Catherine Moar, Team leader, Alcohol Liaison, Edinburgh Royal Infirmary  

Phase 1 story (Spring / Summer 2020)

How have you been able to keep a focus on what matters to people during COVID? 

Our role totally changed during this period as we were not seeing the people we usually  see. Normally a big part of what we do is go and see patients who are admitted who are  showing signs of alcohol related health problems.  

For the past couple of months, we have had more of a focus on offering support to  emergency and ward staff. We have got to know a lot of the staff in the Emergency Dept  and in acute. That has felt positive as we are tucked in a room away from the wards  normally and we can feel a bit cut off.  

What have you had to do differently and what made this possible? 

Really, it’s been about making ourselves known to staff. So we did very short tea tray interventions at the start, where we would go and do a quick talk on what support was available. The offer  was there to have a space to take time out and decompress if the pressure was getting too much. We have been able to provide that support but just as the wards were not overwhelmed, the numbers of staff needing support has been manageable too. I think quite a lot of us have been thinking that support should have always been there for staff. Particularly last Winter when  things were really hard to manage and Winter wards were set up.  Normally we wear our own clothes in our roles but we have  switched to uniform. This has caused some confusion. If a  patient on a ward asks me to perform a nursing task, I’m not going to refuse and I have found myself caught up in a bay more than once!  

What have you noticed that has been better? 

We have worked closely with other staff who are supporting staff, including spiritual care  and emergency dept staff and have had regular meetings to discuss how things are going,  what issues are emerging and so on. Our sense is that having that support available  makes staff feel valued and supported. I think better understood too. 

One of the unexpected changes has been the set-up of the Pilot’s lounge in the hospital,  organised by the Wingman Charity. Airline cabin staff who’ve been furloughed volunteer  to come in their uniforms and provide a table service to hospital staff in the postgrad  education centre. So you can get a pilot coming over to ask if you want tea or coffee! There has been a mutual benefit there as staff from different airlines have been hearing  worrying news about their jobs at various times. We’ve been a listening ear for them too.  

How did this make you feel?  

In the weeks leading up to lockdown and for a while after, there was a lot of adrenaline  for staff, and for me, as we were watching the news from Italy and had to be prepared for  the worst. We did prepare really well during that period.  

We didn’t get to the stage of overwhelm that was experienced in Italy or in London. The  curve began to flatten before Louisa Jordan was really needed. I would say that we are  seeing more physical ailments in staff now and there is a flatness to the atmosphere. It’s  a challenge because even though COVID cases are tapering off, we can’t really ‘get back  to normal.’ We don’t really know what to expect as lockdown eases off – in terms of  changes in infection rates, the backlog of other health issues that has built up and then  there are all the social issues around people’s jobs and so on. That is hard for everyone.  

What have you learned through this?  

I have learned about the value of wellbeing support being made available to staff. I think  in health and social care there can be too much expectation that staff absorb emotionally  challenging events and just keep on without a chance to process things. It has taken a  global pandemic to put a spotlight on this but it needs to continue.  

Anything else you want to tell us?  

There is so much we don’t know yet about how this will play out. That is hard for  everyone. I worry about what’s to come. In our team we expect people to be coming in  after relapsing with their drinking, and that has started. There will be people using  alcohol as a response to the challenging circumstance in which they have been bereaved  during this too.

Phase 2 Story (Autumn, 2020)

What has continued to keep a focus on what matters for people during the pandemic?

Our direct work on alcohol liaison with patients fell of the radar during the initial crisis as our role switched to providing psychological support to staff in the hospital. As wards have refocused on care work, our team has continued to provide support to staff, when asked for. That demand has been less as services have returned to normal.

Our direct work on support to people with alcohol addiction is now busier than before. People are presenting as more unwell and are taking longer to recover. It’s partly the backlash of people being at home during lockdown and waiting until they have relapsed before we see them. Isolation is a factor. The loss of face to face is a big issue for our people because they have multiple complex needs. There are elements of poverty, isolation and loss of family support due to addiction. We are trying to keep people connected as far as we possibly can.

We also have people with new drink problems. People who were normally going out to work every day but were furloughed and started drinking earlier or using alcohol as a coping strategy. The physical effects are more serious alongside the psychological issues.

We are still rarely bringing people back into see us, to reduce the risks. We use phone and video consultations, based on individual preferenes, and access to technology. If we feel someone is high risk we do bring them in for a face to face. Our switch to online has been later than in other organisations because our role had changed to staff support. But it is not satisfactory to us because a lot is lost in translation. That is particularly true if over the phone. Video conferencing is not so bad, but you still lose something, and of course not everyone has the tech to enable that.

There is less demand from other staff because they are adapting to new ways of working. There has been a steady trickle though. We expect that as hospital admissions increase we will see more staff coming in again. We are going to need to work out how to balance our core work with staff needs.

Are there changes that seem to be lasting longer term and are there things that have slid back to old ways of doing things?

Once core hospital business resumed there was an expectation that staff return to normal. There were elements of staff support that should have been there anyway and they have been removed. The lack of staff support is largely about space. Space is a constant issue in how we support people using our service too. Our team here is in a very small office and it is hard to find a private space to do a video or phonecall. The need to maintain confidentiality is not planned in the same way.

We were not overwhelmed as expected back in lockdown. Things were containable. However, there was a loss for many of being part of your existing team in a crisis and that was hard for people. People were fragmented and that had a detrimental effect. I would say that everyone still feels fragmented and burnt out. If you worked through it you continued on adrenaline. When things started to return to ‘normal’ and the adrenaline settled, the exhaustion set in. There is a collective denial going on. The numbers are awful and deaths are increasing but it is hard to take it in and people are detached.

It is such unknown territory. There is a continuing state of confusion and uncertainty, and cohesive teams are critical at this time.

What difference has this made to people

I know some people have adapted well to the online environment. This is not the case for the people we support. People still feel frustrated and not as supported as they would like. Rehab and detox have reduced and waiting lists are longer and that is hard to cope with. For some it’s about the stigma as well. Support groups were a lifeline to people and losing that has made things worse, so we are trying where we can to plug the gaps.

For ourselves we were always a cohesive team and we are now more so. We have supported each other through work and home related struggles so we are stronger in facing what might come next. There is a resilience there.

We are in a fortunate position because we are a mental health service within acute. That means we are fairly autonomous. There is no micro-management here.

We had to wear unforms for the first time during the pandemic because our role changed. We were treated differently in uniform because of the status we were accorded, which was relatively low. We feel more valued and recognised in our role now we are back in our civvies.

How did this make you feel?

People listen to us more again now we are wearing our own clothes. We are more recognisable too. With uniform, haired tied back and a mask on, people didn’t recognise us and we felt professionally compromised.

We feel stronger as a team and feel more confident about possible hurdles. There is a pride in our ability to pull together and work as a team in a different way from we could ever have anticipated and we are encouraged by our creativity in responding.

I feel pride in my team. I have more faith than ever that they can do a good job in adversity.

Reflecting on your experiences what have you learned?

Openness between staff is very important and honest communication and allowing vulnerabilities to be shared is crucial. It’s ok not to be ok is a key mantra.

Covid has highlighted more than ever, the importance for people to feel connected. We all experience a sense of frustration that we are unable to provide more, or know that the closure of some services due to restrictions will directly impact our patients in a negative way and we have to stand back, unable to do much about that.

What difference has it made to you to tell your story as part of this project?

It feels important that the people we work with know that we want to be there for them under these restrictions and we need to find ways to communicate that to them.