The Integrator: Social care ‘Nightingales’ - or not?

Central funding of temporary “Nightingale” care homes ahead of winter to help deal with any covid second wave is under consideration, HSJ understands — but it is clear that government plans to get the care sector through winter are still in flux.

Two recent reports have indicated that some form of social care plan for winter is due out shortly which, you would hope, will take account of input from the Social Care Sector covid-19 Support Taskforce set up in early June to  “ensure that concerted and determined action is taken to reduce the risk of transmission of covid-19 in the sector”.

The Department of Health and Social Care has stated in a press release (which was mainly about the NHS, of course) that: “The government will shortly publish its social care winter plan, building on NHS support for the sector during covid, to ensure the system has the support it needs in preparation for winter and potential future outbreaks.” Yet that was several weeks ago.

Sir Simon Stevens’ phase three letter, sent to all NHS organisations on 31 July, also said: “DHSC are also expected to set out equivalent phase three priorities and support for social care.”

Given the Commons public accounts committee’s excoriating report on social care – which described releasing people into care homes without covid tests as an “appalling error” – it is unsurprising there is pressure for a plan.

But given we are just months away from the start of winter, the plan is ill-defined.

I have heard from a senior source involved in social care that there is currently a debate being had about whether a plan developed in Norfolk during the pandemic should become a “national standard”.

During the pandemic Norfolk and Waveney Clinical Commissioning Group worked with Norfolk County Council to open up a 36-bed step down facility in an empty care home at the start of June. It was for people who were well enough to leave hospital but unable to return to their own place of residence (be that their home or a residential care setting) while isolating as covid-19 positive or negative.

As it was, due to lower than expected levels of covid in the Norfolk area, the facility was not used and was mothballed in mid-July, but I have been told the idea behind it – to stop covid spreading among vulnerable care home residents – has caught the eye of very senior people from NHS England.

One council leader, described Norfolk’s approach as setting up “Nightingale style care homes” and said that any national social care winter plan is likely to say “local authorities should be able to provide alternative accommodation where care homes can’t, or are worried about, isolating those infected with covid”.

Similar ideas have also been explored in parts of the North West region, to use empty care home capacity for step down care (provided covid positive patients can be segregated)

Yet, other well-placed sources said the Norfolk model would not be mandatory and would be far from universal. Apparently fewer than 10 areas expressed any real interest in the model.

But given the failure to protect residents during the first covid wave, and the ongoing concern about acute capacity over winter, an increase in step-down facilities to free up acute beds and stop the infection unknowingly being transferred to a care home, seems essential.

Bill Borrett, Norfolk County Council’s cabinet member for adult social care, says the county will keep its unit available for use throughout the winter.

Funding more facilities will be a challenge — and the Treasury has already said “no” to several capacity bids — which is perhaps why there is such confusion over what any plan will finally contain. Last week HSJ reported that plans for more Seacole rehab centres had been scrapped due to their capital costs.

The Norfolk system, which did not require any significant capital spending, was paid for by the CCG, using funds provided by the government to support discharges from hospital during the covid-19 pandemic. The government has told HSJ that £500m of the £3bn additional funding recently announced is for this discharge process, but on a separate issue also admitted it is earmarked for covid rehabilitation as well. It is clearly a pot of funding from which many hands are expected to take.

On top of that, the better care fund, the settlement of which has been rolled over from one year to the next while a review of the BCF is undertaken, is down £240m compared to last winter, because the additional “winter BCF” provided in 2018-19 and 2019-20 has not been continued in this financial year.

It is clear there is the political intention to publish something about social care in the next month or two, but what is in it, and vitally how it will be funded, is still far from clear.

To borrow the words of Meg Hillier, chair of the Commons PAC, it is clear that “lives depend upon getting our response right”.