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Social care: Learning lessons and preparing for winter

Posted by: , Posted on: - Categories: Coronavirus (COVID-19)

Nurse consoling her elderly patient by holding her hands

Protecting those who use and provide care during the COVID-19 pandemic is crucial. The pandemic has seen a different scale of test for adult social care, going far beyond anything the sector has previously experienced. It has been hugely challenging for the 1.5 million people who make up the nation’s paid social care workforce, in local authorities and the independent and not-for-profit sectors, as well as the 5 million unpaid carers, all of whom provide an invaluable service and selfless dedication, pandemic or not. It goes without saying that it has been an incredibly difficult time for the millions who rely on this care and their families as well.

As demonstrated  with the recently published ‘Adult Social Care: Our Covid-19 Winter Plan’ the government remains committed to supporting those who need and provide care throughout winter.

Through our preparation and planning with the care sector and many others, PHE is resolutely focussed on continuing to play our part in the government’s priority for adult social care – that everyone who relies on the system gets the care they need throughout the pandemic. PHE, our partners in local government and the NHS share this focus, with council leaders and social care lead members providing essential local leadership and oversight in our communities.

The plan outlines the actions every local area (local authorities and NHS partners) and every care provider must be taking right now, if we are to maintain our collective efforts to keep the virus at bay. The plan to protect social care includes increased support to the sector, and further expectations and requirements of care providers, local authorities and NHS organisations to make sure every-thing possible is being done to keep people safe.

To recap, under this plan:

  • The sector is being supported with an additional £546 million Infection Control Fund, to help with the extra costs of infection prevention and control measures – including the payment of care workers who are self-isolating in line with government guidelines.
  • DHSC is scaling up PPE distribution to make free PPE available for all adult social care providers and care workers through to March 2021. All CQC registered adult social care providers can now register on the PPE portal and order limits will be increasing over the coming weeks. The wider PPE needs of the sector will also be supported.
  • All but essential movement of staff between care homes will be stopped.
  • Further steps will be taken to reduce the risks of visiting in care homes. Visits are important for the wellbeing of residents and loved ones, but with higher rates of COVID-19 in the community, extra precautions will be needed including supervision of visitors to make sure social distancing and infection prevention and control measures are adhered to.
  • Designated ‘areas of intervention’ must not allow visiting except in exceptional circumstances, such as end-of-life.
  • A Chief Nurse for Adult Social Care will be appointed to provide leadership to the social care nursing workforce.
  • A new dashboard will monitor care home infections and provide data to help local government and care providers respond quicker.

We know care homes and other care settings were acutely affected with almost half in England experiencing COVID-19 outbreaks. While the summer saw a significant drop in the number of new outbreaks reflecting huge efforts by care providers, as we enter autumn we are now seeing cases rise in the wider community and in care homes too.

Our local Health Protection Teams continue to carefully investigate and analyse outbreaks and are working closely with local Directors of Public Health, Clinical Commissioning Group Infection Prevention and Control leads, and the DHSC to ensure outbreaks are detected as early as we can, helping us provide co-ordinated advice and action on infection control.

Lessons learned across the social care system

The Social Care Taskforce chaired by David Pearson has collectively been looking at the government's response to COVID-19 and producing recommendations which build on and refine DHSC’s interventions so far, including the Adult Social Care Action Plan, Care Home Support Package  and Adult Social Care Testing Strategy.

Aided by more rapid testing, the expansion of whole home testing, and coordinated action on infection control we are better placed to help care settings manage outbreaks.

We know there are still challenges for the sector and as the pandemic progresses, together we continue to learn lessons every day. Information from care users, their families and carers has helped us update guidance and offer more targeted support.

We are integrating our learning in England with knowledge gathered from other countries and using this to inform policy and target resources. For example, our research in April highlighted the scale of risks of asymptomatic transmission for care homes, allowing us to recommend changes, particularly around staff working in more than one location.

As we prepare for winter, we are aware of the impact of rising COVID-19 infection rates and what this will mean for the wider health and social care systems. With non-COVID-19 health care needs that have built up, should there be an influenza epidemic and the usual other winter outbreaks, we will see great pressure on care and health providers again.

We understand only too well the impact there is on people not being able to see their loved ones, and the difficulties this poses for managing risks in care settings and with our partners we are working to see how we can make visits as safe as possible.

With these risks in mind, working with Directors of Public Health in local authorities, local strategies for infection prevention and mitigation are important, informing local outbreak plans and wider approaches to the pandemic. We can all play a part. Complex outbreaks are currently investigated by our Health Protection Teams (HPTs). HPT capacity has been doubled since pre-COVID, but additional training and support to help care home staff to investigate their own outbreaks with local system support is also being brought into place. The NHS has stepped-up training, with each care home having a named contact for this purpose.

We can follow national guidance to keep ourselves and our families safer – washing hands well, making space and wearing a face covering. Taking up the seasonal flu vaccines available, at no cost, to all frontline social care workers will play a crucial role reducing risk of a flu epidemic. When any of us are working in a care setting, we need to maintain high infection control standards and continue to use PPE properly, being aware of the importance of not dropping standards during rest breaks and when travelling to and from work.

However, this is not just about the delivering strategies for the system. As many of us know only too well from personal experience, it is about individuals, families, loved ones and friends – the people receiving care, whether in care homes, in their own home or in day centres and elsewhere.

Millions of people work to provide care and we are acutely aware the advice and guidance we provide is not for systems, but for all these individuals. That is why we are so determined to build on what we have learnt working with local providers this year and are doing what we can to prepare for the coming winter. It will be a mark of our purpose: saving lives, addressing inequalities and improving the wellbeing of all, as far as possible.

Finally, protecting care staff is as important as protecting those they care for. On average, flu kills more than 11,000 people every year. With COVID-19 circulating at the same time as other seasonal illnesses, it is essential that access to free flu vaccinations is quick, easy and painless for all care workers. Eligibility for free vaccines has been extended and pharmacists can now deliver flu vaccinations to care workers in their workplace.

As we consider the prospect of this pandemic persisting into the winter months, keeping our health and care staff healthy has never been more important. The system relies on the mental health of it’s workers as well as their physical health and it’s great to see that many providers have been taking extra steps to support the mental health of staff too. Maintaining these efforts will be crucial through winter and each and every employer should ensure they do all they can to protect and support care workers through this difficult time.

This year has been tough for so many people dealing with the COVID-19 pandemic, with so many losing loved ones and being unable to spend time with them. At PHE, we’ll continue to work with the sector to support best practice and provide comprehensive guidance, to play our part in making the social care system the best that it can be.

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