We realise many of you are facing issues sourcing the appropriate level and quality of PPE and are also confused by the guidance coming from DHSC and the NHS about it. Please note that DHSC is currently developing a Parallel Supply Chain. In the meantime you need to contact Local Resilience Forums or the National Supply Disruption Helpline in an emergency. See the Social Care Action Plan for more details.

Links to Guidance

28.5.20 – Update on Clipper System

DHSC has circulated an update on their plans for the PPE portal.  In short, they are finally moving it out of pilot and starting to roll it out nationally. It will start with small residential settings (24 beds or fewer) and work its way up. They will contact you. We realise this doesn’t solve many of the problems – particularly due to the small amounts of PPE that can be accessed through this system – and will continue to make your issues heard around PPE.

26.5.20 Grant Conditions for Infection Prevention and Control Fund

This should have been circulated on Friday but it appears it was circulated to local authority leaders only. We have only had sight of the final version after it being flagged during the members’ call earlier. It is important to read both the Minister’s Letter and the Grant Circular (Annex C in particular).

22.5.20 – Guidance on the provision of home care

New general guidance has been published for the provision of home care. This does not replace the existing PPE guidance. It is complementary to it.

The new guidance covers:

  • Links to PPE guidance
  • Shielding and care groups
  • Hospital discharge and testing
  • Government support for social care
  • Information collection and governance

Please also see the letter from the Director-General of DHSC.

22.5.20 – FAQs on Care Homes and Care Home Support Plans

Local Authorities have been asked to draw up Care Home support plans. A very detailed FAQ has been created on what this means with some additional information about what commissioners in general need to do and what is being asked of care providers.

22.5.20 – Note about Capacity Tracker

The Better Care Support Team have issued a document explaining the rationale behind the new questions on the Capacity Tracker and the need to complete to receive funding from the new £600m fund.

22.5.20 – Antibody Tests

The government has uploaded more information about the antibody testing programme.

21.5.20 –  New Swab Tests

A new version of the existing swab test (those that tell you if you currently have COVID-19) is being trialed from today which can give a result in 20 minutes on site without having to be sent to a lab. The trial begins in Hampshire – if you have a care home in Hampshire and are part of the trial please let us know.

21.5.20 Infection Prevention and Control Guidance Update

The IPC and general PPE guidance has been updated.  Look at the change log on page 2. Please note the link to this evidence review regarding AGPs.

Updated 21.5.20- Revised PPE guidance and Infection Prevention and Control

The Government has updated the PPE guidance – see here. The main change is a new PDF compilation and a link to evidence review.

The previous change on 14.4.20: The key change was that the Government has updated the COVID transmission status to say that the whole of the UK is now defined as experiencing sustained transmission of COVID 19.

20.5.20 Guidance for stepdown of infection control precautions and discharging COVID-19 patients

The government has updated its IPC guidance for stepdown in hospital or discharge to home or residential settings.

18.5.20 – Expansion of Testing

The government has expanded its testing eligibility to everyone in the UK with symptoms. We’re very aware of the continued issues accessing testing for social care.

18.5.20 – Allocation table for the infection control fund as part of Care Home Support Plan

The allocation table for the £600m infection control fund has now been uploaded to the government website. The allocation formula is in the document. Do also note that each care home should receive an amount per CQC registered bed (not just locally commissioned) representing 75% of the funding. The remaining 25% must be used for infection control measures but local authorities are able to allocate based on need and therefore this may go to domiciliary care.

14.5.20 – Care Home Support Package

Please see the documents detailing the Care Home Support Package (this includes more details about the additional £600m). Please read them carefully and with what was circulated yesterday about testing in mind.

They state that the £600m will be used to reduce the rate of transmission in and between care homes and support wider workforce resilience. It will be ring-fenced and allocated to Local Authorities to distribute. It is in addition to the £3.2bn already allocated and it is expected by the government that Local Authorities will pass on the £3.2bn if they haven’t done already. Local Authorities are being asked to evidence how they have used the £3.2bn.

The Care Home Support Package (referred to as Annex A in the Minister’s letter) contains the following:

  1. Infection prevention and control and PPE: Particularly, training in infection control by CCG infection control nurses, a restatement of the efforts being undertaken to source PPE for LRFs and the establishment of the Clipper system, a statement that workforce movement between care homes should be minimised as far as possible, local authorities are being asked to ensure there are quarantining facilities which can be used before returning a resident to a care home if needed. SAGE have established a sub-group to look at care homes.
  2. Stepping up NHS Clinical Support – including 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.
  3. A commitment to comprehensive testing for all residents and staff – it repeats much of the information I shared with you yesterday.
  4. A commitment to oversight and compliance – all local authorities are being asked to review or put in place a care home support plan, informed by the views of care providers. These need to be submitted by 29 May to DHSC.
  5. A commitment to expanding the workforce by 20,000 people in the next three months. This section mentions the new care campaign, CARE badge and app, as well as measures to fast track DBS.
  6. Funding – it reiterates that the £600m is in addition to previous tranches of money given to Local Authorities for social care among other areas. ADASS is currently surveying its members to understand whether the £3.2bn has actually been passed to social care providers – this needs to be completed by 15th May. Local Authorities are being directed to publish on their websites their rate uplifts and other extra funding they may have given to care providers – deadline for this is 29 May. This section also states that £1.3bn was also given to the NHS to support safe and timely discharge from hospitals into care.
  7. There is an Annex which describes in further detail ‘restricting workforce movement and minimising workforce transmission’

Annex B of the letter is the guidance for local authorities and system partners about the Care Home Support Plan. It details what Local Authorities must now do – including evidencing it to DHSC.

Annex C of the letter details emergency support arrangements and states that providers should escalate all issues to their Local Authorities.

Annex D provides an evidence review and international comparisons about deaths and outbreaks in care homes. It contains examples of ‘what good looks like.’

Annex E is a list of relevant guidance for care homes.

13.5.20 – Testing routes and Prioritisation

We have had a series of new information from the government to try and clarify the testing process and how it will be prioritised.

Please note the following from the above documents:

  • Homes referred by PHE and Local Authorities will be prioritised for testing. The prioritisation criteria are in the letter and factsheet.
  • 30,000 test kits have been allocated per day.
  • DHSC is planning to expand the care home portal to include other types of adult social care over the next few weeks – including those catering for adults with learning disabilities
  • Training and advice can be sought from local CCG Director of Nursing about carrying out tests.
  • Tests results should be emailed directly to the registered manager or directly to staff within 72 hours of the test arriving at the laboratory.
  • The matrix details the different routes to testing for different residents/staff and situations.

12.5.20 – Map of Testing Locations

We finally got a map from DHSC detailing the locations of test sites. We will circulate new versions as we receive them.

11.5.20 – Dedicated Testing Portal for Care Homes

The government has created a new dedicated portal for care home staff and residents to access testing, regardless of symptoms. Please let us know if you find any problems with this new system.

11.5.20 – Face Coverings

The plan to lift the lockdown now advises people to wear face coverings (not face masks!) when in enclosed spaces where social distancing is not possible, such as public transport or in the workplace. As such, they have released guidance on making your own face-coverings.

7.5.20 – New Testing System for Care Homes

A letter from the Minister for Care details plans to launch a new digital portal designed to give care homes priority to testing. It implies that testing will be offered to every staff and resident in care homes regardless of symptoms. The system will allow tests to be ordered for care home staff and residents. Local Directors of Public Health, DASS, local NHS providers and PHE are being directed to prioritise social care.

DHSC will work with local bodies to determine where mobile testing units and homes tests should be sent:

These local bodies should:

  • Identify all eligible care homes in a specific LA area
  • Refer homes for testing via the portal (or supporting the care home referring themselves)
  • Provide local contacts and support information for each home

We will keep you posted with information as it appears. We will be interested to see whether this starts to solve some of your issues accessing testing. We don’t have any timescales yet.

6.5.20 – Answers to PPE Questions from PHE

We have had a few answers to questions you asked us to pose to PHE. Some answers will require follow-up, but take a look a the answers to questions 5 and 6 in particular about the changing of masks when moving between residents with symptoms and those without.

30.4.20 – No VAT on PPE

From tomorrow (1 May 2020), PPE purchased by care homes, businesses, charities and individuals to protect against Covid-19 will be free from VAT for a three-month period.

Updated 30.4.20 – How to Work Safely in Domiciliary Care Settings

PHE has finally published its guidance for those working in domiciliary care. It is applicable to visiting homecare, extra care housing, and live-in homecare. Please see NCF’s summary analysis.

30.4.20 – Testing for Social Care

There has been a further expansion of testing. Testing now includes:

  • Everyone in England aged 65 and over with coronavirus symptoms can now get tested, along with symptomatic members of their households
  • Symptomatic workers who are unable to work from home also eligible for testing
  • Testing of all asymptomatic NHS and social care staff and care home residents also being rolled out
  • New expansion of testing made possible due to rapidly increasing testing capacity

More information on getting tested can be found on the .gov website. To access priority testing see below.

“In order to obtain a login, employers of essential workers should email [email protected] with:

  • organisation name
  • nature of the organisation’s business
  • region
  • names (where possible) and email addresses of the 2 users who will load essential worker contact details

Once employer details have been verified, 2 login credentials will be issued for the employer referral portal.”

You can find more information about the self-referral route on the .gov website linked above.

There are three testing routes:

Self-Referral

This system is overwhelmed because individual members of staff are in competition with all other key employees from all relevant sectors. At the very least, encourage all staff to access this route if you still can’t access the employer portal.

Employer Referral

This system enables you, as the employer, to provide a list of all staff who require testing and will give you priority, alongside NHS employees. This route does not appear to be working for a significant number of members. However, please continue to try and access. We are escalating from our end.

Resident testing

The testing of residents is being handled by a different system run by PHE and CQC. For testing of care home residents, care homes should contact the local PHE Health Protection Team who will organise swabbing and testing for residents. You can find the contact details for your local health protection team here

We believe that PHE and CQC are also running a number of pilots to test all residents and staff in individual care homes. These involve testing swab kits being sent to care home by courier. They should contact you on your CQC registered email address if they invite you to the pilot.  This entire system relies on an accurate email address being held by CQC. If this is out of date we would suggest that you place forwards from that address to a current one whilst you apply to CQC to make the necessary changes.

Swab Testing

Advice on taking swabs is available at https://www.gov.uk/government/publications/covid-19-guidance-for-taking-swab-samples.

27.4.20 – Resuscitation

The infection prevention and control guidance has been updated to add a statement following NERVTAG review of cardiopulmonary resuscitation. It does not regard chest compressions as an aerosol generating procedure. See page 40 of the pdf version of the guidance.

27.4.20 – How to Work Safely in Care Homes

The guidance on ‘How to work safely in care homes’ has been updated again. Please see this NCF summary of changes made.

The flowchart has been removed and the key message is now that facemasks are required in all the scenarios outlined in the guidance – so all staff, all the time, in all care settings regardless of symptoms.

17.4.20 – PPE Guidance Update – Table 4 Supersedes Table 2

We have now been told that the published guidance on the use of PPE for care homes and home care provision has been superseded, as well as Tables 1, 2 and 3 in the infection control guidance. All of the superseded guidance is still live on the .gov website so ensure you are looking at table 4. Table 4 is now the relevant guidance you are being advised to follow.

This means that usage of PPE will inevitably increase.

On 17.4.20 we formally asked DHSC to commission PHE to provide guidance to the social care sector on a risk-assessment methodology to be used when such PPE is not available. We have been advising PHE of the importance of this since 2nd April. NCF and the CPA have pushing the government and PHE to ensure that any updated PPE guidance is supported by a practical risk-assessment methodology in light of the current severe PPE shortages.

We are awaiting further information from PHE. **Update** ‘How to work safely in Care Homes was published late on 17.4.20

17.4.20 – CQC Update on Testing

CQC has given us an update on their testing roll-out. By the end of this week they will have contacted all 30,000 adult social care providers. The invite to test email is being sent to registered managers and they are asked to refer staff members who are self-isolating to access a test at the nearest site. The list of locations is currently as follows and more are being added:

  • Birmingham
  • Chessington
  • Gateshead
  • Gatwick Airport
  • Greenwich
  • Leeds
  • Manchester
  • Smethwick, Birmingham
  • Nottingham
  • Plymouth
  • Preston
  • Sheffield
  • Stansted Airport
  • Twickenham
  • Warrington
  • Wembley
  • Worcester

CQC is now working on a pilot of home testing which will start in the adult social care sector. This is aimed at those who cannot travel by car to the above locations.

A privacy notice for testing can be found on the .gov website and contains information about home testing kits and how that process will work.

17.4.20 – Extension of testing to other frontline workers

The government has announced it is expanding testing to more frontline workers beyond Social Care workers and NHS staff. Included among those now eligible for testing are: police, fire service, frontline benefits workers and those working with vulnerable children and adults.

16.4.20 – PPE Exchange

We have been made aware of a website resource launched this week which puts PPE suppliers and care providers in touch with one another to help try and source PPE. It provides updates of PPE in real time as to what is needed and what is available from suppliers. It was developed by a UK software house and is not connected to the government. It is free to use.

16.4.20 Expanded testing to social care

The government has finally agreed to offer testing ‘for all who need’ it in social care settings. Guidance on accessing testing can be found here. This should be read alongside the new Social Care Action Plan ( updated 16.4.20). The testing will include:

  • All symptomatic care residents
  • All patients discharged from hospitals before going into care homes
  • All social care staff who need a test will now have access to one with CQC to contact all 30,000 care providers in coming days

While welcome news, this comes way too late in the day. NCF has been asking for this testing since day one of the pandemic. It seems that the mantra ‘what gets measured matters’ has been applied to the lives of people in care homes, and without the vital test to tell us that many were suffering, ministers and officials were unable to see the impact of the pandemic outside of the hospital environment. This needs to stop now and NCF will be continuing to apply pressure to the government to see social care as an essential service. To win this ‘war’, the government needs to rapidly equip its whole army of health and social care with the equipment and the resources to fight the fight on every front.

1.4.20 – Parallel Supply Chain & Other Suppliers

DHSC is developing a Parallel Supply Chain to support the normal supply chain with a focus on delivering core PPE products for COVID-19. Until the new solution is fully operational, they are:

  1. Working to provide stock of PPE to wholesalers and distribuors for pharmacies, GPs, dentists, adult social care providers (such as care homes), and the third sector (such as hospices).
  2. Providers who have an urgent requirement for PPE, which they are unable to secure through their business as usual channels, should contact the National Supply Disruption Response (NSDR) via the 24/7 helpline: 0800 915 9964.

 

The seven wholesalers are:

COVID-19: Managing the COVID-19 pandemic in care homes

The COVID-19 pandemic raises particular challenges for care home residents, their families and the staff that look after them. This guidance has been developed to help care home staff and NHS staff who work with them to support residents through the pandemic.