This report provides a summary of the key actions that Adult Social Care services undertook during Covid 19 pandemic.
At the request of the Chair that Items 4 and 6 be considered together.
Item 4: Summary of ASC’s Response to Covid-19
Lisa Redfern provided a summary of key work undertaken by Adult Social Care and Public Health, jointly working with the NHS and H&F CAN volunteers. This had been a time of significant challenge, but excellent work had emerged which had saved lives and protected residents. There had been much learning gained by Council staff and volunteers working jointly and effectively at pace on several areas in an agile manner.
The Council had worked hard to provide social care and support for residents. Four months ago, a situation where people could telephone if they were lonely or isolated, seven days per week, could not have been envisaged and this was a remarkable achievement. Lisa Redfern expressed how proud she was that local volunteers had triumphed demonstrating what could be done with the right attitude. This paved the way and offered a blueprint for working collaboratively in the future.
The Council had improved relationships working closely with the NHS which led to a great deal of innovation and improved relationships. There had been many gaps in the provision of PPE (personal protective equipment, and unclear test and tracing protocols, but the successful delivery of local solutions had won the day. There was an urgent need for social care reform and the pandemic had exposed weaknesses in the care system demonstrated by the crises in care homes.
Covid-19 had shown there had been no regard for care home staff and residents or staff. Social care reform was not just a matter of funding; it was about ensuring parity of esteem between health and social care provision. Lisa Redfern was of the view that there had been no “protective ring” around care homes implemented by central government. Testing patients discharged from hospital into care homes had formed part of the H&F, local solution.
Lisa Redfern expressed concern that test and tracing nationally appeared rudderless. Locally, a team had been established by Linda Jackson and Dr Nicola Lang to work with environment colleagues and staff at Imperial College Healthcare NHS Trust.
Professor Tim Orchard concurred and felt that to state that there was a “protective ring” around care homes stretched the truth. Work that had been done with care homes and clinicians around infection control based at Charing Cross hospital had been very helpful. He recounted the experience of Lombardy which pre-pandemic had one of the best, acute healthcare systems in Europe but had run out of beds in March 2020. In addition to dealing with PPE shortages there had been a shift in focus, and they were forced to make decisions about which patients could be treated in intensive care units (ICU). In principle, he was of the view that discharging patients was not a concern if they did not have symptoms, but, recognised that the circumstances of patient discharge had not been properly thought through.
Professor Orchard also acknowledged that local action had made a difference. Professor Orchard illustrated the scale of the situation and reported that to date, the Trust had dealt with almost 1300 cases of Covid-19 and that of those, 427 had unfortunately died. At the height of pandemic (before and after Easter) 360 cases had been treated and of these, 132 had been ventilated. Under normal circumstances, there were 68 ventilator beds and 88 high dependency beds so that there had been double the number of ventilator beds in use which had required extensive work to set up.
This had been an intense period and a difficult situation for the ICUs but there had also been very sick patients on the wards. Professor Orchard briefly described “happy hypoxia”, a condition where a patient’s oxygen level became dangerously low resulting in them unwittingly feeling relatively well because of the lack of carbon dioxide but perilously close to death.
Professor Orchard concluded that It had been a very positive experience to work with Adult Social Care colleagues. Mark Jarvis echoed Professor Orchards comments and reiterated that the CCG had welcomed improved and effective partnership working arrangements which had facilitated more agile decision making and strengthened partnership between the CCG and the Council.
Victoria Brignell commended the Council on its distribution of PPE to the local community responding to requests with same day delivery. In response to her query about payments to care and support staff who had been asked to self-isolate. Lisa Redfern confirmed that the provision of £200 per week had been devised locally without restriction.
Councillor Lloyd-Harris said that she was impressed with the speed and agility of the Council and enquired if PPE could be provided at libraries so that residents could purchase e.g. masks. Linda Jackson confirmed that they had offered partners access to the Council’s purchasing channel so PPE could be purchased at the same price.
The Leader of the Council, Councillor Stephen Cowan, was keen to maintain support to those that were currently shielding with plans to distribute 9000 plastic visors and masks so that they would have the confidence to go out and about.
This had been discussed with the CCG and local retailers to establish purchase points and the Council had also raised the issue with Transport for London whom they had arranged to meet with. It was confirmed that the Council had stockpiled PPE provision for a short period.
Councillor Kwon sought further information about access issues to testing, given that there were different processes depending on e.g. whether you were NHS staff, drive through testing or doing home kit tests. She asked if and how the issues had been resolved and what the plans for testing were. Professor Orchard explained that North West London Pathology undertook testing for trusts across NWL and had dramatically increased capacity to 3000 tests per day in addition to 500-1000 anti-body tests. Internally, Covid-19 tests were available to staff on request and about 9000 NHS staff had requested anti-body testing which was on-going.
It was thought that this would be completed within the next two weeks despite an issue with insufficient numbers of phlebotomy staff available to obtain blood samples for testing. For residents who become unwell at home with suspected symptoms, it was suggested that they were tested locally rather than go into a hospital. The Trust was also identifying patient pathways for treatment that were low risk to minimise the risk of infection and maintain control. There was now regular testing of asymptomatic staff in these treatment areas so that this could offer an early warning to exposure.
It was also recognised that there was a significant number of people generally who were asymptomatic. It was found that 0.23% of NHS staff tested were asymptomatic which had reduced from 2-3%. Timings for results Pillar 1 (internal) testing were good in NWL, with swabs being returned within 24 hours. Test results for high risk patients were provided within the hour.
Item 6: Staff and Resident Testing in Care Homes
Councillor Richardson welcomed Diane Jones to the discussion, to comment on her work regarding testing in care homes. Diane Jones highlighted the joint approach undertaken with the CCG and GP’s working closely with the Council following concerns identified regarding a particular care home supporting residents with specialist, NHS continuing care packages.
These had first been raised by GPs early on who had found that the care home was struggling to implement measures and ensure the safety of staff and residents. A gap analysis identified further risks and solutions were developed to mitigate that risk which included staff training to manage Covid-19, infection control and training to use PPE safely. Measures were also put in place to help support leadership and to develop staff resilience in dealing with Covid-19.
Roy Margolis offered heartfelt thanks to Lisa Redfern, Diane Jones, Professor Tim Orchard and NHS colleagues on their commitment and work in response to the pandemic which he commended. He explained that his background experience and interest lay in digital health and asked about testing and tracing solutions.
Dr Nicola Lang explained that the contact and trace system was set up by Department of Health and lay outside Council control. The advice to anyone with symptoms was to call 119 and, following a call handler assessment, a home test kit would be despatched. The three-tier system was briefly explained. Tier 3 calls would be initially screened and escalated to tier 2, handlers who were retired clinicians, and then to tier 1. Overall there was data developing that offered a good picture as to who was getting tested.
Jim Grealy commended the Borough’s efforts to keep residents safe, the way in which resources had been mobilised to support this and how the Council had worked with Imperial and health partners. With reference to page 16, line 4, he sought further clarifications of the definitions used, in terms of care homes and vulnerable “local” residents, and whether this was much broader, across North West London.
Lisa Redfern responded that Council officers had participated in daily, local NHS Gold meetings. This had led to a swift problem - solving approach. Lisa Redfern paid tribute to Dr Lang, who, despite being new to the Borough arriving at the just before the start of the pandemic had demonstrated a “can do attitude”, forming strong working partnerships at the outset. Dr Lang was described as a “breath of fresh air” who had created a strong network, who “bucked the trend” and developed a local, innovative response to the crises. Without the partnership with Imperial several weeks would have been lost in developing that response.
Jim Grealy asked if local government funding and the mobilisation of resources would support the expected second wave and how this continue to be delivered going forward. Lisa Redfern confirmed that the H&F Administration was committed to providing whatever it took to combatting the challenges of the pandemic but that all partner organisations and agencies were facing huge financial challenges. Much of this would depend on guidance from central government.
Councillor Coleman added that senior Council officers and health partners had done what was necessary but it was quite concerning that the Secretary of State for Housing, Communities and Local Government, Robert Jenrick, appeared to have backtracked on assurances that local government would be recompensed and supported regarding the expenditure claims that arose from dealing with the pandemic.
The Council would continue to challenge central government to deliver on promised assurances of support. Councillor Coleman stated that the Council, despite strong resistance, had taken a unique decision to close care homes to admissions which had not been replicated elsewhere. Buoyed by the support of colleagues at Imperial, an infection control team had supported a care home in Chiswick. The Council spent approximately £2 million on procuring and distributing PPE and described how the they had worked with volunteers, community groups and mutual aid groups to achieve this. He applauded the work undertaken in bringing this network together, which could be strengthened and maintained.
Jen Nightingale recounted her experience of the pandemic and how she had been redeployed to work in an intensive care unit. Given the significant trauma that could result from dealing daily with Covid-19 related illness and death, she asked what psychological support and counselling was available to staff and community volunteers.
Lisa Redfern explained that the Council’s occupational health team had offered open ended counselling to the Council workforce, care home and domiciliary staff. Professor Orchard explained that the Trust had implemented a range of support options. Clinical psychology teams had been deployed to support staff dealing where required, together with staff counselling. However, he cautioned that the response to trauma often materialised later and that enforcing unwelcomed support could worsen the situation. Counselling would continue to be available and accessible at a point at which individuals had been able to process their experiences. The wellbeing offer to staff was critical.
That the verbal reports were noted.