Minutes:
David Johns, Consultant in Public Health Nottingham City Council, provided the following information about work to support care homes in responding to Covid-19:
a) The Care Homes and Home Care Cell supports a system and partnership response including the City Council, Clinical Commissioning Group and NHS providers. There is a robust governance structure in place that enables issues to be appropriately escalated for a strategic level response to supporting care homes.
b) A daily taskforce meeting is held. The meeting is multi-disciplinary involving partners such as Adult Social Care, Commissioning Teams and Public Health Teams. It looks at issues such as outbreaks, workforce challenges and quality issues, identifying how best to support care homes on current issues.
c) The Incident Management Team meets weekly and draws together themes from outbreaks to either deal with directly or escalate to the LRF or nationally, as appropriate.
d) Outbreak Control Teams are put in place if required.
e) There has been a huge amount of guidance for care homes. On issues such as arrangements for visitors, there is national guidance and Directors of Public Health are able to provide information on the local position in line with that national guidance. While acknowledging the risks, the aim is to keep care homes as open as possible. Care home managers know their homes best and are best placed to make the necessary risk assessment, and they are being supported with the tools to do this.
f) The Infection Prevention and Control Team provides advice on testing. There have been recent changes in guidance and care homes are being helped to work through the implications of these changes. New national funding is being passed on to care homes to support them with putting the new testing guidance into practice.
Steve Oakley, Acting Director for Procurement and Commissioning Nottingham City Council, provided the following information about the work of his Team in supporting care homes:
g) The Team has been in contact with care homes throughout the pandemic, initially on a daily basis although this has reduced now.
h) Care homes are operating in a very challenging environment, but have mostly coped well with the challenges and the changing guidance.
i) Testing has led to issues with staffing capacity, but care homes have generally managed this well so far.
j) Care homes have managed the best they can in terms of meeting reporting requirements. It is important that relevant information is reported and recorded but the Team acknowledges that those required to complete reporting requirements are the same people providing frontline care, especially when there are staffing pressures.
k) One of the challenges for care homes is coping with the number of ill residents and deaths. The inability to hold face-to-face staffing meetings etc reduces opportunities for staff to share, and be supported during these difficult and emotional times.
l) It is important to remember that care homes operate as private businesses and have to make decisions on this basis.
Fiona Branton, from the Infection Prevention and Control Team spoke about the work of that Team, highlighting the following information:
m) It has been an incredibly challenging time.
n) There are currently 23 active outbreaks in the City, as defined in line with the Public Health England guidance. If there is only one case exposure then this is reviewed with the care home and a risk assessment carried out.
o) There is a substantial amount of national guidance for care homes to understand and comply with, so to support with this a local toolkit has been produced pulling together relevant guidance and giving it a local focus e.g. details of how to access the PPE (personal protective equipment) Hotline.
p) Notification of an outbreak comes to the Team from a variety of sources including directly from the laboratory, from the care home itself or from Public Health England live listings. Therefore the Team is confident that it is well-informed about the current position.
q) The Team aims to put infection prevention and control measures in place that prevent ongoing spread. This could include ensuring PPE is being worn correctly, ensuring there is good hand hygiene, isolation, cleaning, testing, monitoring and surveillance and escalating to the daily taskforce meeting if necessary which will look at issues such as staffing and quality.
r) There is a hotline to the Testing Cell if necessary but many homes are doing regular testing on an ongoing basis – weekly for staff and monthly for residents.
s) A care home is allowed to reopen following an outbreak once there has been no new reported cases in the previous 28 days (twice the incubation period).
t) Key learning from the region includes:
i. When community transmission is high, there are high rates in care homes.
ii. PPE needs to be worn throughout the care home at all times. There is some fatigue with this.
iii. Regular testing picks up asymptomatic cases in staff and sometimes residents.
iv. Staff need to socially distance at break times and mealtimes, and follow national guidance out of work.
v. Staff should avoid car sharing to get to and from work. If they have to car share then they should wear PPE.
vi. Care homes should avoid sharing staff across different sites. This can be difficult, especially when there are staff shortages, and the safety of residents has to be the priority.
Sarah Carter, Nottingham and Nottinghamshire Clinical Commissioning Group, reported that all those aged over 65 years resident in a care home were being vaccinated. 95% coverage has been achieved so far. There are only four care homes in the City that have not been fully vaccinated so far and that is due to infection prevention and control measures currently in place. An outbreak does not necessarily prevent residents in care home from being vaccinated but it does depend on the environment in the care home. Staff can book to receive a vaccine elsewhere. There are plans to return to the four remaining care homes to vaccinate residents once the Team is able.