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Strengthening the Ring of Steel: Reflections on The Care Home Support Package

The National Care Forum is the leading voice for not-for-profit care providers. Our Policy Director, Liz Jones, shares her reflections on the government’s latest announcement for social care.

Last week, on 14 May 2020, the Government announced its Care Home Support Package. This was a welcome, if long awaited intervention, beginning to create the ‘protective ring’ around care homes that the National Care Forum has been advocating for (#ringofsteel). However, there is still more to do to really sustain and support the sector through the new COVID-19 reality.

What’s welcome in the package?

Increased focus on infection prevention and control
Care homes are generally particularly good at infection prevention and control; it is part of their daily work to manage viruses. But COVID-19 is a new virus, more like Ebola, than the Norovirus more normally encountered in care homes. The complexity of its management and suppression requires specialist practical advice, guidance and support on infection, prevention and control (IPC) – far beyond the usual PPE donning and doffing. The £600m Adult Social Care Infection Control Fund must make its way directly, urgently, and effectively to the frontline to support IPC. Now that SAGE have established a sub-group to look at care homes, looking at IPC and understanding transmission in care settings must be a priority for them.

Stepping up NHS Clinical Support to care homes
This is a key element of the #ringofsteel. COVID-19 is a health pandemic, but the workforce in care homes is mainly drawn from social care. Early on in the COVID-19 crisis, at the very time we needed it most, support from NHS services to care homes, both acute and primary care, seemed to reduce overnight, leaving care homes feeling abandoned and isolated. However, there is now a promise to accelerate the Enhanced Health in Care Homes approach, which will deliver timely access to named clinical contacts; proactive support for people living in care homes; support for care home residents with suspected or confirmed COVID-19 from multi-disciplinary teams, where possible; and sensitive and collaborative decisions around hospital admissions.

This move to a clear and supportive intent to treat, rather than to assume a blanket DNAR approach, should have been in place from the very beginning of the crisis. Partnership is key here, to bring expert clinical health support into care settings, as and when it is needed for our most vulnerable citizens; ensuring that if they need access to acute care, they now get it.

What more is still needed to sustain and support?

Increased and immediately accessible funding to enable care providers to continue to operate in the face of catastrophic COVID-19 costs
The jigsaw piece that is missing from the Care Home Support Package is adequate funding for social care. Care providers have had dramatic and unanticipated increases in their operating costs – in the region of 35%. These huge increases have resulted from large numbers of staff needing to self-isolate, the unprecedented use of PPE, the additional cleaning and infection control required for managing suspected COVID-19, and other supply costs.

The Government has given £3.2bn to support social care, via LAs. Despite the guidance in early April from the LGA and ADASS to LAs to give a 15% uplift to care, this does not appear to be happening. There is no requirement for LAs to follow this guidance, the Government seems unable to mandate it and consequently, very few LAs are passing any of this to the frontline. Where LAs are passing on the funding, many are not prepared to cover the additional COVID-19 costs for self-funders and many are requiring very detailed evidence of the costs providers have incurred, which is becoming a big administrative burden.

We are now in mid-May and many providers are facing very serious cash flow problems, in the face of catastrophic COVID-19 costs. It is clear that if we are to avoid care home closures, we need proper access NOW to the £3.2bn allocated to LAs to support social care and a direct payment mechanism to help keep providers afloat.

Comprehensive and routine testing
Despite all the promises made, comprehensive routine testing for the care testing is still not a reality on the frontline. While the DHSC has done well to secure 30,000 tests per day for social care, the real ask has to be 200,000 social care tests per day to enable comprehensive, routing weekly testing for care homes, with more needed to cover other independent care settings. It’s still pretty chaotic out there in terms of testing and it has been very confusing, with shifting approaches – there was the first centralised approach via the CQC, then the Getting Tested Portal which diluted the prioritisation of social care, then the CQC system was unhelpfully shut down without notice, and this all sits alongside a postcode lottery of local testing arrangements led by LAs and PH Teams.

The new dedicated social care testing portal will help but only has 30,000 tests per day. This will cover approximately 300 care homes per day, so will take until June to cover all 15,000 care homes, not to mention other social care settings. There is also a PHE designed approach to prioritisation for this testing, based on views of local PH teams as well as size of homes; again, this is not quite the promise that was made in April that all residents and staff would get tested. Given the robust evidence emerging about the prevalence of COVID-19 amongst people who show no symptoms; comprehensive and routine testing is essential for care providers to be able to protect both staff and residents effectively and to continue to provide good care and keep on top of the COVID-19 risk. The latest announcement extending COVID-19 testing to anyone over the age of 5 who has symptoms will simply make priority testing for social care even harder to achieve.

Better access to affordable good quality PPE
Sadly, there’s still a way to go here – access to affordable good quality PPE is still a huge challenge for providers, and while the emergency access to PPE via LRFs has helped, most providers have ended up spending unimaginable amounts of money and time sourcing PPE supplies. The government’s Clipper / parallel supply chain solution is still some weeks off and social care has simply not received the PPE support it needed from the beginning of this crisis.

Overall, this package is a good start – but much more is needed to see the care sector through the next 12 – 18 months of living with COVID-19. And, as care providers face the new reality of living with COVID-19, thoughts now need to turn to how we continue to ensure we can carry on caring well, despite COVID-19, and help people live full, vibrant, happy lives.

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