Chris Watson shares his observations on how commissioners in health and social care have responsed to the COVID-19 crisis.
Author: Chris Watson
This article was first published by the Institute of Public Care (IPC).
Maintaining good lines of communication and positive commissioner/provider relationships: Observations and thoughts around learning disabilities adult care services in relation to Covid-19.
Some local authorities have been facilitating daily conference calls between commissioners, social workers and the management teams of all local support provider organisations to ensure that problems are identified, shared and solutions agreed quickly.
In some areas commissioners have written to providers to confirm that they will continue to get paid at rates in line with existing contracts regardless of whether the full amount of specified support has been delivered (for example as staffing levels reduce due to Covid-19 infections). This approach has been designed to allow providers to flex their workforce as they see fit to deliver critical life support outcomes and not be penalised for non-delivery against the support plan – reducing the risk of provider/market failure.
In areas, where this has not yet happened, some providers are expressing concern about the reduction in demand caused by voluntary self-isolation and the subsequent financial impact of not being fully funded to cover fixed staffing costs. They cannot take advantage of the Job Retention Scheme to furlough staff and in this scenario may be left at increased risk of failure. The impact of these fluctuations in demand relative to reductions in overall staff availability due to sickness has not yet been fully gauged and so the additional costs incurred by providers for increased agency staffing use may also need to be a consideration when planning budgets for contingencies. The LGA and ADASS have recently released a statement suggesting that costs for providers may increase in the region of 10% overall but it is likely there will be significant variations on this figure depending upon individual circumstances.1
There is also a need to consider communications with Direct Payment holders, who are purchasing support from providers themselves, giving instructions regarding the continuation of payments at agreed pre Covid-19 levels when required by the provider (regardless of whether or not the agreed support hours/provision is being fully delivered).
Some authorities have written to Direct Payment holders to instruct them to continue to pay provider invoices for support/day services in order to support sustainability. This approach helps to ensure that providers, with a workforce that cannot be re deployed or that may be required again at short notice, can maintain sufficient income to cover ongoing fixed/staffing costs.
Some Direct Payment holders have taken a pragmatic approach and are continuing to pay agencies and their PAs at either full pay or at a retained rate which has been negotiated according to need (regardless of not having had direct instructions from commissioners to do so or not).
A number of people with learning disabilities require shielding and have chosen to temporarily move back in with family for 12 weeks to self-isolate.
This has left their support providers with the option of:
Where it is not possible to redeploy or re-assign staff, providers may well be left with a significant financial risk unless they receive assurances from commissioners with regards to continuation of their funding. It would appear sensible to have discussions on a case by case basis regarding maintenance of funding as required.
In some areas self-isolating care staff with Covid-19 symptoms have reduced the capacity of providers to deliver sessional community support to people living more independently. Meaning that some have moved to providing support with critical life support functions (such as personal care and food shopping) only. Again, the continuation of funding for providers in these scenarios may be critical in maintaining their financial viability.
Some group supported living homes have increased core staffing and shift lengths alongside a reduction in sessional 1-1 support with the intention of reducing the flow of staff in and out of homes over this period.
The need for individuals, families and support providers to be able to react quickly and respond to reductions in the availability of support staff or personal assistants means that having in place a process for rapid authorisation of contingency funding is also important. In response, some local authorities have preauthorised the award of lump sum contingency funding amounts based on a percentage of the total budget and are making this available on request.
Most commissioned, and previously booked short breaks provision have been cancelled – meaning increased pressure on families to continue to care without breaks. Some councils have therefore authorised, on a case by case basis, the temporary employment of other family members (living in the same household) as a replacement for short breaks, PA’s or domiciliary care agencies in the interim to deliver necessary support/breaks for carers.
There is a need to also consider contingency arrangements in shared lives and to accept that there may be significantly higher costs incurred in these services should 24/7 agency support be required to temporarily replace shared lives carers who are ill or needing to self-isolate.
At time of writing, PPE is still not easily available for providers and this is exposing the workforce to higher risk of infection/cross infection. Some providers have reduced community visits to people’s homes in order to facilitate essential tasks only reducing contact and subsequent exposure risk.
Personal Assistants have had difficulties in evidencing key worker status. Some councils are working with Direct Payment holders to identify PA’s and provide letters of support regarding their key worker status.
There have been instances where people with learning disabilities who are in receipt of 2-1 support to access the community have been challenged by police/public regarding being in a ‘group’. Providers have been requesting (and receiving) letters of support from commissioners and practitioners confirming the need for staff to undertake this role when out in public.
In some areas, routine assessments and reviews have been cancelled and replaced with a triaging system which manages urgent issues arising and requests for care management intervention based upon risk assessment frameworks based upon the Coronavirus Act easements. Some authorities have developed a framework for practitioners and call centre staff to make these decisions ensuring compliance with the Human Rights Act.
Notes:
1. Local Government Association & Association of Directors of Adult Social Services, Temporary Funding for Adult Social care providers during the Covid-19 crisis https://www.nationalcareforum.org.uk/wp-content/uploads/2020/04/Provider-fees-summary-of-the-approach-proposed-by-local-government-ASC-final.pdf
The publisher is the Centre for Welfare Reform.
Social Care's Response to COVID-19 © Chris Watson 2020.
All Rights Reserved. No part of this paper may be reproduced in any form without permission from the publisher except for the quotation of brief passages in reviews.
health & healthcare, intellectual disabilities, social care, England, Article
