Decision details

The Chair welcomed County Councillor Graham Gooch, Cabinet Member for Adult Services; and Sue Lott, Head of Community North and Health and Prisons, to the meeting.

The report presented provided details of the Lancashire County Council Adult Social Care Winter Plan for 2020-21, and the additional capacity that would be mobilised to meet the anticipated demand. The winter plan would be considered by Cabinet when it met on 5 November 2020.

It was explained that for the last 5 years, adult social care had developed a winter plan that set out the challenges of winter and the response to it. The plan sat alongside and contributed to the mandatory NHS plans produced by each Integrated Care Partnership (ICP). This year was anticipated to be a ‘winter like no other’ in terms of the multiple challenges that health and social care could face and planning was therefore driven by a number of potential areas of pressure.  This year adult social care had been allocated £5.5m from the Better Care Fund to ensure risks were managed, people were supported to be safe and well and wherever possible to be supported in their own homes.

The plan set out what adult social care needed to do in response to winter. This included:

·  Service capacity enhancements.

·  Additional staffing capacity.

·  Continued support to care homes.

·  Designated care settings.

·  Resilience and escalation.

In terms of next steps adult social care would continue to work collaboratively with the NHS and other organisations regarding implementation of winter plans and resilience across the winter period and would continue to support the sufficiency and stability of the care market, as part of the winter and Covid-19 response planning. Recruitment campaigns were underway to ensure additional capacity would be in place. The team was also working with the care sector, including the Care Quality Commission (CQC) and local NHS partners in relation to identifying Designated Settings. The team would also monitor the implementation, progress and effectiveness of the winter plan through the Lancashire County Council Adult Social Care Winter Board.

In response to questions from members the following information was clarified:

·  Adult social care was focused on supporting people to remain at home as much as possible, rather than access a hospital bed or care home unnecessarily.

·  It was acknowledged that identifying designated settings was a challenge for the sector and this was understandably so given the challenge around admitting people with Covid19. A policy for designated settings was currently being developed in order to avoid what happened in the first wave of the pandemic. There were a number of stringent regulations to meet in order to become a designated setting. It was highlighted that for a number of care homes across the county their environment did not provide sufficient space to zone Covid19 residents (including those with dementia and learning disabilities) from all other residents and therefore couldn't apply to become a designated setting. For those who were able to meet those environmental regulations and were interested in becoming a designated setting, the county council was working closely with them on infection, prevent and control measures and participating in enhanced CQC inspections. The NHS was looking to create an additional 250-300 beds with some of those beds being in the care home sector (Covid negative beds).

·  It was recognised that care homes would continue to experience outbreaks over the winter period and would close to admissions for periods of time. A number of measures were in place to co-ordinate activity across the county and to ensure that care homes would be supported.

·  On maintaining staffing levels and keeping the system running, the county council made daily phone calls with most care homes to check how they were managing, what issues they had that day, what their staffing levels were and whether they had sufficient PPE. A Lancashire Temporary Staffing Agency had been set up during the first wave. A number of staff had been retained and the service would continue throughout the winter period to support care homes with staffing pressures.

·  Regarding insurance for care homes, the committee was informed that the Cabinet Member for Adult Services had written to Government requesting indemnity for care homes. One care home had reported that their insurance premium had risen by 500%.

·  On the movement of agency staff from one care home to another, it was explained that the county council was working closely with care homes and agency staff in order to minimise the movement between homes. Support was also provided through the Infection Control Fund to help retain staff to work within a single home. Weekly testing of staff in care homes was supporting the infection control plan.

·  Care homes were in the process of setting out how residents with dementia and other cognitive impairments could be isolated. Where necessary the county council would fund a number of 1:1 hours to support the care home to provide additional staffing hours, usually from their own staff to support those residents.

·  In terms of visiting care homes, the county council had received funding from central government to enable safe visits by relatives to take place. The money could be used for both capital (building facilities) and revenue (staffing) expenditure to enable safe visits.

·  Rapid testing was currently being piloted within the Adult Disability Day Services. This would inform the rollout plan for wider testing.

·  Regarding the anticipation of a vaccine it was reported that the NHS was currently planning the rollout and the training requirements to deliver it. It was understood that NHS staff and Social Care staff would be prioritised to receive the vaccine.

·  On the use of iPads in care homes to facilitate family visits, it was highlighted that these were not necessarily a suitable alternative for this purpose in particular for those people with learning disabilities and other cognitive impairments.

·  A suggestion was made that visitors should be subject to the same procedures on testing staff within care homes.

Resolved: That:

1.  The report presented be noted.

2.  The Health Scrutiny Committee supported the ongoing work of Adult Social Care to ensure vulnerable people who need social care support across the winter period and continuing pandemic, receive the right support at the right time.