Agenda item

To receive a summary of the impact of the Covid-19 pandemic and 2021/22 Winter period on the delivery of adult social care, including a summary of the financial impact.

The Director of Operations for Adult Social Care (ASC) and the Interim Director of ASC Commissioning introduced the report and presented the item. The main points were as follows:

Overview:

·       The service had undergone a unique set of winter pressures.

·       National mandated measures to support the ASC service had been introduced in March 2020.

·       Pressures on emergency departments and acute hospitals had taken place.

·       The Incident management hospital discharge scheme was engaged to support the population through this period and was also introduced in March 2020.

·       There were nationwide workforce shortages in ASC and in the local setting the ASC operational area had around 25 vacancies. Other vacancies existed in Occupational Therapy.

NHS System pressures:

·       Acute hospitals continued to see challenges due to their bed occupancy rates, with around 95% of the capacity full, meaning very little scope for further capacity.

·       Community hospitals are also under pressure including mental health facilities.

·       GPs and primary care networks were involved in the nationwide vaccination program.

The Care Market:

·       Since August 2021, 76 packages of care were handed back to BCP from 21 providers.

·       There are 150 Care Providers in the BCP area.

·       Staff morale is low and staff are exhausted.

·       Covid infection and staff resignations are fueling staffing crisis.

·       Residential care staff are 95% double vaccinated with 31% having received the booster.

Operational Pressures:

·       There was a 40% increase in hospital social work demand.

·       The heightened demand meant that waiting times have gone up.

·       Resources were being diverted to hospital discharge out of necessity.

·       There had been an increase in safeguarding concerns, though not all had resulted in a section 42.

Financial Implications:

·       There had been an increase in fees for Care Homes.

·       Patients require 30% more care following discharge. This was not unexpected though as people were leaving hospital at the earliest opportunity and therefore were likely to have greater needs upon discharge.

·       Government funding for the hospital discharge program is set to end on 31 March 2022.

·       Workforce and Infection Grants had been awarded to Care sector over this period.

Risks:

·       The shortage of care capacity that is delaying care and support.

·       The pressure to discharge patient.

·       Financial pressures on the ASC budget.

·       Greater emergency use of Care Homes for people being discharged who may otherwise go home if they were in hospital longer. This requires the individual to go into an interim residence before going back to permanent residency.

The Director of Operations for Adult Social Care (ASC) and the Interim Director of ASC Commissioning answered questions and comments from the Committee. These were as follows:

·       A member asked about staff morale and what had been done to prevent resignations / further staffing vacancies. The Committee heard that there had been two large workforce retention funds which had gone directly to the providers of care for their staff. The service provide regular communications with care providers as well as incentives such as extra money during Christmas, free parking, childcare. A £150 grant was awarded for all care staff over Christmas and the service were committed to showing staff that they were recognised.

·       The Committee heard, following this, that support for the managers was crucial to this issue.

·       Members were informed that the social media campaigns had worked in the past but were less successful in recent times.

·       The Committee were told that many care workers, specifically in the home domiciliary market, opted to work for agencies given the flexibility in working hours. The reliance on agency staff, however, was lower than expected.

·       One member raised the issue of pressure on the A&E service and the Committee heard that the primary care network were doing everything possible, such as seeing patients, holding e-consultations, providing vaccination support, but that emergency departments were extremely busy, by and large with cases that were appropriate for emergency services.

·       Demand for GPs was rising, with people becoming more confident to contact/see their GP. Members heard that, like hospitals, GPs were extremely busy and facing serious pressures that were not all related to covid. The contribution to the vaccination program from GPs and Primary Care was vast, and this had all been done whilst keeping general practice doors open. As an area, BCP have been Care Quality Commission (CQC) rated Good or Outstanding across all services. There is the acknowledgement of variation in services despite the overall good quality, but work is being done across the entire network to share best practice on managing demand, retaining and improving the workforce, recruitment, integrated working, ensuring resilience and open access to the population.

·       Members heard that there was a national shortage of staff in occupational therapy and therapy more widely. It is crucial to share expertise and knowledge within the network to improve.

·       The Committee heard that the use of the 111 telephone service was up by 25% on last year. The BCP area are 4^th in the country for responding to 111 calls. An important element that was introduced recently on this matter was the ability to book GP appointments on 111.

·       Members were told that the hospital discharge fund would finish on 31 March 2022. This funding applies to people enhanced need (a different or new need to what they had when admitted) for up to a 4-week period. During that 4-week period the team assess the individual to know what their needs are and where they will need to go next. The team have helped 3500 people over 6-month period.

·       It was explained that a 35p increase per week was awarded to the carers allowance. The Committee agreed for the Chair to write to the local MPs, on behalf of the Committee, asking them to review the informal carer’s allowance, £67.60 a week, with a view to increasing this figure.

·       It was further agreed that the Committee would champion the Proud to Care funding for Cabinet and request Cabinet’s support for carers through various funding channels.

RESOLVED that the Committee:

·       Recommend to Cabinet that they write to local MPs, on behalf of the Committee, asking them to review the informal carer’s allowance, £67.60 a week, with a view to increasing this figure.

·       Recommend to Cabinet the following: “BCP have a large number of care workers who look after our many elderly and vulnerable residents. We need to promote care work as an attractive career including through apprenticeships with on the job skill training which offer real career progression. As valued workers they should be seen as key workers with a fair wage and all the benefits for the essential service they provide. Will Cabinet approve this course of action”.

The Committee noted the