[David Watts, Director of Adult Services, to present report]
Cllr Evans invited David Watts, Director of Adult Services and Becky Wilkinson, Head of Service Adult Improvement to present their report on response of Adult Services to the Covid-19 crisis and future plans.
The Director of Adult Services outlined the context for the presentation about explained how the service has worked closely with care providers throughout the City to manage the response to the Covid 19 pandemic. In addition, the service has also worked closely with colleagues in Public Health in developing an approach to protecting people, particularly those living in care settings.
The Director of Adult Services detailed the range of specific work done to support care providers, for example, regular communication, the provision of sufficient stocks of protective equipment and the safe arrangements for the discharge of people from hospital to care homes.
The Director of Adult Services advised the panel that he also has responsibility for arranging Public Health funerals and the provision of infection prevention personal protective equipment to care homes.
The Director of Adult Services commented on the challenges that the service faced in providing sufficient supplies of protective equipment stocks towards the end of February and during March 2020 at the peak of the pandemic.
The service was able to build on the previous good working relationships with the Royal Wolverhampton Hospital trust (RWHT) in managing the discharge of people with social care needs back into the community with the added challenge of responding to the frequency of new national guidance being issued to the sector.
The panel were reassured that the correct systems were in place to safely discharge people from hospital either into their own home or into a non-acute care setting. The service has been working extremely closely with the infection prevention team and the rapid intervention treatment service managed by RWHT. This work has helped to put the service in a good position during a period when the number of Covid 19 cases was becoming more prevalent both within the care home setting and the wider community. The Director of Adult Services advised the panel of the detailed planning work ongoing with key partners in care and health sectors to respond the ongoing challenges presented by the pandemic.
The Director of Adult Services invited Becky Wilkinson, Head of Service Adult Improvement, to outline the specific work on infection prevention control done to support residential care homes during the pandemic.
The Head of Service Adult Improvement advised the panel about plans for supporting residential care was developed rapidly in response to the outbreak of Covid 19, for example the bulk purchasing of protective equipment and the offer of infection prevention training to care staff. This work was supported by daily meetings with care providers at the start of the outbreak which provided an opportunity to discuss any specific concerns.
A clinical lead has been appointed within each care home with the aim of trying to prevent a care resident from needing a hospital visit by looking at safe alternatives where they could be treated. This work is supported by other initiatives for example, a proactive community swabbing programme. The programme involves training of the staff in care homes in how do swabs safely.
The Head of Service Adult Improvement advised that a national portal for care staff to book a Covid 19 test opened on 7 September 2020 but where staff are having problems getting a test booked, there is a local alternative available. To reduce the risk of disease transmission the current focus of the service is on care home staff not moving between homes.
The Head of Service Adult Improvement advised the panel of significant challenges at the start of the pandemic of getting sufficient stocks of protective equipment where it was needed. However, as a result of a collective effort across various Council departments considerable progress has been made to resolve this issue. The panel was advised that a million pieces of personal protective equipment (PPE) has been distributed across the City since the start of the pandemic.
The Head of Service Adult Improvement added that there is expected to be an increasing need for PPE throughout the winter as we head into the flu season. A strategy is being developed to have access to the necessary funding during this period. The strategy has involved further building on the close working relationship with local health partners and to provide care home providers with the advice and support needed.
The Head of Service Adult Improvement gave examples of the work done with colleagues in the Clinical Commissioning Group (CCG) to get all care homes registered with an NHS email which has made it easier for them to be updated on new guidance quickly. In March the figure was below 50 per cent.
The Government announced the creation of a prevention fund of £600m in May 2020. Wolverhampton received £3.2m allocation from the fund and of this award £2.4m went directly to Care Home providers to pay for infection prevention work as per Government guidance.
To receive funding the care home has to be registered on a capacity tracker system which requires them to give data on the number of beds and infections to better manage the infection. This work has been supported by training provided by the CCG with the aim of keeping infection prevention under control in the care home sector. The training has covered how to take off PPE and what care staff need to know about cleaning the home to reduce the risk of infection transmission.
The Head of Service Adult Improvement advised the panel that the service has responsibility for arranging public health funerals when there is no one willing to make plans. The number of public health funerals has increased in quarter one from 8 to 13 cases.
The Head of Service Adult Improvement advised the panel that currently there are 686 residents in and care staff in self-isolation on 1 April 2020. At this time there were 13 confirmed cases and 160 suspected cases. As at 4 September the number of confirmed cases had reduced to 1 and there were 3 suspected cases and 4 people in self-isolation.
The service is working with the care homes concerned to improve infection prevention arrangements and to restrict non-urgent visits which has led to a reduction in the number of cases.
The Head of Service Adult Improvement praised the excellent response from the social care sector and the whole Council to set up the food distribution hub and the work done on the ‘stay safe be kind’ helpline and the important learning gained from joint working that will help to improve future practice.
The Director of Adult Services briefed the panel on the changes introduced by the Care Act Easements to allow Adult Social Care Directors to make decisions in consultation with other interested parties if changes were needed to be made about how the service would meet its statutory responsibilities. The Director of Adult Services gave examples of how new technology has been used to complete care assessments.
The Director of Adult Services advised the panel of the work being done locally in response to the increase nationally in the rate of Covid 19 cases and the plans for managing a second-wave. The panel were advised of the risk to the City of a local lockdown based on the increased number of local cases. The panel were reassured that work is being done across the Council and with other providers to better understand the potential impact on how services are delivered in the future.
In view of the changing situation the Council is recommending in guidance to care home providers that only essential health related visits or on compassionate grounds should be allowed to reduce the risk of spreading the infection.
The Director of Adult Services acknowledged the importance of visits to residents from friends and family members but highlighted the need to protect them during a period of increasing rates of infection.
The Council is offering care home staff flu jabs as part of it winter planning arrangements and is working with public health colleagues to improve testing capacity. In addition, a series of provider forums has been setup to allow care staff to share their experiences.
The panel thanked both presenters. The panel highlighted the importance of good communication to explain to family members the reasons for restricting visits and welcomed the work done by the service.
The panel expressed concern about the reported delays in care staff getting test results quickly and more generally issues about getting tests booked through the national scheme when needed. The panel wanted reassurance that everything is being done to prevent the risk of transmission in care homes settings.
The panel also wanted assurance that people who are discharged from hospital to a care home are being tested for Covid 19 before they are admitted.
The Head of Service Adult Improvement advised the panel that patients are tested for Covid 19 within 48 hours of being discharged from hospital. However, regardless of the test results new residents are placed in isolation for 14 days when they move from hospital to a different care setting. In addition, funding from the infection prevention fund is available to care home providers to make sure that people are not mixing between floors during the first 14 days and that the right processes are in place to reduce the risk.
The service is working with homes to avoid people between care homes, unless it is considered to be essential. If a care home is not able to meet the needs of a resident then arrangements are made for any move to be done safely.
The panel discussed delays in getting test results and wanted an update on the current situation. The Head of Service Adult Improvement advised the panel some test results are returned in less than 48 hours, but it can take up seven days, depending on the when the test swabs are collected.
The Head of Service Adult Improvement advised the panel that the service has encouraged care home providers to use the national portal scheme to book a test, which is the best way of doing this. In addition, there are local testing arrangements which can be used to meet demand. The test kits are delivered by courier and are self-administered and then will be collected to be tested.
However, the current challenge is the limits on laboratory testing capacity which has been highlighted as a national issue.
The panel queried the financial support available to minimise the impact on care workers who are required to self-isolate and the problems this may cause. Lynsey Kelly, Head of Community Safety, advised the panel that £3.2m received by the Council for infection prevention fund is allocated on the basis of the number of beds in each care home. However, the funds can also be used to pay care staff above statutory sick pay levels to top-up a carers wages when they are self-isolating.
Care providers who get money from the infection prevention fund are required to sign up to a number of specific conditions about supporting care staff who have to self-isolate. There is currently a work being done to review how this scheme is working in practice.
The panel suggested that the impact of the current guidance to care homes on allowing visitors could be added to the work programme for a review at a future meeting. A copy could also be shared with the panel for information.
The Director of Adult Services advised the panel that there is a dedicated Council website page on the Covid 19 resources which has links to this information. The Council has provided extra guidance to care home providers to help them develop safe arrangement and supporting them to do their own risk assessment. The visiting arrangements will vary between care homes, but all are expected to follow the latest national guidance.
The panel queried if the information on the website is available in other languages or have reading difficulties. The Director of Adult Services advised the panel that the information is not currently published in different languages but was happy for panel to suggest how the Council can work with community groups to translate the information that can better their needs. The current information could then be translated into a shorter document. The panel were advised the Wolverhampton Homes has produced online resources that could be added to the Council website.
The Head of Community Safety in reference to an earlier discussion about financial impact on care home staff who are required to self-isolate advised the panel that there is a trial scheme for people getting working tax credits or Universal Credit to get an extra payment of about £13 a day. The scheme, if considered successful, will be rolled out nationally with the aim of supporting people on low wages.
The panel agreed to receive an update on progress in providing information in different languages to a future meeting.
The panel discussed the challenge facing people who are cannot book a test locally and are having to travel some distance as a result and the specific issue of not being able to get children returned to school until they have been tested.
The Director of Adult Services advised the panel that he is leading a group on dealing with testing issues and accepted that there is not enough national laboratory testing capacity to process samples in a timely manner. The demand for testing slots is very high, which is presents a challenge for people who are asymptomatic who want to be tested.
The Council is lobbying Government to increase national laboratory testing and during a call with the Department of Health and Social Care it was stated that there is further work being done to increase testing capacity, but in the short term other local arrangements have been made to allow pupils and teachers to be tested.
The panel discussed the work done to reduce the lessen the risk to people who in care homes who are most vulnerable.
The Director of Adult Services advised the panel that the Council has data on the high risks and explained the work with colleagues in Public Health around managing individual risks in care homes. In addition, work is also being done to think about the risks to black and minority ethnic health of care workers.
The aim is to ensure that the workers in these groups are protected and that this is supported by having the correct risk assessment plans in place. The learning from work done on risk assessments within the Council is being shared with the care sector.
The panel agreed to receive an update on progress in providing on line resources on Covid 19 in different community languages to a future meeting.