The writing was on the wall when it came to COVID-19: following the outbreaks of SARS and MERS, both related to COVID-19, it is fair to say the scene was set for the day when a more transmissible strain of this group of viruses would spread around the globe and affect individuals in our communities causing widespread illness at all levels of society.
It is a reality of these diseases that they will disproportionately affect the most vulnerable and frail people, including care home residents and other elderly people.
Government, regulators, care providers and the wider health and social care sector have been planning for this event for many years, and the implementation of those plans appear to have enabled the situation in the UK to be managed so as not to overwhelm the NHS. Nonetheless, the unprecedented scale with which the COVID-19 pandemic has reached presents care providers with challenges that require swift decision making that can have implications for the ongoing success of the service they provide.
From speaking to clients, recurring themes that are proving to be challenges above and beyond those encountered in the normal course of delivering care services as part of their businesses include:
- Pressure from local authorities and NHS organisations to accept new, temporary or returning residents as the health service attempts to increase bed capacity;
- Accommodating residents who require isolation or segregation as a result of having been exposed to, suffering or recovering from COVID-19;
- Expectation to take on duties and roles not typically the domain of care providers;
- Concern over workforce health and supporting care staff to continue to provide quality standards of care; and
- Securing and maintaining supplies (in particular PPE) and other procurement and supply chain issues.
In rising to the challenges COVID-19 presents, care providers are required to strike the right balance between cooperating with local authorities and NHS organisations; stretching resources to go that little bit further to keep up with increased demand and protecting the interests of the organisation (such as carrying on ‘normal service’, delivering person-centred care, treating residents with dignity and respect, complying with its duties and obligations to stakeholders, protecting staff and securing the future success of the business). When evaluating where the balance should sit, and developing a response, decision makers should consider:
1. Escalating decision making up the organisational hierarchy early
Escalation to senior management and those who will ultimately be accountable for the outcomes the organisation reaches at an early stage gives greater oversight of the operation of the business as a whole and allows resources and assets not ordinarily available to be mobilised to meet heightened demand.
2. Have regard to existing business plans, risk management and business continuity strategies
Looking to business plans will assist in identifying where additional financial resources and reserves can be drawn from. Looking to existing plans developed internally to mitigate risk and identify areas of weakness within the organisation can provide invaluable guidance to dealing with the challenges COVID-19 presents, and establishing just how far the organisation can stretch. This remains the case even in circumstances that are outside or exceed what has been contemplated as reasonable risk in the past: there is little benefit to re-inventing the wheel.
3. Ensure compliance with legal obligations
Observance of applicable laws at all times is an imperative. Legal obligations that should remain in the mind’s eye of care providers at the moment include health and safety, safeguarding, data protection and information governance.
Both the Care Quality Commission (CQC) and the Regulator of Social Housing (RSH) have indicated that they will have regard to the current circumstances, and act in a proportionate manner when dealing with registrants, however, their expectations are clear that RPs and care provider will continue to meet their regulatory obligations.
CQC has indicated it is unable to relax the regulatory framework. However, in order to provide some relief to care providers it has issued guidance on how it is assisting care providers during this period. The requirement to deliver provider information returns has been suspended for the time being.
Care homes are asked to provide information through the NHS Capacity Tracker and homecare services are asked to complete the new form ‘Update CQC on the impact of coronavirus (COVID-19)’ on a daily basis. Reporting of serious injuries or specific incidents and responding to preliminary reports should continue to be followed (but extension may be available on request and local offices should respond in a proportionate manner when dealing with care providers).
No timeframe has been given for how long these measures will apply, however, CQC’s website is regularly updated. Similarly the RSH has introduced measures to relieve the regulatory burden on RPs including pausing IDAs for the foreseeable future and extended the submission deadline for SDR and LADR to 31 October. Submission of FFRs has also been delayed to later this year. No action will be taken where submission of accounts is delayed by up to 3 months for returns due up to 30 September 2020 and Financial Viability Assessments submission deadlines has been extended to 31 December 2020.
RPs with more than 1000 units, some RPs with over 500 units and/ or high proportion of care/ support and stock holding Local Authorities are required to complete the ‘Coronavirus Operational Response Survey’ on a monthly basis, and smaller RPs are encouraged to contact the RSH urgently where they are being overwhelmed due to COVID-19. It too is regularly updating its website with further measures to relieve the burden on RPs.
4. Record actions taken through reporting procedures
Keeping a clear record of what actions are taken, who was involved, the processes followed and outcome achieved will enable management to report up the organisational structure, ultimately to the board, on the response and performance of the business to current pressures.
Detailed contemporaneous records will be an invaluable resource to those looking to the future and planning how the organisation will respond to the next pandemic.
For more information in relation to this article or other governance issues, please contact Christian Barnes.