Strategic crisis management

Collaborative management in the face of government response to COVID-19? Evidence from care home staff and stakeholder experiences in West England.

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Luke Bradbury

Picture credit: https://socialvalueportal.com/support-national-effort-covid-19/resources/news/social-value-in-action/support-national-effort-covid-19/

As a student on the MSc Public Management course at INLOGOV and having worked part-time in care for a number of years, I felt my final dissertation project was an opportunity to investigate the impact of COVID-19 on adult social care and the implications of government intervention. The works of organisations such as SCIE (Social Care Institute for Excellence) have already shown that inaccurate government guidance – combined with years of underfunding – resulted in the sector being ill-prepared for dealing with a pandemic and that care policy and practices had to rapidly adapt to unforeseen circumstances with limited support.

This case study aimed to explore this in the context of two care homes in West England during the early months of the pandemic. It was also interested in the role of collaborative management between care homes and their surrounding communities including local authorities, charities, businesses etc. ‘Collaboration’, in this context, took some influence from Helen Sullivan and Chris Skelcher’s conceptualisation of a collaborative agenda governing the (often mutually) beneficial cooperation between different public bodies and community agencies. One might consider how care homes may have banded together with their own local communities to ensure they still had the means to provide quality care in the face of COVID-19. Indeed, recent research by Fiona Marshall et al. has shown that, where government support was scarce, many care homes formed resource networks with external stakeholders such as local businesses, dentists, veterinaries, and domiciliary care agencies to source vital materials including personal protective equipment (PPE), electronics, toiletries, bedding and even food.

This study used semi-structured interviews and recruited five participants via a combination of snowball and non-probability purposive sampling. This included two deputy care home managers representing two different care homes in West England as well as a carer, a local parish councillor, and a co-owner of a local chemicals firm. The latter two participants were recruited as active members of the local community for one of the two participating care homes (or ‘external stakeholders’). Thematic analysis and grounded theory-based coding was then used to interpret the data.

The analysis firstly uncovered a strong dissatisfaction with the central government response to COVID-19 amongst all participants. Care staff spoke about how the implementation of the Coronavirus Act forced them to take on extra patients from hospital without an effective COVID-19 testing system in place and that inconsistencies between government guidance and company policy led to confusion amongst managers. Practices were forced to adapt; for example, adhering to stricter infection control measures and taking on extra care duties such as virtual GP consultations. External stakeholders also spoke about how these circumstances encouraged some level of collaboration within the community and a desire to assist local care organisations; for instance, a parish council was enabled to collaborate with the local chemicals firm and local school to source PPE such as goggles and hand sanitizer which could then be distributed to care providers.

Despite this opportunity to establish a resource network, collaboration between the two care homes and their surrounding communities was not evidenced as Marshall et al. had found previously. This was attributed to two main reasons. Firstly, resource dependency was less prevalent because effective internal management within both care homes meant they already had a sufficient supply of PPE. As one of the deputy managers recalled, the manager for her home made the decision to stock up on PPE and to lockdown early, therefore minimising the spread of the virus. The second reason was down to external circumstances that aided both care homes. Since both operate within rural areas of West England, they occupy less densely populated regions than care homes within inner city locations and therefore surrounding transmission rates remained relatively low. The implication is that locality largely eliminated the need to establish support networks with external stakeholders because they were not experiencing the same level of devastation seen in many other care homes. This was corroborated by staff who felt ‘fortunate’ compared to what they were seeing on the news.

These findings indicate the importance of effective management but also the extent to which contextual circumstances may or may not have necessitated collaborative networking between care homes and their surrounding communities during the early months of the pandemic. Whilst collaboration was less necessary here, the background coordination of parish council and local actors to produce a ‘safety net’ of resources did highlight the potential of localised collaboration and intervention in times of crisis. Perhaps, had such coordinated localised governance been enabled within the surrounding communities of less fortunate care homes, they may have been spared some of the devastations of the pandemic. Regardless, there is certainly a strong call for greater support towards the care sector for government and policymakers to consider – particularly in terms of clearer guidance, increased funding, and enabling localised governance to support care organisations.

Luke Bradbury graduated from the MSc Public Management in September 2021.

The UK’s Covid-19 early response

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Paul Joyce

There are many lessons to be drawn from the UK government experience of responding to COVID-19 in 2020 (see Joyce 2021). But some of the most important concern the problems created by a weak surveillance system and a passive response at the start of the year and by the centralised and command-and-control approach to decision making that denied the national government the full benefits of cooperation in a multi-level system of governance.

Weak Surveillance and Passive Response Early On

The UK Government was expecting a flu pandemic: in 2019 a National Security Risk Assessment document went to the UK Cabinet that stated that a flu pandemic was the top civil risk. Its experts seemed to be suggesting that the threat posed by COVID-19 might be thought about as a threat somewhat akin to a flu pandemic: in February 2020, with the COVID-19 virus spreading outside China, a committee that formed part of the UK Government’s structure of expert advice, produced a paper in which it judged that the reasonable worst case for pandemic influenza “would be an appropriate scenario at that point” (SPI-M-O 2020). This expert judgment was based on the evidence available at the time, but the evidence was limited: the UK Government was slow to increase its testing and tracing capability and even in April, after the lockdown had begun, its testing capacity was still quite modest (see Chart).

Chart: Extent of testing for Covid-19

Chart Note: The data was obtained from Our World in Data. Available at: http://www.OurWorldInData.org [3 June 2020]. There are important national differences in the production of the data (e.g., whether tests from all labs are counted, the inclusion of pending tests).

The UK government did eventually expand its capacity to carry out testing but in the early months, when its response emphasis was on surveillance, it was handicapped by a lack of data.

Generally speaking, the initial UK Government response was quite passive by comparison with many other countries, which had often responded quickly with measures to address the threat of the virus entering the country. The UK was different. By the end of May 2020, the UK government still had no measures in place to deal with the threat posed by international travel.

We might call the initial strategy of the UK Government a “spectator” strategy, because it mainly relied on treatment rather than prevention, counting on the NHS hospitals to treat those who became seriously ill; aggressive containment was definitely not part of the initial thinking. The advice coming from the World Health Organization (WHO) in early March 2020 was quite at odds with the UK’s spectator strategy. The WHO’s Director General strongly advocated an aggressive containment response: “So activate your emergency plans through that whole government approach, […] If countries act aggressively to find, isolate, and treat cases, and to trace every contact, they can change the trajectory of this epidemic. If we take the approach that there is nothing we can do, that will quickly become a self-fulfilling prophesy. It’s in our hands.”

Centralised and command-and-control decision making

One question that came up repeatedly concerned whether exactly the same measures should be applied to all four countries of the UK in identical ways and at the same time. It appears that on the whole there was a high degree of commonality in the design and application of measures – but with some differences in detail and timing. The Prime Minister’s briefings to the public on his aspirations and proposals for future measures had sometimes seemed to refer to the whole of the UK when, in fact, his remarks were just applicable to England. The Scottish First Minister, speaking at a televised daily briefing to the people of Scotland, said: “I will, as I have done before, ask the Prime Minister when he’s talking about lockdown and lifting restrictions to make clear that he is talking about England alone”.

In the early months of 2020 London was the place where infections and deaths rapidly increased and the hospitals were put under immense pressure by the pandemic. This is not surprising given London’s importance as a centre of commerce and tourism in the UK. The mayor of London was responsible for public transport in London, amongst other things, and clearly might have been expected to want to engage with the national decision-making process about responding to Covid-19. There was a newspaper report about the 2 March 2020 COBR meeting and the non-inclusion of the mayor of London in that meeting. The report said he had not been invited and quoted someone speaking on behalf of the Prime Minister: “The prime minister’s spokesman said Mr Khan was not invited because the meeting was meant to deliver a “a national response”, while London – and other areas – were involved through local level resilience forums.”

The UK Government decisions about how to end the first lockdown were also a focus of some friction in the UK’s governance system. In particular, some prominent council leaders in local government in the North of England were unhappy about the proposals to reopen schools on 1 June 2020. The concern for them was that they judged that the pandemic had not been adequately contained and controlled and the Prime Minister was bringing forward proposals that were too risky. For one local government leader, the Mayor of Greater Manchester, the source of the problem about too much risk in how the lockdown was to be ended was the advice being given to the Prime Minister by his special adviser, Dominic Cummings. He said: “Far from a planned, safety-led approach, this looked like another exercise in Cummings chaos theory.”

The problem in multi-level governance was not just one of friction. Sinclair and Read, writing in April 2020, pointed to the failure of the UK Government to take advantage of capacity existing at local government level:

“The government has been accused of missing an opportunity after it failed to deploy 5,000 contact tracing experts employed by councils to help limit the spread of coronavirus. … PHE’s [Public Health England] contact tracing response team was boosted to just under 300 staff, deemed adequate for the containment phase of handling the Covid-19 virus up to mid-March… tracing was scaled back when the UK moved to the delay phase of tackling coronavirus in mid-March… in Germany, thousands of contact tracers are still working – with more being recruited.”

The big challenge facing the UK Government is to evaluate its experiences of COVID-19 in 2020 and to learn lessons about how future pandemics may be prepared for and handled better than this time. 

Paul Joyce is an Associate at INLOGOV, University of Birmingham. He is also a Visiting Professor in Public Management at Leeds Beckett University. He has a PhD from London School of Economics and Political Science and is currently writing a book on the execution of strategy in the public sector. 

His recent books include Strategic Management for Public Governance in Europe (Palgrave Macmillan, 2018, with Anne Drumaux); Strategic Leadership in the Public Sector (Routledge, 2017, 2nd edition); and Strategic Management in the Public Sector (Routledge, 2015). 

In 2019 he became the Publications Director of the International Institute of Administrative Sciences, IIAS, headquartered in Brussels, Belgium.)