Agenda item

Summary of the impact of Covid-19 on care homes in Haringey so far, including infection/fatality numbers and details, which care homes were most significantly affected.

Will Maimaris, Director of Public Health, introduced a report summarising the impact of Covid-19 on care homes in Haringey Borough. He said that care homes remain a clear priority for the Council in terms of the response to Covid-19. There had been a significant impact on the care sector in Haringey, particularly in March, April and May in terms of excess deaths. The report highlighted some of the learning from that and the interventions that had been put in place since then. He pointed out that in Haringey there is quite a small number of older people’s nursing and residential homes and so the Council had a close relationship and regular communication with all of the care providers. He said that some of the key priority areas in terms of preventing future outbreaks in the coming months were:

• Personal Protective Equipment (PPE) – which all Haringey care homes have access to.
• Regular testing
• Hospital discharge protocols
• Advice and guidance being received by care homes
• Clinical support for care homes

Will Maimaris said that a further report had been provided to the North Central London Joint Health Overview and Scrutiny Committee which included data on death rates in care homes and that Haringey had performed better than the sector average. (Report available at: https://barnet.moderngov.co.uk/ieListDocuments.aspx?CId=360&MId=10089&Ver=4)

Will Maimaris (Director of Public Health), Charlotte Pomery (Assistant Director for Commissioning), John Everson (Assistant Director for Adults), Angela Healy (Quality Assurance Manager, NCL CCG) and Farzad Fazilat (Head of Brokerage) responded to questions from the Panel:

• Asked by Cllr da Costa about recent media reports about underpaid care workers in Haringey and when the London Living Wage would be implemented for them, Charlotte Pomery said that the reports related to an employment tribunal regarding a historic practice from 2016. She said that the implementation of the London Living Wage was being worked on with the expectation that this would be in place by October.
• Asked by Cllr da Costa for an update about the amended decent sick pay for care workers motion passed at a recent Full Council meeting, Charlotte Pomery said that this was a complex issue and that the necessary background work was currently being done by officers as requested by the motion.
• Asked by Cllr Connor whether care homes were currently able to fund care workers who are required to self-isolate, Charlotte Pomery said that a new initiative had been recently announced to support those who might hesitate to say that they have symptoms for fear of losing out financially. The Adult Social Care Infection Control Fund had also recently been extended. Cllr Connor asked for clarification about whether care workers who are required to self-isolate still receive their full wage. Charlotte Pomery responded that there was some complexity about the different types of care workers and so it would be necessary to gather this information and provide it to the Panel in writing. (ACTION)
• Asked by Cllr Culverwell about the most vulnerable demographic groups, Will Maimaris said that those most at risk were people with long-term conditions, those in the oldest age groups and people from BAME groups. However, people from all demographic groups presenting with Covid symptoms were able to access medical treatment when required.
• Asked by Cllr Connor about access to hospital services for care home residents, Will Maimaris said that during the height of the pandemic there had been few additional services available due to the risk of cross-infection. Services had now resumed but clearly if the number of cases increased again then the risks would become greater. Further details could be provided to the Panel in writing. (ACTION) Asked by Helena Kania about telephone/video triaging for care home residents, Will Maimaris said that many GPs were generally operating in this way currently anyway and Angela Sealy added that some GP visits to care homes were now taking place.
• Asked by Helena Kania about the policy on visitors to care homes, Will Maimaris said that the Council provides public health advice to care homes about whether visitors can be safely allowed and care homes can then carry out their own risk assessment before deciding to proceed. While the advice was currently that visitors can be allowed, with the ongoing rise in community transmission this would be kept under review. Farzad Fazilat added that care homes had been supported to facilitate digital means of communications between residents and family members and to ensure that there is social distancing during physical visits. He added that care homes in Haringey generally have a good relationship with families and engage with them through family forums and newsletters.
• Asked by Cllr Hakata about the how the pandemic had changed working practices with providers, Will Maimaris said that the working relationships were already strong but had recently been further strengthened through the regular meetings that providers were having with the Council and the CCG.
• Asked by Cllr Hakata about supplies of PPE, Will Maimaris confirmed that care homes had struggled to get supplies from the usual channels and so the Council had been making provisions to various providers in the Borough. However, providers had become a lot more self-sufficient in the past couple of months.
• Asked by Cllr Hakata about the heightened risk to BAME people, Will Maimaris said that in the general population it was known that younger BAME people were at higher risk but that he did not have equivalent data for care home residents in the borough. However, it was likely that the discrepancy would not be as significant because people of all ethnicities in care homes have high levels of frailty and risk factors. Registrars in Haringey had recently been asked to record ethnicity when a death occurs, though the place of death of care home residents may often have occurred at a hospital and be recorded as such which makes this more difficult to track. 
• Asked by Cllr Hakata about a recent Joint Partnerships Board report which stated that up to 40% of care homes in the borough may now have financial viability issues, Charlotte Pomery said that Haringey was not unique in facing this problem currently as a consequence of the pandemic. Reasons for this include the requirement for care homes to carry voids and a significant downturn in applications for care home places. Work was ongoing with other boroughs across the North Central London area on this issue and there had been direct representations to central government about social care funding.
• Asked by Cllr Connor about deaths of Haringey residents who had been placed in care homes outside of the borough, Farzad Fazilat said that information about deaths of Haringey residents in care homes outside of the borough could be provided to the Panel, but that it may be more difficult to establish how many of these had died due to Covid. (ACTION)
• Asked by Cllr Connor whether discharges from hospitals to care homes without testing had impacted on the death rate in Haringey, Will Maimaris said that, while that was a possibility, he believed that the main factor impacting on care homes had been widespread community transmission. The lack of testing for care home staff had also been a significant problem.
• Cllr da Costa queried when the discharge protocols referred to in the NCL After Action Review would be completed but officers did not have information about a specific date at this stage.
• Asked by Cllr da Costa about digital inclusion for care home residents, Charlotte Pomery said that in some cases, smartphones and tablets had been provided along with support for access. This work had continued as it is recognised that this would be a long-term issue.
• Asked by Cllr Connor about testing, Will Maimaris said that there had recently been weekly testing for care home staff and four-weekly testing for care home residents, though the process is different in the event of a care home outbreak. If there were to be issues with the national testing system it would be possible to access testing through the NHS in North Central London which can be mobilised quickly – this had already previously been done during the first Covid wave to provide regular testing to the Priscilla Wakefield care home. Farzad Fazilat added that there had recently been delays in the national system with test results taking three to four days. Cllr Connor suggested that the local system could be mobilised if case numbers continue to rise but the national system is still slow.
• Asked by Cllr Connor about the data on learning disability residential care provision, Farzad Fazilat said that information was regularly received from providers and collated including any positive cases. Cllr Connor requested that this information be provided to the Panel. (ACTION)
• Asked by Cllr Connor about the pathways for hospital discharge to care homes, John Everson said that intermediate care beds were generally used for this at places such as Magnolia Court. Where possible the reablement service was equipped to provide care and support to people at home. A lot of work had happened across North Central London to ensure that sufficient capacity was available in the right places. Charlotte Pomery noted that this issue was part of the NCL After Action Review process so there would be an opportunity to report back on this in more detail when this had been completed. Cllr Connor asked for further detail on the specific pathways for hospital discharge and which facilities would be used for this in the event of a second wave of Covid. (ACTION)
• Asked by Cllr Connor about the implementation of Enhanced Health in Care Homes (EHCH), Angela Sealy said that the original EHCH framework was published in 2016, including interventions to enhance the quality of care for residents. The Council had been working on the framework since 2016, particularly on end of life care and on advanced care planning. Covid-19 had accelerated this, such as through the requirement to have primary care networks with a clinical lead for each care home. All Haringey care homes now had an identified clinical lead and there were also now multi-disciplinary team teleconferences.