This report providers a summary of relevant data and intelligence and the support provided to care homes to date as well as a copy of a letter and care home support plan submitted to the Minister of Care on 29 May 2020.
The report was introduced by the Assistant Manager, Adult Social Care. Covid-19 had been an unprecedented event and particularly challenging for Adult Social Care. Work had been undertaken to understand the impact of the crisis on providers and residents and to ensure that appropriate support was provided where possible. All local authorities had been required to submit a Care Home Support Plan to the Government to set out the support provided by the Council, CCG and partners. Medway’s Plan had just received positive feedback through a regional assurance process. This confirmed that all required areas had been covered sufficiently and that there were no areas of concern. There was a need to continue to provide sufficient support to care homes, particularly as it was not known whether there would be a second wave of Covid-19. Lessons from the previous three months would be identified to ensure that sufficient support was available during the coming months.
Members raised a number of questions and comments, which included:
Other Providers – It was asked whether there was confidence whether other types of providers besides care homes were receiving appropriate support. The Assistant Director said that support was available to domiciliary providers, extra care and supported living providers. There had been a national focus on supporting care homes so it was particularly important to ensure that sufficient support was available for other types of provider. The national request for support had been specific to care homes but Medway had chosen to make all support detailed in the Plan available to other providers. Funding had been made available to all local authorities for infection control. In-line with national guidance, Medway had agreed to directly passport 75% of funding to care homes. Medway would be using most of the remainder to support other providers. The advice, guidance and training available to care homes was being provided to others and the providers had been asked to provide feedback on the support provided to date.
Domiciliary Care and Personal Assistants – These had been highlighted to Healthwatch as areas of concern and Healtwatch would be happy to work with Adult Social Care to address any issues.
The Assistant Director acknowledged the importance of personal assistants feeling that they had appropriate support in place. At the beginning of the Covid-19 outbreak, stocks of Personal Protective Equipment (PPE) had been secured and made available to personal assistants. Contact had been made with employers to ensure that they had appropriate infection control measures in place. It was considered that support calls made to care homes should be undertaken to Personal Assistants and domiciliary care providers. Adult Social Care had worked with organisation Think Local Act Personal, who had been impressed with Medway’s response to Covid-19 and had highlighted this work in a meeting with the Care Minister.
Hospital testing, PPE provision, carers and care providers – Clarification was sought regarding testing of patients discharged from hospital to care homes. It was stated that PPE provision had been relatively poor for domiciliary care providers and suggested that there should be a renewed focus on the contribution of carers. It was also asked how many Medway care home residents had died with Covid-19 and whether there was concern about provider fragility and the potential impact of this on provision.
The Assistant Director Adult Social Care advised that national guidance had required testing of care home residents from 15 April and that this had been implemented quickly. Before that date, people had been discharged from hospitals to care homes without having been tested. Ahead of this work had been undertaken with providers to ensure that the risk was managed and that residents who might have Covid-19 were isolated. Outbreaks in Medway care homes had been lower than national averages. Interim packages of care were being put in place while longer terms packages were being developed. The risk of infection in some care settings was being reduced by having different staff working with those who had tested positive for Covid-19 and those who had tested negative. Support to provide respite for carers was also being offered as normal respite provision had been unable to continue due to the virus.
National Carers Week had recently taken place. This had included important work to promote the work that carers do, to highlight the number of hidden carers in the community and to make carers aware of the support available. Healthwatch and Carers First were both able to provide information to carers about the local offer. The Council had agreed to cover the additional costs incurred by providers due to Covid-19 with requests being received from providers daily. The number of people in care homes had reduced during the pandemic and there was less demand for care home places, which was a risk to the financial viability of providers.
The Director of Public Health said that it was difficult to compare mortality rates due to the different methods used to calculate them and also the delay in the death certification process. The monitoring of Covid-19 related deaths in care homes had started on 17 April with there having been 32 deaths in Medway care homes since then. During the week of 17-24 April, there had been a death rate of 28/100,000 residents in Medway compared to an England average of 32/100,000. For the first week of May the figure was 44/100,000 for Medway and 56/100,000 for England. In the week ending 5 June, 2 people had died in Medway with Medway continuing to do well compared to other areas. Plans were being developed to reduce the likelihood of future deaths. This included an outbreak control programme, with a plan being due for completion by the end of June 2020. Daily meetings took place in relation to testing and a multi-agency Health Protection Committee had been convened.
Medway care provider PPE provision – It was asked whether sufficient PPE was available.
The Assistant Director acknowledged that PPE provision had been a significant issue for all providers at the beginning of the crisis. Significant time had been taken to resolve the issue and PPE had been made available to all providers. This had been a significant challenge in the early weeks of Covid-19. Adult Social Care had needed to use initiative and existing working relationships to secure sufficient PPE. There were now stocks available to providers through the Local Resilience Forum with the National Clipper Service having recently launched to provide emergency supplies.
Infection control funding – It was asked how much of Medway’s share of the nationally provided funding for care home infection control had been spent and how this had been used.
The Assistant Director said that the initial funding had covered a range of pressures. Some of the funding was ring fenced for Adult Social Care with some not being ring fenced. Some of the funding was being used to manage financial pressures faced by the Council as a result of COVID-19. At the time the Council had submitted its Care Home Support Plan, £119,000 of the funding had been spent. However, further invoices were expected as there was no time limit for providers to submit invoices that they were looking for the Council to pay. There was flexibility regarding what costs could be covered. A more recent tranche of infection control funding had been available. Medway’s share of this was £2million but there was less flexibility around what this could be spent on with 75% being passed to care homes. The other 25% had been used to support other providers, such as domiciliary care and extra care.
Use of agency staff – It was asked whether there was data available on the use of agency staff in care homes and how staff moving between care homes could have caused Covid-19 infections.
The Assistant Director said that 90% of Medway care homes had taken action to restrict staff movement between homes compared to a regional average of 65%. Guidance on this risk of staff movement between homes had only been published relatively recently. Medway’s figure was likely to be low because it had relatively few large providers running multiple care homes.
The Committee noted the report provided and thanked Adult Social Care staff for their work.