05 Aug Homecare v COVID – Where did it all go right?
The impact of COVID-19 on Care Homes across the UK and Ireland (as well as in many other parts of the world) has been cataclysmic. What is clear, as we move forward, the role of the ‘Carer’ in whatever setting has been finally seen as the vital and key cog within the wider health and social care system. The pandemic has brought at least some understanding, that the frontline, in this type of healthcare crisis, was not in the hospitals or indeed within primary care but in the community. Let’s not make the same mistake again.
However, as in all crisis, the things that go wrong get the oxygen and airtime. Seldom do we focus on the things that have been truly magnificent – other than the human stories of exemplar performance and bravery from the frontline heroes within the NHS and Independent Health and Social Care sector. Homecare as a pandemic performer has had a very different outcome as against our Care Home friends and colleagues. Our own business at Connected Health, a UK and all Ireland agency delivers over 2.5 million physical Care Visits per year – our trained Carers essentially deliver about 80% of a nurse’s function to older people and vulnerable adults in their own home. We employ over 800 staff and look after over 2,000 older people – we lost just three clients across the pandemic – all of which were hospital discharges to our care. Zero instance of Carer to Client transition. Just 7 positive COVID tests from over 80 symptomatic staff tests. 1 positive antibody test from over 60 tests conducted to date. The early data is persuasive but should not encourage complacency. Equally the role of Homecare in a second surge later in the year (which is coming like a inescapable freight train) is currently barely being discussed at policy or political levels as the most appropriate sword and shield of battle at the next stage of the pandemic. The lessons of success have not yet been fully considered.
So why did Homecare perform so well in this scenario? In particular in Ireland, North and South – critically in areas with two differing policy arenas with diverse political leadership – and perhaps what can be learned and applied in the UK from this rather unique experience. Some of the following points are most certainly conjecture – but conjecture based on first-hand data and experience.
- Homecare naturally lends itself to virus suppression. Lock down meant virtually zero footfall (other than carers) in and out of client’s homes. Compare this to Care Homes with communal areas, etc. Older people were often limited to their homes like never before – but the focus on reducing isolation, diverging from core care tasks (e.g. our staff delivered medication, groceries etc, meet and greet from a distance) meant a more appropriate function across the duration of lockdown.
- Physical visits were more limited or involved elements of digital monitoring and communication – at Connected Health we provide a menu of everything from Virtual Care to Clinical Grade Remote monitoring – it was robust, clever and efficient. We need to plot this care augmentation into the future delivery of care. Anything else is insanity.
- PPE: We built our own supply chain to allow the NHS time to catch up. We didn’t accept our staff need less protection than someone in a hospital ward.
- We didn’t allow COVID positive referrals to be ‘thrown’ back across the Acute wall and into virus free otherwise healthy care runs. We knew from an early point that would have horrendous consequences. Instead we created COVID dedicated teams to minimise transition and protect clients and staff. One didn’t need to be an advanced epidemiologist.
- Training, Training, Training. Our staff were trained and re-trained on a weekly basis on all aspects of infection control – we simplified the often conflicting advice from Public Health into understandable chunks as more began to be understood about transmission, the ever changing application of PPE etc.
- Homecare Visits are generally quite short – in NI over 50% of visits are 15 minutes or less. Although in normal times this is blatantly horrific from a ‘caring’ perspective the potential of the virus to infect, even while inside a clients home was more minimal. In a pandemic situation, further epidemiological research would be required to fully understand the transmission suppressant ability of this time issue.
- Staff who were symptomatic were immediately removed form runs and isolated for two weeks. In tandem we recruited over 150 new staff (all recruited and trained via remote digital technology) to ensure we had excess staff to cover absence. This zero-tolerance approach to staff isolation was often not possible across Care Homes – the staffing issue was systemic and pre-dated the challenges of COVID – so much so that we diverted significant care staff capacity into Care Homes – again whilst ensuring staff did not overlap across the two areas.
- Integrated Health and Social Care system – In NI and Ireland we ‘enjoy’ an integrated system of care. We do some things incredibly badly despite this integration. However, unlike the Councils in the UK we were able to access epidemiology, clinical and nursing advice on a real time basis. In the Councils where we are active in the UK the majority of Council leads in Homecare were either administrators or social workers (in normal scenarios this is obviously completely fine) – the ability to access infection control, PPE or epidemiology information was virtually zero. This is not to say staff were unsupportive – just unable to provide the necessary knowledge and leadership. Cutting and pasting outdated advice from PHE was a common occurrence. Inconsistency across Councils was another marked difference to the experience at NI and ROI level. The ability to maximise returns from a new enhanced tech enabled Homecare capacity with wider interactions with the health and social care fabric in the UK will be difficult to convert without some sort of additional integration or more robust referral mechanisms.
- Access to decision makers at policy and political level in NI and ROI was easier – largely centralised contacts were easier to access – a smaller pool was clearly advantageous and the responsiveness and decision making after some early difficulties was on the whole – solid. Credit should be given where it is due. Politicians, Senior Civil Servants and HSE/HSCT staff across Ireland, North and South were, in the main, decent and making every effort to tackle the virus ‘as a team’.
And so, as we march onwards in care most feel like we are on the verge of radical change. White papers that had started to turn brown with age, former change strategy documents now home to cobwebs and stale coffee stains are all the talk. However there remains one great, central problem. There are few, if anyone in a regional and central government with any experience of progressive Homecare delivery. In fact, is there anyone in the Public Sector today in any part of the UK and Ireland who has been out on a care run at 7am on a November morning. I would doubt it. In addition, is there anyone in the public sector who also understands the application of technology to augment or improve the health and wellbeing outcomes for older people in receipt of Homecare. Sadly, there is not and without this knowledge base the much-needed reform and re-engineering of the wider care framework will struggle – or worse still be left in the hands of focus groups, working groups or think tanks.
I always believed Care requires urgent rapid evolution. Today it requires progressive and relentless revolution that will get us to the new improved and transformational normal.
Disclaimer: Care Owl engages a range of guest commentators and writers invited to write honestly about the latest trends and issues in Care across the UK and Ireland. The views of Care Owl do not necessarily reflect the views of Connected Health.