Report to:

People Scrutiny Committee

 

Date of meeting:

 

17 June 2021

By:

Director of Adult Social Care

 

Title:

Covid-19 Response and Implications

Purpose:

To inform the People Scrutiny Committee as to the impact of COVID-19 within adult social care


RECOMMENDATIONS:

The People Scrutiny Committee is recommended to comment on and note the contents of the report.

 

1          Background and supporting information

 

1.2       The COVID-19 pandemic represented an unprecedented challenge for the adult social care sector, which supports some of the most vulnerable residents in East Sussex.

 

1.3       This report sets out the impact of COVID-19 on adult social care and the response from the Adult Social Care & Health Department and the wider care sector in the following five key areas:

·         The work of care staff during the pandemic and impact on recruitment and retention including the use of agency staff

·         Experiences of minority ethnic care workers

·         Support to Care Homes including health service input

·         The experience of informal carers during the pandemic

·         The impact of COVID-19 on services including the response to shielding residents

 

2          The work of care staff during the pandemic and impact on recruitment and retention, including the use of agency staff

2.1       The local care sector has reported positive outcomes from recent recruitment campaigns during the pandemic, as a result of furlough and unemployment in other sectors.  For example, Adult Social Care (ASC) has commissioned 15% more homecare placements during the twelve months of COVID-19. The home care market has been able to meet the increased demand, largely due to their ability to recruit new staff. It is unclear at this stage whether these new recruits will continue working in the care sector or will return to their previous roles as other sectors, such as hospitality, reopen.

 

2.2       Care providers are required to adhere to strict infection, prevention, and control measures, both before and during the pandemic, and reducing the movement of staff between settings has been a key enabler to minimise the transfer of infections. In order to minimise the risk of transferring infections, staff in many care homes in East Sussex temporarily lived in the care home during the height of the pandemic, resulting in the separation from their own families for extended periods of time.  This illustrates the outstanding care and commitment that many care staff showed in order to minimise the spread of infection and protect the residents that they support.

 

2.3       The use of agency staff has continued throughout the pandemic. With significant numbers of care staff, working within care homes and home care, becoming infected with COVID-19 or having to self-isolate over the last twelve months, agency staff have been an essential source of staffing both in terms of care staff and qualified nursing staff (e.g. for medication administration).

 

2.4       In January 2021, the weekly East Sussex Incident Management Team meeting would regularly consider as many as 35 care homes reporting COVID-19 outbreaks, all of which would have varying numbers of staff in self-isolation. It would not have been possible for many of these homes to maintain safe service provision without the use of agency staff.

 

2.5       To minimise the use of staff across multiple homes payments from the Infection Control Fund made to Care Homes had criteria attached that specifically address this point.

 

2.6       Appropriate Personal Protective Equipment (PPE) and testing regimes have been in place to minimise infections. There have also been occasions where Adult Social Care has facilitated the placement of temporary managers from agencies, to ensure Care Homes have had sufficient managerial oversight to continue operating.

 

2.7       In order to maintain and improve the quality of care throughout the pandemic, the Adult Social Care training team has delivered a ‘Well-led’ training programme for care home managers and staff.  The content of each workshop was designed to reflect:

·         CQC Well-led domain;

·         Skills for Care Leadership Qualities Framework;

·         knowledge of the care home sector and issues raised by colleagues in a range of forums; and

·         the need for a response to COVID-19 and day to day difficulties relating to the workforce.

 

3.         Experiences of minority ethnic care workers

3.1       In May 2020, the Sussex Health and Care Partnership (SHCP) established the Sussex Black, Asian and Minority Ethnic Disparity Programme in response to the evidence emerging from the Office for National Statistics around the disproportionate impact of COVID-19 on Black, Asian and Minority Ethnic communities. A key part of the Programme has been the development of the Sussex Care Homes BAME (Black, Asian, Minority Ethnic) Staff Network.

Sussex Care Homes BAME Staff Network

This network is supported by the Sussex Health and Care Partnership which includes all Sussex NHS Organisations and the three Local Authorities. The purpose of the network is to provide a place for care home staff to bring new perspectives and fresh ideas that helps drive change and progress. In this space, staff are able to:

·         Celebrate a range of diversity through social events and activities;

·         Facilitate informal relationships with other BAME care home workers in Sussex;

·         Reflect on the last few months and how the pandemic has made an impact on BAME lives and communities; and

·         Access peer support through discussions about lived experiences.

·         Receive guidance and signposting to appropriate services, if desired; and

·         Work with employers to ensure that BAME staff have a consistent and positive experience in the home(s) they work in.

The first virtual network meeting was held in March 2021.  Posters promoting the network are about to be printed and issued to all Care Homes across Sussex.

Adult Social Care departments from across Sussex are meeting with the BAME Disparity Programme leads next month to discuss what more can be done to support the development of network. It is important that the network is run and developed in accordance with the needs and issues identified by the network members.

 

 

4.         Support to care homes, including health service input

4.1       The challenges faced by care homes have been significant and varied, ranging from the access to PPE (Personal Protective Equipment)  during the first wave of the pandemic; managing significant outbreaks of COVID-19 amongst residents and staff; management of the rigorous COVID-19 testing regime on vulnerable people; maintaining all the necessary infection prevention and control measures with depleted staffing numbers and supporting residents and their families through the most difficult of times.

4.2       Adult Social Care and Health have supported a range of care homes with the provision of temporary staff; meals; cleaning; infection prevention and control guidance; psychological wellbeing support for staff; regular information bulletins; weekly virtual huddles where current issues are discussed with local clinicians. 

4.3       Included below are two examples of the value placed on the ‘huddles’ by independent sector care home providers:

“As a care home manager during the COVID pandemic, the East Sussex huddles have been absolutely invaluable in assisting us to survive! The weekly meetings throughout the pandemic have helped us to understand and respond to the ever changing guidance, stay abreast of sector changes, as well as being a forum to share our difficulties and reach out for support, which has really boosted my confidence. I have made some new contacts (and friends) who continue to be a great source of support and advice. Finding the time to attend has been challenging at times but is really worthwhile if you have burning issues to raise, but the recorded sessions are helpful resources to go back over if needed. I really think these huddles have helped pull the local social care sector together which has been long overdue”.

“The regular huddle organised by East Sussex County Council and Sussex CCG has been invaluable along with the email bulletin throughout the pandemic for providers. The huddle in particular has enabled providers to get updated information from both a national and local level about the virus and its impact. We’ve had national guidance interpreted for us and experts have been able to answer questions or queries about how this works in practice. The huddle has also enabled us to share concerns that have been fed back by ESCC and Sussex CCG to national bodies. Providers are able to support one another at the huddle through the chat function and by sharing best practice through direct presentation. I’d like to thank ESCC and Sussex CCG for supporting us through the pandemic”.

4.4       In addition to the generic support described above, throughout the pandemic, the Adult Social Care Market Support Team has contacted services identified on the Public Health Outbreak List to offer support. At the peak of the second wave, this support ranged from practical support such as the provision of temporary staff to cover shifts, through to advice on staff rostering and delivery of emergency PPE to care homes by Local Authority staff. 

4.5       The East Sussex Care Homes Resilience Plan, published in May 2020, has been reviewed and refreshed. It is being delivered by the East Sussex Care Homes Group which has representation from all key stakeholders including the East Sussex Registered Care Association and Healthwatch.

4.6       The group has overseen the development of the weekly care home huddle webinars; co-ordinated communications to providers and had oversight of the local support arrangements for residential and nursing care providers. The membership of this group includes Local Authority, Public Health, Clinical Commissioning Group (CCG) and Primary Care. The GP lead from the group has also been supporting GP cover arrangements for care homes and providing clinical input to weekly care home huddles.

 

 

4.8       The Enhanced Health in Care Homes Programme is now central to the work of the East Sussex Care Homes Group and Adult Social Care sit on the Pan-Sussex Steering Group. This comprehensive programme of work covers a range of areas including the development of Multi-Disciplinary Teams (NHS employed) to work directly with care homes to enhance links with, and support from, primary care.

 

4.9       The weekly Care Home Incident Management Group ensures that an appropriate system response (PH; ASC; CCG) is provided to care homes reporting a COVID-19 outbreak. This may include advice and guidance about infection prevention and control; testing and (virtual) tailored sessions with care home staff to discuss any concerns and issues with vaccinations.

 

4.10     Local authority support to Care Homes has been positively acknowledged by key partners including The Care Quality Commission.

5.         The experiences of carers during the pandemic

5.1       The impact of lockdown, lack of access to face-to-face and respite support and the general diminished availability of networks such as support from other family members (outside of the household) will inevitably have had a significant impact on carers physical, emotional and mental health and wellbeing. 

5.2       The Carers UK report published in October 2020 ‘Caring behind closed doors: six months on’ (https://www.carersuk.org/images/News_and_campaigns/Caring_Behind_Closed_Doors_Oct20.pdf) reported that:

·         Almost two thirds of carers (64%) have not been able to take any breaks from their caring role during the COVID-19 pandemic; and

·         8 out of 10 (78%) carers reported that the needs of the person they care for have increased since the COVID-19 pandemic.

 

5.5       Locally, the three Carers Centres in East Sussex, West Sussex and Brighton & Hove worked with the Clinical Commissioning Group (CCG) and local authorities to enable carers to be vaccinated.

5.6       In East Sussex, the carers’ services commissioned by Adult Social Care have gone to great lengths to maintain support for informal carers during COVID-19.  There has necessarily been greater reliance on digital solutions, which can be a barrier to access for some carers, however phone-based options have been developed wherever possible and practicable.

5.7       Feedback from Care for the Carers suggests that many carers were under increased strain due to lockdown, social isolation, stress and anxiety, closure of day services, no access to residential respite and many chose to reduce or stop home care services in order to protect the vulnerable cared for person.

5.8       Support provided to informal carers in East Sussex throughout the pandemic is summarised below:

Carers’ Service

COVID-19 Offer

Care for the Carers

Care for the Carers experienced increase in levels of requests for support needed by carers already known to the service and a decrease in “new” carers accessing their services.

·         Information and advice available via ‘phone and email

·         Virtual Support groups established, enabling carers to ‘phone in. Care for the Carers intend to continue with this ‘blended approach,’ recognising meets needs of e.g. working carers/those unable to leave the home.

·         Virtual annual conference

·         Telephone counselling services

·         Actively involved in recent work to identify carers for vaccination

Association of Carers Volunteer Respite service

·         Unable to deliver home-based respite so developed online sessions including yoga, quizzes, etc. to develop virtual wellbeing

·         Garden visits facilitated

Association of Carers Computer Help at Home

·         Provided service virtually to support carers to get online and access online shopping, prescriptions, contact with family

Coastal Wellbeing WRAP courses

Moved online and will continue with blended offer to carers

DISC dementia training

Moved online and will continue with blended offer to carers

Alzheimer’s Society

Moved online and will continue with blended offer to carers

Culture Shift

Online creative support sessions for carers

Motor Neurone Disease Association

Virtual support to carers. Developing digital offer to offer blended model of support ongoing

British Red Cross Carers Crisis Support

Virtual and garden visits facilitated

St Michael’s Hospice

·         Moved support online/remotely will develop carers course online to ensure legacy support for carers

·         Will maintain blended offer of support  

St Wilfrid’s Hospice

·         Moved counselling to phone and online

·         Expanded Bereavement Support Offer to wider community in response to COVID-19

St Peter & St James Hospice

Moved support online/remotely via phone

 

6.         The impact of COVID-19 on Adult Social Care (ASC) services

6.1       ASC’s response to the Government’s COVID-19 ASC Winter Plan was submitted to the Minister for Care on 30 October, to provide assurance that we had plans in place for the winter covering all the required elements. This included the testing, local contact tracing and outbreak control, flu vaccinations, care homes support (including capacity and workforce), IPC, the Infection Control Fund and shielding and Clinically Extremely Vulnerable (CEV) people. Core business such as social work and social care practice including safeguarding, the ethical framework for social care and our ongoing integration and partnership work with NHS partners in respect of timely hospital discharge was also included within the Plan alongside support to care homes, linking with our joint Winter Plan with the NHS, which also took account of the impact of the pandemic in respect of levels of activity and demand.

6.2       The Government also requested all councils complete a care market sustainability self-assessment to provide the Minister for Care with assurance that care markets were sustainable though the winter period. Alongside this, the County Council has continued to engage and emphasise the need for a sustainable funding settlement for social care.

6.3       Work has also taken place to ensure assessment and appropriate care to support those people moving on from the initial COVID-19 Hospital Discharge Scheme 1. Close system working between Adult Social Care and the CCG Continuing Healthcare Team has meant that over 1,000 patients discharged from hospital between March and September 2020, have been appropriately assessed and reviewed, and placed onto their long-term pathways and funding streams. Alongside this, the Government has announced funding to continue the Hospital Discharge Scheme so that patients can continue to leave hospital as quickly and as safely as possible, with the right community or at-home support, releasing acute capacity to deliver the restoration and recovery phase of the pandemic. Hospital Discharge Scheme 3 will fund up to the first six weeks of care after discharge from an NHS setting from April to June 2021 and up to the first four weeks from July to September 2021.

6.4       Many community-based local care providers, such as day services, continue to operate with reduced capacity but continue to deliver support in different ways due to social distancing requirements.

 6.5      ASC continues to work in close partnership with East Sussex Healthcare NHS Trust (ESHT), and the other acute trusts that support East Sussex residents, to ensure the timely discharge of patients from hospital into care homes and community settings. The following measures were introduced within the department’s Directly Provided Services for Older People to support patient flow across the wider system:

6.7       Throughout the pandemic, the department has also continued to provide support to keep vulnerable adults safe within our communities. Many staff have, by necessity, continued to work in offices and operational buildings, others have continued to provide support remotely and face-to-face safeguarding, Care Act and Mental Health Act Assessments have continued within our communities, using appropriate infection control measures.

6.8       Despite there being an initial reduction in contact with the department at the start of the initial lockdown in March 2020, there is now an increasing number of contacts being received through Health and Social Care Connect (HSCC) for both general enquiries and the reporting of Safeguarding. In total, this has increased by 15.8% from December 2020 to January 2021. Whilst overall contact levels remain lower than in previous years, the introduction of vaccinations, community testing and an overall increase in public confidence as we gradually ease out of lockdown is being demonstrated through increase of contact into HSCC.

Personal Protective Equipment (PPE)

6.9       The Department has issued 3,337,743 items in total since the 7th of April 2020.  Of these1.1 million items were issued across internal and external teams, including domiciliary and care home providers, GPs and pharmacists between April – September 2020 in advance of the national portal going live.  In addition since September 2020 2,237,743 items have been issued to internal and external teams unable to access the portal.

6.10     Free Personal Protective Equipment (PPE) continues to be available for COVID-19 needs in line with current national guidance, to care homes and domiciliary care providers via the national PPE portal until the end of June 2021; and

6.11       The Department continues to ensure provision of free PPE to care providers ineligible for the PPE portal (supplied by Department of Health and Social Care [DHSC]) when required (including for personal assistants) directly until the end of June 2021.

 

Clinically Extremely Vulnerable Residents and Community Hubs

6.13     During the pandemic, the County Council assisted Clinically Extremely Vulnerable (CEV) people to shield safely, in line with the Government’s Shielding Framework. This included ensuring all CEV people were contacted, their support needs identified, and direction to local support networks to meet those needs. There were 38,169 residents identified as CEV by the time shielding ended on 31st March 2021.

 

6.14     The five Community Hubs set up at the start of the pandemic continue to offer a local point of contact and support for all vulnerable people struggling to cope with the effects of the COVID-19 pandemic. Contact arrangements are still in place in each District and Borough Council and have been absorbed into existing contact centres.

 

6.15     The County Council have worked well with District and Borough Councils and the voluntary, community and social enterprise (VCSE) sector to ensure comprehensive and localised support for residents. In order to ensure we retain and build on these positive, valuable relationships, the multi-agency CEV Working Group are set to continue collaboration as well as completing a piece of work to scope community assets and resources, so ongoing support and signposting may continue on an ongoing basis.

ASC Contact Strategy

6.17     In addition to support offered to CEV and other vulnerable people, a contact strategy specific to ASC clients and carers has been devised to collect email addresses for future contacts and offer reassurance and signposting to local support. This has allowed for an effectual method of proactively contacting clients at scale so messages can be cascaded promptly and securely. 

Self-isolation

6.18     Although shielding has formally ended, ASC & Public Health have implemented support to residents required to self-isolate in East Sussex. The Government Framework for Isolation Support document is similar in scope to the one produced for shielding support and covers areas such as contact strategy; the basic support offer; communications; and data returns. The basic support offer is broadly similar to that which is currently offered to CEV individuals (albeit shorter term and potentially more urgent) and covers:

 

 

6.19     Our local arrangements to support people required to self-isolate will align our Local Tracing Partnership (LTP) with the existing well-developed support offer in place to meet people’s support needs.

6.20     An infographic summary of the response to CEV, self-isolation and PPE is attached as Appendix 1.

3.         Conclusion and reasons for recommendations

3.1       This report summarises the identified immediate impact of COVID-19 on five key areas of adult social care within East Sussex and outlines the responses made by the department and wider health and social care system. Whilst we continue on the Government’s roadmap out of lockdown, the long-term impact of the pandemic is, at this stage, unknown in respect of:

·         The viability of care homes, particularly those that provide care and support to older people.

·         The delay in people accessing routine healthcare and the impact of ‘ long Covid’ on peoples ongoing health and care needs.

·         The effect that three lockdowns and associated loneliness and social isolation on people’s mental health and emotional wellbeing.

 

MARK STAINTON

Director of Adult Social Care

 

Contact Officer: Tom Hook, Assistant Director Planning, Performance and Engagement Division

Tel. no: 07895 331141

Email: tom.hook@eastsussex.gov.uk