Enhanced Health in Care Homes London Winter Readiness

Enhanced Health in Care Homes London - Winter Readiness Webinar 3: Managing winter illness 11th November 2019 NHS England and NHS Improvement A collective approach to planning for winter The London Enhanced Health in Care Homes (EHCH) programme team have been working together with Sustainable Transformation Partnership (STP) teams, Clinical Commissioning Groups (CCGs) and Local Authorities (LA) to support care providers across London. The London EHCH programme provides information and resources to help facilitate a winter planning partnership between social care and health care providers; with the aim to deliver collective system wide resilience for London. Our vision To help raise awareness of the resources available we have planned 4 commissioner focused webinars and a single provider webinar all these resources will be recorded and available to access via the Healthy London Partnership website or Enhanced Health in Care Homes FutureNHS page You can use the information shared to complement existing resources for your care providers locally.

2 Enhanced Health in Care Homes Winter Readiness Webinars Dates Webinar 1 16th September 2019 13:30pm- 14:15pm Topics to be covered Flu Campaign and vaccination approach for London NHS 111 *Starlines Webinar 2 14th October 2019 13:30pm- 14:15pm Our vision

Promotion and campaigning for NHS 111 *Starlines Guidance information on how to use the service Progress with Star Line Evaluation recommendations Managing winter illness Webinar 3 11th November 2019 13:30pm- 14:15pm Webinar 4 9th December 2019 13:30pm- 14:15pm Flu Outbreak Standard Operating Procedure (SoP) for Care Homes- supporting a system

wide response to an outbreak Infection prevention Managing D&V in a care home setting Winter Readiness Recap Review webinars 1 to 3 Updates from each STP area i.e. Flu Campaign, Vaccination uptake, share learning/ solutions 3 What are we intending to cover today? Flu Outbreak SOP for London Commissioning of Flu vaccinations Access to free flu

vaccinations for social care workers Prevention & Support Sharing good practice and questions 2019/20 An opportunity to share your approach, discuss your challenges and highlight any further topics that we may not have covered A care home can be a centre for infection to flourish!

5 01 Flu Outbreak Standard Operating Procedure (SOP) for London Transforming Londons health and care together 6 The London Influenza Standard Operating Procedure What is a standard operating procedure? Focused on improved safety and quality of care a standard operating procedure (SOP) is a set of step-by-step instructions compiled by an organisation to help support people to carry out complex routine operations. SOPs aim to achieve efficiency, quality output and uniformity of performance, while reducing miscommunication and increasing risk of harm to patients/residents. Why have we introduced the London Influenza Standard Operating Procedure (SOP)? Following several outbreaks of flu in care homes in 2017/18; a standard operating procedure (SOP) was developed to support care homes with responding to an outbreak, in collaboration with local health and social care providers and commissioners. What does it contain?

Our vision It outlines the important roles and responsibilities for the following key stakeholders: Care Home Registered Managers/staff Residents registered GP/GP Practices/GP Out-of-Hour (OOH) services (OOH)/111Integrated Urgent Care (IUC) Local Health Protection Teams (HPT) NHS Clinical Commissioning Groups (CCG) Essentially this guidance aims to ensure an effective and coordinated approach is taken across support services to manage risk assessments and outbreaks in a home. Care homes will need to be made aware of the steps to follow and who to contact for support if needed this is where our resources come in. The SOP can support all types of care homes Nursing, Residential, Learning Disabilities and Mental Health. 7 Reporting an outbreak is so important and simple to do If the answer is yes CALL your local Health Protection Team as it may be an outbreak Our vision

To find contact details for your local Health Protection Team follow this link: https://www.gov.uk/guidance/contacts-phe-health-protecti on-teams 8 How can you help a care home to be ready to act if they do suspect an outbreak? One of the key challenges that teams who have experienced an outbreak talk about is communication and clear information being available 1. Their learning has been fed into the SOP meaning that we are proactively approaching Our vision learning to help not only one care home but also care homes across London to improve together.

2. Helping a care home team to be ready is a really important aspect of our roles as health teams supporting care Talking to your care home teams about this can help them prepare. Alongside the PHE guidance and the SOP what other resources do you have that can support the care homes? Create a list with the GP, of residents you suspect have flu like symptoms (Highlight all residents who may require antiviral treatment). The list should include Name Date of birth NHS Number

Create an additional list of residents who potentially require an antiviral (e.g.: patients with chronic underlying conditions who have not received a flu vaccination this season). 3. Send information from both lists to your local Health Protection Team. 4. Send prescriptions for residents who require anti-virals to your Community Pharmacy. 5. Give residents oral anti-virals as soon as possible, if required, under the guidance of the GP.

6. Contact your Local Authority if you need additional support with staffing resources during an outbreak. 9 Making a note the importance of record keeping and local governance All parties are responsible for ensuring all documentation and communications regarding an outbreak are retained for audit purposes. This should include Records of calls/emails to resident registered GP (In Hours) & GP OOHs via 111 starline, local HPT, local pharmacy and CCGs. Our vision For care homes nursing documentation, this should be in line with the Nursing & Midwifery Council NMC code of conduct (section 10), ensuring that clear and accurate records are kept regarding care delivered to residents. Health Care Professionals to also update the care home documentation, ensuring real

time records are kept during the outbreak. List of residents who were affected by the outbreak and treatment provided alongside further follow up should be maintained as per local policy. The CQC KLOE expects good record keeping in line with their KLOE 1 Where to find the Influenza SOP? You can find the standard operating procedure along with the supporting resources on; The Healthy London Partnership website https://www.healthylondon.org/resource/accelerated-improvement-resources/enha nced-health-in-care-homes/seasonal-readiness/winter-readiness/influenza-flu/flu-o utbreak-response-care-homes-standard-operating-procedures/ Enhanced Health in Care Homes FutureNHS page Our vision If you do not have access to the EHCH or Ageing Well pages please email [email protected] and the team will help get you set up. CarePulse Care Homes can access the quick guide and also the full document on CarePulse.

Please encourage your care home teams to claim their profile which in addition to be able to add on their capacity will also allow them access to the Care Home Resource pages Feedback is really important to the team please do let us know if there is anything else you feel would be helpful to your local teams 1 Supporting Resources These documents are referenced in the SOP in order to signpost care providers and commissioners to national guidance that should be consulted in in response to an outbreak. You may have local processes and resources in place too, so these can just support your existing materials! Our vision 1

02 Free Flu Vaccinations for Social Care Workers plans for London Transforming Londons health and care together 13 How can your teams access the free flu vaccination? Your local social care providers can access free flu vaccinations by one of two means Option 1 Option 2 Vaccinations can be provided in community pharmacies social care workers just need to

take ID into a pharmacy offering vaccinations for information on the nearest pharmacy visit www.londonflu.co.uk Vaccination pop up clinics can be arranged at care homes for >10 staff for more information or to book your vaccinations visit www.londonflu.co.uk Our vision 1 Collecting data for flu vaccinations Local trackers Locally collected data will enable you to feel confident that your care homes are preparing to prevent flu this year. South West England have produced a vaccination tracker to keep a log of staff and residents flu

vaccination. This can be completed and managed by the care home and shared with CCG and Local Authorities as part of regular reporting. Our vision 1 Collecting data for flu vaccinations Local trackers Providers are rewarded with a certificate and letter thanking them for working in partnership with health and social care to prevent flu: >70% of staff - Gold accreditation 60-69% of staff - Silver accreditation 50-59% of staff - Bronze accreditation Our vision NHSE North Region have set up an award scheme for care providers who self report and inform commissioners of staff flu vaccinations.

We would like our London network to adopt the same approach and acknowledge care homes who are supporting the flu campaign. Posters will be available to promote this as part of the campaign (to follow) 1 03 Prevention & Resources Transforming Londons health and care together 17 Helping Care Homes feel confident with Infection Prevention For people living in care homes, infections can be serious, and in some cases, life-threatening. They can also make existing medical conditions worse. Regular contact with staff, other residents, family and friends and the shared living space all mean infection can

easily be passed around. Our vision It is therefore vital to take the steps that can help prevent infection occurring NICE: Helping to prevent infection, quick guide Often we hear that concerns re infection prevention are an issue from care homes when accepting transfers and admissions from hospital it is worth talking to your local infection control team to see how you can support this in partnership with your acute and CCG teams. 1 Helping Care Homes feel confident with keeping their residents warm For a vulnerable person, living in a cold home increases their chance of serious illness or death. They are at higher risk of a heart attack or stroke, breathing problems, flu, depression and falls. NICE - Helping to prevent winter deaths and illnesses associated with cold homes, quick guide

Although this guide is targeted to home care managers, it is beneficial to share this with care homes to raise awareness on what actions managers and staff need to take to keep their care home and residents warm. Our vision Further information and guidance is also available on the NHS website: NHS - Keep warm, keep well Keep track of regular weather forecast updates on radio and TV. Severe weather warnings are also issued on the Met Office website, through the Met Office Twitter feed, or you can call the Weather Desk on 0370 900 0100 or 01392 885 680. 1 Managing a suspected D&V outbreak supporting clear processes D&V / Norovirus is easily transmitted from one person to another, all key services should be notified if there is an outbreak. The virus can occur at any time of year, but most cases occur October- March.

Helping a care home team to respond to an outbreak is a really important aspect of our roles as health teams supporting care. Here we have a short checklist of steps that need to be taken by a care home in the event of an Our vision episode of D&V/Norovirus in their home. Talking to your care home teams about this can help them prepare. Alongside the PHE guidance what other resources do you have that can support the care homes? 1. Notify the residents GP. If an infection is suspected, they may arrange for specimens to be sent to the laboratory 2. Notify the local Health Protection Team (HPT) if more than two cases,

suspected or known to be infectious occur within a few days. 3. Isolate infected residents and exclude infected staff from work, until 48 hours after the symptoms have settled. 4. Infected residents should, if possible, have sole use of a designated toilet or commode as long as their symptoms persist. 5. Prepare information for visitors asking them not to visit if they have had symptoms of diarrhoea or vomiting within the previous 48 hours. 6. Notify the hospital about the possibility of infection if a resident needs a

hospital assessment / admission. 7. Notify transporting ambulance staff about infection before the resident is collected. 8. When discharged from hospital within 48 hours of the last symptoms of diarrhoea and vomiting, a single room with a dedicated toilet and appropriate precautions should be provided until they are clear of symptoms for 48 hours 2 Managing a suspected D&V outbreak supporting clear processes Cleaning regime An enhanced cleaning regime needs to be carried out on the environment and equipment. A

particular focus should be on toilet seats, door/toilet handles and sink taps. Clean disposable cloths and washable mops should be used to clean frequently hand touched hard surfaces and should occur at least twice daily during an outbreak. Our vision Hand washing with liquid soap and water is vital to minimise the spread of infection and should be actively promoted. Alcohol hand rub is not effective at deactivating the viruses and bacteria that cause diarrhoeal outbreaks. Information on slides 21 & 22 has been taken from the Department of Health and Health Protection Agency guidance - Prevention and control of infection in care homes an information resource 2

Recognising signs of deterioration what are you using locally? Are your care homes using tools to support recognising signs of deterioration? NWLCC G There are a range of resources available, here are some examples Our vision 2 CarePulse bed capacity management system for London The resource centre hosts supportive information and guidance for care homes

to access to support them during the winter period Our vision www.carepulse.co.uk 2 How are you supporting your care homes to know what resources are available locally? Clear signposting to local resources We know that care home support services differ across London and this at times may cause confusion. One way to help with this is to support your care home to complete the Are you Concerned about a Resident Poster . This poster would support you to ensure your care homes know who to call at what time getting the help they require to provide great care within the home . Are your care homes aware of the support available to help with infection prevention and managing an outbreak? From Care home support teams Local hospitals

Community support services Local Health Protection Team Public Health England NHS England/Improvement NICE guidance & quick guides Our vision . 2 NICE Quick Guides available for care home managers and staff Our vision Copies can be found on the FutureNHS Collaboration platform (Kahootz), EHCH section and the CarePulse resource centre

2 Other resources what do you have locally? How to access and share resources across London and nationally We recommend you join the Kahootz / FutureNHS collaboration platform, EHCH network Commissioners and providers can register by emailing Our vision [email protected] 2 04 Sharing good practice and questions this is where we

want to hear from you! Transforming Londons health and care together 27 Working together across London - sharing good practice Our vision 2 Links to resources Slide 2 https://www.healthylondon.org/resource/accelerated-improvement-resources/enhanced-health-in-care-homes/ winter-readiness/winter-readiness-2/ Slide 10 https://www.gov.uk/guidance/contacts-phe-health-protection-teams Our vision Slide 11

https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf Slide 12 https://www.cqc.org.uk/sites/default/files/20171020-adult-social-care-kloes-prompts-and-characteristics-final.p df Slide 13 https://www.healthylondon.org/resource/accelerated-improvement-resources/enhanced-health-in-care-homes/ seasonal-readiness/winter-readiness/influenza-flu/ Slide 15 www.londonflu.co.uk 2 Links to resources Slide 16 https://www.england.nhs.uk/south/info-professional/public-health/infection-winter/care-guidance/ Slide 19 https://www.nice.org.uk/about/nice-communities/social-care/quick-guides/helping-to-prevent-winter-deaths-an d-illnesses-associated-with-cold-homes https://www.nhs.uk/live-well/healthy-body/keep-warm-keep-well/ http://www.metoffice.gov.uk/ Our vision

Slide 20 https://www.nice.org.uk/Media/Default/About/NICE-Communities/Social-care/quick-guides/Infection%20preve ntion.pdf Slide 22 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/214929/Car e-home-resource-18-February-2013.pdf Slide 24 www.carepulse.co.uk Slide 25 https://www.nice.org.uk/search?pa=1&ps=50&q=care+home+managers+quick+guides 3 Thank you for joining! If you have any further questions please dont hesitate to contact the team [email protected] 31

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