Minutes:
The Joint Committee
received information on the Overview of the Regional Response to COVID 19
focussed on Care Homes, which was detailed in the circulated report collated by
Jack Straw, Independent Chair of the Health and Social Care Group, on behalf of
the Extraordinary Regional Partnership Board.
An introduction was
provided by Andrew Jarrett, Director of Social Services, Health and Housing,
which included context and clarification on the different areas of
responsibility of the component parts of the Regional Partnership Board. It was
highlighted that the virus had a profound impact on the care homes, residents
and staff across the UK; 46 residents of Neath Port Talbot care homes had died,
including one member of staff.
Members were informed
that now that the first surge had passed, the service area across the Swansea
Bay Region, wanted to make assurances that they had done what was needed and
required of them in terms of safeguarding care homes and that they would be
able to consider lessons learned which would help if a second surge was to
emerge.
Very early on during the
pandemic, it was noted that an emergency response infrastructure was set up to
report to a gold command group, which Jack Straw was commissioned to Chair; the
emergency response infrastructure was also made up of the two Directors of
Social Services and the Executive Director of the Health Board. It was explained
that there were many groups who reported to the gold group including a silver
group, which looked at the operational details of the response across the
health and social care sector. It was added that the gold command group
reported to the Extraordinary Regional Partnership Board, which was set up as a
result of COVID 19.
Members were informed
that the Regional Partnership Board was made up of three statutory partners,
the Health Board, Swansea Council and Neath Port Talbot Council, who were commissioned
to deliver the statutory service on an individual basis. It was noted that at
the beginning of the pandemic, the Extraordinary Regional Partnership Board was
set up with the three statutory partners, which meant that the general Regional
Partnership Board, made up of representatives from the third sector, carers,
patients, citizens and social landlords, did not take part in the decision
making process as it was suspended for the Extraordinary Regional Partnership
Board to move forward with the three statutory partners making the decisions.
Officers clarified that
the Regional Partnership Board was set up to look at health and social care
across the Swansea Bay Region, the Extraordinary Regional Partnership Board
commissioned the circulated report and the West Glamorgan Partnership is the
general name for the region, over and above the health and social care area.
It was added that the
report was the first of its kind in Wales to critically look back as a region
to the response to COVID 19 in care homes, however it was likely that there
would be many more to come as there was a clear focus on this issue across
Welsh Government, the UK and Europe.
Members were informed
that the West Glamorgan Partnership had maintained a comprehensive database of
interactions with care home community, across all aspects including testing and
pastoral support and that it covered a lot of the detail that supported the
report. It was added that this level of information would be important when
future reviews take place, although Professor John Bolton, on behalf of Welsh
Government, was already carrying out review work which the partnership
statutory directors had contributed towards.
It was stated that the
main focuses of the review were on assurance, had the partnership complied with
existing guidance throughout the process; and learning, what had been learned
and would better preparations be put in place in case of a second wave and/or
similar events in the future.
In regards to the status
of the report, it was highlighted that it had been commissioned and would be
delivered to the three individual statutory bodies for them to identify what
further work and/or scrutiny needed to take place and what further evidence or
lines of enquiry should be pursued. It was mentioned that the report does
demonstrated very strong partnership working between Swansea Council, Neath
Port Talbot Council and the Health Board; all of the key issues had been agreed
across the parties, which will be important when the reviews take place.
It was noted that the
report showed that strong assurance could be had in terms of complying with
existing guidance, although there were occasions where guidance was changing
rapidly that there was small delays between; however this was stated to be down
to logistics and not failure to comply with the guidance. It was stated that
another factor that could be strongly demonstrated was the clear evidence that
leadership had sought to influence national policy and guidance, in light of
the current situation in communities, and challenge guidance where appropriate.
Members were informed that there was evidence which showed on occasion, local
activity in the region had resulted in the updating of guidance and
implementation of changes in how issues were managed.
The challenging areas
were discussed with the greatest challenge across the UK, Wales and the region
being the transfer of infection between sectors for example the emptying of
hospitals in preparation for the COVID 19 patients. It was mentioned that where
patients were transferred to care home settings, infection did occur and it was
an issue that would need to be addressed nationally.
In summary, it was
highlighted that capacity creation and the ability to move structures around
depending on what was needed at the time, across the system was much better now
than it was in March 2020, therefore making the service area better prepared if
there was to be another surge of the virus. In terms of infection control and
prevention of the spread of infection, it was noted to also be much better
placed as practices and procedures had evolved and developed over the past few
months.
Members asked was there
any information as to how many people were infected after being admitted to
hospital as it was known that those who didn’t have the virus when admitted to
hospital, contracted the virus following admittance. It was also asked how many
patients had the virus after being discharged from hospital. Officers stated
that there weren’t any figures available due to the fact that at the beginning
of the pandemic tests weren’t being carried out, so weren’t aware of how many
people had contracted the virus; although tests had since been carried out, the
figures wouldn’t be accurate or reliable due the lack of testing at the
beginning.
Within the circulated
reported it stated that despite national pressure to not be so transparent, the
Regional Partnership Board publicly launched a revised social care eligibility
criteria, to which Members mentioned that the revised criteria could be considered
as being high risk, therefore wanted to know what monitoring had subsequently
been carried out in respect of the revised criteria, keeping in mind that
social care was a statutory requirement. Officers reassured the Joint Committee
that statute and guidance had been complied with at all times; it was mentioned
that the law did change at the beginning of the pandemic and changed the
ability within adult services to look at cases differently. It was highlighted
that the eligibility criteria was a document that set out how staff would need
to respond if another surge was to arise, which was a way to keep Members and
the public informed of the plans if that were to happen. It was explained that
in Neath Port Talbot all of the adult services cases were rated via a Red Amber
Green (RAG) system which was a form of preparation and proportionate response;
green being the cases where negotiations had been made with family and friends
in which they would start to provide care and support, amber being heightened
risk if services were to be withdrawn and red was no possible way to withdraw
services. It was mentioned that there was never a time where all of the green
rated cases needed to be switched off, however Officers wanted to make it clear
in the eligibility criteria that they would be prepared to switch the green
rated cases off if the demand and surge came that they were expecting. Members
were informed that even though the individuals were on a RAG status, staff were
in touch with them on a daily/weekly basis and were still maintaining contact
even though the visits weren’t being carried out at the time. Following a
question in relation to how long the revised criteria would be in existence,
Officers confirmed that the service was still in an adaptive phase and
preparing for different possibilities, however if there was a need to enact any
part of the eligibility criteria, Officers would be prepared to inform the
Committee of what had been done, when it would be done and for how long it
would be in place.
Members queried why the
report did not reflect the experiences of the residents, families and staff of
the care homes and asked if any attempts were made to contact those affected or
their advocates, as it was stated that the opportunity needed to be provided to
them to ensure that their voices were heard. Officers explained that an
externally commissioned care group was set up as a sub group of the silver
command group, which was made up of commissioning officers across the region
who were in constant communication with the residential care homes and receive
their input, which overall does have an impact on the delivery of services. It
was clarified that the circulated report was a snapshot whilst in the midst of
the pandemic, to identify lessons learned including the decisions that were
made and the way in which those decisions were analysed. However, Officers
expressed the need for a report to be collated and presented to Members, which
would cover the views of care homes and their residents. Angela Thomas, Head of
Adult Services, agreed to produce the report.
A discussion took place
in relation to pastoral care and what lessons had been learned from isolating
residents and patients from their families; it was asked would there be any
changes to visiting and information given to relatives, including the way in
which funerals would be managed, in the future if a second surge was to occur.
It was stated that throughout the pandemic, staff recognised that they were
balancing risks, the risk of infection against the risk of isolating people
from their families who may have been at the end of their life. Officers
highlighted that they have tried to manage the risks as effectively as
possible, whilst following the guidance from Welsh Government. It was mentioned
that care homes had been very innovative in trying to get their residents to
have contact with their families for example through digital channels including
Microsoft Teams and WhatsApp and where possible, allowing families to have
contact by standing outside. Members noted that the circumstances were not
ideal, however due to the uncertainty of the virus being airborne and the
effectiveness of face masks, these measure had to be taken to prevent the risk
of transferring the virus in care homes. The lessons learned were stated to be
that there were other ways to provide contact between families to help prevent
the spread of the virus, but the decisions being made on a day to day basis
were very difficult and the decisions could only be made on a balance between
the risks and the guidance being provided from scientists. It was added that
the majority of the time when implementing the severe restrictions, authorities
were being guided and instructed by Welsh Government with services such as
cemeteries and crematoriums and that the social distancing measures, which was
still a law in Wales, needed to be complied with to also help prevent the
spread of the virus.
Reference was made to
the key issues surrounding PPE, to which it was explained that based on the
guidelines that were being issues at the time, the authority was complying with
all PPE requirements; due to the continuous changes that were being made by the
Government, the authority also had to re-evaluate decisions that were made. It
was noted that the current annual spend in Wales on PPE was £10 million,
however in the first three months of the pandemic the Welsh Government had
spent £200 million trying to provide efficient PPE. Members were informed that
during the pandemic there was a point where Wales was very close to running out
of PPE, but as a region worked together and used regional processes to purchase
and obtain PPE either through the usual channels or by sourcing it
independently. It was mentioned that in the Neath Port Talbot area, there was capacity
to supplement the care homes and other areas, with sufficient PPE and there was
now a factory in Neath Port Talbot which had changed their manufacturing
process to solely produce PPE and it was now the largest manufacturing PPE company in the UK. Following on from this, Wales became so
efficient with PPE that the country started to supply other nations within the
UK including Northern Ireland and England.
In relation to decision
making, it was asked if it could’ve been done differently in order to have
provided less impact on the community. It was stated that the purpose of the
overview was to identify what could’ve been done better, however based on the
information and advice that was being communicated from the Government and the
evaluations completed by officers, the best possible decisions were made at the
time; when the guidance, legal advice and science was changing, the authority
adapted their processes and decision making.
Officers were asked if
they would be able to provide the figures of how many people were infected with
the virus in the care homes so that Members could gain understanding of how
many elderly residents overcome the virus. It was noted that Officers could
provide Members with this information if it was necessary.
Members made reference
to the joint partnership with Public Health and asked for clarity on how the
recommendations would be monitored and how they would be provided with
reassurance that this work was being completed. Officers highlighted that
Swansea Council and the Public Health Board would be going through the same
process of scrutinising the circulated report. It was added that the
partnership working around this had been effective and this would continue to
be able to hold each other to account and work out common solutions; with
meetings being held on a weekly basis, which had allowed the partnership
relationship that had been formed to strengthen.
The Committee was
informed that although testing sits directly within the NHS remit, there were
now arrangements for national testing plans, issued by Welsh Government, and
local testing plans in which the local authority representatives would be
directly involved with; therefore, there would be local partnership arrangements with direct
input into the development the plan.
Further discussion took
place in relation to testing and ways to improve the reliability of the results
and the speed in which individuals receive their results back. It was noted
that there were two testing mechanisms, local testing which is carried out by
the Health Board and a national self- administered test; the local testing was
stated to be working efficiently with test results being returned in a timely
manner. However, the national testing was often problematic with individuals
struggling to receive their results; it was noted that this had been relayed
back to Welsh Government by Directors of Social Services and the Health Board.
Officers mentioned that having individuals’ complete double tests for the
purpose of reliability, would likely put a burden on both mechanisms of
testing, especially as the local testing was already under some pressure. It
was confirmed that an All Member Seminar on Test, Trace and Protect was
scheduled to take place in September.
It was noted throughout
the report, there were references made to the principle of ‘not knowingly
transfer of infection’; Members asked if officers could expand on this and
confirm if the principle was unique to the Extraordinary Regional Partnership
Board members or did it apply to all members. Officers explained that this was
an important principle, which could have possibly been implemented sooner; it
began with not discharging someone into a care home who was known to be
infectious, and then moved to not discharging someone into community settings
who was known to be infectious. It was noted that the region was ahead of Welsh
Government guidance and one of the only regions to implement the principle at
the time.
Detailed in the
circulated report it stated that some clinicians continued to operate on the
basis that once an individual was medically fit for discharge (MFFD) they could
be transferred to a care home setting, even if still COVID positive; Members
asked if they could receive assurances that if a second surge was to happen,
that this problem would be resolved. It was highlighted that there were now
checks and balances in place to ensure that this does not happen, for example
ensuring up to date tests were undertaken; although it was stated to be difficult
to manage due to it being a large system, officers were more reassured going
forward.
Officers were asked if
there was any forward thinking taking place in relation to where positive COVID
19 patients would be placed if there was a second surge, as it was recognised
there could be risks for them staying in a general hospital or care homes. It
was noted that at the moment the number of patients with the virus is very low,
which had created its own difficulties, however placement of patients was at the
forefront of thinking and if a second surge were to happen cohort of patients
would be placed into particular COVID 19 wards and the field hospitals would be
utilised.
Members asked for
clarification on the conclusion of the circulated report where it stated that
there were a number of areas, notably national NHS capacity-creation, where
assurance could not be given in relation to the transfer of infection or harm.
It was noted that earlier on the in pandemic, one of the main pressures on the
NHS and the social care system was to empty hospital beds and that the then
existing guidance relied on that it was safe to discharge patients into the
community and if they were infected with the virus they could self-isolate. It
was noted that this was a huge managerial pressure across the UK; as routine
testing wasn’t in place and pressures were to empty hospitals, which meant that
people who were infected moved around the system, both coming in and out of
hospitals.
Following scrutiny, it
was agreed that the report be noted.
On behalf of the Social
Care, Health and Wellbeing Scrutiny Committee, the Chair thanked and passed on
appreciation to all those working in the care sector, from officer level to the
front line workers.