Government proposals to ban staff from moving between care homes to stop the spread of coronavirus are “ill-thought-out” and will be hard to implement, a provider body has warned.
The National Care Forum, which represents not-for-profit providers, said the plan failed to take into account the significant staffing and financial pressures and the “potentially devastating” impacts on workers’ circumstances of the policyc.
The Department of Health and Social Care (DHSC) proposals would prevent Care Quality Commission-registered care homes from using staff to deliver personal or nursing care who had delivered such care in any other regulated health or social care setting in the previous 14 days. Providers would be exempt from the ban in circumstances, where they would otherwise have unsafe staffing levels in a particular service, but only for a reasonable period to enable them to comply and only if they had adequately planned their staffing requirements
The government has allowed one week for responses to the plan, which would apply to bank and agency staff, but not registered managers, with its consultation closing on 23 November.
Staff movement a factor behind infection
The temporary ban, which would be imposed through changes to regulations governing the work of regulated providers, would put into law existing government policy to control coronavirus in care homes.
A government-commissioned study, published in July, indicated one of the common factors in care homes with higher levels of infection among staff was the extent to which those homes employed staff who worked across multiple sites.
The two rounds of the DHSC’s infection control fund, worth £1.15bn and mostly targeted at care homes, have been designed in part to enable providers to limit staff movement unless absolutely necessary, by recruiting more workers, paying overtime or compensating staff for lost income. Councils, who receive the grant, must ensure providers are limiting staff movement as a condition of passing on the money.
However, Vic Rayner, executive director of the NCF, said that the ICF “vastly underestimates the costs that providers already incur, before adding on a meaningful compensatory mechanism to address shortfalls in workers’ incomes”.
The scale of the pressures on providers was set out this week by an NCF survey looking at how services were managing the impact of Covid-19 through October.
‘Penalising low-paid workers’
Respondents, who collective operate 1,240 services, reported average staff vacancies of 10% and staff absence rates of 7%, and said that 9% of their staff currently worked in other health and social care settings.
The NCF said that care workers were “already low paid with limited terms and conditions and any measure that sets to penalise care workers fails to understand the seriousness of the issue”.
Other pressures identified by the survey included the impact on homes of reduced occupancy – currently standing at 85%, compared with an 89%-90% average in 2019 – and the costs of purchasing personal protective equipment (PPE) and facilitating visits to residents.
Despite the government announcing through its adult social care winter plan that providers would be able to access the additional PPE they required to manage Covid-19 for free, the portal through which it was being made available was only meeting half of providers’ needs on average.
Also, providers were spending £4,000 per care home to make visits by family members and friends possible, which the ICF was not sufficient to help cover.
‘Significant staffing and financial pressures’
Rayner added: “In the midst of the very significant staffing and financial pressures around delivering care in the midst of a pandemic, managers will be expected to negotiate with staff around critical issues which could have potentially devastating impacts on an individual’s personal circumstance.”
Rayner said that rather than seeking to regulate to reduce staff movement at short notice in the middle of a pandemic, the approach needs to be more supportive and practical.
“Simply legislating against staff movement does nothing to solve the fundamental issues of recruitment, retention, high turnover rates and competition from other sectors,” she added.
UNISON assistant general secretary Christina McAnea said that ministers and providers needed to ensure that care staff did not see cuts in pay as a result of the change.
“This might mean using the infection control fund to pay people for the hours and work they’ll soon need to forgo,” McAnea said.
“With vacancies so high across care, the sector can ill afford to lose anyone.”
Pilot testing care home visits launched
Meanwhile, a pilot for family members to get regular testing for care home visits has launched across 20 care homes in Hampshire, Cornwall and Devon.
Regular testing will be offered to one family member or friend per resident which will enable, where possible, indoor visits without a screen to take place. Visitors will be offered either PCR tests which they can do at home, or the new 30-minute rapid lateral flow tests (LFTs), which can be administered in person at care homes before a visit.
The pilot will be rolled out more widely in December.
In response to the pilot, the NCF said it welcomed the commitment but, in the light of the costs of facilitating visits identified in its survey, this was “an ambitious goal and one that urgently needs a clear, deliverable timetable with sufficient funding to support care providers to make meaningful visits a reality”.
Designated settings for Covid positive residents
Separately, councils, providers and the NHS are working to identify at least one care home in every local authority area to which people who have tested positive for coronavirus can be discharged to from hospital and cared for for the remainder of the required isolation period.
The Care Quality Commission (CQC) must first inspect the “designated setting” and ensure it meets the latest infection prevention control standards.
As per the new requirements, no one will be discharged into or back into a registered care home setting with a Covid-19 test result outstanding or without having been tested within 48 hours prior to their discharge.
A statement from the Association of Directors of Adult Social Services said the recognition that no one will be discharged from hospital without a Covid-19 test result is an important step towards protecting communities.
It added: “Local authorities NHS partners, local providers and DHSC are urgently working together to ensure that this policy can be implemented fairly and in the interests of all those involved. To make it work, we need to work through key issues including – ensuring timely access to PPE for disabled and older people, their families and carers, access to regular testing, the availability of local community healthcare support, and to sort out issues relating to indemnity insurance for social care providers.”
Weekly tests for home care staff
Amid the focus on controlling infections within care homes, the government has announced that weekly testing, already available to residential care staff, will be extended to home care workers from next week.
Registered home care providers will be sent details of how to apply for PCR testing kits next week, and will be responsible for ordering and distributing tests to their staff, for them to conduct at home on a weekly basis.
The service will be extended to live-in carers, personal assistants and carers working for unregistered organisations subsequently, and the government is exploring how lateral flow tests can be used by staff on a self-administration basis at home.