London Borough of Sutton

Supporting our Care Homes to remain safe

29/05/2020

1 - Forward For over 5 years the Sutton Health coordinated approach with homes to and Care system has built a strong required actions. partnership to provide oversight and support to care homes within Sutton. The Chair of our Safeguarding Adults The system is overseen by the Sutton Board (SAB) has been kept updated Health and Care Executive, which on our work and any adjustments that includes, the London Borough of may have been made in relation to Sutton (LBS), NHS Sutton Borough safeguarding. Our SAB has continued Team (NHSS), Sutton Health & Care to meet virtually during this time. Alliance (health and care providers) We have also implemented twice and the community and voluntary weekly System Leaders meetings to sector*. oversee and ensure a coordinated Our partnership has given us a strong approach to our COVID-19 response. foundation to quickly respond and provide effective, joined up support to 1.2 Our COVID-19 response care homes before and during the The Supporting our Care Homes to COVID-19 pandemic. remain safe document sets out our *See full list of Sutton Health and Care system journey to date and the Executive members in the Glossary - Page 32 mechanisms we use to work in partnership with and support our care 1.1 Our System Confidence homes through this pandemic.

As part of our preparations for this Speaking to our care home providers, submission, we have consulted with they commented: our Care Homes, Healthwatch, “We were given an optimal level of Advocacy Provider, Clinical Leaders, the Sutton Health & Care Executive support from LBS, Care Home and staff providing services directly to Support Team and GP” Care Homes. Locally we are confident “The coordinated response saved that the measures set out in the letter lives and helped us enormously” of 14th May 2020 are substantively in place. As a partnership we are continually working with care homes to plan, We have in place a new Care Market review, respond and improve our Oversight & Support Group, which ways of working to ensure residents consists of key representatives from and staff have everything they need across the system. The group ensures to be safe and provide and confidence in our approach remains experience high quality services. high and we are able to quickly take a

1.3 A regional approach Since mid-March this has supported local operational responses: COVID-19 has provided an prioritising active delivery of PPE, unprecedented challenge to adult ensuring appropriate staffing levels social care. The challenge has been and providing Public Health infection significant in London due to early and prevention and control advice and rapid spread of the virus, local support. patterns of deprivation, high levels of air pollution and the high proportion Being alert to emerging issues in the of ethnic minority populations in most system which led to care home London boroughs. challenges and our early response (we started reporting care home Across the Capital, London local deaths and COVID-19 cases from 23rd authorities responded to the March) allowed action to be taken to challenge and our responsibilities respond in London and provided early under the Civil Contingencies Act by warning nationally via the Strategic working together as London ADASS, Coordination Group (SCG) of issues London ADPH and Chief Executives, that would develop across the alongside NHS partners, to identify country. issues, galvanise responses and lead several pan-London initiatives. We A summary of the work across London brought our coordinated response and issues for the future are captured together through the Strategic in section 11 - A London Approach. Coordination Group and joint governance with NHS London. 2 - Our system Using data and evidence we developed a comprehensive journey to date understanding of the London adult In Sutton, health and care social care markets (home care and organisations have been working care homes) during the spread of closely together in a partnership for COVID-19. Our commissioners used five years. this as a key part of their daily interaction to support providers. It has We are committed to supporting our underpinned and strengthened homes to be safe places. This is relationships with providers locally because we recognise that these are and provided information on care people’s homes. We have therefore homes across borough boundaries, organised services around what these which has streamlined the work and residents need, not by organisational reduced the burden on providers. boundaries. Working together makes sense as we can build strong and supportive teams with different skills and roles, all focussed on better and

more efficient health and care for the Sutton over the next five years, and people of Sutton. how different organisations could work more closely together to make a 2.1 Ambitious for Sutton difference for residents. In October 2018 Sutton Council launched our Ambitious for Sutton 2.3 Vanguard programme. This sets out the In 2015, Sutton was awarded Council’s ambitions for Sutton to be a Vanguard status - one of only six great place to live, work and raise a enhanced health in care home family, and describes a plan to Vanguards. The programme was achieve this through focusing comprehensive and included older resources on priority outcome areas: and younger people homes.

● Being Active Citizens Our programme improved the health ● Making Informed Choices and quality of life for all care home ● Living Well Independently residents by delivering a new care ● Keeping People Safe model that offered improved and integrated health care and Keeping people safe is a key priority rehabilitation services. The and includes a focus on maintaining programme resulted in the high-quality residential and nursing implementation of a new Sutton care care provision for the residents of model with three elements: (1) Sutton. Integrated Care, (2) Care staff, education and training and (3) Quality 2.2 Sutton Health and Care assurance and safety. Plan The Sutton Vanguard Programme In September 2019, LBS, Sutton informed the national enhanced care Clinical Commissioning Group (SCCG), support framework and its seven the community and voluntary sector priorities, e.g. the Red Bag initiative and Healthwatch Sutton worked trialled in Sutton has now been rolled together to launch the Sutton Health out to 80% of the CCGs in England. and Care Plan.

The partnership looked at what is important for health and care in

3 - Sutton’s Care Home Market

Within Sutton we have always worked ● SW London & St George’s NHS in partnership with Care Homes to: Trust ● London Fire Brigade ● Ensure they have appropriate ● London Ambulance Service guidance and advice. NHS Trust and Metropolitan ● Provide practical on the Police ground support. ● Support their developments The group's aim is to work in and improvements. partnership with and provide tailored ● Provide a route of escalation, support to our care homes, maintaining where necessary. a strong focus on quality, performance and safety. We utilise a range of mechanisms to support our homes to ensure safety, 3.2 Shared communication quality of care and provide our residents the best experience possible. and training

The following sets out the system’s We have built strong, sustainable collective mechanisms that were in relationships with our care home place before the outbreak of COVID-19 providers and therefore are able to and which were adapted in response to give and receive accurate, up to date the pandemic. information in a consistent, effective manner.

3.1 Well-established We provide sector-wide partnership working communication of service developments and clinical information, There are strong relationships across advice and guidance. the whole care home sector in Sutton. This includes those homes where the Sutton’s provider network has a Council or NHS Sutton do not currently consistent and longstanding have placements. membership of key stakeholders. We work with providers to offer joint The Joint Intelligence Group (JIG) learning and development meets on a monthly basis and engages programmes. a broad range of health and social care stakeholders from: 3.3 Contract Management

● LBS Effective market and contract ● NHS Sutton management in partnership with care ● Care Quality Commission homes and other health and social care (CQC) stakeholders has driven service quality ● Sutton Health & Care (Care enhancements in recent years. For Home Support Team) example over the past 24 months the ● Epsom & St Helier NHS Trust number of homes rated as good or 6

better has risen from 78% to 84%, with level quality concerns with five homes achieving outstanding commissioners. ratings for specific domains and two with an overall outstanding rating. 3.4 Enhanced quality improvement function

Sutton’s continued investment in dedicated Quality Improvement Officers that work in partnership with care homes and other health and social care stakeholders enables:

● Robust assessment of service quality of both borough funded and resident self-funded care home provision; ● Rapid response and investigation of any quality issues or service deficits with shared protocols in place to ensure these result in performance improvement plans, as required.

Working with Healthwatch Sutton we have created a new Care Home project to review service provision in our Older People’s Homes and provide learning for the homes and council.

3.5 Data collection

We have been robust in capturing key information from care homes to inform service improvements, performance management and the identification of best practice.

To ensure all levels of areas for quality improvement can be captured we have in place a Quality of Care Concern form to allow stakeholders to raise lower 7

Our response to COVID-19 in Care Home

4 - What our homes think

● PPE stock adequacy 5 - Oversight and ● Testing compliance A new reporting function has been established to ensure high daily Working in partnership with care response rates and reports that homes, we have adapted our current deliver operational and strategic processes to provide additional reporting of key service data for the support to homes to remain safe. care home market. 100% of homes are engaged in reporting. 5.1 Oversight Public health intelligence advice has Our successful JIG format has been been provided on the data sets to adapted to re-focus on the COVID-19 enable the appropriate interpretation response. The scope has been and validation to help inform decision broadened, membership reviewed making. This includes advice on the and frequency of meeting increased use of appropriate RAG ratings for from monthly to daily operational COVID-19 risk prioritisation. dialogue and a weekly situational The RAG rating of metrics has analysis. provided LBS and the homes a clear The daily oversight meetings are understanding of their situation and utilised to create, monitor and agree therefore advance notice of what support plans to work with each home additional support and measures are to target interventions where needed. required. This process ensures appropriate actions are agreed, implemented, 5.3 Quality Assurance when required urgently, and ultimately Commissioners and Quality homes are supported to remain safe. Improvement Officers (QIOs) are in 5.2 Daily data review regular, approximately weekly, contact with all providers to discuss In partnership with other London how services are operating; any boroughs and ADASS, Sutton has concerns and how the Sutton Health revised the information requested and Care system can support them to from its providers to ensure a shared ensure their home remains safe. and up-to-date view of COVID-19 in Fortnightly meetings with our lead Sutton’s care home sector. The daily CQC inspector also take place to questions cover topics such as: discuss issues and support being ● Prevalence of COVID-19 provided. amongst residents ● Occupancy 5.4 Safeguarding ● Available staffing 11

LBS adult safeguarding teams are specifically at DoLS and visiting to continuing to manage safeguardings undertake assessments. in the usual way. Safeguarding concerns in relation to Care Homes Guidance for DoLS specifically are reviewed in the daily oversight discussing restrictions in times of meetings and additional monitoring COVID-19 has been compiled for Best meetings have been arranged three Interest Assessors (BIA) completing times a week with Team Managers DoLS assessments. and Heads of Service to ensure the ongoing timely management of Care 6 - Infection Home safeguarding concerns.

As part of our COVID-19 response a prevention and Nurse from NHS Sutton is working control alongside council social workers to support any safeguarding enquiries. Our Care Home Support Team We adopted appropriate Infection continues to visit care homes Prevention Control (IPC) guidance and escalating concerns as needed. rapid change in practice through training and communicating with our Where care homes are not adhering Care Homes. We are supporting to Government guidance, in particular homes to continuously apply appropriate use of PPE, adult evidence based Public Health safeguarding will, in conjunction with principles of outbreak management as colleagues from our Care Home required by the emerging evidence, to Support Team, visit homes to ensure reduce the risk of transmission of ongoing compliance through regular infection. monitoring. The South West London (SWL) CCG The Local Authority Deprivation of have recruited an additional Infection Liberty Safeguards (DoLS) lead Prevention and Control Specialist contributes to the daily oversight Nurse. meetings to discuss restrictions placed upon residents as a result of 6.1 Training COVID-19. Where there are concerns the DoLS lead links in with staff from We have provided a number of virtual the Care Home (visiting where and face to face learning sessions and needed), looking at restrictions and tools to homes. We have held: providing advice to staff and linking to ● Weekly Infection and safeguarding where necessary. Prevention Control seminar In addition the DoLS lead is working webinars delivered by the with commissioning regarding SWL IPC nurses. business continuity plans, looking 12

● We have provided weekly IPC communicated with homes for urgent FAQs (based on the webinar) supply of 2 days or less. shared via email. ● Local Sutton Care Home We developed mutual aid webinars including IPC. arrangements for homes across SWL. ● All homes for older people We use our daily oversight meeting to offered face to face training identify homes with limited PPE (less for care staff on IPC than 14 days), and proactively contact procedures and correct use homes and support them to resolve of Personal Protective any supply issues. Equipment (PPE). We have utilised the London We continually communicate with our Resilience Forums emergency PPE homes on the latest IPC and PPE stock providing homes with guidance in the LBS weekly emergency PPE when they need it. newsletter and collate any issues for specialist input via local Public Health We have delivered goggles and face advice. This level of support was shields to all providers. provided to mitigate the risks from rapid changes to guidance and offer To date we have procured over 3 assurance for specific or specialist million items of PPE costing approx £1 areas. million to support local Care Markets access to sustainable, cost efficient We are currently engaging with our supplies via the Pan London PPE providers to understand the training Procurement. they are receiving elsewhere and what other training and support would 6.3 Reducing workforce be most beneficial for us to provide in movement between care the future. homes and minimising risk 6.2 PPE for care workers

We are constantly working with care We are clear that reducing workforce homes to ensure they have access to movement between providers helps the PPE required; feel confident in the to stem the transmission of the virus process to obtain emergency supplies across settings. and have the latest information and guidance about use of PPE. We have provided additional funding to providers to support Infection We have provided details of suppliers Prevention Control and minimise with stock to all Homes and local workforce movements. processes have been established and We have provided advice and information about this potential risk to 13

Care Homes and are continually residents with Learning Disabilities or raising awareness for the issue via the Dementia. newsletter. Care homes are advised to ensure all staff including 6.5 Building our scientific agency/bank staff are able to access understanding and sharing testing in order to minimise the risk of transmission. good practice across the sector 6.4 Quarantining We work closely and meet regularly

with partners from health, social care In our early planning stages, we and wider stakeholder groups across identified additional capacity in the the SWL Local Authorities, CCGs, and Borough and purchased 47 care local Public Health networks (such as home beds. This capacity was there to the London Association of Directors of support speedy discharge and act as Public) to review evidence/soft additional capacity should isolation intelligence, discuss guidance and not be possible at certain homes. share good practice.

We are reviewing vacancy data on a Our plan is to be informed by the daily basis and discussing with homes latest evidence, including local, their requirements. Currently Sutton’s regional, national and global, to older people homes have ensure the safety of the population approximately 27% vacancies and particularly those most at risk from younger adult (age 18-65) care homes COVID-19. have approximately 15% vacancies. The additional capacity identified is 6.6 Managing potential deemed enough for isolation outbreaks purposes, however we are continually monitoring the situation in order to Public Health England (PHE) Health keep the homes safe. Protection Teams (HPTs) within a dedicated London Coronavirus Homes, where needed, have zoned Response Cell (LCRC) are the first properties by floors or wings of their point of contact, when the care home building. This has ensured residents suspects for the first time that a are safe and zoned according to resident has symptoms. need. Staff have also been allocated to work in particular zones in order to The care home manager knows to reduce the transmission of the virus. contact the PHE LCRC, who will arrange for surveillance testing of all Dedicated advice has and continues symptomatic residents at this point, to be made available to Homes to and will provide tailored infection support those who look after control advice.

Care homes also provide daily standardise the local outbreak updates to commissioners via our response and plan appropriate daily reporting. If there is a potential support using the assessment outbreak, a multidisciplinary team checklist, contingency plans and (MDT) assesses the situation, during assessment flowchart. This forms part the daily oversight meeting, and of building a new COVID-19 quality decides on the relevant lead to have a assurance framework for all Sutton discussion with the manager, using an care homes. assessment checklist. Subsequently, the MDT team reviews the situation 7 - Clinical Support using evidence from multiple sources including the discussion with the manager, local data and PHE HPT. Before COVID-19, there was already a The MDT team agrees the most significant amount of clinical support appropriate support such as IPC/PPE, provided to care homes through the enhanced cleaning and established primary care and isolation/cohorting of residents and community services including a staff, for managing the outbreak. dedicated Care Home Support Team. Information is shared as required. Primary care and community response The care home manager is supported have been stepped up during the in developing a plan to manage the COVID-19 pandemic to include timely outbreak. Plans may include further access to clinical advice for care training, review of supplies and any home staff and residents, and other relevant support or advice proactive support through including clinical advice regarding personalised care and support monitoring residents health; provided planning. by the Care Home Support Team in Clinical Directors from the Primary liaison with primary care. The DoLS Care Networks are active members of team will advise regarding isolation our Care Market Oversight and measures where there are mental Support Group and each take a lead capacity concerns. on support to Care Homes, from End Regular updates on guidance are of Life to Learning Disabilities. shared with the MDT team and we are looking to develop training sessions 7.1 Discharge Planning to support the role of the MDT team. We have merged a range of services To ensure comprehensive local risk into the St Helier Hospital 'Hub' base assessment and appropriate advice to join forces and work collaboratively can be promptly provided to care as a single point of referral for all homes with new outbreaks, we have hospital discharges. developed further processes to

The Hub has developed a COVID-19 generic NHS Email accounts to enable discharge checklist to ensure care the secure and fast flow of clinical homes are provided with the relevant information. information for discharge including the person's COVID-19 status. NHSmail address will not only give care homes access to Microsoft An assessment of the individual Teams for running secure virtual health and social care needs, home clinical consultations and virtual environment and living arrangements, connections between residents with social circumstance and existing care their family and friends, but also a arrangements prior to admission are feeling of being part of the health and risk assessed against COVID-19 status care system. to determine the best option for the discharge destination. 7.3 Sutton Care Home Team Intermediate care bed-based rehab settings are used where appropriate; Sutton Care Home Support Team is a step-down placements are used in multi-agency team. The team line with the person’s COVID-19 comprises nurses and therapists, status. working closely with GPs and pharmacists to offer proactive Through agreement with Care personalised care to residents. Providers, Sutton Continuing Health Care assessors (SWL CCG) are the The team has increased from 5 to 7 leads in liaison to make contact with days service provision during the the care home and transfer clinical pandemic. A weekly check in is now information regarding care needs and provided to all care homes to offer ensure the COVID-19 checklist is support, understand their issues and completed and sent to the care home provide valuable context to the daily before discharge. This provides data submitted. additional support to our homes as Out-of-hours support from 111, part of the discharge process. community services and end of life Ongoing tracking, monitoring and teams has been expanded to include: reviews are completed to follow up ● Care home and community and review all discharges to care nurses now trained in death homes including bed-based rehab. verification. ● End of Life Care support to 7.2 NHSMail Learning Disability homes through Sutton Care Home Sutton now has all but 1 home Support Team (currently in progress) with NHS mail ● Clarification of contact details coverage. All care homes have been for both normal working hours supported to access and set up 16

and out of hours advice and urgent care plans for people support. approaching the last phase of their ● Recognition of the increased life. work by primary and community care to deliver 8 - Testing services to vulnerable groups, especially residential homes We have provided consistent communication and guidance on what 7.4 Clinical support is available around testing. However, testing is provided and managed All our Older People Care Homes through central government and not have a designated Clinical Lead(s) by the local Sutton System. who offer continuity of care, weekly contact and timely access to clinical 8.1 Testing and prioritisation advice. Care homes with older residents or We have joined up the working those with dementia can now access arrangements between GP practices, testing for all their residents and staff pharmacy and community nurses in regardless of their symptoms. Tests the Care Home Support Team and are available for booking via a new learning disability teams to provide digital portal for care home testing. virtual rounds, linking into other therapies as needed such as Physio, We have developed a testing position Occupational Therapist, Speech and paper led by the Director of Public Language Therapy (SALT), dietetics Health (DPH) with input across the and Challenging Behaviour teams system. We have also provided a framework for risk rating, prioritisation We have enhanced the working and escalation of Sutton homes for arrangements between our Care testing via the Department for Health Home Support Team and our and Social Care (DHSC) whole home Learning Disability Health Team to testing route launched on 11 May complement skill sets and enable 2020. This information has been equitable access to clinical support for provided to DHSC weekly and as of all care homes. the 26 May 2020, 11 out of the 29 We have provided access to End of Sutton residential and nursing older Life Care medication 24/7 including people homes had received testing review of medication supply policies kits. (particularly end of life) in care homes Care homes reporting a new to reduce wastage. suspected outbreak have been We have worked with care homes to advised to continue to contact the increase the uptake of Advance Care PHE health protection team (London Plans and Coordinate My Care (CMC), Coronavirus Cell) who lead 17

surveillance testing and initial public staff. Testing helps to support early health advice to support care homes detection of infection within the home. reporting a new outbreak. We have advised all care home We initially worked with other councils managers to ensure that all staff across SWL to coordinate access to including agency and bank staff the Chessington testing centre during (unless symptomatic and self-isolating) the early phase of key worker testing. are included in all testing requests. Those homes not eligible for whole home testing have been reminded of 8.3 Escalation the other routes available for resident and staff testing. The Directors of Public Health working with Directors of Adult Social 8.2 Advice and guidance Services (DASS) have referred local care homes for the Department of We provide regular evidence-based Health and Social Care (DHSC) whole Public health advice, communications, home testing, in line with local testing support and guidance about testing, prioritisation of need. linking to outbreak management within care homes. We have bridged the gap and provided regular escalation and Public Health Sutton, provide advice communication between Sutton and support to the wider system to system and PHE health protection ensure a joined up approach on team (London Coronavirus Cell) who testing strategy. lead surveillance testing and initial public health advice to support care Public health advice and content is homes reporting a new outbreak. provided via training webinars on swabbing. Information gathering has intensified to help develop an accurate picture We are continuing the further about testing needs, gaps and dissemination of testing information to support available within the Sutton homes through newsletters, emails system’s control. and phone as it develops. We have and continue to escalate We continue to remind homes that concerns and issues identified by testing is only one element of homes in relation to accessing testing Infection Prevention and Control and with PHE and DHSC. the actions they can take to minimise transmission. This is important to minimise the risk from asymptomatic 9 - Building the transmission of COVID-19 in care homes amongst both residents and workforce

9.1 Staffing capacity interviews, for positions including Health Care Some of our homes may experience Assistant roles, Volunteer staffing capacity issues due to staff Roles, Manager Roles, isolating, shielding, being unable to Administrative Roles, Kitchen work at multiple homes and becoming staff and Cleaning staff. sick. We have a number of processes ● London Workforce Hub: A in place to support homes to mitigate scheme which can fast-track these risks. healthcare professional roles, (for example nurses) into care In the daily oversight meeting we homes where required review each home's staffing capacity ● Allied Health Professionals compared with their occupancy rate (AHP) Hub: A scheme which and proactively contact providers can fast-track AHP roles (for rated ‘Amber’ or ‘Red’. The risk based example psychologists, action plans enable us to provide occupational therapists, support to homes, where needed, to physios/rehab staff) into care ensure safe levels of staffing which homes where required may include redirecting staffing ● Proud to Care: Pan London resources from other parts of the Recruitment programme for health & social care system. social care professionals

Where required we have assisted We have also provided information on homes by organising staff to cover for free job listings, including Job Centre the shifts which cannot be covered by Plus advertising and Twitter Campaign regular agency workers. to recruit local people into social care. Care homes have updated their business continuity plans to include 9.2 Health & Wellbeing contingency planning to address Support staffing deficits. The health and wellbeing of our Plans are in place to redeploy our registered managers and care staff Sutton Health & Care@Home team to has been a top priority for us. We Care Homes as a last resort. recognise that this situation will be new for our homes, we therefore: Sutton is a part of a number of South West London and regional workforce ● Contact our homes weekly to projects, including: provide a listening ear, offer advice and support. ● Prince’s Trust workforce ● Offer access to the LBS’s project: A project which Employee Assistance provides care homes a pool Programme. of ready candidates for virtual

● Ensure Homes were aware of 10.1 Direct Funding the Skills for Care Registered Managers Helpline. Prior to the start of the financial year ● Provide access to the Marie LBS undertook its annual fee review Curie Bereavement Advice process for all Care Home Service for all homes. Placements. This ensured that a ● Signpost Homes to free sustainable price of care is paid to our wellbeing Apps for staff providers and increases in National ● Actively advertise the new Living Wage are accounted for. This CARE workforce App. has resulted in an average 2.4% ● Have sent posters to Homes increase in fees. for displaying to highlight the range of psychological Early on we recognised that providers support available for staff. may need additional support during the main period of the pandemic. We therefore provided care homes with a 10 - Financial one-off payment, paid in a single sum. Over £200k in cash payments have Support been made so far.

So far, as a system we have provided Following the conclusion of national over £1m of additional cash flow into discussions on Funded Nursing Care the Care Home Market. Through the rates, NHS Sutton will pay a administration of the Infection backdated amount of £193k for Prevention Control Fund, this will 2019/20 and £60k for quarter 1 of increase total additional cash flow to 2020/21 to our nursing homes. This over £3m. will add an additional £253k in cash Providers have been informed that flow to Care Homes. they will be receiving an allocation A 4% uplift was also agreed for from the £2.1m of funding allocated to placements procured through the Sutton via the Infection Prevention London Any Qualified Provider route Control Fund to allow them to start for 2020/21. implementing any additional IPC measures now. As a system we block purchased 47 care home beds, injecting an Work has started working with additional £634k into the Care Home providers on plans to administer the market from April - June 2020. passporting of 75% and the discretionary 25% of the Sutton Care Home Payments continue to be allocation. This includes an online paid on an automatic pay run basis, survey and focus group. removing the need for Care Home Invoicing.

We continue to engage with homes on their individual situation and risks Across the Capital, local authorities in a proactive way utilising the London responded to the challenge and our ADASS Market Insight Tool to responsibilities under the Civil facilitate this. Contingencies Act by working together as LondonADASS and Chief 10.2 Indirect Funding Executives, alongside NHS partners to identify issues, galvanise responses We have provided 7 day a week and lead several pan-London Commissioner and operational initiatives. We brought our response support for Care Homes. co-ordinated together through the We have launched through the Proud Strategic Coordination Group (SCG) to Care system a local recruitment and joint governance with NHS campaign for our Care Markets, London. facilitating initial candidate clearance checks. Given the high rate of infections in the Capital, the fact we were ahead of the We have provided access to national curve and the difficult issues emergency PPE free of charge. We created by early national guidance, secured via the Pan London PPE we believe that without collective Procurement competitive pricing for action the impact on residents and the PPE and this will be made available to number of care home deaths would the local Care Market at cost price to have been significantly higher. enable them to return to a normal state in PPE pricing. We continue to monitor the adult social care market to enable us to Made available a range of additional effectively respond to possible further expertise to care homes to support peaks of COVID-19, as isolation rules them to remain safe. are relaxed, and to suppress non-COVID-19 NHS demand. This 11 - A London includes support for older people, those with a learning disability, mental Approach health needs and direct payment users. COVID-19 has provided an unprecedented challenge to adult We will remain vigilant to potential social care. The challenge has been future outbreaks and provider significant in London due to early and financial viability. We will ensure rapid spread of the virus, local sustainable access to PPE and testing patterns of deprivation, high levels of and continue to use data to support air pollution and the high proportion decision making. of ethnic minority populations in most London boroughs. 21

11.1 Pan-London initiatives Early identification of the risks to the workforce were identified and on 10th The following gives a flavour of just April we launched Proud to Care some of the actions taken London to support recruitment, DBS pan-London: checking and basic training of care staff. To date we have had over 1,800 We worked with PHE London in March registrations and of these 180 have / April to develop consistent and up to passed to councils and providers, with date online training in infection control excellent feedback about the calibre and rolled this out to care homes, of the candidates being connected supported by local follow up advice with work settings. It is also worth and guidance. noting that we are reaching a new There was escalation from early April profile of carers – with 1/3 of to advocate for regular testing of both applicants under the age of 30. We care home staff and residents and for are now in the process of transitioning testing of people being discharged the Proud to Care initiative from an from hospital into care settings. We SCG sponsored workstream to have contributed to London work on LondonADASS, in order to further testing approaches for care homes, develop the model with the ultimate alongside PHE. This was identified as ambition of creating a Social Care a significant strategic risk. Academy for London.

Early escalations on the need for a The risk of inconsistent clinical sustainable supply of PPE led to the support to care homes across the PPE task group, reporting into SCG on Capital and the need for the NHS to our response and highlighting this a step up was identified and led to a strategic issue for both our own local joint letter to Integrated Care System’s authority staff and that of the provider (ICS) and local systems from the Chief market. This supported joined up Nurse and lead Chief Executive on the NHS/Local Authorities systems for 9th April to galvanise action. A weekly accessing PPE and, in addition, a regional Care Homes Oversight group London-wide Local Authority PPE was established on the 7th May co-led procurement through the West by the Chief Nurse and London Alliance in response to LondonADASS Vice Chair. unreliable national supply chains. At The objectives of the Oversight Group the local level, where PPE was are to: available, commissioning teams distributed this directly to local ● Oversee the roll out of key providers based on detailed elements of the primary and intelligence about infection and PPE community health service-led supply levels for each care home. Enhanced Health in Care Homes programme including, but not

limited to, access to weekly reflect people’s experiences. clinical reviews, medicines However, engagement largely takes optimisation and advanced care place at the local system level where planning the most meaningful relationships are ● Identify opportunities to support in place. staffing in the care home sector and coordinate any regional We worked collaboratively with NHS response, which may draw upon colleagues on discharge planning initiatives across the NHS and safe pathways and co-ordinated work local government (Your NHS in Sustainability Transformation Needs You / Proud to Care) Partnerships (STP)/ICS sub regions to ● Continue to ensure that all support development of discharge residents are being safely and beds for COVID-19 positive patients to appropriately discharged from prevent spread of infection. hospital to care homes ● Have oversight and assurance of DASSs in London have been able to care home resilience plans, assure themselves that core safety, responding to emergent human rights and safeguarding duties challenges and supporting the are being delivered when Care care home community Homes are in lock-down without the ● Have oversight of Regional usual footfall and community access improvement support, public to residents’ homes. Local health and operational challenges mechanisms for safeguarding using system wide data sources processes, provider concerns and including, but not limited to, quality assurance mechanisms have outbreaks, mortality, workforce continued to inform work with and access to training and clinical providers in the sector. Regionally we in-reach have specifically worked with the ● Have oversight of the Regional Coroner and PMART teams to Test, Track and Trace (TTT) across understand safeguarding concerns care home workforce and and quality alerts and respond residents, ensuring that ‘hot spots’ appropriately. are identified and targeted in a timely manner We have worked in strong ● Implement a ‘super’ trainer collaboration with NHS London and programme in care homes based Carnall Farrar to build a demand and on PHE’s recommended approach capacity model that is intended to to infection prevention and support joint planning of health and control, PPE and testing social care at local authority, STP/ICS and regional levels into the future, Engagement with residents and user populated by our market intelligence voice is central and Healthwatch are with shared understanding of part of the London Oversight Group to assumptions driving the model. This 23

included capturing additional social the spread of COVID-19 at local, care capacity during ‘Surge’, so that STP/ICS and regional levels. any need for further accommodation could be met on a pan-London and The daily survey includes information sub-regional (STP/ICS) basis. Happily, on: as with the Nightingale beds, most of ● Prevalence of COVID-19 and this was not required. However, the associated mortality model will support tactical planning ● Actual and true availability of requirements over an 18 month period supply to support NHS London to return to its ● Discharges from and admissions pre COVID-19 position. to acute care Use of both the 18 month tactical ● Staff availability planning tool and the suite of near ● Details of PPE stock term operational planning tools ● Access to testing covering acute, community, social care and primary care will support We prioritised older people’s care both London region and each ICS to homes because we understood this understand projected demand (non was where the greatest impact and COVID-19 and COVID-19) over the safety issues would be and because next 18 months and the potential 30% of all older people care home impact. Creating an overview of the placements are across borough whole system, we aim to ensure this boundaries, so collaborative work is tool supports planning together in essential. We started the care equal partnership and safer discharge homes data collation mid-March and pathways. have a consistently high daily response rate. This reflects the 11.2 Use of data and leadership of borough commissioners working intensely with their providers intelligence and building these relationships Our response has been underpinned through direct and often daily contact. by data and intelligence. Support to These local relationships are realising the provider market and situation ongoing benefits in relation to our reporting into the London Resilience statutory market management Forum was enabled by our existing responsibilities and support to London wide Market Information Tool providers. (MIT). The tool was developed by LondonADASS to support the delivery The MIT tool has produced: of our Care Act duties and was quickly ● At borough level: Continuous, rd live access since 23 March adapted to establish a comprehensive and up-to-date understanding of for borough commissioners to London adult social care markets a detailed suite of reports (home care and care homes) during allowing them to prioritise 24

the local operational informed the targeting of support to response, such as the care providers and, in partnership with delivery of PPE, ensuring LSE, emerging international evidence appropriate staffing levels has been regularly shared with and providing Public Health London DASSs since the 4th April. infection control support. ● At regional level: Daily Overall, this evidence and analysis information cell SITREP has underpinned our London-wide indicators (including evidence strategic and operational decisions based 7 day projection and meant key issues were escalated figures) for the London to the highest level as early as Strategic Coordination Group. possible. Daily Market Intelligence Now that national data collections are Reports, produced jointly with established on a temporary basis and the London School of the London Strategic Coordination Economics (LSE), and st Risk relating to social care is stepped circulated since 1 April to down, we are working with national each DASS, and DPH across colleagues to ensure a smooth London. These reports have transition to Capacity Tracker. We mapped trends at London, plan to do so in a way that does not sub-regional and borough compromise our responsibilities under levels in key risks for care the Care Act or the systems set up to homes for older people, support the critical incident response people with learning and continues to use the rich disabilities, those with mental longitudinal evidence produced by health needs and home care the MIT to inform strategic social care providers. decision-making across London ● At ICS level: The detailed boroughs. suite of reports and London analysis has been shared with 11.3 Moving forward NHS colleagues to co-ordinate and prioritise We have reflected on the lessons health and local authority learned about resilience and support support and interventions. to both care homes, and the care sector more broadly, over this period The data collected has been used to of intense activity. Much of this is develop models identifying care home reflected above in terms of the need and local characteristics correlated for sustainable PPE and testing; with the spread of COVID-19, streamlined and safer discharge associated mortality, impact on care processes; the need for consistent capacity and supply sustainability, and integrated wrap-around clinical access to PPE and care staff support in the community and the availability. These models have 25

opportunities for joined up demand the system of social care and health is and capacity modelling to support a crucial priority as we move forward. whole systems planning. Now that we understand much more Local Government has played a about the nature of the disease, those critical role in managing the UK’s most likely to be affected and the response to COVID-19. Its wide range appropriate protection and treatment of responsibilities, from public health options available, the social care and social care through to bin community is able to be very specific collection and data analysis have all about how best we can work been key to ensuring that the UK has collectively with colleagues across been able to manage the epidemic, health and care to support and sustain and to sustain vital services. the whole system through the next phase of COVID-19. Social care has played a particular role in supporting those in our We recognise the risks to financial communities who are most vulnerable sustainability for some care homes and, as a nation, we have seen a and are already beginning to use our renewed understanding of the market insight to get a differentiated importance of care and support to the picture of levels of financial risk development of a sustainable and across the market. This, alongside a safe society, alongside the critical deep understanding of the quality of treatment services that colleagues care homes in London, will inform within the NHS provide. local decision-making that drives value for money and the best possible In the first phase of the pandemic, due outcomes and quality of life for to its emergency nature, social care residents. was asked to play a role in the national effort to protect the NHS from We welcome the additional funding becoming overwhelmed in the event that Government has so far provided of a surge of demand. The policy of to support councils’ overall response protection was successful, and the to COVID-19, including adult social NHS was able to respond effectively care, however we recognise that to COVID-19 without at any point there still needs to be a sustainable becoming overwhelmed. Patients funding solution for adult care suffering from COVID-19 were all able services. to receive the treatment they required within a hospital setting. We need to expand and protect our workforce, so that they can continue Although the policy of protecting their vital work maintaining people’s hospitals was necessary and health and independence outside successful, we were concerned that it hospitals supported by their local was not broad enough and protecting communities.

We have demonstrated the value of colleagues in health, the voluntary local strengths and asset-based and community sector and our local responses to support shielded and communities to build effective vulnerable groups in our communities system-wide, place-based responses. and the case for joint investment as a We recognise that we all work best critical part of our heath and care where we plan and deliver together. system to support and sustain this to We will participate fully in the ensure that residents are protected development of effective response from the virus, and that their mental plans for the second phase of health and wellbeing is prioritised COVID-19, both regionally and in our local areas, and need to engage with We need to ensure that care homes partners from the outset of this and home care staff are able to process. provide safe, infection-free spaces for vulnerable people. This may mean Our commitment in London is to zoning care homes in line with current ensure a smooth flow of our clinical practice, and prioritising contribution from recent monies to testing and PPE for homecare our care home providers, alongside all workers. This includes a clear national the other support we offer, in a way strategy on testing and re-testing for that recognises that the care and staff and residents. support we provide to residents is to help them to live their lives safely and We recognise that the response to the with high quality support, in their virus requires a system-wide homes. approach. We will work with

How we will continue to support and work with our Care Homes

12 - Plans

Our plans to support Care Homes in Sutton are based on a continuation of the work that is already in place or underway. The areas identified below will ensure that our homes continue to remain safe, transmission is reduced, infection prevention control is at the forefront of all care staff's mind and high quality homes are provided to and available for Sutton residents.

Workstreams Future plan actions

Continue to provide easy to read briefings for care homes, building on guidance already issued around: ● Infection Prevention Control ● Restrictions ● Access to exercise & fresh air and families etc. ● Physical distancing in homes

Adapt our data collection processes, in line with the Oversight and pandemic journey to support targeted pro-active response compliance where needed. Access to support remains for all homes to activate and utilise NHS Mail and use for clinical advice and guidance.

Implementing regular evaluation of the approach to ensure shared learning across the system and care homes.

Expand our work with Healthwatch to undertake a Resident Family and Friends survey on Care Homes.

Building on our local IPC training, facilitate and deliver additional IPC/PPE training to all care home staff in Sutton via a Train The Trainer model.

This will cover approximately 1200 staff. Phase 1 training is Infection complete and Phase 2 completed by Friday 26th June prevention and 2020. control (IPC) Care Home IPC Champions will have access to ongoing support from ‘Super Trainers’ for IPC advice by end of June.

Continue to provide advice and work with homes to Implement a robust strategy to support reducing workforce movement between care homes.

Revised our systems overall assessment of care homes to determine the level of risk and targeted support required.

Continue to procure additional items of PPE (on top of the 3m we have already purchased) to support local Care Markets access to supplies.

Distribution of Free Hand Sanitiser to all Care Homes.

Work with homes to build on their Information Technology Infrastructure where needed to support virtual health rounds and enable residents to see their family members.

Work with homes to ensure appropriate logistics and safe delivery of flu immunisation this autumn for all care home Clinical Support residents.

Ensure staff at Older People's Homes are aware of their Clinical Lead

Finalise the implementation of Clinical Leads for LD/MH Homes

Continue to support through advice, information sharing, identifying problems and escalation.

Focus on how we can affect factors within Sutton system’s control. We are creating a summary on testing in care homes and issues for escalation by the DPH for the 2 testing routes.

Continue to ensure Homes report positive COVID-19 Comprehensive results to PHE and Local Authority. testing Revise our quality assurance framework (utilising a combination of data sets) to ensure homes can be identified early (ALERT), prioritised using RAG ratings (RESPONSE) and offered full outbreak support (PLAN) tailored to need.

Following feedback from care homes and the latest scientific advice, amend our reactive and proactive support to build resilience and assurance on effective control of COVID-19 transmission within Sutton care homes.

Clarify access to COVID-19 tests including antibody testing for care homes and organising logistics for this.

Utilise test and trace work in care homes.

Continue to work with providers to ensure sufficient workforce capacity to meet risk of a significantly reduced care home workforce due to un-manageable levels of staff sickness or inability to meet contractual/regulatory responsibilities.

Continue to support borough-wide recruitment campaigns for social care - Proud to Care.

Understand the impact of COVID-19 testing on the Building the workforce, in relation to a potential second and third wave workforce of the pandemic. Staff contingency escalation plans to be developed with care homes.

Continue to work with our Volunteering Hub to support Care Homes where required.

Continue to signpost the workforce to appropriate health and wellbeing support - such as the CARE App and Sutton Employee Assistance Programme

Provide additional funding to Providers via the Infection Prevention Control Fund Allocation

Continue to monitor the ongoing financial viable of homes locally and take appropriate action to support. Funding Continue the ongoing dialogue with homes on payment processes to ensure they are optimised to ensure appropriate cash flow for providers.

Procure additional PPE at favorable prices as supplies for the local care market.

13 - Engagement and contributors for this document

Role Organisation Chief Executive Officer London Borough of Sutton Council NHS South West London Clinical Accountable Officer Commissioning Group Chief Executive Officer Healthwatch Sutton Epsom and St Helier University Hospitals Chief Executive Officer NHS Trust

Director of Transformation, Sutton NHS South West London Clinical Borough Team Commissioning Group Strategic Director of People London Borough of Sutton Council Services Director of Public Health London Borough of Sutton Council NHS South West London Clinical Clinical Chair, Sutton Borough Team Commissioning Group

Vice Clinical Chair, Sutton Borough NHS South West London Clinical Team Commissioning Group Head of Commissioning & Health London Borough of Sutton Council Integration Commissioning Lead (Keeping London Borough of Sutton Council People Safe) Care Home Commissioning London Borough of Sutton Council Manager Care Homes Senior Quality NHS South West London Clinical Manager, Sutton Borough Team Commissioning Group Acting Service Lead Adult Safeguarding & Principal Social London Borough of Sutton Council Worker Acting Head of Service: Carshalton London Borough of Sutton Council 32

Locality, Hospitals and Reablement. Acting Consultant in Public Health London Borough of Sutton Council Programme Manager Integrated London Borough of Sutton Council Care Care Home Digital Integration South West London Clinical Consultant, Sutton Borough Team Commissioning Group Chair Sutton Health and Care Provider Alliance Managing Director (Sutton Borough NHS South West London Clinical Team) SRO Ageing Well Commissioning Group Chief Executive Community Action Sutton Director of Strategy, SWL & St Georges Mental Health Trust NHS South West London Clinical Joint Clinical Director Commissioning Group Cheam & South Sutton Primary Care PCN Clinical Director Network PCN Clinical Director Central Sutton Primary Care Network PCN Clinical Director Carlshalton Primary Care Network PCN Clinical Director Wallington Primary Care Network GP Federation Sutton GP Services Limited Executive Director of Integrated Epsom and St Helier University Hospitals Care NHS Trust Director Sutton Health & Care Provider Alliance Chief Executive SWL & St Georges Mental Health Trust NHS South West London Clinical Director of Quality Improvement Commissioning Group Chief Executive officer Advocacy For All Sutton Health & Care Alliance Various Provider focus group Various

14 - Glossary

Term Definition

LBS London Borough of Sutton Council

NHSS NHS Sutton

The Sutton Health Health and care commissioners, providers, the community and Care and voluntary sector, including: Executive ● London Borough of Sutton Council (LBS) ● NHS Sutton, South West London Clinical Commissioning Group ● Community Action Sutton ● Epsom and St Helier University Hospitals NHS Trust ● Healthwatch Sutton ● South West London and St George’s NHS Trust ● South West London Health and Care Partnership ● Sutton GP Services Limited ● Sutton (London Borough) Public Health ● The Royal Marsden NHS Foundation Trust

SAB Safeguarding Adult Board

CQC Care Quality Commission. The CQC is the independent regulator of health and adult social care in England. Their role is to ensure health and social care services provide people with safe, effective, compassionate, high-quality care and advise care services on how to improve.

QIOs Quality Improvement Organisations

JIG Joint intelligence group.

PPE Personal Protective Equipment

IPC Infection Prevention Control

SWL South West London

DoLS Deprivation of Liberty Safeguards

BIA Best Interest Assessors

ONS Office for National Statistics

PHE Public Health England

HPTs Health Protection Teams

LCRC London Coronavirus Response Cell

MDT Multidisciplinary Team

CMC Coordinate My Care

DPH Department of Public Health

DHSC Department of Health and Social Care

AHP Allied Health Professionals

SCG Strategic Coordination Group

ICP Integrated Care System

TTT Test, Track and Trace

STP Sustainability Transformation Partnerships

MIT Market Information Tool

DASS Directors of Adult Social Services

LSE London School of Economics