COVID-19: adult social care commissioning practice resource

Buckinghamshire Council

In Buckinghamshire, up to 240 beds have been made available by transforming the Olympic Lodge into a care and reablement centre within just three weeks. Staffed by care workers and a team of volunteers, the lodge will support people who are medically fit to leave hospital but can’t return home for a variety of reasons, as well as those who live at home but may need temporary short-term support.

London Borough of Tower Hamlets

Tower Hamlets has introduced a range of measures to support providers with additional costs incurred during the pandemic. This includes support with recruitment to care roles (with approximately 40 additional care workers recruited so far) and a 10 per cent contingency put in place for all residents receiving direct payments, see see letter sent to all DP recipients). The borough has also allowed for the purchase of additional homecare capacity at around 10 per cent which is being funded through the additional funding from central government. In Tower Hamlets, services are commissioned on basis of the Ethical Care Charter which enables the maintenance of a more stable care market.

Hertfordshire County Council

A series of financial assistance measures have been put in place by the council to ensure providers have security of cash flow and allow them to adapt delivery patterns to maximise care capacity. In home care, the council has committed to giving providers the ability to flex hours of care up or down 25 per cent in collaboration with people and their families without recourse to the council using the ethical framework.  In addition, and if providers commit to the Mutual Aid scheme, the council has committed to paying providers on ‘planned’ hours rather than hours delivered for a four-month period. It is providing further support to providers by enabling payments to be made weekly rather than monthly.

Successfully solving an insurance issue to help support independent providers struggling with sickness - Leicestershire County Council

Under normal operating practice one of Leicestershire County Council’s responses to provider failure is to place staff into a provider service to assist with delivery of care and / or provide advice, guidance and support to care staff, owners or managers. This has worked successfully in a variety of situations.,/p>

As part of the council's proactive escalation plan during the pandemic, Leicestershire made available a team of council staff able to provide emergency care to support the independent homecare or care home sector.

When the council was considering offering emergency support for a care home (due to high incidence of COVID-19 in the resident and staff group), the council insurance adviser queried the employer liability insurance to cover this, due to the nature of the risk to staff from potential infection. The council therefore could not deploy staff without liability cover.

Colleagues in our local NHS system queried this advice and believed that they could provide the cover required, but as it turned out they too came up against similar issues. In the end, the care home did not need the support requested. However, staff at the council wanted to resolve this unanticipated issue.

Since this problem occurred, the council has worked with the council's legal service, insurers and HR colleagues to develop a process that satisfies all the insurer's requirements to enable future deployment. This has involved developing a protocol which provides for full situational risk assessment; risk management planning; the search for volunteer staffing; and includes variation to contracts, ensuring that staff who volunteer are directly managed and supervised by council managers and do not report to provider managers. This has been a learning experience but the council has successfully problem solved and has overcome these issues.

Buckinghamshire Integrated Care Partnership

The Buckinghamshire ICP has set up a PPE distribution centre to manage and deliver urgent PPE supplies across the health and social care system. System supplies can be pooled to ensure the most urgent needs are met and logistics and delivery is being supported by Aylesbury Logistics.  The seven-day service:

• has delivered between 30-50 deliveries per day and supplied more than 68,000 fluid repellent masks, 125,000 pairs of gloves, 76,000 aprons, 30,000 goggles as well as large amounts of hand sanitizer between 25 March and the end of April
• fulfils urgent deliveries within one hour to ensure that carers can continue to provide support for the most vulnerable residents
• enables the council to track the distribution of LRF supplies and develop intelligence around the levels of emergency usage across the social care sector

The council has also set up PPE pick up points and a volunteer delivery service for paid Personal Assistants who require emergency PPE supplies

South Tyneside Council

As well as Local Resilience Forum PPE drop-offs, the council is also procuring PPE via their purchasing arranging and NEPO framework to support providers to secure the equipment they need. The latest national PPE guidance has been used to understand the potential volumes of PPE required by the council and providers over a specific period. This is helping to inform the ordering process to ensure sufficient supplies are being received, given the challenges within the system for providers. NEPO is the North East Procurement Organisation which works in collaboration with councils to support procurement across the region.  Providers in South Tyneside Social have been complimentary about the support they have received from the Joint Commissioning Unit in response to COVID-19.

North Yorkshire County Council

The council has developed and published an Operational Guide on PPE and its use to support social care staff during the outbreak. It is intended to help with local interpretation of government guidelines. The guide outlines clear steps for social care staff to take across a range of scenarios in community and social care settings as well as the types of PPE that might be used. Within it, this document provides a 4-stage flowchart on self-assessment, initial risk-assessment, PPE requirements and specific requirements for facilities with sustained disease transmission.

This is an example of shared practice at the time of writing and is a local interpretation of guidance to support local services. Please note, as guidance is regularly updated, this guide linked to above may no longer be up to date in line with national guidance.

Buckinghamshire Council  

A single mailbox supported by a team of commissioners has been setup to triage and respond to COVID-19 queries from providers. Over 500 queries were responded to between 16 March – 30 April on a range of issues including PPE and testing, financial support and staffing. A Whatsapp group for registered care managers to provide regular updates is in use and the council is facilitating a series of webinars to provide additional support across a range of areas and encourage peer support.

Buckinghamshire Council has also developed an enhanced offer for providers setting out support across several areas including human resources, staff knowledge and skills, equipment, technology, communication with service users and families, mental health and bereavement support. The first version was published on 1st May and the council is working collaboratively with providers and system partners to continue to strengthen this approach. Whilst this has started as a COVID-19 focused initiative, this will develop into a longer-term support offer for providers.

Herefordshire Council

The council has setup a Care Provider Support Hub to provide assistance to care providers and the care workforce across Herefordshire during the pandemic. The Hub is supported by Public Health, Quality and Improvement and Commissioning and its activity focuses on three priority areas:

• Proactive and regular engagement with providers including through dedicated email address, weekly teleconferences and facilitated online training sessions (based on identified need). 
• Gathering intelligence and data from providers in order to identify emerging issues and provide appropriate responses. 
• Delivering targeted early interventions to mitigate impact of COVID-19 and assist organisations responsible for specialist infection prevention control.

The Hub works closely with system partners to share intelligence and strengthen the offer of the Hub including the CCG, CQC, providers and Wye Valley Trust. An overview of the Hub is available.

Hertfordshire County Council

Hertfordshire County Council’s programme of Mutual Aid is helping to ensure the most efficient use of health and social care resource during this time of heightened demand and pressure on services. The programme includes the setup of a dedicated Provider Hub which provides a single point for providers and health / social care professionals to access up to date information, advice and guidance on Coronavirus. This Hub contains expert staff from Hertfordshire Care Provider Association, the council and NHS with access to latest guidance from Public Health and central government departments. Frequently Asked Questions and links to specific guidance will continue to be updated on the website as more information is made available. The Provider Hub telephone number will continue to be staffed until further notice. HCC has also used the Provider Hub to coordinate advice on training and equipment related to caring for infected persons, in line with guidance.

London Borough Tower Hamlets

The Tower Hamlets Together Partnership and an integrated commissioning function means foundations, trust and ways of working together to support a co-ordinated COVID-19 response were already firmly in place. However, working with service users, carers, providers and the community and voluntary sector to support the COVID-19 response has also been vital. The borough has been able to build on existing good practice in this area for example work with local carers’ centre and work with local disabled people’s organisation (Real DPO – see more). It has also been working closely with unions to ensure that shared workforce concerns are addressed collaboratively. Close working with housing has meant additional accommodation for homeless people has been met with wraparound primary care and health service support.

Social care provider hub (Hertfordshire)

Hertfordshire County Council set up a ‘provider hub’, run jointly with Hertfordshire Care Providers Association, to help social care providers respond to community needs. The hub is currently supporting 800 social care providers by offering professional advice and support through a helpline, where providers can get answers to questions around government guidance, financial support, PPE, food supplies, staffing issues and access to financial support packets. The helpline is available seven days per week to help ensure these providers have access to the support they need.

The hub also collects information on how care providers are coping and challenges they are facing (including relating confirmed cases of COVID-19 and deaths) and shares this with the Adult Social Care Board. In sharing this information, the hub has been able to support the delivery of swift public responses alongside public health partners.

Direct payment holders can also get support from the hub if in need of advice about direct payments and degrees of flexibility the council can offer.

Essex, Kent and Suffolk County Councils

Essex, Kent and Suffolk have developed new virtual care technology approaches to support individuals with low level needs as well as providers of care and support. The three councils have purchased 5,000 locked-down tablet devices to roll-out to people across their respective counties over an eight-week period.  The device allows care workers, family members and other approved services to be able to contact the individual and vice versa through video call. With a sim pre-installed it means that users don’t require Wi-Fi. More detail on the approach being taken is available.

Dudley Council

Dudley Council has been supporting local nursing and residential care providers during COVID-19 with technology adoption. Following engagement with providers about technology needs, the council has funded and purchased a number of tablet devices which are currently being deployed. The 10-inch android tablets are sim-enabled which means that locations with poor or no broadband can still get connected. The council has been working in partnership with My Improvement Network to deploy the devices and this includes remote onboarding, training and technical support if required. To date, over 45 devices have been rolled-out. As well as supporting improved communication between local system partners during the pandemic, the devices are being used to enable residents stay connected to family, friends and faith groups.