Advice on care home visits and further support

This story was published 19 September 2020

Our Director of Health and Adult Services, Richard Webb, has written to all care providers to update them in the light of rising Covid-19 infection rates across the county.

In particular, he has asked care homes within the Harrogate, Scarborough and Selby district areas to restrict visiting with immediate effect. This request will be reviewed again on 30 September. Visiting arrangements for people who are, sadly, nearing the end of their lives will not change, but providers should ensure that they do so in a Covid-secure way.

A task group, including representatives from care providers, care home residents and relatives, is to be established to see if there is a better way, longer-term, to continue Covid-secure visits to homes.

The letter also updates providers about PPE, funding and further support that is available.

Our letter to all care providers

Dear colleagues,

As you will be aware, there has been a significant rise in Covid-19 infection rates in our communities over the last fortnight. We have seen the same in our care homes. Many of the infections are being experienced by care home staff members rather than residents and have been acquired, in the main, through either community or household transmission. Most of these new cases have been identified through whole home testing. There is a particular concern in the districts of Selby (including Selby town, Sherburn, Tadcaster and surrounding areas), Scarborough (including Scarborough town, Whitby and Filey and the surrounding areas), and Harrogate (including Harrogate town, Ripon, Knaresborough, Boroughbridge and surrounding areas), where there are increased numbers of positive cases in care homes, alongside higher levels of community transmission. As a result, and in line with the current guidance for visiting in care homes, we have made the decision that all care homes in these three districts should cease routine visiting immediately. This decision will be reviewed from 30 September 2020 and every seven days and an update will be provided. 

As of this week, the North Yorkshire Local Resilience Forum, which is the body that brings together councils, the NHS, Police and other emergency services across North Yorkshire and York to oversee emergency planning, has reverted to full emergency response mode. This decision is in response to the increasing infection rates and in the context of serious problems with the national testing programme which mean that, although we have testing/swabbing kits available in the County, there is not enough laboratory capacity to provide test results in a timely way. 

As a consequence of the rising infection rates, I wanted to highlight some new asks of the whole care sector. In doing so, I am very mindful of the huge team effort, and all the sacrifices, colleagues have made over the past six months.

Care home and extra care visiting  

We know the restrictions on visiting have been very difficult and we are conscious of the balancing act between protecting people from Covid and supporting their emotional wellbeing through regular contact with friends and family. 

We are now asking all care homes and extra care and supported living schemes within the Harrogate, Scarborough and Selby districts (as described above and as defined as the district council boundaries) to restrict visits with immediate effect, except for people who are at the end of their lives and for health and social care practitioner visits. This decision will be reviewed on a weekly basis with the first review date being 30 September 2020. As part of the review of visiting, we will look at the potential for smaller geographies to be subject to restrictions, as well as a relaxation of the restrictions to visiting in general (or instance, re-introducing window or garden visits only).

Outside of these three named districts, we would ask providers to continue to work on a risk-assessed basis and to always ensure that visiting arrangements are Covid-secure – for example, with limitations to numbers in the building, good access to sanitiser and hand-washing and the wearing of face masks at all times when indoors Where visits are restricted, we would ask you to make every effort to support virtual contact. It is important that people are able to see those friends and family members who are important to them, even if this is not in person.

In addition, I have asked officers here to organise a joint task/reference group with representatives of care providers and residents from different types of care setting to see if we can identify a more satisfactory approach that keeps people safe and keeps them connected with the people who are most important to them.

We want to ensure people who are at the end of their lives, and their loved ones, are treated with compassion. We are confident that with appropriate risk assessment, a flexible approach can be used to allow people to be together at end of life. If you need any additional support with to do so, please do not hesitate to contact the care home support team. Covid-secure visits to people at the end of their lives will continue, even in the three named districts.

Our care workforce

Working in care is a vocation. Our 17,000 care workers across the County have shown huge dedication over the past few months and many have made significant personal sacrifices to support people in their care. 

All of us working within the care sector are now being asked to show extra restraint and caution and to take additional actions above and beyond those required nationally to keep care settings safe. For all of us, this means limiting our social contacts, keeping to the Rule of Six, avoiding events that involve more than 30 people, wearing facemasks in indoor public spaces and in crowded outdoor spaces (especially in those areas where infection rates are at their highest).

We would ask providers to remain vigilant around practice within the home, particularly around staff breaks. Where we do have outbreaks, there have been some instances where we can link this to poor compliance with PPE guidance and to certain behaviours around staff breaks (for example, shared use of smoking shelters). Can we also ask you to share with teams the need for them to socialise safely outside of work? Some outbreaks in care homes in the county are linked to socialising outside of work. Whilst we appreciate team members will want to socialise outside of work, they need to exercise caution and follow the current Government guidelines in order to protect themselves, their families and the people they work with. We will be using upcoming webinars to discuss our approach to supporting providers with their assurance processes around PPE compliance, staff co-horting arrangements and visiting.

Funding

We welcome the news that the Government is planning to extend the Infection Prevention Control Fund. Most providers in North Yorkshire have taken up, and received, the first and second tranches of this funding and, once we have received the revised guidance, we will work with you to make sure funding gets to you as soon as possible. The County Council has continued to make additional Covid payments to provider colleagues during the pandemic.

PPE

We understand providers are all now able to access free PPE via the National Portal. The Department of Health and Social Care are considering increasing order limits and working to add other PPE items to the Portal to meet all of the Covid-19 PPE needs of all sectors. 

If you do encounter any problems with PPE, please use your daily contact routes with the County Council, either the daily call or the survey, to inform us of any issues with PPE. Alternatively, you can contact the North Yorkshire care home support team via the email in the next section of this letter. We will then provide support for you to obtain appropriate supplies of PPE.

Regular contact with the council

During the height of lockdown, we put in place daily calls with all care settings. Since August, we have continued these calls on a risk-assessed basis. As from Monday, we will begin to step up daily calls with all care homes and extra care schemes in the Scarborough and Selby districts and we will phase in a similar approach within the Harrogate district. We will review this approach regularly according to infection levels and care home outbreaks.

A further series of webinars are also being organised, with practical advice on issues such as infection control and PPE.

I am also going to be available every Wednesday from 5pm – 6pm for a NYCareConnected webinar, open to all care providers in the county.

In the meantime, if you have any concerns or queries, please contact us by email.

Thank you, once again, for all of your incredible work to keep people safe and well in North Yorkshire.

Best wishes

Richard Webb   

Corporate Director Health and Adult Services