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Report Recommendations

The Social Care Sector COVID-19 Support Taskforce was commissioned in June 2020, with this report seeing the completion of its work in August 2020. The taskforce was set up to oversee the delivery of 2 packages of support that the government had put in place for the care sector, the Social Care Action Plan and the Care Home Support Plan. In addition, the taskforce was asked to support the government’s work on community outbreaks – areas of the country that needed particular help and intervention to deal with higher rates of infection – and advising and supporting local places to consider and respond to reducing the risk of infection in care homes and the wider social care sector. Its further remit was to provide advice on the requirements for the response to COVID-19 in the next few months, ahead of and into winter.


PPE

Recommendation 1

Sufficient PPE provision to all social care providers (regulated and unregulated settings) should be made, free of charge, until at least the end of the current financial year (until 31 March 2021).

Consideration should be given to making a contribution to the costs of PPE, experienced by the sector in this financial year to date.

Action for: DHSC / Her Majesty’s Treasury (HMT)

The taskforce recognises the contribution of wholesalers to the supply of PPE in the sector, so far, and the need to maintain these relationships so that, when the supply chain returns to normal, the wholesalers are in a position to respond to the needs of the sector.

Recommendation 2

Government to ensure that robust distribution mechanisms for PPE, for the sector, including emergency supply arrangements, are in place; and to communicate clearly to the sector these arrangements for this winter.

Action for: DHSC

Recommendation 3

Local authorities should establish mechanisms for supplying PPE to informal carers based on individual need.

Action for: Local authorities

Recommendation 4

Organisations should work to agree joint mechanisms for enabling staff to raise concerns about access to adequate supplies of PPE.

Action for: CQC and local authorities

Testing

Recommendation 5

NHS Test and Trace should ensure the availability of detailed data on care home tests undertaken and the positive and negative results to local government, taking into account of the legal requirements of general data protection regulation (GDPR).

Action for: NHS Test and Trace

Recommendation 6

In areas of high prevalence and local outbreaks, testing of care staff should be a priority. It is also recommended that SAGE continues to review the evidence to consider whether community staff should be tested routinely. As testing capacity becomes available, the government should review the testing of care staff in the community. A priority for consideration is live-in care workers.

Action for: DHSC / SAGE

Recommendation 7

Testing of regular family visitors to care homes should be reviewed by SAGE considering risks associated with visitors, risks to residents of not being able to see their families and circumstances where relatives’ care and support in the homes is an integral part of the care plan.

Action for: DHSC

Recommendation 8

The testing of essential and regular visitors to care homes, such as CQC inspectors, should be kept under review

Action for: DHSC and NHS Test and Trace

Recommendation 9

Meeting the testing capacity (including asymptomatic testing) needs of the adult social care testing strategy (published 3 July 2020) should remain a first priority for the government. The strategy should be evaluated, in the autumn, as planned

Action for: DHSC

Recommendation 10

Outbreak management in care homes should remain a testing priority utilising ‘pillar one’.

Action for: DHSC

Recommendation 11

All agency staff should continue to receive weekly testing and agencies should put mechanisms in place to ensure this is done. Government should put in place regulations to require providers to ensure staff have been tested before they work in a care home

Action for: DHSC

Flu

Recommendation 12

Arrangements should be made, where possible, for workplace access to facilitate flu vaccination and other bespoke arrangements to ensure high take-up in the social care sector. This should include the training and deployment of peer vaccinators. There should be a local system in place to review progress and remove any barriers.

Action for: DHSC

Recommendation 13

There should be a national communications campaign to encourage take-up of the flu vaccination in the social care sector. This campaign should involve central government, local government employers and trade unions. It should cover service users, carers and the workforce

Action for: DHSC / local government / trade organisations and trade unions

Workforce

Recommendation 14

The government should set up a short-term workforce planning group to further address workforce capacity issues, likely to arise over the next 6 months. To conclude its work within 6 weeks.

Action for: DHSC

Recommendation 15

Government should keep under review vacancies and absence levels and consider further measures to improve recruitment and retention if existing strategies do not sufficiently fill the gap. This should include the continuation of recruitment marketing to attract the right candidates to fill existing vacancies.

Action for: DHSC

Recommendation 16

There should be a review of the access to support available to social care staff, in particular for wellbeing services.

Action for: DHSC

Training

Recommendation 17

There should be appropriate training and support agreed and provided for care staff who are undertaking delegated tasks.

Action for: DHSC / Skills for Care

Funding

Recommendation(s) 18

In view of this and the continued threat of the pandemic to care homes and the wider social care sector, our recommendation is that the Infection Control Fund should be in place for the rest of the financial year. The conditions which led to the provision of the grant still exist and will do so for the remainder of the financial year at least. In addition, we would recommend:

  • Rollover of any unspent committed funding for use in the rest of the year. The impact and response to COVID-19 was immediate and unpredicted. Providers and local authorities had to understand what action they needed to take. It clearly took some time for local providers to determine what changes they needed to make and how the grant would be aligned. There is also feedback that the short-term nature of the grant led to some reluctance in applying some measures, including paying full pay while staff were isolating or absent through sickness
     
  • Specified funding for the rest of the social care sector to enable all staff to self-isolate or to be absent through sickness without losing pay. The proposal here is to use a model deployed by Hertfordshire County Council, which provided an allocation based on the number of service users in home care, utilising self-directed support and supported living
     
  • Use of the funding to support extra staff and equipment to manage the new visiting policy safely and effectively
     
  • Reinforcing the existing conditions, including the ability to employ extra staff or increasing pay to meet the requirements of reducing staff movement, or supporting residents who need extra support to remain socially distanced from others
     
  • Local authorities creating a staff bank to deploy people into the care sector on a placement basis, with appropriate testing and isolation procedures in order to reduce staff movement, responding to any staffing shortfalls as a result of recruitment challenges, or resulting from infection. This would include any costs associated with indemnity. It would include arrangements for the supply of nurses in conjunction with local health services or the returners and young professionals scheme
     
  • Allowing spending on equipment and technology to aid infection control
     
  • Allowing payments to offset reduced occupancy where this is required in order to implement appropriate/cohorting/zoning of residential establishments and staff groups in line with Taskforce recommendations (soon to be available). This includes, for example, the provision of separate rooms for changing into and out of PPE and the storage and retrieval of supplies
     
  • Enabling use of up to 10% of the funding for PPE. The government is keeping under review the provision of free PPE to the sector. This would allow some flexibility in meeting the costs of this very important equipment. However, if the government does, as recommended, make free PPE available for the rest of the financial year with some support for costs incurred, this provision would be unnecessary
     
  • Given the evidence of the link between paying staff full pay to isolate or absent through illness, the government should make the availability of the future grant subject to full pay to ensure that is carried out across the sector during the pandemic
     
  • DHSC should consider an increased respite offer to informal carers. This should sit alongside a campaign for carers, recognising their challenges and encouraging options for them to consider a break
     

Actions for: DHSC

The extra costs of insurance, during this financial year, were considered – DHSC has advised that this will be kept under review by other means.

The Local Government Association has proposed a decrease in the level of the grant that is passed directly to providers, to 50%, on the basis of increased flexibility to deploy the money, based on greatest need and risk. Providers tended to support specific allocations to care homes and the community care sector rather than the flexibility suggested by local government. Clearly, the proposal above to specify an amount for the rest of the sector, in addition to care homes, could potentially reduce flexibility. However, the resilience of services providing care for people in their own homes will be critical during this period of heightened risk, particularly given the number of people who require care at home having left hospital or due to increasing needs while living at home.

Another proposal was a request for further guidance through the Local Government Association on the application and monitoring of the grant in order to achieve greater consistency across the country. A further issue raised by both providers and local government is the uncertainty and administrative burden of the current funding coming in 2 tranches. The government should consider reviewing this position and lengthening the period between payments.

Evidence and Guidance

Recommendation 19

DHSC should ensure that there is an easily accessible central site for all social care guidance relating to COVID-19, produced in a range of accessible formats. The site should provide links to supplementary evidence.

Action for: government communications

Recommendation 20

Government should ensure that all guidance is developed with the sector in all cases and protocols developed for ensuring that this is undertaken efficiently and effectively

Action for DHSC

Recommendation 21

It is recommended that the SAGE sub-group has a wider brief for the social care sector as a whole.

Action for: Deputy Chief Medical Officer

Communications

Recommendation 22

A social care specialist should be included in developing communications in a range of accessible and culturally accessible formats including guidance aimed at unpaid carers at national level to reflect the specific challenges and achievements of the sector.

Action for: DHSC

Recommendation 23

Create a digital space where guidance is easily navigated and accessible to all aspects of the social care system in a simple format. Within this space, create a place to amplify the voices of the sector, share best practice and recognise heroic efforts.

Action for: DHSC

Recommendation 24

Local systems are recommended to establish a weekly joint communication from local directors of adult social services and directors of public health to go to all local providers of adult social care as a matter of course through the winter months.

Action for: Directors of adult social services

Recommendation 25

There should be a single dashboard which can be used by each region for the social care sector based on the national dashboard, and used to identify risk and support improvement.

Action for: DHSC with local government / ADASS / Directors of public health / provider representatives

Clinical support

Recommendation 26

Communicate the aims and best practice for the clinical lead role for care homes, along with advice on how they maximise the value of their clinical lead. Put into place visible arrangements locally and nationally for assuring that a clinical lead remains in place for each care home.

Action for: NHSE / CCGs / Primary care networks

Recommendation 27

Primary care networks and community health services should ensure that a weekly review in care homes is undertaken including structured medication reviews. Care homes should work with the local multi-disciplinary team to ensure this works effectively.

Action for: Primary care networks, community services and multi-disciplinary teams

Recommendation 28

Communicate to providers a clear plan, with timescales, for the implementation of the Enhanced Health in Care Homes programme, detailing what support providers can expect to be in place and what preparations they should be making.

Action for: NHSE / CCGs

Recommendation 29

Local systems should engage with local care providers to implement monitoring and video conferencing tools for increased access to GPs/primary care.

Action for: Local authorities and CCGs

Recommendation 30

Directors of nursing in CCGs to provide professional leadership and expert advice on infection prevention and control in local areas to support the local authority and directors of public health in discharging their responsibilities.

Action for: NHS / CCGs

Clinical support for people living at home

Recommendation 31

STPs and ICSs to ensure that, through their approaches to population health management, primary care networks ensure that the risks and needs of users of social care services in the community are identified and reviewed.

Action for: STPs and ICSs

Movement of people between care and health settings

Recommendation 32

The SAGE sub-group to review the evidence on the risks associated with the discharge of COVID-19 positive people from hospital and admissions of COVID-19 positive people from the community to care homes.

Action for: SAGE sub group

Inspection and regulation

Recommendation 33

The CQC inspection framework should be reviewed to take into account the recommendations in this report and the winter plan.

Action for: CQC

Capacity, expertise and information

Recommendation 34

It is recommended that DHSC significantly boosts its own expertise and capacity, in relation to social care, for the duration of the pandemic and beyond. It should do this by bringing in, perhaps through secondment, senior local authority figures with current/recent experience at senior levels both within social care and public health. Such expertise, allied to the soon-to-be-appointed Chief Nurse, could, for example, be deployed, during the pandemic, on the understanding and effective management of local COVID-19 outbreaks, with a role in linking effectively with regional and local structures. Looking more broadly, it is recommended that DHSC should consider what role a group similar to the taskforce could play in:

  • Providing professional advice to DHSC policy officials, on the basis of interaction with the system, playing a key role in informing its development
     
  • Continued implementation of the Care Home Support Plan
     
  • Implementation of the adopted Taskforce recommendations
     
  • Oversight of the quality and effectiveness of national policy through working in partnership with regional and local structures
     
  • Supporting implementation/delivery – advising/supporting as well as identifying places where there are higher risks on a range of adult social care delivery issues
     

It is further recommended that these national level arrangements continue to be supported by a robust, resilient and agile regional structure which can support a line of sight at a national level into local situations, enable 2-way communications between local and national, and can deploy rapid and targeted support to local systems.

Use of data and digital

Recommendation 35

The government to complete urgently the national COVID-19 social care dashboard.

Action for: DHSC

Recommendation 36

The DHSC must make some infrastructure changes in order to be able to address these data issues. Principles that should underpin this are:

  • Robust data capture – capture once, use multiple times, and ensure that it is clear why data is needed and how it is being used so that good data quality is incentivised. Ideally this would see the establishment of a social care data source, rather than reliance on health or other platforms
     
  • Rigorous database management – collating, cross-checking and processing data from multiple sources and organising it to be used consistently in ongoing reporting and ad hoc analysis
     
  • Operationalising the data – getting the prioritised insights back to users immediately so they can address both emergent issues and data quality, driving proactive improvement. This will help support the sector with problem-solving and managing the pandemic
     
  • Accessibility and democratising data – make both analysis and raw (or appropriately aggregated) data available to everyone as appropriate to their role in supporting the system. This one version of the truth can help to unite a distributed sector behind a shared understanding of where problems lie and what good standards look like
     
  • Operational data leadership – establish the capability and capacity to set new standards of how data will be used to inform decision making. Driving both high standards around the collection and management of data and the active use of data operationally to inform priorities and interventions
     
  • Governance and communication – establish clear roles and responsibilities for who takes which actions and how the data supports them to do so in a prioritised way. Ensure data provides a way to focus on what each part of the system can do and where more complex or multi-disciplinary work may be needed to investigate beyond the existing data
     

Action for: DHSC with support from across government

National, regional and local structures

Recommendation 37

Provider representation should be established in each area as part of the regional support to the sector and assurance for the sector. The model and arrangements need to be confirmed and implemented with the sector.

Action for: DHSC, Care Providers Alliance, with LGA and ADASS

Care Home Support Plan

Recommendation 38

Local authorities should review contingency arrangements for staffing shortages with the aim of reducing the need for staff movement.

Action for: Local authorities

Recommendation 39

In consultation with local government, central government should consider making regulations to give local authorities a responsibility for arranging a staff bank to help meet staffing shortages, where this is required. Arrangements should comply with good infection prevention control including weekly testing and infection prevention and control training.

Action for: DHSC

Recommendation 40

Further explore the level of exclusivity arrangements that exist with care agencies and how to increase them, reducing staff movement.

Action for: Providers

Recommendation 41

The cohorting and zoning recommendations developed by ADASS, working with providers and its implications for commissioning should be adopted across the country. This should include ensuring early partnership discussions with providers about the safety and feasibility of implementing these arrangements within their homes.

Action for: DHSC/ADASS and providers

Recommendation 42

Implement a national framework for learning reviews of care home outbreaks with subsequent advice on good practice and learning.

Action for: DHSC


Adult Social Care Action Plan

Safeguarding

Recommendation 43

In implementing the taskforce Action Plan, local authorities should ensure they take steps, in line with the public sector equality duty of the Equalities Act 2010, to ensure they evidence and address the inequality of outcomes for people affected by COVID-19. DHSC should make available further specific advice for the sector in addressing inequalities.

Action for: DHSC / local authorities

Homecare and other community care settings

Day services

Recommendation 44

A mechanism should be developed for sharing good practice on support for young carers to engage effectively with education providers.

Action for: DHSC

Recommendation 45

The government, in conjunction with local government, carers and service users should establish a project to ensure that day service provision is opened up across the country and the innovative examples of alternatives are spread nationwide.

Action for: DHSC / ADASS / providers

Home Care

Recommendation 46

Government and local authorities should review the options to make occupational health services available to the sector where there are gaps.

Action for: DHSC / LGA

Managing community outbreaks and the response of social care

Recommendation 47

The actions identified in the workshop should be implemented in September 2020.

Action for: DHSC / NHS Test and Trace

Recommendation 48

NHS Test and Trace to ensure that local authorities (DASSs and DPHs) have timely access to test results from residents and staff in care settings, to enable them to manage, effectively, the risk of incidents or outbreaks.

Action: DHSC / NHS Test and Trace

Recommendation 49

There should be a monthly review of the specific arrangements and protocols between NHS Test and Trace, its Contain function, and social care. This is to ensure consistency of approach as well as providing appropriate and proportionate support to localities and the sector.

Action for: DHSC / NHS Test and Trace

Recommendation 50

NHS Test and Trace should determine whether those tested positive for COVID-19 (or their contacts) are working in the care sector, or are unpaid carers, to enable the appropriate advice and support to be offered.

Action for: DHSC / NHS Test and Trace

Key themes emerging from the taskforce advisory groups

Recommendation 51

The advice and recommendations of the advisory groups should be considered by the DHSC and a response be provided on the advice and recommendations and how they are to be taken forward.

Action for: DHSC

Planning for the next phase of the pandemic

Recommendation 52

Following the publication of the national winter plan, each local authority and provider should have in place its own winter plan to build resilience and give confidence to the public. This should include business continuity planning for organisations and contingency planning for service users and carers in situations where there are complex arrangements which depend upon a few key individuals and family carers.

Action for: DHSC with local authorities and providers