Care co-ordinator nurse Claire Glenn believes there is a hidden and terrible impact of the pandemic that could be leading some of her patients to die sooner than they should.
Claire’s problem is not a lack of PPE or ventilators. As in the spring, the services she helps her terminally ill patients access are all available. But fear of infection is stopping the most vulnerable from accessing life-prolonging care, effectively rendering it inaccessible just when it could deliver most benefit.
Normally, Claire explains, she visits people in their own home where it’s easier to have the difficult conversations about “what’s important to them, where they want to have their care, where they want to die.”
She gathers vital information she relies on to do her job well – non-verbal cues picked up face-to-face and other details gleaned from a patient’s living arrangements.
Because of the Coronavirus, all that has changed. “Now, I’m working from the kitchen table and all of my consultations are over the telephone. I’m not doing face-to-face visits with any patients,” explains Claire.
She continues, “People’s homes are so individual. You’ve got to think about how practically it’s going to work. On the telephone, I have to ask all those questions about the environment but also it takes longer to build up that rapport. It wasn’t easy initially to have those conversations over the telephone.”
The most complicated challenge has been working with her most vulnerable ‘shielding’ patients who are extremely anxious about letting anyone into their home, even to deliver care.
She talks about a woman who received a terminal cancer diagnosis just before the first lockdown. “There were no curative options for her, and she knew that, but there would have been some palliative treatments to tackle and manage symptoms.”
After Chemotherapy, her patient returned home where she lived alone, and was told to shield. She avoided all human contact.
“I think if we hadn’t had the COVID situation, she would have been offered a lot more symptom management options,” says Claire.
Claire is quiet a moment, then adds, “The fact that she didn’t have any intervention over 6 months. She deteriorated so quickly that she died far too soon.”
Claire believes fear of allowing people into her house led the patient to go into a care home. “I felt ethically in a very difficult position because I felt I needed to do more for her, but she wouldn’t allow me to because she was so frightened of the physical contact. With the right level of support, she could’ve ended her days in her own surroundings,” she says.
Tragically, this is not an isolated case. Claire’s had four or five very similar scenarios with patients who are, she feels, reaching the end of their lives quicker than they would have done.
Claire and her fellow healthcare workers have needed to adapt quickly to the changed circumstances.
“Even before lockdown, you would never complete an advanced care plan and discussion in one visit,” she explains, “I’ve adapted to the fact that if it takes half a dozen phone calls, and we focus on something different at each call.”
Medical colleagues are supporting each other, but Claire can’t deny the feelings of isolation she has experienced. “It is autonomous, and I’m used to working like that and I like it. However, I felt I’d been left to carry a really big burden,” she says, adding, “you’ve nobody to bounce your ideas off.”
She’s very grateful to a GP colleague who made himself available at the end of a phoneline. “Just being able to speak to a colleague that completely got the difficulties that I was having and the dilemmas I was in, that was really useful. It was a life-saver, really,” says Claire.
People have had to make decisions about care for family members in difficult and distressing circumstances this year.
Claire would advise anyone wanting to be better prepared to have an honest conversation. “Find out what’s important to your loved one. Find out what they want. Find out what they don’t want, more importantly,” she says.
And don’t leave it too late.
“Making decisions about somebody’s deteriorating health is something that needs time. It’s not something we want to do very quickly in a crisis,” she adds.
Although it’s been tough, Claire does think there will be positive lessons learned from this year. For many consultations, the move away from face-to-face is likely to be permanent. “I think what’s amazed everybody is there is so much that can be done and safely. It will have a big part of healthcare in the future. It’s changed the landscape completely,” she says.
But she’s quick to add that there will always be situations where a healthcare professional just can’t be effective without seeing the patient in person. “It’s about getting the balance right,” she says.
For now, in the thick of the second wave, Claire has little time to stop and think about what’s happened. For just a few seconds, she rests back on her sofa and reflects, weariness apparent, “It’s just like we’re in this whirlwind,” she sighs, “We’re caught up in this and we’re getting on with it but at some point, there will be a time where you think I don’t know quite what we’ve been through and how we got here”.
In the spirit of finding a silver lining in the otherwise relentlessly grim 2020, I want to share some of the fun I had researching and writing for Matt Wright’s ‘The Great Food Club’ this year.
Here are the places I’ve experienced in 2020.
Bradt Guides published my diary of our experiences. Read it here:
This summer, my best friend of 50 years and I, accompanied by Buzz the handsome Labrador, walked the full 100 miles of the Leicestershire Round. This video is a diary of one of our favourite days which took us back to the farmland and villages of our childhood. Find more of our adventures on our Facebook page – @fiftynotoutmakecontact
This piece appeared in Active magazine as ‘A hiatus in Helsinki. Read it here:
The events of recent weeks have demonstrated powerfully the value of a workforce with transferrable skills. At a time of international crisis, people must adapt to work in new ways, stepping up to meet the unpredictable demands of an unprecedented situation. In the face of a threat where age and experience may come with a level of vulnerability, it is the young who must shoulder much of the responsibility for staffing ‘front line’ services.
Is this a realistic expectation when just a few years ago Sir Michael Wilshaw, HM Chief Inspector of Schools, described Careers guidance in schools and colleges as “uniformly weak”? (Wilshaw, 2016) Our young people are showing resilience and resourcefulness in responding to the current situation but is Careers education fit for purpose? Are we equipping our young people with the lifelong skills and qualities that will bring employability security in a world where their future jobs may not yet have been invented? And how do we get the people that count, the teachers, school or college leadership, parents and most importantly the learners themselves, to value a process where there are no examinations, no league tables and outcomes are notoriously difficult to measure?
In 2014, Professor Sir John Holman was commissioned, by the Gatsby Charitable Foundation, to investigate Careers education. In his own words, he set out to discover “what career guidance in England would be like were it good.” He wanted to define and share an exemplar of “what ‘good’ looks like” (Holman, 2014).
The high lifetime cost to the Exchequer of each young person leaving school Not in Education, Employment or Training (NEET) was compelling justification for investment in a strategy that could be adopted and applied effectively across a range of educational contexts. Sir John and his team spoke to teachers, pupils and education officials in schools around the world reputed for the great quality of their Careers guidance. The resulting report included a range of recommendations articulated as eight essential benchmarks of good practice in Careers education. Sir John and his team concluded that “Good career guidance is not complicated: it is a matter of schools doing a number of things consistently and doing them well” (Holman, ibid). The benchmarks, which value equally the contribution of schools and employers, encourage a joined-up thinking approach to Careers guidance, tailored to the needs of each pupil, that is a world away from the patchy provision that previously compounded inequalities relating to gender, ethnicity and social class (Moote and Archer, 2017).
In 2015, Baroness Morgan, then Education Secretary, established the Careers and Enterprise Company (CEC). Its task was to support schools and colleges in developing their own brand of world-leading Careers guidance for all pupils between the ages of 11 and 18. Its services would be free to schools and colleges and would target those “cold spots” identified as most in need (Agnew, 2019, p.11). Earlier that year, the DfE had published its statutory guidance for Careers education with the ambition of supporting social mobility by “improving opportunities for all young people, especially those from disadvantaged backgrounds and those with special educational needs and disabilities” (DfE, 2015). During the first three years, the CEC worked with Local Enterprise Partnerships to build a national network of volunteer employers, known as Enterprise Advisers, to work alongside named Careers Leaders in every school and college. Then, in 2017, the CEC piloted Careers Hubs across the country. Headed up by a Hub Manager with the role of co-ordinating, network-building and evaluation, the Hubs bring together like-minded establishments to collaborate in delivering a Careers guidance programme built around the benchmarks and tailored to the needs of their own pupils.
The positive chemistry of the relationship between Careers Leader and Enterprise Adviser underpins the success or otherwise of the initiative. As Gerarde Manley, Careers Hub Manager with the Leicester and Leicestershire Enterprise Partnership (LLEP), puts it, “We’ve got a mantra: ‘It’s the quality of the match.’” He continues, “We talk about that awkward ‘first date’ where everybody’s sat around the table!” Joking aside, getting the partnership right is crucial and like a dating agency, Gerarde and other Hub Managers place great importance on really understanding what a school needs out of the arrangement and what level of involvement the employer is looking for. Although some Enterprise Advisers take a hands-on approach, offering advice with CV writing, conducting mock interviews or assisting at Careers Fairs, Gerarde explains, the role has always been intended to be “strategic” and one that “moves into support and challenge territory,” working with the school or college senior leadership team to plan and develop their Careers policy.
Just as the network of Enterprise Advisers is as diverse as the people that make it up, so the Careers Leader, “the most important role in education that you’ve never heard of” as it’s been called (Simons, 2019), is recruited from all areas and pay grades of a school or college staff; Senior Leadership team members, classroom teachers and admin support staff. It’s probably fair to say that in the past many schools and possibly even some prospective Careers Leaders have underestimated the importance of the role. However, it’s one that encompasses the planning and delivery of a whole school Careers strategy as well as the development of key relationships with education colleagues, business, industry and training providers. With the requirement, in the 2018 update to the government’s statutory guidance, for all schools and colleges to meet the eight Gatsby benchmarks by the end of this year, it’s clear that Careers Education has moved firmly out of the territory of box-ticking to keep Ofsted happy. However, the success of any educational institution’s initiative is still very dependent on the appetite of their Senior Leadership Team.
Abdul Bathin, a Regional Lead at the CEC, acknowledges that achieving meaningful progress against the benchmarks without Senior Leadership Team support can be massively challenging but believes outcomes can be very persuasive.
“When a head sees a programme developed with a network of businesses and sees young people engaged, it has a huge impact,” he says, “If they don’t deliver good, quality Careers education, there’s a number of their young people that will go on to be NEET and really struggle. They’ll be failing their young people.” Abdul believes the simplicity of the benchmark framework, and the way it can be adapted to the goals of the diverse school and college contexts in which Careers Education and Guidance are delivered, is very powerful. “Our model works well in that we are a national organisation that is tailored locally. We have a model that works across the country. It’s simple, it’s easy and it’s aspirational.”
Beaumont Leys School is a Leicester Education Authority 11-16 community school of around 1000 pupils. The proportion of students qualifying for support through the pupil premium (those eligible for free school meals, in care or with a parent in the armed services) is above average. Ofsted judges the school to be ‘Good’ and describes it as one where “The values of success, ‘best self’ and ‘positive future self’ are well understood and believed by pupils and staff” (Ofsted, 2013). It’s an environment where independence, resilience, leadership, a positive attitude and self-management skills are valued highly. It is probably no coincidence that the school is also the LLEP and CEC Careers Hub Lead School, taking a strategic leadership role in bringing the best Careers support to not just the pupils at Beaumont Leys but also those across the city and in the wider county of Leicestershire.
For Paula Staley, Assistant Head Teacher and Careers Leader at the school, their approach is not a simple matter of ticking the Gatsby criteria off a checklist. Paula talks about “the moral imperative to give students the best support” and from the outset worked with her Enterprise Adviser to look “beyond Gatsby”. “It is important for the Lead School to demonstrate to the Hub schools a desire to continually get better, no matter where your starting point is,” she explains.
The profile, locally and nationally, that comes with being a successful Hub Lead School has gone a long way to solving the tricky conundrum of getting the right people on board but there is a strong sense that Beaumont Leys is a living, breathing embodiment of Gerarde’s mantra. “Working with Gerarde and his team at the LLEP has been a dream,” says Paula, “The Hub would not have worked so well if our relationship had not been so strong.”
The levels of engagement in the pupil cohort surely also contribute to that positive impact on the Senior Leadership Team Abdul talked about too. On the school website, alongside the requisite policy statements and the detailed ‘roadmap’ of activities for years 7-11, are case studies that offer a fascinating insight into how Careers has established a firm foothold in the value system of the school’s staff, pupils and their families. Here, you can read about Liam and his nan. Liam would probably have got the chance to visit a local university in due course as part of a Widening Participation programme, but Paula Staley wanted every pupil in year 8 (12-13 years old) to have the opportunity to experience university life. She decided to pilot a Virtual Reality tour at school, in collaboration with mentors from Loughborough University. After the day’s activity, pupils got to take home a VR headset so they could share the experience with family and friends. The feedback from year 8 was very positive but Liam in particular couldn’t wait to get home. “It’s like you are actually there!” he enthused, “I’m going to take my nan on a tour tonight, she’s never been to a university.”
Examples like this make it easy to understand why the CEC concluded, following analysis of its Future Skills Questionnaire (completed by more than 2000 young people who had taken part in Careers related activities in 2018/9), that the positive consequences of an effective Careers programme can be far reaching and ambitious, including outcomes such as improved motivation and resilience, reduced NEET, improved career-readiness and, in the longer term, higher wages(Tanner, 2020).
Although careful to avoid unhelpful comparisons that ranking performance can encourage, the CEC publishes an annual State of the Nation Survey which reports on schools’ and colleges’ engagement with and progress against the Gatsby benchmarks. A key tool used to monitor and drive performance improvement against the framework is the Compass+ digital platform. The software integrates with a school’s or college’s Management Information System data to enable effective and targeted Careers programme planning and delivery. In 2019, analysis of results demonstrated that on average those using the software were achieving 3.2 of the 8 benchmarks, a 50% increase on 2017’s figures, with more than two million young people experiencing an encounter with an employer on an annual basis, representing an impressive improvement of 70% since 2017. Most encouragingly, schools and colleges serving disadvantaged communities were among the highest performers (Tanner and Percy, 2019).
Much in education is cyclical. Strategies and methodologies move in and out of fashion but there are underpinning fundamental entitlements that must surely remain non-negotiable. Careers Education has travelled a long way since Wilshaw’s damning words of 2015, but hard-working education professionals always have, as Paula Staley put it, “a desire to continually get better.”
In this time of world crisis, circumstances represent a huge challenge to that commitment but, like her colleagues Gerarde and Abdul, Paula is optimistic about her ability to equip her pupils with the skills they need to get them through and carry them into their future careers. There is still so much they and others like them across the country want to do to make a difference.
“We’ve got a really strong set of Careers Hub schools,” says Gerarde. “They are really committed so they will come up with some interesting ways of tackling this.”
Paula couldn’t agree more, “It’s what we do in schools!”