Bexley COVID-19 Care Home Support Implementation Status

The local authority has reviewed or put in place a care home support plan.

We have published:

  • a covering letter that gives a short overview of current activity and a forward plan. This includes a brief narrative that describes joint work to ensure care market resilience locally and the support in place for care providers
  • the contents of a short template to confirm the current level of access to the support offer

The covering letter and information from the template are shown below in a format that complies with the accessible information standard. The date of publication is 29 May 2020.

Contact details

The contact person for this return is:

Local Authority

London Borough of Bexley.

Total number of CQC registered care homes in your area

31

Key COVID-19 Support Actions for Care Homes

Under each area of focus below, we have entered the number of registered care homes in the London Borough of Bexley, where the corresponding action or support is in place.

We have then briefly described what additional support providers have said would be helpful to progress implementation further. We have also highlighted any other issues arising.

Helen Whately MP
Minister of State for Care
39 Victoria Street 
London
SW1H 0EU

Dear Ms Whately,

Thank you for your letter, dated 14 May, outlining how the Government is working with local authorities to support Care Homes. We welcome the publication of the guidance on 15 May about the Coronavirus (COVID-19): care home support package and the additional funding for Bexley of £2.1m from the Infection Control Fund.

You may recall that our Leader of the Council, Councillor Teresa O’Neill OBE, our Cabinet Member for Adults’ Services, Councillor Brad Smith, and our Director of Adult Social Care and Health, Stuart Rowbotham came to your Westminster Office in early March to showcase our partnership and integrated approach with the National Health Service and wider partners. Those arrangements – integrated commissioning with the Clinical Commissioning Group and integrated provision with our Community and Mental Health NHS Trust - provided us with a very solid foundation to face the COVID challenge and throughout this crisis we have responded collectively as one. I believe that has proven immensely successful and has been the single biggest factor in ensuring we were able to avoid the most serious consequences of the pandemic.

From the start of this crisis we have fully recognised the demanding role our care home (and indeed home care) providers and their staff are being asked to play in the nation’s response to the COVID crisis. This covering letter describes how London Borough of Bexley and our system partners have been working to support the sector and our plans to further develop this through the work of our Care Home Support Task Force. 

We would like to start by expressing our immense gratitude to our providers for the care and support they are providing to some of our most vulnerable residents and acknowledge the toll on the emotional health and well-being of residents, staff and managers, caused by anxiety, fear and bereavement.

From the inception of this crisis we have taken a system wide approach to discharge management from our three local acute trusts. This, together with the excellent relationships we have with our care home and home care providers, enabled us to rapidly implement the COVID-19 Hospital Discharge Service Requirements and put in place a seven-day process to enable same day hospital discharges at a very early stage. 
COVID-19 has provided an unprecedented challenge to adult social care. The challenge has been significant in London due to early and rapid spread of the virus, local patterns of deprivation, high levels of air pollution and the high proportion of ethnic minority populations in most London boroughs.  

Across the Capital, London local authorities responded to the challenge and our responsibilities under the Civil Contingencies Act by working together as LondonADASS and Chief Executives, alongside NHS partners to identify issues, galvanise responses and lead several pan-London initiatives. We brought our co-ordinated response together through the Strategic Co-ordination Group and joint governance with NHS London.

Using data and evidence we developed a comprehensive understanding of the London adult social care markets (home care and care homes) during the spread of COVID-19. Our commissioners used this as a key part of their daily interaction to support providers. It has underpinned and strengthened relationships with providers locally and provided information on care homes across borough boundaries, which has streamlined the work and reduced the burden on providers. Since mid-March this has supported local operational responses: prioritising active delivery of Personal Protective Equipment, ensuring appropriate staffing levels and providing Public Health infection control advice and support.

Being alert to emerging issues in the system which led to care home challenges and our early response (we started reporting care home deaths and COVID cases from 23 March) allowed action to be taken to respond in London and provided early warning nationally via the Strategic Co-ordination Group of issues that would develop across the country.

A summary of the work across London and issues for the future are captured in the London Region Appendix.

Below we summarise our Bexley system’s approach to supporting care homes. Drawing on the insights from the template completed on 26 May, we will describe what went well and our learning in relation to how we can enhance our support going forward. The feedback from our providers is invaluable to us in this respect and makes clear that while there is much to commend our system’s approach, we need to continually challenge ourselves to:

  • enable easy and accessible access to testing
  • ensure that no member of staff is at financial detriment as a result of being asked to self-isolate. (This does not however include the wider implications of Test, Track and Trace unless appropriate funds are made available)
  • support settings to minimise the movement of staff between settings 
  • ensure a continuing supply of appropriate Personal Protective Equipment
  • further capitalise on the opportunities presented by digital technology to support staff training and facilitate communications between relatives and residents, whilst ensuring we get the right balance between face to face and virtual clinical advice and support

Joint Working

In Bexley our approach to care market resilience sits in the context of our well established joint commissioning arrangements, our integrated ways of working across Adult Social Care, Public Health, Primary Care and Oxleas NHS Foundation Trust and our partnerships with our three main local acute providers.

Market Intelligence 

As soon as we stepped up our local COVID response processes, daily reporting on capacity and capability of the care home and home care markets was initiated. Having initially engaged with providers to support them with their business continuity planning, we then progressed into a regular flow of daily situation reporting and two-way communications which continue to date.

Increasingly, as the crisis progressed, it became clear that our own market intelligence gained from our daily conversations with providers, pointed to the fact that far less beds were actually available than was being reported on the national platforms. This reflected our providers decisions not to accept the discharge of COVID positive patients into settings which were not able to isolate them, in particular, where dementia and other behavioural issues were a factor in safely caring for the patient and other residents. 

Securing Capacity

We also took an early decision to block contract 41 beds from our existing local providers to ensure that we had the community bedded capacity we needed to implement the discharge pathway and to provide a level of financial stability for the providers. We did not however link this, or any other financial assistance, to any requirement to accept COVID positive patients. Whilst fully committed to the rapid implementation of the discharge guidance as evidenced by our early move to seven-day discharge processes, we nevertheless recognised the inherent risks of placing patients with untested COVID status in care homes and therefore took steps to differentiate pathways into care homes according to where infection control was best able to be managed. We also, jointly with our neighbours in Greenwich, developed a COVID positive step-down pathway in a temporary community setting, which very early on meant that no one who was COVID positive needed to be discharged to a care home where they could not be isolated, thereby reducing the risk of cross infection to other residents.

Workforce Support 

We gathered daily intelligence from providers on their workforce status from the outset and captured detailed information on their workforce requirements. We immediately started work on a recruitment campaign which secured a supply of candidates through the Council’s preferred provider of agency staff, with the Council taking the financial risk of retaining candidates while they were matched to vacancies. This has been an iterative process which continues now through linking with the London-wide portal.  Going forward, should we have access in the local system to returning health professionals we will work with partners to prioritise deployment to areas of most need including our independent providers.

Infection Control and Prevention: Testing

Recognising the impact that the COVID status of staff was having on care home resilience we decided to target the initial scarce COVID-19 testing slots made available to Adult Social Care, to our care home and home care providers.

Our response to testing has been an exemplar of partnership working locally. Our Director of Public Health is the designated lead for testing for London Borough of Bexley. A multi-agency Testing Task and Finish Group chaired by the Director of Public Health has been set up to address the challenges in this area and continues to steer the work.

  • testing pre-discharge from hospital and prioritising our allocation of testing slots to care home and domiciliary care staff was facilitated in Bexley, ahead of the change in government guidance. This was possible only through the invaluable support towards testing extended by Lewisham and Greenwich NHS Hospital Trust (Queen Elizabeth Hospital)
  • guidance and flow-charts on the pathways to testing for Care Homes was developed and circulated and the Mobile Testing Unit has been set up in Bexley two days a week for the past 3 weeks. Bexley has been one of the top performers in London in terms of the number of tests done at the Mobile Testing Unit
  • this facilitated the familiarisation and adoption of the national testing portal pathways when they came on-line for Care Homes, with alternative local arrangements in place for specific situations
  • further work is underway to facilitate testing of asymptomatic essential workers, and on training in this area for Care Homes and other settings
  • a testing mail box has been set up for Adult Social Care providers seeking support from the Adult Social Care-Public Health Response Cell system and for any enquiries: Covid.Testing@bexley.gov.uk  
  • there is the provision for the Director of Public Health to fast-track testing in care homes as needed. 

From the template we know that providers are particularly concerned about access to testing and it is clear that we need to continue to prioritise enabling easy access to testing for residents and staff on a regular basis. We are already taking a proactive local approach to testing people with learning disabilities and mental health needs in supported living settings, recognising that these are not included in other testing schemes.

Infection Control and Prevention: Personal Protective Equipment

Having quickly recognised the urgency of provision of adequate Personal Protective Equipment for care homes:

  • Personal Protective Equipment emergency supply arrangements were established in late February, moving to seven-day access to Personal Protective Equipment supplies, including delivery of Personal Protective Equipment to settings by Adult Social Care staff out of hours in response to urgent requests
  • a task and finish group chaired by the Director of Public Health was established to address the challenges
  • we developed our own supply chains to secure Personal Protective Equipment supply and our own approach to ordering Personal Protective Equipment
  • providers were updated on Personal Protective Equipment supply issues and signposted to Personal Protective Equipment training on a daily basis initially, and now twice weekly via our provider briefings
  • regular on-going contact with providers enables us to ascertain the stock levels held by each agency and to continue to secure, procure and allocate Personal Protective Equipment ensuring no organisation runs out 

Infection Prevention and Control: Outbreak Management 

Our Director of Public Health established a COVID-19 Public Health Response Cell in early March to directly support the Council and its partners through the pandemic. Members include a range of staff from across public health disciplines and environmental health. The cell team are also embedded in the four directorates and provide support in real time. A mail box was set-up through which all enquiries are received across the Council: C19PHResponseCell@bexley.gov.uk

  • through regular communication with our care homes, we ensured that they were clear on the guidance on outbreak management, including the definition of an outbreak
  • the email and out of hours telephone number of our local Public Health England health protection team was shared with our care homes, encouraging them to be vigilant and promptly identify an outbreak, and make contact with Public Health England for support
  • our public health team in Bexley continues to provide focussed support on case and outbreak management to care homes. Bexley Public Health developed and offered a ‘Covid-19 in Care Homes Settings’ training to all care homes. This is currently underway and addresses a range of infection control areas including updated guidance, use of Personal Protective Equipment, testing or swabbing and prevention of outbreaks
  • there is an on-going continuous process in place whereby the Adult Social Care Quality Assurance Team maintains regular contact with providers and is the first line of action in case there are any concerns. There is an escalation pathway to Public Health Response Cell for specific infection prevention and control and public health concerns

Clinical Support

Enhanced Health in Care Homes

We have a locally commissioned service in place in Bexley which provides primary care support to all registered care homes for older people. The Clinical Commissioning Group has recently audited the practices providing the service and received assurance that the care homes feel supported by primary care. This has been reinforced by the feedback in the template. Since the inception of COVID, proactive weekly visits have become remote visits using telephone or video consultations and there is also more frequent on-line contact. All our care homes have a named clinical lead and commented positively on their accessibility via digital means. They have also been appreciative of the practical support and presence on site of our District Nurses.

Going forward our plans concentrate on: 

  • improving the support available for managing residents with dementia
  • improved co-ordination of medication reviews
  • enhancing our MDT approach with an on-going emphasis on falls prevention and speech and language therapy
  • building on the learning from the crisis to shape our future support offer in partnership with providers
  • accelerating the roll out of the Docobo remote monitoring system, for which we are a pathfinder site, to provide timely clinical information directly into the GP’s system for a further eight homes by July 2020

We are actively reviewing the primary care support to registered settings for people with learning disabilities and mental health needs. However, many people with learning disabilities and mental health needs live in supported living settings which are not Care Quality Commission registered and residents have their own GPs. Therefore, it is important to provide a proportionate level of support, especially to ensure infection prevention and control.

Recognising the challenging position of care homes at the frontline of the COVID-19 response at an early stage, we took action to develop and improve our existing Enhanced Health in Care Homes offer. We have stepped this up to a multi-agency Care Home Support Task Force which brings together partners  from Public Health,  Primary Care commissioning, Adult Social Care Quality Assurance and Safeguarding,  Primary Care Networks, GP Federation, Healthwatch Bexley, Bexley Care (integrated physical and mental health services), Bexley & Greenwich Hospice, Clinical Commissioning Group Medicines Management and  Quality and Safeguarding  teams, Consultant Geriatrician from Queen Elizabeth Hospital, Alzheimer’s Society, Chair of Bexley Borough Based Board and care home GP, and representatives from two care home providers. 
The Task Force is focused on identifying any gaps in our system wide response to care home support, especially but not exclusively in relation to COVID related needs.

The remit of the Task Force covers:

  • infection control and prevention, including testing, Personal Protective Equipment, training and outbreak management
  • emotional health and wellbeing and bereavement support for staff 
  • end of life care and advance care planning 
  • primary care and medication support 
  • admission avoidance and discharge management 
  • workforce support 
  • digital technology 
  • communications 

Bereavement support, high quality end of life care and advance care planning are clearly an urgent priority at this tragic time. Bexley and Greenwich Hospice is leading our response by pulling together a comprehensive offer of support for staff from local voluntary partners and implementing the ECHO end of life care training across our care home community. Healthwatch Bexley will engage with our providers when appropriate to do so, to independently test our approach and feedback any further areas for improvement or development.

Financial Support 

We are acutely aware of the financial pressures on our provider partners at this time, recognising not only the additional costs of Personal Protective Equipment, additional staffing and overtime, but also the reduced income from both the National Health Service and local authorities due, tragically, to residents passing away and less demand from new self-funding individuals. On 10 April, London Borough of Bexley wrote to providers stating that funding would be provided for; the increased use of PPE, additional staffing to support admissions into care homes (for example one-to-one during isolation period or to support a COVID positive or symptomatic resident with dementia), and flexible deployment or recruitment of staff to provide cover for absence.

We also uplifted our rates for older people residential services by 4.91% as opposed to the 3% we had anticipated prior to COVID and added an additional 1% on top of this for three months. 

We continually monitor occupancy rates across our provider market and we maintain constant contact with our providers with respect to the financial risks they face. These issues are being managed on a case by case basis in line with our provider concerns protocols. The figures quoted below give an indication of funding released to date. Payments to providers of supported living services are included in the domiciliary care figures.

Support to providers that London Borough of Bexley has contracts with (to 29 May 2020) 

Domiciliary Care    £230,625
Residential Care     £196,834
Other provision                £0
Total spent so far   £427,459

Support to providers that London Borough of Bexley does not have contracts with (to 29 May 2020)

Domiciliary Care    £13,784
Residential Care             £0
Other provision              £0
Total spent so far   £13,784

Notes about these figures

Note 1 - Total spent so far means funding or support has already reached providers.
Note 2 - We hold spot and block contracts with most of our in-borough care homes.
Note 3 – Figures do not include Personal Protective Equipment cost for the 12 domiciliary care providers and care homes we do not hold contracts with but supplied with Personal Protective Equipment as requested, as these are not separated in our records.

Alternative Accommodation

We are currently working with our local providers to ascertain whether the designation of one setting for recovery period for COVID positive residents would be a practical solution in our local market. We share a step-down unit for COVID positive patients with our neighbours in Greenwich, which meets most of our needs at the present time.

Our Assurance 

On the basis of all that is set out above I am confident in assuring you that, in Bexley, we had a strong system of support around our care homes before COVID, acted very quickly to step up our support as soon as the discharge guidance emerged, and continue to work in close partnership across the system to develop our support going forward.

Finally to reiterate, we welcome the Infection Control Funding announced on 15 May 2020. In relation to the 25% not passed directly to providers we are committed to using those funds to improve infection control and prevention in our care home and home care settings, both registered and un-registered and will be undertaking a rapid review of the evidence base for what will work best, to protect our residents and staff.

I attach our completed template for care home support planning.

Yours sincerely

Jackie Belton
Chief Executive
London Borough of Bexley

Cc Councillor Teresa O’Neill OBE, Bexley Health and Wellbeing Board Chairman, Leader of the Council; Andrew Bland, Accountable Officer, South East London Clinical Commissioning Group.

The ability to isolate residents within their own care homes

  • 27 out of 31 care homes are able to isolate residents within their care home

Would additional support be helpful to progress implementation further?

  • Yes

If Yes, please offer a brief description of the type of support that would be helpful

  • one to one support would be required for those who lack capacity to understand isolation or to make decisions regarding keeping themselves and others safe
  • more Personal Protective Equipment supply would be helpful. Extra support is required for face masks and hand gloves in some cases

Please indicate any issues that you would like to highlight

  • due to the needs of residents, some of them do not understand that they would need to isolate. Lack of capacity for residents will mean that some care homes need additional staff support
  • the layout of some care homes makes it very difficult to isolate but there are examples of other care homes, where isolation can be encouraged and maintained in individual rooms, where en-suite facilities are available
  • one care home provider has organised a recovery unit for residents and are organising extra staff for this to offer extra support, including at meal times. Staff will also be remaining on that unit. One to one helps, if required, where residents have dementia

Actions to restrict staff movement between care homes

  • 29 out of 31 care homes confirm that actions to restrict staff movement between care homes are in place

Would additional support be helpful to progress implementation further?

  • Yes

If Yes, please offer a brief description of the type of support that would be helpful

  • extra support could include but not limited to: support staff availability in the event of an outbreak and possibly the supply of isolation pods
  • taking the temperature of all staff, including agency if used may help
  • more supply of Personal Protective Equipment

Please indicate any issues that you would like to highlight

  • a number of care homes are not using agency staff or have reduced their agency usage in order to minimise the risk of infection. Instead, some providers have increased the rate of pay for overtime or are using their own bank staff

Paying staff full wages while isolating following a positive test

  • 14 out of 31 care homes confirm that they are able to pay staff full wages while isolating following a positive test

Would additional support be helpful to progress implementation further?

  • Yes

If Yes, please offer a brief description of the type of support that would be helpful

  • care home providers said that being able to offer more than Statutory Sick Pay would be helpful. For example, extra funding to give full or at least 80% pay would be helpful. However, this may be difficult for small providers
  • extra financial support would be helpful. For example, to maintain cashflow and debt liquidity to maintain supplier relationships or to cover the added expenses of agency staff, whilst a staff member self isolates

Please indicate any issues that you would like to highlight

  • currently, where staff are concerned or unclear about whether they will be paid a full wage whilst off, they may be discouraged from getting tested, particularly those who are asymptomatic
  • some providers mentioned that Statutory Sick Pay is agreed from Day 1 currently
  • the feedback suggests that care providers may have different policies in place. For example, only paying full pay for the first period of isolation or making this dependent on previous sickness record. Getting some consistency in approach across the independent sector, sharing good employment practice, promoting adoption of minimum standards or taking action to raise these standards should be further considered at a national level

Registration on the government’s testing portal

  • 20 out of 31 care homes confirm that they are registered on the government’s testing portal

Would additional support be helpful to progress implementation further?

  • Yes

If Yes, please offer a brief description of the type of support that would be helpful

  • support to register for home testing kits for some client groups would be helpful. For example, people with mental health conditions or a learning disability aged 18-64 yrs

Please indicate any issues that you would like to highlight

  • some care homes report that the timeliness of receiving testing kits needs to be improved
  • the Government’s portal will not accept the Location ID for one of our care homes. They contacted the Helpline but were still unable to log on
  • being able to do a group booking of the test is a better arrangement

Access to COVID 19 test kits for all residents and asymptomatic staff

  • 22 out of 31 care homes confirm that they have access to COVID 19 test kits for all residents and asymptomatic staff

Would additional support be helpful to progress implementation further?

  • Yes

If Yes, please offer a brief description of the type of support that would be helpful

  • testing of all care home staff and people they support weekly if this capacity becomes available
  • supply of enough testing kits to be able to test any resident who show to be symptomatic
  • some care home providers would like to have access for staff testing either at work or the staff member’s own home so they do not need to visit mobile testing centres
  • better updates regarding supply of the kits
  • help to support staff and management awareness

Please indicate any issues that you would like to highlight

  • clients have been tested but kits for staff needed
  • supply of home testing kits
  • staff can go to testing centres but have not always been able to get to these due to distance to travel and reluctance to use public transport
  • being able to re-test for positive outcomes

Testing of all residents discharged from hospital to care homes

  • 21 out of 31 care homes confirm that all residents discharged to their care home from hospital have been tested

Would additional support be helpful to progress implementation further?

  • Yes

If Yes, please offer a brief description of the type of support that would be helpful

  • the supply of home testing kits to care homes would be helpful
  • other comments suggested that instant testing at the point of admission to hospital and then making sure there is prompt readmission to care homes after a negative test, plus antibody testing would assist in readmitting to care homes quickly

Please indicate any issues that you would like to highlight

  • feedback from care home providers indicated that many of them had not yet had any people being discharged from hospital into their care home. If this was to occur, they would request a test prior to discharge to the care home

Access to sufficient Personal Protective Equipment to meet needs

  • 29 out of 31 care homes confirm that they have access to sufficient Personal Protective Equipment to meet needs

Would additional support be helpful to progress implementation further?

  • Yes

If Yes, please offer a brief description of the type of support that would be helpful

  • care home providers mentioned that London Borough of Bexley are supporting when needed and that this included support with enough Personal Protective Equipment. In some cases, care homes reported that they were low on stock for some items. For example, face masks, hand gloves and aprons. Other care homes reported that they had been able to order enough Personal Protective Equipment but commented about the extra costs that they had incurred as a result over the past few months
  • one learning disability care home provider commented that currently they had experienced no symptoms and all tests had come back negative. However, if they had a positive result or someone with symptoms, they would want eye protection, face shields and better protective aprons

Please indicate any issues that you would like to highlight

  • the local authority continues to be in regular contact with providers and responsive to requests for support

Access to medical equipment needed for COVID-19

  • 19 out of 31 care homes confirm that they have access to medical equipment needed for COVID-19

Would additional support be helpful to progress implementation further?

  • Yes

If Yes, please offer a brief description of the type of support that would be helpful

Learning disability care home providers mentioned that it would be helpful to have a full list of all medical equipment that would be required for COVID-19. Other care home providers have commented that:

  • additional thermo-thermometers would be helpful but have been difficult to purchase
  • extra equipment would be helpful but would require associated training for residential care staff
  • in the event of an outbreak, a ventilation pump would be useful.

Please indicate any issues that you would like to highlight

  • there are no other issues to highlight

Access to training in the use of Personal Protective Equipment from clinical or Public Health teams

  • 28 out of 31 care homes confirm that they have access to training in the use of Personal Protective Equipment from clinical or Public Health teams

Would additional support be helpful to progress implementation further?

  • Yes

If Yes, please offer a brief description of the type of support that would be helpful

  • any extra training is helpful, especially if guidance changes. It is important for training to be accessible for all staff. Some care homes have asked to be sent links for any additional training needed. Sending helpful links to training to their team members would enable staff to complete the training at a time convenient to them
  • increased technology to enable more staff to access at one time and in a timely manner when guidance changes would be helpful
  • if training can be recorded to make it available to more staff, for example night staff, then that would be helpful
  • extra support may be required by some care homes if required to use other Personal Protective Equipment in the event of an outbreak

Please indicate any issues that you would like to highlight

  • E-learning had been accessed or arranged by some of the providers, which has been useful
  • providers have also signed up to NHS mail so this could be a useful way of being able to access available webinars for training. Care home providers also report that their staff have watched the video available for Personal Protective Equipment on Gov.uk website
  • some care home managers or deputy managers have held mini workshops with their staff, which can be supplemented with training from other sources
  • care home staff have received links to training from Bexley’s Public Health team or plan to attend Bexley training for Personal Protective Equipment. This support has been welcomed by providers. The majority of our care home providers have expressed confidence in their staff knowing how to use Personal Protective Equipment

Access to training on use of key medical equipment needed for COVID-19

  • 16 out of 31 care homes confirm that they have access to training on use of key medical equipment needed for COVID-19

Would additional support be helpful to progress implementation further?

  • Yes

If Yes, please offer a brief description of the type of support that would be helpful

  • any additional training on using medical equipment would be welcomed. More training of staff would also be needed, if they are required to use any new equipment and for any updates
  • care home providers would like to be sent links to access training
  • any training available to support and up skill staff would also be useful

Please indicate any issues that you would like to highlight

  • some providers were not sure what the key equipment is. Training would be needed on key equipment as not all care homes had nurses on site
  • providers mentioned that our District Nurses have been a helpful source of support for staff. Care homes also said that they rely on support from the GP and the hospitals

Access to additional capacity including from locally coordinated returning healthcare professionals or volunteers

  • 20 out of 31 care homes confirm that they have access to additional capacity including from locally coordinated returning healthcare professionals or volunteers

Would additional support be helpful to progress implementation further?

  • Yes

If Yes, please offer a brief description of the type of support that would be helpful

  • care home providers would like some more information about this
  • some providers felt that volunteer carers would be useful
  • others felt that they did not currently require this support or wished to maintain existing restrictions on access to the care home at the current time
  • one care home mentioned that they have not had access to any returning healthcare professionals, which would be useful in supporting staff.

Please indicate any issues that you would like to highlight

  • the local authority is engaging with health partners to explore the available opportunities for gaining access to any returning healthcare professionals or volunteers

Named Clinical Lead in place for support and guidance

  • 29 out of 31 care homes confirm that they know who their identified Clinical Lead is

Would additional support be helpful to progress implementation further?

  • Yes

If Yes, please offer a brief description of the type of support that would be helpful

  • Clinical Lead is GP and has been consulting remotely, this has been effective to date
  • one care home provider has mentioned that sometimes their presence in the care home would be helpful
  • feedback from one of our learning disability providers indicates that it would be helpful to clarify who to contact for what
  • we have been asked to also be mindful of following any agreed communication protocols or channels in operation at the care homes in order to ensure staff anxiety is kept to a minimum

Please indicate any issues that you would like to highlight

  • care home providers report that they know who their identified Clinical Lead is. GP Clinical Leads have been consulting remotely and this has been effective to date. GPs have been available on the phone and on facetime rounds. Care home providers have used video to assist with the GP rounds and found this to be helpful
  • feedback received from care homes indicated that GP Clinical Leads have been easily accessible, including when not on duty
  • the local authority and our health partners, including GPs, have ensured that information about the named clinical lead has been communicated. Staff in the local authority's quality assurance team have also reinforced this message in the last few days through our daily contact with providers

Access to mutual aid offer of primary and community health support

  • 27 out of 31 care homes confirm that they have access to primary and community health support when needed

Would additional support be helpful to progress implementation further?

  • Yes

If Yes, please offer a brief description of the type of support that would be helpful

  • care home providers would like to receive some further information and would welcome any extra support
  • some care homes have indicated a preference for GPs and other health professionals to attend the home rather than relying on technology, for example, to diagnose conditions
  • some care homes would benefit from better internet access
  • the option of using Skype or video calls is not always offered but would be useful

Please indicate any issues that you would like to highlight

  • feedback from care home providers indicates that the support from primary and community health has been good, although generally remotely but the use of technology has proved useful and effective
  • examples cited include where care home providers have liaised with the palliative care team, remotely. District Nurses have also continued to visit care homes but with some restrictions around which areas of the home they can access
  • Speech and Language Therapists and Dieticians have undertaken telephone consultations. Feedback from one of our care home providers has indicated a preference for Skype or video calls to be used so that professionals can view the resident

COVID-19 has provided an unprecedented challenge to adult social care.  The challenge has been significant in London due to early and rapid spread of the virus, local patterns of deprivation, high levels of air pollution and the high proportion of ethnic minority populations in most London boroughs.

Across the Capital, local authorities responded to the challenge and our responsibilities under the Civil Contingencies Act by working together as LondonADASS and Chief Executives, alongside National Health Service partners to identify issues, galvanise responses and lead several pan-London initiatives.  We brought our response co-ordinated together through the Strategic Co-ordination Group and joint governance with NHS London.

Given the high rate of infections in the Capital, the fact we were ahead of the national curve and the difficult issues created by early national guidance, we believe that without collective action the impact on residents we support to live with support from the care sector and the number of care home deaths would have been significantly higher.  

We are now focussed on continued monitoring of the adult social care market to respond to possible further peaks of COVID-19, as isolation rules are relaxed, and to suppressed non-COVID NHS demand. This includes support for older people, those with a learning disability, mental health needs and direct payment users.  We will remain vigilant to potential future outbreaks and provider financial viability, ensure sustainable access to Personal Protective Equipment and testing and continue to use data to support decision making.

Pan-London initiatives

The following gives a flavour of just some of the actions taken pan-London:

We worked with Public Health England London in March / April to develop consistent and up-to-date on-line training in infection control and rolled this out to care homes, supported by local follow up advice and guidance.

There was escalation from early April to advocate for regular testing of both care home staff and care home residents and for testing of people being discharged from hospital into care settings. We have contributed to London work on testing approach for care homes, alongside Public Health England. This was identified as a significant strategic risk.

Early escalations on the need for a sustainable supply of Personal Protective Equipment led to the Personal Protective Equipment task group, reporting into the Strategic Co-ordination Group on our response and highlighting this as a strategic issue for both our own local authority staff and that of the provider market. This supported joined up National Health Service/Local Authorities systems for accessing Personal Protective Equipment and, in addition, a London-wide Local Authority Personal Protective Equipment procurement through the West London Alliance in response to unreliable national supply chains.  At the local level, where Personal Protective Equipment was available, commissioning teams distributed this directly to local providers based on detailed intelligence about infection and Personal Protective Equipment supply levels for each care home.

Early identification of the risks to workforce were identified and on 10 April we launched Proud to Care London to support recruitment, Disclosure and Barring Service checking and basic training of care staff. To date we have had over 1800 registrations and of these 180 have passed to councils and providers, with excellent feedback about the calibre of the candidates being connected with work settings. It is also worth noting that we are reaching a new profile of carers – with a third of applicants under the age of 30. We are now in the process of transitioning the Proud to Care initiative from a Strategic Co-ordination Group sponsored workstream to LondonADASS, in order to further develop the model with the ultimate ambition of creating a Social Care Academy for London.

The risk of inconsistent clinical support to care homes across the Capital and the need for the National Health Service to step up was identified and led to a joint letter to Integrated Care Systems and local systems from the Chief Nurse and lead Chief Executive on 9 April to galvanise action. A weekly regional Care Homes Oversight group was established 7 May co-led by the Chief Nurse and LondonADASS Vice Chair.

The objectives of the Oversight Group are to: 

  • oversee roll out of key elements of the primary and community health service-led Enhanced Health in Care Homes programme including, but not limited to, access to weekly clinical reviews, medicines optimisation and advanced care planning
  • identify opportunities to support staffing in the care home sector and coordinate any regional response, which may draw upon initiatives across the NHS and local government (Your NHS Needs You / Proud to Care)
  • continue to ensure that all residents are being safely and appropriately discharged from hospital to care homes
  • have oversight and assurance of care home resilience plans, responding to emergent challenges and supporting the care home community
  • have oversight of regional improvement support, public health and operational challenges using system wide data sources including, but not limited to, outbreaks, mortality, workforce and access to training and clinical in-reach
  • have oversight of the Regional Test, Track and Trace across care home workforce and residents, ensuring that ‘hot spots’ are identified and targeted in a timely manner
  • implement a ‘super’ trainer programme in care homes based on Public Health England’s recommended approach to infection prevention and control, Personal Protective Equipment and testing

Engagement with residents and user voice is central and Healthwatch are part of the London Oversight Group to reflect people’s experiences. However, engagement largely takes place at local system level where the most meaningful relationships are in place.  

We worked collaboratively with National Health Service colleagues on discharge planning safe pathways and co-ordinated work in Sustainability and Transformation Partnership/Integrated Care System sub regions to support development of discharge beds for COVID positive patients to prevent spread of infection. 

Directors of Adult Social Services in London have been able to assure themselves that core safety, human rights and safeguarding duties are being delivered when Care Homes are in lock-down without the usual footfall and community access to residents’ homes.  Local mechanisms for safeguarding processes, provider concerns and quality assurance mechanisms have continued to inform work with providers in the sector. Regionally, we have specifically worked with the Coroner and Pandemic Multiagency Response Teams to understand safeguarding concerns and quality alerts and respond appropriately.

We have worked in strong collaboration with NHS London and Carnall Farrar to build a demand and capacity model that is intended to support joint planning of health and social care at local authority, Sustainability and Transformation Partnership/Integrated Care System and regional levels into the future, populated by our market intelligence with shared understanding of assumptions driving the model. This included capturing additional social care capacity during ‘Surge’, so that any need for further accommodation could be met on a pan-London and sub-regional basis. Happily, as with the Nightingale beds, most of this was not required. However, the model will support tactical planning requirements over an 18-month period to support NHS London to return to its pre COVID-19 position. 

Use of both the 18-month tactical planning tool and the suite of near term operational planning tools covering acute, community, social care and primary care will support both London region and each Integrated Care System to understand projected demand, non COVID-19 and COVID-19, over the next 18 months and the potential impact.  Creating an overview of the whole system, we aim to ensure this tool supports planning together in equal partnership and safer discharge pathways.  

Use of data and intelligence

Our response has been underpinned by data and intelligence. Support to the provider market and situation reporting into the London Resilience Forum was enabled by our existing London wide Market Insight Tool. The tool was developed by LondonADASS to support the delivery of our Care Act duties and was quickly adapted to establish a comprehensive and up-to-date understanding of London adult social care markets (home care and care homes) during the spread of COVID-19 at local, Sustainability and Transformation Partnership or Integrated Care System, and regional levels.  

The daily survey includes information on:

  • prevalence of COVID-19 and associated mortality
  • actual and true availability of supply
  • discharges from and admissions to acute care
  • staff availability
  • details of Personal Protective Equipment stock
  • access to testing

We prioritised older people’s care homes because we understood this was where the greatest impact and safety issues would be and because 30% of all older people care home placements are across borough boundaries, so collaborative work is essential. We started the care homes data collation mid-March and have a consistently high daily response rate. This reflects the leadership of borough commissioners working intensely with their providers and building these relationships through direct and often daily contact. These local relationships are realising ongoing benefits in relation to our statutory market management responsibilities and support to providers.

The Market Insight Tool has produced:

  • at borough level: Continuous, live access since 23 March for borough commissioners to a detailed suite of reports allowing them to prioritise the local operational response, such as the delivery of Personal Protective Equipment, ensuring appropriate staffing levels and providing Public Health infection control support
  • at regional level: Daily information cell Situation Report indicators, including evidence based seven-day projection figures, for the London Strategic Coordination Group. Daily Market Intelligence Reports produced jointly with the London School of Economics and circulated since 1 April to each Director of Adult Social Services and Director of Public Health across London. These reports have mapped trends at London, sub-regional and borough levels in key risks for care homes for older people, people with learning disabilities, those with mental health needs and home care providers
  • at Integrated Care System level:  The detailed suite of reports and London analysis has been shared with National Health Service colleagues to co-ordinate and prioritise health and local authority support and interventions

The data collected has been used to develop models identifying care home and local characteristics correlated with the spread of COVID-19, associated mortality, impact on care capacity and supply sustainability, access to Personal Protective Equipment and care staff availability. These models have informed the targeting of support to care providers and, in partnership with London School of Economics, emerging international evidence has been regularly shared with London Directors of Adult Social Services since 4 April 2020. 

Overall, this evidence and analysis has underpinned our London-wide strategic and operational decisions and meant key issues were escalated to the highest level as early as possible.

Now that national data collections are established on a temporary basis and the London Strategic Coordination Risk relating to social care is stepped down, we are working with national colleagues to ensure a smooth transition to Capacity Tracker. We plan to do so in a way that does not compromise our responsibilities under the Care Act 2014 or the systems set up to support the critical incident response and continues to use the rich longitudinal evidence produced by the Market Insight Tool to inform strategic social care decision-making across London boroughs.

Moving forward

We have reflected on the lessons learned about resilience and support to both care homes, and the care sector more broadly, over this period of intense activity.  Much of this is reflected above in terms of the need for sustainable Personal Protective Equipment and testing; streamlined and safer discharge processes; the need for consistent and integrated wrap-around clinical support in the community and the opportunities for joined up demand and capacity modelling to support whole systems planning.

Local Government has played a critical role in managing the UK’s response to COVID-19. Its wide range of responsibilities, from public health and social care through to bin collection and data analysis have all been key to ensuring that the UK has been able to manage the epidemic, and to sustain vital services.

Social care has played a particular role in supporting those in our communities who are most vulnerable and, as a nation, we have seen a renewed understanding of the importance of care and support to the development of a sustainable and safe society, alongside the critical treatment services that colleagues within the National Health Service provide.

In the first phase of the pandemic, due to its emergency nature, social care was asked to play a role in the national effort to protect the National Health Service from becoming overwhelmed in the event of a surge of demand. The policy of protection was successful, and the National Health Service was able to respond effectively to COVID without at any point becoming overwhelmed. Patients suffering from COVID-19 were all able to receive the treatment they required within a hospital setting.

Although the policy of protecting hospitals was necessary and successful, we were concerned that it was not broad enough and protecting the system of social care and health is a crucial priority as we move forward.

Now that we understand much more about the nature of the disease, those most likely to be affected and the appropriate protection and treatment options available, the social care community is able to be very specific about how best we can work collectively with colleagues across health and care to support and sustain the whole system through the next phase of COVID-19.

We recognise the risks to financial sustainability for some care homes and are already beginning to use our market insight to get a differentiated picture of levels of financial risk across the market.  This, alongside a deep understanding of the quality of care homes in London, will inform local decision-making that drives value for money and the best possible outcomes and quality of life for residents.

We welcome the additional funding that Government has so far provided to support councils’ overall response to COVID-19, including adult social care, however we recognise that there still needs to be a sustainable funding solution for adult care services.

We need to expand and protect our workforce, so that they can continue their vital work maintaining people’s health and independence outside hospitals supported by their local communities.

We have demonstrated the value of local strengths and asset-based responses to support shielded and vulnerable groups in our communities and the case for joint investment as a critical part of our health and care system to support and sustain this to ensure that residents are protected from the virus, and that their mental health and wellbeing is prioritised.

We need to ensure that care homes and home care staff are able to provide safe, infection-free spaces for vulnerable people. This may mean zoning care homes in line with current clinical practice, and prioritising testing and Personal Protective Equipment for homecare workers. This includes a clear national strategy on testing and re-testing for staff and residents.

We recognise that the response to the virus requires a system-wide approach. We will work with colleagues in health, the voluntary and community sector and our local communities to build effective system-wide, place-based responses. We recognise that we all work best where we plan and deliver together. We will participate fully in the development of effective response plans for the second phase of COVID-19, both regionally and in our local areas, and need to engage with partners from the outset of this process.

Our commitment in London is to ensure a smooth flow of our contribution from recent monies to our care home providers, alongside all the other support we offer, in a way that recognises that the care and support we provide to residents is to help them to live their lives safely and with high quality support, in their homes.   

Paul Najsarek and Sarah McClinton 
On behalf of London Chief Executives and LondonADASS