An ECHO session in progress, pre-pandemic
Gill Early and Tom Tanner from St Christopher’s Hospice in south east London write about the benefits of hosting Project ECHO sessions to support local care homes throughout the Covid-19 crisis.
Stay home, protect the NHS and save lives. Those were the instructions we were all asked to follow when the first lockdown was announced in March. With a tsunami of Covid-19 cases sweeping the country, the NHS certainly did need protection. At that point, there was little notice paid to care homes. Months later, the true scale of the ordeal endured by their residents and staff is now recognised, but not before almost 20,000 residents died with the virus.
The vital role of care homes
Often dubbed the Cinderella service, care homes have been at the frontline for many years, caring for people who often have dementia and frailty as they approach the end of life. By 2040, as many as 40 per cent of all deaths in the UK are expected to occur in care homes.
St Christopher’s Hospice has had a Care Home Project Team for more than a decade, providing support to this dedicated, hard-working but under-resourced and often under-appreciated workforce. During this time the hospice realised that while they appreciated the clinical knowledge and close working ties they received from us, there was a need for opportunities to network and learn from their peers in neighbouring homes. This was a huge untapped reserve, with the potential to significantly improve the end of life care of thousands, while also empowering staff.
Empowering staff with knowledge
During late 2017 and early 2018 St Christopher’s participated as a pilot site for Project ECHO, supported by Hospice UK. Project ECHO is a not-for-profit initiative which brings together specialist teams and primary health care providers such as care homes, to enable learning and support. The goal is to improve best practice and empower participants to make informed decisions when problem- solving in their place of work.
Four nursing homes in Bromley took part in a series of Project ECHO sessions. The agenda and case studies for each session were agreed beforehand by the participants – topics have included recognising pain in people with dementia; working with the London Ambulance Service; and avoiding hospital admissions.
The homes ‘met’ virtually once a month and were able to share and learn from each other, as well as from St Christopher’s clinical experts. By March 2020, 1300 health and social care professionals from 90 care homes had attended 75 sessions.
Support through the pandemic
The ECHO sessions have really come into their own during the Covid-19 pandemic, providing staff with accessible, practical learning as well as the opportunity to share serious challenges with their peers, and overcome the overwhelming sense of isolation felt by many care home professionals.
Appreciating the intensity of the crisis, St Christopher’s increased provision, making the sessions weekly between March and June.
One manager, Gemma Weldon, of Park Avenue Care Home in Bromley, speaks for many when she describes the impact ECHO had during the first lockdown. She says: “The ECHO sessions have been amazing, especially during Covid when they’ve been a fantastic support for the home. The fact that they don’t use complex terminology means anyone can attend. I’ve always got an army of my staff behind me, including the housekeepers.
“It’s so easy to feel alone and not realise that other homes are experiencing the same thing. Sometimes after the sessions we’ll gather as a team to reflect on our experience of a similar situation. That’s where ECHO is so brilliant, because it’s not just a professional telling you something they know about, it’s also really practical.”
Ongoing learning and development
Restrictions on visiting and other limits to normal care home life have led to increased levels of loneliness and isolation for residents. As a natural extension of Project ECHO, St Christopher’s is starting a Community of Practice for Activity Co-ordinators, key members of the care home workforce for tackling loneliness. They will ‘meet’ quarterly online and share their successes and challenges on topics of their choice, with additional expertise offered from the hospice team.
During the spring and summer, in addition to the ECHO sessions, St Christopher’s launched webinars and bitesize learning packages for care homes. The sessions covered things like advance care planning, and wellbeing, resilience and self-care, to support professionals who were dealing with death and dying on a scale they had never experienced before.
Feedback has been overwhelmingly positive so the hospice has developed a further six webinars, designed to give care home staff the confidence to provide the very best care they can during what threatens to be a taxing autumn and winter. You can find out more about the sessions here.
It’s this multi-pronged package that St Christopher’s hopes will support South London homes during any prolonged second wave, as Patricia Lukeca, Training and Development Officer at St Peter’s, a residential home in Clapham says it did during the first. “The ECHO sessions helped make us more assured and confident in ourselves to look at the person as an individual, to treat them with respect and dignity, and endeavour to meet their wishes.”