Agenda item

To receive a presentation on the Covid 19 Pandemic – the Council’s response – Care Homes.

The Committee received a presentation on the Council’s response to the Covid 19 pandemic with regards to care homes.

During the discussion of this item, the following points were made:

·         Councillor Loyes reminded the Committee that the scrutiny of the Council’s response to the pandemic with regards to care homes, had been delegated by the Overview and Scrutiny Management Committee.  He highlighted possible key lines of enquiry.

·         Graham Ebers, Deputy Chief Executive, emphasised that it was an ever changing and highly intense period.  He expressed sympathy for those who had sadly died and their families.  He indicated that he appreciated the huge amount of work that care homes had undertaken and were still undertaking.  They had worked well with the Council and Adult Social Care.  Graham Ebers went on to state that there had been an early recognition of the need for support to care homes.  Officers had been phoning providers on Good Friday, asking what support they needed.

·         Graham Ebers informed Members that 100 staff across the Council had been redeployed to Adult Social Care to assist in the Council’s response.  The Council had responded as well as it could at the time.

·         The whole system was complex.  The Council did not have direct control over the majority of the care homes and could only offer mutual aid and support. 

·         Supporting the Borough’s care providers were one of the Gold Team’s main goals.

·         Graham Ebers suggested that scrutiny focus more on areas that the Council had greater influence over.

·         Matt Pope, Director Adult Services, provided an overview of the Council’s response thus far regarding care homes.

·         He explained the different type of care homes.  The Borough had 52 care homes.  95% of care homes in the Borough inspected by the Care Quality Commission had been rated ‘good’ or ‘outstanding.’  23 of the care homes were Older Peoples Care Home and 28 were smaller care homes for residents with a Learning Disability. 

·         There were 1,352 Care Home Beds in Wokingham.  Approximately 25% of residents were funded by the Council and approximately 75% were self-funded.

·         Members were informed that the majority of care homes in the Borough were run by private or voluntary sector service providers.  Optalis operated one care home, Suffolk Lodge.  There were complexities around the nature of the privatised care home market and how that affected all the various interfaces.  Care Homes were autonomous with their own policies, governance and staff, and varied in size, quality and associated cost.

·         The type and layout of a care home could have an impact on the home’s ability to manage an outbreak and for infection control purposes.

·         Matt Pope took the Committee through a high-level timeline of the Council’s approach.

·         On 19 March, Central Government had issued guidance that hospital discharge be expedited.  At the time, there had been a fear that hospitals would be overwhelmed.  Testing had been an issue.  Routine testing out of the Royal Berkshire Hospital had not begun until 17 April.

·         Members were informed that the Council’s Task Force had taken the position not to take care home residents from hospital until they had been tested.

·         The Office of National Statistics published data every week on Covid 19 related deaths in care homes across the country.  Much of local intelligence came from staff working closely with the care homes.

·         Matt Pope referred to the Covid 19 deaths in care homes information.  This was where the death certificate data mentioned Covid 19.  However, this could vary between surgeries and across the country.  With regards to the all-cause mortality rate, Wokingham had one of the lowest rates compared to the other Berkshire authorities.

·         Matt Pope felt that the all-cause mortality statistics were more helpful. Between 1 January and 19 June, there was a rate of 163 deaths per 1,000 care home beds in the Borough.  The death rate was steadily decreasing and was now below the usual death rate for this time of year.

·         Matt Pope outlined some of the challenges that had been faced by the care homes and adult social care.

Ø  Hospital Discharge requirements and the expectation that discharge from hospital would happen within 2 hours 7 days a week.  The implication of this on the sector had been exacerbated by the lack of comprehensive testing prior to discharge until mid April.

Ø  Access to adequate PPE - Initially the NHS had been prioritised over care homes and other care settings.  There had been a lack of centralised distribution and an insufficient supply chain to meet demand.  Guidance had been confusing and changed quickly.

Ø  Access to testing - Guidance had said that negative tests were not required prior to transfers / admissions into the care home.  Access to testing had been disjointed and inconsistent and there were still gaps in some of the testing required which was due to be rectified over the summer.

·         Adult Social Care had been proactive in supporting the care sector and had been working with the care homes to facilitate mutual aid across the sector.  The Council had extended its offer to support the sector, beyond statutory requirements.  This had included an improved funding deal for care homes it contracted with, prepayments to support with cash flow plus the ability to apply for additional temporary funding.  Regular advice and guidance was also available and help had been provided with regards to sourcing PPE.  Wokingham had been one of the most proactive Boroughs in buying PPE, sourcing over 390,000 pieces of PPE.

·         Other examples of support provided to the care homes included the testing of staff with symptoms, an emergency infection control hotline and spiritual and emotional support for staff via the Community Hub.

·         Locally, a protocol and Care Homes Task Force had been established with health and social care colleagues.  It worked proactively with the care homes to prevent the spread of Covid-19, assessed and supported their readiness to take and manage positive cases and ensured that they received all the support they needed.  Matt Pope briefly outlined the four phases that the Task Force worked to.

·         On 14 May, the Minister of State for Care had written to all local authorities seeking assurance that the social care system was taking all possible steps to stop the spread of Covid-19.  The Council had coordinated a Health and Social Care Plan submission which had been completed on 29 May 2020.  It had been assured and highlighted as an example of good practice.

·         Financial Support to the sector had included;

Ø  Service Sustainability Fund;

Ø  Adult Social Care Infection Control Grant;

Ø  Extended capacity in domiciliary care, care homes and reablement services.

·         The total spent by the Council to date on supporting providers in response to Covid 19 was approximately £2.9m

·         Members were reminded that the pandemic was not over yet and that further outbreaks in the care homes were not unlikely.  The Care Home Taskforce would continue and expand to include all adult social care provision, such as day centres.

·         Councillor Bishop-Firth asked Matt Pope how well he felt the UK had dealt with the pandemic in comparison to other countries and whether earlier testing would have made a difference.  Matt Pope responded that it was difficult to compare countries responses for a variety of reasons.  However, early testing was vital and made a difference.

·         Members commended the decision taken to refuse to take residents back into care homes from hospital, unless they had tested for Covid 19, prior to government guidance on this.

·         Councillor Frewin emphasised the need for lessons learnt.

·         Councillor Grandison asked for information on the work of the Task Force and if other authorities had adopted the approach taken by the Council.  Matt Pope indicated that the protocol about hospital discharges that the Task Force had adopted had also been adopted across Berkshire West and had been circulated as an example of good practice across the South East.  With regards to specific action, he referred to the giving of advice on PPE and ensuring infection control, for example the use of disposable mop heads for cleaning.

·         Councillor Jones commented that the Wokingham Borough Council staff had done a fantastic job in dealing with the pandemic; those who had been redeployed, those who had helped in the food hub based at St Crispin’s School, and those assisting the care homes.  He proposed that the Committee formally recognise their hard work.

·         Councillor Jones went on to say that he believed that more people would have died had the Council not taken the decision regarding hospital discharge into care homes.  On 3 April, the Government had advised that the Council was required to admit patients to care homes from hospital regardless of whether the person had been tested or not.  Officers and councillors had contacted the local MP’s and whilst they had been supportive this had remained the government policy.  He was grateful to officers including Matt Pope and Susan Parsonage for the protocol that they had introduced, and thanked them on behalf of residents.

·         Councillor Jones asked whether the Council had robust plans to deal with a second wave should it occur and also for different pandemics.

·         Councillor Margetts highlighted the difficulties and frustrations of the different systems working together to varying degrees.  He informed Members that the Council had had to do a public appeal for PPE supplies and had also contacted the local MP’s for potential sources.  It had resolved the difficult situation by taking a proactive stance.

·         Councillor Margetts stated that the decision to refuse discharges from hospital had been taken because it had been felt that there was no alternative.

·         Procedures had to be kept as tight as possible to ensure that the virus did not flare up within the care homes.

·         Members were advised to consider the Council’s Outbreak Control Plan.

·         Councillor Mather expressed disappointment at the difficulties the Council had faced with the supply of PPE and commented that he felt that the NHS supply chain had also failed.  He was of the view that the Committee should explore the supply difficulties more, and how it could be more resilient.

·         Councillor Mather thanked Councillor Margetts and officers for raising issues over PPE with the MP’s.

·         Councillor Mather questioned whether the Council was building up a stockpile of PPE.  Matt Pope answered that it was, but that quality and supply of certain types of mask were still an issue.  Councillor Margetts reminded Members that the Council was the provider of last resort for the care homes.

·         Councillor Margetts spoke of the frustration of not always hearing of policy developments until they had already been publicly announced.

·         In response to a question from Councillor Richards, Matt Pope stated that the Task Force would not be not be stood down for the foreseeable future.

·         Graham Ebers stated that there were three main workstreams; continuing response, recovery and business as usual.

·         Councillor Swaddle asked how often care home staff were tested and was informed that staff would be tested weekly and residents would be tested every 28 days.  Councillor Swaddle went on to ask whether the families of care home staff were also tested.  Matt Pope commented that they would be if there were concerns that they or the member of staff may be positive for the virus.

·         Tony Lloyd commented that there were concerns amongst the GP community about the impact of a possible second wave of the virus should there also be a winter flu epidemic, and that they were stressing the importance of large-scale take up of flu jabs.  He asked what measures would be taken to ensure that care home residents received a flu jab.  Matt Pope indicated that he would support a wholesale take up of flu jabs among care home residents and would discuss with health colleagues about how this could be progressed.

·         In response to a question from Councillor Jones as to whether the Council had enough tests available should a second wave of the virus occur, Matt Pope stated that whole home testing was being regularly undertaken so he was more confident that there would be sufficient tests available.

·         The Committee further discussed care homes and finances.  Matt Pope emphasised that the Council was in frequent discussion with its care homes.  Increased costs because of the pandemic would be in place for some time; however, a solution from central government and further clarification on funding was required.

·         In response to a question from Councillor Jones regarding whether the Council would take over a care home should it be at risk of going bust, Matt Pope referred to provider failure plans.

·         Graham Ebers stressed that the financial impact of Covid 19 would be felt for a number of years.  The Council had to support providers but in a way, that was cost effective.

·         Councillor Mather commented that he heard anecdotal evidence of DNR’s being amended without consent and asked that this be checked.

·         Nick Durman, Healthwatch Wokingham Borough, praised the collaboration between the voluntary sector, the health sector and the Council. 

·         The Committee discussed what areas they felt should be looked into further.

·         Councillor Mather commented that it would be helpful to have more information gathering sessions.  Councillor Swaddle asked that information be provided as early as possible to help Members to formulate their questions better.

·         Members agreed that they wished to talk to the Council’s health partners such as the Clinical Commissioning Group and the Royal Berkshire Hospital, to discuss how they felt that they had coped with the outbreak, their views on PPE supply, and whether it would be sufficiently resilient to cope should a second wave occur.

·         With regards to PPE supply, Councillor Grandison asked how many masks had been ordered.

·         Councillor Grandison felt that the Committee should examine what treatments such as cancer screening had had to be postponed because of the pandemic, and the impact of this on residents.

·         Councillor Bishop-Firth suggested that the Committee look at the impact of the pandemic on residents’ mental health.  It was noted that this topic had been delegated to the Children’s Services Overview and Scrutiny Committee.  Councillor Swaddle, Chairman of this Committee, invited other Members to attend the meeting when this matter was considered.

·         It was agreed that the Democratic Services Officer would produce a draft timetable and circulate it to the Committee for agreement.

RESOLVED:  That

1)         Matt Pope be thanked for his presentation

2)         taking into account comments made during the meeting, the Democratic Services Officer to produce a draft timetable for further scrutiny and circulate to Members