Vic Rayner, executive director of the National Care Forum (NCF), shares how the not for profit care provider community has worked together to rise to the challenges of COVID-19.
Representing 120 not for profit care providers across residential, domiciliary, supported living and extra care provision, as well as community support services, NCF has remained a leading voice of the social care sector during the coronavirus pandemic.
Speaking with CHP last month, Vic said NCF’s strong tradition of sharing information and providing support had served its members well during the crisis.
“Our members have been amazing at supporting each other,” Vic said. “It’s a real community.
“There does seem to be a particular way that not for profits work together that is incredibly supportive and incredibly open and willing to share with each other. We have done a lot of work around bringing people together which has been facilitated by technology and members have been really engaged with that. I think members have been really engaged because we have been really clear about how we have been representing them.”
NCF’s support to members during the pandemic has included providing direct interaction with policymakers.
The body has hosted talks to its members by leading figures such as Care Minister, Helen Whately, and Head of the Social Care Taskforce, David Pearson, as well as senior civil servants.
“Members are very engaged because they feel their issues are being picked up and used by government and they are having their voices heard,” Vic explained.
The NCF leader stressed that bringing policymakers and providers together during COVID was mutually beneficial.
“We have tried to encourage traction that if you want policy and guidance to work you have to talk to the people who will be operationalising it,” Vic stressed.
“There was a huge frustration for members when there was a sea of guidance coming out and much of it was not possible to operationalise because it was talking about things that weren’t up and running, such as portals and testing, or it didn’t work in practice and had to be changed but in the interim they had to follow the guidance.”
Another central pillar of NCF’s support to members has been its ‘Here to Care’ campaign which launched at the end of June as the UK emerged from initial lockdown.
“The whole purpose of Here to Care was around showcasing what was happening in care and building confidence in it,” Vic explained.
“People had got into a position where they were looking after somebody who might need care, they were concerned about what had been happening in care homes and we wanted to give them the information they needed to make sure they got the care that individual required. There were also plenty of people looking after people at home and that was causing strain on their relationships. Everything stopped in terms of respite for many people who were caring for somebody.”
As part of the Here to Care campaign, NCF launched a perception survey to understand what was important to the public and how the sector could go about increasing confidence in a COVID environment.
The survey of 1,500 adults included a third of people 50 and over in order to gauge the feelings of those thinking about care for themselves or their loved ones.
When asked about what was really important to them when considering care in a COVID world, three quarters cited robust cleaning and infection control procedures.
A similar number cited a good supply of PPE, regular testing and the safe management of family visits.
The poll found strong public support for care staff as a result of the increased visibility of their contribution during the pandemic.
“They absolutely thought staff had been the stars of an incredibly difficult situation,” Vic said.
“Almost universally, people felt care home staff were doing a great job and were undervalued and should be better paid.
“There are some really interesting things to learn there about how people are seeing the role and there’s really positive things to build on because we have struggled over the years in terms of recruitment and public perception of the role of care workers.”
More than half (57%) said they believed care homes had done everything they could to manage infections during the crisis while just over a quarter (27%) thought the government had supported care homes.
The survey also revealed strong backing amongst the general public for the not for profit care model with more than half (54%) saying they would prefer homes run by a non-profit organisation, more than double the rate who expressed a preference for private or LA operated homes.
The strong public backing for the sector reflected by the findings came despite a strong media focus during the crisis which had inevitably concentrated largely on bad news.
Vic noted the impact of the media’s “catastrophizing of care” on public confidence. She said Here to Care was focused on promoting a more balanced view of the sector though sharing good news.
“Members have been fantastically engaged in this by showing all the different things that they have done for the people they are preparing care for, what their workforce has been doing and their work with the broader community,” Vic said.
“We wanted to show what sort of things care organisations have done to make the environment safer to keep people connected and communicating with their loved ones and in order to ensure that infection control was in place. We wanted people to see the not for profit sector particularly has risen to this challenge and that things had been put in place to provide the best quality care in this extraordinary time.”
Speaking as the rates of COVID-19 infection began to worryingly increase again last month, Vic said the biggest challenge facing care home operators remained testing and getting results.
“Care homes are not getting their results back quickly enough,” Vic stressed. “It’s only just recently that the working age adult homes have come within the testing regimes and we are yet to see whether that will be as disastrous as the old people’s testing programme has been so far. The biggest worry is that it really massively undermines confidence both in the general public and amongst the workforce and residents.
“We are just about to be hit with a massive campaign to get people vaccinated for flu. We need to increase the take up of flu vaccination hugely and of course that’s another national government scheme and if people are losing confidence in one it’s quite hard to boost their confidence in another. Winter pressure is a big problem. Homes are doing everything they possibly can but we need the government to stand up to their bit of the bargain which essentially at this point in time is testing.”
Vic also highlighted the “huge concerns” around funding and sustainability of funding, as well as continuing lack of policy consistency around hospital discharges.
“Hospital discharge has been a real problem and I don’t think it’s been solved consistently,” Vic said.
“There’s still issues around the messages providers are being given by health practitioners on the isolation of people with COVID and the importance of knowing a person’s COVID status at the point of leaving hospital.”
Local lockdowns have also posed “real difficulty” for large organisations working across different areas, Vic said.
Additionally, Vic said care home visiting remained a “very difficult” area for operators, with regular testing again a key part of the solution.
The vagaries of government guidelines on care home visiting, meanwhile, have contributed significantly to providers’ problems in gaining insurance cover and reasonable premiums, Vic added.
On PPE, while Vic noted shortages had largely been addressed, the NCF head observed this was largely thanks to providers.
“Much of the solution to PPE has come from providers themselves and they continue to maintain their own business as usual access to PPE,” Vic stressed.
“However, they can’t do testing themselves so they need government to step up to the plate and get it right.”
Accessing quality data has been another major challenge facing the sector that has been highlighted by Vic since the onset of the crisis.
“It became glaringly apparent at the beginning of the pandemic that there was so little valuable data around social care and that was hampering our understanding of what was happening and the ability of both providers and local and national government to direct resources appropriately,” Vic told us.
“We have been really trying to work with all partners involved in this to enable access to data so that we can make sure that when questions are asked they are asked once and that data is shared much more broadly.”
The NCF head noted there had been “real progress” on data during the pandemic, however, highlighting how the evolution of the Capacity Tracker had provided a “pathway to working together better”.
Developed in partnership with NHS Digital, local government associations and NHS England, the Capacity Tracker documents measures that have been deemed critical to understanding the impact of COVID in care homes, including occupancy levels, availability of workforce, access to PPE and the ability to minimise workforce movement.
“The idea is that you can ask for information just once and that can be made available to a whole variety of stakeholders and commissioners who need it,” Vic explained.
“What’s happened in the past is that people have wanted similar bits of data but they have asked for it in different ways.”
While progress has been made in some areas of data, Vic highlighted that the sector was still lacking a minimum data set.
“One of the challenges in establishing that minimum data set is that if I call this activity ‘supporting independence’ and you call it ‘preparing a meal’ we are actually talking about the same thing but we have a whole bunch of data talking about different things so that I can’t find them in the same place,” Vic explained.
The NCF head noted discussions between Digital Social Care and CASPA in this area and the work of a specific research project that NCF is part of to develop a minimum data set for care homes – the £2.2million DACHA study (Developing research resources and minimum data set for care homes’ adoption and use), which is led by the University of Hertfordshire and funded by the National Institute for Health Research.
“CASPA has done some very interesting and helpful work around using some of their data and have developed a COVID-19 app to help organisations think about how they can use some of that data that they are gathering to manage and support people as effectively as possible,” Vic noted.
“We are beginning to see some really exciting examples of what that might look like in practice and we need to build on that.
“I think the really exciting potential for data is how you use it to improve services. We are getting to a place where we can use Capacity Tracker as a base for residential care as well as the development of a CQC data tool for domiciliary and supported living services, so the challenge is how you use that data to really drive improvement and end up with much better care for individuals.
“We have made some huge leaps in terms of understanding the role of data and how to get people online with things such as NHS Mail in order to be able to share data between them. We are missing a big piece of the architecture. You have got NHS Digital gathering together all the data from health services and analysing it and reporting on it. We don’t have that infrastructure within social care.
“As far as our ability to benchmark and to have longevity around data and understanding trends goes, we are quite a way from that being possible. It will come and we need to continue that focus on it.”
The NCF head also noted the need for people with specialist data analysis skills in the sector.
“I think that’s a potentially very exciting development in thinking about how we attract some of those people in,” she added.
Vic highlighted the potential for digital care planning to transform care through its ability to record up to 400 daily interactions.
“If you aggregate that up across a relatively small service you have got thousands and thousands of bits of data about the way in which you deliver you care,” Vic said.
“That’s huge. If we can use the way that enables us to not just think about how you develop services but how you wrap around and deliver services for individuals by drawing on that data, it’s transformative.”
While noting the transformative potential of digital care planning, Vic acknowledged the sector’s digital revolution would not happen overnight with significant barriers remaining to take up.
“I think to their credit people have taken on additional challenges around moving into data,” Vic said.
The NCF head noted hardware and training costs, as well as the logistical hurdles of operating dual systems simultaneously, as among the main barriers to adoption. She singled out leadership as another key factor in implementation.
“There are still also some barriers around leadership and leadership perspective and I think that’s about how important people see this as,” Vic reflected.
“All care organisations have got huge numbers of competing priorities and if organisations are functioning ok on paper then maybe they just get on with that. We need to think of ways in which we can really sell those benefits and how they can actually transform somebody’s experience of care and the way in which they receive services.”
Vic noted an NCF programme with Skills for Care last year on digital leadership that highlighted ways to more effective implementation.
“One of the really good learning points that came out of that was that people learning was very important,” Vic said.
“People don’t want to be told by a software supplier or the regulator you have to do this, they want to learn about it from their peers. That’s really where the NCF Hubble Project came from.”
Having launched in mid-September, the Hubble Project, which drew inspiration from WCS Care’s Innovation Hub, was initially intended to be a series of face to face events hosted in care homes and supported living settings where people could see technology in action and learn of its benefits.
As a result of COVID-19, the project has been reformatted as 30 virtual events over three months hosted in three care home and supported living hubs.
The care home sessions will showcase digital care planning, eMar and the built environment, including circadian lighting.
“The idea is that there is a whole bunch of tech that people want to see in practice and they want to hear from the people who have put it in place,” Vic explained.
“What you will get with the virtual hubs is a whole set of short films focused on the experience of using it, the leadership thinking behind it and the process they went through to get to that stage and what the tech actually does and what alternative tech might be available. There is then the chance to talk to the people involved at each of the care providers in each hub as the visits are run as live webinars.
“It’s a really full, rounded experience and we think that will really go down well because it’s also about hearing from your peers and from the people who are actually using it.”
While noting the seismic impact of COVID on social care, Vic said it had moved the digital agenda forward four to five years in some areas, and stressed the onus was on government and policymakers to support continued adoption.
“It’s important that policymakers don’t just talk about care services adopting technology but support them to do it and set out a pathway of what they need them to do in the future,” Vic said.
The NCF head called for greater partnership between providers, the government and the regulator in encouraging digital adoption.
“There is a risk that social care gets dragged up by the regulator to integrate with health data systems,” Vic told CHP.
“We need a partnership to ask: ‘what do we see the digital future of social care as and how do we see that enhancing people’s individual care?’ That’s the shared ambition we should be working towards.”
Vic said it was important the CQC took a partnership rather than a punitive approach to encouraging digital adoption.
“I don’t think it would be at all helpful if the CQC said everyone has to have electronic care planning by March in order to be able to get outstanding,” she noted.
“It needs to be a carrot rather than a stick approach and it’s got to be a partnership and it’s got to be absolutely focused around what people need from care and making care better.”
When promoting technology adoption, Vic also noted the key importance of focusing on the care outcomes for individuals.
She cited the controversial area of robots as a good example of the need for careful messaging to encourage engagement and take up.
“People get wound up about using robots as they see them as taking away the care element,” Vic said.
“Maybe people want humans for some things and robots for other things. Because we don’t really articulate what we want it to do, people get in a really narrow mind set about it being a replacement and a cheap alternative and inadequate alternative, when actually it will and already has completely revolutionised some people’s lives.”
She cited the example of assistive toilet cleaning technology and exoskeletons which help people get up independently as instances where technology can successfully stand in for and support human interaction to beneficial effect.
Looking ahead, as the government ponders serious reform of the sector, Vic said NCF would continue to lobby for a fair price for care.
“We want this ‘fair price for care’ to be paid whether you are having services commissioned by the LA or you have to pay for it yourself, so we stop the cross subsidy arrangement,” Vic noted.
Regarding the workforce, Vic said ‘reward, recognition and registration’ were NCF’s three key demands.
The executive director said NCF also wanted to see an increased focus on the not for profit side of care within an ethical investment framework.
She added the not for profit body would continue to work to ensure that voices of care users were heard by government when shaping policy.
“There’s big groups of people whose voices are not being heard and we want people to be much more savvy about engaging with people who might use care services in the future and making sure those voices shape reform and we want the reform agenda to embrace the potential to invest in tech to get to the changes we need,” Vic said.
The NCF leader said she was an “eternal optimist” when asked by CHP whether real reform was on the way.
“I haven’t just been through three years of working on a Green Paper without retaining a shred of optimism,” she wryly commented.
“I think it will be impossible for the government not to develop a reform agenda based on the level of scrutiny that they will have been under around what a lot of people now recognise as systemic failure – be that pay and workforce or the government’s inability to recognise the level of deaths because the data wasn’t there.
“Whichever bit of the system you look at it clearly shows up that something which is underfunded and under-resourced and in desperate need of reform.
“The government has to shift its position so that it’s helping rather than hindering the delivery of quality care.”
While structural reform may be finally on the way, Vic cautioned that it may be a while yet before it sees the light of day, however.
“I can’t see anything meaningful happening pre-Brexit,” Vic said. “Let’s go for 2021 as the year of social care reform!”