Maintaining learning disability care and support during the Covid-19 crisis

This piece has been written by IPC Associate Chris Watson. These are his observations and comments regarding the importance of maintaining good lines of communication and positive relationships between commissioners and providers of care and support for people with a learning disability during the Covid-19 crisis.

Maintaining support for people with a learning disability

Some councils have been facilitating daily conference calls between commissioners, social workers and the management teams of all local support provider organisations to ensure that problems are identified, shared and solutions agreed quickly.

In some areas, commissioners have written to providers to confirm that they will continue to get paid at rates in line with existing contracts regardless of whether the full amount of specified support has been delivered (for example as staffing levels reduce due to Covid-19 infections). This approach has been designed to allow providers to flex their workforce as they see fit to be able to deliver critical life support outcomes and not be penalised for non-delivery against the support plan – reducing the risk of provider and market failure.

In other areas, where this has not yet happened, some providers are expressing concern about the reduction in demand caused by voluntary self-isolation and the subsequent financial impact of not being fully funded to cover fixed staffing costs. They cannot take advantage of the job retention scheme to furlough staff and in this scenario may be left at increased risk of failure. The impact of these fluctuations in demand relative to reductions in overall staff availability due to sickness has not yet been fully gauged and so the additional costs incurred by providers for increased agency staffing use may also need to be a consideration when planning budgets for contingencies. The Local Government Association and Association of Directors of Adult Social Services have recently released a statement suggesting that costs for providers may increase in the region of 10% overall, but it is likely there will be significant variations on this figure depending upon individual circumstances.

There is also a need to consider communications with direct payment holders, who are purchasing support from providers themselves, giving instructions regarding the continuation of payments at agreed pre Covid-19 levels when required by the provider (regardless of whether or not the agreed support hours/provision is being fully delivered). Some councils have written to direct payment holders to instruct them to continue to pay provider invoices for support and day services in order to support sustainability. This approach helps to ensure that providers, with a workforce that cannot be redeployed or that may be required again at short notice, can maintain sufficient income to cover ongoing fixed/staffing costs.

Some direct payment holders have taken a pragmatic approach and are continuing to pay agencies and their personal assistants (PAs) at either full pay or at a retained rate, which has been negotiated according to need (regardless of not having had direct instructions from commissioners to do so or not).

Impact of current crisis on services providers

A number of people with learning disabilities require shielding and have chosen to temporarily move back in with family for 12 weeks to self-isolate. This has left their support providers with the option of:

• Providing partial ongoing support to the person in the family home (difficult to achieve without exposing the person to some risk of external infection)
• Redeploying those staff into services where there may already be gaps in schedules due to staff sickness
• Redeploying staff to act as crisis response or backup for other teams
• Allowing staff to take unpaid leave and/or to work for other agencies

Where it is not possible to redeploy or re-assign staff, providers may well be left with a significant financial risk unless they receive assurances from commissioners with regards to continuation of their funding. It would appear sensible to have discussions on a case by case basis regarding maintenance of funding as required.

In some areas self-isolating care staff with Covid-19 symptoms have reduced the capacity of providers to deliver sessional community support to people living more independently, meaning that some have moved to providing support with critical life support functions (such as personal care and food shopping) only. Again, the continuation of funding for providers in these scenarios may be critical in maintaining their financial viability.

Some group supported living homes have increased core staffing and shift lengths alongside a reduction in sessional one to one support with the intention of reducing the flow of staff in and out of homes over this period.

Contingency

The need for individuals, families and support providers to be able to react quickly and respond to reductions in the availability of support staff or personal assistants means that having in place a process for rapid authorisation of contingency funding is also important. In response, some councils have pre-authorised the award of lump sum contingency funding amounts based on a percentage of the total budget and are making this available on request.

Most commissioned, and previously booked short breaks provision have been cancelled – meaning increased pressure on families to continue to care without breaks. Some councils have therefore authorised, on a case by case basis, the temporary employment of other family members (living in the same household) as a replacement for short breaks, PAs or domiciliary care agencies in the interim to deliver necessary support/breaks for carers.

There is a need to also consider contingency arrangements in shared lives and to accept that there may be significantly higher costs incurred in these services should 24/7 agency support be required to temporarily replace shared lives carers who are ill or needing to self-isolate.

Key worker issues

At time of writing, personal protective equipment is still not easily available for providers and this is exposing the workforce to higher risk of infection/cross infection. Some providers have reduced community visits to people’s homes in order to facilitate essential tasks only, reducing contact and subsequent exposure risk.

PAs have had difficulties in evidencing key worker status. Some councils are working with direct payment holders to identify PAs and provide letters of support regarding their key worker status.

There have been instances where people with learning disabilities who are in receipt of two to one support to access the community have been challenged by police or the public regarding being in a ‘group’. Providers have been requesting (and receiving) letters of support from commissioners and practitioners confirming the need for staff to undertake this role when out in public.

Assessments and reviews

In some areas, routine assessments and reviews have been cancelled and replaced with a triaging system which manages urgent issues arising and requests for care management intervention based upon risk assessment frameworks based upon the Coronavirus Act easements. Some authorities have developed a framework for practitioners and call centre staff to make these decisions ensuring compliance with the Human Rights Act.

Conclusion

What is apparent in many of these situations is the need for enhanced communication and scenario planning across all types of support provision as well as the development of reduced friction decision-making and care management processes. It is also important to work with providers to understand their financial risks and to work in partnership to ensure adequate funding is agreed to avoid provider failure where this has been identified as a possibility.
From what is an unprecedented situation there may be some new and positive opportunities forged from the crisis. In particular, it has highlighted the need for enhanced communication between commissioners and providers, flexible trust-based working and the building of genuine partnerships which share resources and staff across organisational boundaries.
The emergence of a network of community volunteers may also offer the opportunity in future to link people in need with help from people in their local neighbourhood, either through longer term volunteering or by developing local micro provider organisations to supply care or activity-based support.

Whilst acknowledging that this is not a fully comprehensive list of all of the issues faced by the sector it is hoped that this blog will stimulate discussions and will help health and social care managers in their considerations in managing through this difficult period.