Bulletin
June 2020
A Fond Farewell How strange it feels sitting here contemplating a life without full-time work for the first time in 40 years. Retirement, albeit early retirement, is something I’m incredibly grateful for but my word, it really does put things in perspective and has enabled me to reflect upon some of the great experiences and challenges I’ve had over the years. Public service started for me in the NHS back in 1980 and since then I’ve seen so many changes and amazing advances in the delivery of care and support that so many of us rely on to keep us healthy and independent. ‘Integration’(and by that I’m referring to everyone working together effectively and putting people at the centre to best meet their needs and improve lives) has been my passion and something that I truly believe enables a better way for us to deliver services. Without our connections and the ability for us to work together across the system, we would simply never have achieved what we have in County Durham, the level of co-operation particularly between the NHS and social care has been exceptional and undoubtedly has benefited those of us living in the county. I moved to local government in 1994, recognising that my contribution to social care given my background as a health professional was welcomed and valued. During the time I’ve worked in DCC I have been encouraged and hope in turn that I have subsequently encouraged others, to pursue ideas and opportunities that would benefit those people needing support. I’ve been lucky enough to be in a position where I could influence how our local map of service provision looked and in the last 3 years of my career seeing the development of an integrated model that embraces, primary, community, secondary and adult social care has been stimulating and incredibly satisfying. The last few months of course have been very challenging and I’m convinced that the strong
relationships that already existed across our system have resulted in us being able to provide an effective, well-coordinated response to the pandemic. Of course, our future will look very different from here on in. Covid-19 will mean the public sector will have to embrace new ways of working and our ability to utilise digital solutions to our work will be particularly important. Some of the positive examples of joint working and use of technology are featured in this bulletin and illustrate our ability to rise to the inevitable challenges that come with public service. We’re currently recruiting to fill my role, a process that will hopefully conclude early next month. In the meantime, I’m pleased to say Malcolm Walker has been appointed to oversee community services in the interim period. I couldn’t think of a safer pair of hands and I hope you will all support Malcolm during this time. So, it’s time to say so long but before I go, I’d like to say thank you to every single person that has contributed to making services better for the people we serve. It will be the people that I will take with me and in my memory there are many, committed, hard-working, imaginative, supportive and caring people and it has been a real pleasure to know you all. Family, grandchildren and dog walking beckon… With love and best wishes
Community Services response to Covid
– Malcolm Walker, Managing Director for Community Services On 30 January a national level 4 incident was declared, the precursor to the Covid-19 pandemic. Over the following weeks my colleagues in CDDFT and across the Community Service moved at pace to change services, first in preparation for the forecasted number of patients with Covid-19 and the transitioning the management and treatment of those patients. We were given national guidance on the standing down of Community Services, which released staff to be redeployed to critical areas. The willingness to change roles was incredible from all staff, with many learning completely new skills and others refreshing those that they had from previous roles. For a number of colleagues this has prompted thoughts of changing roles and staying with the new work they have taken on. One of the first actions we took was to set up a daily video call between key Partners such as CDDFT, the CCG and DCC to coordinate actions and resources. As an integrated system we were able to collectively develop responses to some seemingly insurmountable problems. The expert knowledge from staff ensured we were able to work with our partners to change clinical practice, sharing workloads and reducing non-urgent work dramatically. We also carried out an analysis of Covid positive patients discharged from hospital to
understand additional health and social care needs immediately on discharge, developing an integrated long-term rehabilitation strategy for discharged positive patients. For Care homes, we introduced rapid implementation of testing for symptomatic residents with processes put in place for returning results to homes and GP practices. There were regular cross-partnership discussions with care homes regarding plans for dealing with the pandemic and ways to offer mutual support, including identification of care homes under pressure, and a coordinated response with support from each organisation. On a number of occasions, CDDFT staff supported the ongoing safe running of care homes, in some instances with actual resource to cover shifts, but in many other with advice on infection prevention and control, end of life care etc. We also introduced revised ways of working and clinical practice to help reduce footfall to patient’s homes, such as the review of patient medication by GPs to reduce the need for District Nurse visits, especially regarding insulin medication. We also provided support for care home residents and staff to undertake more tasks themselves instead of a District Nurse needing to visit and used digital approaches to reduce face to face contact with patients. We increased Primary Care support for Community Hospitals ensuring medical coverage 7 days per week for each site and instigated rapid development of information and training for staff across CDDFT, primary care and care homes regarding Emergency Health Care Planning for care home residents. These are just a few of the many actions that were taken across the Community Service to respond to the unprecedented pressures, non of which would have been possible without the Partnership really pulling together, showing more than ever the value of collaborative working.
Coronavirus Support in County Durham for shielded or vulnerable people Are you working with someone who is shielded or more vulnerable due to the measures put in place to reduce the transmission of coronavirus? The measures put in place to protect people from Coronavirus could be making life very difficult, especially for vulnerable people to access essential supplies and engage in social contact. County Durham Together is a community hub operated by Durham County Council which offers help and support, either through linking with existing services and community groups or directly from the council. If you’re aware of anyone that needs additional support over and above what is already in place during the time of being shielded from covid19, or feels they are more socially vulnerable, please ask them to contact the community hub: Call: 03000 260 260 Email: communityhub@durham.gov.uk or fill in the Covid 19 help form www.durham.gov.uk/covid19help
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durham.gov.uk/carepartnership
Care Academy fast track recruitment supports care sector
In the News!
Salute to Key workers
At a time of increased pressure, it’s vital care providers have enough trained staff. To help address this, County Durham Care Academy launched a fast track recruitment campaign for new care workers and domestic and kitchen assistants. Applicants are supported with remote training and fast track enhanced DBS checks before being matched to adult social care providers with employment opportunities.
In a special northern Echo feature we thank all the key workers and volunteers who have worked tirelessly to help those in need and keep County Durham moving during the coronavirus pandemic. Find out more >
So far 14 people have been appointed, a further 11 are awaiting interview and from over 130 applications, 21 are work-ready and being sourced vacancies. Devonshire House in West Auckland was one of the first care homes to make an appointment through the campaign, taking on a new care worker, Billy Coyle.
Thank you balloon Beachcomber care home in Seaham gave Easington TAP 3 district nurse team a lovely balloon and poem to show their appreciation of all the support and care given by the team to help get the residents through this uncertain time.
“Billy came to us with training and DBS checks already in place, which made the recruitment process much quicker and easier,” says manager Kathryn Cooper. “He fitted in straight away. He is very caring and has a lovely bubbly personality, so the residents love him.” Opportunities are available to anyone wishing to work in adult social care, including those without prior experience. The academy is also offering remote training and development to provide potential new staff with the skills they will need to access opportunities in the sector. Full details and how to apply can be found at: www.durham.gov.uk/careacademyrecruitment with regular updates on the Care Academy Facebook page: facebook.com/CareAcademyDurham
durham.gov.uk/carepartnership
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Adapting the way we work at locality level
Bev Gurney, Locality Team Manager, Dales Locality Team and Rebecca Wright, TAP Lead for Sedgefield TAP 1 share their experiences of working in a TAP during the pandemic and how teams have been adapting the way they work to meet the challenges of the coronavirus pandemic.
Social Workers rise to the challenge - Bev Gurney, Locality Team Manager, Dales Locality Team
For all of us the coronavirus outbreak means that our lives are changing, at least for a while. Lockdown and isolation has meant that many social workers who have never previously been inclined to work from home are seeking new skills, acquiring new ways of working, and literally learning on the job. We are all facing new challenges, rapid change at work, and at home, social workers are rising to their own daily personal successes as we overcome our worries or apprehension, using help from colleagues, and “how to guides” as we get to grips with new technology and communication systems such as Teams. The coronavirus pandemic has had a profound impact on everyone’s lives. Social workers in the localities have had to embrace changes to the way in which they work. Still completing assessments, reviews and risk assessments, the resilience of social work staff to overcome how they approach these requirements needs to be applauded for resourcefulness and success in demonstrating their willingness to use digital IT systems, remote working, assisting hospital social worker teams, or working on a rota 7 days a week 8am to 8 pm. Communication is still the key to social work resilience, caseloads are defined by daily priorities, section 42 alerts, NEAS reports, covering a duty system, knowing which clients are most in need, collating information on new cases ready for assessment and which of our most vulnerable clients are feeling lonely, isolated and need to be prioritised with a contact today.
The professional relationships we have already with partner agencies, such as the district nurses, GP’s, care homes and community services continue to develop, all of us working more flexibly, sharing information to support clients, their families and carers, using these skills to ensure positive outcome to continue in these new ways of working. These new skills such as transferring meetings into video calls, conducting socially distanced visits, and working from home, wearing PPE, completing assessments or reviewing needs, care planning or safeguarding those at risk, remain part of our daily work as social workers as we overcome, adapting to lockdown challenges and our continued commitment to client care and social work responses.
“As a newly qualified social worker working in the Dales Locality, the new working arrangements under the pandemic restrictions and impact of Covid-19 have significantly changed my working day. I now complete assessments over the telephone, phoning necessary multidisciplinary partners such as community psychiatric nurses, care agencies, district nurses and GPs to gauge a picture about an individual’s needs”.
- Sarah Lidster, Social Worker
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durham.gov.uk/carepartnership
A typical nursing day under Covid - Rebecca Wright, TAP Lead for Sedgefield TAP 1
As a TAP we are continuing to adapt to new ways of working which some have proven to be more challenging than others but all of which have been embraced and some of the changes certainly for the better, such as improved use of digital technology, especially for communication. A typical district nursing day would consist of checking the workload and allocation for that day, ensuring all visits are assigned if deemed appropriate (will come onto that). Checking tasks and a handover from night staff if there is anything to report or concerns to raise from overnight. This is where there has been a lot of activity in relation to Covid and end of life care, particularly supporting the care homes within the locality. Supporting staff, checking that all staff are on duty and managing any sickness, this also includes updating a daily staffing spreadsheet to ensure that the service is adequately staffed. The visits for the day will have been allocated the previous day by the Sister(s) on duty, the calls are triaged and prioritised. The caseloads have all been reviewed during the pandemic to ensure that patients and staff are protected due to the risk of Covid-19. DNs have liaised, planned and trained patients and/or their families/carers to provide care where appropriate themselves, for example, in insulin administration and wound care. All diabetic patients have been reviewed from an MDT approach and treatment regimens reviewed. Some of the dual registered care homes have taken over insulin administration of residential patients. This has been appreciated and certainly reduced the number of visits into a care home to reduce the risk of infection and conserve PPE for all. This has also been supported with the use of digital technology and telephone consultations to provide advice and support virtually wherever clinically possible. The DNs have continued to communicate and offer support to the care homes.
Essential face to face visits are then prioritised. Supported by national guidance, the DNs have adapted a red and green approach in order to highlight prioritisation and reduce the risk of infection. All patients on the caseload who are deemed as high risk and have letters from the Government, are identified on SystmOne, there is an icon on the patients record, set by the GP practice and have high priority reminders within their records, set by the DNs. The visiting staff then have a responsibility to check this status and visit these most vulnerable patients first by the green team. All face to face visits will then need to be screened by the visiting nurse. This is done by the nurse telephoning ahead of the visit to check for Covid symptoms within the household, again in an attempt to avoid cross infection so that the green team can remain green. The red team visit those patients who are confirmed or suspected cases of Covid 19, this includes visit to the care homes where there is confirmed or suspected Covid cases. This process also promotes joined up working within a locality as often there is some degree of working across the wider locality with health and social care partners, more often on a late shift and out of hours, in order to maintain either red or green status. There is also a designated red team for swabbing which the DNs are doing within the care homes for suspected cases of Covid 19. As you can appreciate this requires a lot of extra planning. To adhere to social distancing guidelines the TAP has adopted staggered huddles. We have adapted to virtual meetings where required with health and social care partners. As we are not based with our social care partners, we probably haven’t noticed too much of a change as we continue to liaise with one another via telephone, therefore we would continue to link into adult social care without too much of a noticeable change or too much of an impact, which is positive. I feel communication has certainly improved.
durham.gov.uk/carepartnership
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Infection Prevention Control support for Care Homes
Supporting people with Learning Disabilities during the Coronavirus pandemic We know that people with a learning disability have higher rates of morbidity and mortality than the general population which makes them more vulnerable to coronavirus.
The Infection Prevention Control Team (IPCT) have supported care homes through education training and audits over the past ten years. There is a well established network of 97 Infection Prevention Control (IPC) champions who help to deliver the IPC message and ensure IPC standards within care homes are maintained. A well- attended IPC champions conference has been held annually for the past 5 years. The IPCT response to the COVID-19 pandemic has been to practically support the care home sector working collaboratively with the local authority and other agencies to ensure consistent IPC messages following national guidance. Virtual training was delivered by the IPCT super trainers either by zoom or telephone conferencing to trainers in 140 care homes over a three week period. Staff were shown the correct technique to don and doff personal protective equipment and asked to practice whilst on the training to ensure they felt confident to train other staff within the care home. This was only made possible through the continued support of care home managers and staff during unprecedented circumstances.
Clinical Commissioning Group merge
The Integrated Learning Disability Service, a partnership between Durham County Council and Tees, Esk and Wear Valley NHS Trust (TEWV), has been working closely with primary and acute care providers to develop a range of support measures to help keep people in Durham with Learning Disabilities well during the COVID-19 crisis and avoid unnecessary hospital admissions. This includes: • Working with GP practices to ensure that Do Not Attempt Resuscitation (DNAR) forms should not be put in place for people with Learning Disabilities unless it is clinically appropriate based on clinical presentation and quality of life. • Issuing LD families with a COVID-19 contact card that identifies a trusted carer for hospital staff to contact, as carers are not being allowed to accompany people with LD into hospital. • Simplified Hospital Passports that contain vital information have also been issued. • Approximately 400 anticipatory Emergency Health Care Plans are being produced for the most vulnerable service users to ensure that urgent help is accessible quickly including anticipatory anti-biotics to prevent deterioration and admissions to hospital. • Training learning disability nurses to carry out testing for Covid 19 in care homes.
Wednesday 1 April 2020 saw the creation of a new NHS organisation responsible for planning and buying health services for the people of County Durham - NHS County Durham Clinical Commissioning Group (CCG). The CCG was formed following the merger of NHS Durham Dales, Easington and Sedgefield CCG and NHS North Durham CCG. At the same time, the three CCGs covering Teesside and Darlington and Durham (NHS Darlington CCG, NHS Hartlepool and Stockton-on-Tees CCG and NHS South Tees CCG) also merged to become NHS Tees Valley CCG. Between them, the two new CCGs commission NHS services for a population of over 1.2 million people. Much of the work of the new County Durham CCG since this time has centred on adapting to challenges of the fast evolving COVID-19 pandemic. This has involved working closely with other NHS and public sector partners to
For further information and the range of other support measures being developed to help people with a learning disability contact: Judith Richardson, Principal Support Officer Durham County Council judith.richardson@durham.gov.uk or Michaela Hopps, Health Facilitation Team Lead TEWV NHS Trust michaela.hopps@nhs.net
coordinate and support the response to the pandemic within our hospitals and throughout the community and primary care. Many CCG staff are now working remotely and were deployed to support partners in the local healthcare system during this challenging time. As a result there may be a delay in responding to enquiries, as COVID-19 remains the current organisational priority.
Tell us your news! If you have any updates, news or items you’d like to share in the CDCP Bulletin please contact: paul.goodwin@durham.gov.uk or on 03000 265 627 / 07788 363205