Professional Comment

Caring for the Carers

By Richard A. Powell, Project Evaluation Manager, Imperial College London, London

Prime Minister Boris Johnstone’s recent news that COVID-19 vaccines has been offered to all older residents at eligible care homes in England, is a welcomed “crucial milestone.”

The impact of the pandemic upon care homes has been catastrophic. With residents of advanced age, often with deficient immune systems and co-morbidities, living in closed settings with multiple co-residents, viral transmission is that much easier. Compounded by the lack of PPE, poor testing regimes, and unmet need for hospital treatment, over 25,000 deaths in England had been recorded by February this year. While the current vaccination programme rolled out across the UK is, as Mr Johnstone remarked, the “route out of the pandemic,” attention needs to pivot to those in residential care homes whose health needs have also been neglected: care home workers.

The post-COVID landscape should include a focus on the wellbeing of staff who have been at the frontline—but also those who have per- formed in a supportive, backroom capacity—combating the impact of the virus. Responsible senior managers should devote their attention to how, if at all, their colleagues have been physically, but also importantly mentally, affected. To what extent have they been affected, what sup- port services—if any—have staff accessed to help them overcome any problem they encountered, and what should future service interventions look like to ensure they can return to, and fully function in, the workplace? Ensuring mental health and wellbeing challenges are identified and addressed effectively is premised on understanding the lived experience of staff members, helping to determine the long-term sup- port that will enable them to continue providing invaluable care.

It is within this challenging environment that Imperial College (IC) London is conducting a study among care home staff to provide the data to achieve that understanding. As Dr Dasha Nicholls, lead for mental health and multi-morbidity in the NIHR Northwest London Applied Research Collaboration, and principal investigator of the study, commented on the impact of the virus:

“Workers might be particularly affected by fears of contamination, disruption of normal supportive structures, work stress, and retention issues. Many will have to make difficult choices to deliver care they know is not necessarily the best, explain difficult decisions to relatives, or make decisions that jar with their personal values. An immediate research priority is to monitor and report rates of anxiety, depression, self-harm, suicide, and other mental health issues among vulnerable groups of workers, to understand mechanisms and inform interventions.

“We are really hoping that staff from Black, Asian and minority ethnic communities take part in the study given they’ve been especially hard hit by the virus.”

The study, which is conducted online, focusses on the short- and medium-term psychological impact of the pandemic on North-West London social care-related staff, identifying psychosocial indicators of resilience and vulnerability, and evaluating the effectiveness of staff support programmes offered through employer organisations.

It is the first study to include social care (including residential homes), primary care, mental health and acute care staff, enabling a comparison of the virus’s impact across care sectors. A short online survey will collect basic demographic and clinical information, supplemented by more detailed outcome measurements for those wishing to participate. Data collection is repeated at 3, 12 and 18 months, to see how staff feel over time and what is helping or not.

“The study findings promise to provide us with very rich data on vulnerable staffing groups by socio-economic status and ethnicity,” added Dr Nicholls. “It is by gathering such data that we can begin to understand the nature and impact of the pandemic in care homes and plan a way forward with staff support programmes that work.!

For further information on the study, and the survey itself, please visit its website: