Letter from Caroline Lacey to Helen Whately MP, Minister of State for Care
I refer to your letter dated 14 May 2020 regarding the above and set out below our assurance letter.
I am pleased to report on our strong position around how we are supporting our care home sector. I am confident that what we have put in place will enable us to address the challenges of COVID-19 now and into the longer-term future. This confidence is determined through strong leadership within Adult Social Care, Public Health and the place partnership within the East Riding.
There are 140 registered care homes in the East Riding with 4399 registered beds (nb: Number Four, in Hornsea registered with 4 beds is included in these figures, but is a dormant service with no residents). Currently, there are 1809 placements funded by the Local Authority of Health and an estimated 2148 private/other local authority clients; the vacancy level is currently at around 10% of the registered beds. Our care home market is a mixed economy of providers ranging from those that are part of national organisations, to the small independent provider particularly in our coastal towns.
East Riding of Yorkshire Council (ERYC) and East Riding of Yorkshire Clinical Commissioning Group (ERYCCG) along with other system partners are working strongly and confidently together to build an even stronger support offer in collaboration with care home providers through this coronavirus pandemic. As a whole system, we have a pivotal role in supporting care homes, building on the well-established partnerships and relationships across the care sector. Through the mechanisms we have in place we are offering advice and guidance and addressing challenges to support operational and financial resilience, to ensure the careful management of vulnerable people. We are working with providers and local partners to understand and build on the existing business continuity arrangements providers have in place and establishing assurances around the delivery of care and support, while equally supporting the financial challenges our local market is facing.
At a strategic level, our arrangements are overseen by the Director of Adult Social Services (DASS), supported by the Head of Business Management and Commissioning and the Head of Adult Services, ensuring leadership oversight of the Local Authority’s statutory responsibilities under the Care Act 2014. The statutory Director of Public Health also provides specialist support and advice. The interface with the Director of Nursing and other CCG colleagues is strong and is ensuring robust clinical arrangements to support the care homes across the East Riding are also in place. Our local arrangements and response to national requirements have been put in place to ensure safeguarding assurance arrangements across the care sector during COVID-19 outbreak.
The Director of Adult Social Services is part of a wider strategic system response group and also in regular contact with key senior colleagues within the CCG and wider Hospitals system. A Strategic Oversight Group for Out of Hospital Care is led by East Riding CCG providing weekly oversight of the health and social care system particularly linked to the East Riding bed base including community beds and care sector capacity. The group reports to the local Provider Alliance Gold Group and has a strategic approach to oversight of the collective bed base and care sector capacity, primary care support to care homes and medicines management. The group also leads the collective actions identified to respond to national and local requirements to support care homes. This includes oversight of the expectations from NHS England and NHS Improvement as well as government guidance with a clear link to the Adult Social Care Plan and the requirements determined by the Minister of State for Care; Department of Health and Social. East Riding of Yorkshire Council is also collaborating strongly with other health system partners covering the resident flows into the York and Scarborough system and North Lincolnshire and Goole system.
ERYC Adult Social Care has developed a Care Sector Response Team to oversee local resilience plans related to COVID-19 and these services are in place for the longevity of the pandemic to ensure we can continuously support the sector during these uncertain times, working together with our health services, public health and our local health protection agency. A commissioning senior manager is leading our Local Authority COVID-19 Services, coordinating support across the care home sector. The service also extends to support for home care, supported living and those individuals in receipt of a direct payment. The service has a number of call handers operating 7 days a week 8am until 8pm. Please see appendix one Care Sector Response Team (Hot Team) and the document that details the specialisms that support this function.
These arrangements enable us to continue to build an even stronger understanding of the services and support in place and address any risks and issues of concern; we are developing further our data model so that it tracks the impact and supports sustainable recovery. This also includes the development of further measures for staff and visitors that will reduce transmission risks, especially as lockdown measures start to ease. All of this information is collated into a daily situation report that is shared with the DASS and our health partners, providing intelligent data insights to determine where support is required, followed by appropriate action.
Support offer to East Riding Care Homes
As a Local Authority we are working with the ERYCCG, primary care, hospital and community colleagues to deliver an enhanced health support offer. The aforementioned Care Sector Response Team is in contact with providers on a daily basis to collect a range of intelligence, providing a timely understanding of emerging issues and underlying themes so that appropriate and specialised support can be mobilised as required in a timely and co-ordinated way.
Weekly conference calls with providers, led confidently and strongly by the Head of Business Management and Commissioning, are also used to offer support, provide information and advice and address issues related to the challenges of COVID-19. Each care home also has a named clinical lead. Infographics have been shared by both the LA and Health summarising the support available. We have also recognised the outstanding work our care homes are doing and issued letters of appreciation to all care providers and purchased banners for display at care home locations in support of our care workers and their tireless tremendous efforts.
There is a proactive approach to reducing risks for each care home that builds on the home’s own leadership and capacity. The support in place includes:
- Access to Infection, Prevention and Control (IPC) advice and a visit (or if appropriate a telephone call) from an IPC nurse/nurse with knowledge of IPC when this is required.
- A daily visit by a community nurse is provided to those care homes with residents who require a daily clinical intervention to specifically meet the individual patient need.
- Access to support and advice from a nurse with a good knowledge of IPC is also in place. Care homes continue to be supported to develop plans to manage an outbreak.
- Concerns identified within the Capacity Tracker are responded to through an additional support offer and where the Capacity Tracker is not being used care homes are being supported by ERYC populating on their behalf.
- A developing multidisciplinary team (MDT) approach in each locality area delivers a weekly (virtual if appropriate) round to support the care of vulnerable residents, and ensures a clear connection with the PCN arrangements
- Support to ensure all care home residents have a personalised care and support plan, and we plan to work further with homes to ensure there is an individual plan for each home worked up within the scope of our support offer, and undertaken collaboratively with the home so that it addresses the issues the home faces, their capability to respond, and the support required. Where care homes are declining the offer of support additional assurance is being sought about specific reasons for this.
- Visiting staff will, where possible, visit care home residents who are known to be COVID+ at the end of their working day to help to prevent the spread of infection. As agencies providing care we will collaborate to help to reduce footfall into care homes.
- CCG staff, Primary Care Networks and pharmacists will work together to ensure a joined- up approach around medication supply, structured medication reviews, supporting reviews of new residents or those recently discharged and addressing medication queries.
The ERYC approach to testing in care settings as part of the ongoing response to the COVID-19 pandemic is within the context of the national testing strategy, focusing on testing people for COVID-19 who live and work in care settings. The ambition across the East Riding of Yorkshire is to ensure good, timely access to tests and results as part of a systematic health protection approach. The aim of having a local approach is to complement the national offer. Locally, Public Health, Adult Social Care and the NHS, through delivering care sector resilience arrangements, will ensure that testing in care homes is prioritised to care homes or areas where the need is greatest, in line with national guidance. This will enable the local system to maintain an oversight of the prevalence of the virus in a local area and help prevent, reduce or delay transmission and outbreaks of COVID-19 in our care settings.
This local approach across the East Riding of Yorkshire aims to supplement the national processes, in order to build a resilient strategy for our local population. Going forward we will support the contact tracing programme to further manage the risks associated with the spread of infection. Some homes have fed back that there seems to be some inconsistency, barriers or delays with access to testing and receiving results. National improvements in this becoming more timely and consistent could improve the situation. Our local outbreak plans we have in place through our Public Health Team, supported by System Partners are quickly supporting Care Homes.
Using our local authority buying power we have established an enhanced PPE offer for providers in urgent need, working with the Local Resilience Forum to maximise supply. The supply of PPE is monitored daily and weekly and is an identified risk within our system risk register, despite the efforts in place to maximise supply we know this is a national and global challenge. There are concerns around the future supply of PPE particularly as more of the population return to work, lockdown restrictions are eased and our hospitals increase elective care which will result in a greater demand. We will monitor the situation and escalate via our LRF if required.
Timely access and additional Clinical Support
Primary Care and Community Health support to care homes has been bolstered to ensure timely, coordinated access to clinical advice and support. This includes:
- a pre-discharge assessment, virtually or face to face
- ensuring everyone discharged through the rehabilitation pathways and the discharge to assess pathways from a hospital to a care home is followed up by a face to face visit; access to 24-hour support by video link/telephone/telehealth
- remote monitoring to support care home residents with suspected or confirmed COVID-19
- access for care home staff to psychological support in addition to the pastoral support already provided; support, advice and guidance regarding staff and resident testing as required.
Technology and social media has been utilised to facilitate support, examples include:
- each care home has been provided with a tablet for video conferencing to support communication, consultation, and the delivery of the training offer (see below) to support good practice and continuous learning
- a Whatsapp group for all care providers is proving popular to share queries/issues and to provide support to one another
- a webpage is being developed on the ERYC website for care providers where we will publish resources and guidance.
As a System we also continue to work with our providers to support safe staffing within the care home, and ensure care is safe and of good quality. This includes:
- access to staff via the Council’s Choose Care recruitment campaign Continued/
- safeguarding and quality assurance arrangements are continuing to support the safe delivery of care during these challenging times
- increased educational support available, including access to specialist support including Infection Prevention Control and End of Life Care including a “train the trainer” approach, all via technology systems. ERYCCG has identified 2 super trainers and 20 nurses to deliver this programme
- support will be available to staff who are at high personal risk
- a Local Authority Pastoral Care Support Team provides a ‘listening ear’ to care homes, particularly where the daily intelligence shows an outbreak. The Team considers with the Care Home Manager any well-being or mental health issues within the staff team and sends out relevant resource tools / makes referrals to relevant wellbeing / mental health support resources. We are working with ERYCCG and local NHS providers on the second wave of the national Bring Back Staff campaign, coordinating the supply of NHS staff who have chosen to return to the workforce. Returning clinical staff and trained carers will work with existing clinical teams to provide an enhanced in- reach service into care homes for those who require it. The local health economy will provide training and support to returning staff and will actively promote care homes as a rewarding and fulfilling place to work.
Financial Management Support to Care Homes
As previously described East Riding has a mixed market of care home providers and in view of this we have established an approach that recognises that the businesses will have different levels of resilience and therefore we have supported providers based on individual needs as well as recognising the factors that are critical to support them to remain resilient. The council has already put in place a range of financial relief measures. This includes a core offer to providers, supplemented by support on a case by case basis, with the aim of providing a proportionate, targeted response.
Prior to the outbreak of the virus, the council made an early commitment to fund new residential placements at the council's uplifted enhanced rate. The ongoing communication with providers has enabled an understanding to develop about the financial pressures faced by providers. The core financial offer includes paying for voids that have occurred since the end of March, either due to a resident passing away, a planned respite stay not taking place, and utilising shared rooms for single occupancy; meeting the costs of additional PPE expenditure is reimbursed for evidenced additional costs incurred above usual levels. Providers are also being encouraged to supply evidence of the additional costs they have faced on an individual basis. These payments have crucially provided stability and sustainability to the market.
A process is in place to monitor void expenditure and is cross referenced with information received from the sector on client deaths. It is recognised that the on-going payment of voids at the current level is not sustainable and this will be included in the work which has commenced on commissioning priorities for the next six months.
Residential fees for 2020/21 had been increased by between 4.04% and 8.71% following an extensive market exercise involving Laing Buisson. The council is currently working towards a timely distribution of the recently announced Infection Control Fund which will provide further assistance to care homes, and on the most effective way to use the 25% of the fund not distributed on a per bed basis. Among other items of expenditure the Infection Control Fund will further support providers with PPE costs.
The NHS Hospital Discharge Funding is being utilised to support people being discharged from hospital or would otherwise be admitted into it, for a limited time, to enable quick and safe discharge and more generally reduce pressure on acute services. More specifically, the funding is being used to cover the costs of additional short term residential, domiciliary, reablement and intermediate care capacity to reduce hospital admissions incurred jointly between CCG and Local Authority.
Local Market Pressures and Risks
In response to ensuring access to step down and step up capacity to enable isolation where the home of choice is unable to do this, we have mobilised an innovative residential care solution that provides block purchased beds in an unused ward on a hospital site. We are also in the process of soft market testing to identify suitable facilities within our provider market for challenging behaviour and dementia. We have particular challenges in the care home market relating supporting people with challenging behaviour and admitting people that are COVID-19 positive.
In addition, providers are being supported with the cohorting of residents to reduce the risk of transmission by having certain staff, for example, only look after COVID-positive residents in certain areas of a home; understanding each home's ability to cohort is being assessed.
We are experiencing a decrease in demand for care home placements which will impact of our market and the sustainability of some of the care homes. The Council has started to consider what impact COVID-19 will have on the provision of residential care in the coming months and financial pressures experienced by providers will be a key part of this work in collaboration with health and care System Leaders as develop our plans over the next 12 months+.
We are also working collaboratively with our care home providers to prepare for the future easement of lockdown restrictions and to ensure that appropriate measures are in place.
Summary and Forward Plan
As I have stated our System arrangements are strong and now well established. What we have put in place aims to ensure, through collaborative partnership working, the necessary assurances that our provider market is supported throughout this pandemic. It continues to be an uncertain period and we are unclear about the future challenges, but our infrastructure of support and the daily insights, intelligence and data enable us to anticipate the challenges timely and plan accordingly.
As a system we have a number of risks that we are managing through a strategic risk register owned by all key partners. We have also started to consider recovery and the phasing of easement around lockdown in a way that we plan to support providers to manage this well, reducing the spread of infection whilst also eventually supporting families and visitors to see their relatives and friends. We have recognised that the infrastructure of support available to our care home market may form part of our new normal, extended into the future to support general quality assurance, regulation activity, safeguarding as well as the reduction in hospital admission from care homes in the future. Our vital Home Care Providers are continuing to be actively supported and we will consider how we use the second tranche of funding and priorities to support this sector as per your guidance.
These areas bring strategic challenges across our system and there is often within any challenge, always opportunity, which in the East Riding we are eager to grasp with our System Partners. In particular we will build into these considerations the further development of our integrated approach to resource allocation, ensuring that our providers are fully engaged in future service design.
Download: Appendix One - Care Sector Response Team
Care Sector Support Offer
| Organisation || Team name || Description |
|Care Sector Response Team (Hot Team) ERYC & ERCCG || ||The care sector response team provides professional advice and support to all care providers across the East Riding who are working in the front line fight against COVID-19. This will include working together, with system partners, to ensure a shared view of service capacity and pressures, liaising with providers daily to understand their situation and individual needs, providing support either directly or by referral to relevant teams. |
|ERYC ||ASC COVID-19 Pastoral Support Team ||Adult Social Care staff providing pastoral support to care providers – emotional support particularly for providers with suspected or confirmed cases; well-being checks of providers. Team will ‘smooth’ and prioritise access to other support (via ASC COVID-19) and link to other emotional support provided by other organisations Will provide a proactive response based on intelligence gathered but providers can also self-refer contacted via ASC COVID-19 Response Team; Team will link into other pastoral support e.g. bereavement support provided by HFT |
|ERYC ||BMC - Commissioning & Market Intelligence ||Support with the analysis of data and soft intelligence to support the response Brokers / commissions support |
|ERYC ||BMC – COVID-19 – PPE ||Support with PPE issues, stocks, and distribution |
|ERYC ||BMC - Financial Support ||Dealing with payments to providers – COVID-related expenditure |
|ERYC ||BMC - Contract & Quality Assurance Team ||Supports with the improvement of quality of care |
|ERYC ||BMC / Organisational Development ||Recruitment drive – care workforce Email detailing roles, hours, pay etc and team will look at matching applicants to providers |
|ERYC ||AS - Safeguarding ||Safeguarding/quality/Deprivation of Liberty |
|ERYC ||AS – Discharge to Assess ||Team supporting hospital discharge pathways |
|ERYC ||AS – Complex Cases MDT ||Team supporting complex cases |
|ERYC ||AS – Lead and Social Work ||Adult social care; strategic support and social work |
|Commissioning || |
|ERCCG ||Infection Control Team ||Support and advice regarding infection control Advise the homes if think they need other input like the Frailty team for example or PHE re swab results. ASC COVID-19 Response Team will refer providers to this team for the ICT to make contact or providers can contact direct Ring targeted homes and homes with outbreaks - would ring daily as referred by PHE or the council. |
|ERCCG ||CHC ||CHC funded care / oversight of complex cases Support to nursing homes and homes with health funded residents ASC COVID-19 Response Team will refer providers |
|ERCCG ||Quality Team ||Overseeing the quality of health services provided into care homes |
|ERCCG ||Safeguarding Team ||Overseeing safeguarding concerns in care homes, working in partnership |
|CHCP ||Community Frailty Response Team ||Provides specialist advice and guidance to primary and community colleagues for the management of frail |
|CHCP ||Pharmacy Medicines Service ||Supports care homes on medicines management issues, liaising with senior staff to agree action plans, offering advice and support regarding procurement, receipt, storage, administration and the safe disposal of medication. Additionally the care home pharmacist conducts clinical medication reviews. |
|CHCP ||Community Nursing ||Through the door support by district nurses and health care assistants providing support for people with long terms conditions eg insulin injections; or short term needs eg wound care |
|CHCP ||Specialist Palliative Care ||Specialist palliative and end of life care for people requiring more specialist interventions eg syringe drivers, pain control |
|CHCP ||Bladder & Bowel Health/specialist continence management ||Continence assessments, provision of products to manage incontinence, support to regain and maintain continence |
|CHCP ||Therapies ||Through the door support to provide rehabilitation |
|CHCP ||Training & Development ||Provision of health related training for care home staff eg: end of life care, tissue viability, respiratory conditions and falls prevention |
|HTFT ||Care Home Liaison Team - Dementia Crisis Support ||Advice regarding older adults with dementia |
|NECS ||Medicines Optimisation in Care Homes ||Supporting reviews of new residents or those recently discharged from hospital by active searches as well as referrals from the practices. Specific contact email address circulated for all the medication-related queries or problems. All of the homes contacted and details shared. Running the searches on clinical systems to facilitate medication reviews. Care homes contacted over the phone to go through medication charts, queries or any issues. Care home newsletter shared with all the homes. This is done on regular bases. |
|Marie Curie ||Palliative and end of life care ||Palliative and end of life care for people requiring overnight support – delivered in partnership with specialist palliative care team and or GPs (no support currently required, but it is available) |
|Public Health England || ||National guidance and support |
|ERYC Public Health || ||Guidance and support |
|Humber Coast & Vale ||Local Resilience Forum ||Support from key emergency responders and specific supporting agencies |
|Yorkshire Ambulance Service || || |
Financial support provided to the care sector
Support to providers that East Riding of Yorkshire Council has contracts with:
- Domiciliary care – payments made on planned service, half an hour visits paid for shorter calls
- Residential care – payments at enhanced rates for new admissions, payments for void beds following client deaths, some purchase of blocked beds
- Other provision – reimbursement of additional costs, including PPE, on a case by case basis, provision of information and guidance
- Total amount spent to date supporting providers - £1.974 million.
Support to providers that East Riding of Yorkshire Council does not have contracts with:
- Other provision – support for services accessed by clients with direct payments
- Total amount spent to date supporting providers - £0.097 million.