London Borough of Sutton: Keeping our care homes safe during COVID-19

Care homes COVID-19 crisis prompted a local innovative, evidence-based approach to tackling COVID-19 infections/outbreaks and other challenges faced by Sutton care homes.

Public health

24 Feb 2021

This approach is Alert - Response - Plan (ARP), an outbreak management and wider public health quality improvement framework embedded into existing local structures. ARP is driven by the collective learning from the local system experiences and expertise. ARP enables us to proactively identify areas for improvement (change), collectively agree appropriate tools and working practices (method) whilst paying attention to the context (place-based) in order to achieve better outcomes for our care homes population during the pandemic and beyond.

The challenge

COVID-19 has highlighted existing and new challenges in the care sector such as:

inequalities heightened by the disproportionate impact of COVID-19 on care homes where residents and staff experienced higher mortality and morbidity.
largely independent and heterogenous care provider sector with gaps around engagement, accountability and governance worsened by the pandemic.
difficulties in coordination and leadership due to multiple stakeholder organisations involved with the care homes sector.
inadequate data reporting and patchy information sharing.
rapidly changing COVID-19 guidance and voluminous information.

The solution

ARP is a co-ordinated systems approach to outbreak control planning based on timely, accurate data collection, risk assessment and advice in line with national guidance. Appropriate training was provided for all staff involved in supporting the care sector population. We developed processes and work instructions using quality management systems, including routine testing data collection, weekly reporting, rapid risk reviews, escalation notes, actions from meetings, terms of reference, protocols, Responsible, Accountable, Consulted and Informed (RACI) model, letter templates and other documentation. These systematic processes are underpinned by a communication mechanism that relies on timely and accurate information sharing. We established an initial single point of contact via the local public health team which helped to build trust, provide clear, credible and concise information and advice using various media such as webinars, calls, emails and focus groups. We engaged with providers, professionals, service users and their families.

ARP provided the local system a framework to improve quality of care by:

maximising the collective experience across the System from tackling the COVID-19 experience since the onset of the pandemic.
enabling a structured reactive and proactive advice and support to care homes both now and for the future.

ARP is led by the London Borough of Sutton public health team and implementation is across the local system with stakeholder organisations across health and social care working in partnership (i.e. care sector providers, Sutton Health and Care, South West London clinical commissioning group (SWL CCG), Primary Care Networks, London Borough of Sutton Public Health and Adult Social Care Teams). Sutton Community Bed Based Board ratified this framework in May 2020.

The impact

Improved data access and quality: local innovation in data reporting led to timely access to data about infections and outbreaks not available on national capacity tracker (local data collection began before capacity tracker). Further improvements made to local data quality to enhance the national reporting.
Timely local response to infections: 100 per cent of providers reporting infections to the local system undergo a risk assessment to identify any support needs for COVID-19 and other areas such as staffing, admissions and contingency planning. All providers received appropriate advice including the need to notify the Public Health England Health Protection team.
Value for money: use of innovation in the use of the Infection Control fund and Rapid Testing fund to engage providers and support uptake of new guidelines on testing, hospital discharges and admissions.
Support for compliance with guidance: constant changes to guidance such as testing, discharges, visiting etc affected morale and this was identified earlyas an area for additional local support. A series of webinars and bespoke local guidelines and action cards were produced.
Reducing inequalities: risk assessments identified lack of understanding and impact from gaps in areas such as testing, Infection Prevention and Control and other key outbreak control measures. Differences between provider staff and populations such as those in mental health care homes with residents with more complex needs and diverse staff needs were mitigated by increasing engagement with staff through multi-disciplinary teams (MDTs), clinical lead input and focus groups to enable understanding and support to address these gaps. Local partners are advised about Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act 2005 with a dedicated section on the Sutton Care Hub.
Improved local collaboration partnership working: GPs and primary care network were engaged by sharing timely information/alerts on any care home issues and multidisciplinary professionals involvement in our local responses, for example GP-led MDT meetings for clinical input into resident’s needs during outbreaks.
Prompt identification and escalation of areas for improvement or support: local risk assessments for care homes covers multiple areas and highlighted concerns such as residents and staff health and wellbeing, relatives visiting care homes, safeguarding, leadership, training needs and communication which are escalated to the relevant leads, including the Care Quality Commission (CQC), who are able to respond and advise.
Increased communication and engagement: Use of a range of media to support and target various audiences by creating our dedicated Sutton Care Hub website, undertaking surveys, focus groups and hosting virtual meetings. Weekly online meetings are held with care setting providers and their staff to discuss any concerns, changes to guidance and answer questions. Frequently Asked Questions are published on the Sutton Care Hub. We supported providers and families to communicate effectively on the visiting guidance by creating a bespoke web page and visiting letters are sent to providers to discuss with families. We held webinars for families prior to vaccination to support informed consent and to discuss planning for best interests decisions where applicable

How is the new approach being sustained?

Evaluation of this approach is beginning and initial feedback from providers and professionals has been very positive. Plans are underway to apply the ARP approach to other areas of practice within the health and social care sector. Buy-in has been obtained and each lead organisation has been empowered to focus on their area of work through weekly public health reports and recommendations to enable improvements in the care sector. A weekly situation report (SITREP) is also shared with system leaders and the CQC and Public Health England (PHE) are able to receive detailed relevant information about our care homes when required. We are maintaining and enhancing the existing Sutton system care sector joint working partnerships as described in the Sutton Plan Supporting our Care Homes to remain safe publication. We have embedded a continuous learning culture through our weekly reporting and escalation system. We have shared examples of good practice from this approach with PHE and the SWL CCG.

Lessons learned

Strong partnerships and co-creation are important to implement and achieve change rapidly and to adopt the use of innovation during a crisis. However, clear leadership, good communication and defined roles and responsibilities are vital for sustaining the change and embedding processes into everyday practice. Stakeholders should be supported to focus on their areas of expertise and to communicate effectively to achieve desired outcomes. Good quality data and recordkeeping provide sustainable and replicable ways of working which is important for shared learning and planning of high quality services. Building trust and a sense of ownership through appreciation, strong peer to peer support and regular feedback can increase engagement and confidence. It is difficult to introduce a new concept during a complex and challenging situation like a pandemic, however, if the focus is on working together we can achieve the best for the population and all parties can remain motivated. Our aim must always be to achieve high quality care for residents characterised by safe, effective, positive experiences, equity of access and usage, well-led and sustainably resourced service delivery across the care sector.

Contact

Modupe Omonijo, Acting Consultant in Public Health (Public Health Lead for Sutton Adult Social Care COVID-19 response, SWL CCG Public Health Lead for Temporary Alternative Discharge Destinations

c/o Molly Jordan, Public Health Project Officer, [email protected]