Giving everyone the best opportunity to receive care during COVID-19

Case study summary

Key learnings from East and North Hertfordshire NHS Trust.

  • During the pandemic, safeguarding needed to adapt to new ways of working, new challenges and new opportunities.
  • Meaningful engagement and communication enabled the best care and support for people with limited understanding of their situation.
  • To think flexibly and consider safeguarding outside of the box through COVID and the lack of ‘normality’ is even more important.

Background to learning

During the pandemic, the awareness of safeguarding those at risk has been heightened.  Safeguarding continues to be everyone’s business and during the pandemic has needed to adapt to take account of new ways of working, new challenges and new opportunities. The pandemic has introduced complexity in supporting vulnerable and ‘at risk’ patients. This case study explores how the nursing team at East and North Hertfordshire NHS Trust are working to ensure patients have the best possible outcomes whilst in hospital.

Learning and advice to be shared

Prior to the pandemic, systems were in place to support ‘at risk’ patients such as those with a learning disability, cognitive impairment or disability, in a way that met their needs. Teams worked with the patient, their families, and carers to provide the right care, at the right time. This communication offered a vital opportunity to learn more about the person’s needs, likes/dislikes, triggers and concerns when they are unable to express these themselves. The pandemic challenged these usual ways of working and nurses at the trust developed reasonable adjustments to minimise infection prevention and control risks, whilst maintaining effective communication with patients and families.

They adopted new technology to ensure virtual visiting was in place and patients could maintain networks and communication as well as implementing new systems for carers to keep informed and in regular contact with the nursing teams. As part of the ‘Keeping in Touch’ project, new initiatives such as the daily postal service, delivering messages from loved ones directly to the bed side, have lifted the spirits of both patients and staff.

This focus on communication has supported staff to care for vulnerable patients where being in hospital may be a challenge and for whom familiar faces are integral to their wellbeing. The expansion of the Learning Disability Health Liaison Team has also helped to adjust care for people with learning disabilities. The expanded team:

  • visit wards daily to offer support, advice and guidance bringing therapeutic activities for patients and supporting teams to utilise these, for example, radios or drawing books.
  • work closely with palliative care teams and a knitted hand-to-hold initiative has supported people with apprehension to receiving care for example when venepuncture or canulation is needed.
  • deliver knitted love hearts for patients at the end of their lives and their families to symbolise the connection they have, and the care given.

Teams acknowledge that safeguarding considerations apply beyond the hospital and the importance of close working with discharge teams and community therapists, especially where there are concerns of harm or abuse. Coordinated approaches to discharge and longer-term planning for those ‘at risk’ has been strengthened to ensure patients are safe, as are their carers where they themselves may also be vulnerable.

The CNO national Shared professional Decision-Making council reflected their own experience of supporting vulnerable or ‘at risk’ patients during the pandemic, including;

  • enabling visiting through visitor passports or flexible access to clinical teams
  • carer support groups to ensure support and feedback is gathered
  • home visits to patients/carers through specialist nurse and outreach roles to look at ways of supporting people outside of the hospital whilst adhering to social distancing polices
  • Activity Coordinator roles offering risk assessed activities specific to the person’s likes and needs. For example, art, music, knitting or crocheting.

Would it be beneficial to keep this change?

Nurses have reported how these approaches have increased the wellbeing offer available to patients and allowed greater connection with patients which is having a positive effect for both.

Creating space for conversations with patients and their carers will always support the best care and experience.  COVID-19 has created its own complexities but the responses from teams to connect with patients and families could also better support care of patients with dementia or disabilities, who at this time are also experiencing higher levels of distress.

As the pressure from successive waves of pandemic subsides it would be easy to overlook the potential for lasting hidden harms.  The impacts of COVID-19 will last long beyond the level of infections are brought under control.  A focus on promoting wellbeing, safeguarding and space for conversations that enable nurses to utilise their professional curiosity will be vital. For example, checking whether vulnerable patients have somewhere safe to go back to or, at least, to discreetly raise the issue and help, advise and guide.

This case study is by Rosie Cowling, Adult Safeguarding Nurse and Nurse Team Leader, East and North Hertfordshire NHS Trust. To find our more about this case study or connect with Rosie please email: