Special Edition for the Care Sector
INTRODUCTION
This Bulletin gives a summary of the Government’s newly published ‘Adult social care:
Coronavirus (COVID-19) Winter Plan 2020 to 2021’.
The Winter Plan sets out:
- The Government’s ambitions for the sector and the challenges facing adult social care this winter
- Key actions for national bodies (Department of Health and Social Care), local systems (Local Authorities and NHS England) and adult social care providers
It covers 4 themes:
- Preventing and controlling the spread of infection in care settings
- Collaboration across health and care services
- Supporting people who receive social care, the workforce, and carers
- Supporting the system
Each section sets out the Government’s offer of national support and their expectations for adult social care providers alongside published guidance.
The plan applies to all settings and contexts in which people receive adult social care. This includes people’s own homes, residential care homes and nursing homes, and other community settings. It also defines the main actions to be taken by Local Authorities, NHS organisations, and social care providers, including in the voluntary and community sector.
THE HEADLINE CONTENTS
The Government pledges that it will:
- Continue to engage, across the sector, including with Local Authorities, care providers, people with care and support needs and carers, to understand their needs and to provide appropriate support
- Continue to provide financial support to the sector, by providing over £500 million of additional funding to extend the Infection Control Fund to March 2021. This is in addition to the £3.7 billion in emergency funding for local authorities, and the £588 million for discharge as part of the £3 billion NHS winter funding to cover the costs of ongoing care for the remainder of the financial year
- Lead and coordinate the national response to COVID-19 and provide support to local areas, where needed, as set out in the contain framework
- Appoint a chief nurse for social care to the Department of Health and Social Care (DHSC)
- Work up a designation scheme with the Care Quality Commission (CQC) for premises that are safe for people leaving hospital who have tested positive for COVID-19 or are awaiting a test result
- Continue to develop and publish relevant guidance, accessible for everyone supported by social care services, and update policies and guidance based on the latest science and evidence. HMG will work proactively with the sector to communicate vital updates to this Winter Plan and other guidance
- Work relentlessly to ensure sufficient appropriate COVID-19 testing capacity and continue to deliver and review the social care testing strategy, in line with the latest evidence, scientific advice on relative priorities and available testing capacity
- Work to improve the flow of testing data to everyone who needs it
- Provide free personal protective equipment (PPE) for COVID-19 needs in line with current guidance to care homes and domiciliary care providers, via the PPE portal, until the end of March 2021
- Provide free PPE to Local Resilience Forums (LRFs) that wish to continue PPE distribution, and to Local Authorities in other areas, to distribute to social care providers ineligible for supply via the PPE portal, until the end of March 2021
- Make available for free and promote the flu vaccine to all health and care staff, personal assistants and unpaid carers
- Play a key role in driving and supporting improved performance of the system, working with Local Authorities and the CQC to strengthen their monitoring and regulation role to ensure infection prevention and control procedures are taking place
- Publish the new online Adult Social Care Dashboard, bringing together data from the Capacity Tracker and other sources, allowing critical data to be viewed, in real time, at national, regional and local levels by national and local government
- Publish information about effective local and regional protocols and operational procedures based on what we have learnt so far to support areas with local outbreaks and/or increased community transmission
KEY ACTIONS FOR PROVIDERS TO TAKE + INFORMATION ON INPUT FROM OTHERS
1) Summary Actions
- Providers must keep the needs and safety of the people they support and their staff at the forefront of all activities
- Providers should review and update their business continuity plans for the autumn and winter, of which workforce resilience should be a key component
- Providers should continue to ensure that all relevant guidance is implemented and followed, using the new guidance portal for providers, overview of adult social care guidance on coronavirus (COVID-19)
- Providers should utilise additional funding available to implement infection prevention and control measures, in accordance with the conditions of the Infection Control Fund and those given by Local Authorities, and should provide all information requested on use of the funding to Local Authorities
- Providers must provide data through the Capacity Tracker or other relevant data collection or escalation routes in line with Government guidance and the conditions of the Infection Control Fund
- Providers should ensure that both symptomatic staff and symptomatic recipients of care are able to access COVID-19 testing, as soon as possible. Care homes should adhere to guidance on regular testing for all staff and care home residents
- All eligible care providers can register for and use the new PPE portal. All providers should report any PPE shortages through the Capacity Tracker, LRFs where applicable, or any other relevant escalation or data collection route
- Providers ineligible to register for the portal (such as personal assistants) should contact their LRF (if it is continuing to distribute PPE) or their local authority to obtain free PPE for COVID-19 needs
- Providers should proactively encourage and enable people who receive care and social care staff to receive free flu vaccinations and report uptake
- Care home providers should develop a policy for limited visits (if appropriate), in line with up-to-date guidance from their relevant Director of Public Health and based on dynamic risk assessments which consider the vulnerability of residents. This should include both whether their residents’ needs make them particularly clinically vulnerable to COVID-19 and whether their residents’ needs make visits particularly important
2) Guidance on infection prevention and outbreak management
All care providers should:
- Continue to follow all relevant guidance on how to prevent, control and manage an infection in their care setting
- Undertake a learning review after an outbreak, with support from their Local Authority
- Liaise fully with their PHE local health protection team and other local partners as needed
- Report shortfalls in support or equipment, to Local Authorities, and through established data capture portals
- Ensure all care staff have ongoing training on infection prevention and control, the appropriate use of PPE, and can engage with online training for learning reviews when available. The CQC’s registration requirements support this approach during the COVID-19 pandemic in line with the relevant guidance and code of practice
- Ensure staff are carrying out all relevant infection prevention and control procedures to a high standard through a robust system of audit and quality assurance
- Identify and support an individual to be the lead for infection prevention and control for COVID-19 to ensure adherence to infection prevention guidance
- Ensure staff do not work if they have COVID-19 symptoms, or a member of their household has symptoms or a recent positive test, or they have been told to isolate by NHS Test and Trace
3) Managing staff movement
Stopping staff movement in and between care settings is critical to minimise the risk of infection of COVID-19 and other viral illnesses, including flu. The extension of the Infection Control Fund will:
- Continue to support all providers to put in place measures to stop staff movement
- Continue to support providers to pay staff who are self-isolating, in line with Government guidance, their normal wages while doing so
Limitations on staff movement between care homes will be enforced through regulations focused on care home providers.
Local Authorities will:
- Distribute money from the Infection Control Fund, and submit returns on how the funding has been used in line with the grant conditions
- Consult the guidance available on redeploying staff and managing their movement, and support providers in their area to access other initiatives – for example Bringing Back Staff
- Continue to review contingency arrangements to help manage staffing shortages, within social care provision, through the winter, with the aim of reducing the need for staff movement
- Provide clear communication to social care providers regarding the importance of implementing workforce measures to limit COVID-19 infection, signpost relevant guidance, and encourage providers to make use of additional funding where appropriate
- Actively monitor Capacity Tracker data to identify and act on emerging concerns regarding staff movement between care settings, including following up with care providers who are not limiting staff movement
Care home providers should:
- Limit all staff movement between settings unless absolutely necessary to help reduce the spread of infection, including by reviewing exclusivity arrangements with recruitment agencies, and considering the recruitment of additional staff over the winter period
All care providers should:
- Use funding from the Infection Control Fund to meet additional costs associated with restricting workforce movement for infection control purposes, in accordance with the conditions on which it is given by Local Authorities
4) Personal protective equipment (PPE)
Local Authorities will:
- Provide PPE for COVID-19 needs (as recommended by COVID-19 PPE guidance) when required, either through the LRF (if in an area where they are continuing PPE distribution), or directly to providers (if in an area where the LRF has ceased distribution)
- Report shortages to the LRF or to DHSC
Providers should:
- Follow all relevant guidance on use of PPE, including recommendations for those providing support to people with learning disabilities or autistic people
- Make use of free Government-funded PPE stocks where needed and in line with COVID-19 PPE guidance. Care homes and Domiciliary care providers, along with some others, are eligible to register for the PPE portal guidance and can obtain free PPE through this route. Providers ineligible to register for the portal (for example, personal assistants), should obtain PPE from their LRF (if it is continuing to distribute PPE), or their Local Authority
- In the event of urgent need for PPE stocks, use the National Supply Disruption Response (NSDR) or contact their LRF to access free emergency supply from the LRF stockpile
- Report shortages via Capacity Tracker and/or the CQC community care survey
5) COVID-19 testing
Testing is a critical part of supporting adult social care in the fight against COVID-19 and helps to prevent and control the spread of infection and outbreaks by breaking the chain of transmission. Through the Government’s testing programme, the DHSC is committed to delivering the testing needed to limit the spread of the virus and to save lives.
You can see guidance on the testing strategy for adult social care, including a graphic showing testing for different adult social care services. The Government have set a target of 500,000-a-day UK antigen testing capacity by the end of October 2020. They will provide local areas with improved testing data and are working to further refine and improve data flows for the winter period.
Local Authorities will:
- Ensure positive cases are identified promptly, make sure care providers, as far as possible, carry out testing as per the testing strategy and, together with NHS organisations, provide local support for testing in adult social care, if needed
- Actively monitor their local testing data to identify and act on emerging concerns, including following up with care homes that are not undertaking regular testing, as per the guidance
NHS organisations will:
- Continue to test people being discharged from hospital to a care home
PHE Health Protection Teams (HPTs) will:
- Continue to deliver their testing responsibilities, as outlined in the testing strategy. This includes continuing to arrange testing for outbreaks in care homes and other adult social care settings, as appropriate
- In an outbreak area, refer to the COVID-19 Contain Framework and follow the local outbreak plan as directed by their Director of Public Health. A risk-based testing regime should be implemented appropriate for the area, seeking advice from the National COVID-19 Response Centre as needed
- Advise care homes on outbreak testing and infection prevention and control measures
All providers must:
- Ensure all staff are aware of how to access symptomatic testing
- Contact their local HPT if they suspect an outbreak within their service
All care homes should additionally ensure that they are following the guidance regarding regular testing of staff and residents.
6) Support for unpaid carers
There are over 5.4 million people in England providing care to loved ones, including young carers. Supporting them to continue to make this invaluable contribution is vital over the winter period.
The Government is:
- Providing guidance for those who provide unpaid care to family and friends, including young carers, and will continue to keep this guidance up to date to communicate any new advice. This includes guidance for carers supporting adult with learning disabilities or autistic adults
- Extending funding to Carers UK’s support phone line, until March 2021, to cover the winter period
- Ensuring carers can access free flu vaccines to protect themselves and loved ones
The Department for Education (DfE) has funded ‘See, Hear, Respond’, a new service led by Barnardo’s, which supports young carers. DfE is working closely with DHSC to scope initial policy options to support young carers in the medium to longer term, with a focus on improved visibility in the system and to provide greater recognition of their needs.
Local Authorities will:
- Make sure carers, and those who organise their own care, know what support is available to them and who to contact if they need help
- Follow the direct payments guidance and be flexible to maximise independence
- Ensure that assessments are updated to reflect any additional needs created by COVID-19 of both carers and those in need of social care
- Work with services that may have closed, over the pandemic, to consider how they can reopen safely or be reconfigured to work in a COVID-19 secure way and consider using the Infection Control Fund to put in place infection prevention and control measures to support the resumption of services
- Where people who use social care services can no longer access the day care or respite services that they used before the pandemic, work with them to identify alternative arrangements that meet their identified needs
Actions for providers:
All services are provided on the basis of need and therefore all providers should be proactively considering how to meet those needs in a safe and secure way. Community and respite services could consider the following options:
- Provision of outreach support or support based in outside community spaces
- Digital support
- Support provided less often in smaller groups
- Cohorted or isolated support
7) CQC support: Emergency Support Framework and sharing best practice
In March 2020 the CQC introduced the Emergency Support Framework (ESF). This interim approach was put in place to lessen the burden of regulation on providers by taking a more data-driven and risk-based approach to regulation. The ESF involves gathering and sharing information to target support where it is needed most and taking action to keep people safe and to protect people’s human rights.
The CQC will continue to work with providers to ensure robust infection control measures are in place and will take swift regulatory action where needed.
The Government is working up a designation scheme with the CQC for premises that are safe for people leaving hospital who have tested positive or are awaiting a test result.
The CQC will (on regulation):
- Introduce a Transitional Regulatory Approach from October 2020, which will bring together existing methodologies with new learning from its COVID-19 response. This approach will place people who use services at its centre, and will focus on safety, access and leadership
- Develop a new approach to monitoring, which will capture a much broader range of topics, as part of the monitoring process, to present a clearer view of risk and quality
- Increase the number of physical inspections, focussing on high-risk providers where there are safeguarding concerns, the provider has an overall rating of inadequate, and other factors
- Continue to inspect any service where people may be at risk of harm and publish a report for each inspection in line with normal procedures
- Ensure that all inspections of care providers consider how well services are managing infection prevention control, taking swift regulatory action where provider-level performance requires rapid improvement, including adherence to infection prevention and control measures for visitors
- Ensure information on additional risks and pressures are raised with national Government and relevant system partners
The CQC will (on best practice):
- Share findings from a series of targeted inspections, completed in August 2020, which looked at a sample of care homes where the CQC’s intelligence indicated that infection prevention control had been well-managed, either during outbreaks or in settings that have remained COVID-free
- Share findings from an initial series of provider collaboration reviews (PCRs) in 11 integrated care system (ICS) or sustainability and transformation partnership (STP) areas. These reviews have focused on the experience of people over the age of 65, with and without COVID-19, across health and social care providers, including the independent sector, local authorities and NHS providers. The reviews share examples of where collaboration has worked well across the system, helping to drive improvements and prepare for future pressures on local care systems
The CQC has published headline findings from both pieces of work in the September COVID insight report. More detailed findings and information on further work planned in this area will be published in the State of Care report this autumn.
ADDITIONAL INFORMATION
The Government’s entire Winter Plan can be found by following this link:
A letter from Helen Whately, Minister for Care, to outline the expectations of Local Authorities in relation to the adult social care Winter Plan can be found by following this link:
We will issue further advice and guidance Bulletins as the Covid-19 situation develops.
Sir Henry Boyle
1630 hrs 20th September 2020
