COVID-19 Update 26

Trust Status Update: Second Lockdown

Introduction

I write today after our first day of the second national lockdown, implemented to ensure that rising case numbers of COVID-19 do not overwhelm our health services. Although we do not offer acute physical health services, we play a key part in our health system and have not been immune to significant rising additional cases in our service users and our staff. In this respect, the last week has without doubt been the most difficult week operationally that we have had in Combined Healthcare for a very long time. I would like to start by saying how hugely grateful all the senior team is across Combined, for the hard work, professionalism and flexibility our staff are showing at this time. You should be incredibly proud.

You may have already seen the video message this week from our Chief Executive, Peter Axon, setting out the fundamentals of what this means for us as staff and a Trust. If you haven't already seen it, you can watch it via this link.

We have always been entirely transparent about the status of the Trust and how our services have been affected by COVID-19. We currently have active outbreaks of COVID-19 in Harplands Hospital on Wards 4, 6 and 7 and Ward 2 is open but in a period of monitoring following a previous outbreak. This has impacted on staffing levels as a number of staff are either symptomatic or isolating. To maintain staffing levels in our inpatient areas we are asking staff across our wider services, who have appropriate skills, to support our staff on inpatient areas by undertaking shifts where possible. This can be in an area that is not affected by COVID and still makes a significant difference to the staffing levels and safety of our services. If you are able to support our inpatient services by undertaking some shifts, please contact the temporary staffing team via erostering.tempstaffing@combined.nhs.uk or 01782 441600 Extn 4683.

Despite all of this, I also know that the majority of our staff who work in our community based services continue to do a fabulous job in keeping the majority of our patients, who never require inpatient care, safe and well. Thank you and please keep going.

As is normal practice in responding to such situations, we have now stood up our Incident Control Room to operate seven days a week once again. This is being staffed every day including weekends by a member of my team – either myself, my Deputy or one of the Associate Directors - so there is always a very senior member of staff on site and readily available to help run the Trust and support staff. This will continue on a seven day basis throughout the winter period.  

There are some very important updates today about the practicalities of how we will work over the coming months, how we can all stay as safe as possible and the care we need to take for one another in respect of our health and wellbeing:

1. Working Arrangements – Lockdown 2 
2. PPE 
3. Health and Wellbeing Support

You can continue to ask questions relating this communication or to COVID-19 via email and the best way of contacting the Incident Control Room is via covid.questions@combined.nhs.uk – we continue to endeavour to answer within 24 hours of receiving a each email.

Jonathan

Working arrangements - Lockdown 2

I have been asked many questions over the past week about how the Tier 3 restrictions or Lockdown 2 will impact on our working practices and what staff should do differently. The simple answer is nothing and there is a very clear reason for this which I will explain. When we designed our six point plan in late summer about how we were going to work over winter, we were very aware the situation would likely change. We therefore designed our guidance for how staff should work with this in mind, to ensure consistency of messages and to reduce any confusion for staff. The guidance below remains fully compliant with government guidance despite the fact we have entered Lockdown 2 and has not changed. Please remind yourself and your colleagues about this and ensure you are working to this. It will keep you safe whilst allowing us to continue to provide effective care.

1. In person face-to-face assessments and care can be undertaken in community facilities for all service users when required. This includes urgent and routine cases of all ages where a physical face-to-face consultation would be preferential to a digital one. Digital video contact still remains our default preferred option if this method allows a safe level of assessment and effective care to be provided. When seeing service users in person, staff should adhere to social distancing guidance and utilise PPE in line with guidance on the COVID intranet page. PPE is available in all community sites.
2. Staff can use community facilities to work, providing risk assessments are completed for the premises and staff. Your team leaders and service managers will be able to inform you when this is complete. All staff should continue to adhere to social distancing guidance (2 metres) and utilise PPE (in particular, a face mask).
3. Continuing to work from home remains a perfectly good option for the many of our staff and we would encourage staff to continue to do so where possible. This will continue to be agreed through line management structures and personal plans. It will facilitate social distancing within sites via fewer staff being present at once. Arrangements for the number of staff in individual sites at one time have been agreed and signage distributed to all sites to make this clear.
4. All teams categorised patients using a risk-based approach during the initial wave of the pandemic and continue to do so. It is expected that all patients categorised as highest risk continue to receive face-to-face reviews and interventions and this can be done via either digital means or in person.
5. The Trust is recommending that all clinicians consider the impact of COVID-19 and lockdown in all assessments and reviews. Clinicians are encouraged to openly discuss such issues with service users under their care, recognising that recent events will have affected the lives and the mental health of many of our service users.
6. All discharges from inpatient care should be made using a CPA approach in line with Trust policy on care plans and fully involve home treatment and community teams as required. In particular, wards are asked to ensure community teams and families and carers are involved in all discharge plans to ensure safety of transition.

PPE

I am acutely aware that wearing face masks for long periods of time can be uncomfortable, so taking regular breaks (outside or on your own) to remove the mask is encouraged where possible. It is also important to remain well hydrated and nourished and removing your mask to enable you to eat and drink is, of course, also fine.

Health and Wellbeing Support

We have all learnt much since March about the practical realities of working from home, as well as the personal challenges it can pose for individuals. 

Support is available to you through our Health & Wellbeing Services, Occupational Health (Team Prevent), Staff Support & Counselling Service (Tel: 0300 124 0104), in addition to your line manager. 

Reinforcing the message from Peter, I would really like to emphasise to you all the full range of health and wellbeing resources we have available for all our staff, as well as the wider range of methods we have for anyone to raise and questions or concerns - completely confidentially if necessary.

Our core message to everyone during these challenging times is simple - you are not alone and we are here to help and support you in whatever way you need.

In particular:

• there are a full range of health and wellbeing advice, resources, tools and tips available for free to you via the Health and Wellbeing pages on our website;
• if you have a practical question or wish to raise an issue about specific working arrangements, you can speak to your Line Manager or send an e-mail to the dedicated Covid-19 e-mail address;
• if you have any concerns at all for your own wellbeing or need to speak to someone, confidentially if necessary, you can access either the national confidential NHS staff support helpline or our own staff counselling services via the numbers on our Speak to Someone webpage;
• If you have any concerns about safety or working practices and you wish to raise them confidentially, you can either contact our Freedom To Speak Up Guardian or directly and entirely confidentially with myself via the Dear Peter website