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Introduction

The Deputy Minister for Health and Social Services set out six 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 ahead of winter pressures, 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
Initial action and progress Next steps

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.

The IP&C contingency template is currently being finalised, informed by expert stakeholders on the Nosocomial Transmission Group.  It is anticipated that individual care homes will be supported to complete the template by Local Authority Environmental Health Officers and community IP&C teams.  Once completed this template will support homes in ensuring strong IP&C arrangements are in place, including in relation to the movement of staff, tailored to the specifics of the individual premises.

We will share the clinical contingency template with care home providers and details of assistance that will be available to aid completion. Target date: October 2020.

Vaccination of our vital social care workers will be paramount to minimise infection transmission. Health and social care partners are considering how they will deliver an influenza and Covid-19 vaccination programme for the social care workforce.We will receive assurance of the vaccination delivery arrangements for the social care workforce in each region in early October and monitor implementation.

Target date: early October 2020.

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

An IP&C training task and finish group is 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 for example PHW guidance for care homes and further correspondence on minimising staff movement in care homes was issued in August. Information is shared directly via Care Inspectorate Wales care home distribution list and other well established sector mechanisms such as the Association of Directors of Social Services Cymru (ADSSC) sector wide newsletter and provider leaders.

Regular communication and support for care homes is essential.

We will continue to work with the Nosocomial Transmission Group to raise awareness and provide training, guidance and support to care homes.

Target date: ongoing.

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.

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 and staff in line with emerging scientific evidence.

Target date: ongoing.

Personal protective equipment (PPE)

Table 2
Actions and progress Next steps
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.

Target date - 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 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.

 

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

We are working with NHS Wales Shared Services Partnership (NWSSP) on the implementation of a nationwide electronic stock management system for the provision of PPE for the social care sector.

Participation of the 11 Joint Equipment Stores (JES) across Wales will 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.

We will monitor the implementation of the 'Stockwatch' PPE inventory management system which will be deployed by NWSSP across all JES. Data input will initially be undertaken by NWSSP with a plan including training and support to migrate data input responsibilities to JES personnel.

Rollout commences October 2020

General and clinical support for care homes

Table 3
Actions and progress Next steps

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. 

The review included analysis of a large number of interviews, focus groups, learning reports and regional seminars where experience of those commissioning, operating and supporting the delivery of care in care homes was explored and good practice shared. Recommendations considered by the RPB’s resulted in the development of their own bespoke care home action plan to ensure support is tailored to meet local need.

A national report has been completed.

We will seek a report of progress against the 7 regional care home action plans from Regional Partnership Boards (RPB’s) 

Target date - November 2020

We will publish the national report to ensure learning is shared across Wales.

Target date - completed.

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.

We will work with the National Strategic Programme for Primary Care regarding the development of a care home framework for primary and community care provision for care homes.

Target date - November 2020.

Care home residents’ wellbeing

Table 4
Actions and progress Next steps

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 commissioned the third sector to engage directly with care home services and are currently awaiting feedback.   

We will continue to explore with our partners ways to effectively engage directly with residents of care homes.

Target date - ongoing

We will share what residents tell us matters to them to assist their wellbeing.

Target date - December 2020

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 (DWC) 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. 

Target date - ongoing

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 wellbeing of care home residents through vital contact with loved ones. 

Target date - ongoing

We will continue to work with care homes to maximise appropriate opportunities for visits. 

Target date - ongoing 

We will consider the effectiveness of the Digital Communities Wales project for care homes when the evaluation is completed.

Target date - December 2020.

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. 

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

Target date - ongoing

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 wellbeing of care home residents through vital contact with loved ones.

Target date - ongoing.

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

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. 

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. 

Target date - ongoing.

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.

Target date - ongoing

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. 

Target date - December 2020

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.

Target date - ongoing

Social care workers’ well-being

Table 5
Actions and progress Next steps

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 wellbeing 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 

An Employee Assistance Programme for social care workers who do not already have access to such a scheme will be established and managed by Social Care Wales.

Tender issued September 2020. Anticipated completion date – December 2020.

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. 

We will evaluate the use and effectiveness of the tool via the First Minister’s COVID-19 Social Care Implementation Group. The tool is available https://gov.wales/covid-19-workforce-risk-assessment-tool

Target date - November 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.

Target date - ongoing.

Financial sustainability

Table 6
Actions and progress Next steps

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 considered the specific costs that care home businesses have incurred throughout the pandemic. 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, this includes further funding for social care.

We will continue to monitor the financial pressures experienced by care homes. 

Target date -  ongoing 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
  • £40 million initial funding and £22.7 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.

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.

Target date - 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. 
 

Completed

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 has been developed and issued to local authority directors of social services to support their care home contingency planning. Similar action is being undertaken by Health boards in relation to specific contingency planning for care homes with nursing. 

We will review the progress with contingency planning.  

Target date - October 2020

 

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