Coronavirus

Coronovirus

Guidance Documents

The Government has published several sets of guidance on the COVID-19 virus all
of which is being updated regularly, if not daily:

Action Plan for Adult Social Care – click here

Admission and Care of Residents during COVID-19 in a Care Homeclick here

Personal Protective Equipment (PPE) – click here

Hospital Discharge Service Requirementsclick here

Specific advice for a number of other settings including:

For businessclick here

For health professionalsclick here

For the general publicclick here

Care Home Priorities

We are clear in all our conversations with the different parts of the system, DHSC in particular, that your priorities at the moment are access to PPE and access to testing for your staff.

Further crucial information and advice can be found below for these areas:

 

Member Ebulletins

We send regular ebulletin updates to our members with important information signposted for them. During the course of the pandemic this has been more frequent as the situation has changed so quickly. A summary of the May Ebulletins can be found here.

Member Ebulletins

We send regular ebulletin updates to our members with important information signposted for them. During the course of the pandemic this has been more frequent as the situation has changed so quickly. A summary of the May Ebulletins can be found here.

Further information on COVID-19 testing in social care

The DHSC has today, 27th April 2020, sent out a letter to the Adult Social Care sector. It begins as follows:

“Last week saw the publication of a dedicated national action plan to support the adult social care system and the COVID-19 testing offer to the sector. Below outlines the national offer to various groups and how they can get it.

We would like to acknowledge the work led locally, regionally and sub-regionally over recent weeks to ensure that testing has been available to staff and residents. That has played an invaluable role whilst national testing capacity has been coming on line and the offers of testing should be seen as additional to these. We are working quickly to support the hard work you are all doing to look after the most vulnerable in our society. This note represents the very latest position and things will change over the coming days as new capacity becomes available and we learn from you how best to deliver this service most effectively.”

The full text if the letter can be seen here

The Goverment have also issued an information pack for the employers of Essential Workers. This includes step by step guidance on the Employer led and Employee led routes as well as some FAQs. The pack can be downloaded here.

Personal Protective Equipment (PPE)

In the case of PPE you should, in the first instance, continue to attempt to order your normal amounts of PPE from your usual supplier. In the event that you are unable to obtain supplies then you should contact:

The National Supply Disruption line, Tel: 0800 915 9964, Email: supplydisruptionservice@nhsbsa.nhs.uk

The DHSC has sent out letter which contains the details of how eligible organisations can contact Local Resilience Forums to request urgent PPE supplies locally. A copy can be found here.

On the 9th of April Jonathan Marron of the DHSC issued a letter to all Directors of Adult Social Services, a copy of which can be found here

Revised guidance about the use of Personal Protective Equipment in all settings has been published. This guidance outlines the infection prevention and control advice for health and social care providers involved in receiving, assessing and caring for patients who are a possible or confirmed case of COVID-19. It should be used in conjunction with local policies.

On 2 April 2020, the main changes to the previous guidance were:

  • enhanced PPE recommendations for a wide range of health and social care contexts
  • inclusion of individual and organisational risk assessment at local level to inform PPE use
  • recommendation of single sessional (extended) use of some PPE items
  • re-usable PPE can be used. Advice on suitable decontamination arrangements should be obtained from the manufacturer, supplier or local infection control
  • guidance for when case status is unknown and SARS-CoV-2 is circulating at high levels
  • recommendation on patient use of facemasks

The overall guidance can be found here, and the detailed guidance for each health and care setting is here.

Please note that there is detailed guidance, tables of what equipment to utilise in what setting along with posters which you may wish to utilise to publicise the exact requirements with staff and visitors.

Staffing. 

Social care workers are clearly within the definition of key workers and hence our nursing and care staff can continue to send their children to school during this period. The   overall guidance for staff is here and and the guidance to schools (which contains some further detail) is here .

A number of staff have been worried about them or their children developing a new persistent cough. There are a  number of videos and assistance on the internet, such as https://www.bbc.co.uk/programmes/p0871lq7 or the NHS 111 website. A new, continuous cough is on the nhs website as “coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)”

Otherwise, given that the planning assumption is to expect up to 20% of our staff to be self isolating over the coming weeks, now is the time to recruit whilst staff are being laid off from other sectors such as hospitality.

Our Frontline was launched on the 22nd of April. This will give access to information, emotional support and crisis support for anyone who is working as a key worker, whether in the NHS, Social Care or elsewhere. It’s a collaboration between Samaritans, Shout, Mind and Hospice UK. More information is contained here

Hospital Discharge. 

Members must download and read the service requirements which are to be applied to all hospital discharges over the period of this emergency. The document is at https://www.gov.uk/government/publications/coronavirus-covid-19-hospital-discharge-service-requirements?utm_source=2afe0e24-a83f-4660-bb43-4bb839453d2f&utm_medium=email&utm_campaign=govuk-notifications&utm_content=immediate.

Members should in particular read Annex B to give themselves a sense of how quickly people will be assessed to be discharged from hospital and hence a sense of how the system will operate over the coming weeks. A press commentator referred to the acute NHS as going to become a COVID-19 service for the emergency and the rest of the system has to support this. Also please look at Annex A which describes the Discharge to Assess model which is to be used during this period.

Section 8 of this document has the requirements of social care providers for this period, being to use the NHS capacity tracker to report occupancy on a daily basis, embed the Enhanced Health in Care Home Framework, implement NHSmail, and work with a trusted assessor model.

The capacity tracker can be found at https://carehomes.necsu.nhs.uk/ and there are videos available under help which explain how to gain access to the system for those members who do not use the system already.

We are working with various parts of the system in this coming week to determine what assistance members may have access to implement the NHSmail system and members should continue to use our Digital Social Care website, https://www.digitalsocialcare.co.uk/ to find the latest guidance.

Resources and Money

There is little detail on exactly what is to be provided to care providers since the policies have changed fundamentally during the last week. You should also note that the majority of initiatives taken by the chancellor do not affect Care Home providers since we do not pay business rates and are outside the sector specific provisions. The recovery of SSP is however relevant to us, see below.

During the week Matt Hancock has written to all social service directors which includes the following:

 “Building on the helpful commissioning guidance note recently published by the LGA, ADASS and the Care Provider Alliance, this funding could be used to help in:  

  • Protecting providers’ cashflow by accelerating payments and paying ‘on plan’ where appropriate. We recognise that where the support providers are able to provide is significantly below plan, commissioners may have needed to fund support elsewhere.
  •  Helping providers deal with the costs of increased workforce pressures due to higher sickness absence caused by the outbreak, but also due to self-isolation and family caring responsibilities. Care providers will need to able to deploy their staff flexibly. They may need to hire new staff quickly or increase use of agency staff, creating additional cost pressures. The funding could also help providers support workers on zero-hour contracts. 
  • Facilitating arrangements for adjusting packages as required in a timely and non-bureaucratic way, especially where providers are having to operate beyond normal services in order to respond to need. 
  • Ensuring councils can adjust care packages in accordance with guidance on prioritisation and social work ethics. 
  • Helping providers to meet costs associated with enhanced infection control and the protection of staff. 
  • Ensuring there is clear and effective transfer of information between commissioners and providers on the general market picture, including the picture around self-funders. 
  • Finding supportive and creative ways to support providers in handling wider pressures caused by COVID-19. 

 Clearly, this is not an exhaustive list and other pressures are likely to emerge.”

 Full text can be seen here – https://local.gov.uk/coronavirus-information-councils/social-care-provider-resilience-during-covid-19-guidance-commissioners

 In other words financial support will come to us through the local authorities and some local authorities have already committed to protect the cash flow of care providers in their area by guaranteeing to pay at least the average of the payments made in the previous three months.

We expect that the CCG’s will continue to make payments for Funded Nursing Care and NHS Continuing Care on a similar basis but further telephone conference calls are booked for early this week to clarify how the system will work during this period.

 Members should therefore make themselves aware of the local arrangements in their area for this period.

 Some members have queried the repayment of Statutory Sick Pay announced ten days ago. The only guidance available to date is at https://www.gov.uk/government/publications/guidance-to-employers-and-businesses-about-covid-19/covid-19-support-for-businesses#support-for-businesses-who-are-paying-sick-pay-to-employees but this states that a rebate scheme is being developed. Evidence requirements are within the guidance.

CQC

You will have seen from bulletins from CQC that their normal inspection regime has been suspended. They have not suspended all inspections and should there be safeguarding concerns then they have stated that they will undertake short inspections but this would be preceded by a telephone call to the service.

Members should also note that notifications have not been suspended and hence the full range of issues will continue to be required for notification, eg a high level of staff absence

CQC have  created a frequently asked questions page on their website which can be accessed here.

Policy amendments

During the past week you should have reviewed your visiting policy to determine on what basis you allow visitors and how you are minimising the risk of the virus entering your premises. This may include temperature testing, restricting all but essential visits, and or placing restrictions on where within building people may visit.

A further change to your policies should be the procedure to be followed by staff if and when a resident is suspected of having the virus. This procedure is outlined in the middle of the general guidance for care homes at https://www.gov.uk/government/publications/covid-19-residential-care-supported-living-and-home-care-guidance/covid-19-guidance-on-residential-care-provision.

The Coronavirus Act

The act enables action in 5 key areas:

  1. increasing the available health and social care workforce – for example, by removing barriers to allow recently retired NHS staff and social workers to return to work (and in Scotland, in addition to retired people, allowing those who are on a career break or are social worker students to become temporary social workers)
  2. easing the burden on frontline staff – by reducing the number of administrative tasks they have to perform, enabling local authorities to prioritise care for people with the most pressing needs, allowing key workers to perform more tasks remotely and with less paperwork, and taking the power to suspend individual port operations
  3. containing and slowing the virus – by reducing unnecessary social contacts, for example through powers over events and gatherings, and strengthening the quarantine powers of police and immigration officers
  4. managing the deceased with respect and dignity – by enabling the death management system to deal with increased demand for its services
  5. supporting people – by allowing them to claim Statutory Sick Pay from day one, and by supporting the food industry to maintain supplies

The act significantly enhances the ability of public bodies across the UK to provide an effective response to tackle this epidemic. 

Care Planning

The importance of having a personalised care plan in place, especially for older people, people who are frail or have other serious conditions has never been more important than it is now during the Covid 19 Pandemic.

Where a person has capacity, as defined by the Mental Capacity Act, this advance care plan should always be discussed with them directly. Where a person lacks the capacity to engage with this process then it is reasonable to produce such a plan following best interest guidelines with the involvement of family members or other appropriate individuals.

Such advance care plans may result in the consideration and completion of a Do Not Attempt Resuscitation (DNAR) or ReSPECT form. It remains essential that these decisions are made on an individual basis. The General Practitioner continues to have a central role in the consideration, completion and signing of DNAR forms for people in community settings.

It is unacceptable for advance care plans, with or without DNAR form completion to be applied to groups of people of any description. These decisions must continue to be made on an individual basis according to need.

This is a joint statement from the following organisations:

British Medical Association (BMA),

Care Provider Alliance (CPA),

Care Quality Commission (CQC),

Royal College of General Practice (RCGP) 

Other Useful Documents

    1. The Secretary of State has published an open letter to the social care workforce which can be found here.
    2. Some police forces and supermarkets have stopped social care staff and queried with them if they are key workers, usually asking for NHS ID. We have created a template letter which you can format and give to your staff to enable them to prove that they are indeed key workers. You can download a copy here
    3. Local protocols for assessing for COVID-19. Several local areas have produced protocols for the assessment of residents showing symptoms of the virus.” An example can be seen here.
    4. Guidance on care of the deceased with suspected or confirmed COVID_19 is here

Lessons learnt from Care Homes in Spain

 Clece Care is a Spanish company who operate over 95 care homes and integrated care services across Spain. Their CEO has recently written,

 “I just want to share with you what is proving to be a very effective measure to prevent the spread of the virus in certain facilities, in particular Nursing and Care Homes. Basically we are experiencing an extremely positive correlation between the level of deep cleanings and disinfections and the incremental number of cases. I know is quite obvious but I think is worth to mention and promote the need to increasing deep and disinfection cleanings in Nursing, Care Homes, Supported Living, Extra cares and also, care providers offices that are so critical to assure continuity of the services. In the case of the ExtraCares, unfortunately we do not have the autonomy to do this in most of the cases as we are not managing the building but maybe you could do an action with building management associations to promote this.”

We have also seen a report on initial lessons learnt so far in Spain, which is here

Sector Wide Cooperation

The RNHA is an active member of the Care Provider Alliance who are working closely with the DHSC to ensure information is disseminated as quickly and effectively as possible.

The CPA website has a section dedicated to the Coronavirus here:

https://www.careprovideralliance.org.uk/coronavirus.html