Association of Mental Health Providers

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Guest Blog: Governance During Covid-19

– Anna Barnes, Chair, Seaview

I have been chair of Seaview, an open access health and well-being centre in St Leonards on Sea, East Sussex, since 2013 but involved with and supported the charity for over 35 years. On a usual day, we can work with up to 100 people.

It feels like a very long time since the beginning of March, when we all began to be aware of what was about to hit us. Looking back on my diary, we undertook a visit to another open access day centre on March 5th and we were all using hand sanitiser and being cautious then. However, I had no foresight that by March 23rd the entire operation would have shut down overnight and we would have to completely reinvent our service.

Like everyone, I guess my memory of this time is vivid and unrelenting: I had my day job in NHS construction, my other roles as Health Research Ethics Committee member and as Infrastructure Projects Authority (IPA) Gateway reviewer to juggle as well as home and family worries…..but my main concern was “what about street homeless people”?

I could not initially conceive how we were going to keep people safe out on the streets, or fed, and when the public toilets were all shut it began to feel like a pretty nasty dystopian film plot with our clients as the victims.

Luckily we have a fantastic, agile staff team who very quickly reinvented the service as a remote offer. The MHCLG, after a slow start, also ensured we had sufficient resources to house 45 out of 50 of our street homeless clients who were willing to leave the streets, using central funds to pay landlords direct. For those people who initially found it hard to socially isolate we provided mobile phones, and then introduced daily food deliveries to all clients who needed support. We now ensure that they have occupational support; daily activities as well as phone support check-ins.

As with my other NHS roles, somethings were actually simple: all meetings went remote, and our Seaview staff quickly adapted to Zoom meetings. Those staff who needed shielding were immediately accommodated, our Chief Officer miraculously found enough PPE so that the centre could prepare food and emergency supplies without endangering staff. Our Board of Trustees instigated remote weekly check-ins so that staff could feel that they were supported as new dilemmas surfaced (and they did). The main tension which arose was how to look after clients without putting staff at risk; after all, social care staff are not paid to risk their lives-and have never expected to do so in the past. Some were confident about taking risks, whilst others, understandably, not prepared to take any.

Yet, our clients are some of the most marginalised people across the South East, with limited life expectancy because of co-morbid conditions like mental illness, drug and alcohol problems, extremely poor housing and virtually no family support networks. As our Chief Officer said earlier this month in reflecting on Seaview’s work during the pandemic to date; “We are the eyes and ears for social care services locally”.

Despite our initial successes, we continue to wrestle with this dilemma; when should we begin providing a day service to people who might not see anyone else for potentially months on end? How secure is the Transitional Accommodation which has been provided to them? How can we keep our staff safe when we begin to lift our own lockdown? How can we provide commissioners with assurance that we are meeting our charitable aims and objectives and meeting the terms of our contract(s).

I do count my blessings that, despite all the trustees being volunteers, they bring an enormous range of experience and empathy to their roles: I have people with social work, teaching, policy, nursing, finance and legal skills on the Board and their flexibility, intellectual agility and commitment to our organisation makes it considerably easier to find a way forward. There is also strong public service ethos within the Board, something that both reflects and reinforces the principles that have guided the charity throughout its 35 year history.

As a Board of trustees, we have been unambiguous that the charity’s response to C-19 must, at all times, prioritise the well-being and safety of our staff and service users. We have been clear that a ‘conventional’ strategic planning approach has limited utility at present, as we support and help guide our Chief Officer and his team navigate the charity during the crisis. We have adjusted our expectations in terms of reporting etc. accordingly and focussed our energies on the assistance the Executive team has indicated it needs. On reflection, crisis management is only possible if you have done the hard work before-hand. If you know what your core values and principles are, as a Board of Trustees, this makes urgent decision making relatively straightforward; you already know your red lines and non-negotiables. In our case, this was life support for clients without compromising safety for staff.

Our experience of the crisis has, for me, thrown into sharp focus many of the assumptions about the skills, knowledge and competencies required for effective governance of charities that operate in the health and wellbeing care sector- both now and into the future-as we anticipate living in a society in which the impact of C-19 is likely to be felt for some time e.g. in relation to the demand for services, their design, delivery and funding.

Whilst we may have paused business planning activity, we continue to think about our future, particularly as we have to match fund our core grants every year in order to pay what it actually costs to provide a service in line with our ethos (which is very different from what we are paid, sadly). COVID-19 will make this even harder, we know as a lot of our public-facing awareness and fundraising events cannot take place in 2020.

By nature, I am an optimist, so generally feel positive about the future for our service and look forward to coming out the other side to a society which is changed (hopefully), in some ways, for the better. The pandemic has proven that housing street homeless people can be done-we did it once resources were made available. It has renewed attention on the need to raise the status and reform of the funding of residential social care for older people. It is highlighting the essential role, in an increasingly uncertain world, of the voluntary and community social care sector, in engaging with and helping people who are homeless, insecurely housed and who may be mentally ill, have poor mental health and/or drug and alcohol issues.

The C-19 pandemic is also making clear that, moving forward, governance arrangements that emphasise the importance of emotional intelligence and have real insight into the operational challenges of this complex and dynamic environment, will be key to the ability of charities like ours to survive in it and continue to work successfully with and for some of the most excluded and disadvantaged members of our society.