Daniels, explains: “We are seeing increasing levels of staff attrition, absenteeism, poor psychological health, and loss of life, yet frontline doctors are expected to just carry on.”

These findings build on recent work, including the CERA study, which sought to quantify psychological distress experienced by emergency doctors during Covid-19, and the Covid-19 Clinician Cohort (CoCCo) study model, which highlighted a hierarchy of needs for frontline workers responding to the pandemic. These ranged from supporting workers’ basic needs with hot food and drinks, through to embedded peer support, psychological care, and interventions. The team say it is imperative policymakers learn lessons from this study as they respond to the impact from the latest Omicron variant.

Dr Edd Carlton, Professor of the Royal College of Emergency Medicine and Emergency medicine doctor, co-authored the research. He said: “This work demonstrates the massive impact the pandemic has had on our frontline medical workforce in terms of working conditions, morale and psychological distress. What is most worrying is that Covid-19 has compounded issues that were already commonplace pre-pandemic and now are putting a tangible strain on doctors’ own physical and mental health.”

My work at UWE Bristol continues to collaborate with the team, bringing my expertise in Health Psychology into this space. We are very grateful to those who gave up their time to tell their stories, which were striking in their agreement that this had been unrelenting, traumatic and had placed unsustainable pressure on frontline doctors. As we move into what may prove to be yet another wave of the pandemic, this research shows that there needs to be a renewed focus on properly supporting doctors to protect their health and wellbeing so that they can be there for all of us when we most need them.

Read the academic paper here and click here for an animation based on Covid-19 healthcare research.

Learning from lockdown: how teachers adapted to online learning

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By Dr Jane Carter, Senior Lecturer in Primary Education

Learning to read is perhaps the most important thing we will learn to do in our primary education. There is a huge amount of evidence that identifies that being able to read impacts on our future social, emotional, economic and academic success. Not only that, a failure to learn to read comes at a great cost: to the economy; to public health; to our diet and safety and in terms of democratic and community engagement.

When Covid struck and schools closed their doors and migrated to online learning, there was a deep and real concern for the most vulnerable learners: those who had been identified as needing additional support and specialist intervention; and those with few books at home and parents lacking the confidence and resources to help their children.

I have been awarded a small grant from the British Educational Research Association to study the impact of coronavirus on one-to-one reading for children in need of additional support, with a focus on the innovations and challenges experienced by teachers.

Some Bristol schools have specialist reading teachers who implement the Reading Recovery intervention programme for the lowest attaining children in Year 1 (aged 6) and these teachers also use their skills and knowledge to support reading programmes for children throughout the primary school age groups. It is these teachers who leapt into action when Covid struck and who are the focus of my study.

The national lockdown saw many schools and teachers forced to adapt to online learning. Many were innovative in their practice and in numerous cases, online learning was a success. One such school is Glenfrome Primary in Bristol which has worked tirelessly to support young readers. The head teacher has worked alongside the school’s Reading Recovery Teacher to ensure the children who were receiving one-to-one support before lockdown were able to continue their one-to-one reading online. You may think that this is an easy task, but just take a moment to think about the hurdles that need to be overcome:

  1. Do these young readers (6 years old) have access to appropriate IT hardware to engage in online learning?
  2. With the child at home and the reading recovery teacher at home, what are the safeguarding implications of one-to-one online tutoring?
  3. Are there GDPR issues?
  4. How can a book be shared online – both the reading recovery teacher and the child need to be able to see the text?
  5. How do you engage a child on screen with reading when the child is already reluctant to read, finds reading difficult and is often easily distracted?

These were just a few of the hurdles that the Reading Recovery Teacher navigated. She also developed banks of scanned books to use; enabled parents to learn more about supporting their child with reading (helping also with the IT issues and addressing some of the safeguarding concerns); working with publishers around copyright and adapting sessions to address the engagement of each child.

Lockdown uncovered numerous challenges and barriers with online learning, but it also proved how effective it can be. In the case of Glenfrome School, the children made accelerated progress with their reading during this time. The one-to-one reading was also a lifeline for some families, particularly those that were feeling isolated and alone during lockdown.

By carrying out my research study, I hope to uncover the practical approaches to supporting the teaching of reading online and learn how teachers, parents and pupils overcame barriers during the national lockdown to continue learning. With an increasing number of local lockdowns already taking place around the UK, this study is key to identifying how best to support pupils with their reading online. The findings will help schools and teachers to support children with their learning in future lockdown scenarios or in the event of children and households isolating, class closures or full school closures.

With a new academic year underway, we know that education will continue to be affected by the pandemic for the foreseeable future. It is crucial that we, as educators, continue to adapt our approach and overcome challenges. And, just as we ensure that our children continue to learn, we too must learn from the lessons of lockdown.

Apart but not Alone? Neighbour support during lockdown

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By Amy Beardmore, Research Associate in Public Health and Community Development

As the UK went into lockdown on 23 March in response to the Covid-19 pandemic, communities across the country sprang into action and initiated a rapid process of self-organisation, the likes of which had never been seen before. Help for people within communities was quickly coordinated using online platforms such as Facebook, WhatsApp and the hyperlocal social network Nextdoor, alongside more traditional forms of communication such as phoning neighbours or dropping notes through letterboxes. The pace at which this unprecedented community response to the crisis was organised appeared to overtake the implementation of more formalised voluntary and statutory sector support in the area. The result was a complex network of street, neighbourhood and community level help, support and resources.

Rapid research

It quickly became apparent to researchers in the Centre for Public Health and Wellbeing that a unique opportunity was emerging to document the extent of this sudden surge in ground level support and how it might be affected by levels of social deprivation. Enlisting the help of colleagues from within the centre and external partner organisations, as well as a number of community researchers and public contributors, the team designed a piece of research consisting of three distinct phases. This work began just four days after lockdown on 27 March under the heading Apart but not Alone, starting with an online cross-sectional survey.

Survey One

Launched on 2 April and promoted largely through online channels, email and text messages, the first survey asked respondents about who and how they were helping, and their wider experiences of personal involvement in neighbourhood life. Of the 862 people who responded to the survey, a total of 539 responses from the Bristol built-up area were eligible for analysis.

Complex picture in areas of higher deprivation

The results showed that help and support unsurprisingly tended to be aimed at the most vulnerable in communities – specifically the over 70s and those self-isolating. Interestingly, the data also indicated that respondents from more deprived areas of the city and surrounding areas tended to be disproportionately supporting those with disabilities and mobility issues, those with no access to outdoor space and those experiencing financial difficulties. These areas of higher deprivation were also less likely to strongly agree that neighbours were supporting each other well.

Women shouldering majority of the burden?

It is notable that 80.9% of survey respondents were female. There could be a number of reasons for this, including the possibility that women are more actively engaged in social and community networks – both on and offline – and men’s helping behaviours therefore exist but are simply less visible. It may also be that women are shouldering the burden of caring for their community as well as immediate family members, with many also trying to work from home, often with children present.

Low BAME response rate

Bristol has a BAME population of around 14% (although this figure is much lower for South Gloucestershire and North Somerset), so a survey response rate of 5.3% does not appear to be representative of the local population. This may well be due to the restrictive nature of an online survey promoted largely via social media, although the sample did specifically include BAME organisations. It is hoped that the experiences of the BAME population will be explored in more detail through the qualitative element of the project.

In-depth interviews reveal lived experience

The second phase of the project consists of in-depth qualitative interviews with some of the survey participants in order to get a better understanding of how social capital – the resources and connections that people have access to that can influence their ability to navigate systems or to generally do well in life – influences individual and community experiences of lockdown. Eighteen interviews have been conducted so far as part of a unique piece of research in which the researchers themselves are living through the same experience as their interviewees.

“Two of my neighbour’s cousins have died because of Covid-19…and it’s difficult for her because they can’t get together as a family to mourn…”

Research participant

Follow-up survey on community spirit

Participants from the original survey who expressed an interest in taking part in further research were also invited to take part in Phase Three – a follow up survey, published on 27 May. This survey asked about positive and negative experiences in communities since the easing of lockdown on 10 May, and early analysis suggests that whilst many reported a continuation of positive activity (such as increased communication, street level events and volunteering), participants also identified a number of emerging concerns. These tended to indicate that tensions were starting to creep in, particularly associated with confusion over the rules and social distancing as well as more general concerns about previous negative behaviours being exhibited by some members of the community. Of particular note were a number of negative comments about the behaviour of young people and teenagers, indicating potential generational conflict.

What next?

Results from Survey One were recently published in Emerald Open Research, and it is hoped that a second article will be published in the next few weeks summarising the findings of Survey Two, which is currently undergoing analysis. The qualitative element remains ongoing as we continue to explore the participant links to social capital and the impact it has had on their experiences of lockdown. For regular project updates, please follow us on Twitter @ApartAlone.

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