1.1. Safety of the people we support and our staff 

People who are ‘clinically extremely vulnerable’ will have received a letter from the NHS or their GP advising them of the recent changes to the government’s shielding policy. From 1 August, the government has advised that clinically extremely vulnerable people do not need to shield because the transmission of coronavirus in the community has fallen.

Clinically extremely vulnerable people are advised to follow the same guidance as the wider population on social distancing. However they could be advised to shield again if the situation changes and there is an increase in the transmission of COVID-19 in the community.

Individuals’ names will be kept securely on the shielded patient list by NHS Digital and they will be contacted quickly if the advice changes.

A wider group of people – including everyone aged 70 years or over and those with long-term health conditions of any age (anyone advised to get a flu jab as an adult) – are considered ‘clinically vulnerable’ and are also advised to carefully follow social distancing advice.

1.2. Dividing people who receive care into ‘care groups’

While clinically extremely vulnerable people are no longer being advised to shield, many have been identified as having specific medical conditions that, based on what we know about the virus so far, place someone at greatest risk of severe illness from COVID-19.

According to the guidance received, one way of reducing the risk of exposure to COVID-19 to people who are clinically extremely vulnerable can be for us to divide the people we are caring for into ‘care groups’ and allocate subgroups of our staff team to provide care to each.

Should we decide to do this but be unable to divide our care team into subgroups for each category, we have the option of dividing the care team into two groups:

• one to support the clinically extremely vulnerable
• the other to support ‘clinically vulnerable’ groups and everyone else

Whilst at the moment Devon Home Care has not needed to make such arrangements, we acknowledge that if we were unable to work this way, our local authorities may be able to provide support through their plan to provide mutual aid, and should they be unable to provide assistance, contact can be made with our Local Resilience Forum.

Commissioners, including local authorities and clinical commissioning groups (CCGs), from whom we receive the majority of our clients, would be able to support us with the costs of extra staffing and any other costs incurred during the pandemic, such as the donning and doffing of PPE, the time spent explaining to people with cognitive impairment why masks are being worn, and additional travel costs.

1.3. Reducing contacts for clinically extremely vulnerable and clinically vulnerable people

Should the need arise, and in order to reduce such contacts, we can work with other agencies involved in the health and wellbeing of the people for whom we provide care by developing a multi-agency plan to reduce the number of people going into an individual’s home.

Again, should the need arise, we would:

• work with commissioners, including local authorities and CCGs to identify which people they care for are within the clinically extremely vulnerable category, and in identifying which other agencies are providing care and support
• work with the people identified as clinically extremely vulnerable and clinically vulnerable to understand which other professionals they have contact with, and confirm whether they have received advice to shield or practise social distancing respectively
• identify the priority needs and work with the person, their carer and partners in primary care, commissioning, and other care providers to review the plan for providing care and support across the wider community care team

• • determine the priority health and care needs of the person receiving care and support
  • consider whether the needs currently met by different services can be better met by a single, or reduced number of agencies
  • identify whether staff can perform the duties of other team members or partner agencies when visiting to avoid multiple visits
  • if visits from one or more agencies can be reduced
  • if the number of people seeing the person from within each agency can be reduced

Where it is not possible to allocate specific care groups to specific staff, we can consider scheduling for clinically extremely vulnerable and clinically vulnerable individuals to be seen before people from other categories. Although, it is important to understand that this may not be fully possible given that personal care tasks are often required at similar points in the day.

1.4. Mental health support for staff

Devon Home Care is particularly aware that building trusting relationships and delivering compassionate care are at the heart of home care provision, and that this is emotionally challenging work.

We know too that the difficulty of the circumstances that people are working under at the current time are unprecedented and so we want our carers to feel they have somewhere to turn, or someone to talk to, when they are finding things difficult.

Accordingly we make our team aware that they can send a text message with ‘FRONTLINE’ to 85258 to start a conversation. This service is offered by Shout and is free on all major mobile networks and is a direct support for those who may be struggling to cope and need help.

The Samaritans too has extended its confidential emotional staff support line to all social care staff who might be feeling increasingly stressed, anxious or overwhelmed. This service offers carers the opportunity to speak with a trained volunteer who can help with confidential listening and signposting to further support. To access this support, our carers can call 0300 131 7000

In addition Hospice UK has extended its bereavement and trauma line to provide support to social care staff. This service offers a safe space for care workers to talk to a professional if they have experienced bereavement, trauma or anxiety as a result of the COVID-19 pandemic. To access this support our carers can call 0300 3034434

1.5. Additional help

Guidance is being updated frequently for social care, and with it the need to make it easy for frontline staff to access. A new CARE branded website and app, CARE Workforce, has therefore been developed in partnership with NHSX and NHS BSA for carers, aimed at providing timely information and signposting to support.

It contains a range of resources to help individuals and care teams manage in this new situation, understand what they might need to be doing differently to support each other and pay attention to their mental and physical wellbeing.

The site contains bitesize videos as well as guides to help staff access the information quickly. Guidance to support and maintain the wellbeing of those working in adult social care has also been published on GOV.UK. It provides advice and resources on maintaining mental wellbeing and how we can take care of the wellbeing of our staff during and beyond the COVID-19 pandemic. This resource can also be accessed on the CARE Workforce app.

2.1 Business continuity planning

All local areas are required to have arrangements in place for responding to emergencies under Civil Contingencies legislation. These specify the roles of the different agencies involved and who takes responsibility for what.

In relation to adult social care, the lead role in responding to incidents is with the Local Authority. As more people will now be living at home with COVID-19 and those who have been hospitalised with the virus will be increasingly discharged from hospital, the strategic co-ordinating groups of the Local Resilience Forum will be working with, and responding to, unresolved issues from Local Authorities, Clinical Commissioning Groups and Safeguarding Adults Boards (SABs).

These organisations are responsible for the relevant Category 1 and 2 responders (for example, CCGs) collaborating to support home care providers adequately, especially concerning their staffing levels; infection control practice and access to PPE, and the role of the Local Resilience Forum is to support the stabilisation and recovery of home care and care home providers

 2.2 Social care recruitment

An essential element in reviewing and updating our Business Continuity Plan is the maintenance of our continuous social care recruitment programme. Although we are proud to acknowledge that the majority of our new care team members come to us from personal recommendation, we nonetheless seek to continuously promote and recruit new carers through social media activity and participation in programmes such as the CARE campaign.

In turn the government is supporting our workforce needs through its social care recruitment campaign, encouraging job seekers to work in the care sector and giving access to free initial training. This campaign highlights the vital role that the social care workforce is playing during a pandemic, along with the longer-term opportunity of working in care.

It targets returners to the sector, as well as new starters who may have been made redundant from other sectors, and those able to take up short-term work (including those who have been furloughed) by directing people to the national campaign website which links to advertised social care jobs on its Find a Job site.

In addition we benefit from the Join Social Care website to fast-track recruitment into the adult social care sector. This website allows candidates to access free training via Skills for Care and be considered for multiple job opportunities and streamlines the recruitment process for candidates and employers.

2.3 Training to support those moving into the social care workforce

Continuity of employment is the key to continuity of business, and training to support those moving into social care as well as those already so employed is essential.

Accordingly, a priority is for all carers to achieve the Care Certificate with training available from Skills for Care, the use of which makes it easier for us to access rapid online induction training for new staff.  This in turn is part of Devon Home Care’s own full training programme to enable carers to progress to further qualifications.

Such formal and programmed training is vital for the successful recruitment, retention and development of staff and is therefore an integral part of our maintenance of the continuity of business strategy.

2.4 DBS checks 

All our carer team must now hold a current Enhanced Disclosure Notice issued by the Disclosure and Barring Service.

To obtain such an Enhanced Disclosure Notice requires an application to be made to the DBS, together with the payment of a fee by the person making the application.

Notices are then issued by the DBS after they have checked the details provided against their national database, and because our work involves providing care for adults, these checks include particular reference to POVA, or the Protection of Vulnerable Adults.

To enable applications to be made for such a Notice from the DBS, we use what is called an “Umbrella Organisation”. This is an agency that is recognised by the DBS and that specialises in processing such applications on behalf of companies such as ours.

The first step for our carers is to complete and sign the DBS application form we provide and return it to our offices. They are then issued with a unique user-name and password to enable them to process their application on line with the agency.

This can be done either in their own home or in a private location within our offices, whichever is preferred by the applicant. The application process is then usually completed within four to five working days of the application.

Any fee paid for the application is then refunded to the carer after three months of working for the company.

2.5 Financial monitoring for continuity 

Continuity in business can only be achieved if there is financial stability, and never more so than in a pandemic when so many businesses that provide essential services to our own business are no longer able to operate as normal.

Devon Home Care achieves such financial stability by thoughtful monitoring, reviewing and updating of the company’s finances on a regular ongoing basis.

Careful budgeting and monitoring progress against financial targets ensure that the company’s expenditure is carefully controlled, and its revenue is maximised.

It should be noted that built into such budgeting, controls and targets are facilities for bonuses to staff.

Such bonuses are designed to provide both a reward and an incentive.  A reward for not only the hard work now involved in providing safe care for vulnerable people in the midst of a pandemic, but also for the retention of good staff as an incentive to remain with the company and providing an extra inducement for new staff during recruitment in a fiercely competitive employment market.

3.1 ENSURING ALL RELEVANT GUIDANCE IS IMPLEMENTED 

3.1.1 Reducing contact between staff

To reduce contact between staff:

• team meetings and handovers are now held remotely wherever possible
• we provide a high level of support and a focus on staff health and wellbeing during this unprecedented time, and access to staff support initiatives is available if required through the Adult Social Care Action Plan
• teams and individuals now have remote access to regular supervision
• remote, secure sharing of information relating to care between other agencies and commissioners is utilised, if necessary, through NHSmail, or other secure email systems.

3.1.2 Managing our clients safely

Decisions about reallocating tasks or reducing visits are made with:

• due consideration of the wishes and feelings of the person and unpaid carers, such as relatives, in line with a personalised care approach
• agreement with partner agencies and commissioners that the reduction balances the risks of reducing care with that of potential transmission
• understanding that if a person receiving care wishes to suspend their care, the organisation with responsibility for developing the care plan should be alerted
• accepting that all involved parties should work together to agree whether such a suspension is an appropriate step, and what can be done to ensure the person has access to essentials throughout this period, for example food, medicines etc.
• understanding that it is important to understand the reasons behind the request to cease care and to provide reassurance around precautions taken to reduce the risk of transmission.
• accepting the need to assess the risks posed by a reduction or suspension of visits, and if there is concern about the risks, or the capacity of the client to make this decision, advice from the commissioning authority would be sought
• accepting that if the person receiving care is self-funding, it still may be necessary to contact the local authority and others for advice.
• understanding that there is further guidance available on how the Mental Capacity Act applies to a person’s ability to make decisions about receiving care, and that if it is considered that someone may be making this decision on behalf of an individual, and not acting in their best interest, contact should be made with the local safeguarding team
• accepting that if not all care tasks for people receiving care and support from the service can be delivered due to our own staffing capacity, interventions should be prioritised for those identified as highly vulnerable if they do not receive care.
• recognising also that where care is commissioned by the local authority then this must be the decision of the local authority in partnership with the client in accordance with Care Act Easements guidance and the ethical framework for social care
• accepting in this instance that mutual aid support should also be urgently sought from the local authority and escalated to the Local Resilience Forum if required; and additionally that the incident should be reported in CQC’s ‘Update CQC on the impact of COVID’ online form.

3.1.3 People who are ‘clinically vulnerable’

This group will already have been advised to follow social distancing guidance and so we will undertake a review of our caseload lists to identify people aged 70 years or over, and those with long-term health conditions of any age.

This group includes:

• people aged 70 or older (regardless of medical conditions)
• people under 70 with an underlying health condition listed below (anyone instructed to get a flu jab each year on medical grounds):
  • chronic (long-term) mild to moderate respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis
  • chronic heart disease, such as heart failure
  • chronic kidney disease
  • chronic liver disease, such as hepatitis
  • chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), or cerebral palsy
  • diabetes
  • a weakened immune system as the result of certain conditions or medicines they are taking (such as steroid tablets)
• people who are seriously overweight (a body mass index (BMI) of 40 or above)
• pregnant women

and in addition, particular attention to clients who are hospital discharges.

4.1 Government support for social care

On 18 April 2020, the government announced £1.6 billion of new funding for councils, in addition to the £1.6 billion provided in March. This takes the total funding provided to councils to over £3.2 billion, which councils can use to address pressures produced by COVID-19 including in adult social care. As sum of £850 million has also been brought in social care grants to councils to help with cashflow.

On 14 May 2020, an additional £600 million was announced to support providers through a new infection control fund. The fund will support adult social care providers such as ourselves to reduce the rate of transmission in and between care homes and support wider workforce resilience. This will be allocated to local authorities and is in addition to the funding already provided to support the adult social care sector during the COVID-19 pandemic.

Information Collection and Governance 

5.1. How information and data will be collected 

To enable us to understand the impact of COVID-19 on our clients, our workforce and our ability to deliver services, we need to collect data to ensure resources are targeted most effectively where they are needed.

This will mean that homecare providers such as ourselves complete CQC’s ‘Update CQC on the impact of COVID’ online form to be available to Shared Lives services, Extra Care and Supporting Living services.

5.2 CQC Monitoring

To ensure the national system can deal with unprecedented pressures, local authorities need to have the strongest possible intelligence about emerging risks to continuity of service, and at the centre CQC needs to have robust information about risks to enable a national-level response where necessary.

Accordingly, CQC has developed a tool for home care providers to update daily about the impact of COVID-19 on their service. This will support Local Resilience Forums and local authorities to direct mutual aid to providers where needed.

5.3 What to do if someone being cared for develops COVID-19 symptoms

If anyone for whom Devon Home Care provides care is reported to have developed COVID-19 symptoms, they would be supported and advised to contact NHS 111 via telephone, or online.

In addition, our carers will report any suspected cases of COVID-19 to the Care Manager and where we are working with community partners or commissioners, they will be contacted to review and assess the impact on their care needs.

Suspected cases of COVID-19 will also be reported in CQC’s ‘Update CQC on the impact of COVID’ online form.

5.4 Clinically extremely vulnerable people and care groups

If, as a result of testing, we are contacted, the following information may be requested at short notice:

• the dates and times that the carer or carers is at work
• a log of the carers visits to individuals receiving care for the previous 21 days, including, where possible, arrival and departure times of their visit, as well as a record of the name and addresses of the clients visited
• the names and telephone numbers of other carers, when working in close proximity, for example, during a ‘double up’ visit
• the name, telephone number and address of any clients for whom that carer provided care
• the name and telephone number of the client or the client’s representative
• the name and telephone number of the client or the client’s representative
• advise NHS Test and Trace of these records where it is necessary
• all confirmed and suspected cases of COVID-19 will be reported daily in CQC’s ‘Update CQC on the impact of COVID’ online form.

6.1 COVID-19 testing for carers and clients

Anyone experiencing coronavirus symptoms can now be tested and can be accessed through the digital portal, or by calling 119 to book testing.

Every carer who needs a test can access one, as confirmed in the government’s Adult Social Care Action Plan, and Devon Home Care has a supply of testing kits available for use as required.

If, as one of our carers, a COVID-19 test is needed because they have symptoms of COVID-19, they will be self-isolated and will be able to access testing through the self-referral or employer referral portals found on www.gov.uk/coronavirus.

6.2 How we can support the NHS Test and Trace service

NHS Test and Trace is a key part of the government’s COVID-19 response. If as social care providers we can rapidly detect people who have recently come into close contact with a COVID-19 case, we can take swift action to minimise transmission of the virus.

Devon Home Care is able to assist NHS Test and Trace by keeping records of our care staff and our clients, and can provide this information on request.

Staff from NHS Test and Trace or other public health professionals can therefore contact us if one of our staff or clients has tested positive for coronavirus in order to alert those who have been in close contact with them.

7.1 Personal Protective Equipment (PPE)

The most recent guidance from Public Health England on the use of PPE can be found on GOV.UK.

7.2 Getting the right PPE

Although PPE supply has been an issue globally, including for many home care providers, we acknowledge that work is undertaken nationally to ensure staff on the front line such as our carers can do their job safely.

The government will continue to make PPE available for distribution by the LRFs to meet priority needs, and our PPE stock levels are reported in CQC’s ‘Update CQC on the impact of COVID’ online form.

If therefore we are unable to obtain PPE through our usual suppliers however and there remains an urgent need for additional stock, we are able to approach our Local Resilience Forum (LRF). The short-term supply of critical PPE they can then arrange is intended to help us respond to any urgent local spikes in need in line with clinical guidance.

7.3 National Supply Disruption Response

If however our LRF is unable to supply, we can also contact the National Supply Disruption Response (NSDR) system to make an emergency PPE request by calling 0800 915 9964.

Whilst the NSDR does not have access to the full lines of stock held at other large wholesalers or distributors, it can mobilise small priority orders of critical PPE to fulfil an emergency need.

If a call needs to be made to the NSDR hotline, then the following information will be requested:

• our name, email and telephone number
• name, email and telephone number of a contact for the next 24 hours (for example, out-of-hours cover if the original requestor will be unavailable)
• delivery address, including postcode, and named contact for receiving deliveries
• confirmation that our organisation is able to receive the delivery outside of normal business hours
• number of people with COVID-19 being treated, both confirmed and suspected
• how long our current PPE stock provides cover for, for example, less than 24 hours, 1 to 2 days, or more than 2 days
• which products we are requesting and in what quantity
  

Encouraging and Enabling

Devon Home Care will continue to proactively encourage and enable both clients and our care team to receive free relevant vaccinations and report their uptake accordingly.

In addition we will continue to make them aware that during the current pandemic we will be regularly assessing our precautions, procedures and systems to ensure that we provide the best possible protection and control by use of our Covid19 Risk Assessment,

This asks:

• what are the hazards?
• who might be harmed and how?
• controls
• what further action do we need to consider to control the risks?
• who is responsible and needs to carry out the assessment?
• when is the action needed by?