By HCI editor, Sarah Clarke
It’s no secret that the home care sector has faced a number of challenges throughout the COVID-19 pandemic, but it’s fair to say that providers, their staff and clients would be a lot worse off if it wasn’t for the tireless work of organisations like United Kingdom Home Care Association (UKHCA).
Earlier this month, I attended the virtual Home Care Research Forum, hosted by King’s College London. During the session, UKHCA chief executive Dr Jane Townson (pictured) gave a high level overview of the home care market, and discussed how UKHCA has represented and supported providers during the COVID-19 pandemic.
As a business journalist focused on the home care sector, I already had some idea of the work that the organisation has been doing behind the scenes, but Jane’s talk opened my eyes to exactly how providers, and the people they care for, have benefited from this.
I wanted to share what I learned from the Home Care Research Forum. So, here is an overview, in Jane’s words, of how UKHCA has supported home care providers over the last 12 months, from translating complicated PPE guidance and convincing the Treasury to allocate infection control funding to home care providers, to lobbying for routine testing for the workforce.
Words by Dr Jane Townson
Going back to last March, the Department of Health and Social Care formed a National Adult Social Care COVID-19 Planning Group, and we were members of that group. It met weekly, to begin with, and then it started to spawn a whole range of different work schemes underneath it, and we were involved in all of those, so we’ve literally been careering from one Zoom call to the next.
A huge amount of work went on with regard to supporting the workforce. We managed to lobby to get the social care workforce considered as key workers and we persuaded the government to relax some of the bureaucracy around DBS checks so that they could be done more quickly and easily. We also made sure the money was available to enable people to self-isolate and still be paid.
We’ve also worked closely with organisations like Carers UK to make sure the people informally caring, who often work in concert with the paid workforce, received support.
Capturing meaningful data
Collecting and using the right data was a big issue from the beginning because the social care market is very fragmented, and many of the organisations are in the independent sector. Central government didn’t have a grip of what was going on and didn’t have the mechanisms to find out what was going on, so we spent a lot of time talking with the Care Quality Commission and the Department of Health and Social Care about what data would be useful to help manage the pandemic.
Interpreting PPE guidance
PPE was a huge bane of our lives this time last year. Actually acquiring it was a real challenge, but so was working with Public Health England and the NHS to make sure the national guidance that came out actually meant something and was relevant to people in home care.
Quite a lot of the language that was used was clinical and hospital-like sounding. We knew that the care workers on the ground would not know what some of the terms meant, so we spent a lot of time trying to translate guidance and going back to Public Health England and saying “no one is going to understand what that means”. That was a huge amount of work and it’s still going on. There’s another provision of PPE guidance that is in the works, but we have now established good relations with the people involved, so it much easier to get changes made.
Persuading the Treasury to allocate funding
Very early on, we were very concerned about the sustainability and viability of providers. Luckily, we had some offers of help from some of the big management consultancy firms and they worked with us to do some really detailed analysis of the additional costs being incurred by providers as a result of the pandemic. We were able to take that analysis to the Treasury and say that we need extra money urgently, otherwise everyone is going to collapse and that’s not going to be good for the NHS.
The first tranche of £1.6 billion was made available from the Treasury on March 19 last year and we spent substantial amounts of time working with local government to make sure that money got out to providers as quickly as possible, and in a way which would have maximum impact.
One of the things which we advocated for was for councils to move to paying in advance on planned delivery, rather than in arrears of actual delivery, which is the normal state of affairs. There were quite a lot of staff self-isolating at that point, and that meant it was quite difficult for providers to keep their cash flow going. That was a large piece of work and is still on-going and, since then, we’ve lobbied to get extra funding for infection control. In the first tranche, 75 or 80 percent went straight to care homes and the remaining 25 percent was left to the discretion of local government.
The data showed that only half of that 25 percent – about 13 percent – ever went to home care providers, and we complained vociferously about this. So when they released the second tranche of the infection control, they put home care into the core grant, which meant that councils had to transfer money to home care providers based on how many people they were supporting.
Convincing the CQC to conduct virtual inspections
During this period we also worked closely with the CQC to keep the system assurance going. The CQC agreed to pilot virtual inspections of home care and that’s gone really well. We said to them that they should be doing more of that anyway as, quite often, it’s difficult to really hear the voices of the people receiving services. The BBC and other broadcasters have been interviewing people just using smartphones, so we said to the CQC “if the BBC can do it, why can’t you?’ So they took that on board and have been experimenting with it, so that’s been quite interesting.
We also did a lot of work with NHS England on discharge from acute hospitals to community settings. The NHS have got a home-first policy where its supposed to be the case that people are discharged to their own home directly, rather than being discharged to a care home. That didn’t always work that brilliantly in the first wave, but we’re constantly pushing on that. There’s a proposed change in legislation to make it possible for people to be assessed when they’re at home rather than in hospital, which we all know is better.
Lobbying for routine testing
Routine testing was made available early on for care homes, but we kept being told that the prevalence of COVID-19 in the home care workforce was pretty similar to that of the general population and there was no need to routine test. We said, actually, the people that we are supporting are some of the most dependent and high-risk individuals and we need that testing.
Eventually, in November, it was agreed that routine asymptomatic testing was made available, but the testing kits themselves weren’t available until about December. As it turns out, there’s a lot of administration involved in tracking all the results of your workforce, so we asked that some of the infection control fund could be used to pay for the administrative costs of the testing and the recording of the testing, and the same with vaccination, which is currently where we’re devoting a lot of our time.
Vaccine roll out
The home care workforce was put into the second priority group by the Joint Committee on Vaccinations and Immunisations, so we were really pleased about that. Since then, we have been working really closely with local and national government, the NHS and primary care on the roll out of the vaccinations to the home care workforce.
We carried out a survey in the last week of January and, at that point, an average of 32% of the home care workforce had been vaccinated. When we spoke to some of our members that week, some of them were reporting 80 percent or even close to 100 percent vaccination rates, while others hadn’t managed to get any of their staff vaccinated. That’s not because the care workers don’t want to be vaccinated – actually, the majority really do – it’s just the booking system and the logistics have proved to be a challenge in some areas.
We’re working on unplugging some of the blockages in the system to make sure everyone gets vaccinated as soon as possible.