Helen Whately MP Minister of State for Care Department of Health and Care

Date: 29 May 2020

Dear Ms Whately MP COVID-19 has provided an unprecedented challenge to the whole fabric of our society – touching, as it has, the lives of everyone to a greater or lesser degree. In Haringey, the profile of our population and patterns of deprivation, have meant that we have seen, and continue to see, considerable impacts from Covid-19 for local communities. We have also seen, however, that the pandemic has led to significant collaboration, increased integration and some genuine whole system working at pace and with immediate impacts across not only the health and care sectors, but across the voluntary and community and faith sectors for example. Haringey Council and our NHS partners have been at the heart of the response, working together to ensure that we look holistically at need – both in the immediate impact of the crisis and as we seek to renew our communities and build greater resilience. Such a response builds on a history of joint working at a local, sub-regional and regional level – a history which stands us in good stead as we move to the next phase of our recovery and renewal. We recognise too that the challenge has been significant across London due to early and rapid spread of the virus, local patterns of deprivation, high levels of air pollution and the high proportion of ethnic minority populations in most London boroughs. London response As a region, we responded to the challenge and our responsibilities under the Civil Contingencies Act by working together as London ADASS and as Local Authority Chief Executives, alongside NHS partners to identify issues, galvanise responses and lead several pan-London initiatives. We brought our response co-ordinated together through the Strategic Co-ordination Group and joint governance with NHS London. Using data and evidence we developed a comprehensive understanding of the London adult social care markets (home care and care homes) during the spread of COVID-19. Our commissioners used this understanding as a key underpinning of their daily interaction with support providers. It has provided access to information on care homes across borough boundaries, which has streamlined the work and reduced the burden on providers. This in turn has supported local operational responses: prioritising the delivery of PPE, ensuring appropriate staffing levels and providing Public Health infection control advice and support. A summary of the work across London and issues for the future are captured in the attached London Region Appendix (Appendix 1)

North Central London response As well as contributing to London wide planning and resilience, we as a local authority have also worked with system partners, notably the newly formed NCL CCG and our NHS Trusts, across North Central London to ensure a joined-up response across our sub-region. This builds on work already in place to develop and shape the care market – work underway across the sub-region in recognition of the fact that very few London authorities can respond fully to the need and demand from their own residents, within their own local authority boundaries. We have well established systems and joint working in place which are set out in more detail in our North Central London Sub-Region Appendix (Appendix 2). Haringey Local Response Locally in Haringey, we have been working closely with all our care providers, including home care and supported living providers as well care homes with daily communication and effective gathering of data and intelligence to support capacity. We are working more closely with our care sector than ever before and are developing a local plan iteratively with partners which reflects wider NCL work and which focuses on our known areas of greatest need – for us, in Haringey, this relates to the consistency of our clinical guidance and support across the whole care sector. In Haringey, we believe that it is critical that we act in a co-ordinated and aligned way at local, sub-regional and regional levels as set out in this response. We have high levels of confidence in this approach which recognises that there are clear and serious challenges both in the short and longer-term but which then has the necessary structures in place to address these. We as partners have established and participate in appropriate governance within each layer, bringing together key partners with agency, expertise and authority in this area to ensure we develop appropriate actions, implement them and review their impact. Our system’s collective level of confidence that these actions are being implemented and that we have plans in place to urgently implement all actions required is high, due to the continued focus on joint working and a coherent sub-regional response. As a very diverse borough, with over 180 languages spoken in the borough, we in Haringey are particularly mindful of the implications of access to high quality health and care provisions for our BAME communities. We are keen to develop community engaged and enabled health and care systems which fully build better and more resilient health and wellbeing for all our residents. Our local plan is being overseen by a new Haringey Care Sector Sustainability Strategic Group reporting into the Haringey Borough Partnership and ultimately to the Health and Wellbeing Board. The response to COVID 19 has highlighted the important role of the care sector. We have worked on a local, sub regional and regional level to support the response to the pandemic. There has been increased focus on increasing clinical support to care homes. We have also built on the key local relationships with providers that has enabled us to support them through the crisis. As we start recovery planning we are focused on the shared endeavour to build a sustainable social

care system. Towards this end senior LA and health colleagues have come together to plan how to take this forward. This involves the following areas:

• The NCL ASC programme will play a key role in developing a programme of work within the Integrated Care System, ICS, linked to other relevant organisational governance structures

• Establishment of Haringey Care Sector Sustainability Strategic Group with key senior members from the local CCG, commissioning ASC and NCL market management and the wider NHS including secondary care colleagues from the local Trusts

• Important focus on residential and nursing homes, but clearly within scope are home care and other forms of direct care delivery

• Understanding that all cohorts have vulnerabilities to Covid-19 and therefore the need for enhanced clinical support and guidance, so we have included extra care and supported housing, and other care groups such as LD and MH

• The focus on home care specifically will pick up key connections with primary care as we move to a locality mode of implementation.

• Recognition that there is an immediate, interim position on this work – but a key focus will be on develop a longer-term view on what the care sector will look like in Haringey going forward, including lines of enquiry such as the potential for reduced demand for residential care and implications for delivery and management models, which the Strategic Group will consider

• Practical interventions to support the sector will continue to be important given the current critical pressures

• There will be an emphasis on the financial resilience of the sector, bearing in mind shifts in demand and activity as we move through the pandemic and the need for underfunding over many years to be addressed

Our local plan, developed across partners and underpinned by effective stakeholder involvement and provider engagement, is appended as the Haringey Care Sector Support Plan at Appendix 3. We are pleased that there is a recognition that this critical work will continue to develop over time and that it has a number of facets. We appreciate the need to work iteratively across local systems, notably our Haringey Borough Partnership, the sub-regional Integrated Care System and at London regional level, to ensure we have a sustainable care sector going forward which can act to strengthen partnerships across local government and the NHS and lead to improved outcomes for local residents. We are particularly mindful of the significant additional financial burden on the care sector, and therefore on local authorities as well as care providers, of the specific need for infection control measures to be in place in the long term, which we are anticipating to be at least a further 12 months, but also of the increased focus on building a truly resilient and sustainable care sector. After many years of tight funding settlements, and therefore of severe pressures on care budgets across the country, the recent short term injection of funding to the care sector was welcome, but it will not extend even to cover increased costs (of PPE for example) for the 12 months ahead. We

know therefore that already stretched care budgets will be placed under further pressure as we continue to live with Covid-19 and its aftermath. We now need certainty and tangible evidence of significant additional funding not just in the short term but for the future. Such certainty will help to maintain the excellent work already in place and to ensure the care sector is more resilient to future challenges, enabling a robust infrastructure to continue to support our most vulnerable residents. Yours sincerely

Zina Etheridge Chief Executive CC

• Tony Hoolaghan, CCG Accountable Officer

• Will Maimaris as Director of Public Health

• Beverley Tarka as Director of Adults and Health

Appendix 1: London Region Response Pan-London initiatives Examples of action taken pan-London include:

• Working with PHE London to develop on-line training in infection control and roll this out to care homes, with local follow up advice and guidance.

• Escalations to advocate regular testing of care home staff, care home residents and patients being discharged from hospital.

• Escalations on the need for a sustainable supply of PPE that led to joined up NHS/Local Authorities systems for accessing PPE as well as a London-wide LA procurement through the West London Alliance. At the local level, where PPE was available commissioning teams distributed directly to local providers.

• Early identification of the risks to workforce were identified and we launched Proud to Care London to support recruitment, DBS checking and basic training of care staff. This has so far delivered a number of new recruits to the care sector.

• Escalation of the risk of inconsistent clinical support to care homes led to a joint letter to ICSs and local systems from the Chief Nurse and lead Chief Executive to galvanise action. A weekly regional Care Homes Oversight group was established co-led by the Chief Nurse and LondonADASS Vice Chair.

DASSs in London have been able to assure themselves that core safety, human rights and safeguarding duties are being delivered when Care Homes are in lock down without the usual footfall and community access to residents’ homes. Local mechanisms for safeguarding processes, provider concerns and quality assurance mechanisms have continued to inform work with providers in the sector. Regionally we have specifically worked with the Coroner and PMART teams to understand safeguarding concerns and respond appropriately. We have worked in strong collaboration with NHS London to build a demand and capacity model that is intended to support joint planning of health and social care at local authority, STP and regional levels into the future, populated by our market intelligence. This included capturing additional social care capacity during ‘Surge’, so that any need for further accommodation could be met on a pan-London and sub-regional (STP/ICS) basis. Happily, as with the Nightingale beds, most of this was not required. However, the model will support joint planning going forward as we seek to ensure equal partnership in creating an overview of the whole system and work together on safer discharge pathways. Use of data and intelligence Our response has been underpinned by data and intelligence. Support to the provider market and situation reporting into the London Resilience Forum was enabled by our existing London wide Market Information Tool (MIT). The tool was developed by LondonADASS to support the delivery of our Care Act duties and was quickly adapted to establish a comprehensive and up-to-date understanding of London adult social care markets (home care and care homes) during the spread of COVID-19 at local, STP/ICS and regional levels. The daily survey includes information on:

• Prevalence of COVID-19 and associated mortality

• Actual and true availability of supply

• Discharges from and admissions to acute care

• Staff availability

• Details of PPE stock

• Access to testing

We prioritised older people care homes because firstly, we understood this was where the greatest impact and safety issues would be and, secondly, 30% of all older people care home placements are across borough boundaries, so collaborative working is essential. We started the care homes data collation mid-March, and we have had a consistently high daily response rate, based on the leadership of borough commissioners working intensely with their providers and building on these relationships through direct and often daily contact. We believe these local relationships are realising ongoing benefits in relation to our statutory market management responsibilities and support to providers. The MIT tool has produced:

• At borough level: Continuous, live access since 23rd March for borough commissioners to a detailed suite of reports allowing them to prioritise the local operational response, such as the delivery of PPE, ensuring appropriate staffing levels and providing Public Health infection control support.

• At regional level: Daily information cell SITREP indicators (including evidence based 7 day projection figures) for the London Strategic Coordination Group. Daily Market Intelligence Reports, produced jointly with the LSE, and circulated since 1st April to each DASS, and DPH across London. These reports have mapped trends at London, sub-regional and borough levels in key risks for care homes for older people, people with learning disabilities, those with mental health needs and home care providers.

• At ICS level: The detailed suite of reports and London analysis has been shared with NHS colleagues to co-ordinate and prioritise health and local authority support and interventions.

The data collected has been used to develop models identifying care home and local characteristics correlated with the spread of COVID-19, associated mortality, impact on care capacity and supply sustainability, access to PPE and care staff availability. These models have informed the targeting of support to care providers and, in partnership with LSE, emerging international evidence has been regularly shared with London DASSs. Overall, this evidence collection and analysis processes have underpinned our London-wide strategic and operational decisions and meant key issues were escalated to the highest level as early as possible. Now that national data collections have been established on a temporary basis and the London Strategic Coordination Risk relating to social care is stepped down, we are working with national colleagues to ensure a smooth transition to Capacity Tracker. We plan to do so in a way that does not compromise our responsibilities under the Care Act or the systems set up to support the critical incident response. Moving forward We have reflected on the lessons learned about resilience and support to both care homes and the care sector more broadly over this period of intense activity. Much of this is reflected above in

terms of the need for sustainable PPE and testing, the need for consistent and integrated wrap-around clinical support in the community and the opportunities for joined up demand and capacity modelling to support whole systems planning. Local Government has played a critical role in managing the UK’s response to Covid-19. Its wide range of responsibilities, from public health and social care through to bin collection and data analysis have all been key to ensuring that the UK has been able to manage the epidemic, and to sustain vital services. Social care has played a particular role in supporting those in our communities who are vulnerable, or who have become vulnerable through the crisis and, as a nation, we have seen a renewed understanding of the importance of care to the development of a sustainable and safe society, alongside the critical treatment services that colleagues within the NHS provide. In the first phase of the pandemic, due to its emergency nature, social care was asked to play a role in the national effort to protect the NHS from becoming overwhelmed in the event of a surge of demand. The policy of protection was successful, and the NHS was able to respond effectively to Covid without at any point becoming overwhelmed. Patients suffering from Covid 19 were all able to receive the treatment they required within a hospital setting. Now that we understand much more about the nature of the disease, those most likely to be affected and the appropriate protection and treatment options available, the social care community is able to be very specific about how best we can work collectively with colleagues across health and care to support and sustain the NHS through the next phase of Covid 19. People – Protecting our People to Protect People

• We need to expand and protect our workforce, so that they can continue their vital work maintaining people’s health and independence outside hospitals supported by their local communities.

• We have demonstrated the value of local strengths and asset-based responses to support shielded and vulnerable groups in our communities and the case for joint investment to support and sustain this to ensure that residents are protected from the virus, and that their mental health and wellbeing is prioritised

Places – Creating Safe Places within Communities

• We need to ensure that care homes and home care staff are able to provide safe, infection-free spaces for vulnerable people. This may mean zoning care homes in line with current clinical practice, and prioritising testing and PPE for homecare workers.

Planning – Planning Together; Delivering Together

• We recognise that the response to the virus requires a system-wide approach. We will work with colleagues in health and our local communities to build effective system-wide, place based responses. We recognise that we all work best where we plan and deliver together. We will participate fully in the development of effective response plans for the second phase of

Covid 19, both regionally and in our local areas, from the outset of this process, which should begin immediately

We continue to be committed to focusing our support to the care sector in a way that recognises that the care and support we provide to our residents is to help them to live their lives in their homes and in their communities, whatever setting that might be.

Appendix 2: NCL Programme response

Joint work to ensure care market resilience locally

NCL ASC Programme The 5 Councils have a well-established NCL ASC Programme that has longstanding programmes of work around care homes and the independent sector workforce. This has given us a robust structure to work collectively to respond to the pandemic, where it makes sense, whilst recognising that the majority of activity continues to happen on the borough footprint. This structure enables us to ensure that we build in a social care ethos and values into the work of the STP, promoting strengths based approaches that maximise a person’s independence and wellbeing, and recognising that care homes are primarily our residents’ individual homes, rather than simply a setting for care. Around care homes we have existing joint Council work around sustainable pricing, quality assurance and promoting a strong local workforce. As part of the covid-19 response the 5 Councils collaborated to purchase additional care home capacity to use flexibly as a system. In addition, our innovative Proud to Care model, which has been bringing new staff into the sector has supported us to increase capacity into some key services has now been scaled to London as part of the London SCG workforce workstream. In total, from mid March to May 26th this has generated 265 expressions of interest for Barnet, 72 for Camden, 147 for Enfield, 138 for Haringey, 274 for Islington. Each borough has established a local team able to match processed applicants to our local providers based on the providers stated needs and our understanding of the volume of work they were receiving as a result of Covid19 discharges (www.proudtocarelondon.org.uk #proudtocarelondon). In addition, boroughs are also undertaking a range of employment support work locally, and we are aware of lots of innovation from providers. We have a well-established a social care provider reference group in NCL, which gives us strategic feedback on joint work with the NHS and our NCL wide ASC priorities. We are establishing a session in June to share feedback and learning on how we have managed the pandemic and to plan how we would respond in the event of a second wave. Provider Recovery & Response The CCG and NCL Councils established a provider recovery and response workstream around care homes and independent sector providers in March, which is co-led by the NCL ASC Programme and CCG. This has supported our

system response, including around the 5 focus areas in this return, of which there is more detail below. The work is supported by a joint care homes oversight group and a care home clinical reference group. Advice and guidance Through the Provider Preparedness and Response work we have worked with public health, Council and CCG quality colleagues to develop information packs on key topics for care providers, which we update regularly. This has helped care providers to interpret and implement aspects of the guidance and has responded to their concerns around the amount of “noise” in the system by providing an authoritative voice. Importantly, this document is owned and shared by local Council and clinical leads who have established effective relationships with providers. IPC Through the provider preparedness work a significant amount of support has been made available to care settings on IPC from public health and CCG clinical quality leads. Including:

• Weekly IPC webinars, providing guidance on IPC / appropriate use of PPE (this is separate to the webinars provided by the London Public Health teams) – the weekly webinars have 40-80 providers most weeks.. This includes 2 IPC training webinars early on, in March, attended by care home and home care providers.

• IPC, PPE and a ‘How to guide’ on COVID testing training both virtually and face to face through the ‘train the trainer’ offer – all to be offered training by the 29 May.

• Dedicated IPC email and telephone helpline manned by a member of staff with significant IPC knowledge and experience – we will send out reminder communications to care homes via the Local Authorities

• A care home WhatsApp group launched by the CCG Governing Body Nurse on 20th May

• IPC website with all up to date resources in one place

Following the NHSE request from 1 May, NCL CCG have been facilitating the delivery of training to care homes around IPC, PPE use and testing. This is being delivered through a range of CCG and community health staff and we have tailored the programme locally to meet provider needs, including robust observation of practice. This has been delivered or booked to 103 care homes in NCL on 23.05.20, and is being managed via local council quality teams, with a view to coordinating this support alongside other efforts to support the care market. The NCL CCG are also providing virtual training on IPC which are made available to extra care, home care and supported accommodation providers, as well as care homes. By 29th May all care homes either well have received training or will have had multiple opportunities to do so. Testing In NCL testing for COVID-19 has been rolled out to a wide range of staff and residents, making use of both the NHS ‘in-house’ capacity and the capacity from the national programme. This has been in line with the first two pillars of the governments testing strategy. Mass testing in care settings

- 13 care settings have received tests via NCL NHS providers, >1,200 residents and staff tested - We are supporting all care homes to access the national offer - Alongside this we have developed an outbreak model to supplement national testing offer for care homes

and other care settings not able to access the national offer. This is a multi agency approach with public health oversight to mobilise NHS testing capacity across wider care sectors.This is likely to support c. 10 care schemes each week, with priority to be given to schemes unable to access national offer

- NCL NHS providers offering on-site support with testing to build sector capacity to self-manage swabbing, to support future repeat mass testing

- Local capacity to test adult social care providers is finite and is not sufficient to cover the range of ASC provider sectors ineligible for resident testing nationally. Providers such as extra care and supported housing

have similar risks to care homes given the vulnerability of their residents so comprehensive national testing for these settings would make a huge difference.

NCL testing capacity for key workers

- We now have extensive ‘in-house’ NHS testing capacity at trusts across NCL as well as testing sites open to health and social care staff through UCLH, NMUH, RF, RNOH and GOSH. Booking for NHS capacity are managed by a NCL webpage. Social care staff began to access NHS testing capacity from w/c 6th April.

- We currently have sufficient NCL staff testing capacity to meet the demand from the adult social care workforce

In addition, an NCL guide for care home staff on how to access COVID 19 mass tests and support to manage outbreaks has been compiled and disseminated. PPE and Clinical NCL has developed a comprehensive PPE network across Local Authorities, NHS Acute, Community and Mental Health Trusts, and Primary Care Services. The network has focussed on addressing procurement and supply challenges, with weekly system meetings since end March 2020. This has facilitated the provision of mutual aid, including appropriate diversion of key items of PPE from the NHS Supply Chain to nursing and residential homes, GP practices etc when emergency supplies have been required. Individual boroughs are continuing work to support provision of the correct PPE for all health and care staff and all providers are aware of local reporting and escalation routes; which are addressed in the daily calls each Council has with providers. This is a key area of work for local authorities, and in Haringey has enabled effected distribution of PPE, often at short notice.

A PPE demand model has been developed by 4C Associates with all partners across NCL. The model pulls provider data from the ADASS Market Insights Tool, and has several functions, including distribution and usage dashboards, as well as recording stock levels in each borough’s central distribution hub. Nevertheless it’s important to remember that for the first few weeks of the covid-19 there were significant shortfalls of PPE, due to the lack of national supply, so whilst our systems have worked well, they remain vulnerable to supply fluctuations. Clinical leads identified that extra vital signs equipment was needed by staff working in older people’s care homes in order to care for COVID-19 patients. The extra vital signs equipment that was identified includes: • Pulse oximeters • Thermometers (in ear) together with single use ear covers • Blood pressure monitors • Pen torches Where providers do not already have these in place we are procuring them across NCL and we have developed an associated training package to support providers to use them under the direction of a clinician. In coming weeks we will review the need for them in MH and LD homes and extra care supported housing. The CCG has taken action to review and strengthen the clinical support offered to care homes (enhanced health in care homes) on a borough by borough basis, including developing new provision where there were gaps. This has included identifying a primary care clinical lead for each home and named community health service clinical leads, and sharing approaches between boroughs around models of support for MH and LD homes. Developing and sustaining effective clinical support models, including for settings not currently consistently covered, such as extra care and supported housing, is a key priority for the system. Enhanced health in care homes is one of our priority projects for coming months, building on the successful provision in parts of the region, including Haringey.

Workforce support In addition to the Proud to Care recruitment approach we have built on our quality offer by designing a workforce development framework for care providers in light of covid-19. This includes developing support and training in increased areas of need (e.g. IPC as covered above; digital maturity) and also a wellbeing section, including peer support group, a WhatsApp group for registered managers (with clinical input as required) and access to the NCL developed Together in Mind resources. We have been fortunate to be part of an NHSX pilot to provide tablets that enable residents to contact family and friends, which we have provided to over 250 care settings in NCL. In Haringey, we have implemented a Care Home Chaplaincy model (equivalent to the chaplaincy offer in acute settings) which enables residents at the end of life to link in with an appropriate faith leader, currently virtually, to support both the care home and the individual and their family. In Haringey, we have also developed a Bereavement Support Framework for the whole community, in which the care sector is considered a key stakeholder.

Your system’s collective level of confidence that these actions are being implemented or plans are in place to urgently implement

In Haringey, we believe that it is critical that we act in a co-ordinated and aligned way at local, sub-regional and regional levels as set out in this response. We have high levels of confidence in this approach which recognises that there are clear and serious challenges both in the short and longer-term. We as partners have established and participate in appropriate governance within each layer, bringing together key partners with agency, expertise and authority in this area to ensure we develop appropriate actions, implement them and review their impact.

Short description of the approach that commissioners (LAs and CCGs) are taking to address short-term financial pressures

Across NCL, all councils have taken a common approach to supporting care homes with short-term financial pressures. Within NCL we have a long-standing NCL ASC Programme which has supporting councils with efforts to manage and support a sub-regional care home marketplace. NCL councils have agreed a range of financial support to care homes where they have spot and block placements, as well as significant provision of in-kind resource, notably PPE has been provided at significant cost to each borough. Direct funding has been provided as non-ring-fenced grants to allow care homes to direct resources as necessary where needed. In Haringey, we have agreed an additional 5% uplift to all care home fees for the months of April and May and supported care home providers through paying for voids necessitated by Covid-19. This has eased the financial pressures on care homes which has meant we have been able to respond to outbreaks in a holistic way based on clinical and care issues. Each NCL Council will passport the entirety of the 75% IPC grant funding to care homes in their borough, based on a flat rate per bed. This constitutes a clear fair offer to all care homes, reflecting the spirit of the guidance. The remaining 25% will be allocated based on local market need to support effective clinical infrastructure and to contribute to developing a sustainable, long-term approach to the care sector. In Haringey, we are mindful of the range of different care providers in the borough, ranging from small family-run homes and agencies to larger players, operating across a number of London boroughs. To provide rapid high impact actions to support care homes the CCG has provided significant financial support both in-kind and directly to care homes from the outset of the NCL COVID-19 response. This has included:

• increased income to providers for placements made during this period (above AQP rates)

• secured block arrangements to provide secured income to providers which reduces risks from void beds etc

• to support provider sustainability in May we initiated a process to support cash flow - prioritising payments based on commissioned care for care homes (with retrospective reconciliation where required)

• put in place a new Care Home LCS (primary care locally commissioned service) in Barnet to ensure GP care is provided ahead of the implementation of the PCN DES in October

• invested in and supported equipment, technology and digital to support care homes (vital signs monitoring equipment, roll out of NHS Mail, distribution of Facebook portals to allow friends and family to stay in contact with residents, development and launch of an NCL webpage for care homes

• Support care homes with infection prevent & control (IPC) including training, development of and access to super-trainers, webinars and a telephone response service to provide advice

• Redirected significant CCG resource, clinical and non-clinical to support the care homes response to COVID-19

• Supported the provision and distribution of PPE The CCG have indicated that their understanding of the guidance around support for care homes is that the Council should fund increased cost pressures arising from existing social care placements, therefore they have not provided additional funding for this purpose. However, the CCG is providing funding as per the guidance around admission avoidance and discharge, and in addition is providing a wide range of in-kind support, including local testing capacity, IPC train the trainers (beyond the minimum quantum in the national guidance), provision of PPE and medical equipment etc.as set out in the paragraphs above. Whilst we are working collaboratively across the care home sector already, the additional focus on home care and supported living is being largely led by local borough areas, given the variety of home support/supported living models in place in each local authority. The mechanism and infrastructure for collaboration across the sub-region is, however, in place for sharing of best practice and the development of consistent approaches as appropriate. In Haringey, we see the work as a coherent and comprehensive approach across the care sector, rather than for one part of the sector alone, given the levels of need, vulnerability and complexity we see in all cohorts using social care.

Approach agreed locally to providing alternative accommodation

Across NCL Councils and the CCG collaborated to ensure that there was sufficient bed supply to respond to the NHS modelling on demand. Through our NCL ASC market management programme we commissioned 61 additional pathway 3 beds in care homes that were used as surge beds between boroughs across health and social care. As per the guidance around discharge pathways we have been assured that these will be funded by the CCG. Commissioning providers that were well set up to support people with a covid-19 positive diagnosis and had vacancies also supported market sustainability. We also collaborated with the CCG to develop a range of short-term pathway 2 beds in a range of settings, including care homes. This gave us flexibility around discharge pathways to support our integrated discharge teams. As the surge demand didn’t reach the NHS forecast for discharges, we have always had sufficient supply of beds within the system. The short-term impact of covid-19 has risks of cost pressures associated with increased care placement prices which threaten Council and CCG finances in the medium term. We have agreed in principle with the CCG to do further joint work around market management, building on the success of our NCL ASC Programme. In Haringey, we reopened Osborne Grove, a nursing care home recently closed (in preparation for major redevelopment as a larger nursing home) to add much needed capacity to the health and care system across NCL. It has been in operation as a ward of one of our local acute hospitals, North Middlesex University Hospital, to ensure effect joint working and interfaces across care pathways.

Local co-ordination for placing returning clinical staff or volunteers into care homes

There has been limited take up as there were only 3 returning nurses and they were not able to work face to face.

Appendix 3: Haringey Care Sector Support Plan

Care Model Sub Elements Comments

1. Enhanced primary care support

Weekly check in by Primary Care Network / GP to care homes

In place for some older people's care homes and intermediate care settings already. Now being expanded to all residential and nursing care homes with named GP Clinical Leads in place, supported by named secondary / community clinical leads. We are exploring extending this across the care sector.

Structure Medication reviews In place in some homes already via our EHCH teams; now to be expanded to all care homes, led by primary care Pharmacists supported by the specialist care home pharmacy lead.

Access to EOL medicines and implementation of Covid medicines guidance

Available on prescription. Guidance to be implemented locally.

Out of hours/emergency support (medical, nursing, medicines)

GP access hubs and Rapid Response available 8-8, 7 days. New all-age MH Crisis SPA in place 24/7

2. MDT in-reach support

Care, advice and support for those with the most complex needs

Geriatrician hot phones in place and hot phone support from discharging local hospital for Covid19 positive patients. MDT teleconferences in place; community services support into care homes established including named medical lead.

Physical and mental health support for care home residents including therapy services

Care Home Advice Team support our Nursing Homes and Community Services support residential homes. Therapy teams in-reach into MH and LD homes, supporting residents directly and support providers in care planning and delivery.

4. High quality end of life care and dementia care

Advance Care Planning and End of life care Palliative Care Team well established and supporting into care homes. EOLC Educator in place. Advance Care Planning nurses trained and supported by a practice network.

Dementia care. Support to isolate and care for people living with dementia

Mental Health Team helpline available. Develop training for staff and flexible support offer from OP mental health team [rated ‘outstanding’] into all borough homes/residents.

Care Model Elements

Sub Elements Comments

5. Commissioning and provider support

Clear communication and co-production with care homes and the care sector

Daily communication currently in place, enhanced by regular briefings, webinars in place. To take forward a developmental programme for all care agencies, even where capacity to participate is limited

Proactive and timely provider support e.g. daily calls In place across Council/CCG. To continue

Osborne Grove - planning for the future To develop ongoing plan with system partners

Overview of care home and home care capacity Capacity Tracker in use

Commissioning plans to respond to future need Additional nursing capacity required locally, need to respond to dip in demand for residential care

Oversight of provider financial resilience and support

Existing provider oversight / provider failure approach well established. NCL Councils / CCG developing proposals for responding proactively to concerns about financial resilience. Covid finance support proposals now being signed off.

Haringey workstream being established under Borough Partnership governance to lead on market oversight and – current funding models are reactive.

Funding mechanisms consistently applied across CCG and LA and across NCL

NCL CCG and Councils are working together around resilience funding and seeking to align approaches. Haringey operates integrated brokerage for all client groups and this has improved alignment in market pricing and funding strategies. We have well established joint funding mechanisms between the CCG and Council which supports provider cash-flow New commissioning models increasingly link increased investment levels to outcomes across the care sector.

Provider failure arrangements appropriate for Covid-19 era Robust arrangements already in place. All provider business continuity plans reviewed and providers supported where necessary. Review of provider failure mechanisms and provider of last resort undertaken.

Staff testing for Covid and management Weekly reporting in place. To support care homes as appropriate

6. Community engagement

Care sector is fully embedded as a key sector in the local economy

Building on Proud to Care and focus on social care to build status and value over time, economically and socially.

Community, voluntary and volunteering capacity contribute to an enhanced user experience

Particularly mindful of impact on BAME communities, need culturally specific models of care to be developed further. Track record of BAME specific home care services in borough and established community involvement and co-production arrangements in place in partnership with Healthwatch / Public Voice.

7. Workforce development

Training and development for care staff To link with NCL training, Super Trainers. Coordinate training as needed. EHCH leads oversee provider development programmes and workforce is a theme area in our new Borough Partnership care sector programme.

Psychological support for care homes IAPT support in place with prioritised access for care sector staff. Bereavement support coming on line, training available funded through NCL and access to phone

and digital support including Kooth, Good Thinking, SilverCloud and a suicide prevention support line.

Provider network of support across the sector Capital Nurse WhatsApp Group; Provider Forum for the care sector led by LA is meeting at least fortnightly (virtually) during pandemic. Consideration of how to develop capability through this group.

Joint workforce planning, staffing levels In progress through Proud to Care and through enhanced focus on staff capability and competence

8. Harnessing data and technology

Distribution and roll out of devices In progress – most homes already using and some now acquired Facebook Portals Linked with NCL programme and now developing links to wider digital inclusion plan

Access to care record and secure email In progress. To encourage all CH. 95% coverage of nhs.net mail in borough homes.

Distribution and roll out of telemedicine kits In progress. Link with NCL CCG colleagues who are leading on distribution roll out now

Health Information Exchange and HealtheIntent developed to include the care market as well as the care assessment functions

Work in progress, as part of roll out across NCL

Opportunities for improved multi-disciplinary working through digital platforms such as Attend Anywhere to be promoted

Work in progress, as part of consideration across NCL. Attend anywhere now adopted by local mental health trusts and in place

9. PPE and Infection Control

Clear processes on ordering PPE and methods of escalation. In place and working. To monitor and escalate as needed

Advice and information on Infection prevention and control in a care home and for home care agencies

In place. NCL CCG IPC helpline in place; borough webinars in place and supported by phone support from Brokerage and Public health functions.

10. Testing and Contact Tracing

Clear and accessible processes for testing staff and residents In place.

Local Outbreak Control Management Plans executed for the care sector

In development – guidance just issued and being considered for the care sector

Contact tracing infrastructure in place to extend to care sector

In development – guidance just issued and being considered for the care sector