Tag Archives: COVID-19

Forecasting the Trajectory of an Epidemic

Mark Levene is Professor of Computer Science in Birkbeck’s Department of Computer Science and Information Systems. He shares insights from research into modelling the waves of an epidemic.

Epidemics such as COVID-19 come in “waves”, although the precise definition of a wave in this context is somewhat elusive.  A standard way to model the epidemic is as a time series that records, say the number of daily hospitalisation or deaths, and these can be plotted to view the progress of the epidemic.

Waves in the time series span from one valley to another with a peak in between them. The shape of an individual wave can be modelled as a statistical distribution and several waves can be sequentially combined. More often than not waves are not symmetric, that is, the rate at which, say hospitalisations, increase is not the same rate at which they decrease once the peak of the wave has been reached. This non-symmetrical nature of a wave is called its skewness.

To take into account the skewness of epidemic waves we introduce the skew logistic distribution, which is a novel yet simple extension of the symmetric logistic distribution widely used in the modelling of epidemic data.

To validate our model, we provide a full analysis of the first four waves of COVID-19 deaths in the UK from the 30 January 2020 to 30 July 2021.

Our results show a good fit to the proposed skew logistic distribution, and thus could potentially augment existing more established models that are being used to forecast the trajectory of an epidemic.

Our findings have been published in MDPI Entropy.

Further Information

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Back to basics: how employers can help solicitors’ well-being

Law is one of the most popular degree choices, forming part of the ‘big triad’ along with medicine and finance in terms of a career of choice. But does a career in law come at a cost, and if so, what can employers do about it? Lucinda Soon, Solicitor and PhD student at Birkbeck’s Department of Organizational Psychology, highlights key findings from her research with co-authors, Dr James Walsh, Professor Almuth McDowall and Dr Kevin Teoh.

Over the past five years, the well-being of solicitors in England and Wales has become a topic of growing concern. In part, this was triggered by the disciplinary case of Sovani James. James, a junior solicitor, was struck off the Roll of Solicitors by the High Court for acting dishonestly at work, despite the Court acknowledging her behaviour may have arisen because of toxic work conditions and the stress she was under as a result. This decision sent an immediate shockwave through the solicitors’ profession, and an increased urgency developed to take the well-being of solicitors more seriously.

The Law Society of England and Wales has launched several surveys on the well-being of its junior members. Its latest survey, published in 2019, revealed that over 90% felt stressed in their role, with almost 25% feeling severely or extremely stressed. Last year, a study by the charity LawCare reported considerable risks of burnout, particularly relating to exhaustion.

These reports point towards a problem, but there is little evidence to inform us of what factors might be contributing to it and, importantly, how firms and organisations can help to address it. In our study, we sought to shed some light on this by looking at some possible aspects of work. Drawing on self-determination theory, we investigated how solicitors’ well-being might be affected by job autonomy, perceived belonging (or relatedness) at work, feelings of competence, and levels of mindfulness. To do this, we analysed responses from an online survey of 340 trainee and qualified solicitors practising in England and Wales.

The ABC’s of solicitors’ well-being

According to self-determination theory, we all have three basic psychological needs which must be satisfied if we are to flourish, thrive, and be well at work. These are the needs for autonomy (feeling we are in control of and have choice in our work), belonging or relatedness (feeling socially connected and supported at work), and competence (feeling we are effective in what we do, that we have mastery and skill, or that we can develop them). As the core psychological requirements for well-being, these factors also form a memorable acronym; to help solicitors’ well-being, do we need to go back to the basics of their ABCs?

We found the more that solicitors felt satisfied in their autonomy, belonging, and competence at work, the higher their well-being. This was observed regardless of gender, level of post-qualification experience (PQE), or type of organisation. In other words, common to all the solicitors we surveyed, feeling supported in their ABCs at work was important to their well-being.

Does mindfulness play a role?

Our study also found that solicitors with higher mindfulness experienced greater well-being. Again, this was the case regardless of gender, level of PQE, or where a solicitor worked, suggesting the benefit of mindfulness may be generally applied.

Interestingly, not only did higher mindfulness alone correspond with greater well-being; solicitors who were more satisfied in their needs for autonomy, belonging, and competence at work had higher levels of mindfulness, which in turn contributed to their well-being. Having the basic ABC building blocks in place appeared to cultivate mindfulness, amplifying the well-being benefits for solicitors.

What does this mean for managers and leaders?

While a clear link was found between mindfulness and solicitors’ well-being, our study points towards the importance of ensuring solicitors are satisfied in their ABCs at work. These basic and fundamental work factors play a direct role in solicitors’ well-being and may also help to facilitate the development of mindfulness to strengthen it even further. This places the work environment and work conditions of solicitors firmly into the spotlight.

Solicitors need to feel they have autonomy, that they belong, and are supported and cared for at work. They equally need to feel they are competent and effective in their jobs. Without these basic elements, their well-being will suffer. Our findings raise the possibility that had Sovani James been supported by her firm in terms of her ABCs at work, her mental health and well-being may not have deteriorated to the extent that it did, ultimately resulting in the end of her legal career.

The impact of Covid-19 and beyond

The changing context of work arising from Covid-19 cannot be ignored. Remote working and a greater appreciation for more flexible ways of working may have given many solicitors more autonomy in terms of when, where, and how they work; however, it has also introduced new challenges into the mix.

Our study shows that feeling connected and cared for, and competent and effective at work, matters for solicitors’ well-being. These work conditions can be easily frustrated when solicitors work in isolation from colleagues, mentors, and leaders, especially over a prolonged period of time. This may be particularly so for trainees and junior solicitors, who are less experienced and may need more frequent support from others.

Social-networking tools and formal and informal virtual catchups can help solicitors feel connected and supported by their work community even when they are working from home. Likewise, regular access to learning and development opportunities, agreed channels for feedback, and effective supervision can all be achieved using technology to facilitate communications. Remembering the need for autonomy, management and leadership practices which respect individual circumstances are also critical. One size will not fit all. Understanding people’s differing needs and wants and giving them a degree of control and choice over their work will all feed into their well-being.

As the profession continues to adjust to a new hybrid way of working, being alive to the importance of solicitors’ ABCs is a crucial starting point for all law firms and organisations looking to safeguard the well-being of their staff.

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My PhD focuses on well-being in the legal profession. While the findings of this study highlight some of the ways in which employers can help to promote solicitors’ well-being, there is more to the story. Please get in touch at l.soon@bbk.ac.uk, on LinkedIn or Twitter, if you’d like to discuss this study or share your thoughts.

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The Experiences of Junior Doctors Working During the COVID-19 Pandemic

In light of the rapid rise in Omicron cases in the UK, Dr Kevin Teoh, Senior Lecturer in Organizational Psychology, shares the latest findings from a study exploring junior doctors’ mental health.

Dr Kevin Teoh smiling, standing against a wall.

A big factor behind the increasing COVID-19 restrictions being (re)-implemented following the emergence of the Omicron variant is the pressure that our healthcare system is under. It is easy to see the healthcare system as this big organisation and not fully realise that its most important makeup is its people – who have their own thoughts, feeling and emotions.

In this study, we sought to better understand what that experience was like for individual doctors working during this pandemic. Over the past three years I have been working on a project led by Dr Ruth Riley at the University of Birmingham on working cultures, mental health and suicide among junior doctors in the National Health Service. When the COVID-19 pandemic started, we were able to capture the experience and impact of our participants working on the front lines, and in this study we focus on interviews with fifteen junior doctors drawn from a larger online survey of 456 junior doctors.

Challenges of working during the pandemic

Here we saw participants share at a personal level strong feelings of helplessness and powerlessness – especially in relation to the exposure to death and suffering. One participant shared that: “’I’d seen a whole ward just emptied out and then refilled overnight, after people had just died. It was horrendous”. There was also significant concern not only about being infected, but about potentially infecting loved ones outside of the workplace.

Unsurprisingly, the pandemic created substantial upheaval for junior doctors’ workplaces. Patients loads increased substantially while there was a distinct lack of support reported by others. The already under-staffed system was stretched even further as colleagues were infected, had to isolate or simply needed a break having exceeded their working hours.

On top of that, our junior doctors reported a new pressure in having to take on all the new information about this new virus on top of their existing heavy workloads, as this participant shared: “We were getting 20 emails a day, and every single one would have a red flag saying ‘vital, important, must read’, and you’d worry you’d missed something […] there’s so much information, it was constant, and you couldn’t switch off”.

There were changes to work practices, such as increased phone and online consultations, which not only necessitated learning new systems but also was not always conducive to the task at hand or supporting patient needs. It was also an additional source of complaint and abuse from patients who were frustrated with these new forms of consultations. Restrictions on group sizes, socialising and training also accentuated feelings that their training, support and learning needs were not being met.

Strategies of coping with the pandemic

Recognising the challenges from the pandemic, it was therefore concerning that many participants shared the inadequacy of personal coping strategies. Although these may have been useful before the pandemic, it was often felt that it was not enough during the pandemic.

Participants here shared how crying was one way of dealing with emotions. Others tried to be stoic – over time they were worn though and resigned that things were not going to get any better. This led to one participant sharing that “we’ve sort of entered a collective sort of depressive state of acceptance”.

More proactive examples had junior doctors trying to exert more control over their situation, seeking out new roles and tasks, such as getting more involved with supporting relatives which helped them feel as though were actually accomplishing something – “It wasn’t that sort of like, ‘I put lines in people and hopefully’, and then just watching them die”. Others shared about how they had to actively seek out psychological support to help them cope and prevent them from spiralling further.

Positive impact on working practices

Not all was doom, with participants also sharing positive examples of change. Crucially, some changes to work practices – such as longer rotations and working in consistent teams – led to feelings of better stability and more support. There were also examples of how less bureaucracy and more control allowed junior doctors to focus on more efficient and better ways of working with each other and for their patients.

Organisations too had to rapidly learn how to support their workers, with more access to psychological help and resources, or the provision of basic facilities being reinstated – including refreshments and rest areas. These were important given that “there were huge queues at the supermarket, and we were working 12-hour shifts, and it was unpredictable whether you could get food”.

What does this mean?

This study was an eye-opening experience into the challenges faced by junior doctors on working on the front-line at the start of the pandemic. As we enter its second year, serious questions need to be raised about how we support and retain not only junior doctors, but all workers in the healthcare system who likely have similar experiences. At the very least, a greater sense of appreciation and empathy for the work that they are doing is needed.

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Caring about Homecare

Caroline Wiemar and Kerry Harman from the Centre for Social Change and Transformation in Higher Education discuss the ongoing challenges faced by homecare workers since the homecare sector was privatised in the 1990s.

A carer with and elderly person in a carehome

Photo courtesy of Matthias Zomer

The invisibility of women’s work has been documented by feminist scholars for decades (see DeVault, 2014) and here we are in 2020 and, for paid homecare workers in the UK (and many other countries), the situation has not improved. Indeed, things have gotten a lot worse. While the COVID-19 crisis has drawn attention to the importance of ‘key workers’, particularly those employed in the care sector, proposed government immigration policy which prevents ‘low skilled’ workers entering the UK, including care workers, makes the weekly ‘clap for our carers’ feel like shallow rhetoric. Indeed, Hayes and Walters point to ‘the exploitation of care workers for political profit’ during the pandemic.

So what do we know about these homecare workers that, until quite recently, have been largely invisible? Annual reports on adult social care workforce data provide an overview of the workforce in England. Approximately 295,000 care jobs are in care home services with nursing; another 305,000 jobs in care only home services and the majority of jobs are in homecare, with 520,000 employed in this work. In other words, the provision of paid care is a major industry in the UK. Of the homecare workforce, approximately 50% were employed on zero-hours contracts, 84% were female, the average worker was 43 years old, 83% were British, 7% were EU (non-British) and 9% were non-EU. Across the care sector, there are large variations in ethnicity by region with London having the most diverse workforce (67% BAME) and the North East the least diverse (96% white). So homecare workers are likely to be more mature women, on precarious employment contracts, and Black or from a minority ethnic background if they work in London and white if they work in the North East.

While the outbreak of COVID-19 has contributed to a recognition of the ‘crisis in care’, a number of reports over many years indicate the homecare sector was in crisis well before the pandemic (BBC Panorama, 2019; Gardiner, 2015; Holmes, 2016; Koehler, 2014; UNISON, 2016). A shift to the outsourcing of this work to the private sector by local authorities during the 1990s had resulted in a race to the bottom in terms of hourly rates of pay and overall employment conditions for homecare workers (Hayes, 2017). This is exacerbated by an aggressive tendering process which often forces smaller, local agencies to eventually close their doors. The experience of working in the sector and changes that have taken place since the 1990s is provided in the following account by one of the authors:

I started working in the care sector 31 years ago when I got a part-time job as a ‘home help’ with the local council. My role was to help elderly disabled people in their own homes and to maintain their independence by doing shopping, laundry, housework, getting medications. The pay and conditions were good, with paid annual leave and sick pay. It was a satisfying job to strike up a relationship with the people I helped, hearing their stories of the past. I had time to have a conversation with them, which they enjoyed as sometimes I was the only person they might see that week. Then after a few years we were renamed ‘homecare workers’. With this title came changes –service users times were cut and they started to charge for their care. We had to do more in less time.

When the council outsourced homecare we were transferred to a non-profit organisation and we all had to take a pay cut. Our hours were cut, as well as sick pay and annual leave. If we did not take these cuts we did not have a job. You keep going because the vulnerable need your assistance. It’s not their fault we now work for less than previously. Then the non-profit organisation lost the contract and we were transferred over to a profit making company. I cared for a lady called Edna for just over ten years and she saw the changes with me. Edna had no family and I became her family. I used to get half an hour in the morning to give her a bath, dry her, help her dress, give her a drink, breakfast and medication. I used to go in earlier, just so I didn’t have to rush, as I knew I could not do all that in the time I had been given. We would have our conversation while I was carrying out my tasks. I would do all the things she no longer could because she was hard of hearing, like making phones calls. I’d organise appointments to doctors, hospital, medications and go with her in my own time. I’d make sure she had food, clean clothes – all things we able people take for granted. Over the years carers have lost pay, conditions, working hours and time to care.

Homecare is a low paid job and carers are not recognised for what they do . All I ever wanted was to have time to care, to give the person that I care for their dignity and independence – make them feel valued as a person and that they matter. Carers are everything to our service users – we are carers, nurse, secretary, friend, relative, the go to person who can sort everything out. Most of it is done in our own time. Sadly, my Edna passed away. She was classed as a vulnerable adult, but how vulnerable did she have to be to get the time and care she should of had? How long can carers go on giving their all and not being recognised and respected, on low pay and zero hours contracts? Carers look after the vulnerable but who looks after the carers?

(also listen to Caroline at a recent ‘How might we recognise the value of homecare provision?’ event at Birkbeck)

The ongoing ‘crisis in care’ resulting from the privatisation of the care sector since the mid-1990s points to the urgency of public policy interventions, backed by the resources to enable local authorities to bring homecare services back in-house. This would make it possible for fair wages to be paid and better working conditions for homecare workers across the country. Public policy interventions would also make it easier for trade unions to organise care workers, which is extremely challenging in the private care sector.

Another possible solution to the crisis in care in the UK has been a call for the professionalisation of the sector and this is usually accompanied by proposals for training and development. However, will more training and development get to what we believe is the heart of the problem, which is the ongoing failure to attend to the often embodied skills and knowing that homecare workers have developed in and through their everyday practices and experience at work? Indeed, many training and development programmes are underpinned by the same set of assumptions on what counts as ‘good care’ and who knows about ‘good care’ that work to make the everyday knowing in practice of homecare workers invisible.  As Weimar points out above, carers are also: ‘nurse, secretary, friend, relative, the go to person who can sort everything out’ and this is not ‘low skilled’ work.

During 2018/19, a participatory project with homecare workers was started in two boroughs in London called the ‘Invisible work, invisible knowledges?’ project. The authors met during that project. The purpose of the project was to make contact with homecare workers and find out more about their everyday experiences at work as part of a planned larger project on ‘Reimagining care’. One of the authors met with 13 homecare workers overall, in either individual or small group meetings, and the conversation usually started with: ‘Can you tell me what happens during a normal day at work? Is there such a thing as a ‘normal’ day?’ She was interested in hearing from homecare workers about what they actually do and, as part of these conversations, the homecare workers would often talk about the challenges they experience in their daily work. The resounding problem identified by care workers was the lack of time in the Care Plans[1] they are given to complete their work in a way that enables the people they care for to be treated with dignity and respect. This has resulted in many homecare workers providing additional hours of unpaid care to provide a level of care to care recipients that they consider adequate. As one care worker said, ‘If you see that there’s no food in the fridge, are you going to let someone go hungry?’ This is a reminder that, sometimes, care workers are the only point of contact that care recipients have with the outside world.

Another issue raised was the precarity of homecare workers’ employment contracts. The majority of care workers in London are employed by private agencies, with a large percentage on zero-hour contracts. Many care workers spoke about contracts that had eventually dwindled to very few hours work each week and the need to look for work elsewhere. A reduction in weekly hours was often connected with concerns raised by the care workers about the welfare of their clients/their working conditions. This is an issue that has been raised recently by the MP for Nottingham East, Nadia Whittome.

One outcome from the first stage of the project has been establishing a core group of homecare workers who are interested in documenting their embodied skills and knowledges which are so often overlooked. A crucial aspect of the research is recognising these workers as active producers of knowledge on care rather than passive recipients of knowledge produced in the academy and it is for this reason that homecare workers must be paid as co-researchers on the project. We are hoping the research will contribute to changing the ways care is able to be imagined as well as more democratic processes for developing policy on care, which includes homecare workers getting a seat at the policy making table.

To find out more about the ‘Reimagining Care’ project contact Kerry Harman.

References

DeVault, M. L. (2014). Mapping Invisible Work: Conceptual Tools for Social Justice Projects. Sociological Forum, 29(4), 775-790. doi:10.1111/socf.12119

[1] These are the plans which are put together, usually by an Occupational Therapist, after conducting an assessment with the person requiring care. They specify how many visits per day are required, the duration of each visit and the key activities to be undertaken at each visit.

 

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