ABSTRACT
People with disability are an ‘at-risk' group in a pandemic context for various clinical and structural reasons. However, in the early stages of the COVID-19 pandemic, people with disability were not identified as a priority group, which exacerbated this risk, particularly for those living in congregate settings. This paper examines inter-organisational issues during the second wave of the COVID-19 pandemic in disability residential settings gathered from senior managers, team leaders, and disability support workers. We use Victoria as a case study since several Victorian disability residential settings were in mid-transition from state provision to non-profit organisations. We argue that residential settings in mid-transition had clearer lines of organisational accountability and communication, which was thought to reduce the impact of outbreaks compared to residential settings in other States and Territories with multiple lines of communication and blurred accountability. The paper contributes to the literature on inter-organisational collaboration by reinforcing the necessity of clear lines of accountability and leadership in collaborative governance during emergencies. The evidence suggests how government and disability residential settings could better support residents and staff in future COVID-19 outbreaks or other pandemics. Points for practitioners: People with disability, particularly those living in congregate settings, are often at heightened risk during public health emergencies. Clearer lines of responsibility, administrative, and communication arrangements across organisations and governments, alongside tailored responses within residential settings, are required to keep ‘at-risk' individuals safe. Emergency management block funding could be designed to alleviate the financial pressures identified in this study for residential disability services in future pandemic responses. © 2023 Institute of Public Administration Australia.
ABSTRACT
People with disability are an at-risk group in the COVID-19 pandemic for a range of clinical and socioeconomic reasons. In recognition of this, Australians with disability and those who work with them were prioritized in access to vaccination, but the vaccination targets were not met. In this paper, we analyze qualitative data generated from a survey with 368 disability support workers to identify drivers of COVID-19 vaccination hesitancy and why the implementation of this policy may have experienced challenges. We identify a range of themes within these data but ultimately argue that a major driver of vaccine hesitancy in this group is a mistrust of government and an erosion of employment terms and conditions. Drawing on the policy capacity literature, we argue that the "Achilles' heel" for the Australian government in this case is the critical policy capacity of political legitimacy. This finding has important implications for where the government needs to increase/build policy capacity, strengthening its efforts and better relating to organizations that can be helpful in terms of developing public health messaging for disability support workers.
ABSTRACT
The COVID-19 pandemic created a working from home experiment for the public sector. This paper examines what might happen next as countries move towards a COVID-normal environment. Since the academic literature on public sector agencies and working from home since the onset of the pandemic is scant, we focus on the non-peer-reviewed literature as our evidence base. This paper identifies the main issues public sector agencies need to consider as new ways of working emerge. The key facets are emerging preferences for hybrid working, productivity and remote working, and impacts of working from home on employees, especially gender equality. We highlight a range of emerging challenges, including how to maintain productivity, the need to redevelop employee value propositions to attract and retain employees in this changing landscape, and the risks of proximity bias. We conclude by identifying questions to be addressed in subsequent research.
ABSTRACT
As a national nursing service providing community nursing support for patients receiving enteral, parenteral nutrition and other intravenous therapies employing over 300 nurses, it was important to support the NHS during the Covid-19 pandemic. An NHS support campaign was launched which began by implementing a guiding principle across our service in relation to sending patients to hospital. The guiding principle was framed around keeping the patient at home safely to avoid admission. The guiding principle was: ‘why hospital, why today’. This was communicated out across our nursing service and our standard operating procedures were updated to reflect this. To help raise awareness to this initiative we also launched a logo. This was added to the email footers of the nursing team and shared with our NHS partner hospitals. We increased the nursing service offering to further support admission prevention, to include the following: • Blood taking visits • Additional drug administration • Virtual patient assessments and training • Support/facilitate virtual clinics • Condensed patient training to aid reduced number of visits for training • Rapid discharge for nursed patients We reduced the number of nursing visits our patients were having to reduce the risk through contact: • Patients were offered training for themselves or a carer • Where clinically safe and in agreements with the referring centres and our patients, we reduced patient’s visits to once a day from twice per day by administering 24-hour infusions, thus reducing contact and exposure to nurses and patients We offer a 24hour nurse Advise Line to support our patients and nurses in the community. As part of the ‘Why Hospital Why Today ‘initiative, the Advice Line worked hard to find ways to keep patients safely at home rather than advising hospital, along with discussions with the manager on call were able to reduce the number of out of hours hospital admissions. We also considered our patients mental health and well-being. Our patient cohort is a vulnerable group and they were being isolated from family and friends as well as reduced nursing visits which could impact on their mental health and well-being. We initiated weekly supportive calls to all our patients which were well received. During 2020 at the height of the pandemic, 27 hospital admissions were avoided, 6 patients completed the condensed patient training package, 160 patients had amendments to their prescription regime to reduce number of nurse visits, 63 patients initiated 24-hour parenteral nutrition infusions, halving their contact with nurses.
ABSTRACT
Background: The provision of cancer services has been strongly impacted by the outbreak of SARS-CoV-2. Our Cancer Centre in South-East London treats about 8,800 patients annually (incl. 4,500 new diagnoses) and is one of the largest Comprehensive Cancer Centres in the UK. The first COVID-19 positive cancer patient was reported on 29 Feb 2020. Whilst we are dealing with the second wave of COVID-19, it is important to further evaluate safety of cancer treatments whilst balancing risks of COVID-19 infection and complications. Methods: Using descriptive statistics, we report on the patient/tumour characteristics as well as short-term clinical outcomes of those patients undergoing radical treatment (i.e. systemic anticancer treatment (SACT), surgery, or radiotherapy (RT)) for their cancer during the first wave as to help establish the clinical guidelines for the management of cancer patients in a SARS-CoV-2 epidemic. Results: Between March-July 2020, 1,553 patients underwent surgery, 1,125 received SACT, and 814 had RT. Compared to the same period in 2019, there was a decrease of 28% for surgery, 15% for SACT, and 10% for radiotherapy. Whilst surgery was performed on more male patients (58%), more women received SACT (75%) and RT (58%). The age distribution was similar between treatment arms, with the majority of patients aged 50 to 80 years. The most common tumour types were breast (21%), thoracic (20%), and urological (29%) for surgical treatment;breast (49%), gastrointestinal (18%), and gynaecological (10%) for SACT;and breast (40%), urology (25%), and head & neck (11%) for RT. Within SACT, 36% received combination therapy, 35% received systemic chemotherapy, 23% targeted therapy, 5% immunotherapy, and 2% biological therapy. In terms of oncological outcomes, outcomes were similar to pre-COVID-19 times;with 6 deaths at 30 days (<1%) for surgical patients and 36 readmissions (2%), 10 deaths (<1%) for SACT patients, and 52% of RT delivered with radical intent (which was the same in 2019). The COVID-19 infection rates for our patients were very low: 12 patients were positive pre-surgery (1%), 7 post-surgery (<1%), 17 SACT patients (2%) and 3 RT patients (<1%). No COVID-19 related deaths were registered for the surgical, SACT and RT patients. Conclusion: Whilst there was a decline in overall radical treatment, likely due to a delay in cancer diagnoses, those who did undergo their treatment were treated in a safe COVID-19 managed environment. Our findings highlight that cancer patients should have the confidence to attend hospitals and be reassured of the safety measurements taken.
ABSTRACT
Introduction: A better understanding of the reality for cancer patients during COVID-19 will help us readapt current predication models. To further inform future clinical guidelines, we need a deep dive into rich data sources from apex Cancer Centres. We report on the outcomes of cancer patients receiving radical surgery between March-September 2020 (as well as 2019) in the European Institute of Oncology (EIO) in Milan and the South East London Cancer Alliance (SELCA). Methods: IEO is one of the largest cancer hospitals in Italy. SELCA includes 3 major hospital trust, treating about 8,000 new cancer patients per annum. Both institutions implemented a COVID-19 minimal pathway, whereby patients were required to shield for 14 days prior to admission and were swabbed for COVID-19 within 3 days of surgery. Positive patients had surgery deferred until a negative swab. Surgical outcomes assessed were: ASA grade, surgery time, theatre time, ICU stay>24h, pneumonia, length of stay (LOS), and admissions. For COVID-19, we focused on infection rate and mortality. Results: At IEO the number of radical surgeries (270 for gynaecological, 339 for head and neck, 377 for thoracic, and 491 for urological cancers) declined by 6% as compared to the same period in 2019 (n=1477 vs 1560). The main decline was observed for thoracic surgery (377 vs 460, i.e. -18%). Age, sex, SES, ethnicity, comorbidities, and performance status were all comparable between both periods (e.g. 58% male, 38% aged 70+, 48% high SES, 15% with existing cardiovascular diseases). Readmissions were required for 39%, and <1% (n=9) developed COVID-19, of which only 1 had severe disease and died. 11 died of other causes during follow-up (1%). At SELCA, the number of radical surgeries (321 for breast, 129 for colorectal, 114 for gynaecological, 152 for head and neck, 92 for liver, 56 for plastics/skin, 305 for thoracic, 72 for upper gastrointestinal, and 312 for urology) declined by 29% (n=1553 vs 2182). Even though a different geographical setting, characteristics were fairly comparable with the IEO: 58% males, 30% aged 70+, 34% high SES, 16% with existing cardiovascular diseases. Readmissions were required for 22%, <1% (n=7) developed COVID-19, and none died from it. 19 died of other causes within 30 days (1%). Conclusion: Milan and London were both at the epicentre of the first COVID-19 wave. Whilst a decline in number of surgeries was observed, the implemented COVID-19 minimal pathways have shown to be safe for cancer patients requiring radical treatment, with limited complications and almost no COVID-19 infections.