Following the release of the government’s Covid Winter plan Vic Rayner, Executive Director at the National Care Forum shares her thoughts on the impact it will have on social care and of its potential impact on care providers:
The social care score card is in for the Winter Plan. We have consistently called for a more supportive approach to care home visiting and to the rollout of testing beyond care homes to the wider care sector, so it is hugely positive to see reference to that in the Winter Plan.
However, the truly wonderful news about the vaccine and the seemingly extraordinary news about the new elasticity and capacity of the testing regime are overshadowed by the giant elephant in the room of cost and resource.
It is a real cause for concern that the government feels able to announce a quadrupling of the testing regime within individual care homes without even considering any extra resource to do this. Either they have so little knowledge of what happens in a care home that they assume this can happen without additional resource, or conversely so little respect for what people are doing and the care that others need that they think that this can happen without impact on the care provided.
This sounds harsh – and to be fair it feels harsh against a backdrop of a plan which does – for once – put social care front and centre of the things that need to happen. However, it is unfortunately a position borne out of long experience – once again reinforced by the announcements in that self same Winter Plan that is providing the NHS with an additional £3 billion ‘to preserve the essential and necessary functions of the health care system’ – whilst at the same time asking the care home part of the sector to simultaneously process an additional nearly 11 million tests per month without any additional resource. That is some cheap super lab!
So – to the maths.
The government has provided funding for care homes in the form of the Infection Control Fund (ICF). This second wave of the fund was smaller in totality, apportioned more widely across the sector, and spread over a longer period. For a care home – the outcome of all of this was a much smaller pot.
Our estimations are that a medium sized care home of 50 residents and 100 staff will receive somewhere between £5.5k and £6.5k per month to support all of the multiple core objectives of the Infection Control Fund.
In November 2020 this ‘average’ 50 bed care home was being asked to deliver the following tests:-
- 50 Resident PCR tests monthly – administered in the home and sent off to the lab.
- 400 staff PCR tests – administered in the home and sent off to the lab.
- This already adds up to 450 tests undertaken per home.
All of these tests need to be ordered, received, administered (with consents documented) logged online, recorded on the government portal, updated in resident and staff records, dispatched, and then all the results appropriately recorded and stakeholders informed.
In December 2020, this ‘average 50 bed’ home will now be asked to deliver the following tests (we’re assuming a mix of PCR and Lateral Flow Tests):-
- 50 Resident PCR tests – administered in the home and sent off to the lab
- 150 Resident Lateral Flow Tests (additional tests) – administered and processed within the home
- 400 Staff PCR tests – administered in the home and sent off to the lab
- 400 Staff Lateral Flow Tests (additional tests) – administered and processed within the home
- 800 visitor Lateral Flow Tests – administered and processed within the home (additional tests)
These additions take the total tests to a minimum of 1,800 tests undertaken per care home.
The PCR tests need to be administered as described above. The Lateral Flow Tests need a different system, currently primarily manual, to record and log tests and results. In addition, the tests need to be taken in a dedicated environment, and held for processing for half an hour. The results then need to be communicated and relevant action taken – which could be visitors accessing the home, or being asked to go away and test. In the situation of resident testing positive, will involve taking an additional PCR test and sending away for analysis.
So, in short, with no additional resource for December onwards, the ‘average 50 bed care home’ will need to administer an additional 1,350 tests per month minimum. Even on extremely conservative estimates about the length of time to manage each test – for example an average 20 minutes – this still adds an additional 450 hours to the testing regime in a single home or an average of 9 hours additional time on testing per resident of a care home per month. Which if you apply across the 400K or so residents of care homes, scales up to a staggering additional 3.6 million hours per month of testing alone. Which without additional resource – is 3.6 million hours per month which cannot be used to provide care.
With this in mind, it is not just insulting, but dangerous for government to suggest this can be delivered without extra resources and staff. We are already seeing members raising huge concerns and anxieties about how they are expected to deliver to this.
Of course government will reiterate that it has provided funding through the Infection Control Fund. Yet, the ICF cannot provide the response that is required. It is already flexed way beyond capacity in meeting existing requirements. There is no way that this can be stretched to cover nearly 11 million additional tests per month.
However, it seems that the Government believes that time is cheap in care – it has demonstrated that in spectacular technicolour in the COVID Winter Plan. Late on the 13th November the government put out a short notice 10-day consultation on the introduction of legislation around restriction of staff movement in care homes. I have no doubt there will have been hundreds of responses on this hugely contentious issue, equating to thousands of hours of social care time. The consultation closed at 12pm on the 23rd November, and by 3pm that same day the COVID Winter Plan was produced, enshrining the inception of the same said legislation that the introduction of had been out to consultation some three hours earlier, by the end of the year. Now that feels like the action of a government that not only doesn’t ‘know social care’ but also does not value or respect it’s work or it’s time. Warm words yet again provide cold comfort for social care in the latest Winter Plan.
Tomorrow the government will announce it’s Spending Review. It needs to urgently use this as a moment to redress the shortfall in resourcing care to deliver these 11 million tests per month and counting. The Chancellor must act now if the government commitments to visiting and testing are to be delivered. The policy intent must be supported by resource – it is not enough to want it – we need government to do the maths.