Features

Working from home: the new reality

22 July 2020

As the fight against Covid-19 continues, and CPs find themselves working from home at least in part, journalist Linsey Wynton considers the main issues this presents for CPs. 

Our acute health service staff have been under unprecedented pressure during the pandemic (Busby, 2020), and community practitioners (CPs) have adapted to meet families’ needs.

Some HVs and many school nurses (SNs) have found themselves redeployed to NHS wards, care homes, immunisation clinics and screening centres, as well as homeless shelters and women’s refuges to give infection control advice.

As SNs have been returning or preparing to return to schools, CPs shielding because of a medical condition or pregnancy have been working from home (WFH), as have many HVs at least part of the time, according to Janet Taylor, CPHVA executive committee chair.

Janet says that, across the UK, many CPs have been juggling their own and partners’ work schedules around WFH, home schooling and other caring responsibilities. So what is key and how have they managed?

Rights and responsibilities

‘Employers have the same health and safety responsibilities for home workers as for any other worker,’ says Unite (2020). ACAS recommends employers and employees are ‘practical, flexible and sensitive to each other’s situation when WFH’, and consider offering those with caring responsibilities reduced working hours and targets, or the option to work different hours (ACAS, 2020).

Obi Amadi, Unite lead professional officer for strategy, policy and equality, says: ‘Every organisation is different. There is guidance to interpret, not “must-dos and don’ts”.’ Janet, who is also a public health nurse manager in children’s services, and lead Unite representative for the South Eastern Health and Social Care Trust in NI, explains that working practices have varied across the UK since Covid-19, with no face-to-face contact with families or limited visits in some areas.

‘In NI there have been reduced visits with a risk assessment and appropriate PPE for new birth visits, three-month visits and visits for vulnerable families. HVs have also been seeing their clients for immunisations in clinics,’ she says. ‘Visits for six to eight weeks, and two, three and four years have been by telephone, unless there was a need or health plan.

The correct tools

‘Technology made WFH easier in trusts where HVs have iPads and smartphones, but not in trusts where they don’t,’ Janet adds.

NHS Employers (2020) recommends that employees should, where possible, have ‘software that enables remote working’ and ‘a quiet, confidential space if speaking to patients or colleagues’.

The Health and Safety Executive (HSE) is aware that WFH does not have the same oversight as in a workplace. It says that employers should recommend staff WFH complete a workstation checklist and allow workers to take home items such as a keyboard and mouse if necessary (HSE, 2020a).

Colenzo Jarrett-Thorpe, national officer for health at Unite, says there is no issue with staff using electronic files remotely, but with hard copies ‘there are issues taking files [away], as well as letting staff in’.

Training could address this. The Chartered Institute of Personnel and Development (CIPD) states that employees should be trained on data protection, and that employers should consider whether staff have secure cabinets for confidential files, or consider providing them (CIPD, 2020).

‘One organisation expected staff to take confidential notes home without policy guidance on secure storage in place,’ Obi says. ‘Employers need to ensure paper records are away from base for a minimal time and returned promptly. Confidential conversations should not be overheard.’

Flexible working

NHS Employers states that ‘line managers should agree the flexibility of working hours and availability of staff working at home, taking into account each person’s individual personal circumstances, including caring or childcare responsibilities’ (NHS Employers, 2020). ACAS advises an agreement on when employees will be available to work, stressing employees must get the same pay for working their usual hours (ACAS, 2020).

The CIPD suggests giving employees clear targets and asking for daily or weekly updates while providing updates on developments/response to coronavirus (CIPD, 2020). Janet stresses the importance of staff having choice in how they work. ‘WFH is hard when you have children – so there has been flexibility about when you work. Some people with a partner who was out in the morning would make calls in the afternoon and do write-ups in the evening. But managers can’t sit clock checking that you’re doing 7.5 hours a day.’

She adds: ‘Some staff said “I want to come into work – being at home is driving me mad!”. Others came in if their husband was WFH a couple of days a week and maintained social distancing.’

In other trusts managers have expected staff to work between 9am and 5pm, even though this can cause staff anxiety, Janet says. ‘These are times that none of us have lived through before – but a pragmatic approach of partnership working with people and meeting their needs is vital so we can keep folks in work and continue to deliver a service.’

Tax guide

Tax relief is available to CPs who are WFH, including a £6-a-week allowance to cover expenses such as electricity, heating and broadband (UK Government, 2020a).  

Colenzo says: ‘We would urge people to claim their tax relief for WFH, and Unite can give advice on how to claim.’

There is now tax relief on office equipment you have bought entirely for work purposes that your employer has not refunded (UK Parliament, 2020).

According to HM Revenue & Customs (HMRC) it is also possible to claim 45p a mile mileage for cars up to the first 10,000 miles of travel, and 20p for bicycles tax free, which HMRC says are allowable with home as a base (HMRC, 2020).  

Wellbeing wisdom

The NMC states: ‘Getting the help you need will help you care for others.’ The HSE stresses that managers must regularly keep in touch with staff WFH, stating: ‘If contact is poor, workers may feel disconnected, isolated or abandoned. This can affect stress levels and mental health,’ (HSE, 2020b).

Janet says supervision is continuing by phone, and staff must be made aware that they can refer themselves to NHS support services such as occupational health, psychological services or counselling.

Janet adds: ‘Our staff have elderly parents, grandparents and daughters having babies they cannot go and see. As an essential service we still continue and when things open up, there are going to be safeguarding, mental health issues and depression among clients. Robust people are having enough difficulty in lockdown. What about the vulnerable who have a new baby?’

Beware the rise in abuse

Cases of domestic violence have risen during the lockdown, as reported in the May/June issue of Community Practitioner (Astrup, 2020). Janet stresses the importance of managers sending guidance to CPs who may themselves have been facing domestic abuse or have clients experiencing it.

Boots has been offering a safe place for those experiencing domestic abuse to contact specialist services (Boots, 2020). Meanwhile, the TUC has produced a guide on domestic abuse and Covid-19 (TUC, 2020).

Janet adds that HVs have been unable to detect domestic abuse to the same extent as before, because they have not been visiting all families. ‘There could be clients where partners may have been moved out and then moved back in and you do not know – that is the tsunami we are worried about when things open up.’ 


Helen Knapman, Flying Start health visitor from Newport, Wales

Helen has been WFH two days a week and from a health hub three days a week with a rota and request system to reduce staff in the building.

She says: ‘Initially, I was desperate to help my nursing colleagues in hospital during this crisis. I felt a loss of control – moved from my office for safety reasons, colleagues redeployed, completely new ways of working, HV students returned to the hospital, my status as a practice teacher and team coordinator suddenly taken from me – and I was concerned about my clients’ and my parents’ health.

‘I struggled each Thursday evening when my neighbours clapped for me and the NHS. As the “new normal” emerges, I see how many of my vulnerable families have displayed resilience when faced with adversity, but also how many new mums have missed seeing me.’

Helen’s team paused home visits at the start of the lockdown. She says: ‘Initially, I sent a standard text to all my families outlining the situation, so parents could contact me directly with any concerns.’

She then phoned clients and used Facetime. Then new parents were invited to the health hub for two to six week checks, where staff wore PPE, as were children with safeguarding concerns and child protection registration. Later, some home visits were carried out, with PPE, for vulnerable families and those with transport issues.

‘Families are constantly assessed about individual needs. This constant change has been incredibly stressful, but necessary.

‘Personally, I have found WFH challenging! I’m a “people person”. My daughter is 16 and has been getting on with her home schooling and I’m fortunate to have IT support available. This is not the situation for some colleagues. Unfortunately, I still work with paper notes and this is a huge challenge, a completely computerised notes system would have made WFH much easier.

‘All my safeguarding and meetings are arranged when I am in the hub. I complete my “routine” contacts at home using the WFH proformas and file them in the original notes when next at the hub.’


Structure your day… and stay out of your pyjamas!

  • Establish a routine, with sufficient breaks, in a place free of distractions – and don’t wear pyjamas all day!  
  • Use video calls when possible, as non-verbal cues indicate how someone is feeling u Write a daily list of priorities  
  • Have an exercise break – outdoors ideally – and use self-care techniques such as mindfulness u Set separate times for home schooling and for working.

Mental Health Foundation, 2020 


Resources  

General support  
For staff, including on flexible working, from NHS Employers bit.ly/NHS_Employers_wellbeing

Equipment  
HSE workstation checklist bit.ly/HSE_DSE_checklist

Wellbeing  

  • A free wellbeing support helpline for NHS staff in England 0300 131 7000, open from 7am to 11pm every day, plus 24/7 text alternative – text FRONTLINE to 85258. In addition, there is an online portal with peer-to-peer, team and personal resilience support at people.nhs.uk/help/ headspace, plus an app focused on meditation and mindfulness to help reduce stress and aid better sleep headspace.com/nhs  
  • Mental Health Foundation on looking after your mental health while working during the outbreak bit.ly/MHF_Covid-19

Tax relief  
HMRC guide to tax relief bit.ly/HMRC_Covid-19

WFH  
Unite Home working guide bit.ly/Unite_WFH

Domestic violence  
TUC on Domestic abuse and coronavirus bit.ly/TUC_domestic_abuse


References

ACAS. (2020) Working from home. See: acas.org.uk/working-from-home (accessed 12 June 2020).

Astrup J. (2020) The danger indoors. Community Practitioner 93(3): 14-17.

Boots. (2020) Boots Pharmacy consultation rooms become safe spaces for victims of domestic abuse. See: boots-uk.com/our-stories/boots-pharmacy-consultation-rooms-become-safe-spaces-for-victims-of-domestic-abuse (accessed 12 June 2020)

Busby M. (2020) ‘Complete anarchy’: frontline NHS staff on the coronavirus peak. The Guardian. See: theguardian.com/world/2020/may/07/complete-anarchy-frontline-nhs-staff-on-the-coronavirus-peak (accessed 12 June 2020).

Cabinet Office, Department for Education. (2020) Critical workers who can access schools or educational settings. See: gov.uk/government/publications/coronavirus-covid-19-maintaining-educational-provision/guidance-for-schools-colleges-and-local-authorities-on-maintaining-educational-provision (accessed 12 June 2020).

Health and Safety Executive. (2020a) Display screen equipment (DSE) workstation checklist. See: https://www.hse.gov.uk/pubns/ck1.pdf (accessed 12 June 2020).

Health and Safety Executive. (2020b) Protect home workers. See: https://www.hse.gov.uk/toolbox/workers/home.htm (accessed 12 June 2020).

HMRC. (2020) Check which expenses are taxable if your employee works from home due to coronavirus (COVID-19). See: gov.uk/guidance/check-which-expenses-are-taxable-if-your-employee-works-from-home-due-to-coronavirus-covid-19 (accessed 12 June 2020).

Mental Health Foundation. (2020) Looking after your mental health while working during the coronavirus outbreak. See: mentalhealth.org.uk/publications/looking-after-your-mental-health-during-coronavirus-outbreak/while-working (accessed 12 June 2020).

NHS Employers. (2020) Enabling and supporting staff to work from home. See: nhsemployers.org/covid19/health-safety-and-wellbeing/enabling-and-supporting-staff-to-work-from-home (accessed 12 June 2020).

TUC. (2020) Domestic abuse and coronavirus. See: https://learning.elucidat.com/course/5e875ae4d0715-5e8c6417dfc28 (accessed 12 June 2020).

UK Parliament. (2020) Exemption for coronavirus related reimbursed home office expenses: Written statement – HCWS237. See: parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2020-05-13/HCWS237 (accessed 12 June 2020).

Unite. (2020) Covid-19 checklist for action. See: https://unitetheunion.org/media/3016/pdf-unite-covid19-equalities-checklist.pdf (accessed 12 June 2020).

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