COVID-19 oral history project

The project focused on the experiences of speech and language therapists, student speech and language therapists, members of the RCSLT Board of Trustees, and RCSLT staff during the COVID-19 pandemic. Individual and group interviews were conducted via Zoom, and the recordings now form an archive of the experiences of the speech and language therapy profession during the COVID-19 pandemic.

Although each group spoke to some themes particularly relevant to their area of work and perspective, all interviewees spoke to the aspects of the pandemic more generally that had a far-reaching impact regardless of any particular clinical expertise people have – themes such as mental wellbeing and uncertainty as a result of the pandemic and changes to ways of working and learning. A number of broad themes emerged from these conversations.

Innovation

With government and health service guidance often slow in evolving to meet the needs of the profession, speech and language therapists in many cases took it upon themselves to find solutions and ensure service users’ needs were met. Transitioning to tele/virtual health options may be the more obvious example of this but it went beyond that.

Speech and language therapists described forming support networks among colleagues to share ideas, those working in intensive care units developed ways to help people communicate when their speech was limited, and those in the community found ways of engaging with their service users while maintaining social distance measures. It became clear that speech and language therapists were able to achieve innovative solutions in these exceptional circumstances in large part because of the nature of the profession and people within it.

Regional health inequality

There permeated through this project a very real sense that access to treatment and care was not equal across the United Kingdom. This had little to do with actual frontline staff who all expressed an unwavering commitment to their service users. What became apparent, however, was that those staff did not enjoy consistent levels of support from those further along the managerial chain, including more senior decision makers. In many ways, it became something of a ‘potluck’ situation as to whether speech and language therapists were given the support they needed to facilitate their roles to the high level they all wanted to for their service users.

Access to personal protective equipment (PPE)

A theme that appeared consistently were the issues early in the pandemic with accessing PPE. Even late into the process, things like clear masks for those needing to lip read continue to be an issue. This speaks further to the aforementioned issue of inconsistent levels of care that speech and language therapists were able to offer across the country, because they were not supported to the same levels. This also raised anxieties around safety where lower levels of PPE than was deemed necessary by experts were nevertheless often the only products available.

Interactions with guidelines

Speech and language therapists often described being dependent on the strength of support from their management team and trust as to whether their feedback on the feasibility of national and trust guidelines was listened to. The speed at which national guidance was able to adapt to better suit the needs of the profession was frequently raised as being an issue. As noted above, things like what was classed as an aerosol generating procedure (AGP) or what PPE should be offered in certain settings proved hugely challenging.

In the community, many spoke of feeling ignored or forgotten when broader guidance was published as they did not feel the needs of role was adequately considered. The RCSLT were also often praised for generating and championing more comprehensive guidelines that speech and language therapists felt better supported the reality of their needs. Overall, the picture was one of real anxiety, uncertainty and frustration that the profession was not being fully considered in government and health service guidance.

SLTs in the wider health landscape

Although it was not in the planned themes, discussions around the perception of the speech and language therapy profession became common over the course of the project. Through the worst periods of the pandemic, when many speech and language therapists were being redeployed, interaction with other professionals or time in departments they would not normally encounter seems to have had the outcome of increasing the general awareness of what speech and language therapists are capable of.

The RCSLT championing the importance of the profession by arguing against redeployment was also crucial in maintaining a perception of the profession as being highly skilled, valuable in its contribution to patient care, and distinct among the healthcare community. As a relatively small profession in the wider context, this demonstrated a positive long-term outcome in terms of greater awareness of the value of speech and language therapy. Some speech and language therapists also spoke of feeling like they have a greater appreciation for where their skills can best be utilised and even of realising where they wanted to specialise as a result of their experiences during the pandemic.

The role of the RCSLT

With the expected caveat that people participating in this project were aware it was being run by the RCSLT in mind, many participants expressed their respect for and gratitude to the work of the RCSLT over the course of the pandemic. The support given to members was appreciated by many, and often came up unprompted particularly on the issue of guidance. Students also noted the support of things like suspending fees and offering tailored advice on placements. General engagement between members and the RCSLT also appeared to be high during the pandemic with both members and staff noting the scale of communication across multiple platforms.

Mental wellbeing

It is difficult to speak of the considerable scale of the impact of the pandemic on participant wellbeing. It should go without saying that people were negatively affected by this period in our history, while simultaneously it feels not enough can be said about it. This project made clear that we are far from living in a ‘post pandemic’ world as far as speech and language therapists and healthcare professionals more broadly are concerned.

Many participants noted that the challenge of the pandemic has not passed. The pressure they are under is immense, the anxiety about getting ill themselves persists and thoughts of the welfare of their loved ones has not abated. The toll of redeployment was significant on many of the participants as they had to deal with situations they could never have expected to encounter. There is a considerable degree of uncertainty and concern among students and newly qualified SLTs, as well as their educators, about what the future of the profession might look like as it seeks to adapt to the challenge of a pandemic recovery.

There were, however, positives as well. Many mangers spoke of having a greater understanding and consideration for the wellbeing of their staff, of wanting to actively consider a more holistic view of the person over the job they do. Additionally, while undoubtedly many participants struggled with adapting to work from home, they nevertheless spoke of gaining a greater appreciation for what was important to them and to understanding their work/life balance more.

Overall, while the scale of the challenge to people’s mental wellbeing both during the pandemic and moving forward cannot be understated, this project offered a hopeful vision too. There was a real undercurrent of strength and determination among participants to do their best for their service users and to make more time for their own wellbeing. Within the RCSLT, it also felt like there was a real commitment to improving the standing, and standards, of the profession for the benefit of speech and language therapists, both professionally and personally.

Next steps

RCSLT is storing the archive securely to ensure that this valuable record of reflections and observations is maintained. Discussions are currently underway for the use and sharing of the archive and the key information and perspectives stored in it including in our ongoing policy and influencing work.

We are very grateful to Johnnie for his brilliant work conducting the interviews and developing this archive. This archive could not have been developed so completely and holistically without his hard work. We are also indebted to all the participants for taking the time to share their stories and experiences with us. We understand that for many, recalling these memories and experiences was not easy, and we are incredibly thankful to them for being willing to share these with us.