Providers should share staff and get cashflow support from councils to tackle coronavirus impact

By Charlotte Carter and Mithran Samuel (story updated 16 March 2020)

Care providers would share staff and get support with their cashflow from councils, according to guidance issued by government and sector leaders to manage the impact of coronavirus (Covid-19).

Councils were tasked with drawing up plans for home care, care home and supported living providers to work together, including by sharing staff, in guidance for each of the three service types published on Friday (13 March) by the Department of Health and Social Care.

Meanwhile, local authorities were also urged to help providers manage cashflow challenges created by the impact of the virus on their services and workforce, in separate guidance issued by the Local Government Association, Association of Directors of Adult Social Services and Care Provider Alliance.

The organisations said the support should be funded by each council’s share of the £5bn announced in last week’s Budget.

Following the publication of the guidance, the Care Quality Commission announced it would suspend routine inspections of social care and health services from 16 March.

Mutual aid

The government guidance is designed to help councils, providers and the NHS manage the impact of widespread transmission of Covid-19 among people receiving care, who are at particular risk from the disease, and the staff who support them.

It said that councils should contact providers to establish plans for ‘mutual aid’, which must include provision for people who fund their own care. This may include staff being redeployed from one service to another in the event of a provider being particularly affected by workforce shortages.

The guidance also said care homes should review their visiting policies to ensure that no one with suspected Covid-19 or who is generally unwell visits their premises, while recognising the positive impact of seeing family or friends for relatives.

However, some providers have gone further in restricting visits. HC-One has stopped ‘non-essential’ visits to its homes, including routine visits from family or friends, Barchester Healthcare have asked people to minimise visits to loved-ones, and cancelled visits from the local community.

Isolation in rooms

The government said care homes should isolate residents in their rooms if they’re showing symptoms of Covid-19 and care workers should be given personal protective equipment (PPE) to minimise the risk of transmission. Supported living and home care workers should also have access to PPE which should be used when visiting anyone showing symptom.

Care providers will be able to access some free PPE through the pandemic influenza stockpile, with new kit used for each episode of care.

For staff, the general advice on self-isolating themselves for seven days if they have the symptoms of Covid-19 – a higher temperature or persistent cough – applies.

The government will also repay businesses with fewer than 250 staff – including care providers – with up to two weeks’ statutory sick pay (SSP) per eligible employee. Under the emergency legislation being introduced this week to tackle Covid-19, SSP will be available from day one for people diagnosed with the virus or who are self-isolating in line with government guidance, rather than day four, as at present.

However, there are concerns that many care workers – particularly those on zero-hours contracts in home care – will not qualify for SSP because their irregular hours they do not earn the required £118 a week. MPs have written to health and social care secretary Matt Hancock to guarantee sick pay for social care staff forced to take time off work because of Covid-19 (source, The Guardian).

Cost of staff sickness

In addition, the LGA, ADASS and CPA guidance pointed out that the compensation for SSP would not apply to bigger providers (those with 250 or more staff) and,  with all providers having to backfill sickness absence to ensure continuity of care, staff sickness would represent a significant cost to services.

“Commissioners can mitigate this through funding these extra costs, either through a lump sum or through increasing the fee rate,” said the guidance. “They can assist with cashflow by agreeing a reasonable amount based on an assumed average sickness absence rate and paying upfront, rather than awaiting detailed records of actual sickness taken and backfill provided and agree reasonable and proportionate ways of later reconciliation.”

This was one of a number of ways in which the guidance advised commissioners to help providers deal with the impact of the virus, drawing on local authorities’ share of the £5bn emergency set aside by the government for tackling the impact of the virus. Other measures included:

• Helping providers fund agency staff costs to cover staff absences.
• Relaxing contracts to allow providers to hire staff without a full DBS check but after potential workers had had a DBS Adult First check, under which their name is checked against the list of those barred from working with vulnerable adults.
• Supporting providers’ cashflow by paying for the planned amount of care delivered, even if the actual volume of care provided is less.
• Agreeing with home care providers policies enabling them to adjust care packages without commissioner authorisation in response to changing needs and to minimise infection risks.
• Funding the provision of PPE for providers.

The pieces of guidance were published before Hancock announced that the government would “in the coming weeks” announce measures for older and vulnerable people to self-isolate for up to four months (source, Sky News).

Suspension of inspections

Meanwhile, the CQC said it would stop routine inspections – only visiting services in rare cases when inspectors had concerns about harm to service users – for the duration of the Covid-19 pandemic. When physical inspections are required it anticipates contacting the provider in advance.

The regulator said providers should notify it within 24 hours of any suspected or known case of Covid-19 among service users, staff, volunteers or visitors, including suppliers.

It also said it would be providing more support to registered managers during the pandemic, including by reducing reporting burdens. Social care providers will still be required to send CQC provider information returns, containing information about their services, but will not penalise them for sending these in late. It will also share information from the returns with local authorities and clinical commissioning groups, so that commissioners do not also ask for the same details from the provider.