Edition 4 - 15 July 2020

Dear colleagues,

As the country sees a gradual easing of the lockdown, with adults living alone or with dependent children now being able to form social bubbles, the re-opening of non-essential shops and, most recently, re-opening of pubs and restaurants, it is easy to forget that the NHS is still in a level 4 pandemic.  The ask of our staff is a tough one as their hard work to protect people against and care for people with COVID-19 means the positive steps to ease lockdown are possible, but at the same time, they are fully monopolised by the current huge demands to support local residents.  

It was pertinent that the nation came together on Sunday 5 July to pause, recognise and say thank you for all the work across health services, the community, supermarkets, schools and the public that has taken place over the last few months. Of course, that day also marked the NHS's birthday and I would like to join this expression of thanks by thanking you all for your dedication and commitment over the last few months. You have made us all enormously proud to be part of the health and social care system in England, with community health professionals having been truly outstanding amidst tough local circumstances.

In NHS England and NHS Improvement, we have begun to learn from the last few months how we can restore services safely, and how we can preserve the innovation and good practice that has emerged during the response to the pandemic. For community health services, we have already published guidance on how we should be restoring services for children and young people, and we have asked teams to share their innovative practice during COVID-19; we are using these examples to inform our business planning for this year. 

It is likely that there may be increased demand for rehabilitation as people recover from COVID-19 and require support out in the community. To underpin this, community hospital bed providers have been asked to undertake daily clinical reviews of plans for every patient and record that information appropriately. You can find out more below. 

As you may recall from our last update, we are urging the system to continue to implement and improve the hospital discharge to assess approach; while the pressure on hospitals from COVID-19 cases has decreased considerably from the peak, is it vital that we do not lose the progress we have made and the positive impact this has had for patients and services. The local surges we are seeing show that the virus is not over, and systems must continue to apply the discharge to assess ethos. You may be interested to read my recent blog where I discuss this in more depth - more details will also be available in Amanda Pritchard’s imminent letter to local systems which will provide the national priorities for the rest of the financial year.

Kind regards,    

News and updates from across the sector

New EPRR (Emergency Preparedness, Resilience and Response) data collection during COVID-19 incident for community hospital bed providers

With the likely increased demands for rehabilitation, from 23 July 2020, community hospital bed providers are being asked to undertake daily clinical reviews of plans for every patient and record that information appropriately. This data will reinforce the professional practice of daily reviewing patients in community rehabilitation beds; aid organisations, regional and national teams to monitor patient numbers on a live basis and ensure emerging issues around discharge are promptly tackled; and allows local systems to have a full understanding of the reasons patients are in NHS bedded care in any area, and plan for the capacity needed on discharge.  A letter was sent to community hospital bed providers containing further information on this review, and what it should entail, along with a workbook to support with the submission of data.  Join the FutureNHS platform to access these documents. 

Comprehensive new funding package for councils to help address coronavirus pressures and cover lost income during the pandemic

On 2 July, the government announced a major new support package to help councils respond to coronavirus, as part of a comprehensive plan to ensure councils’ financial sustainability for the future. A further £500m brings funding given to support local councils with pressures to £4.3 billion, part of a package of over £27 billion to help councils, businesses and communities.

Transition between COVID-19 care home support and the Enhanced Health in Care Homes service in the Network Contract DES and training requirements for personalised care roles

From 31 July 2020, the interim COVID-19 care home service will transition into the more comprehensive Enhanced Health in Care Homes service as described in the Network Contract DES. To avoid disrupting the positive relationships that are developing between general practice, community services providers, and care homes, NHS England and NHS Improvement intend to amend the Network Contract DES so that, by exception, the clinical lead role for the service may be held by a clinician, other than a GP, with appropriate experience of working with care homes provided this is agreed by the practices in the primary care network, the CCG and the relevant community provider. They are encouraging PCNs to engage personalised care roles - social prescribing link workers, health and wellbeing coaches, and care coordinators - as these roles will be able to support the COVID-19 response through embedding personalised care approaches. Find more information here.

Stepping back up of key reporting and management functions

A letter was published on 6 July from Amanda Pritchard, Chief Operating Officer, NHS England & NHS Improvement, to advise on the stepping back up of key reporting and management functions now that we have now passed the initial peak of COVID-19 and are well into phase 2 of recovery planning. The letter to CCGs and NHS trusts and foundation trusts covers governance and meetings, reporting and assurance, vulnerable staff and annual leave. Anything not addressed in the letter remains as outlined in the letter of 28 March.

NHS volunteer responders - supporting patients in primary care and community health

A new one-page guide sets out the different roles and tasks the NHS Volunteer Responders can perform to support patients. If you work in primary care and community health, including in general practice, community pharmacies and community health services, you can offer your patients the support of an NHS Volunteer Responder. Download the guide from the NHS Volunteer Responders website and use it to refer patients to the right support now.

The CQC publishes second coronavirus insight report

The CQC has now published the second edition of their regular coronavirus insight reports. This month’s report focuses on closer working between hospitals, primary care, social care and community services and includes case studies of where this has been done well. The report highlights the importance of collaboration between services as integral to meeting people’s needs. More information can be found on their website here.

Brief guidance for safe enquiry about domestic abuse in ‘virtual’ health settings

As we have seen the use of virtual health settings increase during the pandemic, there has been a need for more support for healthcare professionals to ask about domestic abuse whilst on a telephone call or virtual consultation. SafeLives and IRISi, together with input and endorsement by partners in the Violence Against Women and Girls sector, have created guidance to support professionals to safely ask patients about domestic abuse in virtual settings. It sets out five simple steps to help staff identify and respond to people who might be at risk. 

Personal Protective Equipment (PPE) and heat: risk of heat stress

The Medicines & Healthcare products Regulatory Agency (MHRA) have advised that wearing PPE in warm/hot environments increases the risk of heat stress. Heat stress occurs when the body is unable to cool itself enough to maintain a healthy temperature. Heat stress can cause heat exhaustion and lead to heat stroke if the person is unable to cool down. Measures to control the temperature of clinical environments and enable staff to make behavioural adaptations to stay cool and well hydrated should be taken. Staff may require more frequent breaks and the frequency of PPE changes may increase, with a resulting increase in demand. See the Chief Medical Officers (CMOs) alert for further information and action.

Shielding update: letter to patients

Translations and accessible format versions of the Government’s letter sent to patients who are shielding are now available.

COVID-19 stories from the system

Independent healthcare providers case studies

In responding to the COVID-19 pandemic, independent primary and community providers have quickly adapted to ensure patients continue to receive treatment in a safe and timely way. The Independent Healthcare Providers Network (IHPN) has published case studies from across the country that outline the  This includes switching from face-to-face to virtual consultations, as well as repurposing their services to help support the NHS as “hot” or “cold” sites. Further information on how the sector has supported the NHS during this time can be found here.

Isle of Wight: raising standards and Personal Assistant hospital discharge initiatives

The Better Care Fund commissioned the Social Care Institution of Excellence (SCIE) to create a series of local practice examples to shine a light on good practice in integrated care locally. One of these case studies looks at work carried out by the Isle of Wight in developing the quality of, and increasing the number of Personal Assistants (PAs) and establishing One of these case studies looks at improvement work carried out by the Isle of Wight that resulted in 200 hundred hours of PA support being provided to facilitate hospital discharge. Find out more here.

Resources and useful links

Updated guidance on the Admission and Care of Residents in a Care Home during COVID-19

The government has updated its guidance on the Admission and Care of Residents in a Care Home during COVID-19, using the latest domestic and international evidence brought together by Public Health England (PHE), and drawing on the insights of care providers.This document updates the previous Admission to Care Homes guidance published on 2 April 2020, in line with the latest updated advice on testing and infection, prevention and control (IPC). It also reflects the support package for care homes announced in May 2020 by HM Government, backed by a £600 million Adult Social Care Infection Control Fund.

Update from the Better Care Fund Team

The Better Care Fund Team (BCFT), previously the Better Care Support Team, has continued its work on the Government’s Care Home Support Plans, working with regional partners to build a local, regional and national picture of support to care homes in responding to COVID-19. The BCFT is working closely with the new Social Care Sector COVID-19 support taskforce in ensuring that local authorities and care homes receive the support they need. You can register for access to the Better Care Exchange, where you can find the latest news and COVID-19 discharge and social care related content, by emailing us.

NHS Volunteer Responder programme updates – new webinars

Fortnightly webinars are being held to provide regular updates on the NHS Volunteer Responder programme. The webinars are for referrers and colleagues working across health and care, including: primary care; social care; local authorities; government departments; voluntary sector organisations; STPs and ICSs; and NHS England and NHS Improvement regional teams. These webinars will provide an overview of the programme, including facts, figures and the most recent updates on programme adaptations in response to policy changes and the needs of vulnerable people. They are also an ideal opportunity to ask questions about the programme and hear about the impact it is having. Dates for the first six webinars, and the links to join them, are below:

• Thursday 23 July, 11am-12pm - Join Microsoft Teams Meeting
• Thursday 6 August, 11am-12pm - Join Microsoft Teams Meeting
• Thursday 20 August, 11am-12pm - Join Microsoft Teams Meeting
• Thursday 3 September, 11am-12pm - Join Microsoft Teams Meeting
• Thursday 17 September, 11am–12pm - Join Microsoft Teams Meeting
• Thursday 1 October, 11am-12pm - Join Microsoft Teams Meeting

Recovery from COVID-19 - Patient video from the Chartered Society of Physiotherapy

The Chartered Society of Physiotherapy has produced a useful animation for individuals recovering at home from COVID-19.  The short film addresses what is normal during the recovery process, as well as providing information on the best way to recover as quickly as possible, including recommended exercises to do at home.