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Care Home Resilience Plan – Lincolnshire's Response to Covid-19 This document sets out the joint response to Covid-19 and the support provided to the Care Home sector to date, including future plans. Section 1 – Summary

Financial Support

Annual rate uplift for Financial Year 2020/21 to take account of inflationary cost pressures

Guaranteed minimum payments – based on average of last 3 months invoices

Service Sustainability Fund to Support Additional Covid Related Costs

Additional payment runs

Finance support to non-commissioned homes

Infection Prevention Control (IPC)

Dedicated Lincolnshire County Council (LCC) Health Protection Team and NHS Lincolnshire Clinical

Commissioning Group (CCG) Health Protection Team/nurses

Established link practitioner programme

IPC Universal Training Programme – targeted response to the pandemic

Outbreak management surveillance and support

Proactive IPC assurance visits - currently on hold due to the pandemic although most homes received a visit

during 2019/2020)

Reactive IPC inspections - essential visits will still be conducted if significant concerns raised

Advice and guidance

NHS CCG IPC Training Support offer to care homes (face to face or virtual offer)

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Testing for Covid-19

Local Reactive Testing (symptomatic residents)

Testing of symptomatic staff – local solution commenced 9 days earlier than the National Testing Programme

Testing of residents discharged from hospital (see also Hospital Discharge Pathway)

Whole Care Home testing

Personal Protective Equipment (PPE)

Guidance to Care Homes

Access to emergency supplies

Local assessment of PPE usage/supply

Monitoring of stock issues

Establishment of an Approved Supplier List for PPE

Providers supported by Lincolnshire Care Association (LinCA)

Contract Officer Support

Experienced Contract Management Team – aligned to Neighbourhood Teams and CCG localities

Nominated Contract Officers (pre-pandemic)

Regular proactive contact

Seven day working

Dedicated contact number

Proportionate contract management approach

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Hospital Discharge Pathway

Covid-19 Hospital Discharge Pathway for palliative, residential and domiciliary care

7 day & joint working

Support around inappropriate hospital discharges (pre-pandemic) Review of attendance and discharge from A&E

Continuing Health Care provide a service for placement of complex patients from 8am – 8pm seven days a week

NHS CCG Enhanced Care Home Support service in partnership with LCC to support discharge and flow during

Covid-19

Communication

Dedicated email address (pre-pandemic)

Managed communication through regular FAQs/guidance notes

Establishment of a LCC Commissioned Services generic email account for partners to escalate concerns

LinCA Daily Briefing

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Cell Structure & Joint Working

Comprehensive Cell Structure with appropriate representation ensuring the interests of the Care Home sector are

represented

o Commissioned Services Cell

o Health & Social Care Cell

o Discharge and Flow Cell with Palliative Care Delivery Group

o Operational Cell

o Hospital Sub-Group

o Primary Care Cell

Weekly Registered Care Home Managers Meeting

Service Quality Review (SQR)

Updated format to meet requirements of the current situation

Re-focussed to meet current requirements

Establishment of a Commissioned Services generic email account for partners to escalate concerns

Digital Support

Roll out of Whzan, which is technology that allows basic observations to be reviewed and shared with Health

colleagues

Facebook portals have been secured that allow residents to keep in touch with families

Both technologies can support the weekly ward round requirement

NHS.net email addresses for providers

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Workforce Support

New joint project on the External Workforce with LinCA and Skills for Care (SfC)

Care in Lincs website

Strategic Market Support Service Contract

Establishment of a Mutual Aid Team

Assessment of capacity across private sector

Clinical staff within the Lincolnshire Clinical Commissioning Group have accessed update training to increase

workforce capacity if required

Support from Lincolnshire Partnership Foundation Trust (LPFT – our Mental Health Trust), 7 days per week

e-Learning

Data & Intelligence

Risk Matrix

Daily data capture

Dashboard development

NHS Capacity Tracker

IPC Daily Updates for infectious disease outbreaks in Lincolnshire Care Homes circulated to key stakeholders for

dissemination

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Other

Verification of Death Guidance developed by the system (CCG, LCC, LINCA, LMC, LCHS)

St Barnabas & Marie Curie support including a bereavement help line, increased training for management of end

of life via 'Echo webinar forums'

Palliative Care Support and Guidance and advice line from St Barnabas

o Access and advice via the Palliative Care Co-ordination Centre (PCCC)

Additional support for review and completion of ReSPeCT forms and having difficult conversations

o Resources are available here: https://www.eolc.co.uk/

Advice, support and care provision for residential and nursing homes from Lincolnshire Community Health

Service, eg: Diabetes Management, Wound Care and continence

Clinical Assessment Service (CAS) for Care Homes – access to a local clinician for advice to reduce unnecessary

ambulance conveyance to hospital (pre-pandemic)

Information on how to access Child Care for key workers

Summarised legislation changes

Facilitated offer from Bookers Cash & Carry to support Care Homes who experience food supply issues

Primary Care Network meetings which include Social Care representation

LINCA daily briefing, support meetings and education

CCG accelerating the home round, personalised care & support planning and pharmacy & medication support with

Neighbourhood Team Leads/GP Practices/PCNs/LCHS and Care Homes

NHS national purchase of pulse oximeters for distribution in local systems including care homes

Enhanced Health in Care Homes (EHCH) programme (Programme SRO - Associate Director of Nursing & Quality,

Lincs CCG) – to deliver the EHCH framework to provide a guaranteed NHS support offer to all care home

residents and to ensure stronger links between primary care networks and their local care home (system wide

steering group)

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Section 2 - Detail

Financial Support

Annual rate uplift for Financial Year 2020/21 to take account of inflationary cost pressures

o Set and agreed with market in 2018 as part of 3 year framework contract cycle o 2020/21 rate uplift at 3.78% with effect from April 2020

Guaranteed minimum payments

o Average of last 3 months invoices being paid as a guaranteed minimum income for providers on volume based contracts, which includes Care Homes

o If actual activity volume is above the pre-covid average payment level, payment is made based upon actual activity delivered o If actual activity volume is below the pre-covid average activity level, payment is made based at the pre-covid average activity level o Payment frequency continues to be made on the standard 4 weekly payment cycle o Intended to support cash flow and promote financial stability

Service Sustainability Fund to support additional Covid related costs

o Open book approach to reimbursement of additional costs related to Covid-19 incurred by commissioned care homes o Payment runs made weekly upon evidence of actual additional costs incurred to ensure timely support o Focus is on essential business expenditure impacted by the pandemic, including PPE, staffing (including additional agency costs and

overtime payments), Statutory Sick Pay (days 1-4 for organisations with more than 250 employees), and additional cleaning supplies and equipment

Additional payment runs

o Additional costs related to the pandemic are being paid weekly in order to support providers cash flow

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Financial support to non-commissioned Care Homes

o Financial support is also being made available when requested to non-commissioned Care Home providers (of which there are 15, although 13 are connected to organisation who are commissioned by LCC)

o When approached for support by one of these organisations, a financial standing assessment will made by LCC, followed by a proportionate offer of financial support based upon additional costs incurred.

Details of Financial Support Payments to Date

o Up to mid-May we have issued £953k to Care Homes via the Service Sustainability Fund

Infection Prevention Control (IPC)

Dedicated Lincolnshire County Council (LCC) Health Protection Team (HPT) and NHS Lincolnshire Clinical Commissioning Group

(CCG) Health Protection Team/nurses (pre-pandemic) o LCC Health Protection Team made up of 4 full time experienced registered Nurses, Health Protection Programme Manager and a Public

Health Emergency Planning Officer o NHS Lincolnshire CCG IPC team support to LCC team with IPC training & Covid 19 testing in Care Homes with ‘respiratory’ symptom

outbreaks

Link Practitioner Programme (pre–pandemic, in place since Sep 2014) o Contractual requirement – all home to have a nominated Link Practitioner (must attend three out of four sessions annually) o Quarterly IPC sessions delivered face to face in 7 locations across County o Structured programme to facilitate learning and sharing of best practice o 87% of commissioned homes attended one or more Link Practitioner sessions in the year 2019-20

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IPC Universal Training Programme (proposed programme as a result of pandemic)

o The LCC Health Protection Team (HPT) universal IPC training offer will replace the normal Link Practitioner delivery model for the duration of the COVID-19 response. In order to adapt to the unique challenges posed by COVID-19 and the limitations cause by social distancing measures, the universal IPC training offer seeks to maximise engagement with all care homes through the use of digital technologies. A range of digital options are being developed to deliver IPC training that is accessible to all care homes, with a focus not only on delivering content but ensuring that a two-way dialogue can be maintained between the care home and the LCC HPT team to provide direct support and engagement opportunities

o The LCC HPT universal IPC training and support offer will include: Participation in LinCA weekly Webinars – a clinical representative from LCC HPT will participate in weekly webinars held by LinCA

to offer IPC advice & guidance to Care Providers and Registered Managers IPC Podcasts – a series of topical audio-files that users can stream or download to a personal device for easy listening will be

developed IPC Audio-visual Presentations – pre-recorded training sessions that guide the participants through the presentation with

accompanying audio guidance will be made available via our website

Enhanced support to Care Homes Training Offer o Intended to supplement the universal IPC offer, the enhanced training support to Care Homes has been developed nationally in response

to the specific risks that homes are managing as a result of COVID-19. This offer will be delivered in partnership by the LCC HPT with support from the wider Adult Care and Community Wellbeing directorate, as well as mutual aid support from the NHS Clinical Community Response Cell (which includes the CCG IPC team) as outlined in the Second Phase of NHS Response to COVID-19 letter available here.

o The enhanced support to Care Homes offer will deliver one-to-one training with the nominated staff at each home to cover: IPC core principles Personal Protective Equipment (PPE) Donning and Doffing Swabbing techniques for COVID-19 testing

o To ensure that those who would benefit the most can access the enhanced support to Care Homes offer earliest, the LCC HPT within Public Health categorise care homes within Lincolnshire into three categories, with Category 1 homes contacted first. Priority will be given to homes that have already experienced a COVID-19 outbreak, as well as those who may be more at risk of infection (e.g. from increased risk of exposure to the virus or issues/difficulties with infection control practices) and those who would be more vulnerable to severe infection. The majority of Lincolnshire Care Homes will have received this training by 30th May 2020

o The enhanced support to Care Homes offer is closely aligned to the Care Home Testing strategy outlined in the following section.

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Outbreak Management Surveillance & Support (operating 7 days per week since 2014, no change to service during pandemic) o All outbreaks must be reported to the LCC HPT o The role of LCC HPT is to lead the delivery of the health protection response to local outbreaks through:

Initial detection of an incident or outbreak from routine surveillance or ad hoc reporting Initial risk assessment, escalation (if required) and notification of partners Provision of clinical guidance on IPC measures for the duration of the outbreak Establishing special management arrangements, including Outbreak Control Team as required, in liaison with PHE Communicating daily updates (Monday – Friday) to the whole-health economy for infectious disease outbreaks in Lincolnshire Care

Homes, schools, and child-care settings o Maintenance of the Care Home Case Tracker. This document lists all Care Homes that have reported one or more suspected cases of

COVID-19, tracking the number of suspected and confirmed cases amongst care home residents and staff for the duration of the outbreak. The Care Home Case Tracker is shared with the LRF, LCC Commercial Team, and NHS colleagues to inform the common operating picture.

o To date, 64 care homes in Lincolnshire have reported an outbreak. Preliminary analysis of our data indicates that 34 homes managed to keep the proportion of residents affected (symptomatic of Covid-19) under 20%.

Proactive IPC Assurance Visits (Currently on hold due to the pandemic – though most homes received a visit during 19/20) o The IPC assurance visits facilitate a structured approach in the gathering of compliance evidence highlighting areas of good practice and

areas for improvement o Supportive visits undertaken bi-yearly o During 2019/20 a total of 143 IPC inspection visits were undertaken in residential care and nursing homes across Lincolnshire o Bespoke support & additional training given in where need is identified o IPC Assurance Framework, launched 2017

Reactive IPC Inspections (essential visits will be conducted if significant concerns raised)

o IPC inspection to seek assurance of compliance of 10 criteria set out in Health & Social Care Act

Advice & Guidance o The provision of specialist and technical advice is fundamental the role of the HPT. To support care homes in Lincolnshire the team have

produced a suite of resources incl. audit templates and care plans templates o As part of our response to COVID-19 the team have supported care homes through the interpretation of national policy and have produced

local guidance to inform IPC practices in line with local protocols

NHS CCG IPC Training Support offer to care homes (face to face or virtual offer)

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Testing for Covid-19

Local Reactive Testing (symptomatic residents) o When a care homes identifies their first symptomatic resident and is concerned they may have an outbreak. In these circumstances the

home should contact the LCC HPT, or out-of-hours PHE, who will undertake a risk assessment, provide public health advice, and arrange urgent testing of all symptomatic residents by the NHS Clinical Community Response Cell.

o Daily contact will be maintained with the Care Home by LCC HPT (Monday – Friday) for the duration of the outbreak in line with LCC's existing Outbreak Management Procedures. If any further cases are suspected after the initial outbreak access to testing is through the DHSC national testing service after seeking medical advice.

Testing of symptomatic staff o Local arrangement for testing of symptomatic staff , or members of their household who are symptomatic, began on 16th April, 9 days

earlier than National Testing Programme o Testing for symptomatic care home staff is now organised nationally and delivered at local drive-through key worker testing sites

(including mobile testing units) or by post with home testing kits. This service is accessed by the individual via the self-referral portal or by their employer via the employer’s portal.

Testing of residents discharged from hospital (see also Hospital Discharge Pathway)

o In line with the Covid Hospital Discharge Pathway, testing of residents being discharged from a hospital setting Whole Care Home Testing

o Service provided by the Department of Health and Social Care (DHSC) and accessed via the digital portal which has been launched and is available through the coronavirus testing page which can be accessed here.

o This service is being rolled out to all care homes in a phased approach; it is currently available for care homes whose primary clients are older people or those with dementia. Over the coming weeks this service will be rolled out to other types of adult social care settings for example those catering for adults with learning disabilities.

o The portal enables individual care home managers, or representatives within Local Authorities, to request whole care home testing and confirm the number of residents and staff within the home. This process verifies care home contact details and ensures the right numbers of kits are provided. The care homes’ details will be cross checked against the Care Quality Commission database.

o Once the order is processed, postal testing kits will be delivered to all care homes in order to test all residents and staff. The postal testing kits are designed to be used by care home staff to undertake testing; however there may be occasions when local support from the NHS Clinical Community Response Cell may be appropriate or is requested by the home to support this testing option. Prioritisation of testing in Care Homes will be aligned to the approach for prioritising Enhanced Support to Care Homes detailed above.

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Personal Protective Equipment (PPE)

Guidance to Care Homes

o Responsive regular guidance issued to Care Homes interpreting national guidance on the appropriate use of PPE o Including a PPE FAQ document

Access to emergency supplies

o Providers requiring emergency supplies have been able to request this from the Health Protection Team who have triaged and distributed requests

o Additional route for emergency supplies via the National Disruption Supply Line

Local assessment of PPE usage/supply o Activity has been undertaken to assess current usage and supply chain issues across the Care Home sector

Monitoring of stock issues o Daily reporting on Care Home stock levels using a RAG system. All providers reporting issues are proactively contacted by their

nominated Contract Officer to offer guidance and support

Establishment of an Approved Supplier List for PPE o LCC have established an Approved Supplier List for PPE which would control costs and ensure a more reliable supply for the sector o Go live mid-June 2020

Contract Officer Support

Experienced Contract Management Team

o Team of experienced Contract Managers dedicated to supporting the Care Sector o Three teams aligned geographically to support CCG and Neighbourhood Team Working o Mix of experience and skills aligned to best support the sector, including Clinical and Service Management backgrounds

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Nominated Contract Officers (pre-pandemic) o Each of our 270 commissioned Care Home has a named Contract Officer

Regular proactive contact

o Since the middle of March Contract Officers have been making regular contact with all providers within their portfolio (daily in the first instance)

o The purpose of the regular contact is to build on existing relationships, understand the current position, identify areas where additional support and advice can be offered, escalate issues through the Health & Social Care System

Seven day working

o During the first 8 weeks of the crisis Contract Officers provided cover 7 days per week o This has now been scaled back with on-call arrangements in place over weekends and bank holidays

Dedicated contact number o Each Care Home will have the contact details of their named Contract Officer; however, for times where the Officer is not available there

is a dedicated number where a voicemail message can be left. All voicemail messages are emails to an email account which is being monitored 7 days per week

Proportionate contract management approach

o Continued contract management with a proportionate approach focussed on supporting providers to manage service continuity and sustainability during a period of unprecedented pressure

Hospital Discharge Pathway

Covid-19 Hospital Discharge Pathway for palliative, residential and domiciliary care

o Pathway that provides clarity and reassurance that Care Homes can expect an confirmed Covid-19 test result prior to agreeing a new or returning placement

o Includes supporting guidance from Health Protection Team

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7 day & joint working

o 7 day working by Social Care staff to facilitate timely discharge across Acute and Community Hospitals o Operational staff facilitating discharges and commissioning packages on behalf of NHS 7 days a week o Patient Flow and Discharge Cell in operation with multi-agency membership across Health and Care system

Support around inappropriate hospital discharges (pre-pandemic)

o A process for reporting inappropriate hospital discharges has been in place for some time, this form has been updated to make it as easy to complete as possible

o Inappropriate hospital discharges are escalated into the wider Health & Care System for review and action

Review of attendance and discharge from A&E o Review of transfers from residential settings to hospital to evaluate opportunities of alternative care delivery, including promotion of Clinical

Assessment Service to reduce avoidable A&E attendances o Review of discharges from A&E (those outside of the scope of the Hospital Discharge Pathway)

Communication

Dedicated email address (pre-pandemic)

o All communication issues from the Commercial Team is sent using the same generic email account to make it easier for providers to identify useful communications

Managed communication through regular FAQs/guidance notes o Production of regular guidance notes bringing together relevant information and articles connected to Covid-19 from across the local

Health & Care System including National sources o Provider Questions log established to capture the current issues/themes, this has been used to;

Inform content for the FAQs/Guidance Notes Ensure consistent responses and messages are given

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LinCA Daily Briefings

Cell Structure & Joint Working

Comprehensive Cell Structure with appropriate representation ensuring the interests of the Care Home sector are represented

Commissioned Services Cell

o Commissioned Services Cell call established from 23rd March, initially daily but now convenes three times per week o Incorporates operational and strategic work and decision making o Includes representatives from Children's Services, Public Health, Operational Teams, Health (Continuing Health Care,

Lincolnshire Clinical Commissioning Group, Lincolnshire Community Health Service), Lincolnshire Care Associated (LinCA) and Safeguarding Leads (LCC & CCG)

Health & Social Care Cell

o Issues from Commissioned Services Cell are escalated through to the Health & Social Care Cell o Membership of the Lincolnshire Resilience Forum Health & Social Care Cell includes the Lincolnshire Care Association

ensuring that care sector are able to rapidly escalate challenges and seek support Discharge and Flow Cell with Palliative Care Delivery Group

o Discharge and Flow Cell ensures safe provider admission, flow through and discharge pathways are in place o Multi agency group considering the issues and needs of all those involved in palliative and end of life care

Operational Cell

o Cell focussing on operational issues including the impact on Care Homes

Hospital Sub-Group o Focussing on operational challenges around hospital discharge and patient flow

Primary Care Cell

o Focussing on ensuring supportive integrated community team working around care homes

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Weekly Registered Care Home Managers Meeting

o Co-ordinated by LinCA and held via Zoom o Attendance by CQC, LCC Contract Management and other partner agencies as required (e.g. Health)

Service Quality Review (pre-pandemic)

Updated format to meet requirements of the current situation

o Previously a monthly multi agency face to face meeting this has now been moved to a weekly conference call o Membership includes CQC, CCG, Safeguarding, Continuing Health Care, Community Provider (LCHS), Quality (LCC), Fire & Rescue,

Contract Officers (LCC) and Infection Prevention Control

Re-focussed to meet current requirements o Focus on areas of immediate concern enabling a joint response regarding actions

Establishment of a Commissioned Services generic email account for partners to escalate concerns

o The purpose of this account is to enable partner agencies (e.g. Health, EMAS, CQC) to report concerns regarding any provider to the Commercial Team – People Services

Digital Support

Roll out of Whzan

o Whzan is technology that allows basic observations to be reviewed and shared with Health colleagues to monitor deterioration of residents. It can also be used to support with medication reviews and is compatible with existing applications

o Rolled out to 74 Care Homes (as at mid-May) with funding for a further 76 to be rolled out by end of June 2020 o Joint project between LinCA, LCC and Health o https://www.whzan.uk/blue-box

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Facebook portals have been secured that allow residents to keep in touch with families o Secured 32 Facebook Portals via NHS Digital to trial in Care Homes, primary use to facilitate residents keeping in touch with family

members o Due to arrive w/c 18th May

Both technologies can support the weekly ward round requirement

NHS.net email addresses for providers

o Continued roll out of NHS.net email accounts for Care Homes to facilitate secure communication between Care Homes and Health organisations such as GP's (pre-pandemic)

o Programme accelerated during pandemic, currently we have over 70% of care homes now able to share information securely with health, improving the discharge process and further reducing the need for non-essential contact

Workforce Support

Strategic Market Support Service Contract (pre-pandemic)

o Contract dedicated to the support of the sector including training and workforce support New joint project on the External Workforce with LinCA and Skills for Care

o Several work streams including; promotion of National recruitment campaigns, identification of furloughed staff who may be appropriately skilled and willing to support the care sector

o Identification of potential capacity within the external Day Care sector o Pilot programmes assessing alternative workforce models

Care in Lincs website

o Established in February 2020 the platform allows all care providers to advertise their vacancies o In light of Covid-19 the platform also enables individuals to register their interested in volunteering o https://www.careinlincs.co.uk/index.asp

Establishment of a Mutual Aid Team

o Identification of resource that can be made available to support a Mutual Aid Team should any care provider need emergency workforce support

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Assessment of capacity across private sector o Regular review of capacity within the private sector (non-commissioned domiciliary care providers, care agencies etc.)

Support from Lincolnshire Partnership Foundation Trust (LPFT – our Mental Health Trust)

o 7 days per week o Specialist support for patients with Dementia o Health and Wellbeing Helpline for staff

e-Learning

o To support staff understanding of the COVID-19 virus e-learning modules were developed and made available to all Adult Care, Public Health staff and staff in the wider Health and Care system on 25th March. These e-learning packages covered Coronavirus: COVID-19 – Awareness and Infection and Control and Coronavirus: COVID-19 - Managing the signs and symptoms for Health and social care workers. To date over 1,000 care workers have accessed this training

Data & Intelligence

Risk Matrix (pre-pandemic) o Robust and comprehensive approach to assessment and management of providers deemed 'high' or 'medium' risk

Daily data capture

o Since 20th March daily data capture implemented to provide a rich picture of Covid-19 impact across the sector o Over time this has been revised to ensure it providers areas of greatest risk, e.g. PPE stock levels

Dashboard development

o Using daily data submissions a local dashboard has been developed to track the impact of the pandemic over time, identify potential issues and respond appropriately

NHS Capacity Tracker

o Assessment of content and compliance of the NHS Capacity Tracker to ensure request for local data is valid o Plans in place to support the sector to transition from local reporting to national via the NHS Capacity Tracker

IPC Daily Updates for infectious disease outbreaks in Lincolnshire Care Homes circulated to key stakeholders for dissemination

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