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

JUNE 2020

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SPECIAL EDITION

GETTING THROUGH TOGETHER Working as one in end of life care

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In this issue REGULARS From the Editor

Inside CQC Kate Terroni focuses on the Care Quality Commission’s Emergency Support Framework and what it means for providers.

CMM News

COVID-19 and registered manager mental health It’s easy to see how coronavirus is affecting day-to-day business operations, but we must recognise the impact on people’s mental health. Lisa Lenton, Chair of the Care Provider Alliance shares ways of coping.

Life in lockdown: A manager’s perspective In an honest article, Sarah Burton, Services Manager at Choice Support, explains the challenges her services have faced as a result of COVID-19 and how she’s overcoming them.

Supporting each other through end of life care With the number of deaths in care homes creeping up daily, we look at how relationships with local hospices can help providers. Sharon Allen, Chief Executive of Arthur Rank Hospice Trust, details the support available.

COVID-19 insurance cover: What you need to know Insurers across sectors are amending policies, making claims around COVID-19 difficult. Simon Bentley, Director at Phoenix Specialist Risk Solutions, looks at what’s changing and what providers can do about it.

Making connections with your community Building relationships with external organisations is important, but with the current risks, how can you interact with other businesses? My Home Life England details the ways we can all still come together, despite social distancing.

Everything in its place: Creating COVID-19 policies Clear policies are vital at any time, but now more than ever. Offering advice from their own experiences, Insequa looks at the process of creating and implementing a coronavirus policy despite the changing environment.

The road ahead: Legal ramifications of COVID-19 Providers must act swiftly to avoid possible legal action in the future. In this article, Mei-Ling Huang from Royds Withy King gives options for providers to protect themselves and their businesses.

Creating and maintaining your business continuity plan The Access Group's Martin Lowthian gives his key guidance on creating robust continuity plans, and maintaining them – even when at the centre of a crisis.

FEATURES

CMM June 2020

EDITORIAL editor@caremanagementmatters.co.uk 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

@CPA_SocialCare

@Choice_Support

@sharonallenarhc

Kate Terroni Chief Inspector of Adult Social Care, Care Quality Commission

Lisa Lenton Chair, Care Provider Alliance

Sarah Burton Services Manager, Choice Support

Sharon Allen Chief Executive, Arthur Rank Hospice Trust

@myhomelifeuk

@insequaltd

Jen Lindfield Senior Development Officer and Lead for Social Action, My Home Life England

Pamela Holmes Lead for Care Home Friends and Neighbours, North West London, My Home Life England

Bill Watson Director, Insequa

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 17.4

Simon Bentley Director, Phoenix Specialist Risk Solutions

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Mei-Ling Huang Partner, Royds Withy King

Martin Lowthian Business Development Manager, The Access Group

From the Editor In my last column I wrote optimistically about the way the Government had appeared to change its discourse on social care. Officials were talking about care workers as ‘highly skilled’ people adding value to society and deserving more recognition. Another national recruitment campaign was set up and things looked positive. Since then, there have been cash injections into the care sector – mainly for care homes, with other areas of adult social care expecting plans for them to follow – but this money has been allocated to local authorities for dissemination, and, according to many, is yet to be seen by providers. Meanwhile, the Immigration Bill, which will see a new points-based system implemented, has been discussed in parliament again, still excluding care workers from the list of skilled workers able to work in this country under the new scheme. This hypocrisy has only been added to, with Matt Hancock suggesting in a daily briefing that

Government threw a ‘protective ring’ around care homes ‘right from the start’ of the virus. Many have taken serious issue with this statement, feeling that real, actionable support has only just begun to be seen. In fact, Dr Jane Townson, Chief Executive of the United Kingdom Homecare Association, referred to the Secretary of State’s statement as, ‘one of the most depressing and shocking moments of this whole hideous experience’ on Twitter. From what we at CMM are hearing, there is a huge disconnect between what the Government says is available to care providers, and what providers are actually seeing in their operations. Money, in most places, doesn’t seem to be making it to the front line, PPE is still difficult to come by (to say the least), and support from health services is patchy. It is fantastic that the media is giving more airtime to representatives of adult social care, but it’s equally heart-breaking to see the comments on social media when these news outlets share the

Editor, Angharad Burnham looks at how the sector is being discussed, by both Government and the public.

interviews. People write that care providers are private businesses and therefore should have been prepared for this, had stocks of PPE ready, had plans in place, and shouldn’t require or receive support from the Government. Providers are made out to be money-grabbing con artists who put profits first. Maybe you can tell from my tone, but I am tired – and so is much of adult social care – of hearing that providers can do, or should be doing, better on their own. It’s time that people put aside their feelings on whether or not providers ‘deserve’ help, and recognise that if that help isn’t received, millions of people –

people with lives, families, histories and futures – will be at risk; that their lives and the things they might do with them, however long they have left, matter just as much as the lives of people who are ‘lucky’ enough not to need extra support to live life to its fullest. Getting this message heard should not be down to providers. You have enough to do and I once again hope that the articles in this issue will help with some of the pressures you are currently facing. For real change to happen, Government messaging needs to be clear and consistent, and attitudes must change right through to the highest levels.

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

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This month is an important one at CQC, as we launch our interim approach to having structured conversations with providers. These conversations offer support and give us an opportunity to understand the impact of COVID-19 on people who receive services and social care providers during these unprecedented times. You will recall that back in March, we announced we were stopping routine inspections to play our part in limiting the spread of the virus. In the past few weeks I have had lots of positive feedback from those of you who have had conversations with your local inspectors about how you’ve found our approach; offering support, signposting and escalating issues when needed. On Tuesday 5th May, we launched the Emergency Support Framework (ESF). The ESF allows us to have structured conversations with you, very much through the safety lens, about how you are responding to the challenges of COVID-19 and what barriers you are facing. The framework will help us to understand what is going on for individual providers and we will use the information to

Inside CQC K

A T

Chief Inspector of Adult Social Care, Kate Terroni looks at the new Emergency Support Framework, its aims and what it means for providers.

“We want to hear what’s working well for people as well as what needs to be improved.” look at the regional and national level impacts of COVID-19 on adult social care as a whole. We also want to know how services are using innovative ways to manage, so that we can share this learning. This is a new way of working and we will be reviewing and adapting it as we go forward. You can find out what to expect from the ESF using the guidance on our website. I would encourage you to get in touch and give us feedback on how you have found the new process if you have been part of it so far, as this will help us to improve the experience. You can do this via our digital participation

platform, which you can sign up for online if you have not already. We still expect services to continue to do everything in their power to keep people safe and we still have the power to take enforcement action if we think that people are unsafe or are at risk of abuse. It is also more important than ever that we hear feedback from people about the care they’re receiving, which helps us make sure people are kept safe and their human rights are protected. Please can you encourage the people you support and their families to tell us about their care. We want to hear what’s working well for people as well as what needs

to be improved. You can tell us about it using our 'Give feedback on care' service to share your experiences. The COVID-19 pandemic has been more demanding and put more pressure on our sector than any of us could have imagined, which has led to CQC becoming involved in tasks outside our usual role. This includes helping to establish a national testing programme. Our main focus as the regulator, however, is on what the sector needs from us, which is ensuring that people are receiving safe high-quality care, and I am confident that the ESF Is the right mechanism for us to do this during COVID-19.

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

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NEWS

New online portal for care homes to access testing Care Workforce app launched A new online portal launched by Government aims to make it easier for care homes to arrange coronavirus testing, with access to deliveries of COVID-19 test kits. All care home staff and residents in England are eligible for testing, regardless of whether they are displaying symptoms. Testing will be

prioritised for care homes that look after the over 65s. The Department of Health and Social Care (DHSC) is working with local authority Directors of Public Health, Directors of Adult Social Services and local NHS providers to deliver this coronavirus testing programme for care homes.

Previous to this, a survey of National Care Forum members found the original employer portal was not working for social care employers. Using this route, only 2% of staff (138 out of 6,469) were able to receive a test at drive-through centres, with no home testing at the time available on the system via this route.

COVID-19 related deaths in social care staff New data released by the Office for National Statistics has revealed social care staff have significantly raised rates of death involving COVID-19 compared to those of the same age and sex in the general working-age population. Amongst the total deaths from COVID-19 in working age adults, there are 9.9 deaths per 100,000 men, compared with 5.2

deaths per 100,000 females. For social care staff, these figures are 23.4 deaths from COVID-19 per 100,000 men (45 deaths) and 9.6 deaths per 100,000 females (86 deaths). Healthcare workers were not found to have raised rates of death from COVID-19. Dr Layla McCay, Director at the NHS Confederation, said, 'There is a tragedy unfolding... and these figures which show

men particularly and women working in social care have significantly raised rates of death involving COVID-19 are extremely concerning. 'Radical reform is needed... That means doing our utmost locally and nationally to support this vital provider of care, with the proper PPE, training and support in infection control, as well as adequate funding.'

Aiming to unify the sector and support staff through the coronavirus pandemic, a Care Workforce app has been launched for adult social care in England. The Care Workforce app, developed with NHSX and NHS Business Services Authority, will be introduced under the new CARE brand and will act as a single digital hub for social care workers to access relevant updates, guidance, support and discounts from their phone. The app comes in response to calls from the sector for a more unified and connecting brand, and can be downloaded on Apple and Android supported smartphones or accessed by browsers on any device.

Internet connection offers for care providers

Visa extensions for frontline workers

Telecoms providers have released a series of special offers to help care providers get online during COVID-19. A working internet connection allows care providers to use technologies including remote GP consultations, digital ordering of prescriptions and other remote communications with health and care professionals, families and loved ones. Data from the Care Quality Commission (CQC) and BT Openreach shows that 7,000 care homes in England are without

Frontline workers, including social care staff, who have a visa due to expire before 1st October 2020 will receive an automatic one-year extension. It will apply to those working both in the NHS and independent sector and will include their family members. This follows a request by the Association of Directors of Adult Social Services (ADASS) to make changes to the Immigration Bill after it was announced that overseas NHS workers would receive visa extensions.

adequate internet connections. Only a third of the sector is fully digital, with the remaining two thirds either entirely paper-based or using a mix of paper and digital. The offers include deals for those connecting to the internet for the first time, and for those who want to upgrade their existing internet connectivity during COVID-19. NHS Digital is also providing free NHS Mail accounts to care home providers to help them safely share residentsâ&#x20AC;&#x2122; data and queries with doctors, nurses and GPs involved in

their residents' direct care. This can be accessed from mobile devices as well as desktops and includes collaboration tools such as Microsoft Teams. It is anticipated that better connectivity will have lasting benefits across the care sector. Being better connected will enable care providers to connect people they support with other health and care professionals, families and loved ones, reducing the need for faceto-face contact and ensuring good quality care.

CMM June 2020

NEWS

Funded Nursing Care rate 2020-21 The Government has announced the increase of the NHS Funded Nursing Care (FNC) rate for 202021, as well as a backdated increase for the last financial year. The standard rate of £165.56 has increased by 9% to £180.31 for the 2019 to 2020 financial year, while the higher rate of NHS Funded Nursing Care has also

been increased by 9% to £248.06 per week for 2019 to 2020. This is only relevant for people who were already on the higher rate in 2007 when the single band was introduced. This will also be backdated. For the 2020 to 2021 financial year, the NHS Funded Nursing Care standard weekly rate per person

will increase by 2% from £180.31 to £183.92. The higher rate of NHS Funded Nursing Care will also then increase for 2020 to 2021 by 2% from £248.06 to £253.02 per week. This is only relevant for people who were already on the higher rate in 2007 when the single band was introduced.

Skills for Care COVID-19 advice line In response to the COVID-19 pandemic, Skills for Care has launched a new advice line to support the sector’s 20,000 registered managers and other frontline managers. The advice line will offer

bespoke advice to registered and front-line managers who are managing CQC regulated adult social care services, helping them to access the latest information, resources, funding, online learning and other opportunities, both

from Skills for Care and other agencies. It is open from 9am to 5pm, Monday to Friday on 0113 241 1260. Visit the website for more information.

Urgent need for better support for disabled people New data from adult social care providers has revealed an urgent need for better support for disabled people and their services through the coronavirus (COVID19) pandemic. The Government response to supporting adult social care through this time needs to be more inclusive to enable the social care sector to support people with disabilities, and their services,

according to the Voluntary Organisations Disability Group (VODG). VODG, in collaboration with Professor Chris Hatton from Lancaster University, undertook a rapid audit exploring both regulated and non-regulated services for working-age adults to examine how the pandemic is impacting on disability services. The findings revealed that

while the dominant focus remains on the NHS and older people’s care homes, there is a wide range of essential care and support services for the nation’s disabled people that are facing challenges and that risk being excluded from the Government’s COVID-19 pandemic response. More information on the report's findings can be viewed on the VODG website.

Surviving the pandemic: New challenges for Adult Social Care and the Social Care Market A discussion paper by Professor John Bolton at the Institute of Public Care (IPC) looks at how councils have avoided the predicted collapse over the period of austerity (2010-2020) and highlights new problems that have emerged during the COVID-19 pandemic and how these might be the issues that push social care over the edge. The paper suggests a number of steps such as formulating a short-term strategy to address the local issues, and engaging more with providers of care to fully understand how they operate 10

CMM June 2020

and what additional costs they experienced during the COVID-19 outbreak. It suggests considering the death rate in care homes in their area and looking at the impact on short-term occupancy levels as well as what financial assistance providers will need to be sustainable again in the longer run. When reviewing domiciliary care, the paper suggests conversations with providers and customers, highlighting the need for assurance that the capacity is still there to support the growing number of people who may (partly as a result

of the pandemic) be looking for new forms of care to help them in the future. There needs to be a review of approaches to commissioning care to learn from those that have successfully developed local social enterprises or built on local community capacity to contribute to meeting people’s needs in the future. The paper predicts there is likely to be a real challenge in the numbers of staff available in a number of settings and to consider the mental wellbeing needs of staff.

Campaign to recruit care workers during COVID-19 Government has launched a new campaign to recruit care workers during COVID-19. The campaign, titled ‘Care for Others. Make a Difference’, will look to inspire the public to consider a career in social care. To help fill the recruitment gap, the Health and Social Care Secretary, Matt Hancock and Care Minister, Helen Whately have launched the campaign to encourage the right people with the right values and attributes to consider a career in the sector. Free-to-access e-learning courses and webinars for local authority and care provider staff are also being developed.

Changes to Mental Health Act complaints process In response to the coronavirus crisis, the Care Quality Commission (CQC) has made changes to the way it responds to people contacting it with a complaint about the Mental Health Act. The regulator is now taking individual complaints for people that are detained or have been detained under the Mental Health Act. To ensure that its monitoring work is focused on protecting the human rights of the most vulnerable people, it is prioritising contacts received from or about people who are currently detained on an inpatient ward in hospital. All other Mental Health Act complaints – new or existing – will be reviewed, but may be paused during the coronavirus outbreak.

NEWS

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For more information, contact David Werthmann: Email: david.werthmann@carechoices.co.uk • Tel: 01223 206981 CMM June 2020

NEWS

Reuse of medicines in a care home or hospice

VODG membership open to smaller organisations

Updates have been made to the standard operating procedure on how to run a safe and effective medicines reuse scheme in a care home or hospice during the coronavirus outbreak. This standard operating

Voluntary Organisations Disability Group (VODG) is offering potential new members with an income of less than £1m, free membership for 2020/21. The offer is part of VODG’s wider response to COVID-19. It aims to help smaller not-for-profit

practice gives guidance to care homes and hospices about using medicines labelled for one patient who no longer needs them for another patient and can be found on the GOV.UK website.

CQC’s regulatory approach during coronavirus The Care Quality Commission’s (CQC’s) chief inspectors have issued a joint statement setting out the approach to regulation during the coronavirus pandemic. The statement highlights CQC’s Emergency Support Framework (ESF) which aims to provide the regular conversations that inspectors are having with providers in a structured way. It will cover four areas: safe care and treatment, staffing

arrangements, protection from abuse, and assurance processes, monitoring, and risk management. Information gathered is another source of intelligence that CQC is using to monitor risk, identify where providers may need extra support to respond to emerging issues, and ensure they are delivering safe care which protects people’s human rights. Visit the CQC website for more details.

disability organisations face the extraordinary challenges the pandemic presents by providing access to VODG’s membership, public affairs, and sector development services. More information can be found on the VODG website.

Death in service benefits Recognising the increased risk faced by staff during the COVID-19 crisis, families of health and care workers on the frontline in England will benefit from a new life assurance scheme during the coronavirus pandemic. It will cover coronavirus-related deaths of workers in frontline health and adult and children’s social care roles during the outbreak and also staff who provide hands-on personal care for people who have contracted coronavirus or work in health or care

UNLEASH

settings where the virus is present. Bereaved family members will receive a £60,000 lump sum, with the cost met by the Government. Within social care, the scheme will cover employees of publicly-funded care homes, home care, directlyemployed care workers, including personal assistants, and frontline child and family social workers. The scheme also includes cleaners and porters who continue to carry out vital duties in these care environments.

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Supporting adults with learning IPPR report on caring for care workers disabilities and autism The Social Care Institute for Excellence (SCIE) is regularly updating is guidance for social workers and occupational therapists supporting adults with learning disabilities and autism through the COVID-19 crisis. As well as aiming to keep both parties safe, the guidance aims to protect and promote people’s rights wherever possible. The guidance highlights the importance of helping the person to understand any

changes to their routines and to use the usual methods of communication that are effective with the individual to help them understand the social distancing restrictions. As well as giving guidance on physical health, such as infection control, client visits and testing, the guidance highlights people may need additional support with handling their emotional life. Visit the SCIE website for more details.

UN Policy Brief: The impact of COVID-19 on older people The United Nations (UN) has published a policy brief, The Impact of COVID-19 on older persons which highlights the need for improved social support and smarter efforts

to reach older people through digital technology to reduce the effects of isolation under lockdown. Visit the UN website to download the full briefing.

The Institute for Public Policy Research (IPPR) has released a report looking at the importance of caring for care workers and NHS staff across the UK. Drawn from IPPR and YouGov polling, an IPPR consultation and a literature review, Care fit for carers: Ensuring the safety and welfare of NHS and care workers during and after COVID-19 reveals the experiences of the health and care workforce during COVID-19 so far. IPPR states COVID-19 is one of the most significant threats our

country has faced in modern times. The Prime Minister has compared it to a wartime event; but, argues IPPR, war, and events like it, requires a change in the social contract. The think tank is calling for an intervention in caring for care workers and NHS staff that is similar to the First World War's ‘homes fit for heroes’ and the Second World War's ‘from cradle to grave’. Read the full report on the IPPR website.

Extra payment for staff in Wales The Welsh Government is funding a £500 extra payment for all social care workers in Wales. First Minister, Mark Drakeford said the payment provides further recognition for an often

‘under-valued and overlooked’ workforce. The payment will be available to 64,600 care home workers and domiciliary care workers throughout Wales.

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D N A 9 1 D I V CO

REGISTERED MANAGER MENTAL HEALTH 14

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Coronavirus has impacted businesses in social care like nothing else. But it’s impacting the sector’s staff too. Lisa Lenton, Chair of the Care Provider Alliance (CPA) explores the additional pressures registered managers are facing and offers ways of maintaining and improving mental health.

some successes. Despite this, the pressures on registered managers are huge, and it’s bound to impact their mental health.

ADDITIONAL PRESSURES

As we enter into the summer months, the requirement of the social care workforce to support the most vulnerable within our communities continues. Our already stretched sector, as highlighted by the King’s Fund’s Social Care 360 review, is under intense pressure. As the virus began to spread across the globe, the care sector was taking note, and as early as February CPA surveys revealed where support was needed the most: • Maintaining the care workforce. • Access to, and the supply of, the correct PPE to keep people safe. • Finding novel strategies to care for people in the absence of appropriate protection. • Understanding new hospital discharge rules, driving providers to adapt existing policies quickly to support people returning into care settings. • Cash flow– Increased payroll costs and escalating costs for PPE caused significant numbers of providers to report concerns. The CPA has worked extensively to influence Government action and resolve key issues, and whilst progress has been slow, there have been

In the face of challenge, care workers have gone above and beyond in their resolve to care for the most vulnerable in our society. It’s with a heavy heart that we hear of the tragic loss of care workers to the virus. This has had an impact on the wellbeing of our care workforce beyond anything we have experienced in the past. Skills for Care estimates there are around 22,000 registered managers in social care, and the additional pressures relating to the massively expanded responsibilities of their role potentially pose a significant risk of overloading to managerial mental wellbeing. Furthermore, confusing and sometimes conflicting official guidance has managers questioning whether they are doing the right thing to keep both staff and the people they support safe. As well as being energy draining, it’s physically time-consuming to read through endless new protocols, source PPE, communicate to staff the latest guidelines and, at the same time, reassure everyone they are doing OK. Then there are the stresses unique to each service; Nick Kelly, Chief Executive at Axela Healthcare, points out the COVID-19 pandemic has led to his management resources being diverted towards multiple scenario contingency planning. For example, drawing up transport provisions for care workers when the Government was considering shutting Transport for London services.

SHARING, CARING AND SUPPORTING Social care managers we know have an enviable resilience, and together with the CMM June 2020

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COVID-19 AND REGISTERED MANAGER MENTAL HEALTH

right team and resources behind them, they continue to not only deliver quality care services in these challenging times, but also support their exhausted teams. Harnessing technology, the sector is witnessing countless online meetings, creating Facebook and WhatsApp groups where knowledge is shared; there’s reassurance from the top, and there is mutual support across services like never before. Axela has given all its staff mental health first aid training and, like many organisations, has ensured all staff have access to resources to help manage and address any mental health issues they are experiencing. These support tools go beyond stresses at work, to giving guidance to manage stress and anxiety in personal lives too, such as with finances or relationships. Making Space manager, Judith Oaks points out it’s a team effort in keeping the physical working environment upbeat and humorous. She highlights the importance of having open and honest conversations with staff when there’s conflicting and confusing guidance. ‘It’s also about acknowledging it’s OK to get annoyed and to have times where you vent to trusted individuals,’ she says.

SECTOR SUPPORT To help with the practical side of things, we are collating and signposting to the latest guidance and advice from reliable sources on the coronavirus workstream on our website, but there’s also a wealth of mental health and wellbeing resources available to the sector. We have partnered with Big Health to give care workers the tools to manage their sleep and anxiety at no cost for all staff through to December. Sleepio is a highly personalised, digital sleep improvement programme based on cognitive behavioural therapy (CBT), that gets to the root of poor sleep. There are also tools to help manage any worries and thoughts that make it difficult to sleep and ways to improve your environment and habits for better sleep. Sleepio is backed by clinical evidence, including 12 published randomised control trials and 37 published papers. Key workers can access Sleepio from a computer or laptop at www.sleepio.com/ care-access. Daylight is an app that teaches ways to manage worry and anxiety in life. The programme gives a range of techniques and guides the user through daily practice sessions. Key workers can access Daylight at www.trydaylight.com/careaccess.

In addition, our ten members all have resources and guidance on their websites, specific and relevant to their members.

ADDITIONAL SUPPORT FOR BUSINESS CONTINUITY Knowing where to look for guidance and help in these unprecedented times can also help take some of the stress away from managing a service. The King’s Fund has a dedicated section on its website aimed at providing support to health and care leaders, working in the NHS, social care, public health or the voluntary and independent sector. As well as local networks and guidance

How one care provider is supporting manager mental health Coverage Care Services is a not-for-profit care provider which currently operates 14 care homes in Shropshire. The support it has provided to ease the risk of overstretching and exacerbating the mental health of managers includes: • Zoom meetings as often as needed to keep abreast of national, local and company developments at least twice weekly. • Access to Director support 24/7. • HR managers being available to talk to managers and reduce their own anxieties or stressful situations with staff issues. • Listening to the managers’ suggestions for maintaining staff morale and implementing the suggestions, such as small gifts of thanks. • Weekly letter from the Chief Executive to managers and staff explaining what the company is doing and why and praising their contribution to keeping residents safe. • Agreeing a very flexible approach to managers’ working week and ensuring they are getting time away to rest. • Zoom session with external trainer focusing on personal wellbeing and resilience.

webinars, Skills for Care has also set up a new advice telephone line and email inbox to provide managers with support and answers to questions. Furthermore, the Government has recently launched the Care Workforce app, a single digital hub for social care workers to access relevant updates, guidance, support and discounts from their phone. It has also published tips and guidance for managing any concerns and worries that social care managers might have as a result of COVID-19 on its website. While there is good support available to managers now, let us not forget months down the track, when times are less challenging, the support for care managers, and indeed the workforce as a whole, must carry on to ensure continuity of the sector. CMM

Advice for care managers from WHO Social care managers are recognised by the World Health Organisation (WHO) as a group currently facing particular challenges to mental and psychological wellbeing. It has outlined the official following guidance to support care managers: • Keeping all staff protected from chronic stress and poor mental health will mean that they will have a better capacity to fulfil their roles. Focus on longer-term occupational capacity rather than repeated short-term crisis responses. • Ensure that good quality communication and accurate information updates are provided to all staff. Rotate workers from higher-stress to lower-stress functions. Partner inexperienced workers with their more experienced colleagues. • Initiate, encourage and monitor work breaks. Implement flexible schedules for workers who are directly impacted or have a family member affected by a stressful event. Ensure that you build in time for colleagues to provide social support to each other. • Ensure staff are aware of how they can access mental health and psychosocial support services and facilitate access to such services. It is important that the above provisions are in place for both workers and managers, and that managers can be role-models for selfcare strategies to mitigate stress. • Manage urgent mental health and neurological complaints (e.g. delirium, psychosis, severe anxiety or depression).

Lisa Lenton is Chair of the Care Provider Alliance (CPA). Email: info@careprovideralliance.org.uk Twitter: @CPA_SocialCare How are you ensuring your registered managers’ mental health is maintained, despite the current challenges? Share your tips and ideas on the CMM website, where you can also feed-back on this article, www.caremanagementmatters.co.uk 16

CMM June 2020

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CMM June 2020

Life in lockdown:

A manager’s perspective Across England, Choice Support employs around 2,800 staff to support about 2,500 people with autism, learning disabilities and mental health issues. Sarah Burton has worked for Choice Support in Wakefield for four years, managing a team of 18 staff that support six people living in their own homes. Here, she shares her experience of running a service during coronavirus.

It’s been busier than I’ve ever known. The hours we put in as managers have been immense, because straight away we had 25% of our workforce go off work – including staff who had pre-existing health conditions. Over recent weeks, since the COVID-19 outbreak, we’ve all learnt so much about ourselves and what’s really

CMM June 2020

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

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CMM June 2020

Ask questions Get involved Join the family

LIFE IN LOCKDOWN: A MANAGER’S PERSPECTIVE

important. As managers, we are always prepared for incidents, accidents and emergencies. We have risk assessments in place for staff to know how to deal with most eventualities, but where was the manual for the deadly COVID-19? How could we plan for something we didn’t know anything about and that hit us so quickly? We all created a contingency plan outlining the lowest staffing level we could go down to in a crisis. I looked at the support for each person and what we could offer with fewer staff so that everyone would have the same quality of life and then I put safe staffing levels in place. There was so much work and planning to make sure each person got what they needed. Then we went on to planning what would happen if anyone caught the virus, how we would support them, and what that was going to look like.

MAINTAINING CONSISTENCY To limit how many people are coming into the services, my staff were happy to work overtime to cover as many shifts as possible. We also thought about family and friends who could come in and help us on standby. I already oversaw all the staff recruitment in Wakefield, so this is where I came up with the idea of recruiting temporary staff. I suggested changes to our recruitment processes, including over the phone interviews and fast-tracking people through. My ideas have been shared and are now being used across the whole of Choice Support. I’ve recruited consistent temporary staff for each service to come in at midday to provide a fresh face for activities and to take the burden off any tired or exhausted staff. This is my top tip to keep everyone safe, rested and happy in lockdown. It’s been so, so busy but I cannot praise the staff enough. They’ve all just pulled together. In some services they’ve even left their families and bought blow up beds to start sleeping in, just so they can protect the people

we support in lockdown. This is also providing important companionship and emotional support to people who don’t have family or whose family cannot visit. Even at the start of the outbreak, people we support had to say goodbye to familiar faces and routines. A quarter of staff weren’t working, and most families aren’t able to visit because of social distancing. We needed to keep consistent relationships and routines going because people living with autism, Attention Deficit Hyperactivity Disorder (ADHD), and other needs already find it difficult to cope with everyday life. To suddenly change everybody’s routines could cause significant mental health and behavioural issues.

through to FaceTiming families who are desperately worried about the outbreak and missing their relatives. Using tablets and phones to keep in touch has made life on lockdown a lot less isolating. Providing fun is the easy bit, but how do we ensure that the individuals are safe and keeping up with important appointments? One person required a speech and language assessment due to a recent diagnosis of thyroid problems. Again, technology came into play and we used a video conference call so the specialist could watch him eat and drink and assess his abilities. We discovered that this assessment approach probably worked better for the person we support than someone he doesn’t know sitting beside him.

CARRYING ON

THE IMPORTANCE OF SUPPORT

Another challenge was helping people to understand COVID-19, social distancing and lockdown. Why couldn’t we do the things we used to do? We used easy read messages, memos and signs to help us explain what was happening and we pinned these up around people’s homes. Hand gels, sanitizers and gloves are still on display as objects of reference to guide everyone into more effective and thorough cleanliness. Face masks as well as gloves have become a familiar sight when we are helping people with their personal care. We came up with ideas for regular activities to give structure to our days. We bought games and materials for making arts and crafts. We bought a lot of flour so we could bake buns and cakes for our weekly bake-off competition. Staff brought in their Hairy Bikers cookbooks to entice individuals to cook and to pass time following a recipe. We decided to go for a walk each day at the same time. Some individuals also rely on a daily drive as part of their behaviour management plan and we placed key worker signs in staff’s cars so those people could still go out. Thankfully, we have technology and we can access a wide range of online activities ranging from art and craft competitions, exercise sessions,

There’s been a lot of anxiety. The media makes you anxious, and my staff constantly ask, ‘Are we doing the right thing?’ However, in terms of support from the organisation, this has been amazing. We receive one daily email from senior managers updating us on any advice from the Government. We also have a daily online catch up with other local managers, where we keep each others’ spirits up. We feel that it’s important for us as managers to keep positive and this motivation will feed down to our staff who are on the front line. In addition, we have weekly vlogs from our Chief Executive, and regular emails and even phone calls from the directors. The support has been endless, and we do feel our hard work is being appreciated. So, how do you cope in a crisis when there are no manuals or rule books? You have a fantastic team of support workers that pull together when they need to. People who put others before themselves. Staff who come up with ideas for keeping people entertained all day, keeping up everyone’s self-esteem. You don’t need policies, procedures and regulations to provide care in line with your values, this comes from within and this is what COVID-19 has shown us. CMM

Sarah Burton is Services Manager at Choice Support. Email: Sarah.Burton@ChoiceSupport.org.uk Twitter: @Choice_Support How have you supported your staff to keep going during coronavirus? How are they adapting to carry on? Share your experiences on the CMM website, where you can also leave feedback on this article, www.caremanagementmatters.co.uk CMM June 2020

SUPPORTING EACH OTHER through end of life care The statistics of deaths in care homes during COVID-19 are shocking and sad, and those receiving care at home aren’t currently being counted. Providing end of life care has never been more difficult and it’s vital that services come together to support each other. Here, Sharon Allen OBE, Chief Executive of Arthur Rank Hospice Charity explores ways hospices can help, and details useful resources for guidance.

One of the great loves of my life was my beautiful little dog, Mollie. A Bedlington terrier who brought joy to our lives for over 15 years, my heart broke when she died. Taking her for a walk was a treat, watching her joy as she bounded, taking exercise, sniffing, greeting and continually being told by people she didn’t know that she was beautiful. She was. Now, limited on how much time we can spend outdoors, taking a walk has a new context, I miss little Mol in a different way. As joy and sorrow

CMM June 2020

so often intertwine, a new pleasure is hearing my neighbours’ dog, who we sometimes ‘foster’, come calling. She comes bounding in and off we go for a walk (letting her family know of course!). Lovely story you may be thinking, and the point is? The point is, that it was on one such walk a few weeks back, when I took a call from a colleague in the local Clinical Commissioning Group (CCG). They were asking if Arthur Rank Hospice Charity, where I am Chief

Executive, could help a local nursing home that was experiencing a high number of deaths due to coronavirus. The tragedy facing nursing and residential homes and domiciliary care, who are dealing with extremely high rates of death amongst those they care for, has now made national headlines. Itâ&#x20AC;&#x2122;s a crying shame that, yet again, social care must reach such a devastating scale before serious attention is paid. The answer as to whether we could help our colleagues in the nursing home (and others who have been put in touch with us) was of course, yes. This is part of our role as a community hospice: to share our expertise and experience, skills and knowledge with all our colleagues across social care and health. We know that not everyone who is at the end of their life needs our care and support; many will die with family, including the care workers who are like family and who have lived and worked with them for many years. Our role is to provide information, advice, guidance and support so that everyone has a good death. It is also our role to support our colleagues who are used to providing high quality care at the end of life, but are not accustomed to facing the unprecedented volume and extreme challenges of the circumstances we are currently in.

KEEPING ON TOP OF GUIDANCE Over recent weeks, lots of guidance has been provided for the care sector on how to keep people safe and well and it can be hard to navigate it. As you would expect, the first place I would refer to is the Skills for Care website where there is much useful information. Specifically, End of life Care: Support during the Covid-19 pandemic, which is based on the previously produced Common Core Principles for End of Life Care, has links to a range of resources. Their End of Life Care website page has further resources which I encourage care providers to access. Registered managers are key professionals providing guidance, setting and maintaining standards and supporting colleagues. Now, more than ever, they need active support and Skills for Care has a wealth of support, including its newly launched advice line. At a local level, Registered Manager Networks and local care provider associations are invaluable sources

CMM June 2020

SUPPORTING EACH OTHER THROUGH END OF LIFE CARE

of support. It is likely that right now managers may feel too busy to join. However, at this time it’s vital that registered managers take some time (and are supported to do so by their organisation if they are part of a larger provider, or give themselves permission if they are an independent provider) to invest in themselves. This is the only way we can ensure we have sufficient energy and resource to continue doing incredibly demanding roles. We’ve taken advantage of these sorts of support – just before the pandemic broke, a new Provider Alliance for Cambridgeshire www. cambridgeshirecares.org was established. What a timely inception. The weekly Zoom meetings, liaison with the local authority, CCG, Care Quality Commission and local businesses are invaluable for members. Nationally, The Care Provider Alliance has been working hard and is raising the issues for care providers. Their website is a good source of resources and can help you stay informed with the latest updates. Hospice UK’s website shares guidance ‘Caring for your dying relative at home with Covid-19’. Many hospices, including Arthur Rank Hospice Charity in Cambridgeshire, provide Hospice at Home provision to support people who have chosen to die at home and their families. They might be able to support your service too, check with your local hospice about what support they could provide (you can find your local hospice at www.hospiceuk.org/about-hospicecare/find-a-hospice) Dying Matters, part of Hospice UK, also has resources supporting people, families and services to think about, plan and prepare for when someone is dying, while weekly webinars from the likes of The British Geriatrics Society and Social Care Institute for Excellence (SCIE) cover a range of topics, providing rich support for hospices and our partners, including care providers. In a blog for Skills for Care, our Matron, Carly Love mentions a toolkit we are working on to support providers. This is nearly complete and includes further links to resources and support, including offerings from Beyond Words, who have produced free downloadable

booklets to support people with a learning or communication difficulty. It also includes a checklist for delivering unwelcome news over the phone and advice for having difficult conversations. This will be available on our website soon so check it out.

MANAGING VISITORS An area that both hospices and care providers are finding challenging is how to manage visiting, or rather, the restrictions we have been forced to introduce. The hospice ethos, like care and nursing homes, is to actively welcome visitors, so they become part of a wider family and work together with our colleagues and volunteers. Sadly, we have had to restrict visitors to one member of the close family per patient per day. We are fortunate that our hospice is a relatively new building and all rooms on our Inpatient Unit (only one part of what we provide) face out on to garden space. This means we can enable other family members to visit and talk to their loved one through the glass doors – it’s not the same as being in the room, but perhaps the next best thing? We have been able to help support contact between patients and their loved ones in new ways too, thanks to our community’s generous response to our call for iPads, alongside an opportunity to take part in an NHSX initiative to trial Facebook Portals. This means everyone staying in our Inpatient Unit has access to a tablet to communicate digitally with those they love. We know this is no substitute for the ability to be there in person, to share loving touches and kisses, but it is something. We have also offered to share our temporary visiting policy with local care providers so that they can learn from what we are doing.

CARING FOR BEREAVED FAMILIES One of the services we provide through the hospice is bereavement support for families of those we care for. We know that there is going to be increased need for this type of support for our wider community, including our care

provider colleagues. We also know that bereavement in the COVID-19 era is likely to be more complicated due to factors such as feeling disenfranchised; the sudden nature of losses; multiple losses; not being able to be present at end of life, throughout hospital admissions or for loved ones living in residential or nursing care; social isolation before and after the loss; spatial distancing measures; and the likelihood that there will be an increase in mental health issues due to the anxiety provoking context of COVID-19. The possible silver lining to the situation is that people may be more likely to know someone else bereaved in a similar circumstance, enabling mutual support, and for conversations to happen between them and the wider community, which as a whole is starting to talk openly about bereavement much more. It is worth remembering that under normal circumstances, only 10-15% of people who have been bereaved require additional support, with the remaining 85-90% managing with the support of family and friends. Although these numbers are likely to change, given the current context of increased risk factors for complicated grief, the potential of community support and community education is still important. One of our psychologists penned a beautiful poem shared in our weekly bulletin for colleagues; I’ve paraphrased some of this to share here: we cannot take away each other’s pain or fear, we can walk with you for some of the journey until you feel steadier and can find your own way. It is OK to tread water or even reverse, before you feel better, you may feel worse, that is OK, let us hold our nerve and space and go at the bereaved person’s pace. It is true that life will never be the same again and true that time will soften the pain. Let tears fall, let yourself feel, be patient with yourself, it will take time to heal. CMM

‘And remember, love and grief are inextricably entwined. Grieve hard, but love fearlessly And to thyself, be kind’

Sharon Allen OBE is Chief Executive of Arthur Rank Hospice Trust. Email: sharon.allen@arhc.org.uk Twitter: @sharonallenarhc What new ways are you finding to cope with end of life care? Have you spoken to your local hospice? Feed-back on this article and share your thoughts on the CMM website, www.caremanagementmatters.co.uk 24

CMM June 2020

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COVID-19 insurance cover: NOW K O T D E E N U O Y T A H W

With news that insurers are amending policies, claims could be made difficult for care providers. What is changing and what can you do to protect your business? Simon Bentley, Director at Phoenix Specialist Risk Solutions, shares the details.

COVID-19 has impacted us all in different ways and you donâ&#x20AC;&#x2122;t need to be an insurance expert to have noticed the bad press that insurers have had in the recent weeks around cover for coronavirus, so we hope this article helps with what you need and what you should be aware of going forward. There are different aspects of cover included within most policies and we are focusing only on a few aspects here. If you are in doubt about your cover

CMM June 2020

COVID-19 INSURANCE COVER: WHAT YOU NEED TO KNOW

or choices, please contact your broker or us and we will try to help you. At the time of writing this, there have already been a number of changes within the insurance market for care, with some insurers not writing new business, some covers being restricted, and some being removed totally. Here, we’ll go through what you need to look out for.

BUSINESS INTERRUPTION This cover is designed to keep you in the same financial position as if the event had never occurred, however the event is usually linked to a material loss, such as that resulting from a fire or flood. Following the SARS outbreak in 2002-2004, many insurers changed their wording from ‘infectious diseases’ to a list of diseases. However, due to COVID19 being a new disease, it is not included on the list. This could make it difficult for providers to make a claim. Some policies also have certain trigger points, such as the business having been forcibly closed by a competent local authority, and whilst many establishments, such as bars, shops and restaurants have been forced to close, care businesses have not and thus a claim has not been triggered. Nearly all policies which are being renewed will now have a COVID-19 exclusion for business interruption claims, so if you did have the cover you are unlikely to have it going forward.

EMPLOYER’S LIABILITY Employer’s liability is a statutory cover and if you employ anyone you have a legal requirement to have Employer's Liability Insurance. The statutory minimum level of cover is £5m, however it has become general practice for cover to be issued at £10m. Most of these £10m employer’s liability policies have an inner limit for terrorism cover at £5m. This could be a possible area where cover might change to include an inner limit for COVID-19 but the cover cannot be excluded.

PUBLIC LIABILITY Unlike employer’s liability policies,

public liability is not a statutory cover and as such changes can be made to the cover and it is possible to exclude COVID-19 from policies. In the general insurance market, this is already happening, with some insurers adding a COVID-19 exclusion. This often also refers to SARS. Some insurers have taken this a step further and are applying a pandemic exclusion from their cover. Others are taking a different approach and are specifically including cover for COVID-19 but are applying an inner limit on the amount which can be paid out for costs and expenses. This approach has received mixed responses, as whilst it is limiting the cover it is also specifically including the cover.

LEGAL ADVICE AND EXPENSES Legal advice and expenses are usually included within your policy and this is sometimes overlooked, but it is an important part of the cover. Insurers’ solicitors provide helplines and advice for clients on many topics, including human resources issues. It may be you need to furlough staff members who are not able to work during the pandemic, for example if they are on the shielding list. In these circumstances, the advice line will be able to provide you with guidance on what to do. Several insurance providers also include confidential counselling lines which are available for you and your staff to talk in a confidential environment, about not only issues arising from COVID-19, but wider topics too. At a time of great stress, such helplines could prove their worth.

LIFE AFTER COVID-19 We don’t have a crystal ball, but what is understood is that life will take on a new normal. The insurance market was already going through a number of changes, with insurers looking reduce their exposure in loss-making business. This has seen reduced capacity within Lloyds of London, with the worst performing classes either dropped or subject to review and price increases. The actions of Lloyds are mirrored in the

“When your policy renews, carefully check what you are sent to review and look for any new restrictions placed on your policy.” general insurance market. It is inevitable that the care sector will suffer, and price increases are to be expected; a number of insurers have also already stopped writing new care business, at least for the time-being.

OUR ADVICE I recommend that: • When policy renews, carefully check what you are sent to review and look for any new restrictions placed on your policy. • If you find COVID-19 is excluded from the liability cover, consider if this is acceptable to you as alternatives which include the cover may still be available. • Concentrate resources on ensuring the safety of your staff with adequate PPE etc. This is something your insurers will expect you to do. • Above all, keep your staff as safe as you can to protect yourself in the future. When we finally get out of this strange place, life will be different, and we will need time to reflect and mourn. During these times, remember the amazing work you have done to care for vulnerable people when they needed it. We are all clapping to show our appreciation to you – well done and thank you. CMM

Simon Bentley is Director at Phoenix Specialist Risk Solutions. Email: simon@phoenixsrs.co.uk Do you have any questions for Simon? Leave a comment on this article on the CMM website and Phoenix will do their best to help, www.caremanagementmatters.co.uk. Alternatively, get in touch directly. 28

CMM June 2020

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CMM June 2020

MAKING CONNECTIONS WITH YOUR COMMUNITY We all know that building relationships with external organisations is important. But how are you supposed to do this during coronavirus, with the additional risk of infection? My Home Life England details the impact of COVID-19 on community engagement and how we can all still come together despite social distancing.

CMM June 2020

The COVID-19 crisis has brought into sharp focus the central role that the care sector plays in the health of the nation. For too long, care homes have been easy to ignore as places removed from communities, places that simply house the old and dying. This was evidenced just earlier this year, with fatalities in care homes not initially

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MAKING CONNECTIONS WITH YOUR COMMUNITY

mentioned as part of the official COVID-19 death toll statistics. But finally, this changed. Recent media focus has served to highlight that people who live and work in care homes are part of our society. Care homes support our relatives and friends; the staff and residents are people with names and histories, people who have things to share and lives to lead, people we love. People like ‘us’. Engaging with local communities will help to strengthen and sustain this view of care homes. Of course, it is not the appropriate time to ask people to come in and visit. However, it is a brilliant time to reach out to communities – if and when managers have the energy and capacity – as care homes may for once be pushing at an open door.

REACHING OUT Over the past month or so, staff at My Home Life England (MHLE) have been contacting the network of care home managers who have graduated from the My Home Life leadership programme. Through phone calls, MHLE has been showing its recognition and appreciation for the incredible work they do. We’ve been listening, offering practical support and capturing (with their permission) the ways in which care homes are adapting their daily routines during this crisis to maintain some sort of normality for residents, relatives and staff. Our new YouTube channel, Conversations with Care Homes showcases many of these discussions. The short videos offer ideas and tips as well as sources of support for managers and frontline staff, such as free counselling. Topics discussed include ways for managers to practice self-care, ‘quick wins’ to improve resident and staff morale, techniques to reassure relatives and keep them connected, and offers of free emotional support to frontline workers, for example from the Southern Association for Psychotherapy and Counselling. One of the most common things that care homes managers say has brought them joy, is the heart-warming response many have received from their neighbours and local communities. It seems that as a result of this terrible crisis, a perhaps unlikely but positive thing has happened: with the support of the British media, communities are waking up to the needs of older people living in care homes and are recognising the small and simple ways in which they can make a difference to other people’s lives. For example, we’ve heard stories of podiatrists, tattoo artists, beauticians and veterinary surgeries all donating critical and much-needed personal protective equipment to local care homes. Managers shared 32

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“Finding practical and achievable ways for care homes to connect with local communities is vital, not only during this crisis but also for the future.”

that, whilst donations are of course hugely appreciated and welcomed, it is the thought and recognition that count even more. Across the country, many care homes have been approached by their local places of worship and we’ve heard that some churches are now live streaming services directly to care homes. One church even went the extra mile by asking the children of their congregation to write cards to residents, while a different church created rainbow drawings with their youth, which were later displayed in the care home’s windows. It’s obvious that some members of our communities have the confidence and ideas to connect well with care homes. But there will be others – individuals, clubs, groups and businesses – that are not clear about what is possible. They might be looking for ways to help and not quite know how. It’s worth getting in touch with any ideas you might have, as many organisations would welcome suggestions. Over the past three years, the Care Home Friends and Neighbours programme has highlighted the importance of care homes opening their doors to communities and has provided resources and ideas to support this action. The COVID-19 crisis has demanded that we consider and re-shape our offer. Finding practical and achievable ways for care homes to connect with local communities is vital, not only during this crisis but also for the future.

One idea, for example, saw a call put out via social media before Easter to encourage local people to think about isolated residents and to consider giving chocolate eggs, flowers and other gifts. Tesco in both Essex and in Bristol donated Easter eggs, while another branch delivered spare food. This activity was also promoted via the COVID-19 Mutual Aid network, which sees groups of local people across the country, who want to help, coming together to organise support during the crisis. The initiative reached over 2,000 people on Facebook and achieved around another 2,000 impressions on Twitter. The power of social media shouldn’t be underestimated and if you want to connect with your community remotely, this is one way of seeing what’s out there.

OUR FREE RESOURCES My Home Life England has a host of free resources that can be shared and used across the care home sector. Care Home FaNs has been developing an Intergenerational Linking Project (a joint venture between My Home Life England and The Linking Network), which has recently launched an activity pack of resources for young people aged 5-14 to help them remotely connect with people living in care homes. The aim is to encourage meaningful intergenerational relationships between young and older people, at a time when face-to-face

MAKING CONNECTIONS WITH YOUR COMMUNITY intergenerational activities aren’t possible. To encourage other members of the public to connect with their local care home, and to support them to understand how they can help, Care Home FaNs has also developed a set of posters to be placed in windows or supermarkets. These suggest easy things the public can do right now to engage with and support care homes, such as sending in letters or dropping off a magazine. The posters can be easily modified to add the care home’s name and contact details, and to personalise the list of suggested actions. They are available to download from the resources section of the Care Home Friends and Neighbours website. We know that care homes will take up this opportunity as and when it feels right. In the meantime, we are exploring how this ‘call to action’ could be promoted via local press, councillors and MPs as well as social media.

FINDING HELPFUL SOLUTIONS Since the COVID-19 crisis hit, care home managers have identified the valuable role that technology such as Skype, FaceTime and WhatsApp plays in connecting residents to their loved ones. Having devices opens up opportunities for residents to connect out; for example, chatting with a local friend, virtually visiting groups and clubs or going on virtual tours of local places. These are all effective ways of reducing feelings of isolation and increasing connections. However, some care homes lack sufficient laptops and tablets. Providers who need more devices to enable residents to engage in these virtual calls could again reach out to a local shop or organisation who might be willing to

support by donating tablets or funds.

THINKING OF THE FUTURE It seems that communities are now finally understanding and appreciating how important care homes are for our families, friends and communities. Providers need to embrace this moment and use it to

form lasting connections with local people and businesses, that they can continue to develop when social contact is allowed once again. What’s more, when the crisis has passed, there will be a golden opportunity for care homes to open their doors and welcome the community in. Look out for this, and make sure you take the chance. CMM

Jen Lindfield is Senior Development Officer and Lead for Social Action, and Pamela Holmes is Lead for Care Home Friends and Neighbours, North West London at My Home Life England. Email: mhl@city.ac.uk Twitter: @myhomelifeuk Are you finding your local community more open to engagement? How are you working together with others? Share your insights on the CMM website and leave feedback on this feature, www.caremanagementmatters.co.uk

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EVERYTHING IN ITS PLACE: CREATING COVID-19 POLICIES

Having clear and concise policies in place is always key in adult social care, but itâ&#x20AC;&#x2122;s essential now that providers are communicating everything with their staff. Here, Insequa looks at the process of creating and implementing a coronavirus policy despite the everchanging environment.

The ongoing coronavirus pandemic and the frequent changes in Government guidance and requirements for care delivery are key illustrators of the need for clear and up-to-date company policy to guide practice in a rapidly changing situation. Here, weâ&#x20AC;&#x2122;ll talk you through how to create a coronavirus policy to help you keep up with changes.

The function of a policy is to communicate your company position and requirements to all staff, so it is important the policy is clear and understandable for all. In general, policies should be as brief as possible in order to maximise their clarity and ease of comprehension. Stick to the point, avoid deviation and repetition and write in clear, straightforward terms.

WHERE TO START

Ensuring information is current All policies must be based on up-to-date information. However, this is a challenge with coronavirus as Government guidance is evolving quickly. The current Government position is published at www.gov.uk/ government/collections/coronavirus-covid19-social-care-guidance and regular updates

To create an effective coronavirus policy, you need to compile up-to-date and accurate information and guidance about the nature of the pandemic and its implications on care delivery and convey that information to your workforce.

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EVERYTHING IN ITS PLACE: CREATING COVID-19 POLICIES

are published via the @DHSCgovuk Twitter feed. Several important easements have been made to the Care Act 2014 which can be reviewed on the Government website, and Schedule 12 of the Coronavirus Act outlines measures relevant to care and support provision – see www.legislation.gov.uk/ukpga/2020/7/ contents/enacted. Keep up to date with how these changes might affect your business and ensure any updates are made to your policy if needed. Clarity – understandable terms The key challenge in creating a coronavirus policy is digesting the current guidance to create a straightforward company position statement and a set of practical guidelines for staff to follow to enable them to maintain your company position. Clarity is therefore vital in order to avoid confusion and misinterpretation. Try to write the policy in the most straightforward terms possible, avoiding complex language and convoluted sentences. Be aware that the people reading your policy are busy and some, if not many, might have English as a second language. The Plain English Campaign publishes a number of free guides designed to help people to write straightforward, easy to understand content – see www.plainenglish.co.uk/free-guides.html. Structure the document Having researched the current guidance on COVID-19 measures, you’ll need to put this across in a logical structure within the policy document. In general terms, our suggestion for the structure of a coronavirus policy would be something along the lines of: Definition Implications for care delivery • Hand washing • Social distancing • Use of PPE Taking sick leave and self-isolating Issuing ‘key worker’ notification letters Providing care to someone with suspected or confirmed COVID-19 Providing care to someone who is part of a household of someone with suspected or confirmed COVID-19

Criteria for coming to work – personal health criteria, family health, age Notifications – making notifications to the CQC Partnership working – collaborating with other local care providers Of course, you may wish to add further sections, for example on the use of volunteers or the management of care and support plans during the pandemic. In general, however, keep the structure consistent and logical with clear headers and sections.

IMPLEMENTING Having developed the policy it is important to manage the implementation process carefully in order to achieve the most effective translation of policy into practice. The most well-written, carefully-researched and clearly-presented policy can fail in practice if the implementation isn’t given appropriate consideration. There are a number of factors that can improve the efficacy of the policy’s translation into practice. Version control It is critically important that you can be confident all staff are using the correct and most up-to-date version of the policy. It is easy, particularly where a policy is being updated frequently due to rapidly changing advice and guidance, to run into problems with version control, i.e. staff referencing different iterations of the same policy. This could lead to out-ofdate practice continuing and critical messages and updates being overlooked. To reduce the risk of issues with version control, always make sure a policy is clearly marked with a version number and take care when making revisions to advance the version number marked on the document. At Insequa, we use a decimal version number structure (e.g. 2.4), such that minor revisions would be denoted with an advance of the decimal place (e.g. 2.5) and a major overhaul of the policy would be denoted by an advance of the whole number (e.g. 3.4). Make sure all staff are notified of the most recent version number. Also, in order to protect version control, avoid printing policies. Viewing them in a cloud-based or server drive or in a policy management system is much safer for version control than printing documents, which can then get stored in folders or drawers and reappear to confuse matters after subsequent

versions have been released. Practical relevance Another key aspect of implementing a policy is the consideration given to helping staff translate it into practice. It is very common for people to read a policy and understand the main points in theory, but then struggle to apply those points to their day to day work. Including practical examples in the document of how the policy operates in the workplace will really help staff make the connection to their everyday context and will help ensure your policy is implemented in a consistent manner.

MONITORING PERFORMANCE Having implemented your policy, don’t leave it there and assume everything will be fine. Your staff team may have read your policy but not understood it fully. As such, you and your management team need to be monitoring practice and staff conduct to create the ‘feedback loop’ that will inform you of whether your policy is being implemented in practice as you intended. It may be necessary to clarify key points or offer staff individual and specific guidance to ‘fine tune’ the implementation of your policy. Monitoring for updates Once you have implemented your policy and are confident staff have translated it into practice accurately, it is important you continue monitoring appropriate information sources, e.g. CQC, Department of Health and Social Care, for updates. Ensure any updates are reflected in your policy promptly and that all staff are notified of the policy revision, to keep your practice up-to-date and relevant.

ENHANCING CARE DELIVERY As with all policies and procedures, an up-todate and clear coronavirus policy is an important aspect of your overall care governance. It promotes consistency across the organisation, ensures your management and practice are current and, ultimately, good policies enhance the quality and safety of care delivery. Writing a coronavirus policy may seem like hard work, with all the research and effort of compiling the document, but, with COVID-19 deaths increasing in care homes at a point where deaths are decreasing in the overall population, the benefits to staff and residents alike of having clear and up-to-date guidance are manifest. CMM

Bill Watson is Director at Insequa. Email: billwatson@insequa.co.uk Twitter: @insequaltd How are you keeping on top of coronavirus policies? Let others know what’s working for you, and provide feedback on this article in the comments section of the CMM website, www.caremanagementmatters.co.uk 36

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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

• Regulation & Legal – Care Act easments, DoLS & DBS

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• Workforce - Terms & Conditions & Recruitment • Supported Housing & Homeless

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• Wellbeing • Volunteering • Practical Activity Resources NCF members benefit from: • Weekly Zoom Calls • Daily Briefings • NCF is also working closely with CPA & other members of the All-Party Parliamentary Group on Adult Social Care (APPG) to influence parliamentarians • NCF is ensuring the amazing work happening in the sector is being recognised at national & local government and in the media

• Access to leading industry experts & a wide range of membership benefits

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The road ahead:

LEGAL RAMIFICATIONS OF COVID-19

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The legal implications of coronavirus could begin to cause major issues for providers if they donâ&#x20AC;&#x2122;t actxxnow. Mei-Ling Huang from Royds Withy King explains what providers can do to protect themselves and reduce future difficulties. Coronavirus has challenged the sector like nothing before and the operational strain is more than anyone should have to bear. Unfortunately, the legal reverberations from this pandemic could go on for some time, even after we have controlled the spread of the virus. What do providers need to think about to protect themselves from repercussions down the line? The critical issues include insurance, indemnities, the risk of negligence claims (and practical steps to avoid them), and managing the media.

NEGLIGENCE CLAIMS: THE RISK IS HIGH A lot of businesses are reviewing their insurance cover right now and it is a smart thing to do. Word on the street is that insurers are running scared from COVID19. The liabilities from the pandemic could potentially bankrupt them. Operationally, the situation on the ground has been extremely difficult, with the vast majority of care services having difficulty sourcing PPE. Furthermore, the guidance about PPE has been in constant flux and sometimes the national and local guidance has conflicted, causing confusion. The ensuing chaos will probably result in some staff and clients becoming infected. When the dust settles, you may find yourself in the firing line of a negligence claim. If this happens, you will want to be protected. You should check your insurance cover with your broker now. When you renew, you are likely to find that you struggle to obtain cover for COVID-19-related issues. You may want to start discussions with your broker early so you have time to look at the options.

GOVERNMENT INDEMNITIES (BUT NOT FOR SOCIAL CARE) The risk that health and care services will be in the firing line for negligence claims is something the Government has already contemplated. Its Coronavirus Bill guidance explains that the Government will provide an extra layer of indemnity for healthcare providers. Unfortunately, it appears that the Government does not currently intend to provide any additional indemnity for social care providers in England, Wales or Scotland. This contrasts with the position in Northern Ireland. The Coronavirus Act specifically mentions both health and social care in regard to indemnities in

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THE ROAD AHEAD: LEGAL RAMIFICATIONS OF COVID-19

Northern Ireland, meaning that social care providers there will have the same additional safety net as the NHS. The omission of this specific language in regard to England, Wales and Scotland indicates that care providers here are (again) on their own. If negligence claims against care providers reach significant levels, the Government may eventually have to agree to provide an indemnity to prevent care providers from being overwhelmed financially. However, it remains to be seen how this will play out and, for now, you will need to do what you can to protect yourself from negligence claims.

PRACTICAL PROTECTIONS FROM NEGLIGENCE Practically, what can you do to avoid becoming a target? First, it is important to understand what you are protecting yourself from. Tort law is complex but in essence, an allegation of negligence boils down to an assertion that someone failed to take reasonable care. If a claimant threatens a negligence claim, you are likely to get into an argument about whether you took reasonable care in the circumstances. To protect yourself, you should take as much care as possible in the particular circumstances and be able to prove that you did. For example, if you had difficulty sourcing PPE, you should keep a running record of your efforts to obtain it. What is “reasonable” will depend on the circumstances, so if it was impossible to buy PPE, you should keep a record of your attempts. Where there is government guidance, you should ensure that your operational procedures and risk assessments cite and follow that guidance and ensure that your staff are putting it into practice. Paperwork is a burden we can all do without, but keeping your risk assessments updated may not only help keep people safe, but will also demonstrate that you acted thoughtfully and took reasonable care in difficult circumstances. You may also want to consider trying to get back-up. For example, if your local CCG infection control team visits, ask them to review and approve your procedures and risk assessments. Confirm in writing that they have agreed that you are following current best practice. This may prove useful later as evidence that you were taking reasonable care.

TESTING, TESTING… In addition to PPE, the other major issue during this pandemic has been the lack of available testing. The Government has finally rolled out testing for all social care staff and clients. Unfortunately, confusion remains about who should carry out the swabbing (e.g. care homes or district nurses) and how dependable the results are. As a provider, you will naturally want to ensure that your clients and staff are tested. You will also need

to take care in regard to how you process the data associated with the test results. The Government’s guidance states that testing is voluntary and care staff do not have to reveal their test results to their employers. Most staff will agree to be tested and share their results but if they refuse, you will have to balance their data protection rights against your health and safety obligations to your other staff and clients. Asking staff to undertake testing and share their results is likely to be a reasonable management instruction, the refusal of which may warrant disciplinary measures. However, if staff refuse, you will need to carry out a robust investigation to ascertain the reasons for the refusal and whether disciplinary procedures are justified. In some cases, they might not be.

DON’T GET PAPPED Lastly, a word about the media. Some elements of the press love to give social care a kicking. The most harmful stories are the exposés, which are designed for shock value. There have been reports of an increase in the number of journalists trying to gain entry to care homes and speak to care staff. They sometimes tailgate paramedics or other medical professionals to gain entry into a home, asserting that they have authority to do so. Some pretend to be from the Care Quality Commission (CQC). This poses a physical risk to clients and staff, a reputational risk to the provider, and a risk to people’s dignity, privacy and other rights under the Mental Capacity Act 2005. How can you prevent this? During lockdown, this should be easy. However, as restrictions are lifted, it may once again become an issue. It is worth reviewing your media/social media policy. If you don’t have one, put one in place. The journalists who carry out tailgating tactics are likely to say that your staff agreed to let them in and that clients or relatives have agreed to the use of the footage. You need to make your staff aware that under no circumstances should journalists be permitted into the premises and you should provide them with clear instructions about what to watch for and what to do if they are approached. Make it clear that only a director has the authority to make that decision. If they need to check an inspector’s identity, they should call CQC. If a journalist does manage to gain entry or talk to staff without your permission, you should mount a robust challenge. They will want to use the footage but may think twice if it means they will be sued.

FOREWARNED IS FOREARMED None of these issues are pleasant and it is unfortunate that providers and managers have to contemplate them. Thinking ahead won’t prevent every problem but it will help limit the damage. When it comes to surviving Covid19, it is all about damage limitation. CMM

Mei-Ling Huang is Partner at Royds Withy King. Email: mei-ling.huang@roydswithyking.com Twitter: @RWK_SocialCare What do you feel are the biggest risks for your business? How are you mitigating them? Share your experiences on the CMM website, where you can also feed-back on this article, www.caremanagementmatters.co.uk 40

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CREATING AND MAINTAINING YOUR COVID-19

BUSINESS CONTINUITY PLAN The intensification of the countryâ&#x20AC;&#x2122;s response to the COVID-19 pandemic has, for obvious reasons, created a host of new considerations and priorities for care providers. At this time more than ever, having business continuity plans in place is essential. The Access Group's Martin Lowthian gives his key guidance on creating and maintaining robust plans, even when at the centre of a crisis.

Business continuity plans lay out how an organisation responds to threats to its regular operations and are often planned in advance. But due to the speed and intensity of the spread of COVID-19, many providers will inevitably be on the back foot. Even the best plans will have struggled to meet the demands and pressures the sector is facing right now. Care England has suggested that the number of care home residents to have died as a result of coronavirus could be

CMM June 2020

CREATING AND MAINTAINING YOUR COVID-19 BUSINESS CONTINUITY PLAN

up to five times that of official Government figures. And YouGov polling has found that half of 1,000 healthcare workers surveyed in the UK said their mental health had deteriorated since the virus began taking its toll. Care providers have already acted quickly to put plans in place, but with the situation unfolding at pace, keeping a watchful eye and updating these plans can prove essential. Here are my tips for those who are tackling the biggest crisis to impact the care sector and our wider society for a century.

DON’T RUSH The first thing to bear in mind, is not to rush. Be decisive when you have to be; however, crisis management is about taking the necessary time to make a good decision based on good data. Don’t be too quick to make business decisions as this can lead to a worse scenario or business challenge. Investing the time upfront pays off in the long run. My suggested approach is to decide: a. What are my business-critical processes? b. What are my resource dependencies to deliver these? This is mostly staff, but equipment including PPE, technology and consumables are critical too. c. Who are my highest risk clients/ residents and how can I identify them to those that need to know so that we can continue to support them – and what resources do I need for this? d. What are the most critical care services being provided? Which services, if not provided, could cause harm to the physical or mental wellbeing of those we are caring for?

STOP, START, CONTINUE With the answers to the above, you can create your plan of what

must continue based on your business impact assessment. You can then decide what you will do to ensure that this happens and take a planned approach to how you will communicate if you have to scale down service delivery. This should not be reactive messaging, but rather

your remaining business priorities without distraction.

MAINTAIN A RECORD It’s important to keep logs of the decisions you have made and the actions that happen as a consequence. Don’t forget to also

“You should have communication plans that are timely, clear and efficiently delivered.” pre-planned and with proactive guidance to the team to advise how they should mitigate their own risks.

CLEAR OWNERSHIP FOR EVERY ACTION AND RESPONSE Clearly set out what the trigger points are for your business; and ensure that there is a named person with responsibility for each. For example, a non-clinical director is not best placed to make clinical decisions, so give authority to someone who is.

PRIORITISE COMMUNICATIONS You should have communication plans that are timely, clear and efficiently delivered. Preparing these in advance using communication templates avoids having to reinvent the wheel every time there is an update. Automating the delivery of these communications to the whole audience can be helpful – updating everyone with one action rather than piece-by-piece gives you the freedom to manage

log instances where you take the decision to do nothing and the rationale. Recording decisions throughout any incident enables providers to offer reliable evidence later on. Regulators, insurers and other stakeholders will be satisfied that you acted reasonably and based on the information available.

MONITOR CHANGE Changes to the plan may be driven by government announcements and interventions. These are currently being delivered on a daily basis. Watching the Downing Street press conference, or reading the highlights, to consider how any macro changes will impact your operation is crucial right now.

EMBRACE TECHNOLOGY At a time when you can become distracted with communication, consider opportunities to avoid the need to spend time on tasks like answering phones. Technology enables you to be proactive. For example, if a relative can see their loved one’s care record securely online and understand how they

are, they don’t necessarily need to phone. If they can see a visit is happening, they won’t be concerned that a team member won’t turn up. Technology has a vital role to play in alleviating pressure for everyone.

CONSIDER TEMPORARILY BOOSTING YOUR WIDER WORKFORCE Less experienced or less skilled team members can be deployed to deliver lower level support activities, based on their training and assessed competency; whilst experienced colleagues maintain continuity for those who require more specialist support. The government has said that furloughed workers can join the care sector workforce during this crisis and they will not lose the 80% contribution from their primary employer. Planning now to create an efficient screening process and also a process to advertise temporary roles will enable you to recruit quickly, should you need to. This could be a major boost should this crisis intensify further or continue to persist. Having these processes in place to quickly increase the workforce if needed will reduce pressure on staff and ensure they can self-isolate safely without feeling they are leaving colleagues overstretched.

MITIGATING RISK My experience in social care and the NHS has taught me that having robust plans in place, as outlined above, mitigates risk and ensures there’s time to react in a planned and sometimes rehearsed way. Having well-structured plans in place may not alleviate the need for masks or more staff, but it will help you to respond to this crisis as best as possible and to ensure you are making well-considered decisions. CMM

Martin Lowthian is Business Development Manager at The Access Group. Email: Martin.Lowthian@theaccessgroup.com Twitter: @AccessCareMgmt How are your continuity plans holding up? How are you keeping up with the ever-changing situation? Share your learning on the CMM website by commenting on this article at www.caremanagementmatters.co.uk 44

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

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Care Management Matters COVID-19 Special Edition June 2020

Articles inside

Everything in its place: Creating COVID-19 policies

Making connections with your community

COVID-19 and registered manager mental health