Allison Cannon is Chief Nursing Officer for the Sussex NHS Commissioners
What began as a necessary response to the challenges faced by care homes during the first wave of COVID has created a foundation to truly transform how homes can be supported at the heart of our health and care system.
As the country grappled with COVID in the first half of this year, care homes found themselves on the front line. Local authorities and the NHS have always worked closely with care homes, nurturing relationships and supporting residents and staff alike. However, traditional arrangements were not sufficient to deal with the speed and scale of the challenge.
Supporting care homes through COVID required a truly system-wide partnership approach. While great strides have been made in recent years to integrate more seamlessly with community and secondary care, the care home sector remains complex. The vast majority of homes are private businesses, with care predominantly purchased by individuals, as well as local authorities and the NHS. They are regulated by the CQC, safeguarded by commissioners and supported by GPs, community and primary care.
Moving beyond these organisational structures to work urgently, and compassionately, in partnership with and for our care homes was the first step in our response to the COVID challenge. Together, local authorities, providers and commissioners put in place Incident Management Teams (IMTs) for each local authority area in Sussex to support care homes with pressures and issues including staffing, quality of care, testing, PPE and infection control training.
It was through these partnerships – strengthening and expanding previous arrangements – that primary care in Sussex was able to deliver the requirements of the Enhanced Health in Care Homes DES (directed enhanced service) ahead of schedule. This included named clinical leads for each home and weekly check-ins; proactive, personalised support and planning; multi-disciplinary support for residents with suspected or confirmed COVID-19; and structured medication reviews for all patients in care homes.
In addition, collaborative working enabled us to swiftly provide tailored training to all 764 care homes in Sussex. Delivered by Sussex Community NHSFT and East Sussex Hospital NHS Trust, the training covered infection control, signs of deterioration and when and how to escalate, among other issues. The Brighton and Hove IMT also worked with Sussex Partnership NHSFT to develop psychological support tools for care home staff, focused on resilience and wellbeing, that have now been rolled-out Sussex-wide.
The IMTs may have been forged as a reactive response to the pandemic, but they have led to a more proactive partnership approach to supporting care homes, their residents and staff. While the specific arrangements differ in each of the three places in Sussex, care home teams – bringing together local authorities, primary care, secondary and community providers, public health, CQC, market managers, infection prevention and control, safeguarding leads and care home associations and representatives – now work together formally on an ongoing basis to coordinate proactive support. The wealth of data now available – covering not just capacity but staffing levels, COVID levels, flu vaccination coverage, CQC ratings and more – means that homes that may require additional support can be identified and engaged proactively.
More proactive system-wide working is also enabling a greater role for public involvement to shape care home policies and approaches. For example, Healthwatch have been working to better understand people’s views on visiting policies while care home residents remain vulnerable to COVID-19 and the partnership is enabling care homes to access and explore this feedback.
What began as an approach to managing COVID-19 is becoming established as a new way of working for the long term. In one innovative example, there are now weekly ‘care home huddles’ in East Sussex. All care homes are invited to a virtual meeting to learn more about various aspects of care – topics have included diabetes, falls, information governance and staff wellbeing – and to question a panel including GPs, community nursing and public health. Some huddles have had as many as 30 care homes joining, with a further 90 accessing the video recording afterwards.
In West Sussex, integrated care home support teams led by admission avoidance matrons are empowered to deliver care in the home to avoid the upset of an admission for residents, anxiety for their families and carers and a better use of health and care system resources.
What underpins all of these initiatives is compassion. The desire to bring together the skills, experience and expertise of all our colleagues, in order to give the very best care for the people in our communities who need it.
This was epitomised, at the height of the first wave of COVID, by the team from Martlets Hospice in Brighton who stepped into a care home at risk of closing because of staff illness. It did not matter that they were not their residents; they were people who needed care. Inspired by this, care homes across Sussex are developing a mutual aid agreement to support each other, and each other’s residents, if necessary.
Care homes are a vital part of our health and care system. The interconnectedness of services, and the crucial role of care homes in the ‘flow’ of patients are well recognised. But they are much more than a part of a system. They are places for people who need care and, above all, they are people’s homes. Residents and their families and carers should be confident that we are doing our very best for them.
The imperative of responding to COVID unleashed energy, innovation and a commitment to do everything in our power to support care homes. Working together we have created a firm foundation that should stand us in good stead as COVID cases, sadly, rise again. As partnership working through our ICS continues to strengthen, we must build on this opportunity to truly transform the support we can offer for care home residents and staff in Sussex.