Care Management Matters COVID-19 Special Edition May 2020 by Care Choices Ltd

SPECIAL EDITION MAY 2020

www.caremanagementmatters.co.uk

RECRUITMENT Solving your staffing issues

Compliance

Key areas for consideration

What’s in store?

How will COVID-19 change the sector’s future?

Financial support The options available

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In this issue REGULARS From the Editor

Inside CQC Debbie Ivanova writes about what the regulator is doing to make life easier for providers, and thanks the sector’s staff.

CMM News

When tomorrow comes: Life after coronavirus What will happen to social care once other sectors have returned to something more ‘normal’? Vic Rayner examines what we can learn from the devastation the sector is enduring, and what could be around the corner.

Practical steps for recruiting during coronavirus Issues with staff levels and recruitment processes in social care have never been so important to resolve. Sharing results and analysis of a COVID-19 staffing survey, Neil Eastwood offers providers practical ideas to overcome challenges.

An untapped resource: How to use volunteers We are hearing more and more about people who want to help make a difference through this crisis. But how can social care utilise volunteers? Isabel Clift from Florence offers considerations and ideas.

Keeping compliant in the face of change There’s no easier time to let the things that make your service great slip, but keeping high-quality care at the fore will be essential in getting through this pandemic. Philippa Shirtcliffe, Head of Care Quality at QCS, explains how CQC is trying to help, and why compliance will always remain central.

Getting care workers through COVID-19 The sector’s staff are being recognised for the work they do for perhaps the first time. But what can providers do to support them further, and what resources can we direct them to for help? Karolina Gerlich offers some ideas.

Keeping coronavirus at bay Infection control is key at all times, but now more than ever we need to ensure correct procedures are followed. Ben Kilbey from Spearhead Healthcare shares six tips to help providers prevent the spread of coronavirus.

Knowing your options: Financial support during COVID-19 Rachael Anstee, Partner at Hazlewoods sets out how providers can find financial support and what considerations they need to give to their finances during these exceptional times.

Staying connected Whilst we are being told to stay at home and avoid contact with others, it’s imperative for the social care sector to keep those it supports connected. Helen Wildbore, Director of the Relatives and Residents Association gives her top tips for keeping people in touch.

FEATURES

CMM May 2020

EDITORIAL editor@caremanagementmatters.co.uk Editor in Chief: Robert Chamberlain Editor: Angharad Burnham Content Editor: Emma Cooper

CONTRIBUTORS

PRODUCTION Lead Designer: Ruth Clarry Director of Creative Operations: Lisa Werthmann Studio Manager: Jamie Harvey

ADVERTISING sales@caremanagementmatters.co.uk 01223 207770 Advertising Manager: Daniel Carpenter daniel.carpenter@carechoices.co.uk Assistant Advertising Manager: Aaron Barber aaron.barber@carechoices.co.uk Director of Sales: David Werthmann david.werthmann@carechoices.co.uk

@CQCprof

@vicrayner

@stickyneil

@WeAreFlorence

Debbie Ivanova Deputy Chief Inspector of Adult Social Care, Care Quality Commission

Vic Rayner Executive Director, National Care Forum

Neil Eastwood Author of Saving Social Care

Isabel Clift Head of Content, Florence

@UKQCS

@KGerlich777

Philippa Shirtcliffe Head of Care Quality, QCS

Karolina Gerlich Chief Executive, Care Workers’ Charity

SUBSCRIPTIONS Non-care and support providers may be required to pay £50 per year. info@caremanagementmatters.co.uk 01223 207770 www.caremanagementmatters.co.uk Care Management Matters is published by Care Choices Ltd who cannot be held responsible for views expressed by contributors. Care Management Matters © Care Choices Ltd 2020 CCL REF NO: CMM 17.3

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Ben Kilbey Business Development Manager, Spearhead Healthcare

Rachael Antsee Partner, Hazlewoods

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Helen Wildbore Director, Relatives and Residents Association

www.caremanagementmatters.co.uk

From the Editor We are living through testing times. Unprecedented times. These are words we’ve all heard over and over in recent weeks. And they’re not exaggerations. Our lives have changed in a few short months from a state we’ve been used to for decades, to something entirely new. But as a global pandemic sweeps through country after country, and entire populations retreat into the relative safety of their homes, social care carries on. There has been an unwavering determination to make sure that the people relying on this sector continue to be treated with dignity, compassion and kindness; that this virus doesn’t leave people stranded or alone. At a time when guidelines have unforgivably suggested the people social care supports are at the bottom of the pile, homecare workers have gone on with their days, despite being verbally abused and spat at; and care home staff have moved in with residents in a bid to limit exposure to this illness and protect those they care for.

And not only are care businesses boldly continuing on, but they are doing so under ever-increasing difficulties. All the while, this virus that so wickedly preys on older generations and people living with disabilities is making its way into people’s homes and services and taking their lives. The emotional toll that this pandemic will have on the sector’s staff should not be underestimated. In CMM, we often report on the lack of parity with the NHS, and the unrecognised value that social care offers society. But, finally, it has been recognised in national media that the sector not only supports the NHS, but is essential to its ability to help people. It has been seen as a service that gives the people it supports everything it’s got, that will go above and beyond to keep them happy and safe. This is what the best social care has always been about and it’s heartening to see this perception filtering through to the public. There have also been pockets of panic at what might happen if

Editor, Angharad Burnham looks at how the adult social care sector has responded to the COVID-19 crisis.

social care services don’t continue the work that is so vital to the country’s whole population. In response, councils in some areas are paying more for services, and some are increasing the amount they pay care staff. These small shifts in attitude must carry through to the day that COVID-19 is no longer the focus of our actions, our conversations and our thoughts, so that the sector can come back from this pandemic and thrive in a new and improved ‘normal’. This month, we’ve focused exclusively on the things providers need to know now. All the information in our features is as up to date as possible, but please

keep checking the government website and other resources listed throughout for the latest updates. There is also a new, dedicated COVID-19 area on the CMM website with news, blogs and information to keep your service running. As a final note, I would like to thank all of the sector’s staff – at every level – for all they are doing to support society’s most vulnerable people. You deserve our gratitude, appreciation and respect. This time will be remembered and the efforts you are all going to will not be forgotten by the professionals, people, friends and families you are working with, and hopefully not by the rest of society either.

Email: editor@caremanagementmatters.co.uk Twitter: @CMM_Magazine Web: www.caremanagementmatters.co.uk

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We find ourselves in incredibly challenging times and I want to start this column by thanking each and every person working in adult social care during the coronavirus (COVID-19) pandemic. There has been incredible support across the country for those working on the front line in NHS hospitals which is very much deserved, but the front line is also in care homes, supported living services, people’s homes and all of the other places people are receiving adult social care. The work you are doing to keep people safe during COVID-19, and the care you are giving to those who are afflicted with this terrible disease, is incredible and something to be extremely proud of. At CQC, we want to spread the word to everyone in health and social care that we are here to work with you, support you with difficult decisions, and listen when you need us. Our inspection teams are making their priority reaching out to registered managers and letting them know that we are here to help support them to keep people safe. I want to reassure you that we are listening to everything we hear from the sector and are feeding this into the many conversations we are having at both local and national levels, as well ensuring it also informs any action we need to take at CQC. As the regulator, we have the responsibility to ensure providers of health and social care are keeping people safe, which includes during times such as these. We do however have to do this in a way which does not burden providers when they are under immense pressure on all fronts. Because of this, we are making changes to the way we work during the coronavirus outbreak, which includes the suspension of our routine inspections from Monday 16th March until further notice. Using technology to assist in this, we will be shifting towards more remote ways of working which will allow us to be assured of safety and quality of care from a physical distance. We still do have the responsibility to use our regulatory powers if the circumstance arises, such as where there are allegations of abuse. This is why it’s never been more important that we hear from you if you have concerns about people’s safety, which you can share though the Give Feedback on Care form on our website. This is unlike anything we have done before and we have to be quick and agile in this new way of working to respond to the evolving situation. I think it’s fair to say that providers and professionals of health and social care are

Inside CQC D E B B I E

I V A N O V A

Deputy Chief Inspector of Adult Social Care at the Care Quality Commission (CQC) writes about what the regulator is doing in these times, and thanks staff across the sector.

inundated with communications at the moment and we want to make sure that information you need from the CQC is clear,

“The work you are doing to keep people safe during COVID-19, and the care you are giving to those who are afflicted with this terrible disease, is incredible.” concise and easy to find. We’re publishing answers on our website to the most common questions from adult social care providers we

have received, updating the page regularly, to help providers find the answers without having to wait for a response. You can also sign up to our newsletters, which we are currently sending weekly to provide the most up to date and relevant information for the sector, and look at the dedicated COVID-19 area of our website. I hope it is reassuring to know that we are doing everything we can and doing this as quickly as we can, to help the national effort in beating this virus. The sense of community at a time in which resources are stretched, people are losing loved ones, and the whole country is restricted in movement is an incredible thing. While we will look back at this time as the national emergency it is, I hope that we will also remember the kindness and dedication that has been shown across the country. Again, thank you to everyone who is working to keep the most vulnerable in society safe.

Debbie Ivanova is Deputy Chief Inspector of Adult Social Care at the Care Quality Commission. Share your thoughts and feedback on Debbie’s column on the CMM website, www.caremanagementmatters.co.uk CMM May 2020

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COVID-19 testing expanded for social care Government has announced that more COVID-19 testing will be carried out for social care, with all care home residents and all social care staff with COVID-19 symptoms being tested for the virus. Up until this announcement, testing was available for the first five symptomatic residents in a care home setting to provide confirmation of whether there was an outbreak. However, Government has expanded testing to include all care home residents and staff

who develop symptoms. Testing will now also be provided to all those who are to be discharged from hospital to a care home, before they are discharged. If the person tests positive, providers will be able to take appropriate action to ensure that social care workers and other residents are safe – including implementing isolation procedures for those who test positive. The Health and Social Care Secretary has also confirmed that every social care worker who

needs a test can now get one. Government will prioritise the testing of symptomatic social care workers and anyone in their households who have COVID-19 symptoms. The Care Quality Commission (CQC) is leading the co-ordination of more COVID-19 testing for social care, and should by now have contacted all 30,000 care providers. Care providers should identify workers eligible for testing and refer them to their local testing centre.

COVID-19: adult social care action plan The Government has set out its plan for how it will support the adult social care sector in England throughout the coronavirus outbreak. It includes details about controlling the spread of infection in care settings, supporting the workforce, supporting independence, supporting people at the end of their lives, responding to individual needs, and supporting local authorities and the providers of care. The plan applies to all settings and contexts in which people receive adult social care. This includes people’s own homes, care homes and care homes with nursing, and community settings. It applies to people with direct payments and personal budgets, and those who fund their own care. The sector has responded with

mixed feelings, with most grateful for the plan but worried it’s come too late. Voluntary Organisations Disability Group (VODG) has called the plan a 'canter through the Government’s reactions thus far', stating, 'What the sector needs is a clear plan that instils confidence among social care providers coupled with a meaningful commitment of financial investment in a sustainable future.' Meanwhile, Helen Walker, Chief Executive of Carers UK, said, 'At long last, the Government has recognised the role of the social care sector in this fight back against coronavirus...A plan for our sector should have come sooner. 'It’s good that testing and personal protective equipment (PPE) are now being prioritised for social care workers who need it most, but it is vital that it reaches

them. There must also be enough for unpaid carers, some of whom are caring for extremely vulnerable people, including those who are shielding.' Chair of Social Care Institute for Excellence (SCIE) and former Care Minister, Paul Burstow, stated, 'The growing death toll amongst social care workers and those they care for is deeply distressing. It demands a determined effort to ensure that social care now gets everything it needs to carry on caring. The Government’s strategy is an overdue recognition that social care is on the front line battling to keep the most vulnerable and frail safe from COVID-19. A fitting legacy of the pandemic would be that finally after decades of delay the time has come for reforming our social care system, not for patching.'

Joint statement on advance care planning The Care Quality Commission (CQC), Care Provider Alliance (CPA), British Medical Association (BMA) and Royal College of General Practice (RCGP) have issued a joint statement on advance care planning. The statement sets out and reaffirms guidelines on advance care planning, noting that plans should be individual and not applied to groups of people. It accepts there is additional pressure on providers currently, but says, 'The importance of having a personalised care plan in place, especially for older people, people who are frail or have other serious conditions has never been more important than it is now during the COVID-19 pandemic. 'Where a person has capacity, as defined by the Mental Capacity Act, this advance care plan should always be discussed with them directly.' With regards to those who do not have mental capacity to decide on care plans for themselves, the statement suggests, 'It is reasonable to produce such a plan following best interest guidelines with the involvement of family members or other appropriate individuals.' The statement is extremely clear on how advance care plans should be applied to people, expressing that decisions must be made on an individual basis. More information is available at www.scie.org.uk. CMM May 2020

NEWS

COVID-19 registration framework The Care Quality Commission (CQC) has announced a new COVID-19 registration framework to support providers to be reactive during the outbreak. The CQC website states that a COVID-19 registration is any application from a health or social care provider which: • Intends to deliver services which provide additional health and

social care capacity in an area. • Contributes to the control of the outbreak of coronavirus or the treatment of people who have contracted the illness. For existing social care services that might want to make a change to their registration, for example to increase capacity or to add a location, the regulator has set

out the process that needs to be followed. CQC states that, when assessing these applications, it will look at management and response to COVID-19 against Safe and Well-led, and that any changes may be treated as conditions to registration for the duration of interim arrangements. In many urgent cases, CQC

has said that a provider can increase its capacity as soon as the regulator is notified and CQC can run the registration process at the same time as the provider makes the requested changes. A blog written by CQC explains the full process for the COVID-19 registration framework, and there is more information on the CQC website.

Parallel Supply Chain for PPE access The Department of Health and Social Care has announced it will be putting in place a Parallel Supply Chain for health and care providers to access PPE during the coronavirus pandemic. The aim is to improve the delivery of essential items, both in terms of speed and reliability, and to ease the pressure on the usual supply chain so that it is able to deliver other products that are

needed day-to-day. Until this new solution is fully operational, two processes are being undertaken: • The Department of Health and Social Care is working to provide stock of PPE equipment to wholesalers and distributors for pharmacies, GPs, dentists, adult social care providers, and the third sector. It suggests that this will enable more providers

to order PPE through their usual supply chains. • The Department of Health and Social Care has mobilised the National Supply Disruption Response (NSDR). It asks providers who have an urgent need for PPE, who are unable to fulfil this need through their business as usual channels, to contact the NSDR via the 24/7 helpline: 0800 915 9964 (Freephone number in the UK).

Callers will need to have certain details and information to hand, and this is listed in the letter. In the letter announcing the Parallel Supply Chain for PPE access, there is also a list of frequently asked questions, as well as details of business as usual suppliers of PPE. Read the letter in full on the Care Quality Commission website.

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NEWS

COVID-19 guidance for care homes Government has published detailed guidance for care homes who are supporting people during the COVID-19 outbreak. It is specifically for the residential care sector, including registered providers of accommodation for people who need personal or nursing care, local health protection teams, local authorities and clinical commissioning groups (CCGs). Regarding homecare providers, the document states that the

Government will 'continue to provide domiciliary care providers with the information they need to continue providing care during the COVID-19 pandemic.' Containing information on the admission and care of residents, the COVID-19 guidance for care homes covers aspects such as reporting of COVID-19 cases and national support available to implement the guidance. There are also annexes

containing useful information and contacts for topics such as infection control, receiving residents who have been discharged from hospital and isolation of symptomatic residents. The full document can be read on the Government website. On the Social Care Institute for Excellence (SCIE) website, there is also a set of answers to questions asked by both people using adult social care services and providing services to people.

Interim guidance on DBS and other recruitment checks In response to temporary changes being made by the Disclosure and Barring Service (DBS) to DBS applications and processes, interim guidance on DBS and other recruitment checks has been issued. This is aimed at providers recruiting staff and volunteers to health and social care services in response to

coronavirus. It applies to individuals (paid staff and volunteers) being recruited as a consequence of and during the coronavirus pandemic, is applicable when providers need to start staff urgently, and waiting for a full DBS check could cause undue delay, and this delay could lead to risks to

the continuity of service, impacting the safety and wellbeing of people using the service. The guidance will be in operation for the period the Coronavirus Act 2020 remains in force and will be reviewed on a regular basis. The full guidance can be found on the CQC website.

COVID-19 programme A coronavirus programme has been created by Health Education England e-Learning for Healthcare (HEE e-LfH) in response to the global coronavirus pandemic. The programme includes key materials to help the health and care workforce respond to coronavirus, such as essential guidance from the NHS, UK Government and World Health Organisation, information on Infection prevention and control, resources for staff working in critical care settings, resources for staff working in primary care and community settings, resources for nurses and AHPs returning to work, being redeployed or up-skilled, resources for other healthcare staff returning to work, resources for end of life care during COVID-19 and much more. Content is updated and added to as new information and guidelines emerge. Visit the website for more information, www.e-lfh.org.uk.

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NEWS

Guidance for family carers Government has released guidance for family carers who are supporting someone who cannot manage without their help. Building on the Stay at home guidance and the Guidance on social distancing, the latest information gives tips on what carers can do to ensure they are protecting themselves and the vulnerable people they

support. This includes creating an emergency plan, advice for those caring for someone in the 'extremely vulnerable' category, what to do if they are worried about visits from home care workers, accessing alternative care if the family carer is unable to provide support and collecting prescriptions. The guidance recommends

that people speak to care providers about processes they are following to ensure good hygiene, and that clients should inform their providers if they are reducing social contact and whether this will affect their care package. Alternative packages may need to be put in place. The full guidance is on the Government website.

Guidance on Care Act easements The Government has published guidance for the Care Act easements in place to help councils with the coronavirus pandemic. Easements have been created under the Coronavirus Act 2020 and aim to ensure support is given to the people who need it most. They make temporary changes to the responsibilities of local authorities set out in the Care

Act 2014, detailing what does and does not have to be carried out. For instance, local authorities will not have to carry out detailed assessments of people’s care and support needs. However, they are still expected to respond as soon as possible to requests for care and support, and to consider the needs and wishes of people needing care and their family and carers, and they must still make an

assessment of what care needs to be provided. Councils must also still be able to give providers enough information about a person's needs and circumstances that they are able to make an informed decision on whether or not to accept the referral. The full guidance on Care Act easements is available on the Government website.

Centre for Ageing Better Following the release of its report, Doddery but dear? Examining agerelated stereotypes, the Centre for Ageing Better is highlighting how the coronavirus epidemic shows why it’s so important to ‘get it right’ when talking about ageing. The report found attitudes to ageing and older people in the UK are mostly negative, with older people seen as incompetent,

hostile or a burden on society. The report also found that negative stereotypes are rife in the workplace, in health and social care and in the media, with women and people from black and minority ethnic groups facing ‘double jeopardy’ of discrimination. Chief Executive, Dr Anna Dixon said in light of the COVID-19

outbreak, articles that celebrate a ‘cull’ of the elderly remind us to think more carefully about our attitudes towards ageing. She believes when it comes to coronavirus, the impact of language and attitudes that lump everyone over a certain age into a category labelled ‘vulnerable’ could do much more harm than good.

NCF data on deaths in care homes The National Care Forum (NCF) has revealed a potential doubling of COVID-19 related deaths in UK care homes in just one week. With deep concerns that the national statistics for coronavirusrelated mortality rates presented by Government were not incorporating deaths within care homes and care homes with nursing, the NCF led an independent benchmarking exercise of its members. Of its care provider members, 47 contributed to the audit, representing 1,169 care 12

CMM May 2020

services that collectively support 30,217 people across the UK – 7.4% of the overall residential care sector. The report compares baseline data from providers at the earliest stages of the pandemic, from 6th March to 7th April, with results from 7th April to 13th April. It demonstrates a significant increase in coronavirus-related deaths within care homes, which, when scaled up, suggest that more than 2,500 care home residents may have died of suspected or confirmed COVID-

19 during this one week period, representing a 193% increase. This analysis also suggests that 4,040 people may have died of coronavirus in UK residential services before 13th April, rising to 7,337 when including the deaths of individuals who were admitted to hospitals. The NCF hopes that this data on deaths in care homes will put into sharp focus the challenges of the adult social care sector and deliver greater support from Government, at a national and local level.

CQC sets out action The Chief Inspector of Adult Social Care, Kate Terroni, has written to the adult social care sector highlighting the action the regulator is taking to support providers at this time. In her letter, Kate Terroni outlines how the role CQC plays in Government’s action plan for adult social care is very much shaped by what the regulator has heard from providers. The letter sets out what CQC is doing to help care staff get access to testing, and to ensure greater transparency on the impact of COVID-19 on the care sector. The full letter can be found on the CQC website.

Sparkle for Social Care Backed by the Care Sector Fundraising Ball Committee, a new campaign is asking people to wear anything that sparkles or to put fairy lights or tinsel in their windows to show their support for social care. The Sparkle for Social Care campaign is aimed at raising money for Care Workers’ Charity and encourages people to donate £1 and post photos on social media using the hashtag #SparkleforSocialCare. The campaign wants to show those who care for society’s most vulnerable that they are valued and appreciated. Donations can be made on the Just Giving webpage.

C19 CONTROL A new, free service has been released to support providers with recording how coronavirus is impacting the people they care for as well as PPE levels. Sign up on www.c19control.com or for more information, read the interview with Duncan Campbell on the CMM website.

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WHEN TOMORROW COMES: LIFE AFTER CORONAVIRUS

We are all imagining what might become of the social care sector once the rest of the country’s lives have returned to something that feels like normal. Looking ahead, Vic Rayner asks, what can we learn from the devastation the sector is enduring, and what good can we glean from the experience so far?

It is hard to lift your sights towards the end of this pandemic, but the only way forward is to assume that at some point in the not too distant future, this too will pass. When it does, we will need to understand what it was we learned about social care – our sector, our place in the world, our resilience and our people.

OUR SECTOR We have always known that there are real challenges around how social care is delivered in England. Across the country, there are tens of thousands of different organisations and individual personal assistants, offering predominantly bespoke and personalised services to their geographic community. Their service ‘patch’ is often no more than three to five miles from base, and their workforce drawn from within that reach. Their links are with their local clinical commissioning group (CCG) or local authority, or if they only work with those who pay for their own care, they may be largely independent of even these. Whilst this can be challenging at the best of times, it has proved to be a real barrier in the face of the 14

CMM May 2020

management of a national pandemic. The demand for accurate and appropriate national guidance is being regularly undermined by conflicting regional guidance. The postcode lottery approach to the sourcing and dispatching of Personal Protective Equipment (PPE) that effectively enables compliance with the ever-changing guidance; the massive shortfall in staffing as waves of the workforce enter self- or household-isolation; the piecemeal approach of community health services reducing supply of nurses and GPs into care settings; and the dogged determination of local authorities and CCGs to engage in single-point negotiations around commissioning – all belie the real need for a national response to a national crisis. All the focus from commentators that this is the proverbial marathon, rather than sprint, is cold comfort for a sector that has, for the last ten years, been starved of the necessary supplements and headspace for training that would enable it to be prepared for either. This has caught our sector seriously under-prepared for operating in the harshest of environments that anyone could have imagined. With – I suspect – still harder times to come.

OUR PLACE IN THE WORLD Social care – forever destined to sweep the ashes whilst the NHS goes to the ball? I think it is very hard to predict precisely where the sector might emerge at the end of this crisis, but it is absolutely important to be planning for this. There are some important markers that have happened that give some hope for a shift in the narrative. Whilst the headline on the Prime Minister’s podium talks of saving the NHS, the spoken words often reference care workers and the provision of care. When the Queen addressed the nation for only the fifth time in her 68-year reign, the second group of staff she thanked was care workers. When the new Labour leader took power, a key focus of his critical narrative was around how the care sector had been treated. However, the message is being hard fought with the media, which still seems unable to recognise that without a robust and functioning social care sector, the feted NHS would not be able to provide the stories of heroics that continue to dominate the headlines. Relations between key commissioners such as CCGs and local authorities remain very localised and individual, and whilst there is some exemplary partnership practice, it does not dominate the landscape. The approach to truncate assessment information for those being discharged from hospital, and increasingly for those entering the care sector from the community, shifts the risk directly onto providers, who are often being pressured to take people and then having to assess them once in situ, without a clear understanding of whether or not they will be able to meet their needs.

RESILIENCE We are not yet at the stage of determining bounce back. I suspect there are many more months to go until we fully understand just how low things will have got, and therefore how far we need to travel in order to

CMM May 2020

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WHEN TOMORROW COMES: LIFE AFTER CORONAVIRUS

return to steady state. Early lessons from other countries suggest that some of the long-term implications for care and the people we support are brutal. High numbers of deaths in care homes dominate the media in continental Europe (and now in the UK too); stories of military intervention to support the deep cleaning and provision of care; and wholesale abandonment of services by staff too frightened or exhausted to continue. It is hard to feel optimistic about how our fragmented sector will survive this, and there are undoubtedly very real challenges for all, but particularly the small providers. Scale does appear to be your friend with this virus. Those who can buy big have advantages within the supply chain. Those with a logistical task force can more effectively redeploy resources. Those with a larger workforce can move staff between services, and those with a head office can take some of the day-today strategic decision-making away from the immediate frontline. These advantages allow just a little more

“Without a doubt, the real heroes of this story are the social care workforce.” headspace to plan day by day, rather than minute by minute. How that plays out in the long term will be one to watch – but in the interim, it is incumbent that as a sector we play our part in sustaining and supporting services of all shapes and sizes. There will be a growing need for both national and local resources to flow towards those bowing under the weight of fighting a sustained daily battle to provide safe care, and mechanisms such as the Local Resilience Forums will need to up their game in working directly with the sector to keep services going under extreme duress.

OUR PEOPLE Without a doubt, the real heroes of this story are the social care workforce. They are showing a level of resilience that far belies the way in which wider society

values their contribution. They are living through the real front line of resistance to this virus, offering ongoing care and kindness in the face of huge adversity. For the last couple of months, they have had to become the substitute family for many, as care homes shut their doors to relatives and friends and social distancing took its toll on the numbers visiting those in their own homes. They have had to learn how to work in an environment where the wearing of PPE has gone from a part-time pursuit, to being as natural as the donning of any uniform or work attire. They have had to cope with the heartbreak of losing people that they have cared for for many years to this cruel and undiscerning disease. In some cases, they have had to endure the fear of the wider population, who – rather than revering them for their compassion and continuing care – have vilified them as being potential carriers of the disease. In short – they have proven once again just how professional they are under the most extreme pressure. If nothing else good comes out of this awful situation, then the increased understanding of exactly what social care offers and how vital its work is to support the most vulnerable in communities must change. We need to ensure that we never return to these staff being viewed as low-skilled, and that we demand that the resources flowing into care enable people’s pay to reflect their skills, passion and dedication to providing care each and every day – come rain or COVID-19.

WHAT WILL TOMORROW BRING? There are few certainties to hang onto in this crisis. The only certainty seems to be that there are greater challenges on the horizon than those that sit behind us. We know that, as the rest of society gets back to some semblance of normality, we will still be feeling the impact of the virus in care settings across the country. Many voices have come together, including that of the National Care Forum, to call out some of the more insidious assumptions that underline the response to this crisis – that appear to have justified the rationing of services to the fit and healthy, that have waived the rights of the some of the most vulnerable under the auspices of Care Act easements, and that have sustained the focus on the NHS as the only front line where the virus is being fought. When the sun shines, and the shops are full again, these presumptions and legal shifts are likely to remain in force, sustaining the disadvantage of older people and those with disabilities. We will have to fight together and fight hard to ensure that the people who we care for and support, our workforce, our sector are not forgotten – and, as the rest of the world scrabbles to assemble a new order and new sense of living, that the people who need care and support are not pushed yet further down the priority pile. CMM

Vic Rayner is Executive Director at National Care Forum. Email: vic.rayner@nationalcareforum.org.uk Twitter: @vicrayner Do you feel that the current crisis will impact on the sector once it’s over? Share your thoughts and feedback on the CMM website, www.caremanagementmatters.co.uk CMM May 2020

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CMM May 2020

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PRACTICAL STEPS

for recruiting during coronavirus As the impact of coronavirus becomes clearer, issues with staff levels and recruitment processes in social care have come to light. Examining results and analysis of a COVID-19 staffing survey run by himself and CMM, Neil Eastwood shares the steps providers can take to make their lives a little bit easier and to overcome some of the particular challenges that have raised their heads.

With COVID-19 rapidly forcing many changes on social care employers, the sector has had to drastically adapt the way it operates. One of the biggest emerging impacts is on staffing, which is set to intensify in the coming weeks and months. In collaboration with CMM, I asked over 200 employers about the workforce challenges they were experiencing, the effect on their recruitment needs, and any action plans they had in place to combat them. Below are the key findings, followed by some practical steps I recommend employers take to relieve the pressure and adapt their recruitment.

CMM May 2020

PRACTICAL STEPS FOR RECRUITING DURING CORONAVIRUS

CURRENT STAFFING SITUATION

25%

Average percentage of frontline workforce unable to work This figure varies significantly between providers with some reporting no absences and others with over 50% of their workforce absent

Reasons for frontline workforce being unable to work 10% 6%

5% Childcare

Self isolation

Social distancing

4% Shielding

On average, employers reported approximately 25% of their workforce was currently unable to work due to the impact of coronavirus. Allowing potential for some duplication across categories, it is likely the sector is now experiencing between a 15% and 20% staffing reduction at any one time. Given that many employers already had job vacancies before the crisis, this represents a significant impact, which has the potential to worsen. On a more positive note, almost threequarters of care staff with school or pre-school aged children were successful in seeking key worker exemption, keeping their children in childcare. Of course, we can’t compare this to the experience of NHS staff in the same situation.

RECRUITMENT REQUIREMENTS

34%

of providers reported they urgently need more staff now

Unsurprisingly these workforce shortages have intensified pressures on recruitment, with a third of respondents describing their need for more staff as ‘urgent and immediate’. By way of some compensation, there has been a reported increase in job enquiries, with 39% of employers reporting more applications than usual, and 17% reporting fewer – a net change of +22% than would be typical for this time of year. However, bringing new staff onboard takes time, especially with social distancing constraints and operational pressures. Employers told us it is too early to determine the ‘suitability’ and ‘stickability’ of these recent jobseekers. 20

CMM May 2020

EMPLOYER ACTIONS PLANS We asked employers about what actions they were taking to address workforce shortages around these four points: 1. How they were speeding up the recruitment process. 2. The opportunity to bring in more temporary staff. 3. The potential for utilising volunteers. 4. Managing social distancing during recruitment. Speeding up recruitment How providers are taking steps to speed up the recruitment Evening/out of hours interviews

Extra induction sessions

33%

27%

Using DBS Adult First checks to commence supervised work (England only)

60%

Using the internet and digital technology

None

Other

72%

11%

Almost 90% of employers are taking, or plan to take, steps to shorten the time to hire new staff. One of the longest delays in this can be completing DBS and reference checks, and 60% of employers saw the DBS Adult First check as a faster route to bring staff in, albeit accompanied, until the Enhanced DBS was received. Helpfully, recent changes by DBS include a Fast Track service, which can be used where the new starter is specifically being recruited to support someone with coronavirus, or coronavirus symptoms. Employers should read the guidance to determine whether their recruitment cases would qualify. Reference-taking is another typical delay that has been made harder with office staff now working from home. The Care Quality Commission (CQC) has addressed this in its most recent guidance. You can find out more about the new DBS Fast Track service, and the latest CQC guidance on overcoming reference-taking challenges, on the Skills for Care website. Digital technology is proving to be the most popular method of speeding up the whole process, encompassing a range of approaches

such as online recruitment, video interviewing (which we look at in more detail below), and e-learning. Another way to reduce staff deployment times could be to approach ex-colleagues, especially those who have left the sector but could be encouraged to return. Although attracting care workers currently employed with other providers can seem appealing, given their job-readiness, simply churning staff between settings is a zero-sum game. Asking staff to identify their friends and contacts who may be recently out of work, and who they consider to have the right values for care, is another option and one most likely to bring in new entrants to the sector who will choose to stay after the crisis has passed. Bringing in more temporary staff About half of providers said they were considering using, or were already relying more on, temporary staff. For residential settings, this may mean turning to temporary staffing agencies or over-recruiting with the expectation that many recent jobseekers won’t have a long-term commitment to the role. For homecare providers it is more likely to be the latter, given their generally very limited use of agency staff. However, it’s important for all providers to bear in mind that agency workers might present a heightened risk of infection, as they move between several care settings. Using volunteers The media has reported large numbers of volunteers coming forward to offer support in their local communities, either of their own volition or encouraged by initiatives like the National Care Force. Just over a third of employers told us they had been approached directly by would-be volunteers, but over 60% of managers were unable or unsure on how to use this resource. For many independent providers, this could be their first contact with volunteers, and it raises many questions, such as training, supporting and safety concerns. In contrast, the not-for-profit sector has deep experience of attracting, valuing and using volunteers. Liz Jones, Policy Director at the National Care Forum commented, ‘We need volunteers now more than ever. Our members have a long history of using them, and they are ever more important during this COVID-19 crisis. Examples of how volunteers can lend a hand include – helping with household tasks in care homes, such as supporting the kitchen, catering, or laundry staff, offering phone-based or videocalling based companionship and connection with residents, helping with admin support or providing a pen pal or letter writing connection with the home.

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CMM May 2020

PRACTICAL STEPS FOR RECRUITING DURING CORONAVIRUS

‘The national drive for volunteers must ensure that social care can offer volunteering opportunities to the army of folks who have signed up, as well as the NHS and wider community support.’ More information on volunteering is available on the Methodist Homes (MHA) website, which has over 5,000 volunteers. Social distancing during recruitment Three-quarters of employers told us they have, or are about to, put in place social distancing measures as part of their recruitment process. The most popular change is the use of video interviewing. But embracing this technology can be daunting for both interviewer and interviewee, especially for those who are unfamiliar with the technology or lack experience. To help with this, I asked Ian Inglis, director at Bluebird Care South Bucks, South Wycombe & Slough, a CQC Outstanding rated provider, who has video-interviewed applicants for over five years, to share his top tips for successful video interviews. You can find links to them in the resources section at the end of this article. How providers are changing their interview processes Additional questions/checks regarding their risk of having been in contact with the virus

60%

Live video interviewing (e.g. via Skype or WhatsApp) Off-site interviews (to avoid contact with those being 15% supported)

48%

Using social media for the first time to promote 15% vacancies Recorded video interviews (where applicants record their answers to set questions) Other

such as access to a car or willingness to work unsociable hours, ending in a confirmation of a face-to-face interview date. Because previously meeting in person was always the next step, there was never too much pressure to maximise the value of that call. But that has now changed. I recommend making the phone call work harder for you, hopefully putting potential new staff at ease, though do keep in mind the risk of over-formalising the call, thus frightening people off! I have listed some simple tips, also available in the resources section at the end of the article, as well as a template telephone screening form which you can adapt for your needs.

LEARNING DISABILITY PROVIDER LEADING BY EXAMPLE 73%

Telephone audio-only interviews (if you previously didn't use this method)

“Completely reshuffling deeply engrained processes is not an easy feat, especially with such short time restrictions. ”

Almost half of employers said they are adding a telephone interview stage, where they previously didn’t have one. Every social care recruiter will have experience of telephone contact with applicants, but this is usually a short, unplanned (and unstructured) chat, more to confirm basic job requirements,

There are some great examples emerging of providers successfully – and rapidly – repurposing their entire face-to-face recruitment processes. One such case is Precious Homes, a national learning disability provider that, until the coronavirus restrictions, ran regular assessment days processing over 1,500 attendees a year. ‘We have replicated our entire assessment day experience virtually,’ explained Tony Ferrari, Head of Talent Acquisition & Retention. He said, ‘Applicants are first asked to record and send us a short video answering three evaluation questions. If they meet our criteria, they are then asked to take an Assessment Evaluation Task via an online survey. They are then sent a link to a short film explaining more about the role, the company and popular questions, and the final step is a live video interview with service managers via Skype or WhatsApp. We were adamant we would continue with our high standards of values-based and safer recruitment. The first two virtual assessment days resulted in 12 job

offers.’ Completely reshuffling deeply engrained processes is not an easy feat, especially with such short time restrictions. This is a time of great change, and I believe that we in the care sector need to support each other, where possible, through this crisis. So, if you have any tips or tricks, or examples that are working for you, please share them – far and wide – so that anyone who is struggling to put measures in place for their own business might learn from them. Thankfully there may be some positive points to come out of this otherwise very anxious and unusual time. Firstly, the brilliant new people that might discover (and hopefully stay in) social care, by volunteering, or sadly by being forced to change their career in this current climate. Secondly, there is no doubt that this pandemic will raise awareness of, and appreciation for, the critical work of our care workforce, and that will always be welcome. CMM Useful resources Skills for Care resources and latest guidance for employers: www.skillsforcare.org.uk/About/News/ COVID-19-Guidance-from-other-agencies. aspx More information on volunteering from MHA: www.mha.org.uk/get-involved/ volunteering Telephone interview tips sheet Telephone interview template Video interview tips sheet: available on the CMM website, www.caremanagementmatters.co.uk

Neil Eastwood is author of Saving Social Care and Founder of Care Friends. Email: neil@carefriends.co.uk Twitter: @StickyNeil Have you found recruitment practices that have helped to get staff in during coronavirus? What can you share with others? Make a difference by commenting on the CMM website, where you can also feed-back on this article, www.caremanagementmatters.co.uk 22

CMM May 2020

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CMM May 2020

HEADER

AN UNTAPPED RESOURCE

HOW TO USE VOLUNTEERS With staff absence an issue and only so many people to fill the roles, should the sector look to volunteers? What can they help with and what checks need to be done? Isabel Clift from Florence goes into detail here.

As a care provider, you’re likely to be looking for extra help during this busy and challenging time. Volunteers are perfectly placed to support you – and there’s a huge public appetite for giving back. This was recently seen in the call for volunteers to support the NHS during COVID-19, which received over 750,000 sign-ups within three days of launch. Social care organisations

CMM May 2020

AN UNTAPPED RESOURCE: HOW TO USE VOLUNTEERS

can tap into this national mood by deploying their own volunteer workforce. Here, we’ll provide steps for how to find and manage volunteers, as well as tips for keeping volunteers and those you support safe.

KEEPING PEOPLE PROTECTED Firstly, it’s worth mentioning, members of the public are allowed to volunteer within England’s lockdown rules. However, there are safety concessions to be made. The Government’s overarching rule is to stay at home where possible – so opportunities that enable people to help from their homes are preferable. If your organisation can accommodate at-home volunteers – say, those who can offer regular companionship phone calls or emails to the people you support – that’s ideal. If you need volunteers to help with tasks outside of their homes, these jobs must be undertaken by those who can do them within their daily single outdoor activity, and shouldn’t cause long stretches of time to be spent outside. This volunteering can only be undertaken by those who feel well, who aren’t in high-risk groups and who haven’t been told to self-isolate or shield. When working at your organisation, for example within a care home, volunteers should follow social distancing rules according to Government guidance. If your service provides care for at-risk groups, such as elderly or immunodeficient people, volunteers should be kept completely separate from them – though roles such as fetching shopping are permitted.

FINDING VOLUNTEERS Start with your network. Send a call-out message to friends, family members and colleagues to ask

for their help and connections in finding people. Add a page to your website asking for volunteers, and email your database (if you have either of these). Neighbourhood and mutual aid groups have surged in popularity in the wake of coronavirus. Tap into these networks to find potential willing candidates. Search your postcode on www.volunteercoronavirus. com to find local groups, or join your organisation’s neighbourhood group on www. nextdoor.co.uk. Create a system to manage those you hear back from. This could be as simple as a spreadsheet with columns for names, contact details, and links to other relevant information you may ask for – such as a folder with photos of identification or an up-to-date DBS certificate (within a timeframe compliant with your organisation’s guidelines). Stick to GDPR rules when collecting volunteer data. This means setting appropriate access levels for where volunteer data is stored, for example, making sure any spreadsheets and personal documents aren’t publicly accessible. If you’d rather avoid finding and setting up suitable volunteers yourself, several organisations can connect you with volunteers for free. Look at joining the National Care Force or Do-it, or speak with local charities and volunteer centres who could help source people for you. The National Council for Voluntary Organisations (NCVO) has a handy volunteer centre finder for this.

MANAGING VOLUNTEERS Think carefully about what volunteers can do to help your regular workforce and the people you support, and set expectations around what you need.

Remember, volunteer help is freely given, and can be withdrawn any time. Volunteers shouldn’t have the same obligations as permanent staff, and must work with clear instructions so they’re best equipped to support you. Volunteer tasks could include: • Shopping and errands for those in self-isolation. • Driving people to and from health appointments. • Organising food and other essential deliveries. • Providing childcare for workplace staff. • Befriending people who use your services over phone or email. Know the identification and reference or background checks you require. This will depend on the nature of the work you need help with. If it involves childcare or work with vulnerable adults, your volunteer will need an upto-date DBS certificate. Note, the Government is fast-tracking DBS checks for certain people and applications are now free of charge. You should ask volunteers to bring their identification (for example, their passport, drivers’ licence or identity card) on your first meeting, and their DBS certificate if necessary.

RECOGNISE SCAMS Sadly, coronavirus has led to a rise in scams and false offers of help. Make sure your volunteers are aware of common scams. These might include: • Fundraising appeals for donations to develop a vaccine for the virus (this can occur by phone, online or door-todoor) – no such fundraising is legitimate. • Emails or social media adverts offering fake products such as coronavirus cures, or antibacterial gels. • Cold calls or emails offering to

help with shopping for those in self isolation – it will follow that card details or a cash payment will be asked for upfront. Volunteers should know to report anything suspicious to the volunteer lead at your organisation. Concerns around scams can also be passed to Action Fraud on 0300 123 2040. Volunteers are a fantastic addition to your roster during this time. They can be a real lifeline if you’re facing staff gaps, or a resource strain due to extra requirements from those you care for. When deployed correctly – with clear instruction, and within the government’s lockdown criteria – this hidden workforce will help keep social care going strong. CMM Useful resources • The National Care Force – free platform to connect social care services with vetted volunteers. • Do-It – free platform to connect all organisations with volunteers (including social care). • NCVO Volunteer Guidelines – a detailed overview of how to run volunteer work for your organisation, including information on recognising and reporting scams. • National Trading Standards – provides detailed information for safeguarding against scams, including a free e-learning course. • NCVO: Volunteers During Lockdown – advice for government rules to follow when working with volunteers during lockdown. • GDPR: Volunteer Considerations – written for mutual aid groups, but a super-clear guide for anyone on how to store and protect volunteer data.

Isabel Clift is Head of Content at Florence. Email: managers@florence.co.uk Twitter: @WeAreFlorence What are your tips for using volunteers? Share your best practice on the CMM website, where you can also leave feedback on this article, www.caremanagementmatters.co.uk CMM May 2020

HEADER

KEEPING COMPLIANT

IN THE FACE OF CHANGE

CMM May 2020

We are living in difficult times. For the last few months, we have been at war with an invisible and insidious virus, which, to date, has claimed over 170,000 lives globally. With nearly 126,000 confirmed cases and over 16,500 deaths, the UK has been hit particularly hard by this new strain of coronavirus, yet the spirit, compassion and resolve of the UK’s 1.49 million frontline carers, who provide outstanding person-centred care for millions of people, remains undimmed. Regulators too are playing their part. While I cannot speak for the Care Quality Commission (CQC), as the Head of Care Quality for Quality Compliance Systems (QCS), I talk to registered managers from care homes and domiciliary care agencies every day and a significant portion of our customers have fed back the positive role that CQC is playing in supporting them to provide outstanding care in highly challenging circumstances.

CHANGE OF FOCUS

From changes to regulation, to having to find new ways of working, COVID-19 is certainly making life different. Philippa Shirtcliffe, Head of Care Quality at QCS, explains where coronavirus is accelerating positive change and why compliance will always remain central to providers.

Indeed, with all inspections cancelled, CQC has shifted its focus, carving out an important role for itself in helping providers to adapt and respond to the changing situation. Care providers – and we talk to services of all shapes and sizes – are telling us that CQC has adopted a much more flexible approach to regulation. Many say that in this unprecedented climate, it has recognised that providers may not be able to keep up to date in terms of auditing. I also know that CQC has opened up digital communication channels recently. The message it is communicating to providers up and down the country is overwhelmingly positive and reassuring. In a time of national crisis, the regulator is saying, meet us halfway; follow regulation where you can and if you’re unable to do so, document the reasons why you have had to deviate away from normal processes. In an age of social distancing, CQC inspectors are also participating in webinars, where they're providing key advice to providers. As they create a new collaborative relationship with care providers, barriers are being broken down, and the hope is that the sector is witnessing real and lasting change. But if it is to happen, the sector must come together as one and use its collective voice to work with regulators to ensure that national and regional protocols remain consistent.

CMM May 2020

KEEPING COMPLIANT IN THE FACE OF CHANGE

SOME PROGRESS BEING MADE

For several weeks, QCS customers were telling us that local and national guidelines surrounding PPE were confusing. Regional and national guidelines were different. Public Health England listened and on 17th April, it produced a comprehensive document providing guidance on the use of PPE. The 12-page explainer is broken up into clear, easy-to-read sections and uses ticks and crosses to highlight when PPE is and isn't necessary. PHE has directly addressed the most frequently asked questions and has provided a set of clear answers. Finally, to reinforce learning, it has produced two case studies, a flow chart and a video too.

COMPLIANCE IS KEY While new and updated guidance is a very welcome step, it must cover all of the different entities that make up the care sector. Take the UK’s domiciliary care services, who, between them, look after hundreds of thousands of people. Since the coronavirus epidemic began in February, most of the questions that we've received around PPE have come from them. For example, questions such as, ‘when and where does a domiciliary care worker, who uses public transport to travel between homes, put their PPE on?’ Or, ‘when a domiciliary care worker reaches a home, do they have to change PPE every time they venture into a new room as national guidelines dictate?’. While it comes too late for this article, it is hoped that new and updated guidance being published exclusively for homecare workers will address these questions. But on a wider level these micro examples serve to illustrate a real need for bespoke and structured messaging. Thanks to 24-hour news stations, and a daily update from Government, there’s no shortage of information. But as far as the care sector is concerned, there are very few organisations, who are capable of taking a step back, disseminating and distilling that information and integrating it into easily digestible policies and procedures.

At QCS, we have been gathering and sifting through coronavirus best practice guidance – such as PHE’s new PPE document – to produce easy-to-read policies and procedures. We’ve also created factsheets, bulleted information cards and produced a series of ‘How to’ blogs, which anyone can access on our coronavirus hub for free, even if they don’t use our software. Many of our providers are feeding back that the policies, which are regularly updated, are helping them to stay compliant. But it is not just Pandemic Infection Prevention and Control policies that are valued in a time of crisis. Even now, providers must not lose sight of CQC’s key questions and the Key Lines of Enquiry that underpin them. When you’re stressed and busy, it’s easy to forget that person-centred care is holistic in it's nature. It’s not just about protecting residents from coronavirus, it's also about ensuring their happiness, their wellbeing and making sure that no one’s human rights are being breached.

TECHNOLOGY CAN BE A GREAT LEVELLER With the coronavirus pandemic intensifying recruitment and retention challenges, providing outstanding care is not easy. But technology is a great leveller. Providers who find themselves suddenly short of staff due to Government’s seven- to fourteen-day selfisolation policy can now use technology to form partner networks with local providers, and share staff when possible. Technology can also help raise efficiency and productivity. If a registered manager, for example, is presenting with mild coronavirus symptoms, they could use Zoom or Skype to communicate with staff, even while they need to self-isolate at home, and can use digital systems to ensure that regulation is being adhered to. This means that a service can continue to be well-led, even in the middle of a pandemic. Technology also ensures that training doesn’t have to stop. Zoom and Microsoft Teams enable providers to foster an eLearning approach. That said, while eLearning is extremely effective, the best providers realise that a ‘hybrid’ structure, which also encompasses face-

to-face teaching, is required. This requires training providers to embed several steps into their programmes, which provide tangible evidence that staff have understood what they have been taught and how it fits into the wider regulatory context. One-on-one meetings are not only an extremely effective way of checking understanding and identifying any gaps in knowledge, but they also help to flag wellbeing issues. Indeed, if anxieties and concerns are aired at an early stage, it can prevent more serious issues at a later date. Therefore, this hybrid approach, if used correctly, can alleviate pressure and help to build future resilience.

GREATER COLLABORATION Most of all, this crisis has shown us the power of collaboration. Whether you’re one of the courageous few working on the front lines, or, like most of the population, applauding their efforts from our doorsteps and windows, it demonstrates what can be achieved when we pull in the same direction. With recessionary clouds gathering on the horizon, even when we have beaten the virus, there will be major challenges to overcome. Budgets will inevitably be cut. But the heroic deeds of care workers will be remembered by the public. The hope is that the NHS and the social care sector will work together much more closely than they have done in the past. Before the crisis, it would have been inconceivable to think that the care sector could ever shake off its ‘Cinderella service’ tag. Now, however, thanks to the brave actions of a few, we may be on the cusp of positive and profound change. There are have been very few beacons of light in this crisis, but this might be one of them. CMM Useful resources QCS Coronavirus hub: www.qcs.co.uk/coronavirus-updates CQC coronavirus information: www.cqc.org.uk/guidance-providers/all-services/ coronavirus-covid-19-pandemic-information-providers

Philippa Shirtcliffe is Head of Care Quality at QCS. Email: sales@qcs.co.uk Twitter: @UKQCS How are you keeping compliant? What are you finding most difficult at the moment? Share your experiences and knowledge on the CMM website, where you can also feed-back on this article, www.caremanagementmatters.co.uk 30

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Getting care workers through COVID-19 The current coronavirus pandemic has made things even harder than usual for many. With care workers needing support at the best of times, we know some are struggling. Here, Karolina Gerlich, Chief Executive of the Care Workers’ Charity, sets out how you can support your frontline staff.

At this time more than ever, it’s vital that we support our social care workers. They are amongst the lowest-paid people in our community and are – no matter what some might say – carrying out highly skilled work. Many of the people they support couldn’t get through without them and we must show that we care about them and want to help them through this current crisis.

FINANCIAL SUPPORT One way of doing this is to offer financial support. Whilst those running services might not be 32

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GETTING CARE WORKERS THROUGH COVID-19 able to spare any money to pay their staff more, especially given the testing times ahead, there is no reason not to signpost care workers to outside aid. The Care Workers’ Charity has set up an emergency crisis fund to offer frontline care staff assistance in the form of grants. Any care worker who has been affected by coronavirus can apply for a grant to help them through this distressing time. The charity has been inundated with requests since the launch of this fund and is doing its best to support everyone, but donations are essential to keep this going. Anyone in a position to do so can make a donation on the Care Workers’ Charity Just Giving page, and the money all goes directly to care workers. There are other options out there for support too, and the best thing you can do might be making sure staff are aware of the support that’s available. Money is a difficult topic and staff might not be keen to share with you that they are struggling. But remaining open and approachable, and perhaps even broaching the subject with all of your staff at once with an invitation to speak to you separately if they are facing issues, can help to encourage anyone who does need help to come forward. One thing you will want to make staff aware of is that Government has made Statutory

Sick Pay accessible to anyone who is self-isolating due to having coronavirus symptoms. This includes people who are isolating because someone in their household has symptoms. Whilst it isn’t ideal for providers to lose staff to sickness at this time, for some employees, knowing that they will still have an income might encourage them to stay at home in line with Government guidance, as opposed to continuing to attend work with symptoms because they are worried about not getting paid. For those who are having difficulties with childcare, social care staff are key workers and therefore should be able to keep children in school. If your staff are having problems with this, for example if they are being turned away or told they aren’t eligible, they can contact the local authority who should be able to help them with securing a place at school for their child.

HOUSING PAYMENTS Ensure that employees who might have a mortgage are aware that they can take a ‘mortgage holiday’, meaning they don’t need to make payments for up to three months. Decisions are made by mortgage lenders on a case by case basis, and this option will need some consideration, but is potentially available if staff are struggling to make ends meet.

For those who are renting, Government has put a stop to new evictions, meaning that tenants can’t be evicted until they have missed three months of rent payments. Even then, landlords are expected to do what they can to ensure people can stay in their homes, potentially including working out a reasonable payment scheme that allows people to pay what they can.

KEEPING UP WITH BILLS Regarding other bills and expenses, it could be worth suggesting that people speak to their utilities providers if they think they might not be able to pay. One of the best places to get information on what help is available is the Money Saving Expert website. There are details there about which organisations are offering support to customers and what that support looks like.

OFFERING A HELPING HAND Other ways of supporting your staff include thinking about what small pieces of help you could offer them. For example, is there food in your care home’s kitchen that might go to waste? Can you offer staff a voucher to put towards their food shopping? In care homes, if you know that someone’s commute has been

affected by coronavirus, is there something you can do to help them with getting to and from work? Could a car share scheme be temporarily put in place, or is it possible to set up somewhere for staff to stay if they aren’t able to get home? Both homecare providers and care homes could consider reaching out to local businesses to see if there’s anything they can offer. Some restaurants are offering deliveries to care services free of charge, and some local shops might be able to put together food or toiletries parcels to give out to staff. This is also a great opportunity to set up lasting relationships with your local community that can endure long after we’ve seen the end of coronavirus. This is a difficult time, but if businesses pull together and we make sure we share information and resources, and do what we can to support each other, we will come through it stronger. CMM

Karolina Gerlich is Chief Executive of Care Workers’ Charity. Email: karolina@thecwc.org.uk Twitter: @KGerlich777 Share the things you’ve been doing to support staff in your service. Help others with ideas by leaving a comment on this article on the CMM website, www.caremanagementmatters.co.uk

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KEEPING COR NAVIRUS AT BAY The whole country knows (or should by now) that washing our hands helps prevent the spread of coronavirus. But what additional measures can providers take to ensure they are doing all they can to prevent the spread of infection? Ben Kilbey from Spearhead Healthcare shares six tips to help.

Of the huge range of important daily tasks any care worker undertakes, at present, infection control is the most vital. Many, if not all, care providers across the UK are reinforcing their infection control and cleaning procedures. Here, we will share our six practical pieces of advice for managing the current crisis. 1. Commonly touched surfaces need more attention In care homes especially, items and surfaces that are touched regularly should be cleaned more often than

usual. This includes: • Grab rails. • Handles. • Doorknobs. • Chair arms. • Tables, including coffee tables. • Sideboards and other surfaces. • Remote controls. • Frequently used buttons (for example, door entry buttons). • Light switches. These, and other frequently touched areas, should all be cleaned regularly in all areas of the home

CMM May 2020

KEEPING CORONAVIRUS AT BAY

to help prevent any infection spreading. In the current crisis, particular attention should be applied to communal areas, in addition to your normal room cleans. 2. Personal hygiene One of the best ways to protect the people you support as well as care workers is to ensure everyone is looking after themselves. This includes washing hands regularly with water and soap and drying them with paper towels. Paper towels are much more effective than hand dryers or the more modern jet dryers at helping to reduce the spread of infections. One study conducted by the University of Westminster found that traditional hand dryers spread 20 times more virus than paper towels, and jet dryers spread over 190 times more virus than paper towels. Use hand sanitiser where appropriate but remember that alcohol levels must be over 60% for it to be effective. Medical grade gloves and aprons are day to day essential bits of kit and should continue to be used as needed. Remember to change these after each use, to avoid spreading any infections around. It is also expected in the current crisis that additional protections be added in as needed. Moisture repellent face masks and face vizors are two key items, aimed at preventing any infections from entering through the mouth, nose, eyes and ears, but should only be used while caring for someone with suspected or diagnosed coronavirus or symptoms. 3. Use cleaning products correctly In the current heightened atmosphere, it is easy to over-use cleaning products in an effort to prevent infection. However, it is important to ensure everyone’s safety by using the right products in the right ways and in the right places. We would strongly recommend continuing to follow the directions for use for every cleaning chemical, as some substances can react with different surfaces. For example, bleach on safety (non-slip) flooring causes the floors to break down, tarnishing the surface and removing the anti-slip properties over time.

Colour-coding cleaning products can help to easily identify what should be used and where, and following suppliers’ guidelines for dilutions is important in keeping residents safe – and to keep costs at the appropriate level. You should also make sure your products meet the appropriate standards, such as BSEN1276. This is one of the key standards for cleaning chemicals and provides proof of effectiveness against a range of harmful micro-organisms such as MRSA, salmonella, E. Coli, Flu Virus (H1N1) and Pseudomonas aeruginosa. Your supplier should be able to tell you whether your products meet these standards; however watch out for claims that products will kill COVID-19 as, while BSEN1276 is often proof that a product is effective against other viruses in the coronavirus family, no organisation has been able to test against COVID-19 specifically, due to the virus still being so new and access to laboratory samples being restricted. Another vital part of infection control is making sure staff do not use the same cleaning items, such as cloths, in multiple areas of the home. Splitting these out so that you have dedicated materials for different rooms, often effective through the use of colourcoding, helps reduce the risk of cross contamination and spread of infection. 4. Get your COSHH training updated With many care workers being asked to do more than ever, under increasing amounts of pressure, making sure that they feel well trained and prepared to meet the challenges that may come is important. Speak to your current training provider and see if they are moving to, or can facilitate, online training or video support. While the merits versus face-toface training can be debated, everything that can be done to help care workers feel confident and well trained in the right practices will provide huge benefits to your service. 5. Review your current practices You will undoubtedly already have processes and procedures in place for infection control, and these should be kept together and consulted regularly at this time. Review these practices with

the current outbreak in mind – are they robust enough? Go over them with staff if necessary, to ensure they understand what steps will be taken. In addition to hopefully providing some peace of mind, this makes sure that you are prepared and ready should the worst happen. It also gives you a chance to review and refine your procedures, as well as check that the chemicals you use are the most effective for the job. Finally, it also provides a centralised place, should you have to self-isolate and another member of staff pick up responsibility for this. 6. Reuse your spray bottles At present, one of the issues suppliers are feeding through is that there is a worldwide shortage of spray-top bottles. Many suppliers are telling us that, while they are struggling to keep up with demand, they are perfectly able to keep producing the chemicals needed for cleaning. However, the lack of plastic spray-top bottles means that, while you may not be able to get your usual ready-to-use bottle, you will be able to get larger containers of what you need, which can be decanted into spray bottles. In addition to helping you keep stocked up, larger containers often offer better ‘per use’ costs. It’s important if you do choose to decant from large containers into smaller bottles to ensure that your bottles are clearly labelled to prevent the wrong chemicals being used when cleaning. As always, all chemicals and cleaning products should be stored in a safe, secure place, such as a lockable cleaning trolley. CMM Useful resources www.newcarestandards.scot www.cqc.org.uk/guidance-providers/adult-social-care www.nice.org.uk/Media/Default/About/NICECommunities/Social-care/quick-guides/Infection%20 prevention.pdf www.england.nhs.uk/coronavirus/community-socialcare-ambulance/infection-control www.rcn.org.uk/clinical-topics/infection-prevention-andcontrol/novel-coronavirus

Ben Kilbey is Business Development Manager at Spearhead Healthcare. Email: Sales@spearheadhealthcare.com What ways are you finding to ensure best practice infection control during coronavirus? Share your tips and experiences on the CMM website where you can also leave feedback on this article, www.caremanagementmatters.co.uk 36

CMM May 2020

Find all the latest guidance to help people at risk of coronavirus www.carechoices.co.uk/coronavirus-latest

Our summary and links to the latest available guidance on the coronavirus pandemic in the UK • Current guidance for citizens

• Isolation – staying safe and well

• Guidance on protecting those more vulnerable to COVID-19

• Care Act easements

• Guidance for family carers • End of life care planning and arrangements

www.carechoices.co.uk

• Guidance for care facilities • Our latest news and blogs related to coronavirus

@CareChoicesLtd CMM May 2020

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FINANCIAL SUPPORT DURING COVID-19

The health and care sector faces unique pressures during the COVID-19 pandemic. The industry has now – rightly – been recognised as critical in ensuring the most vulnerable in our society remain safe. Whilst operators will continue in most senses to be operating ‘business as usual’ there will inevitably be an impact from a number of factors. Rachael Anstee, Partner at Hazlewoods sets out the key aspects operators should be considering in managing their financial affairs during these exceptional times.

CMM May 2020

In these uncertain times, it is important to review the position of your business to understand the potential risks, to give some thought to an emergency business plan and to understand what other help is available to you to aid your business continuity. Here is our assessment of the most important areas providers need to consider.

TRACK KEY PERFORMANCE INDICATORS (KPIS) It is well worth ensuring you monitor KPIs very closely during this period (potentially daily but at least weekly). Think about any indicators that would be particularly important to consider at this time, such as staff attendance statistics, details of staff self-isolating or on sick leave, levels of agency usage and any other aspects that might be important to understand at as early a stage as possible.

STATUTORY SICK PAY The Government has announced that ‘eligible’

employees diagnosed with COVID-19 or ‘eligible’ employees who are unable to work as they are self-isolating in line with Government advice due to displaying COVID-19 symptoms, will be entitled to statutory sick pay (SSP) which will be payable from day one. Those employees who are not eligible (earnings of less than £118 per week) will be able to make a claim for universal credit or contributory employment and support allowance.

MANAGEMENT OF CASH FLOW Cash management is likely to be crucial during the pandemic and we would strongly advocate preparing and maintaining a detailed forward-looking cash flow in order to ensure continued liquidity during the crisis. We have free tools on our website that might help you to prepare this. It is probably too early in the crisis to see any noticeable trends or issues arising, such as interruptions in local authority funding payments – although it is conceivable

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Take a look at this For coronavirus updates and support for parents and carers of a disabled young person

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KNOWING YOUR OPTIONS: FINANCIAL SUPPORT DURING COVID-19

there could be delays as councils have to manage their own issues around staff absence due to self-isolation and sickness. Aspects which operators may want to explore in order to carefully plan treasury management might include: • Deferring rates payments. • Agreeing rent and other expenditure deferrals. • Deferring capital expenditure. • Updating your credit control procedures. • Reviewing any contractual obligations and advance orders you may have in place. • Talking with key suppliers. These conversations may be easier than you think. The Government has also announced certain measures that operators could potentially take advantage of in order to assist with shorter term funding and cash flow pressures. If you have concerns about tax liabilities, a helpline has been set up to specifically address these situations (0800 024 1222) and measures can be put in place to help you.

FUNDING AND LOANS Small- or medium-sized businesses may benefit from a new temporary Coronavirus Business Interruption Loan Scheme (CBILS), which launched on Monday 23rd March 2020. This is aimed at supporting SMEs with turnover up to £45m and businesses can approach a list of 40 accredited lenders with a sound borrowing proposal. The scheme supports businesses in accessing bank lending and overdrafts. Loans of up to £5m are available, each provided with a guarantee of 80% for which businesses and banks will not be charged. Furthermore, the Government will cover the interest payments for the first 12 months. It will be important to assess the relative merits of each lender’s scheme as we have heard of instances of personal guarantees also being required in certain cases for the element not covered by the government guarantee. However, the Chancellor has since stated that no personal guarantees should be sought on loans of less than £250,000. For larger businesses being affected by the short-term funding squeeze, there is the option of the COVID-19 Corporate Financing Facility (CCFF). Funded through the Bank of England, the scheme is available to all non-financial companies that meet the eligibility criteria.

CORONAVIRUS JOB RETENTION SCHEME Whilst it might be less relevant to social care operators that continue to attempt to operate as usual, all UK businesses that had staff employed within a PAYE payroll scheme on or before 28th February 2020 are eligible for the coronavirus job retention scheme, which will part pay the wages of employees who may have needed to be laid off due to financial pressures. Businesses will receive a grant for 80% of a furloughed employee’s earnings (capped at £2,500 per month), plus the associated employer’s national insurance contributions (NIC) and minimum automatic enrolment employer pension contributions on that subsidised wage. Employees on sick pay or who are selfisolating cannot be furloughed but can be furloughed afterwards. Employees who are shielding for 12 weeks in line with Public Health England guidance can be placed on furlough. It is a temporary scheme, expected to last for at least three months, starting from 1st March 2020. It can be used at any time during this period using a portal that HMRC have indicated will be live from 20th April. Businesses will need to identify employees as ‘furloughed workers’, and should discuss with their employees, and make any changes to, the employment contract by agreement (seeking legal advice and negotiating with union representatives where necessary). Payments received by a business under this scheme are made to offset normal deductible revenue expenditure. They will therefore be treated as taxable profits for income tax and corporation tax purposes, in accordance with normal principles. To the extent that operators find that they are in the position that members of staff are unable to undertake their duties as normal then this might be of benefit. However, the guidelines are not clear as to whether operators receiving public funding will be entitled to furlough staff. The guidance currently states, ‘Where employers receive public funding for staff costs, and that funding is continuing, we expect employers to use that money to continue to pay staff in the usual fashion – and correspondingly not furlough them. This also applies to non-public sector employers who receive public funding for staff costs.’ We hope that this key aspect will be

clarified to ensure that care operators receive fair and equal access to this key measure. If you are in doubt about your company’s entitlement to join this scheme, we suggest that you contact your employment lawyer. However, we hope that the guidance will be clarified for the benefit of the sector in the near future.

VAT DEFERRAL For any operators that may be VAT registered, the next quarterly VAT payments have been deferred by the Chancellor such that no VAT will be due between now and the end of June. Instead, businesses will have until 31st March 2021 to settle this deferred liability. Any payments deferred during the suspension period will need to be settled before the end of the 2020/21 financial year (31st March 2021).

KEEPING UP The support that is being offered to businesses is currently changing almost daily. Many of the measures may not be perfect but importantly they have been rolled out at speed to address a rapidly evolving situation. If you would like to discuss any of the support schemes available or would like any assistance in accessing these measures we would be delighted to offer our support during these unprecedented times. CMM

Useful resources HM Government Business Support: www.businesssupport.gov.uk Government guidelines for employees, employers and businesses: www.gov.uk/government/publications/ guidance-to-employers-and-businessesabout-covid-19 HMRC dedicated coronavirus helpline: www.gov.uk/difficulties-paying-hmrc World Health Organisation – country and technical guidance: www.who.int/emergencies/diseases/ novel-coronavirus-2019/technicalguidance www.hazlewoods.co.uk

Rachael Anstee is Partner at Hazlewoods. Email: rachael.anstee@hazlewoods.co.uk Twitter: @Hazlewoods Have you used any of the financial support that has been made available to businesses during coronavirus? What are your experiences? Share and feed-back on the CMM website, www.caremanagementmatters.co.uk CMM May 2020

connected In a time when we are all being told to stay at home, and to have no face-to-face contact with any person we don’t live with, people care providers support are at risk of loneliness. To combat this, Helen Wildbore, Director of the Relatives and Residents Association, has shared her top tips and methods for keeping people in touch.

Stay home, protect the NHS, save lives. This is the message echoing across the country as we come together to try to prevent the spread of COVID-19. Families find themselves suddenly separated, no longer able to visit relatives or friends receiving care, whether at home or in a care setting. We know from the calls we are receiving to the Relatives & Residents Association Helpline the impact this is having on those receiving care and their families. We hear from callers struggling with this loss of contact, racked with worry about how their relative will cope without seeing them. Contact with family and friends is vital for everyone’s emotional and mental wellbeing, but especially so for those 42

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who are older, or affected by dementia or other conditions. These connections can help to avoid isolation, loneliness and depression.

HOW TO STAY IN TOUCH Staying away doesn’t have to mean losing contact, and care providers have a key role to play in supporting the wellbeing of those they care for by helping them to stay in touch with relatives and friends. There are several ways to do this – with the most effective often being video or phone calls. Even where a person communicates non-verbally, or perhaps appears not to take in verbal communication, a phone call from a family member/friend, with their familiar voice, could still be beneficial.

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Professor Trish Hafford-Letchfield from Middlesex University shares latest research and best practice in supporting people to be open about their identities in care.

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It is safe to say that working positively and inclusively with people who have diverse sexual and gender identities can be a very challenging area for social care, yet numerous research studies have shown that this remains a peripheral issue for the workforce.

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This is despite evidence showing that the LGBT+ community experiences higher incidence of mental health issues, such as anxiety and depression, suicide and problematic substance use, and that their general health can be worse than that of heterosexual or cisgendered people. Additionally, findings from research with LGBT+ adults indicate that they lack confidence in care services, causing a reluctance or delay in seeking help. This is primarily a result of people’s previous experiences of discrimination, but is also down to a continuing lack of clear direction in working with members of the LGBT+ community, and a distinct absence of targeted policies and practice guidance. Opportunities have been made to remedy this within generic policies impacting on care (such as in mental health, dementia and ageing), but they have so far been disappointing and have only paid cursory attention to the LGBT+ community’s specific needs and circumstances.

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As well as this, people could face discrimination, or fear facing discrimination, in services such as care homes and supported housing, where other residents might be intolerant of living with LGBT+ people who are open about their sexuality and gender identities. These fears must be seen in the context of the enormous disparities and inequalities that LGBT+ people face.

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There is also an issue in the idea that some professionals and care workers might operate from the presumption that all people identify as heterosexual or cisnormative (meaning that we see people with a fixed stereotyped gender). Whether or not this is true for a social care professional, the idea itself makes it very difficult for people using services, and their carers, to talk openly about their lives and relationships.

The scope of the issue In 2018, Government commissioned a national survey with over 108,000 LGBT+ respondents to find out more about the prejudices they are facing. Some of the findings make for difficult reading in light of perceived progress – LGBT+ people reported being less satisfied with their life than the general UK population, with particularly low scores for transgender respondents.

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More than two thirds of LGBT+ respondents said they still avoided holding hands with a same-sex partner for fear of a negative reaction from others. Verbal harassment or physical violence is an ever-present experience which was significantly underreported, and ‘conversion’ or ‘reparative’ therapy offered to ‘cure’ people with different identities is still present in UK society. This all feeds in to how people will feel about being open about their sexual and gender identities in later

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However, there are other options. We teamed up with Dementia UK to bring together our ideas for care providers to help keep families in touch, and many can be useful for people who aren’t living with dementia too. Below are some of the simple steps you can take and the considerations you might need to think about. Explaining the situation • Explain the situation to those you care for, and why relatives and friends are no longer able to visit. • For people with mental capacity issues, explain using simple and short sentences that you can repeat on a frequent basis if needed, rather than trying to explain things in detail. • Have these sentences written on notes throughout the home (the person’s own home or a care home), particularly in line of sight. • In a care setting, consider putting a notice inside a person’s bedroom door as a daily reminder. Using technology • Discuss with the person you care for, and their relatives, how they can use technology to keep in touch. • Explore which forms of communication might be most suitable, bearing in mind any sight or hearing impairments or mental capacity issues. Think about using: – Video calling like FaceTime, WhatsApp, Messenger, Skype or Zoom. These can be great for one-to-one calls or for group calls with several members of the family for example. – Telephone – for some, landlines may be the preferred option. – Virtual assistants, like Alexa, which can be particularly useful for those in their own homes. – Emails to relatives, providing updates. • Support the person you care for, where necessary, to contact their relatives using their preferred technology. This might include helping them dial, set up or join a call, ensuring they can reconnect if their call gets disconnected, making sure they can see and/ or hear the people they are speaking to, or putting an email together. • In a care home, think about setting regular times when relatives/friends can get in touch with residents. Setting a time that works for the person you care for and their relatives

will help provide reassurance, can help with making sure people are supported to use the technology and can ensure that calls aren’t missed by either party. Other ways to keep in contact • Support people – by providing paper, stamps and help if necessary – to write letters or send cards to relatives (as long as they don’t have coronavirus symptoms). This can help people to feel that they are keeping in touch, even if they aren’t comfortable using technology. • Where the person consents, send photos to relatives/friends to help them stay connected and up-to-date with how the person you care for is doing. • Be aware of milestone dates, like birthdays, wedding anniversaries, or anniversaries of deaths which may affect the people you care for, particularly without the physical support of their relatives. Sensitively and gently encourage them to contact their family on these dates, or ensure relatives are able to get in touch. • Make sure people have access to family photos, with people’s names written next to their picture if necessary. Stay positive • Remind everyone, often, that this situation is not permanent, and to keep positive. • Plan a social event that everyone, including friends and family, can take part in when this is all over. Your mental health • Be aware of your own and your colleagues’ mental wellbeing. • Support each other and seek support from external sources to help you through this challenging time.

GETTING THROUGH Care staff are working incredibly hard on the front line of the COVID-19 pandemic under extremely difficult circumstances, despite some being short-staffed due to colleagues being ill or self-isolating. Providers are facing a daily dilemma of working to protect people’s physical health, whilst also trying to protect everyone’s mental wellbeing. Helping to maintain vital relationships is a key part of this and can help with creating an environment of reassurance and openness through this crisis. CMM

Helen Wildbore is Director of the Relatives & Residents Association. Email: info@relres.org Twitter: @relresuk Share what you are doing to keep those you care for in touch with families and friends – send your stories to info@relres.org or comment on this article on the CMM website, www.caremanagementmatters.co.uk 44

CMM May 2020

The National Care Forum (NCF) COVID-19 resources – for members and non-members. Make sure you are aware of all the latest guidance, thinking and intelligence in response to the fast changing situation with COVID-19 Visit the NCF website: www.nationalcareforum.org.uk • The latest from PHE, DHSC & NHS England • PPE guidance, Infection Prevention & Control • Hospital Discharge, Critical Care guidance & Commissioning • Information Governance & using Technology & Data

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Care Management Matters COVID-19 Special Edition May 2020

Articles inside

Getting care workers through COVID-19

Staying connected

CMM News

An untapped resource: How to use volunteers

Inside CQC