COVID
The challenges posed by the COVID-19 virus have added another dimension to our Market Position Statement. All plans developed in the wake of the pandemic need to be seen as part of the overall plan to enable the care sector to recover and, where appropriate, be reshaped to more appropriately fit the post-COVID-19 social care landscape.
Liverpool was one of the hardest hit core cities and the virus has made a huge impact on the care home market in particular, in terms of occupancy levels. The impact of the COVID-19 pandemic is almost certain to include a much higher need for psychological support and other responses to poorer mental health as a result of trauma and loss. It has also introduced a need to rethink day support services and has highlighted opportunities for more use of personalised services, investment in earlier help, and for a greater use of assistive technology.
In addition COVID-19 accelerated a five-year commitment to address rough sleeping in the city, and presented a new challenge; preventing rough sleepers from returning to the streets, sourcing sustainable housing options and longer term solutions for those requiring ongoing support.
As for other health outcomes, the overall risk of experiencing life-changing outcomes from the Coronavirus pandemic, is mediated through systematic differences in;
■ vulnerability, e.g. from pre-existing health conditions,
■ exposure to harm in the world around us – infection and other health risks from living and working conditions
■ resources and influence – the money, knowledge, skills, support and autonomy a person can call upon to help them deal with the sudden risks and challenges brought by the pandemic – this is shaped to a large extent by past and present social and economic policy
Risks associated with deprivation add to non-modifiable risks such as sex, age and genetics. They increase the likelihood of becoming infected, of developing severe disease or dying from Covid-19, and of experiencing more lasting
and more impactful consequences from the pandemic and the virus. Local and national policy interventions should target vulnerability, exposure, and resilience factors.
As the graph below shows, the gradient in Covid-19 mortality along lines of deprivation is easy to spot. Other dimensions of inequality are very relevant in Sefton as well.
The impacts of Covid-19 on individuals and communities can be direct and indirect; immediate, or longer-term; predictable or unexpected. Some social and environmental changes will be positive for population health. It is important to be alert to opportunities and innovations as well as risks and challenges.
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The North West Association of Directors of Adults Social Services (ADASS) recently published a North West Service Continuity and
Care Markets Regional Account, which looked at the market viability and threats to service continuity for the 23 local authorities (LAs) with
statutory responsibilities for adult social care (ASC) and the 3,113 active ASC organisations within the North West region. The report reflects the fragilities identified in 2017 market analysis have been heightened through the pandemic and new risks have emerged, most notably:
■ Unsustainably low occupancy in areas of the market;
■ Low levels of local authority reserves, impacting on the ability to manage additional cost (such as insurance premiums) and demand pressures, coupled with a lack of clarity around funding settlements and strategic direction within the sector, which makes it harder to develop effectively for the next 2 to 4 years;
■ Heightened staff recruitment, retention and absence challenges; and
■ Emotional and psychological impact of the pandemic on local authority and provider staff, individuals in receipt of services, their families and Unpaid Carers.
Whilst local authorities in our region individually, and collectively, are working tirelessly to meet the additional pressures the pandemic has brought about, there are three key areas which we require support from our colleagues in the Department of Health and Social Care; these are:
■ Urgent government intervention on key operational challenges, such as spiralling increases in insurance premiums and improved access to testing for social care services
■ Short term financial support for the next 6-12 months to assist with increased resource and cost pressures; and
■ Development of a long-term strategic plan and funding settlement upon which the social care services of the future can be developed
In October 2020 across the North West there were 5,686 bed vacancies which account for 9% of the total CQC registered beds in the region; however, there is are some regional variances, with rates rising to 16%. Furthermore, there were over 3,000 excess deaths in care homes registered up to 17th October
compared with the previous 5 years average. Up to 20th October, 1,134 (59.1%) care homes had reported a Covid-19 outbreak to PHE-NW
Post Covid Syndrome (up until now known as Long Covid) effects a significant minority of people who contract COVID-19. It causes debilitating illness and a range of symptoms that effect people’s ability to participate in employment, education and other social interactions. Persistent health problems reported following acute COVID-19 disease include: respiratory and cardiovascular symptoms; protracted loss or change of smell and taste; depression, anxiety; inflammatory disorders; gastrointestinal disturbance; continuing headaches; fatigue; liver and kidney dysfunction; clotting disorders; and skin rashes.
The NHS in the North West has been allocated £1.2 million to establish services for people with long COVID and NICE are currently developing guidelines.
However, prevalence estimates vary and there is not a robust system of measuring it through existing surveillance systems. This makes service planning challenging. As Sefton CCGs plan/develop ‘long COVID’ clinics, there is a need for the Health and Wellbeing partnership to work together to assess local needs, develop pathways and evaluate services. The partnership will also
need to communicate the risks of Long Covid and ensure equitable access to healthcare, but also self-help resources and holistic support on housing, job losses, access to benefits etc.
The Impact on Services
Knowsley has been one of the worst hit local authorities for COVID-19 and has had the highest rates of COVID-19 for the whole pandemic nationally (up to April 2022, when mass testing ended). It is still essential that robust outbreak management mechanisms remain in place to mitigate against the effects of the pandemic.
The most significant impact was experienced across Nursing and Residential care, as the impact of COVID-19 resulted in 20 of 27 Knowsley care homes being closed by Infection Prevention Control because of a suspected or confirmed COVID-19 outbreak.
Face-to-face delivery within long term care and support services was severely reduced, because of Covid-19. External visiting to settings, such as extra care schemes and care homes, was restricted to only those with urgent medical health needs or on compassionate grounds for those approaching end of life. Restrictions were placed on face-to-face activities, especially those carried out in communal spaces. In community settings, some essential activities, such as assessments, are no longer carried out face-to-face.
Many other commissioned services, particularly community-based services, were able to adapt quickly as restrictions were imposed by central government, and to the threat of Covid-19 while continuing to deliver care and support. Typically, these services were able to enact business continuity measures such as home working, and adaptations to communication methods used for key functions, such as assessments, to continue service delivery safely and reduce the risk of spreading the infection. The Council worked closely with community-based providers to monitor workforce capacity, and ensure that where capacity was limited, a risk-based approach to deliver was adopted to ensure the needs of individuals were met appropriately.
Most day service providers in Knowsley ceased day service provision at the onset of lockdown, although several providers altered their usual arrangements to offer more of a PA service to service users who needed it. Several day services resumed face to face delivery with a range of measures in place to minimise risk to staff and service users.
Supported living providers continued to maintain delivery of services throughout the pandemic. For most providers there are no major concerns with respect to service delivery.
Providers have remained financially stable during the pandemic. The additional cost of PPE was a concern for some; however, this is no longer an issue due to the local and central government support that has been available since the start of the pandemic. Knowsley providers have also benefitted from the Council’s own support schemes and central government funding administered by the Council.
Recovery from the Pandemic:
The Council has also developed the Knowsley Council Plan (previously known as the Corporate Plan) for 2022-2025 which includes the ongoing management of COVID-19 as a key theme, as well as responding to the impacts of COVID-19. In particular, there is a focus on managing COVID-19 in vulnerable settings, such as nursing homes. The response will continue to evolve in line with national policy changes.
Published in 2020, The Recovery and Transformation Plan for adult social care sets out not only how care services in Knowsley will recover from the pandemic, but how we are going to transform care services in Knowsley so that they are set up in a way better than before to meet people’s care needs now and in the future.
COVID-19 has highlighted opportunities for potential changes, particularly for more use of personalised services, investment in earlier help, and for a greater use of Technology Enabled Care. Whilst the coronavirus pandemic has been challenging for our health and care services, it has also presented new opportunities to transform care in Knowsley, including maintaining and enhancing people’s independence so that they are healthier, stronger, more resilient, and less reliant on formal social care services.
Many face-to-face services have been reintroduced, where they had been stopped or moved to an alternative method of delivery. However, the Council will encourage providers to maximise the use of new technology to continue to manage risks and also as potential business as usual solutions, where there is additional benefit to service users.
The recovery from the pandemic gives rise to several opportunities, including service improvements achieved through digital elements of support and the role of assisting technologies (Technology Enabled Care). The role of prevention and early intervention can also be further embedded, and the case for collaborative working has been strengthened by the pandemic, as the response required significant joint working across organisations. Innovation has been required in terms of day opportunities and in many areas, communities have responded to these and other urgent needs during the pandemic; demonstrating the need to provide opportunities for the voluntary and community sector going forward.
It is anticipated that in several areas there will be an increase in demand for services, including support for carers and those for mental health and wellbeing support. This reflects the additional strain felt by people during the pandemic.
The intense stress placed on staff working for providers of long-term support during the Covid-19 pandemic may impact on the health and wellbeing of the workforce. The Council is still actively monitoring the impact with providers to ensure that workers are offered the support that they require as the workforce continues to recover from the pandemic.
We understand the challenging environment that social care is delivered in, and the impact that COVID-19 has had on service users and providers. The Council is committed to working with providers to ensure a commitment to quality and high standards of care practice, so that we make a real difference to the quality of life for people receiving care.