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The Winter’s Tale

The government has now published it’s Covid-19 Winter Plan 2020/21. The full plan can be found here. It is a 52 page document – intense experience to read in one chunk for my tired zoomed out Friday night brain (this was published along with 9 other reports at 9.30pm!!) – so bear with me as I try to break it down.

We urgently need this plan and it is helpful that it lays out clearly and coherently the actions required for central government, local government and NHS and providers.

The headlines for the plan will be beginning to be familiar. The announcement around the extension of the Infection Control Fund – placing more concerted emphasis on providers requirements to restrict staff movement, accompanied by cash to achieve, and enforcement if you fail. The plan also highlights an offer around free PPE. Having delved further into the document I am less clear as to what the actual offer is. It refers to the portal – which at present is offering very small allocations of free PPE and there has not been wide sign up by providers as until now access has been very limited. If this is the mechanism, there is indeed a lot of the heavily vaunted ‘ramping up’ to be don’t to make this a meaningful offer. It also refers to providers continuing to source their Business as Usual PPE, suggesting that there may be some rather tortuous calculations to come in the promised PPE strategy about what constituted BAU in a pandemic that is likely to require large scale consumption of PPE for at least the next 6 months, if not several years to come.

The plan also brings together some of the less well known positive actions that have been fundamental to the social care Covid-19 response – and there is a useful section around the future role of technology. This includes support packages around accessing wifi, roll out of free devices to enable enhanced integration with health records and essential IG support.

The plan feels very light in relation to the social care workforce. Much feted over recent months, the government has not taken the opportunity within this plan to celebrate and reward their efforts. The introduction of the Chief Nursing Officer for Adult Social Care is to be welcomed, NCF have been consistent champions of the role of nursing in social care, and feel that this position will do much to stimulate interest and recognition of the vital contribution of nurses to the social care sector. However, aside from that the primary offer to the majority of the workforce consists of apps and guidance which is no substitute for the serious call for a bespoke occupational health scheme to support the workforce called for in the workforce advisory group recommendations. The workforce is our most valuable asset – and the plan ignores or minimises that fact at all of our peril.

Finally, there are for me a number of red lines that the plan should just not have crossed.

In several places within the plan it refers to the possibility of taking homes taking patients from hospital without the home knowing the outcome of their test. This has to be a red line. It is not possible for us to return to a position where people come into homes, whether or not they have been designated as able to accommodate people who are COVID-19 positive, without the home knowing the test result. The only reason this is being considered is because the testing regime is not sufficiently robust to ensure timely results. Make the testing regime more robust – do not discharge people to homes without knowing whether or not they are covid positive. This is not acceptable.

Secondly the plan talks of blanket bans on visiting in ‘areas of intervention’ of which there are already over 40 listed by Public Health England and growing. This feels like we have not listened and not learned from people about the immensely distressing impact of not receiving visits during the first period of national lockdown. I refuse to believe that we have not learned – and therefore we must show this and act on it.

I believe the plan offers a solution. It outlines a role for CQC to designate homes that are safe to receive COVID-19 positive patients. Doing this will cost money – to inspect, to determine and to designate. If we are going to spend money – then we should be thinking about how those resources could be turned to maximise the benefit to those within the home as well as designing an environment safe to bring in others. We need to call on the CQC and government to turn their attention to supporting homes to enable visiting throughout any future lockdown – and to work with homes to designate that they can offer safe visiting environments. Care homes are where people live, and we should make it our top priority to keep them safe in both heart and health. We need both for a positive and fulfilled life.

Vic Rayner, Executive Director NCF


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