A well-established culture of partnership working has been bolstered to support and protect residents and staff in care homes.
There are 80 older adult care homes in Lanarkshire, the majority of which are owned by independent sector providers. Although the sector has exhibited remarkable resilience in coping with Covid-19, the pandemic has, and continues to pose, significant challenges to some homes in the area.
NHS Lanarkshire, along with North and South Lanarkshire Health and Social Care Partnerships (HSCPs), continues to work closely with all care homes and a range of supports has been enhanced to further strengthen preventative measures – and the management of outbreaks when they occur. Crucially, this has included shoring up robust lines of communication between all partners.
Gabe Docherty, director of public health in NHS Lanarkshire explained: “The care home sector has been routinely involved in engagement with health and social care partners.
“The challenges presented by Covid-19 has, however, seen us step up that approach. This includes a programme of supportive discussions involving care home management, care home liaison, infection prevention and control nurses, HSCP staff and the Care Inspectorate.
“This engagement helps to identify what is working well in the home and identify areas where further support from across the partnership would be beneficial.”
Mr Docherty continued: “Health and Social Care Partnerships have also established weekly multi-agency conference calls with homes in North and South Lanarkshire.
“The conference call provides the opportunity to share and update information and signpost providers to emerging guidance and reporting requirements.
“Care home providers, in turn, can run through any issues they have regarding the impact of Covid-19 and pressures they are experiencing. This is assisting to develop a shared understanding of the care home sector and, importantly, where particular support may be required.
“This dialogue also provides care homes with the opportunity to share examples of learning and collaborative working, highlighting a range of positive and innovative activities care home staff are undertaking to support residents.”
More formal arrangements of buddying between geographically close establishments can be introduced through these calls.
Feedback from the care homes indicates the partnership collaboration has been highly beneficial.
An additional variety of measures, detailed below, are being applied to engage, support and protect care home residents and staff in Lanarkshire.
Mr Docherty added: “It is recognised that this has been a difficult time for care home residents, their families and friends and members of staff.
“In response to this unprecedented challenge, as well as enhanced communication, a number of key actions have been taken to strengthen the management and oversight of care home outbreaks, enhancing supports offered routinely to the sector.
“The implementation of these actions demonstrates the commitment of all key agencies and care homes working together, with a unified aim of protecting life and supporting frontline staff.”
Measures to engage, support and protect care home residents and staff include:
Personal Protective Equipment (PPE): The director of public health in NHS Lanarkshire recently recommended all care homes in the area implement the universal use of PPE, as per ‘Table Four’ of the national guidance, set down by Public Health Scotland. In essence, this means gloves, aprons and fluid resistant surgical masks (FRSMs) are used for all direct resident care (within two metres) whether the individual is symptomatic or not. Eye protection is also being used where necessary, based on risk assessment.
Testing: NHS Lanarkshire is managing the testing programme for care homes with outbreaks in line with public health principles, Scottish Government expanded testing guidance and Public Health Scotland guidance. Given the number of care homes in Lanarkshire, we have agreed local prioritisation for testing so that we are able to test all residents and staff, in a timely way, where this is of most benefit. Our testing programme is being delivered in a proportionate, planned and co-ordinated way to ensure safety isn’t compromised and stability of the care home sector is maintained. Expanded testing began in Lanarkshire following the First Minister’s announcement on 1 May in care homes where there is evidence of a new outbreak of infection, in order to detect positive cases early. This means all residents and staff are tested, subject to consent, whether or not they are symptomatic.
Where a care home with an outbreak is part of a group or chain and staff may still be moving between homes, we will investigate whether testing is required in any of these linked homes. We are working to further develop the infrastructure to increase our capacity to test more care homes going forward, in a planned and prioritised way, including prospective screening in care homes with no Covid-19 cases or outbreak. Staff across care homes who have symptoms of Covid-19 have also been offered full access to staff testing via NHS Lanarkshire’s occupational health and the Glasgow Airport drive-through arrangement.
Increased clinical support to care homes: Medical cover has been provided largely by local GPs under contract arrangements. In light of changing clinical demands, Hospital at Home – a multi-disciplinary care team – provides hospital level care to frail, older people in their own homes and are now providing support to all care homes in Lanarkshire. There is also support from the pharmacy service that extends to the availability and management of medications.
Support to staff: It is fully recognised that this is a very difficult time for staff within care homes. NHS Lanarkshire’s care home liaison service (CHL Service) assists with a wide variety of supports and education, with the service now extended to seven-day cover over the area. Recent developments have included advice on how to set up ‘Take Five’, where staff can take some time out from ongoing pressures. NHS Lanarkshire and partners have also identified the need to support the sector in relation to supporting workforce issues, particularly nursing cover, which is being facilitated where needed.
Management of outbreaks: NHS Lanarkshire’s health protection team continues to manage care home outbreaks using well-established procedures. The health protection team provides advice and support to care homes, in line with national guidance, on key issues such as infection prevention and control and use of PPE.
