Adult social care: winter plan

There was a flurry of publications last month in respect of the social care sector.

The Social Care Sector Covid-19 Support Taskforce published its final report, advice and recommendations. It was chaired by David Pearson, CBE and had eight advisory groups working from mid-June to end of August 2020. It referenced a national offer, regional response and local response. It accepted the challenge was significant given there are 38,200 settings in this country in which people receive care and support. It also could see that there was a balance to be struck between reducing the risks of the virus and the need to receive care and support and the fact that assurance was needed in respect of human rights obligations.

At the time of writing 62 per cent of care homes had not experienced an outbreak. However the taskforce was encouraged to be ambitious and bold – and it made 52 recommendations (almost matching its 55 pages) in light of that!

The Winter Plan was published on the same date. It confirms the Government's three overarching priorities for adult social care are:

• ensuring everyone who needs care or support can get high-quality, timely and safe care throughout the autumn and winter period;
• protecting people who need care, support or safeguards, the social care workforce, and carers from infections including Covid-19; and
• making sure that people who need care, support or safeguards remain connected to essential services and their loved ones whilst protecting individuals from infections including Covid-19.

It sets out key actions for local authorities, the NHS (15 in total) and providers (ten in total) to undertake.

Key actions for local authorities and NHS organisations to take:

• local authorities and NHS organisations should continue to put co-production at the heart of decision-making, involving people who receive health and care services, their families, and carers
• local authorities and NHS organisations should continue to recognise the importance of including care provider representatives in local decision-making fora, ensuring they are involved throughout
• local authorities must put in place their own winter plans, building on existing planning, including local outbreak plans, in the context of planning for the end of the transition period, and write to DHSC to confirm they have done this by 31 October 2020. These winter plans should incorporate the recommendations set out in this document. NHS and voluntary and community sector organisations should be involved in the development of the plans where possible.
• local authorities and NHS organisations should continue to address inequalities locally, involving people with lived experience wherever possible, and consider these issues throughout the implementation of this winter plan
• local authorities must distribute funding made available through the extension of the Infection Control Fund to the sector as quickly as possible, and report on how funding is being used, in line with the grant conditions
• local authorities must continue to implement relevant guidance and promote guidance to all social care providers, making clear what it means for them
• local systems should continue to take appropriate actions to treat and investigate cases of Covid-19, including those set out in the contain framework and Covid-19 testing strategy. This includes hospitals continuing to test people on discharge to a care home and Public Health England local health protection teams continuing to arrange for testing of whole care homes with outbreaks of the virus
• local authorities should ensure, as far as possible, that care providers carry out testing as set out in the testing strategy and, together with NHS organisations, provide local support for testing in adult social care if needed
• local authorities should provide free PPE to care providers ineligible for the PPE portal, when required (including for personal assistants), either through their LRF (if it is continuing to distribute PPE) or directly until March 2021
• local authorities and NHS organisations should work together, along with care providers and voluntary and community sector organisations, to encourage those who are eligible for a free flu vaccine to access one
• local authorities should work with social care services to re-open safely, in particular, day services or respite services. Where people who use those services can no longer access them in a way that meets their needs, local authorities should work with them to identify alternative arrangements
• local authorities should work with social care services to re-open safely, in particular, day services or respite services. Where people who use those services can no longer access them in a way that meets their needs, local authorities should work with them to identify alternative arrangements
• local authorities and NHS organisations should continue to work with providers to provide appropriate primary and community care at home and in care homes, to prevent avoidable admissions, support safe and timely discharge from hospitals, and to resume Continuing Healthcare (CHC) assessments at speed
• NHS organisations should continue to provide high-quality clinical and technical support to care providers through the Enhanced Health in Care Homes framework and other local agreements
• local authority directors of public health should give a regular assessment of whether visiting care homes is likely to be appropriate within their local authority, or within local wards, taking into account the wider risk environment and immediately move to stop visiting if an area becomes an ‘area of intervention’, except in exceptional circumstances such as end of life.

Key actions for providers to take: 

• 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

The plan goes on to confirm that the NHS will continue to:

• support care homes and social care through primary care and community services and the rollout of the Enhanced Health in Care Homes model, including a named clinical lead and weekly multidisciplinary support
• provide professional leadership and expert advice on infection prevention and control in local areas through Directors of Nursing in Clinical Commissioning Groups (CCGs) to support the local authority and directors of public health in discharging their responsibilities. This will include offering targeted mutual aid and support where it is needed in a system
• support care providers in their local area to enable NHSmail and collaboration tools; and to use this, as much as possible, to provide data and information to care homes (for example discharge checklists ahead of discharge to a care home).
• enable discharge to be safe and timely, ensuring that testing takes place before every discharge to a care home, and results are available and communicated before discharge, unless otherwise agreed. No one should be discharged from hospital directly to a care home without the involvement of the local authority
• CCGs will work with local authorities on their requirement to identify alternative accommodation where care homes cannot isolate safely. As before, care homes have a right to refuse admission to residents and should not accept admissions if they cannot safely cohort or isolate them
• provide reablement and rehabilitation services, following discharge from hospital, to support independence and potential return to a person’s own home, and provide clinical support to avoid inappropriate admissions to hospital from an individual’s home, including where that is a care home
• ensure that personalised care and support planning is at the heart of decision making. For the avoidance of doubt, NHS policy is clear that clinical decision making should always be personalised and should never be done on a blanket basis. This includes decisions on the application of do not attempt cardiopulmonary resuscitation orders (DNACPR), decisions on admission to hospital and decisions on the use of ambulances

However that’s only just covered in the executive summary.  A myriad of sections contain further more detailed actions for local authorities, the NHS and providers:

• Preventing and controlling the spread of infection in care settings
• Collaboration across health and care services
• Technology and digital support
• Supporting people who receive social care, the workforce, and carers
• Supporting the system
• Care home support plans

Commentators have expressed concerns that:

• the Plan does not take account of Care Act 2014 obligations on local authorities to promote the wellbeing of an individual;
• there are possible breaches of the Human Rights Act 1998; and
• the 14 day isolation period could constitute a Deprivation of Liberty.

There is so much in this plan to grapple with so please do not hesitate to get in touch with our experienced social care team to chat through any issues.