Agenda item

To consider and note the changes to service delivery in response to the Covid-19 pandemic and the winter and Covid-19 planning undertaken by Adult Social Care.

John Everson, Assistant Director for Adults, introduced the item which provided an update on how Adult Social Care had responded to the Covid-19 pandemic and how they were preparing for winter during the Covid-19 pandemic. It was noted that the detailed information had been provided in the agenda pack but that the key points would be presented.

In the first wave of the Covid-19 pandemic, support had been provided for over 9,000 people in Haringey who were shielding or vulnerable. Adult Social Care worked with the Connected Communities Team to provide support for a variety of people across Haringey; notably, they spoke directly to over 2,000 people who were shielding.

Within Adult Social Care, there were service delivery changes which provided adapted capacity to meet new demand. For example, it was possible to double the capacity of the Reablement Service, which supported timely and appropriate discharges of patients from hospital. It was noted that discharging patients who were clinically well enough was key to reducing the impact of Covid-19. 

It was explained that impact and performance monitoring had been undertaken during the first wave of the pandemic. It was noted that the London ADASS Market Insight Tool monitored Covid-19 activities to produce live, daily reports on things such as capacity, the workforce, and Personal Protective Equipment (PPE) stock. There had also been internal monitoring in Adult Social Care and the Council data sets linked to Health eAnalytics which supported admissions to and discharges from hospitals.

The Assistant Director for Adults explained that, after the first wave of the pandemic, there was a period of review to identify learning points and possible improvements. In particular, After Action Reviews were carried out with each Integrated Care Team across North Central London (NCL). The Local Government Association and Emergency Care Improvement Support Team had developed a gap analysis self assessment based on best practice and there had been peer partner visits to review and share best practice. It was also noted that new NCL Discharge Principles had been put in place which would assist with ensuring an integrated system with high quality and consistent processes.

It was noted that significant work had been undertaken with partners to understand how to support the care sector and co-produce planning work for the upcoming winter period, including enhanced clinical support to care homes and robust outbreak management and prevention plans. It was explained that a key learning point had been to ensure that patients who tested positive for Covid-19 were not discharged directly to care homes but had a clear pathway into intermediate care beds; this would protect care homes from wider outbreaks.

In relation to winter planning, it was noted that there was usually a 10% increase in demand for hospitals in winter but that Covid-19 would result in additional demand. Planning and modelling had been undertaken to increase capacity in the system to support discharge; in addition, areas for focused attention had been identified, such as nursing rapid response which aimed to avoid inappropriate hospital admissions. It was added that there was the ability to increase capacity in response to demand and it was highlighted that capacity in the Reablement Service had been retained. It was also explained that there would be support for those who were more vulnerable, including shielded patients, throughout winter and this would include information about flu vaccinations. The Assistant Director for Adults noted that the full detail of the planning was provided in the report but questions were welcomed.

Sharon Grant, Healthwatch Haringey, noted the efforts undertaken by Adult Social Care and raised concerns that the Reablement Service was under-resourced. She explained that, for many cases, six weeks of support was not sufficient and that Healthwatch were receiving more referrals for support, particularly in complex cases. It was noted that the length of Healthwatch’s interventions had been extended from six to 10 weeks and that this would be important during the winter period. It was also highlighted that new ways of working used by Adult Social Care involved greater use of remote working and IT. It was considered in the report that this had led to increased performance but it was enquired how this was measured and whether the move to digital platforms had been assessed from a patient perspective.

The Assistant Director for Adults noted that the capacity of the Reablement Service had been doubled and that no-one should be discharged without the appropriate care and support in place. He stated that he would be happy to discuss this with Healthwatch to understand the issues. Beverley Tarka, Director of Adults and Health, added that there were a significant number of individuals with longer lasting health implications from Covid-19, referred to as Long Covid. Conversations had been undertaken with NCL CCG and work was underway to enable support to be provided, both in local areas and virtually, in the longer term.

In relation to improved performance, it was acknowledged that face to face interactions could not be replaced. However, it was explained that increased remote working allowed practitioners to have more contact with those who were digitally enabled. In addition, options for those who were not digitally enabled were being investigated. Charlotte Pomery, Assistant Director of Commissioning explained that digital exclusion was a known theme and it was acknowledged that virtual options were not appropriate for everyone. It was noted that there was a programme of work to support access to devices, data, and training which included care homes.

The Chair highlighted the impressive amount of work that had been undertaken to support residents in terms of health, wellbeing, food security, and socioeconomic inequality, both during lockdown and on an ongoing basis. On behalf of the Health and Wellbeing Board, the Chair applauded this work. 

RESOLVED

To note:

1.    The changes in service delivery within adult social care made during lockdown in response to the Covid-19 pandemic outlined in the report.

2.    How performance and risk have been monitored and managed during this period.

3.    How adult social care was building on lessons learnt and positive changes made during lockdown and planning for a second wave.