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Coronavirus (COVID-19): Letter to Department of Health and Social Care - 29 May 2020

Dear Colleague,

South Tyneside Council has a strong track record of working in partnership with Health and Social Care Providers. This is supported by clearly articulated and communicated alliancing principles. As one of the first Local Authority areas to establish a Health and Wellbeing Board, we have strong and consistent leadership, which supports our local system and drives delivery of the priorities identified and developed by our local partners. In the face of the challenges posed by COVID 19, our established framework has mobilised quickly to plan for and address issues facing our local system.

The impact of COVID 19 is highly complex. The Council is acutely aware that the effects of COVID 19 cannot be resolved by a plan put in place by an individual agency, including the local authority. Whilst our Care Home Support Plan sets out a number of actions to mitigate the risks and impact to our care home residents and staff, we must emphasise that some of these actions are reliant upon the activity and ownership of others, including national systems and processes, to which the Local Authority has little, if any, influence, such as testing. Having raised this previously, you will be aware that testing is currently proving problematic. 

As a local system, we have introduced robust oversight and governance arrangements to support and advise our Care Providers in order to protect residents and staff. Our focus as a system has been to work with our Providers to ensure they have proper and appropriate business continuity plans in place and there is suitable resilience within the local system to respond and react to all the challenges, both current and future, posed by COVID 19. Proactive communication, such as our daily calls with care home staff, allows us to record and understand local data and intelligence to identify issues and trends, understand any issues and provide timely and meaningful support to address those issues. In addition, our weekly calls with care home managers and bi-weekly calls with regional managers, allow us to collectively understand local and regional care market resilience. We have recently reviewed our quality assurance framework in view of the current circumstances to support Care Providers and are reintroducing quality assurance support visits. These will commence in June.

The use of safeguarding and quality data is also important to inform our knowledge in relation to our Care Homes and their residents. We know that our Providers in the North East have a higher than average quality rating when compared to national ratings. The number of Providers within the North East rated as 'Outstanding' is currently 6.7%, which is higher than the national figure of 4.6%. The number rated as 'Good' is also higher at 82.6% with the national figure being 79.5%.

We know that during the current period, the Care Quality Commission have suspended their approach to inspection, and that they are using the emergency support framework to deliver against their core regulatory role and core duties. Under this revised approach, we understand that 14 Providers within South Tyneside considered against the new framework and all 14 were assessed to be 100%.

Our local action plan addresses the key areas that we have completed as well as the areas we need to take forward as a system to ensure the appropriate measures are in place to support our Care Homes. The plan is a system response with appropriate oversight from both myself as Local Authority Chief Executive and the Accountable Officer from the CCG. The plan has been developed in partnership with the Providers from the South Tyneside System, including our Care Homes and there are lead roles for the Director of Adult Social Services, Director of Public Health and Director of Nursing. Information gathered from a variety of sources including the completion of the capacity tracker has been used to complete the assurance documentation. The plan provides the system with an evidence base of the actions we have taken locally to support the Care Homes and provide assurance the appropriate guidance has been followed and implemented.

In response to The NHS Discharge Requirements, which were published in March 2020, we have worked with the local system, including our NHS partners to implement the requirements locally. At the time of publication of this guidance, it is was noted that those who were deemed to be medically optimised, rather than the previous definition of medically fit, were identified as safe to leave the hospital setting. As system partners, we worked collaboratively to ensure the capacity of the hospital was available. As a system we have kept this under review and provided regular support, advice and guidance to all our providers, as well as reviewing the needs of our system in relation to planning alternative accommodation, where necessary. We continue to keep this under review, balancing this with the needs of those individuals within the Care Homes, those who need to return, the risks of infection and the impact of several moves on an individual.

In accordance with the Adult Social Care Action Plan, it was understood that a small number of people may be discharged from the NHS, within the 14-day period from the onset of COVID-19 symptoms, who would require ongoing social care. On 15 April the Government made a commitment, taking effect from the 16 April, that all NHS organisations would be responsible for testing all those being discharged into Care Homes. This was immediately implemented.

For those residents that did require ongoing social care, the pathways in the discharge requirements were followed. For those requiring care provisions, we have worked with our Care Homes to ensure they were clear about Public Health England guidance in relation to infection control and that isolation and cohorting of residents were in place upon discharge.

We have continually kept our Providers informed of the ongoing changes to guidance and discussed the requirements of PPE, the need to ensure staff comply with the requirements of infection control procedures, social distancing and that they have taken appropriate actions within the Care Home to reduce the risk of infection.

This ongoing focus with our Care Homes to ensure they adhere to and implement the PHE guidance has been an ongoing part of our support. Having ensured speedy distribution of all Government and PHE guidance to our Care Homes, we have followed this up through our daily calls, weekly calls with managers, discussions with regional managers and proactive reviews by specialist infection control nurses. This will continue to be part of our quality assurance process. In addition to this we have monitored closely PPE supply and stock levels with all Care Homes on a daily basis to ensure all our Care Homes have adequate stock levels at all times.  Whilst identifying any stocks issues, we have also used this daily check to identify those Care Homes who may not be using sufficient levels of PPE in accordance with the PHE guidance. Based on the data and information we have been able to assess PPE usage and where misuse of PPE has been identified, the matter has been addressed and resolved immediately with the Care Home and its staff.

As a local system we have continued to support our Care Providers to ensure they have timely and sufficient access to meet their PPE and medical equipment requirements. Access to PPE was a significant challenge for our Providers but South Tyneside Council took an early decision to ensure arrangements were in place to support Providers with the guaranteed provision of PPE. The Local Authority has provided PPE on a weekly basis where a Care Provider's own arrangements, mutual aid arrangements, PPE Portal and LRF supply has been unable to source the amount of PPE required to comply with infection control guidance. This has been an important factor in supporting our Care Homes to minimise the risk of infection within their Homes. We have supported Care Homes with access to training in the use of PPE, as set out by NHS England. 'Super Trainers' have overseen the training of 'Local Trainers' and Infection Control Leads within our Care Homes. All of our Care Homes have been very responsive in their uptake to this training.

Establishing a Care Home Support Team from the outset has been a critical element to our response. This Team, compromising of Commissioning Officers, Primary Care support, Public Health expertise, Director of Nursing and Council Officers have been able to and continue to support our Care Homes in several key areas (including understanding and application of the Public Health Guidance, testing, workforce and finance issues. The Team also works closely with our community services colleagues, including infection control specialists.

We successfully implemented local arrangements that offered Care Providers timely testing and communication of results for symptomatic residents and staff. We know not all Care Providers have registered on the Government's testing portal due to difficulties with the system and that some Care Providers have experienced delays in accessing COVID testing kits for residents and asymptomatic staff. We continue to support Care Providers with information and access to testing as best we can.  However, improvements are necessary to the national testing programme to support an increase in local capacity, ensuring sufficient access to relevant supplies to enable more regular and timely testing of asymptomatic residents and staff.  Of concern is the required level of weekly testing of all Care Home residents. It is also worth noting that whilst a focus is required for Older Persons Care Homes, this should also be the case for other aspects of care, such as supported living, extra care and other areas of support.

Care Homes must be able to continue with routine admissions from community settings. In normal circumstances this is the key route of admissions. To date, there has been no regular or enforced testing of admissions from the community or requirement of a period of isolation for asymptomatic admissions. Work will be required with Providers to ensure that this is in place going forward. There has been little information made available to Local Authorities, particularly in relation to test results.  Contact tracing will result in more information flowing throughout the system.  Local Authorities must receive more timely and relevant information to support measures to reduce community transmission.

We have provided medical equipment to those Care Homes with an outbreak or without access to medical equipment and have offered training on how to use it. Care Homes now have access to digital tablets and can use the National Early Warning Score (NEWS2). We will continue to provide medical equipment to the remaining Care Homes, once national supply chains allow. This has proved beneficial to our Homes in being able to identify those people who may have a deterioration in their health and wellbeing.

Workforce availability is reviewed daily, including levels of sickness absence with Care Providers alongside other data. Current data suggests that staffing levels are adequate. This may however be impacted by testing of asymptomatic residents and staff and ensuring that staff do not work across more than one Care Home to reduce the spread of infection. Each Provider is required to have a business continuity plan in place to allow it to operate safely on an overall reduced staffing cohort. Experience to date based on Care Homes with previous significant outbreaks is that staffing arrangements have thus far been maintained. Consideration will need to be given to the potential impact of the contact tracing system and how this could impact upon our Care Homes and the need to ensure Local Authorities have access to timely information and data so we can manage effectively issues relating to potential outbreaks but also staffing implications for the Care Homes.

We have worked with regional colleagues to support a recruitment campaign and undertake a workforce analysis review. In addition to this we have worked with colleagues from North East Commissioning Support to access the 'Redeployment Hub'. The uptake from Care Homes appears to be limited in terms of this support to access the Redeployment Hub. A Memorandum of Understanding has been provided but this requires all parties to agree and work to it. The difference in terms and conditions between the Care Sector and NHS needs to be given much greater consideration. The impact of this when trying to recruit to the sector is proving challenging. As a system we have been supporting our Care Homes by providing additional support through our Community Support Teams including District Nursing Provision, Palliative Care Teams and access to Primary Care support.

When looking at the recruitment of volunteers into Care Homes, careful consideration needs to be given to the roles in which volunteers can truly support Care Homes, how this is managed in terms of safeguarding and foot fall into the Care Homes and the message to residents and families in terms of how this is perceived in relation to visits to the Home.

Care Providers have primarily sourced agency staff and utilised existing staffing, whilst symptomatic or isolating staff have returned to work. We have worked closely with our Care Homes to identify issues in relation to staffing to support them to source additional staffing where needed. In addition to this, staff wellbeing is important to us and our partners and we continue to provide support to our Providers in relation to accessing resources for staff wellbeing, including psychological therapies and wellbeing support.

Named Clinical Leads are in place for both our residential and specialist care Providers whilst Care Providers have acknowledged the access to primary and community health support. Once again through the work of our Care Home Support Team, arrangements were made for access to primary care support to be in place for our Care Homes at the outset. Our Homes continue to be supported by a range of system partners and professionals as we recognise the difficult circumstances in which they are working and responding to.

We have provided ongoing financial support to our Care Providers through an initial 5% unconditional payment, which we have now increased to 10% in addition to the inflation plus increase that applied from April 2020. We have at all times considered support on an individual basis where Care Providers have requested additional financial support and ensured that payments have been made to Providers on a timely basis.

The Local Authority has funded PPE equipment to Care Providers, at no charge to them. We have also offered providers the option for alternative payment mechanisms to assist with their financial situation, which would include payment in advance to suit local circumstances. The Local Authority is now working to ensure a timely allocation is made in respect of the Infection Control Fund in accordance with the grant conditions to our Providers.

Communication, advice and support to South Tyneside Providers has been coordinated by the multi-agency Care Home Support Team, which incorporates representatives from agencies across the health and social care system, working collaboratively to provide the necessary assistance to our Care Homes, our staff and our residents. Our proactive approach in setting up this Team, prior to any national requirement, has enabled us to respond swiftly and proactively in these unprecedented times.  We continue to work collaboratively with our providers to implement the requirements of the Care Home Support Plan for those areas that are within our local system. However, the impact of our work will be assisted significantly by greater clarity of coordinated information and communication at a national level.

Care Home Support Plan - 29 May 202045.87KB

Yours sincerely

Martin Swales
Chief Executive

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