Practice examples: Challenges and solutions of commissioning during COVID-19

• Provider responsiveness
  Mencap in Kirklees Open

  Summary and purpose

  Dawn is an operations manager in Mencap in Kirklees. She works with day care services, domiciliary care and three residential homes for adults with learning disabilities (30 residents across the three residential homes).

  When COVID-19 lockdown began, the day care services closed, the domiciliary care services reduced enormously due to shielding, and staff numbers in residential homes were reduced due to being ill or symptomatic.

  The senior management team created a ‘backup workforce’ from these affected staff to work across different services – most of whom agreed to take part. Staff previously working in day services or domiciliary care started working in residential homes to fill the gaps and keep the service safe.

  One of the care homes had several people ill and three individuals had died, which created a staffing problem in terms of numbers. It was also hard on those who were still working or in the care home and affected by the illness/death of people close to them.

  Staff suggested and implemented very innovative and engaging activities for people to thrive. For example:

  • Being inspired by the quote ‘you can’t go to the world so we bring the world to you’, staff dedicated one day each week to a specific country so staff and residents experienced food, films, songs, etc. from that country.
  • Residents ran a walk in shop, so others could buy those little things that they missed such as sweets, magazines and toiletries.
  • Residents used social media platforms to video call people important to them and to maintain relationships. They also wrote letters to the local school children to maintain community links and much more.

  One of the great achievements has been the increase in knowledge, skills and sense of one big team. The relationships between staff at a personal and professional level have developed in a very positive way, which allows them to work better together.

  Challenges and learning points

  The challenge will be to build members' confidence to return and engage in the new normal; some people and family carers are very fearful.

  One key lesson Dawn learnt is that it would have been better to centralise calls to reduce the amount of them, rather than relying on different service managers to deal with the calls to their individual service.

  Contact Dawn Wood, Operations Manager

  Mencap in Kirklees website

  Facebook

• Collaborative working and maintaining quality
  Princess Homecare Open

  Summary and purpose

  Princess Homecare is a small domiciliary care agency in a rural part of Wiltshire Council with less than ten clients (older people). Since the start of the COVID-19 crisis, the Council has been proactive, supportive, as well as approachable and responsive to questions. They have acted as a sounding board for questions or signposted Princess Homecare to further information, which has been crucial particularly at the break of the crisis.

  Wiltshire Council have supported us providers by agreeing to pay all invoices sent to us, ensuring we are financially stable to continue the service during the crisis. They have also offered to pay for additional costs such as training new staff, extra travel incurred due to emergency service provision and the purchase of tablets for the use of video calling service users’ families during the lock down. These have enabled our company to continue providing services safely and without financial concern, particularly with the cost of personal protective equipment (PPE).

  We have kept a log of actions and activities taken due to COVID-19 to ensure we know what happened and when. We have also been able to keep in touch with the service users’ families with regular updates on top of their video calls. Because of this, we are able to easily reference resources we have found, reasons we have taken actions and provide accurate information to families for peace of mind.

  Examples of actions taken below:

  • Providing video calls between clients and families.
  • Recruiting volunteers to phone clients weekly.
  • Working collaboratively with other providers, sharing resources and involving them in contingency plans.
  • Working with Wiltshire Care Partnership (WCP) to connect with other providers.
  • Sharing our insights and experiences with SCIE.
  • Engaging with webinars provided by organisations such as Skills for Care and SCIE.
  • Providing technology to ensure those who can work from home are able to, boosting motivation and support.
  • Continually checking latest guidance and best practice to ensure we are working as safely as possibly.
  • Making sure staff never run out of PPE.
  • Regular checks on staff health and mental wellbeing.
  • Working with staff to develop working schedules rather than just handing them their weekly rota.
  • Providing regular updates to staff (weekly videos in a format they all wanted) and clients/families (website updates and email communication).
  • Separating staff from care service and other services to ensure minimal cross-over and risk of transfer.
  • Use of technology to enable call diverts away from land-based office to remote working.

  Challenges and learning points

  The key challenge has been to keep up to date with the amount of information being released daily, and being able to translate it in a practical way to staff, service users and families. The fact that the information is not organised in one same place has added to the difficulty, as some days we received several emails from different sources with similar information.

  To help combat this, we have been recording weekly video updates for staff with the key information they needed to do their jobs. We also forwarded some information for them to read, but provided a video summary to facilitate accessibility to the key messages and give staff the opportunity to listen to them when suitable.

  One key lesson is how much more we can achieve and how much further can we reach working collaboratively. We have been linking to other small providers in the area and supporting each other emotionally and professionally. The level of collaboration between small companies has been incredible.

  Contact Charlie Marillier, Registered Manager

• Information and advice hub
  North Tees and Hartlepool NHS Foundation Trust Open

  Summary and purpose

  North Tees and Hartlepool NHS Foundation Trust set up a coordinated staff psychology support hub at the end of March to ensure internal coordination of support for staff, patients and carers in terms of information, toolkits, advice, risk assessment and onward support where needed.

  The hub was created following the basics of the major incident policy already existent in the Trust; it held and organised collated information from outside sources to reduce the burden of information gathering to the wider Trust and individuals. We also coordinated and planned in the early stages with neighbouring, acute, mental health and IAPT service providers to ensure there were no gaps or duplication in this process.

  We reached a 'saturation' point in terms of any novel and useful new information after approximately two weeks.

  The service offered:

  • A hot line for senior managers and clinicians who needed support individually or asking for team support.
  • Reflective spaces for individuals and groups.
  • Physical space near to the hospital, but in a different space that is not a COVID-19 red zone.

  Individuals seeking support were asked for agreement to provide some data, though no demographic or identifiable data was collected – the majority of them had no issues with this. Information has been collected and processed in relation to the use of the hub and an end of month report has been produced for April and May.

  A risk assessment was carried out and a series of protocols were developed to support the local helplines, such as toolkits for staff, toolkit for patients, child friendly booklets, etc.

  It has a real example of collaboration where all staff were caring and showing a clear understanding of roles and working together.

  Challenges and learning points

  The main challenge will now be going back to normal, as this threatens the continuation of what is still needed. The Trust has no capacity to fulfil this, even with support from partners and stakeholders received during the COVID-19 crisis.

  Feedback

  This 'command and control' style of setting up and continuing to run coordinated support services for our staff has worked well and has strengthened internal support services cooperation, learning and planning to continue to meet this needs for the future.

  Contact Dr Elaine McWilliams, Consultant Clinical Psychologist, Head of Medical Psychology Department

• Community responses
  Midlands Partnership NHS Foundation Trust Open

  Summary and purpose

  David worked in mental health day services until they started to be decommissioned in 2016. As a consequence, he looked into what was the best way to redesign the service, providing support to the community and maintaining people’s jobs. They created the personalisation and social inclusion (PSI) team and the role of the navigator, which is core to the PSI team.

  David manages a team of ten people who cover the entirety of South Staffordshire. He also manages eight community managed libraries for Midlands Partnership NHS Foundation Trust (the Trust) in partnership with Staffordshire County Council (LA), with one paid for member of staff, whose salary is generated from the libraries income, and a group of 200 volunteers. The community managed libraries won the HSJ Health and Local Government Partnership Award last year.

  The vision is to bring together the volunteers, the member of staff and the navigators:

  Our vision is to spread a 'Staffordshire Together' ethos across statutory and voluntary, community and social enterprise sectors with robust coordination focused on prevention and early intervention.

  COVID-19 impact

  The impact of COVID-19 has been enormous, as the libraries are now temporarily closed and the PSI team have had to adapt service delivery.

  The LA and the Trust have built a pool of volunteers ready for COVID-19 support, so David, alongside them, is looking into how best to deploy these volunteers going forward. For example, using them for running the libraries, enhancing the resilience of community groups, and supporting people to go back to their lives and communities as the lockdown eases and circumstances change. There is a workshop to elicit ideas from various stakeholders and parties.

  Due to a reasonable volume of the library volunteers being over 70 and currently either shielding or under the ‘vulnerable’ category, this is being considered in the recovery plan.

  The aim is to spread this model across the entire county, and David is already in conversations with the North Staffordshire teams.

  Next steps:

  • Identify ‘small initiatives’ that have emerged and link them together.
  • Identify opportunities for volunteer deployment across the service delivery model.
  • Interview existing volunteers to identify skills and interests ready for flexible deployment.
  • Recruit more volunteers.
  • Identify funding streams.
  • Undertake research across the Trust and social care on what needs to go back to how it was and what does not.

  Challenges and learning points

  The main challenge has been the fact that South Staffordshire is a very rural area, and maintaining communication and linking to different parties or delivering training has been challenging. They have, however, overcome this challenge and are using Microsoft Teams and OneConsultation software successfully.

  Another challenge is the lack of equipment, set up or knowledge of some individuals to enable them to communicate through technology (i.e. broadband, phone, teams, etc.).

  The key learning point is 'that for years we have been doing things in one particular way of thinking that it was the only way. Under crisis, we have found different ways of working.’

  Contact Dave Bradbury, Social Inclusion and Community Capacity Lead (Staffordshire)

• Sustaining intergenerational initiatives
  Liverpool City Council Open

  Summary and purpose

  The Inter-generational Sustainable Skills Exchange is funded by Liverpool City Council and is delivered by IIIN Community, a Community Interest Company.

  The sessions bring together socially isolated older adults and allow them to teach their life skills to parents and children in their community. These skills include, but is not limited to:

  • sewing
  • knitting
  • crocheting
  • embroidery
  • card making
  • cooking
  • baking
  • gardening
  • wood work
  • bike repairs.

  The older adults would plan the session in advance amongst themselves, with IIIN Community providing a little guidance or steer as needed. These sessions empower the older adults and enhance their feelings of self-worth and value. Older adults feel valued and respected in society once again and begin to realise they have a wealth of skills and experiences that are incredibly valuable and we mustn’t lose. As sessions progress the younger generations share skills, often digital skills, supporting the older adults to become proficient in any areas they wish to be.

  These sessions also:

  • help parents and children reduce, reuse and recycle items/clothing that many would normally throw away
  • allow parents to devote a large amount of time and attention to their children which improves the relationship between parent and child
  • help older adults make and maintain friendships with members of their community, which they can call upon in a time of to help reduce feelings of social isolation and loneliness.

  COVID-19 impact

  When the COVID-19 pandemic hit Liverpool, all intergenerational sessions were halted as the majority of the older adult participants were required to shield, unable to spend time with anyone or leave their homes.

  Initially, significant support was given around meeting essential needs, such as food shopping. ‘Hello’ bundles were established from donations with some essential items, including a range of toiletries when items were hard to obtain. However, it became apparent that the older adults were missing the contact they had with the children and parents.

  The IIIN Community devised ‘VIRTUALITEA’ where older adults would eat a meal with each other via FaceTime/WhatsApp video. This alleviated some of the isolation the older adults were feeling. IIIN Community decided to attempt to bring the groups together virtually and ‘Virtual knit and natter/Crochet and Chat’ was born.

  The idea was for older adults to attempt to continue teaching their skills to parents and children virtually.

  Challenges and learning points

  Internet access was a huge obstacle. Many older adults who were able to use smart phones/iPads etc. would use communal WiFi areas (e.g. in sheltered accommodation) to access the internet. These areas were placed out of bounds by housing providers, which then resulted in their internet access being suspended. Many older adults who used their own internet had low data plans which would not allow them long periods on FaceTime/WhatsApp. IIIN Community spent many hours talking participants through how to increase data plans or access WiFi outside of communal areas.

  IT Proficiency
  Most of the older adult participants could not use or had no access to smart phones/iPads and only three of our 50 older adult participants had the necessary skills and knowledge to be classed as proficient. Social housing providers/community organisations loaned equipment to those without the necessary technology to get involved. IIIN Community then began to devise a teaching programme to enable all participants to take part in online sessions. Additionally, we assigned one of our local high schools to design lesson cards to teach older adults how to use a mobile phone and load FaceTime and WhatsApp.

  The online sessions drastically reduced the older adults’ feelings of social isolation and loneliness. They began finding activities for the parent and child to do during the week based on their skill i.e. sewing or knitting task and the sessions gave them a focus, a purpose. Older adults continued to plan these sessions between them, identifying the focus for the session, any resources required etc. to which IIIN Community would then facilitate.

  All resources were delivered to participants by IIIN Community.

  Feedback

  Parents reported children were thrilled to maintain contact with their older adult. Children found the activities a nice break from the online homework tasks. Children also maintained some form of routine by virtually meeting with their older adult, which gave them some stability in extremely uncertain times.

  Older adults have reported their relationships and friendships with parents and children have become deeper. They were able to call upon them for shopping, prescription collection, as they were unable to go out due to shielding. Many reported feeling well supported and classed them as family/friends rather than being supported by the state/local government. Many older adults returned/stopped government food parcels as they had food support from their parent/child partner. Parents have gone above and beyond to support the older adults involved in our intergenerational sessions – cooking meals, purchasing shopping, delivering books and magazines to alleviate boredom. Children have surpassed all expectations by writing letters, drawing pictures and designing cards to send to their older adult partner to show how much they value them and the role they play in their life.

  Contact Gemma Black, Commissioning and Contracts Manager