appendix 1 covid-19 care home resilience plan introduction › media › 15545 › appendix... ·...

Appendix 1

COVID-19 Care Home Resilience Plan

Introduction

As part of the COVID-19 emergency response, the East Sussex Health and Social Care System has developed a plan focussed on support to residential and

nursing homes. This builds on and complements other joint plans and delivery arrangements as part of ensuring we provide the best possible response to the

pandemic for our local population. In addition to setting out the detail of what support is available to care homes, this shared plan provides the framework for the

immediate decisions and tasks required to support homes effectively through the COVID crisis, and also respond rapidly to put measures in place in the case of

COVID outbreaks or other care home emergencies.

This plan to support care homes builds on existing plans focussed on securing additional capacity, hospital discharge pathways and responding to the

Department of Health and Social Care (DHSC) Action Plan for Adult Social Care. Many of the agreed actions in those plans have subsequently moved into the

daily operational management process.

The draft plan should be treated as a live document. Some of the tasks are already in train, and new actions will be added as they are agreed to enable

oversight of progress in one place. New actions requiring resolution will also be identified and escalated. Tasks have been grouped under the following

headings:

1. Infection prevention and control (IPC) o Training in infection control o Personal Protective Equipment (PPE) o Reducing workforce movement between care homes and minimising risk for care workers o Quarantining o Building scientific understanding and sharing good practice across the sector

2. Stepping up NHS Clinical support 3. Comprehensive testing 4. Building the workforce 5. Communications and Engagement

The plan draws on guidance and information in the following documents to support local implementation:

• Care Home contingency planning work and risk assessment framework (Policy and Strategic Development, ASC&H 13/04/20)

• COVID-19 Our Action Plan for Adult Social Care (DHSC 15/04/20)

• Revised LHRF modelling and next steps (Sussex data and monitoring cell 16/04/20)

• Sussex Health and Care Partnership COVID-19 Briefing (16/04/20)

• ‘New requirements to test patients being discharged from hospital to care home’ (NHSE Letter 16/04/20)

• Sussex care homes - NHS commissioned health services - stock take (Sussex CCGs 17/04/20)

• Second phase of NHS response to COVID-19 (NHSE/I letter 29/04/20)

• COVID-19 response: Primary and community health support care home residents (NHSE/I letter 01/05/20)

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Tom Alty (TA), Jessica Britton (JB), Andy Brown (AB), Adrian Bull (AB), Simone Button (SB), Alison Cannon (AC), Niki Cartwright (NC), Joe Chadwick-Bell (JC-B), John Childs (JC), Glynn Dodd (GD), Penny Ford (PF), Darrell Gale (DG), Jason Hathaway (JH), Sarah Henley (SH), Keith Hinkley (KH), Tom Hook (TH), Elizabeth Mackie (EM), Kate Pilcher (KPi), Chloe Rogers (CR), John Routledge (JR), Sally Smith (SS), Vicky Smith(VS), Mark Stainton (MS), Lesley Walton (LW), Mark Watson (MW), Samantha Williams (SW)

• Further CCG Assistance to local resilience forums in supporting care homes: ‘Training the Trainers’ on infection prevention and control (NHSE/I letter 01/05/20)

• Support for care homes (Minister for Social Care letter 14/05/20); Annex A COVID-19 Care Home Support Package and Annex B Guidance for Local Authorities and local system partners

The plan is owned and supported by the East Sussex Health and Social Care Executive Group, which is accountable for delivery. The membership of the Executive Group is East Sussex Clinical Commissioning Group (CCG), East Sussex County Council (ESCC), East Sussex Healthcare NHS Trust (ESHT), Sussex Community NHS Foundation Trust (SCFT) and Sussex Partnership NHS Foundation Trust (SPFT).

No. Action and key milestones Lead Management capacity

Start date

End date

Progress/comments

1. Infection prevention and control

1.1 Training in infection prevention and control, PPE usage and testing advice

1.1.1 Continue to support the rollout

of targeted training and support

to use PPE in care home

settings, IPC, and isolation and

cohorting of patients

MC CCG Quality Team, ASC&H SC&SM, PH, Sussex CCGs Surveillance

Group

Ongoing activity Update 26/05/20: As part of the Sussex COVID19 response, Sussex CCGs have formed an Infection Prevention and Control Care Homes work stream. This work stream works with each Local Authority, Public Health Team and Acute and Community providers to support the COVID19 response to care homes:

• The Sussex CCGs Infection Prevention and Control team provide a follow up call to all care homes and providers who declare a suspected or confirmed COVID19 outbreak via Public Health England outbreaks reports. This call includes providing homes with advice and guidance on following national IPC and PPE guidelines for COVID19.

• Advice is provided on how to isolate and cohort residents within the home environment according to their particular circumstances.

• Homes are also given support on ensuring IPC measures in relation to staff and the care home

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environment are taken to limit transmission this includes advice on managing laundry, refuse and cleaning regimes.

• The CCG IPC team also work closely with system colleagues in each Local Authority area as part of their Care Homes Incident Management response, following up requests for additional support regarding infection prevention and control to assist homes in managing their current outbreak situation.

The Sussex CCGs IPC Care Home work stream sits as part of the CCGs Quality and Safety Directorate which provides oversight and assurance regarding the status of care homes across the county during the COVID19 pandemic via a Surveillance Group meeting with system partners including the CQC, this in turn reports to the Sussex Quality and Safeguarding Committee.

1.1.2 Mobilise and implement ‘train the trainers’ on IPC for all care homes

• Confirm with LRF about offer to supply trainers who could be mobilised immediately if requested by care homes and as directed by LAs

• Mobilise the offer and identify as many trainers as possible, as directed by LRF/Las

• Confirm the offer has been made and an estimate of

CCG Chief Nurse and

LAs

CCG Quality Team, DoNs ESHT, SCFT,

SPFT, PH

01/0520 15/05/20

Task complete Update 14/05/20: invitation has been sent to our 307 homes to attend the training and bookings are being taken via Eventbrite. The training will be delivered virtually via Microsoft Teams and will last no longer than 2 hours and there will be 4 bookable sessions a day. Each session provides expert training that can be cascaded to others, offered in small groups of no more than 8 homes with live conversation and practical elements and importantly support providers with CQC regulations under the Health and Social Care Act, (regulation 12 outcome 8 and provide evidence).

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the number of staff available to support this with the Regional Chief Nurse by CoP 04/05/20

• Invite care homes to attend training by 15/05/20

The training is free and will be delivered by a team of Super Trainers and trainers along with the commissioned training provider who has supported the Infection Prevention Champions program here in East Sussex for the last 3 years. The core elements are mandated and will cover three aspects:

• Infection Prevention and Control

• Donning and Doffing of Personal Protective Equipment (PPE)

• How to undertake a COVID 19 Swab Update 21/05/20: Please see section 2.2 for more information on the SCFT COVID Care Home Support Team service for High Weald Lewes and Havens, which includes training support package, and access to advice and support, covering infection control, PPE and testing. Update 26/05/20: Infection Prevention Training has been provided by the CCG Infection Control Nurse Specialists to all providers including Care, Residential and Domiciliary providers across Sussex since March 2020. This training has included the use of Personal Protective Equipment. In addition, Sussex CCGs in partnership with local authorities are implementing the National Infection Prevention training programme which includes the practical application of Personal Protective Equipment. Following this national programme Sussex system will continue to provide specialist Infection Prevention training to support Care Homes. As a system we have identified super trainers and trainers in line with the national ask, risk stratified care

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homes into high or low risk categories, prioritised face to face and virtual training with individual care homes.

1.2 Personal Protective Equipment (PPE)

1.2.1 Escalate access to PPE (Social Care) issues

• Raise the urgent and

critical need for PPE to

unblock market response

via ADASS and DHSC

• Work through the LRF to

secure as much PPE stock

as possible given the

critical situation for social

care providers - care

homes, home care, extra

care housing, community

hubs, Personal Assistants,

sheltered housing

• Set up a dedicated e-mail inbox to record all requests, with social care providers completing a pro-forma so we can distribute stock on a daily basis.

• Set up process to distribute limited drops from the LRF on a priority basis to social care providers.

• Include care providers as part of work on the need for PPE across the whole

KH

TH, SW

TH, SW

TH

DG

ASC&H, LRF

Action completed

Update 20/04/20: raised as an urgent risk as current supply does not meet demand even for urgent requests. Risk escalated through all routes, and requires ongoing management.

This details what is required across all sectors This represents the calculated need and will form the

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social care sector to support the requirement for immediate additional Sussex drops.

evidence base of the Sussex LRF submission for support until the Clipper service is established.

1.2.2 Access to PPE (NHS) and

mutual aid

Continue to manage ongoing

Sussex-wide shortage of PPE,

including daily reporting of

stock levels to modify delivery

the following day, and mutual

aid via increasing stocks held in

a central system hub for

distribution

Mutual aid

Link up work on PPE across the health and care system and between local health and social care providers to ensure oversight and mutual aid

GD

GD, TH

Sussex CCGs, ESHT, SCFT, SPFT, ASC&H Sussex CCGs, ESHT, SCFT, SPFT, ASC&H

Ongoing SH&CP C19 Briefing Update 16/04/20: There is a

continued shortage of PPE, with mutual aid in the

short term, use of hardship fund, non-NHS supply

chain sources and delivery of orders already placed

as ongoing mitigations.

Awaiting update on the national logistics solution for

supply to Primary Care and care homes - ‘push’

deliveries remain approximately 2 weeks out.

The mutual aid process is now formally approved, and work is taking place with Trust leads to formalise the individuals coordinating the mutual aid process. Update 28/05/20: Locally there is good operational process to link up PPE supply between the Councils and NHS mutual aid process, to ensure that there are continued supplies to all areas of the system. There are occasional short term short stock issues that have been managed between the agencies. Health services are not yet assured that the PPE supply is sufficiently robust to re-open capacity and therefore this continues to be a limiting factor in the restoration of services. The national strategy has not yet been clarified and there remains separate purchasing and distribution lines between health and care

1.2.3 Continue to use LRF PPE source for care homes for urgent shortages, and in turn contact the National Supply and Disruption service if the LRF cannot meet urgent needs

TH

LRF, ESCC

Ongoing

Update 18/05/20:

• Process, policies and protocols in place with the risk being managed on a daily basis.

• PPE stock levels across the sector still a major concern but supplies being managed.

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• Single point of access has been communicated to providers – [email protected]

• Proforma and distribution mechanisms agreed and working well. Most distribution within 24 hours of agreeing allocation.

• Daily reporting of stock levels to the LRF.

• Clear escalation routes if stock flow stalls.

• Advice and guidance being promoted through daily provider bulletin

1.2.4 Undertake modelling of future PPE requirements for ESCC Aim being to:

• Ensure long-term supply and mitigate risk re a second wave

• Create resilience in ESCC stock

• Provide figures and guidance for the Independent Care Sector to create wider PPE resilience

TH Public Health Team

28/05/20 30/06/20 Update 28/05/20: Aim to undertake initial modelling to help define and set up the next phase of dialogue and procurement in the medium term time frame.

1.3 Reducing workforce movement between care homes and minimising risk for care workers

1.3.1 Develop a menu of options to reduce workforce movement between care homes and minimise risk for care workers:

• Minimise staff movement between care homes, subject to maintaining safe staffing levels, providers

SW, MS, JC-B, KP

ASC&H

Operations and Strategy,

Commissioning and Supply

Management, ESHT, SCFT

19/05/20 05/06/20 Update 19/05/20: A menu of support options for mutual aid between organisations is in the process of being developed and costed for further consideration including:

• ASC&H Directly Provided Services support offer

• Independent sector offer

• Clinical offer

• Accommodation for care staff

mailto:[email protected]

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should employ staff to work at a single location

• Providers to support care workers to minimise the risk of picking up COVID-19 outside of work

• The Infection Control Fund (ICF) is intended to help providers pay for additional staff and/or maintain normal wages for staff, who need to reduce the number of establishments in which they work, reduce the number of hours they work, or self-isolate.

• Implications of utilising agency workers between homes to be considered

1.3.2 Implement agreed approach to pan Sussex workforce mutual aid escalation:

• System conversation about the framework and enablers for consistency

• Following from the above, develop local response plan for enhanced workforce response (noting this might be slightly differently implemented in the 3 places). Cross reference with 1.3.4 below

Sussex-wide

conversation

to be led

and

coordinated

by SCFT:

KPi, SCFT

DoN, AC,

DF

JC-B, AC, KPi, NC,

SW

SCFT, Directors

of Nursing and

HR

Directors of Nursing, HR

Directors

Action arising from the Sussex ICS Care Homes workstream on care home support and mutual aid strategic review call on 27/04/20. Update 21/05/20: SCFT Provider Workforce Response Team – providing workforce to care homes with sudden and significant staffing capacity issues. SCFT (Chloe Rogers) is working on the production of a Sussex-wide paper on the development of a small team of nursing staff to support care homes in crisis from a workforce perspective, as part of a multi-provider response including all community and acute providers. Paper will include how this would work logistically across multi-providers and a set of principles which require agreement with each Local Authority.

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1.3.3 Create empty bed capacity as part of business continuity planning for emergency provider closures.

MS ASC&H, OMT, Project

resource

26/05/20 30/06/20 Update 26/05/20: Agreement secured to repurpose

Firwood House (an ASC&H directly provided facility)

to create 19 empty beds as part of business continuity

planning for emergency provider closures, potentially

utilising staff from the care home that people would be

moved from.

1.3.4 Confirm and agree a local multi-agency urgent response plan for COVID-19 outbreaks and business continuity plans for emergency provider issues and closures, including workforce mutual aid, covering:

• System protocol (roles and

responsibilities) and;

• Processes for care home

business continuity plans

and escalation routes in

place and working

effectively in the context of

the COVID response

SW, MS, NC, JC-B,

KP

OPEX and project team

resource

05/06/20 30/06/20 This will further support a coordinated system

response underpinning the standard management

process that is in place for outbreak management set

out in Appendix 1 and business continuity plans.

1.3.5 Explore potential use of agency

staff to support care homes

during COVID-19

SW ASC&H, Strategy,


management

Action complete Update 28/05/20: ESCC have done a piece of work

through our Agency staffing contract to look at the

potential for agency staff to support care homes

during covid19. Whilst there have been a small

number of occasions where agency staff have been

able to cover shifts for some homes, this is

understandably very challenging if the home has a

COVID-19 outbreak.

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The following issues present real barriers to agency

organisations being a source of support for care

homes during covid19.

• PPE

• Travel arrangements to and from the service.

• Assurances from the agency about necessary steps they will take to reduce risk of cross infection from agency staff working in a number of homes.

• Clarify expectations for agency staff members in relation to periods of self-isolation or testing requirements.

We will continue to liaise with the wider agency staffing sector to identify any opportunities to take this work forward.

1.4 Quarantining

1.4.1 Secure additional capacity to enable effective isolation of COVID-positive patients. “LAs should ensure that there is sufficient alternative accommodation as required to quarantine and isolate residents, if needed, before returning to their care home from hospital in line with DHSC Adult Social Care Acton Plan (costs covered through £1.3bn discharge funding via the NHS)”

JC-B,MS,NC (OPEX)

ASC Commissioning and Operational

Project Team

Complete Already in place as part of responding to the DHSC ASC Action Plan utilising Bexhill Irving Unit, Rye Memorial, Bexhill Care Centre. Update 22/04/20: Additional capacity secured:

• Bexhill Care Centre (BCC) is set up for use by

patients who have tested Covid-, with a total of 43

beds

• EMI residential beds: provisionally agreed 2 x blocks of 5; Moretain Place in Eastbourne and Castlemaine in Bexhill

Update 22/04/20: BCC – will be receiving patients as of 22/04/20, EMI beds mobilisation estimated to open 27/04/20

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Hospital discharge pathway definitions:

• Pathway 0 – No additional support (may include restart of existing service): patient returns to usual place of residence (inc. residential care home)

• Pathway 1 – Additional support at home or usual residence: patient returns to usual place of residence with interim support

• Pathway 2 – New community bed only: patient is transferred to a non-acute bed and receives care and support until able to safely return to usual place of residence

• Pathway 3 – Complex: patient is transferred to a short-term bed or D2A/Escalation bed to await further assessment and long term planning

Capacity as at 28/05/20: Alternative accommodation capacity for pathway 3 patients is as follows:

• 133 Discharge 2 Assess/Interim beds (this includes the 43 BCC beds)

• Of which 35 are vacant as at 27/05/20 (includes 14 vacant BCC beds)

• 26 vacant Intermediate Care Beds (includes SCFT community hospital vacancies in Crowborough, Uckfield and Lewes Victoria Hospital)

1.4.2 Confirm discharge pathway arrangements and capacity for the following cohorts of patients:

• COVID positive

• COVID pending test result

• COVID negative

JC-B,MS,NC

ESCC, ESHT, East Sussex

CCG C19 OPEX and

project resource

Complete Update 28/0420: Options explored with final

agreement to discharge the sufficiently medically fit

patients that meet Bexhill Care Centre (BCC)

restricted admissions criteria to BCC (i.e. a clear

COVID-19 negative test prior to admission, and

patients who have tested positive over the 7day

period and who are asymptomatic).

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Including asymptomatic patients who have tested negative for the virus, to meet the recommendation that they should be isolated for 14 days following admission to a care home. NB this also applies to step up patients.

Update 29/04/20: System agreement reached that the COVID pathway for MFFD patients confirmed as Option A with immediate effect:

• positive patients, confirmed 7 days or more to BCC

• positive patients, less than 7 days to BIU

1.5 Building scientific understanding and sharing good practice across the sector (national lead)

1.5.1 Promote scientific understanding, good practice and practical tools for care homes as they come on line through the national SCIE good practice hub

SW, TH, MC ASC&H, PH, CCG

Tbc Tbc Continue to utilise the Independent Care Sector Provider Bulletin and regular webinar forums to share and promote good practice and practical tools as these are published.

2. Stepping up clinical support

2.1 Introduce a Sussex-wide Locally Commissioned Service (LCS) COVID-19: Temporary specification for Care Home Support for immediate implementation across the whole of Sussex, covering:

• A named contact point for care homes

• Weekly check-in (remote)

• Process for personalised and support plans

SS, SH Sussex CCGs, PCNs, General

Practice

01/05/20 28/05/20 Update 19/05/20: Across Sussex these requirements have been delivered in full or in part, where there are gaps in service the CCGs have developed a COVID-19 specification for Care Home Support in the form of a Locally Commissioned Service, for implementation with immediate effect. The LCS requires practices to undertake a weekly check in to all Care Homes and to develop a process for personalised care and support planning. The New LCS affords the opportunity to ensure we have a consistent offer across all homes and removes the current variation to the service offer/package of

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• Data submissions (to feed into weekly CCG returns to NHSE)

the pre-existing LCSs, particularly with respect to having a weekly check in and a process for care and support plans. The existing Medicines Optimisation teams in each CCG have been refocused to fulfil the clinical pharmacy support requirements, with the additional CCG pharmacists and pharmacy technicians being aligned to practices to support Medicines Optimisation in all care homes. NHSE also requested a named Clinical Lead is identified to provide clinical leadership support for each care home. This has been accomplished and all Care Homes have a named Clinical Lead to be their single point of contact in exceptional circumstances / crisis. In addition to this, Sussex CCGs have introduced two Locally Commissioned Services for General Practice to sign up to further support care homes, these are:

1. Temporary GP Remote Out of Hours Cover for patients in Care Homes, to:

• Provide enhanced clinical support to care homes outside normal GMS hours.

• Reduce the risk of inappropriate conveyance to hospital.

• Improve timely access for care homes to

o Clinical decision making.

o Prescribing.

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o implementation of end of life / palliative care

• Reduce the burden on other out-of-hours services for this population (111 / 999)

2. Temporary Placements (Discharge to assess) in Care Homes and other Community based beds (Sussex) to:

• Provide the medical care of patients placed temporarily in purchased beds in the community (usually in care homes) after discharge from hospital, under the following arrangements

Joint work is also taking place now with community service providers and PCNs to jointly plan for and deliver the full proactive multidisciplinary PCN Enhanced Health to Care Homes requirements which need to be in place by October 2020.

2.2 Primary and community support in place by 18th May, providing:

• Timely access to clinical advice for care home staff and residents, including a named clinical lead for every care home and weekly check-ins

• Proactive support for residents, including personalised care and support planning as appropriate

• Provision of pharmacy and medication support to care homes

SS, NC, JC-B, KP

East Sussex CCG, ESHT, SCFT, PCNs,

General Practice

01/05/20 18/05/20 The East Sussex population is served by 2 community health providers who offer a core service to care homes. In addition to the action at 2.1 above the following arrangements have been put in place by community health services to ensure enhanced support to care homes: There is a consistency of offer across East Sussex as a whole that includes: a 7 day per week contact point with a named nurse for each care home; training development and support; infection prevention and control advice and training, and discharge planning and support. There is a range of wider support that has small differences dependent on provider and includes:

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• Support for care home residents with suspected of confirmed COVID-19 through remote monitoring (and face-to-face assessment where clinically appropriate) by a multidisciplinary team where practically possible (including those for whom monitoring is needed following discharge from either acute or step down bed)

• Sensitive and collaborative decisions around hospital admissions for care home residents if they are likely to benefit

• Discharge planning support to facilitate

discharges with assessment and care planning

in the home on discharge if required

• Weekly contact with each care home to

proactively support staff

• Train the Trainers – providing a named contact

for every care home trainer for infection

prevention and control training and support

• Training pack with guides and links to on-line

training

• Telephone and email access to a dedicated

team

• Support for care home residents who have

recently left hospital

• Virtual attendance at ‘Care Home Huddles’, to

support staff and the management of residents

with proactive, health promotion, admission

avoidance advice to support keeping residents

healthy and out of hospital.

• Testing for care home staff at the local, ESHT-

run testing hub

• Training and development support with

particular focus on infection control, PPE, hand

hygiene, holistic assessment of needs, the

deteriorating patient, syringe drivers, end of life

care, wound and pressure care, falls

prevention, catheter care and continence care

Medicines Optimisation in Care Homes (MOCH): GP practices now have a named pharmacist/pharmacy technician to support their MDT service to care homes. The MOCH support includes resolving medication queries, facilitating medicines

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supply, Structured Medication Reviews and supporting transfer of care. Virtual attendance at ‘Care Home Huddles’, to support staff and the management of residents with proactive, health promotion, admission avoidance advice to support keeping residents healthy and out of hospital.

Care homes can contact the MOCH service through the following emails address: HWLH: [email protected] EHS/HR: [email protected] Enhanced Health in Care Homes (EHCH) DES Specification – work is underway to respond to the immediate NHSE letter requirements (weekly check in by MDT with care homes; reviewing patients identified as a clinical priority for assessment; development and delivery of personalised care plans) and the fuller EHCH DES specification milestones by October. A plan to agree the proposed model will be signed off by July 2020 at an ICP level, and this links into the system work being facilitated by the CCGs on a Sussex wide approach.

2.3 Ensure mental health support is available for care homes

SB, JC Community based mental

health and ASC teams

Support is ongoing Update 27/05/20: In East Sussex Mental Health services provided by Sussex Partnership NHS Foundation Trust (SPFT) work very closely with Adult Social Care services and other health and care partners in support of care homes. Secondary care mental health assessment and treatment services are provided to care homes through community based mental health teams. These services are structured to support adult

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and older adult populations. SPFT also provide assertive outreach services in care homes and provide extended hours older people services. To further support the immediate COVID response SPFT are partners in the care homes Incident Management Team and are working to provide clinical support to help with testing, particular in those care settings for people with dementia and learning disabilities.

2.4 Ensure Care homes have access to urgent and emergency advice and guidance from ambulance services

SECAmb SECAmb Ongoing Update 28/05/20:

• SECAmb has worked across the system to provide urgent and emergency advice and guidance specifically regarding Falls in Care Homes, ie a resident who has fallen, with or without injury, and requires assistance. This provides additional guidance on what to do in an urgent or emergency situation, with additional guidance tailored to the place based area and access to Responsive Community services

• Working alongside additionally provided acute support services, SECAmb will access fuller clinical guidance where required to avoid acute conveyance. This support sits alongside the Trusts developing Urgent Care Hubs, where advanced clinical guidance is provided to crews on scene via local call backs to treat as many patients in the community as is safe to do so and / or provide referrals into community pathways especially for Frailty. This will include consideration of any relevant advanced care plans and guidance within when available to view via IBIS.

• SECAmb is working jointly with ESHT to provide swabbing of patients in the community and in care homes, once referred via GP / 111 or 999. Currently SECAmb are operating 2 vehicles daily,

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1 from Polegate and 1 from Hastings, to meet local demand for this support across East Sussex. Additionally, 1 SWambulance per day is allocated to provide priority support to PHE for suspected outbreak swabbing in care homes, with the other vehicles in support as needed. Care Home testing referrals are authorised by the CCG / local HPT, and CCG’s and Public Health are identifying the priority list of homes for swabbing.

2.5 Introduce the use of key medical equipment such as pulse oximeters to enable remote monitoring of COVID positive residents.

AL, East Sussex CCG

Ongoing Update 21/05/20: There are 315 oximeters and 123 non-contact thermometers available for East Sussex care homes. These will be offered in the first instance to care homes without the equipment via the ASC&H Provider Bulletin. The number of devices and approach will then be reviewed.

2.6 Support the local work by Community health improvement teams working with NHSX to roll out video consultations within care homes

MW Sussex CCGs, Digital

workstream, Sussex Care

Homes Programme

Ongoing Update 28/05/20: A digital work stream has been established as part of the multi-agency Sussex-wide Care Homes Programme. Work is underway to define the work stream, benefits, timescales Work already in delivery is: NHS mail has been rolled out to 258 of the 306 care homes in East Sussex. This will provide the building block for the roll of virtual consultations. A project manager has been identified to lead the next phase of this project. The variability in connectivity will influence the next stage of the roll out. A Remote Monitoring pilot for nursing homes has been concluded in Sussex Work is underway to scale up to cover all nursing home as part of the Sussex-wide Care Home Programme

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2.7 Coordinate local activity to ask returning Nurses and OTs to work in social care

Sussex Health and

Care Partnership

ICS AB, JH, NC

NC and place leads

15/05/20 Ongoing Update 15/05/20: A central hub has been created for Sussex Health and Care Partnership initially to help match returners which the Trust they were originally allocated to. The hub also has information about staff that may be available to work in social care, including:

• Allied Health Professionals - Occupational Therapists, Physiotherapists, Osteopaths, Podiatrists

• Doctors – Obstetrics and gynaecology, Paediatrics, Radiography

• Nurses – Occupational Health, midwifery, hospice/palliative care

A process is being explored to assess the need in each area and liaise with the returners hub as to how local opportunities can be identified for returners to work in social care in each place. Additionally, there is a second wave of returners, which is due to include health care support workers that could be deployed to social care. The number of HCSW is small at present – c.14 in South East – but this many grow. A process is also being explored to enable these returners to be directed to the Sussex system to work directly in social care.

3. Comprehensive Testing: There are a number of different ways that care homes can have access to COVID-19 testing. The following describes the current

national and local options, although the national testing landscape is evolving rapidly and is subject to revisions. There are a set of tools set out in Appendix 2, and 3 designed to support navigation

3.1 Put in place arrangements for testing hospital patients 48 hours prior to discharge so that testing does not delay discharge.

JC-B ESHT In place and ongoing

Update 29/04/20: Patient testing is in place for all patients being discharged into vulnerable settings;

• Nursing and residential homes, Milton Grange, community wards, Rye Memorial Hospital – yes

• Bexhill Irvine Unit – needs to know patient status

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• HWLH community beds – need a status update, have not requested swab on discharge yet

• Other vulnerable settings – yes

3.2 Initial outbreak: Ensure there are clear options and processes in place

Public Health

England

SECAmb Ongoing Update 22/05/20: If a care home has a suspected outbreak of COVID-19 they must notify Public Health England who will risk assess, provide advice, and issue guidance for them to follow. At this point the home will be eligible for testing for initial symptomatic patients which is arranged by the local ambulance service (SECAmb) – see section 2.4 above

3.3 Whole home testing: Encourage care homes to register on the national portal to access testing for care home residents and asymptomatic care home staff

DPH, DASC&H

Provider communications

Ongoing Update 22/05/20: As part of the national testing system, care home testing is available for all care home residents and asymptomatic care home staff. Care homes need to register on the portal (https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested#care-home) to access this testing. Of those who register, the issuing of tests will be prioritised in the following order:

1) Care homes that have notified PHE that they have a suspected outbreak. The national team will be automatically made aware by Public Health England of those care homes with a known outbreak

2) Care homes that have more than 50 beds 3) Care homes identified by the Director of Public

Health (DPH) as being a priority (see 3.4 below) 4) All other care homes

The testing arrangements have been communicated through the regular bulletins; webinar briefings; live webinars; are via the local website

3.4 Local prioritisation of tests: Contribute to the prioritisation of tests and support the local coordination of testing so that

DPH ASC&H, East Sussex CCG,

PHE, Care Homes

Ongoing Update 22/05/20: DPH priority list The DPH is required to submit a list of priority care homes which, as described above, is part of the overall prioritising of care home staff and residents. To

https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested#care-home

https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested#care-home

21


the sequence of testing meets local needs. “Care homes to be referred referred by LAs based on size (over 50 beds) and local knowledge. LAs to refer care homes in priority order so that deliveries can be scheduled accordingly”

inform local prioritising the following system has been developed:

1) A daily report is produced by the East Sussex PPE cell to flag up any care homes where testing may need to be prioritised

2) A separate return is provided by the following parts of the system who are able to identify priority homes:

a. Market Support b. CCG infection prevention team c. Public Health England d. Care homes self-identifying as being a priority

3.5 Testing for symptomatic care home staff

Sussex CCGs, ICS

Testing Group

Ongoing Update 22/05/20: Symptomatic care home staff can access testing through the Central Booking Team ([email protected]). Testing is also available through both the essential worker self-referral portal, https://www.gov.uk/apply-coronavirus-test-essential-workers), and the employer referral portal (https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested#employer-referral).

3.6 Ensure local booking system and capacity is in place for urgent testing

Sussex CCGs, ICS

Testing Group

Ongoing Update 22/05/20: Local booking system A small quota of daily testing is available through the Sussex Central Booking Team ([email protected]). This can be used in exceptional situations where urgent testing is needed and will access testing through SECAmb

4. Building the workforce

4.1 Ensure local approach is in place to complement the following national measures designed to build the care workforce:

• New national recruitment campaign to attract 20,000

TH ASC&H, Planning,

Performance and

Engagement

Ongoing Ongoing Update 19/05/20:

• The ESCC local recruitment campaign is integrated with the national campaign.

• The Independent Care Sector (ICS) have their own free recruitment pages on the ESCC job website for them to post vacancies automatically via the DWP Find a Job and national campaign website

https://www.gov.uk/apply-coronavirus-test-essential-workers


https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested#employer-referral

https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested#employer-referral


22


people into social care in three months

• Campaigning materials for use locally

• Fastrack measures for DBS checks

• Funding for free rapid online training for new recruits, staff and volunteers

• New Care workforce app to access relevant updates, guidance, support and discounts

(27 provider vacancies across East Sussex currently listed).

• The daily Provider information bulletins have included a Top Recruitment Tips bulletin, with fast track measures for DBS, Values Based Recruitment guidance, telephone references form and free ESCC online local training/ induction for new recruits, staff and volunteers provided by the ASC&H training team.

• A local staff register and job matching service for temporary staff for the ICS provided by ASC&H is about to be launched and advertised

• Training for all care providers continues to be free to access through the ASC training portal. This includes Care Certificate, refresher and specialist courses. Additionally, we are rolling out Leadership and management courses based upon CQC Well-led domain.

4.2 Recruitment linking service for

the Independent Care Sector

(ICS) - supporting recruitment

to temporary paid roles

Purpose:

• To enable members of the

public (non ESCC

employed) to register an

interest in paid temporary

roles with the Independent

Care Sector (ICS).

• To communicate available

paid temporary ICS roles to a database of interested

candidates.

SW ASC&H Strategy,


Management

01/05/20 15/06/20 Update 28/05/20: Adult Social Care has been working with Domiciliary Care and Care Home providers to develop a recruitment linking service which will be hosted by ESCC and go live early June 2020.

Benefits include:

• Provides a streamlined recruitment process

support offer to the independent care sector to

enable the sector to recruit to bank staff roles or

temporary paid roles at quicker pace in response

to meeting staff shortages

▪ Offers an additional recruitment support function

that could potentially be continued post pandemic

crisis period

▪ Creates a central resource of expressions of

interest in social care roles (distribution list)

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• The linking service (hosted

by ESCC on the

consultation hub) enables

people who have

registered an expression

of interest to receive job

adverts for them to then

contact the provider

directly.

• The linking service will

offer providers an

accessible route to people

interested in working in

social care and support a

quicker recruitment

process

4.3 Produce an evaluation report of the Well Led Project which provides support to Registered Managers, including monthly webinars, website collating info, and pastoral support and contact for Registered Managers from the Well Led project manager Use the learning to inform next steps, taking into account the context of the COVID pandemic and the need for ongoing support for managers

AB Sussex Health and Care

Partnership, Health

Education England (HEE),

University of Chicester

In place 15/06/20 Update 28/05/20: The Well Led Project ended at the end of March and the evaluation report is being produced by the University of Chichester. It was agreed with HEE (who provide workforce development funding to SH&CP) just before the end of March to extend the project for three months until the end of June

24


5. Communications and Engagement

5.1 Maintain the regular production of the Provider Bulletin, and hold web based provider forums to ensure care homes and other care providers are fully briefed about the wider system support available to them during the COVID-19 emergency, and get feedback on the issues.

SW Strategy, Commissioning

and Supply Management

Ongoing Ongoing Update 22/05/20: review regularity of the provider bulletin with care homes to ensure maximum use

5.2 Promote registration and daily updating of the Care Home Capacity Tracker by care homes in East Sussex through existing communications mechanisms

SW Strategy, Commissioning

and Supply Management

Ongoing Ongoing Update 26/05/20: messages have gone out encouraging this, and the Council Care Home Capacity Tracker Champion has made contact with the approximately 10 remaining individual homes to discuss and understand the issues, and encourage registration.

5.3 Understand the impact of the COVID-19 response on patients, clients and families of those in care homes

• Analyse initial feedback from recent engagement against the national COVID 19: Care Home Support Package and use the feedback themes to identify gaps and potential new actions in the Care Homes Resilience Plan

JR, EM, VS Healthwatch East Sussex,

ESCC ASC&H, East Sussex

CCG

19/05/20

29/05/20

Update 26/05/20: analysis has been undertaken of recent engagement and contact from homes and members of the public, against the key areas in the national COVID-19: Care Home Support Package and themes have been collated. This has helped further shape and inform the Care Homes Resilience Plan.

25


DRAFT 2.0_28/05/20: OWNER [email protected]

5.4 Explore ways to further understand the impacts of COVID-19 in East Sussex communities, including for residents of care homes and their families and friends, and use this to inform recovery planning.

JR, EM Healthwatch East Sussex,

ASC&H Community Relations

Team, East Sussex

CCGs Engagement

Team

tbc tbc We are planning to gather some patient and client experience insights from our local communities experience during our COVID response to inform future commissioning. This will explore incorporating feedback from residents of care homes, understanding the impact of COVID measures and how this can be alleviated on residents in care homes

Appendix 1

Outbreak management

Public Health England are the lead agency for outbreak management. If a care home has a suspects a COVID-19 outbreak then they are required to

notify Public Health England (PHE). PHE will risk assess the situation and provide comprehensive advice across all aspects of infection control, PPE

requirements and access, isolation and cleaning, and all the latest guidance on outbreak management. They will also arrange testing of symptomatic

residents and advise about how staff and non symptomatic residents can be tested. After giving all the required advice the care home will be advised to

contact PHE if they have any further concerns. All homes are then contacted 48 hours later by the CCG’s Infection Control Team.

If there is a level of complexity with the care home then PHE will form an Outbreak Control Team meeting which will include Local Authority

representation.

If a care subsequently home re-contacts PHE with further concerns then this will trigger follow up involvement with the CCG’s Infection Control Team and

if necessary further follow up by the local Public Health team within the Local Authority.

A follow up email is sent to all care homes where a suspected outbreak has been notified to PHE, once they have conducted the initial risk assessment

and provided verbal guidance:

OFFICIAL_ Standard

care homes email.msg

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Appendix 2 Covid-19 Testing Routes Prepared by Emma King, East Sussex County Council (v5, 19/05/20)

Main Testing Routes

Access route Who can be tested within the care home? Methods available

Sussex Central Booking Team [email protected]

Symptomatic and asymptomatic staff Symptomatic household contacts of staff

National testing sites (Gatwick, AMEX) Local testing sites (Bognor, Bexhill) SECAmb (for those unable to drive to testing sites)

National Testing website- Self-Referral Portal https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested

All symptomatic staff (self-referral portal) https://www.gov.uk/apply-coronavirus-test-essential-workers

National testing sites (Gatwick, AMEX) Home testing kits (short supply) Military mobile testing units

National Testing website- Employer Portal https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested

Asymptomatic staff who have a symptomatic household member

National testing sites (Gatwick, AMEX) Home testing kits (short supply)

Public Health England [email protected] 0344 225 3861

Initial symptomatic residents/patients when outbreak first reported

SECAmb

Care Home Portal https://www.gov.uk/apply-coronavirus-test-care-home

Residents (with symptoms and without) and staff without symptoms in care homes who look after older people or people with dementia and are CQC registered. LA are able to prioritise care homes on a weekly basis.

Home testing kits

All patients in ‘discharge to assess’ beds being discharged to a care home

Case by case basis. Through Sussex Central Booking Team.

SECAmb

All patients from community to care home

Case by case basis. Through Sussex Central Booking Team.

SECAmb


https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested







https://www.gov.uk/apply-coronavirus-test-care-home

https://www.gov.uk/apply-coronavirus-test-care-home

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Appendix 3 National and local testing locations

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