The Coronavirus Act has made emergency changes to the way Adult Social Care works. These are called “Care Act Easements”.
Here’s an outline of the new processes Calderdale Council has put in place, together with info about Personal Protective Equipment for care homes and care workers.
The Adult Social Care Forum says “These measures are only temporary and should only be used when absolutely necessary…Local Authorities should report any decision to use the easements to DHSC”.[Department of Health and Social Care]
Calderdale Council has had to significantly alter the way it provides care packages for people discharged from hospital who need continued care and rehabilitation.
The Coronavirus Act has effectively downgraded Councils’ statutory duties to provide adults’ social care. These changes will last for the duration of the Act, which has to be reviewed after six months.
At the end of March, NHS England ordered a rapid mass discharge of 15,000 hospital patients who were medically fit to leave, in order to free up space for more Intensive/Critical Care wards. This was in preparation for the surge of Covid 19 patients.
Obviously normal care assessments went by the board.
Update 7 Sept 2021
The discharge to assess model has been implemented since March 2020, first in order to speed up the hospital discharge of patients to make space for Covid 19 patients, and later to make space for patients on the huge elective care waiting list that has built up since the pandemic hit.
In July 2021 NHS England announced that “Health and social care systems are expected to build on this work during the first half of 2021 to 2022 to embed discharge to assess across England as the default process for hospital discharge during the funded period.”
Coronavirus Act curtails people’s legal rights to social care services
An editorial in the British Medical Journal slammed the Coronavirus Act’s social care “easements”:
Emergency legislation in the UK has severely curtailed the legal rights to social care services of elderly, ill, and disabled people in the community and in residential settings. In place of the duty to meet all essential social care needs, the coronavirus act substitutes a minimal obligation not to cut support below the level required to maintain their most basic human rights.
Now the Council only has to carry out proportionate assessments of people’s care needs.
Calderdale Council’s senior Adult Social Care officers say this means that for the time being, the Council doesn’t necessarily have to carry out a full care assessment, but it still has to do enough to identify an individual’s care and support need.
At the Calderdale Council Cabinet meeting on 27 April, Cllr Bob Metcalfe confirmed that the Council had not introduced social care “easements“. Despite the Council’s precarious finances as a result of the Covid19 pandemic, there was still enough money to provide the full range of statutory social care services. But just in case, Council Officers are drawing up a framework for how to introduce social care easements if necessary.
To make sure they have the right information about an individual’s care needs, Calderdale Council, Calderdale and Huddersfield Foundation Trust and Calderdale Clinical Commissioning Group, have an agreed hospital discharge pathway and joint assessment documentation.
Covid19 testing for discharged hospital patients, care home staff and residents and care workers
So far we don’t know if the hospital is testing patients for Covid19 before discharge, or whether Covid 19 tests are being given to care home staff and residents, and to care workers who visit many people daily in their homes.
This info will be updated asap.
Hotel “step down care” for non-Covid 19 patients
For some patients who are medically fit to leave hospital, there may be a delay in sourcing the appropriate package of support at home. So patients who’ve been in hospital for reasons other than Covid19 may be discharged to hotels that have had to close to the public, because of the Covid 19 lockdown.
Calderdale Clinical Commissioning group info to its Governing Body meeting on 23 April says that Calderdale Metropolitan Borough Council (CMBC) have agreed to contract a number of beds from Cedar Court. This is for patients who require social, rather than residential or nursing care. Typically this will involve low level step support, housing issues, and support for carer breakdown. The initial offer is for 70 beds, but the opening would be phased in line with demand.
In the hotels, discharged patients will looked after by trained care staff, in so-called step down care. The council and Clinical Commissioning Group will be providing social care staff to support these patients and the hotel provider will provide ancillary staff, who would otherwise have been furloughed.
Hotel “step up care” if formal or informal care breaks down
The Council are also planning to use the hotel capacity if people’s formal or informal care breaks down (for example due to illness or unavailability of carers), and to ensure that people receive the right level of care and support. (They often refer to this as step up care.)
However, the Council say that if care breaks down, where possible they’d prefer to supplement that care in the person’s own home. They are working with all their home and day care providers to support them and have daily contact with all their care providers.
The Council add,
“If we need to use these hotel facilities we will always look to work with the person, their families and care providers to ensure we can provide the right level and type of care and support to get them back to their own home environment as soon as is practical with the right support in place.”
Discharging hospital patients to care homes
The Council will also place discharged hospital patients in care homes, and where they do this, the council and Clinical Commissioning Group will supplement existing staff employed by the care provider.
NHS England’s hospital discharge directive estimates that 4% of discharged patients will need “bedded rehabilitation”.
3 Designated care homes for Covid19 patients discharged from hospital
For patients who have recovered enough from Covid 19 to leave hospital but still require some nursing before they can return to the community, Calderdale Council says that the council and Clinical Commissioning Group are in the process of creating additional capacity in 3 designated care homes in Calderdale. This should be available over the next two weeks.
Info for Calderdale Clinical Commissioning Group Governing Body meeting on 23 April says that these post-discharge nursing homes are for patients who are Covid19+ and who are not.
One of these is the Retreat Nursing Home in Greetland, owned by HC-One. It has an 18 bed nursing service which the Halifax Courier reports can be staffed and run entirely independently of the rest of the care home. The care home staff who have volunteered to care for discharged Covid19 patients are supported by Calderdale’s NHS District Nurse Team, an enhanced GP service and QUEST, a dedicated nursing team for care homes in the community.
Calderdale Clinical Commissioning Group says there are two other care homes with post- discharge residential beds for both Covid19 positive and non-positive patients. These are a 25 bedded unit at Calderdale Retreat and 6 bedded Valley View Annex. As of 23 April, they are not currently opened, and are developing a workforce model.
Extra support from council care staff and managers
Council care staff and council care managers are being redeployed to care homes and people’s own homes where sickness levels within the workforce are becoming challenging, or where specialist support is needed because a resident has developed COVID-19.
Calderdale Council adult social care support to aged and vulnerable people staying at home while suffering Covid19 symptoms
The council has established 2 local hubs for such people – a social care hub and volunteer hub.
The Social Care Covid Hub (email: email@example.com) is to enable people to refer themselves or for someone to refer on their behalf. Social work staff receive and triage referrals on a daily basis and either arrange for care support if this is required or refer them on.
The Volunteer Hub is where people can offer their services as a volunteer – (email: firstname.lastname@example.org ) It also provides for more basic needs such as food, shopping etc.
PPE for home care workers and care homes
Calderdale Council has distributed 1,000s of pieces of Personal Protective Equipment and aim to make sure their care providers and carers have a regular supply, either through their existing suppliers or supplemented by the Council.
The Council is being sent PPE by a government agency to pass on to care providers that are registered with the Care Quality Commission. But the quantities seem to be inadequate.
They are working with all their care providers who receive PPE directly and people who directly employ their own staff. They are checking on PPE levels on a daily basis.
But the Local Government Chronicle reported on Friday 17th April that Yorkshire councils have chartered a plane to deliver PPE from China:
“Supplies of personal protective equipment in parts of Yorkshire are running so low that directors of adult social services are joining forces in an unprecedented collaboration to charter a plane from China to deliver desperately needed equipment. A flight from China is set to arrive…”
This PPE is for care homes/care workers.
Calderdale Council Leader Cllr Tim Swift tweeted,
“The charter was initiated by one of our neighbours but is bringing some supplies for all West Yorkshire councils. Calderdale officers are monitoring the position with care homes on a daily basis to ensure they have sufficient PPE.
“Supplies are very tight and some providers have made appeals for extra because they are worried about running out. And our officers are constantly chasing deliveries.
“But if individuals have specific concerns or info about PPE being missing, please email email@example.com and officers will check it out.”
Eileen Kelly, from Hebden Bridge home care company Welcome Independent Living, told the Halifax Courier that affordability as well as availability of PPE is an issue.
As a registed care provider, they received an initial supply of 300 masks from Calderdale Council – enough to last three days. But they cannot afford to buy more.
Masks cost around £1.50 each, Eileen said,
“To put this into perspective, we make a profit of £1 per care call. Many calls require two carers, therefore, if each was to wear a mask, that’s a cost of £3 per call.
“We therefore decided to put out a plea for masks on social media, via Facebook, Twitter, Instagram and LinkedIn.
Updated 22 April with info from Calderdale Clinical Commissioning Group about additional nursing and residential beds for patients discharged from hospital.
Updated 28 April with info from Calderdale Council Cabinet meeting 27.4.2020