COVID-19 resources for Managers and leaders

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Vivaldi 2: COVID-19 reinfection in care homes study report

Department of Health and Social Care

The Vivaldi study, led by University College London, was set up in June 2020 to investigate SARS-CoV-2 transmission, infection outcomes, and immunity in residents and staff in care homes in England. Between 1 October 2020 and 1 February 2021 the study considered the number of people in an adult-social care home setting who had previously been infected with COVID-19 (confirmed by antibody testing), who then tested positive for virus with a PCR test more than 90 days later. The sample size of the study was 682 residents and 1,429 members of staff. The data shows a positive picture of the degree of natural immunity from COVID-19 amongst staff and residents in care homes in England, which suggests the risk of being infected twice from this virus is low.

Last updated on hub: 11 May 2021

Homelessness and rough sleeping in the time of COVID-19

London School of Economics and Political Science

The objectives of this study are to review how COVID-19has impacted on the problems of homelessness and rough sleeping; to clarify how policies, implementation and funding have changed; and to ask where we go from here. In particular, we look at how local authorities have changed their approach; the relationship between private renting and homelessness; and the effectiveness of the Everyone In initiative. During this first year of the pandemic the accommodation and support needs of rough sleepers have dominated the homelessness agenda. And despite success in bringing people off the streets and rehousing others from shared facilities, a continuing flow of people has appeared or reappeared in need of support throughout the pandemic. As a result, in total far more people were accommodated than expected. Given projections of unemployment and the relationship between unemployment and rent arrears, over 400,000 tenant households might be expected to be in significant arrears at the end of the year. In many cases landlords and tenants have found ways of coping. But the longer tenants remain in accommodation where they can’t pay the rent, the higher their future debts will be and the greater difficulties facing both tenant and landlord. Prior to the pandemic the number of those sleeping rough was measured at around 4,250 in November 2019. By May 2020 nearly 15,000 people had been accommodated (around 30% in London), including many who had been living in COVID-19 unsafe accommodation. Based on November 2020 evidence the NAO suggested that over 33,000 had been helped while the latest figures quoted by the MHCLG Select Committee suggested the figure had risen to 37,500 by March 2021. Numbers of those moved on to settled and supported accommodation were stated to be of the order of 26,000.

Last updated on hub: 11 May 2021

Vivaldi 2: coronavirus (COVID-19) new variant (B.1.1.7) in care homes study report

Department of Health and Social Care

The Vivaldi study, led by University College London, was set up in June 2020 to investigate SARS-CoV-2 transmission, infection outcomes and immunity in residents and staff in care homes in England. This report shows that he proportion of infections in care home staff and residents caused by the variant B.1.1.7 rose from 12% in the week beginning 23 November to 60% of positive cases just 2 weeks later, in the week beginning 7 December – with the B.1.1.7 variant spreading fastest in London during this period.

Last updated on hub: 11 May 2021

The state of end of life care: building back better after Covid-19

Institute for Public Policy Research

This report explores how to build back better end of life care after Covid-19. This should be based on delivering a managed shift to community-led end of life care. This would not be one size all – rather, it would be about a model led by the community, and through which people receive the specialist and non-specialist services that are right for them. The report identifies three disruptive trends in the 2020s: the pandemic’s aftershock – the ‘end of life care backlog’; more deaths in 2031 than in 2020 – total mortality will rise faster than the population grows over the coming decades; an ageing population means more complicated health needs. Key findings on resource allocation and healthcare utilisation, undertaken by Imperial College London, five areas where to focus efforts to accelerate managed delivery of high quality, community-led care in the decade to come: end of life care remains tied to hospitals; resilience on hospital care is higher in the North East, Yorkshire and the Humber, West Midlands and London; there is evidence of healthcare inequalities in healthcare and resource use; people do not feel confident in the whole workforce; and quality and access to care. The report makes a series of recommendations supporting a new framework for the shift to community-led end of life care in England, based on four elements: providing everyone; the right care; from the right person; at the right time.

Last updated on hub: 11 May 2021

Coronavirus and depression in adults, Great Britain: January to March 2021

The Office for National Statistics

Analysis of the proportion of the British adult population experiencing some form of depression in early 2021, by age, sex and other characteristics, including comparisons with 2020 and pre-pandemic estimates. Around 1 in 5 (21%) adults experienced some form of depression in early 2021 (27 January to 7 March); this is an increase since November 2020 (19%) and more than double that observed before the coronavirus (COVID-19) pandemic (10%). Around 1 in 3 (35%) adults who reported being unable to afford an unexpected expense of £850 experienced depressive symptoms in early 2021, compared with 1 in 5 (21%) adults before the pandemic; for adults who were able to afford this expense, rates increased from 5% to 13%. Over the period 27 January to 7 March 2021: younger adults and women were more likely to experience some form of depression, with over 4 in 10 (43%) women aged 16 to 29 years experiencing depressive symptoms, compared with 26% of men of the same age; disabled (39%) and clinically extremely vulnerable (CEV) adults (31%) were more likely to experience some form of depression than non-disabled (13%) and non-CEV adults (20%); a higher proportion of adults renting their home experienced some form of depression (31%) when compared with adults who own their home outright (13%); almost 3 in 10 (28%) adults living in the most deprived areas of England experienced depressive symptoms; this compares with just under 2 in 10 (17%) adults in the least deprived areas of England.

Last updated on hub: 10 May 2021

Incidence of SARS-CoV-2 infection according to baseline antibody status in staff and residents of 100 long term care facilities (VIVALDI study)


Background: SARS-CoV-2 infection represents a major challenge for Long Term Care Facilities (LTCFs) and many residents and staff are now sero-positive following persistent outbreaks. We investigated the relationship between the presence of SARS-CoV-2 specific antibodies and subsequent infection in this population. Methods: Prospective cohort study of infection in staff and residents in 100 LTCFs in England between October 2020 and February 2021. Blood samples were collected at baseline (June 2020), 2 and 4 months and tested for IgG antibodies to nucleocapsid and spike protein. PCR testing for SARS-CoV-2 was undertaken weekly in staff and monthly in residents. The primary analysis estimated the relative hazard of a PCR-positive test by baseline antibody status, from Cox regression adjusted for age and gender, and stratified by LTCF. Findings: Study inclusion criteria were met by 682 residents and 1429 staff. Baseline IgG antibodies to nucleocapsid were detected in 226 residents (33%) and 408 staff (29%). A total of 93 antibody-negative residents had a PCR-positive test (0.054 per month at risk) compared to 4 antibody-positive residents (0.007 per month at risk). There were 111 PCR-positive tests in antibody-negative staff (0.042 per month at risk) compared to 10 in antibody-positive staff (0.009 per month at risk). The adjusted hazard ratios for reinfection in staff and residents with a baseline positive versus negative antibody test were 0.13 (95% CI 0.05-0.40) and 0.39 ((95% CI: 0.19-0.77) respectively. Of 12 reinfected participants with data on symptoms, 11 were symptomatic. Antibody titres to spike and nucleocapsid were comparable in PCR-positive and PCR-negative cases. Interpretation: The presence of IgG antibodies to nucleocapsid was associated with substantially reduced risk of reinfection in staff and residents for up to 10 months after primary infection.

Last updated on hub: 10 May 2021

Care homes: visiting restrictions during the Covid-19 pandemic: fifteenth report of session 2019–21

UK Parliament

This report focuses on the visiting restrictions in care homes that have been enforced in England. Given the similarities of some of the restrictions and the shared challenges, many of our conclusions may well also be of relevance in Wales, Scotland and Northern Ireland. Over the last 14 months, family members—many of whom perform essential care giving roles—were either banned from visiting their loved ones or faced very significant limitations on their ability to be with them. The human cost of the visiting restrictions has been vast. Despite the efforts of the hardworking and dedicated people who work in social care, we heard numerous reports of people suffering rapid declines in their physical and mental health as they were isolated from their families for over a year. It has been a powerful reminder of why the right to family life is so important. Of course the Government has a duty to protect the lives of residents in care homes. But it also has an obligation to uphold their right to family life and ensure that this is facilitated in practice. As restrictions have started to ease in recent months, the Government’s guidance, which applies in England only, has begun to reflect the importance of allowing care home residents to be with their families. However, many care home providers are arguing that it is not yet safe to follow the guidance, denying care home residents these important family links as part of their right to family life. The report reiterates our call for legislation to require that individualised risk assessments are undertaken for each resident, and to ensure that procedures are in place so that such assessments can be queried where they have omitted relevant factors or not made adequate efforts to consider how Covid-secure visits might be facilitated.

Last updated on hub: 10 May 2021

LSE–Lancet Commission on the future of the NHS: re-laying the foundations for an equitable and efficient health and care service after COVID-19

The Lancet

The UK-wide London School of Economics and Political Science (LSE)–Lancet Commission on the future of the NHS provides the first analysis of the initial phases of the COVID-19 response as part of a uniquely comprehensive assessment of the fundamental strengths of and challenges that are faced by the NHS. The NHS has long been regarded as one of the UK's greatest achievements, providing free care at the point of delivery for over 66 million people from birth to death. The Commission sets out a long-term vision for the NHS: working together for a publicly funded, integrated, and innovative service that improves health and reduces inequalities for all. The Commission makes seven recommendations, and associated sub-recommendations, for both the short term and long term, with a 10-year timeline. First, increase investment in the NHS, social care, and public health by at least 4%, in real terms. Second, improve resource management across health and care at national, local, and treatment levels. Third, develop a sustainable, skilled, and fit for purpose health and care workforce to meet changing health and care needs. Fourth, strengthen prevention of disease and disability and preparedness to protect against major threats to health. Fifth, optimise diagnosis to improve outcomes and reduce inequalities. Sixth, develop the culture, capacity, and capability to become a so-called learning health and care system (ie, in which data-enabled infrastructures are routinely used to support policy and planning, public health, and personalisation of care). Finally, improve integration between health care, social care, and public health and across different providers, including the third sector (ie, charity and voluntary organisations). The report argues that, similar to the establishment of the NHS after World War 2, after the COVID-19 pandemic and leaving the EU, the UK faces a once-in-a-generation opportunity to invest in the health of all its population and secure the long-term future of the NHS.

Last updated on hub: 10 May 2021

COVID-19 and the female health and care workforce survey update: survey of health and care staff for the Health and Care Women Leaders Network (February - March 2021)

NHS Confederation

Findings of a survey commissioned by the network, to find out how the impact of the pandemic on women working across health and care changed as the crisis progressed. The report shows that, since summer 2020, the impact of the pandemic on the female workforce has demonstrably worsened and more women are reporting an even greater negative impact on their physical and emotional wellbeing. This is linked to the increase in the number of hours women report spending on their caring responsibilities (both in and outside of work). The impact of these responsibilities may be greater for women from black, Asian, and minority ethnic backgrounds. The findings of the survey also show improvement in some areas, including teamworking and increased feelings of camaraderie - but the marked deterioration in the key areas of physical and emotional wellbeing cannot be ignored. With 78 per cent of the health and care workforce being female, the impact of the pandemic on women needs to be considered as part of overall recovery plans.

Last updated on hub: 10 May 2021

In need of support? Lessons from the Covid-19 crisis for our social security system

Resolution Foundation

This briefing note looks at the lessons we have learnt about the UK’s welfare system over the course of the Covid-19 crisis so far, and what those lessons might mean for its future direction. The report draws out the lessons for the welfare state from both how the existing system performed and also the changes that were swiftly made to it. It also offers examples of practical policy changes that draw on the experience of the past year. It sets out seven lessons: Lesson 1 – Earnings-replacement is a fundamental role of the social security system; Lesson 2 – Our system of sick pay leaves workers with too much of a financial imperative to carry on working; Lesson 3 – Treating employees and self-employed differently is hard to justify, and getting ever-harder to implement in our modern labour market; Lesson 4 – The level of support provided by the pre-crisis safety net was insufficient given the needs of low-income families, and particularly for younger adults; Lesson 5 – The safety net needs to reflect the variation in costs faced by different households; Lesson 6 – Delivering real-time, multi-billion pound programmes is possible but will inevitably result in design flaws that leave the state exposed to greater risk of fraud, and have too many rough edges; Lesson 7 – Our system for supporting those with long-term health conditions may soon be under much greater strain if long Covid leads to people withdrawing from the labour market. Drawing on these lessons, we set out three possible directions for reform: providing a greater degree of earnings-replacement; ensuring a more generous system overall; and doing more to support those with additional costs. The suggested policies are intended to be illustrative examples, rather than concrete proposals, and are not intended to be mutually-exclusive – indeed, progress could be made on all three fronts

Last updated on hub: 05 May 2021

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