We have worked together and developed a further plan (September 2020) in preparation for a second COVID-19 surge which we are now implementing as we move into the winter months and face further potential difficulties.
The objectives of this surge plan are:
Protecting residents in care homes during the Covid-19 pandemic is an absolute priority for everyone working in health and social care and the wider community.
Our nursing and residential care homes continue to be at the forefront of the battle against COVID-19. We want to pay tribute to the hard work and dedication of staff working across the care sector at this very challenging time. It is vital that we continue to support care homes and their staff to keep themselves, and the vulnerable people they care for, safe and well.
Measures aimed at safeguarding the financial resilience of care home providers by guaranteeing a level of income have been in place since mid-March.
On 27th April, Health Minister Robin Swann announced £6.5m in additional funding for Northern Ireland’s care homes, as part of a series of measures to support the sector during the Covid-19 pandemic.
This helped ensure homes can increase the level of cleaning undertaken and bring in any additional staff they need to help support the isolation of residents when this is necessary.
Under this support package, homes received a payment of £10k, £15k or £20k depending on their size.
On June 5, the Health and Social Care Board (HSCB), the Public Health Agency and the Department of Health secured a further £11.7m financial support package for care homes to help them meet the challenge of the pandemic.
The additional support made available to care homes included improved access to PPE; enhanced cleaning regimes; wrap-around support/mutual aid from HSC Trust colleagues; protocols to reduce footfall in the homes; enhanced support from primary care through virtual ward rounds and from community pharmacy partners; IPC training for all staff; provision of additional equipment to support care and contact with family members etc.
A further £27m funding package was announced by the Minister for Health on 21 October 2020 to support care homes to:
In addition, a further expansion of testing and the publication of updated guidance for care homes have been issued aimed at strengthening infection prevention and control and protecting residents and staff in care homes. The guidance can be viewed on the link below which:
Trusts and care homes will continue to work closely together to ensure regional guidance continues to be implemented, to help ensure residents are kept safe and well.
The PHA’s health protection team continue to support the sector throughout the outbreak process from the time of notification to its conclusion.
Care home residents are more at risk because of individual vulnerabilities, shared living space and frequent close contact with others who can unwittingly spread Covid-19 within and between settings.
The Covid-19 dashboard on the Department of Health’s website provides daily updates on the number of confirmed outbreaks in NI care homes. This dashboard is the responsibility of NI Statistics and Research Agency (NISRA) statisticians within the Department of Health.
The live dashboard can be accessed at: https://app.powerbi.com/view?r=eyJrIjoiZGYxNjYzNmUtOTlmZS00ODAxLWE1YTEtMjA0NjZhMzlmN2JmIiwidCI6IjljOWEzMGRlLWQ4ZDctNGFhNC05NjAwLTRiZTc2MjVmZjZjNSIsImMiOjh9
NISRA is responsible for the weekly bulletin, providing comprehensive statistics for confirmed and suspected Covid-19 related deaths across hospital and community settings, including care homes.
Further information can be accessed at: https://www.nisra.gov.uk/statistics/ni-summary-statistics/coronavirus-covid-19-statistics
Covid-19 testing is available to all asymptomatic care home residents on a 28 day cycle and testing is undertaken of asymptomatic staff on a 14 day cycle across Northern Ireland. Additional testing takes place on a ‘whole home’ basis should any results be returned as positive and meet the definition of an outbreak.
Further information can be accesseds at: https://www.publichealth.hscni.net/covid-19-coronavirus/testing-and-tracing-covid-19/testing-covid-19/covid-19-implementation-planned
Am I still able to visit a relative in a care home?
The latest guidance on visiting a care home can be viewed here: https://www.health-ni.gov.uk/news/visiting-guidance-issued-hospitals-and-care-homes
Ensuring that care homes continue to have sufficient supplies of free PPE is an absolute priority, and Health and Social Care Trusts are working closely with care homes in their local areas to ensure that each home has a sufficient supply of PPE stock.
A further regional HSC Care Home Surge Plan has been devised (September 2020) in preparation for a second surge of Covid-19. The plan has been co-produced by the Health and Social Care Board, Public Health Agency, HSC Trusts, Primary Care and the Regulation and Quality Improvement Authority (RQIA) and informed through consultation with multiple stakeholders including the Independent Health Care Providers and Third sector organisations.
The surge plan has been developed to provide support to care homes, help slow the spread of the virus and to provide competent and dignified care to those who need it.
Health and Social Care Trusts are working closely with care home providers to protect older people in care homes from Covid-19. Additional advice and guidance is available from RQIA Service Support Team who act as a central point of contact for care homes.
Key actions of the surge plan include:-
All patients/residents being transferred into a care home from any setting, whether that be from hospital, supported living or directly from their own home, will be tested 48 hours prior to admission to the care home. This will help care home staff to understand each resident’s status and to plan their care effectively. An individual risk assessment will be undertaken and appropriate arrangements put in place in consultation with the patient / resident and their family.
The updated guidance makes clear that all patients discharged from hospitals into care homes should be subject to isolation for 14 days in line with infection control advice. Where a home is unable to isolate a patient, the local Health and Social Care Trust will make arrangements for isolation in a suitable setting until they can be admitted to the care home.
The Health and Social Care Board, Public Health Agency and Health and Social Care Trusts will continue to work in partnership with care home providers to help deal with staff shortages. Where people have responded to the HSC Workforce Appeal, those with the right skills will be prioritised for deployment with independent care home providers. Trust staff has already been redeployed to care homes and will continue to be when necessary.
Essential to this is the provision of nursing care and HSC want to in particular encourage registered nurses who have transferable skills, expert knowledge and experience of caring for older people in a range of other settings to come forward and play their part in keeping vulnerable people out of hospital and in their own home.
Will staff be redeployed from hospitals to support care homes?
Health and Social Care Trusts have stepped in to provide thousands of hours of free staffing time in homes during the pandemic. Some staff were redeployed during the first Covid-19 surge. This included support service staff and professional staff e.g. nurses, occupational therapists, physiotherapists etc. from both community and hospital settings. HSC recognises that this second surge has impacted on the workforce in both statutory and independent sectors and as we restart and rebuild, we must do so in a way that maintains adequate staffing levels across all our services.
Trusts will ensure that appropriate staffing and medical input is available to the homes when required.
Support and expertise has also been made available from the RQIA’s Service Support Team and in the event of an outbreak support has been provided from the Public Health Agency.
The Public Health Agency (PHA) has long-established, well-trusted and robust systems in place to monitor infectious diseases and provide direct advice and support to manage outbreaks and limit onward spread.
While a lot of this work goes on behind the scenes, the public should be reassured that the PHA have well established links with these facilities. Whenever there is evidence of COVID19, or respiratory illness, in a home the PHA works intensively to limit spread.
When the PHA receives a notification of an issue of acute respiratory infection in a care home the agency’s health protection team investigates and supports the provider in managing the outbreak.
A comprehensive risk assessment is completed of the incident, which includes an assessment of each individual resident and the environment, and an ongoing assessment of the severity, spread and context of the incident.
Advice specific to COVID-19 is given regarding isolation, containment, and infection prevention and control practice, including cleaning, testing information, how to manage symptoms, when to request additional medical advice, and PPE.
When a nursing or residential care home outbreak is over, a thorough clean of the facility is advised. The PHA’s health protection team will support the facility through this process, and following this a final outbreak summary report is produced.
HSC has seen an increase in the prevalence of COVID-19 in care facilities, and anticipate that this will continue. We do expect there will be further outbreaks of COVID19 in the coming weeks and months. The HSC wide system works closely with all partners to reduce the risk of further transmission of the virus.
The work PHA undertaking with care homes is what we do with a range of infectious diseases week-in, week-out, and the same processes are being followed to deal with coronavirus.
It can often be difficult to identify the symptoms of COVID-19 in some older people, therefore enhanced testing in care homes is being undertaken. When COVID-19 is identified in a facility, all residents and staff are now tested.
Another key role of the PHA is to undertake surveillance of the situation on an ongoing basis.
A range of methods are in place to monitor the course of COVID-19 in case homes and the wider community. The data collated by the PHA is used to monitor the situation as closely as we can.
Have all GP visits to care homes halted. What procedures are in place for GPs to assess residents if they become ill or need medication if no face to face GP visits?
No. GP visits to care homes have not stopped.
At this time all GPs are operating a ‘telephone-first’ access system where all requests are triaged by a doctor.
It is important that any concerns about the level of care provided to residents in a care home are identified and addressed as quickly as possible.
If you have a concern about any aspect of the care a family member is receiving, you should immediately raise that concern with the manager of the home so that the appropriate action can be taken as quickly as possible.
If the manager is unable to resolve your concern or you are dissatisfied with their response, then you should contact the relevant Health and Social Care Trust and raise your concerns with them.
The Patient and Client Council is also available to assist you if you wish to pursue a concern or make a formal complaint. They can be contacted at: https://patientclientcouncil.hscni.net/
How many care homes/beds are there in Northern Ireland?
As at 13 October 2020, there were 482 registered care homes in NI of which 248 are nursing and 234 residential care.
The total number of registered beds is 16,110.
A residential care home provides residential accommodation with both board and personal care for people in need of personal care due to old age and infirmity; disablement; past or present dependence on alcohol or drugs; or past or present mental disorder. They do not provide nursing care.
A nursing home provides nursing care for people suffering from illness or infirmity. Some homes are registered to care for both people in need of residential or nursing care.
For further information on Covid-19, see below some useful links: