Kingston’s Health & Care Response to Covid-19

Joint SeminarHealth Overview Panel and Health & Wellbeing Board

July 21st 202018.30 - 20.30

Kingston’s Health & Care Response to Covid-19 - Joint Seminar

Introduction

Health Overview Panel Chair: Cllr Anita Schaper

Health & Wellbeing Board Co-chair: Dr Naz Jivani

Covid-19 Timeline to date - Iona Lidington, Director of Public HealthDec 2019 - first cases of ‘COVID-19’ (coronavirus) were reported to WHO by China Jan 2020 - National UK public health advice on prevention precautions; contact tracing (contacting contacts of cases) started 31st Jan 2020 - first cases officially recorded in the UK February 2020 - UK focussed on public advice related to handwashing, & intensive focus on any suspected or confirmed new cases. In addition, some ‘self-isolation’ measures for incoming travellers were put in place. 11 March - CHancellor announces initial £12bn package of support for the NHS, wider public services, businesses and others to help tackle COVID-1912th March 2020 - WHO declared a pandemic situation. Evidence from China indicated likely impact of the virus. Move from ‘contain’ to ‘delay’ 19th March - Emergency legislation introduced – The Coronavirus Act 2020 – became law on 25 March20th March - schools closed, except to children of key workers and vulnerable children; bars, restaurants and other premises told to shut22nd March - 1.5M people most-vulnerable to COvid-19 recommended to ‘shield’ for at least 12 weeks23rd March - ‘Lockdown’ - people asked to stay at home except in certain key/ urgent circumstances. 10th May - PM announces new plan to ‘beat the virus and reopen society: ‘COVID-19 Recovery Strategy’28th May - new national NHS Test-&-Trace system launched; local Infection Control FUnd and Adult Social Care COVID-19 plan

30th June - local Outbreak Control Plans published

Epidemiology: Kingston (20/07/2020)

Area Number of lab confirmed cases

Rate per 100,000 pop

England 253,585 453.0

London 34,557 387.9

Kingston 744 424.0

Source: https://lginform.local.gov.uk/reports/view/lga-research/covid-19-and-care-homes?mod-area=E09000021&mod-group=AllBoroughInRegion_London&mod-type=namedComparisonGroup

Source: https://coronavirus.data.gov.uk/#category=ltlas&map=rate&area=e09000021

Children’s Services - response Ian Dodds, Director Children’s Services

Social Care Education SEND

Risk-rated all children to inform safeguarding response.

Implemented new operational guidance for child assessment, child protection conferences, statutory visits and care plans, with a focus on virtual contact.

Provided additional support for children in care/care leavers; suspended supervised contact and introduced virtual contact.

Recruitment of contingency foster carers from workforce.

Supported partial closure of early years’ settings, schools and colleges except for critical workers’ children and children who are more vulnerable.

Supported schools to establish virtual classrooms and remote learning.

Maintaining critical education support services, eg. school admissions.

Moving universal services to online delivery, eg. children’s centres and youth services.

Risk assessment of all children with an EHCP; deliver revised requirement for ‘reasonable endeavours’ for children with SEND.

Implementing online therapies and clinics and maintaining community paediatric nursing services.

Managing reduced availability for commissioned short-break care and providing alternatives, eg. direct payments.

Continuing EHC assessments, plans and reviews.

Children’s Services - recovery

Social Care Education SEND

Return to face-to-face contact for assessments, statutory visits and care plans - August.

Maintaining digital services and virtual contact where successful, including hybrid models eg. child protection conferences.

Restarting suspended services, eg. supervised contact - July.

Planning for predicted spike in referrals for safeguarding and emotional wellbeing and mental health services - expected from October.

Supported wider school opening and return to school for prioritised year groups - June.

Supporting full school opening from September, including plans for catch-up learning and potential local lockdown.

Supporting schools with return of pupils who may be emotionally resistant or ‘happy at home’ and for emotional wellbeing of all pupils.

Coordination of holiday activity and support programmes, including food support and holiday hunger.

Revising needs assessments for children with EHCPs to reflect return to ‘best endeavours’.

Return to face-to-face therapies and clinics - August.

Planning for increase in requests for EHC needs assessments - September.

Delivery of short-break care for summer holidays and expansion of overnight care; continue work to open new short-break care centre at Moor Lane, Chessington.

COVID-19 ASC Commissioning Care Market Resilience Plan - Helen Coombes ASC Strategic Commissioning

Pillar 1 - Infection control

Pillar 2 - Workforce

Care market PPE

Care market Outbreak mngmt plans

Care market Test,Track and Trace

Commissioning Hosp discharge - care homes

Staffing/ recruitment

Security & wellbeing Appreciation

Pillar 3 - Supporting Independence/end of life care/responding to individual need

Integrated Health & care

SOP & business processes

Advance care planning

LD & MH/BAMEinequalities commissioning

Quality & monitoring

Pillar 4 - Supporting LA’s & Care Providers

Funding Digital/ Provider forums

Care home dashboard Integration

Digital, Data & Insights, Comms & Engagement

Market Insights

Market Development

Carers

Care Market risk & resilience (recovery)

Surge plans

Discharge Planning & Community Care - Jane Bearman, Interim Director Adult Social Care, RBK; Grant Henderson, Your Healthcare

Community and system partners moved swiftly to prioritise roles and increase capacity to support discharge

Daily interaction with the Joint Assessment and Discharge Team and extended to include primary care colleagues, PCN Directors

Rapid implementation of Discharge to Assess guidance and introduction of Community SOP including extension to business hours 8-8pm 7 days per week

With partners, increased access and availability of equipment,same day delivery options across the week and provision of a handyman service e.g Staywell

Increase in capacity and availability of community beds (extra 19) to promote flow

Discharge Planning & Community CareWorked collaboratively with the Response Coordination Centre to support the health needs of residents who could not leave their homes, including vulnerable groups and those self isolating

With partners, YH maintained a frontline visiting for all those where this continued to be a requirement e.g community nursing, Urgent care response teams, specialist dementia nurse and community outreach.

Additional capacity within our Care Home Support Team to provide support with urgent visits, education and training with PPE , Infection control and testing

With partners provided increased support to those unable to access their usual arrangements like Day care and other support services.

Discharge Planning & Community CareProvision of a Wellbeing service for those with complex needs especially mental well being

Delivery of Wellbeing packs, personalised gift boxes

Introduction and provision of virtual/ facetime type contacts for those not able to receive visitors particularly within our inpatient setting including EoL

Introduction of large scale testing prior to an individual's receipt or onward transfer into another care setting

Widespread testing amongst frontline teams with repeat testing regime every 14 days

Issued Guidance: highlights“Discharge requires teamwork across many people and organisations and the funding and eligibility blockages that currently exist cannot remain in place during the COVID19 emergency period. Therefore, a discharge to assess model will be introduced across England”.

The discharge to assess model is based on using four clear pathways for discharging patients:

Pathway 0: 50% of people, simple discharge - no input from health and social care

Pathway 1: 45% of people, support to recover at home

Pathway 2: 4% of people, rehab in a bedded setting

Pathway 3: 1% of people, life changing event and home is not an option at point of discharge.

*Timescale set for a discharge within 1-3 hours from point of referral to SPA

The Standard Operating Procedure (SOP)

Single point of Access (SPA) operating by YHC

System operation 7 days a week 8am-8pm

Daily calls to discuss patients clinically optimised

Pathway 0 managed by Kingston Hospital

Pathways 1-2 managed by Your Healthcare and Hilton

Pathway 3 managed by Continuing Health Care Team

Includes Homelessness discharge pathway

Joint collaboration between RBK, Your Healthcare, LBR, Kingston Hospital and HRCH

● Regular collaboration workshops with partners to strengthen partnership working.

● Agreed all system Discharge to Assess (D2A) process including referral form.● Streamlined Covid-19 and reablement offer to ensure all who needs this

service receives it.● Integrated RBK OT and YHC OT case allocation discussions.● Decreased and maintained super stranded patients number significantly,

those remaining in this cohort are those that are critically ill.● Introduction of triage/testing prior to any admission,outpatient attendance,

discharge or onward transfer plus regular testing of frontline staff● Continued use of digital technology to support virtual consultation/ contact ● Increased support, training and education continuing into nursing, care and

LD homes

Activity and successes following Covid-19 peak

Demand and Challenges ahead

● People coming out of covid 19 have been extremely unwell, therefore discharges home is lower than thought due to the acuity of patients and are requiring step down/community bed rest.

● Strategic workforce planning to meets demands of surge for non covid patients when confidence in system is restored.

● Performance measure setting. Renewal of monitoring systems such as DTOC, ensuring accurate kingston status. Meeting the new timescales set out in the guidance as opposed to previous assessment and discharge notifications timescales. Monitoring of stranded and super stranded.

● Restore JAD team and hospital presence● Maintaining levels of support for Care Homes and increased demand on

community services

● Most people that are unable to leave their home because of COVID-19 can manage this themselves and with the support of family, friends and trusted neighbours.

● For those who need additional support the Kingston Stronger Together Support Hub offers:○ Information on COVID-19 and staying healthy○ Help to get essential supplies delivered○ Emotional and social support○ Referral onto existing health and care services

● To access the Hub services people can complete the form at https://www.kingston.gov.uk/COVID-19_NeedHelp. ○ You can complete the form for yourself or someone you are caring for. ○ If you do not have online access you can phone 020 8547 5000.○ Most requests for help are managed from Monday to Friday, but we do respond to

urgent requests over the weekend when necessary.

Dr Andrew Cross Corporate Head of Service / Public Health Consultant

Hub activity

● Activity○ Number on shielding lists (excluding those identified deceased) - 5935○ Number requiring support from the hub - 540 (10% of those on list)○ Total number of Hub support requests including non-shielders - 2762○ Total number of proactive phone calls made to those shielding -15,000 (2000 for

people discharged from hospital) ○ Food parcels delivered - 1,222 by the KST hub. (+8,293 Govt parcels to

shielders)○ Frozen meals delivered - 18,000+○ Shopping service cases - 120○ Prescriptions delivered - 540○ Buddies allocated - 194○ Mental Health Support Cases - 21○ Referrals to Tier 4 health and care services - 79○ Number of resident volunteers deployed to meet needs - 174

Hub activity● Number of hub support requests appear to map closely to deprivation

Hub support request density Index of Multiple

Deprivation Decile

Hub next steps

● Proactive calls stopping at the end of July*

● Reactive support will continue - reviewing support offer so as not to promote dependency

● FutureGov leading an external review as part of a series of work to develop a sustainable model that continues to meet evolving support needs and feed into longer term transformation

Voluntary and Community Sector Response

Sanja Djeric Kane, CEO Kingston Voluntary Action

Supporting RBK with a telephone buddy scheme

supporting residents through loneliness and anxiety

Supporting RBK with the development of Connected

Kingston covid-related content

Covid specific VCSE workshops• Test and Trace• Preparing for the ‘new normal

at work• 5 thematic funding

partnership networks attended by 40 people

• Submission of food related funding bid for £100,000

Since March 2020• 5 VCSE CEO Network meetings• 2 e-bulletins per week• 5 surveys exploring the state of

the sector and local need

Raising funds from London Community Response Fund

to support local VCSE through crisis

Love Kingston Covid-19 Emergency Fund raising

£20,000

Exploring with RBK safe shared spaces for live

interviews for Information and Advice VCSE

organisations

Superhighways supporting VCSE organisations work remotely and take services online:• setting up laptops• sourcing tablets• weekly Teams training• new Digital Champions

sessions

Good news storieshttps://kva.org.uk/kingston-s-vcs/stories/

Staywell• 3,679 referrals received• 8,377 calls with 2,896 unique clients• 798 individual shopping trips made• 58 hospital discharges supported

Kingston Churches Action on Homelessness• 120 homeless placed into accommodation to

help them self-isolate• 24 people helped to ‘move-on’ to better

accommodation• 87 volunteers donated 881 hours delivering

meals and helping clean buildings

Refugee Action Kingston• 576 people supported with English classes,

counselling & immigration advice• £18,000 raised through LCRF

Further examples of Kingston’s VCSE supportKingston Carers Network• 4,000 + carers supported • 1 carer only referred to the hub

Yorda Adventures• 3 new services set up as a result of covid• 65 families with parents who are key workers

accessed term-time day care• 11 Saturday programme sessions for families

facing crisis• 103 family exercise sessions for children with

disabilities who were self-isolating

HealthWatch Kingston• Published the ‘Experiences of NHS and social

care services in Kingston before and during the Coronavirus pandemic’ report

Volunteering Kingston contribution

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We believe in an inclusive and innovative approach to care. www.swlondon.nhs.uk

Primary Care Response - Dr Annette Pautz, GPPhase 1 Response ● Designed and implemented hot hub model across Kingston

○ Repurposed extended access service capacity to deliver standalone pathway for COVID-19 suspected / positive patients

● Implemented integrated hot and cold service home visiting services ○ Deployed a paramedic home visiting service for suspected / positive patients

● Management of COVID-19 in General Practice• All practices have successfully put in place full triage model • All practices providing remote consultations via video and telephone are being provided possible and

appropriate • Majority of practices operating zoning in practices for patients that require face to face consultations

Phase 2 Response ● Stood down hot hub and paramedic services and developing outbreak preparedness model

○ Scaling up normal extended access provision to historic contracted levels○ Develop a plan to reinstated similar hot hubs pathway in response to a future surge

● Implementation of General Practice Standard Operational Procedure and Infection Control and Prevention Guidances ○ All practices working to implement requirements to manage patient flows, and infection control risk○ All practices operating digital by default service, where appropriate / technically possible / user dependant

● Reinstated locally commissioned enhances services

○ Services are being reinstated where clinically and operationally possible

We believe in an inclusive and innovative approach to care. www.swlondon.nhs.uk

Primary Care Recovery • Providing effective care to COVID patients in a safe environment, whilst minimising the risk of

infection to all staff and patients; Protecting the capacity of ITU will require a continued (e.g. 12m) operating model within general practice that focuses on COVID positive/suspected patients, whilst minimising risk to the vulnerable.

• Supporting a resilient general practice; General practice will remain at the heart of the NHS, and we need to take pro-active steps to both support resilience whilst at the same time taking opportunities to transform how great care is delivered

• Designing and implementing new ways of working (including good practice and clinical effectiveness); Many new ways of working have been implemented recently that practices report they want to keep, e.g. video conferencing, and therefore we need to support this to both happen and to encourage people to get the most benefits.

• Embedding new ways of working; Several new innovations have been adopted recently, which by definition, may not have given people the time to properly understand how the new ways of working should be delivered. Providing educational tools and toolkits will be important to ensure good practice is articulated.

• Supporting the BAU of general practice; Ensuring practices receive support to deliver contractual requirements.

Acute Care - Sally Brittain, Director of Nursing & Quality, Kingston NHS Foundation Trust

The Intensive Care Team: Planning for a pandemic

We believe in an inclusive and innovative approach to care. www.swlondon.nhs.uk

Our Mental Health Covid response to date - Vanessa Ford, CEO SWL St George’s Mental Health Trust

● Mental health providers have complied with all guidance working with primary and secondary care ● Services continue to be delivered using new modalities where appropriate.

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Keep Kingston Safe, Outbreak Control Plan: Iona Lidington● supporting the national search for existing

cases - we need to ask ALL of our residents with symptoms to get tested - and make it easy for them to know how and where they can get tested

● Supporting cases and contacts that need to self isolate - we must help our residents doing their civic duty by making sure that they are not penalised when they self-isolate

● Preparing ‘outbreak management plans’ - to develop and have agreed plans in place with partners

● Supporting the implementation of outbreak management plans if outbreaks (local cases in situations such as schools or care homes, particular locations or similar) occur - having an agreed way to quickly commit people/ resource/ other to help shut down any local outbreaks

Thank you for listening

Any further questions?