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Introduction

The Deputy Minister for Health and Social Services set out 6 themes in July that would be considered over the summer to support care homes. The themes encompass work being undertaken with our partners including Regional Partnership Boards who have identified specific support they will deliver to care homes in their areas. These themes are:

  1. infection prevention and control
  2. personal Protective Equipment (PPE)
  3. general and clinical support for care homes
  4. residents’ well-being
  5. social Care workers’ well-being
  6. financial sustainability

The Care Homes Action Plan sets out our high-level actions under these themes to ensure the care home sector is well supported throughout the winter, learning lessons from the COVID-19 pandemic. This plan is a component of our overarching Welsh Government Winter Protection Plan. 

The table summarises the progress that has been made – and that we are continuing to make - against the high level actions in the plan.

Infection prevention and control (IP&C)

Table 1

Table 1
Initial action and progress Next steps Target date

We will develop a clinical contingency template and will provide further advice and support for individual care homes to complete the template, to enable their whole team to prepare for the management of any further infections in the home. The template, which will include environmental and staff management (minimising staff movement), personal protective equipment (PPE) and testing of care home residents and staff will enable care homes to consider their own resident group, staff group, environmental layout and service delivery. 

We have worked with colleagues from the Nosocomial Transmission Group to develop an Infection Prevention and Control Checklist for the management of COVID-19 in care homes. This has been signed off by the group and consideration is now being given to the logistics of rolling out the checklist to care homes, and ensuring providers are supported to complete it for their individual premises.

Vaccination of our vital social care workers (i.e. care home staff and domiciliary care workers) and care home residents will be paramount to minimise infection transmission. 

A COVID-19 vaccination programme has commenced and all care home staff have received invitations to have the vaccine. We are currently working with health and social care partners to determine how the vaccine can safely and effectively be rolled out to residents.  

We will be starting to deliver some vaccine to care homes this week and if all goes well, we will roll out care home vaccination at greater pace ahead of Christmas and bring a new level of protection to some of our most vulnerable people.

We will continue to work with partners on the vaccination programme for care home residents and staff. The next set of vaccines, which we hope will be approved by the Medicines and Healthcare products Regulatory Agency within the next few weeks, can be transported and stored at more manageable temperatures than the current Pfizer/BioNtech vaccine and will offer more flexibility in vaccinating care home residents and staff.  

End of 2020/early 2021.

Ongoing

We will continue to work with the Nosocomial Transmission Group, chaired by the Deputy Chief Medical Office.

Regular communication and support for care homes is essential. We have continued to work with the Nosocomial Transmission Group to raise awareness and provide training, guidance and support to care homes.

An IP and C training task and finish group has been developing consistent COVID-related training materials across health and social care, reporting to the Nosocomial Transmission Group. Short and longer term support is being considered. Current advice and guidance is shared across the social care sector as it becomes available. A draft training strategy has been developed and views are being sought sought from members of the health, social care and childcare sectors via a survey.

We also introduced the COVID-19 Statutory Sick Pay enhancement scheme on 1 November. This provides funding for care workers, ancillary staff and agency staff in care homes to receive full pay when they should stay off work to protect residents in the following circumstances:

  • Experience possible symptoms of COVID-19
  • Receive a positive test result
  • Contacted by TTP
  • Required to self-isolate as household member has symptoms or tested positive

Providers can claim the cost of employer’s National Insurance and pension contributions, and a small administration fee, to support the scheme. We have held several large online events to explain and respond to queries about the scheme, which is managed by local authorities on our behalf.

Further guidance was issued to local authorities and providers on 14 December.

 

Publication of final training strategy

Further online events with local authorities, providers, agencies and unions to further embed the scheme to be held w/c 21 December. 

January 2021

December 2020

We will set out the ongoing arrangements for testing care home residents and staff in line with scientific evidence as it emerges.

A national testing programme is in place for care homes which includes regular asymptomatic testing for all care home staff and whole home testing (including residents) where an outbreak occurs. Bespoke local testing arrangements will be developed and implemented to respond to the needs of local communities. Guidance has been issued to Incident Management Teams to support good governance in local decision making in relation to testing approaches for social care.

Testing has been piloted in 10 care homes across Wales to enable indoor visiting. This is being rolled out to all care home from the 14 December.

We will monitor prevalence rates in care homes and communities closely and the testing programme will be amended accordingly. 

We will continue to update care homes on the arrangements for testing residents, staff and visitors in line with emerging scientific evidence.
 

 

Ongoing

Personal protective equipment (PPE)

Table 2
Actions and progress Next steps Target date

We continue to supply PPE free to the social care sector. 

Our position remains strong as we continue to supply PPE free to the social care sector 
 

We will ensure sufficient PPE continues to be made available, free of charge, for all care homes in Wales during the pandemic.

Ongoing

We are exploring the PPE procurement arrangements across the social care sector to better understand supply patterns and products to ensure longer term security of product availability. 

Public sector partners including the Association of Directors of Social Services Cymru (ADSSC) meet regularly with Welsh Government to consider policy, demand, procurement and distribution of PPE.

We have put in place a Service Level Agreement (SLA) between the Welsh Local Government Association (WLGA) and NHS Wales Shared Services Partnership (NWSSP) to provide PPE for Social Care within local authority areas including private, independent and third sector providers. The SLA continues to deliver sufficient, timely, free PPE for all social care providers.

Work with  Directors of Social Services to determine current PPE levels within care homes and at their Joint Equipment Stores (JES), and whether this provision will be enough to support visitors as well as staff.  Following the outcome of these discussions we will review the position with NWSSP and PPE Sourcing and Distribution Group to determine if adjustments to local PPE delivery quantities is needed.

December 2020

We are considering whether a digital recording system will aid the request and receipt of specific PPE items.

We have continued to work with NHS Wales Shared Services Partnership (NWSSP) on the implementation of a nationwide electronic stock management system called Stockwatch for the provision of PPE for the social care sector to enable real-time stock levels to be monitored and used to inform regular deliveries. The system is intended to be more responsive to local demand, and will help us ensure that local authorities can maintain their distribution appropriate PPE supplies to social care providers at sufficient levels to protect staff and the vulnerable individuals they care from COVID-19.

Data input will initially be undertaken by NWSSP with a plan including training and support to migrate data input responsibilities to JES personnel. Training has now been completed. We have monitored the implementation of the Stockwatch system.

We will continue to support JES staff directly as well as via local authority contacts to ensure that all JES effectively use the e-system.

 

December 2020

General and clinical support for care homes

Table 3
Actions and progress Next steps Target date

We will review the general and clinical support provided to care homes for adults in Wales between July and September this year to identify areas of best practice and lessons learned ahead of winter pressures. 

We commissioned Professor John Bolton, a consultant in adult social care, to undertake a rapid review of care homes’ operational experience during the COVID-19 pandemic between July and September. A national report was published in October 2020 to ensure learning was shared across Wales.
Recommendations resulted in the development by Regional Partnership Boards of their own bespoke care home action plans to ensure support is tailored to meet local need.

Progress in implementing the 7 regional care home action plans shows a significant shift in the level of support that is being provided to care homes. There is increased partnership working and communication with care homes with the sector represented at a strategic level within many RPBs. Sharing of good practice and lessons learnt is also a common feature. Areas of particular support include:

  • Addressing staff shortages
  • Infection prevention and control
  • Discharge planning, including the provision of intermediate care beds
  • Access to PPE
  • Staff and resident well-being (including training, testing, flu vaccinations

There is also acknowledgement of the need to continue to support the sector financially both now and in the future, including work on sustainable fee levels and regional modelling of market stability. 

It is apparent that the on-going pandemic and the reactive demands on service delivery in supporting care homes with testing and infection prevention and control in particular, has meant it has been challenging at times to take planned work forward in a timely way. Staffing issues in care homes and supporting them with infection prevention and control were highlighted as particularly resource intensive.

A further report on progress against the 7 regional care home action plans from the Regional Partnership Boards (RPBs) will be sought. 

March 2021

Support for care homes is noted as a key milestone for NHS quarter 3/4 reporting under the primary and community care priority, which is one of the six priorities identified by Health Board Directors of Primary and Community Care and agreed by the National Primary Care Board and the Welsh Government’s Primary and Community Care Recovery Oversight Group.

The Strategic Programme for Primary Care published a Care Home Framework in October 2020, looking specifically at the role of Health Board Primary and Community Health Services. This was co-produced with sector providers and seeks to complement the other actions in the care home action plan. Through the Care Home Collaboration meetings and the National Commissioning Board, wider stakeholders have also had the opportunity to input.  

Health Boards will assess their provision against the framework with a view to adopt, adapt or justify.  

Ongoing

Care home residents’ wellbeing

Table 4
Actions and progress Next steps Target date

We will ensure care home residents have the opportunity to share their experiences of living in care homes during the COVID-19 pandemic.  

We considered a range of reports and information gathered such as those from the Older Person’s Commissioner for Wales, Care Inspectorate Wales and other stakeholders to understand residents’ experience during unprecedented lockdown measures.  Based on this analysis we have asked Age Cymru, All Wales People First and Voices from Care to engage with older people, younger adults and children who live in care homes to ask them about their experience during the pandemic and, in particular, what has supported their well-being during this time. 

The results of this engagement will be shared with our partners as soon as they are available to ensure that they can effectively engage directly with residents of care homes.

We will work with partners to produce a good practice guide to promote well-being which takes into account what matters to care home residents, based on their own experiences. 

March 2021

We will ensure care home residents are supported to maintain contact with their friends and family. We will continue to keep our care home visitor guidance under review, making changes as necessary.

We are aware that the restrictions on visits in particular have been extremely difficult for residents and their loved ones. The decision to restrict visiting was not taken lightly and was considered necessary during the peak to protect people from the risk of COVID-19. Visiting advice may need to change rapidly as information about virus transmission becomes available.

 

 

 

 

 

 

 

 

 

 

 

 

To support residents to connect with their loved ones in other ways we funded Digital Communities Wales to purchase and distribute over a thousand digital devices to care homes across Wales. 

We will continue to work with our stakeholder group to keep our care home visiting guidance under review. 

We will continue to promote a rights-based approach to visiting and ensure the balance is struck between protecting residents from COVID-19 and promoting the health and well-being of care home residents through vital contact with loved ones. 

We will continue to work with care homes to maximise appropriate opportunities for visits, including over the Christmas period.

 

We will continue to progress our pilot scheme to provide visiting pods, free of charge to care home providers for a 6 month period.  The first visiting pods have now been delivered and we will continue working with the sector, and suppliers to have more in place before Christmas.

We will continue to progress our separate scheme to support those providers that choose to source their own visitor pods.
 
We will consider the effectiveness of the Digital Communities Wales project for care homes when the evaluation is completed.

Ongoing

 

 

Ongoing

 

 

 

Ongoing (FAQs for Christmas visiting – December 2020)

December 2020

 

 

 

Ongoing

 

 

December 2020

We will ensure care home residents receive the care and support from professionals in the most appropriate way, either via technology or in person. 

GP support has been enhanced by the “Attend Anywhere” video consultation service which is now being made available free of charge for widespread adoption in secondary care across Wales, including care homes.

Revisions have been made to the Care Homes Directed Enhanced Service (DES) to refocus GP support to care home residents.  The DES was introduced in July 2020 and is time limited, focused on GP support during the pandemic particularly through the winter period. The main aims of the DES are to:   

  • Optimise access to primary medical care for care home residents 
  • Enable urgent access to primary medical care advice for care home staff  
  • Continue provision of pre-emptive proactive and anticipatory care 
  • Promote a high quality consistent approach across health boards whilst at the same time being flexible enough to be adopted by clusters or individual practices 

85% of practices across Wales have signed up to the DES to date.

We will work with partners to identify and share good practice.

The Cwtch project has offered a platform for care homes to share best practice and self-manage some of the challenges of providing care through the pandemic, as well as offer peer support. 

We have facilitated a series of care home collaboration meetings for professionals supporting care homes to come together to share practice, avoid duplication, complement one another’s work, identify gaps and work together to develop solutions. 

An evaluation of this time limited DES will be undertaken in the Spring but in the meantime we will continue to monitor uptake and implementation of the DES to ensure care homes get access to the GP services they need. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

We will continue to encourage projects funded via our Third Sector Sustainable Services Grant to extend their support to older people living in care homes and their carers.

Ongoing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ongoing

Social care workers’ well-being

Table 5

Initial actions and progress Next steps Target date

We are continuing to develop a broad range of provision from online and virtual face to face support to suit the variety of ways that staff may prefer to seek support at this sensitive time. We will publish the range of support available to social care staff on the Social Care Wales website alongside the existing offer of learning and improvement resources. Materials for distribution at care homes will be included. 

Details of the emotional well-being support available to social care workers was collated and a road map to signpost social care workers to specific resources was published on Social Care Wales’ website at: https://socialcare.wales/service-improvement/health-and-well-being-resources-to-support-you-during-the-coronavirus-covid-19-pandemic

An Employee Assistance Programme providing health and well-being support, including one-to-one counselling for all social care staff across the sector was launched in early December. This scheme is being managed by Social Care Wales as part of its wider package of wellbeing support for the workforce

We will continue to promote the availability of the package of wellbeing support to social care workers and their employers through a series of mailings of promotional materials (both electronic and traditional) and webinars 
 
Ongoing

We are monitoring the implementation of the COVID-19 workforce risk assessment tool for social care workers providing seminars to support its use over the summer. 

An All Wales COVID-19 Workforce Risk Assessment Tool has been developed which helps workers consider their personal risk factors for COVID-19 and suggests how to stay safe. Support for the social care sector to use the tool has included good practice webinars, a social care champion’s network, FAQ and animation. The tool is available at: https://gov.wales/covid-19-workforce-risk-assessment-tool

We continue to evaluate the use and effectiveness of the tool via the First Minister’s COVID-19 Social Care Implementation Group. 

December 2020

 

We will work with our partners to identify any further specific support required for our valuable social care workforce

A well-being network, made up of key stakeholders from across the sector, has been established, coordinated by Social Care Wales. 

The well-being network meets monthly and continues to identify support that maybe needed for social care workers. Ongoing

Financial sustainability

Table 6
Actions and progress Next steps Target date

We will consider the specific costs care home businesses have incurred together with the measures and actions that were effective in alleviating financial pressure. 

We have been considering the specific costs that care home businesses and other adult care providers have been incurring throughout the pandemic. As a result around £68 million to date has been made available to local authorities to assist adult care providers with the additional costs in delivering social care they have faced as a consequence of the pandemic. This is in addition to over £22 million that has been made available to health boards to assist care homes and other adult care providers with the additional costs they have faced in delivering healthcare. 

Providers may continue to face financial pressures due to COVID-19 for some time to come, which may well be exacerbated during the winter. As a result the Minister for Housing and Local Government recently announced an additional £264 million for local authorities for the remainder of 2020-2021 for COVID-19 related costs, which includes further funding to support adult social care providers. Alongside this the Minister for Health and Social Services has recently confirmed a further £22 million until the end of 2020-21 for health boards to similarly continue support for the additional costs in relation to healthcare, care homes and other care providers will face.

We will continue to monitor the financial pressures experienced by care homes and other adult care providers.  

Ongong monitoring

We will review the range of support and funding made available to care home businesses through a variety of mechanisms across Welsh Government departments and the impact they have had on improving sustainability during the Covid-19 pandemic.

We have reviewed the range of financial and support mechanisms put in place. The funding and support provided by Welsh Government included:

  • A free service from Business Wales that provides impartial, independent support and advice to businesses
  • Nearly £1m in grant funding via the Economic Resilience Fund to support businesses forced to temporarily cease trading
  • The £100m COVID-19 Wales Business Loan Scheme announced by Welsh Government and the Development Bank of Wales to support businesses that experienced cash flow difficulties as a result of the pandemic
  • £44 million initial funding and £24 million subsequent funding for adult social care within the Local Government Hardship Fund to support local authorities to maintain their commissioned and in-house adult care
  • £100m funding made available through the Transformation Fund for projects that demonstrate integrated models of health and social care
  • An additional £264 million for local authorities for the remainder of 2020-2021 for COVID-19 related costs which includes further funding for social care providers.

Lessons learned from the use of these funds will assist consideration of long term measures to improve the sustainability of the sector.

We will evaluate relief provided by the range of funding mechanisms we have made available.

 

March 2021

We will review the experience of organisations which established temporary services to provide additional social care surge capacity and identify lessons on issues such as cost and accommodation management. 

We have reviewed the experience of organisations which set up temporary, emergency residential care to respond to predicted pressures. Five local authorities developed additional provision. We have worked with them to understand the lessons learned on cost and accommodation management. 

  Complete

We will consider the experience of any care homes that required contingency support to continue operating. We will develop a decision tree tool for those at risk of business failure or closure to assist in identifying and resolving key issues.

A decision tree was developed and issued to Directors of Social Services to support their care home contingency planning. Similar action was undertaken by health boards in relation to specific contingency planning for care homes with nursing. 

Local authority and health board contingency planning shows that there is a clear approach across Wales to supporting care homes to remain operational during the pandemic wherever possible and that systems are in place to identify care homes who are experiencing difficulty.  In the event of provider failure plans are in place setting out a robust process in response.  There is clear evidence of partnership working at a regional level between local authorities, health boards, housing and third sector partners and this has been demonstrated in the way that health boards and local authorities have provided additional emergency staff cover to those homes that have experienced significant unforeseen temporary staff absence.

The additional funding provided by Welsh Government to support the financial sustainability of care homes during COVID-19 includes an element to enable local authorities to assist care homes with the financial consequences of voids they may be experiencing as a consequence of COVID-19. 

We will continue to review progress with contingency planning by local authorities and health boards 

Ongoing
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