Edition 5: 10 September 2020

Dear colleagues,

Since the last edition of the bulletin was published in mid-July, the country has seen a relaxation of lockdown rules including the reopening of pubs, restaurants and non-essential shops. However, there have been numerous local spikes of COVID-19 and reminders that the pandemic has not gone away. For colleagues working in community health services this means being faced with a world that is trying to get back to normal, whilst their work is nothing like ordinary. The pace has not let up; all services are being delivered in a COVID-19 compliant manner and we continue to care for large numbers of people impacted by COVID-19, whilst also trying to re-establish all services provided in local areas. 

Innovation has thrived in the community health sector, with our clinical teams adapting and finding impressive ways of delivering care differently to local residents. As we move into phase three of responding to the pandemic we will need a hybrid of continued COVID-19 vigilance and renewed focus on all the vital services the NHS offers. We need to capitalise on the innovation seen during the pandemic response and enshrine that in business as usual practices. I think we can all agree that we do not want to simply return to the old ways of working.

Our recent publications build on this. The Hospital Discharge Service: Policy and Operating Model incorporates the good practice developed in responding to COVID-19 and reinforces the HomeFirst approach, which has demonstrable benefits for patients, staff and service provision. The staff Action Cards, which sit alongside the guidance, clearly articulate how staff roles have evolved and introduce the single co-ordinator post, which takes the lead in establishing more joined-up discharge processes. This will enable more people to return home and receive NHS-funded care for up to six weeks as they are assessed for future care needs. In tandem, guidance on the Reintroduction of Continuing Healthcare assessments has also been published. We need to be able to track the effectiveness of the new discharge approach through the new acute and community rehab SITREP data which includes the number of people leaving hospital and where they are heading, alongside the number of people who remain in hospital beds and the reasons they need to stay. You can read more about the ambitions for hospital discharge in my latest blog.

Lastly, thank you to all the health and care community staff who continue to go above and beyond to provide the best services and care possible to meet people’s needs. Thank you for your commitment and your determination to improve service delivery and patient experience, even in the most challenging times.

Kind regards,    

News and updates from across the system

Hospital Discharge Guidance and Action Cards

Two new documents have been published to support hospital discharge processes; these documents take account of the learning gleaned from the pandemic and support the discharge to assess principles on which the COVID-19 Hospital Discharge Service Requirements were based. The documents aim to reinforce appropriate and timely discharge, ensuring individuals have the best possible outcomes when they return home from hospital. The Hospital Discharge Service: Policy and Operating Model outlines the national policy for discharge across health and social care, and Hospital Discharge Action Cards  provide role-based specifications which highlight the important elements of work for key groups of staff involved in discharging patients.

Reintroduction of NHS Continuing Healthcare (NHS CHC) – Guidance

New guidance has been published to support the reintroduction of NHS Continuing Healthcare assessments by Clinical Commissioning Groups (CCGs) and Local Authorities from 1 September 2020.  The new guidance document sets out how CCGs, working with local authorities, will reintroduce NHS CHC assessment processes and how this aligns to the introduction of a maximum of 6 weeks of funded health and care recovery and support services after discharge from hospital. It also addresses the deferred assessments from the period of 19 March – 31 August 2020.  

Personal health budgets for NHS continuing healthcare home care packages

Following the reintroduction of continuing healthcare (CHC) assessments from 1 September, CCGs are expected to resume delivery of personal health budgets as default for all home care arrangements based on local capacity and readiness to do so. This applies to all new CHC home care packages, and work should continue to transition existing traditional packages of care to a personal health budget. People should know upfront what their budget is, be involved in personalised care and support planning and have the option of a direct payment. Tools and resources are available on the Personalised Care Collaborative Network. For more information email england.personalhealthbudgets@nhs.net, or to join the network email england.pccn@nhs.net.

Additional guidance to support implementation of the third phase of NHS response to COVID-19

Community health and hospital discharge both feature prominently in plans for phase three of the pandemic response. Further to the letter of 31 July about the third phase of the NHS response to COVID-19, NHS England and NHS Improvement has published Implementing phase 3 of the NHS response to the COVID-19 pandemic. The guidance on the restoration of adult and older people’s community health services supersedes the prioritisation guidance for community health services, which was published in March and updated in April. All service areas should now be fully reinstated including, where needed, home visits for vulnerable adults.

Online rehab service for people experiencing the after effects of COVID-19

The new ‘Your COVID Recovery’ service forms part of NHS plans to expand access to COVID-19 rehabilitation treatments for those who have survived the virus but still have problems with breathing, mental health problems or other complications. Following a face-to-face assessment with their local rehabilitation team, those who need it will be offered a personalised package of online-based aftercare lasting up to 12 weeks. The advice section of the website launched in July – it is available to all and will be continually updated. The personalised support packages are in development and will be made available later in the summer.

New infection prevention and control guidance 

Public Health England has published updated infection prevention and control (IPC) guidance. The guidance applies to all healthcare settings and supersedes previous guidance. It takes account of increasing experience and knowledge in managing COVID-19 and is based on the best available global evidence. The guidance has been updated to help you to assess how settings can be classified by risk with appropriate infection prevention and control measures.

New approach to containing local COVID-19 outbreaks

New powers have been given to local and national government to help them prevent the spread of COVID-19. Regulations that came into force on Saturday 18 July permit the closure of outdoor spaces and the premises of businesses as well as restrictions on events and public gatherings. The regulations are accompanied by the COVID-19 Contain Framework, which the Department for Health and Social Care describes as ‘the blueprint’ for how the NHS Test and Trace programme is working in partnership with local areas to take action against outbreaks.

Primary care networks and care homes

The COVID-19 pandemic has brought into sharp focus how important it is for primary care network teams to be well organised and support care home residents and staff. The NHS Confederation’s PCN Network’s new briefing explores pharmacy’s role in PCN multidisciplinary teams supporting care homes, including case studies, top tips and where to go for support.

Government announces ‘most comprehensive flu programme in UK history’

The Department of Health and Social Care has announced that the free flu vaccination programme is being extended this year to children in their first year at secondary school, people living in households with someone on the shielded patient list and 50 to 64 year olds. All frontline health and social care workers will also be urged to get their free vaccine to protect themselves and their patients or residents from the flu. Publicity resources targeting this group will be available on PHE’s Campaign Resource Centre later this month.

Better Care Fund (BCF) team expands its support offer to systems

The BCF team has expanded its programme of support to systems in response to the COVID-19 pandemic. Building on their ongoing offer of bespoke support, the team is working with the Local Government Association (LGA) to provide a range of opportunities for systems to identify and continue the good practice which came about in response to the pandemic, while targeting support in areas which have been experiencing challenges or wish to accelerate their BCF and integration ambitions. Support is delivered at no cost to local systems by the LGA working with partners within the BCF team and using a pool of peers and consultants with lived experience and expertise. Further information is available on the Better Care Exchange, where you can also find COVID-19 discharge and social care related content, alongside registration details for webinars and virtual clinics. Register for access by emailing Better Care Exchange.

Availability of pulse oximeters for use with people at home and in care homes  

NHS England and NHS Improvement has purchased a limited supply of pulse oximeters that can be transferred to CCGs free of charge, where there is an urgent local need such as increased COVID-19 infection rates. CCGs will need to provide assurance that oximeters will be used under general practice supervision and that people at greatest risk of COVID-19 will be prioritised and supported. CCGs are expected to make reasonable efforts to reallocate oximeters if required and provide information to help improve future oximeter use.  For more information and to submit a request, please email england.home@nhs.net. General practice colleagues have been advised to contact CCGs if there is an urgent need of which their CCG is not already aware. Guidance is available on the use of pulse oximetry to detect early deterioration of patients with COVID-19 in primary and community care settings.

Rapid reviews of collaborative COVID-19 working

The Care Quality Commission has begun working with Sustainability and Transformation Partnerships and Integrated Care Systems to understand how partnership working that began during the pandemic can be used to drive future improvements. The rapid reviews will support providers across systems by sharing learning, helping to drive improvements and prepare for future pressures on local health and care systems. A key focus of the reviews will be understanding the journey for people with and without coronavirus across health and social care providers – especially among the over-65 population group. Read more here.

More time to have your say - involving patients in patient safety

As a result of COVID-19, NHS England and NHS Improvement has extended its consultation about involving patients in patient safety. Respondents now have until Sunday 18 October to comment on a framework setting out how NHS organisations could support patients, their families and carers to be directly involved in their own or their loved one’s safety. The draft document also outlines how organisations could involve patients, carers, family members and other members of public in wider governance of safety activities. View the draft framework and access the consultation here.

Care Quality Commission and Getting it Right First Time (GIRFT) programme announce closer cooperation

CQC and the GIRFT programme have published an agreement setting out how they will work together to safeguard the wellbeing of people receiving health and social care. Among other things, the Memorandum of Understanding confirms that CQC and GIRFT will liaise closely where providers are failing to implement action plans in response to GIRFT reviews. The NHS GIRFT programme exists to improve care by reducing unwarranted variations. In 2016, DHSC announced that it would receive an additional £60 million funding to expand and accelerate delivery. The programme is a partnership between NHS England and NHS Improvement and the NHS Royal National Orthopaedic Hospital Trust, which first piloted the GIRFT approach.

Changes to COVID-19 weekend data collections

Weekend data collections ended on Saturday 8 August following the decision to move the NHS EPRR incident level from Level 4 (national) to Level 3 (regional). The data collection system still opens for submissions during the weekend - but it now remains open until Monday lunchtime. As a result, organisations can choose to continue to upload their data daily or submit three days' worth of data on Monday. The reporting of deaths remains unchanged and will continue daily. Read more here.

Call for evidence: reducing bureaucracy in the health and social care system

The Department for Health and Social Care wants English health and social care employees to share their experiences of overly burdensome or dysfunctional bureaucracy. Responses will be used alongside other sources, such as meetings, interviews, research reports and academic literature, to:

• build an up-to-date picture of the most common bureaucratic burdens experienced by those providing care directly, as well as managerial and administrative staff in the NHS, public health and social care sectors
• inform action by government and relevant arm’s length bodies to change processes, rules and regulations, including through planned reform of professional regulation, where there are existing powers to do so in the short-medium term

The deadline for responding is Sunday 13 September 2020. Read more here.

NHS Volunteer Responder programme updates

Webinars are being held to provide regular updates on the NHS Volunteer Responder programme for referrers and colleagues working across health and care. They 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.

• Thursday 17 September, 11am - 12pm
• Thursday 1 October, 11am - 12pm

Case Studies

Hospital care at home

The COVID-19 response in Lambeth and Southwark has been made easier thanks to the @Home service offered by the local hospital trust. Badged as ‘bringing hospital care to your home’, the service offered by Guy’s and St Thomas’ NHS Foundation Trust (GSTT) provides a wealth of support at the patient’s usual place of residence. The care is delivered by a multi-disciplinary team of nurses, nursing assistants, pharmacists, physiotherapists, occupational therapists and social workers. Referrals come from GPs, care homes, district nurses and community matrons, the ambulance service, NHS 111 and the hospitals themselves. The sister service of @Home – known as pal@home - provides an out-of-hours palliative nursing care service for patients who prefer to receive end-of-life care in their own home.

Call out for discharge to assess case studies

NHS England and NHS Improvement are looking to build a library of national case studies which reflect the work being undertaken around the foundations of discharge to assess and high impact changes. If your organisation has been implementing initiatives in any of the following areas, we would love for you to get in touch and share your work:

• Foundations - Front door team, frailty service, Early identification of issues on admission, Minimal functional assessments of transfers and walking, the four questions, medication
• High impact changes - Early discharge planning, Monitoring and responding to system demand and capacity,  MDT working, Flexible working patterns, Engagement and Choice

Get in touch by emailing our team.

Resources and useful links

Video consultation advice for Wound Care Services

NHS England and NHS Improvement hosted a webinar about remote wound care consultations in July. You can view the presentation slides on the Future NHS online platform. Hosted by the Community Health Improvement team, the event included presentations from Dr Una Adderley from the National Wound Care Strategy Programme and Dr Leanne Atkin from Mid Yorkshire Hospitals NHS Trust. To view the slides, visit the Future NHS website then search for the Community Services and Ageing Well workspace. If you are not a member of the workspace, you can register by emailing ageing-manager@future.nhs.uk

Conference – ‘Reset, not restart: shaping the future of social care in light of COVID-19’

You can watch a recording of this virtual conference here. Speakers included Minister of State for Care Helen Whately , ADASS president James Bullion and Anna Severwright, the co-chair of the Coalition for Collaborative Care.