Durham CC’s focus during the COVID-19 outbreak is on supporting commissioned adult and health services to continue to deliver sustainable high quality care, says Neil Jarvis
The outbreak of COVID-19 changed the social care and health system in Durham overnight. As commissioners, we have to respond to multiple complex issues which have become apparent very quickly and it has been an incredibly busy, pressured time for my team.
Our main focus has been on supporting our local commissioned services; both in terms of their ability to continue to provide high quality care to users of their services during the pandemic, and in making sure they are sustained and able to return to normal functionality as quickly as possible when restrictions are lifted.
We have worked with colleagues across the system to take a strategic view of this work. Some support is generic to all provider types, with an agreement to provide critical provider services with advance payments and payment on planned care at a minimum level, based on recent service volume. This is designed to provide immediate liquidity and a ‘backstop’ level of funding during a time of uncertainty.
Building on this approach, we have also had to work on tailoring the financial assistance to specific sectors – for example, where demand pressure is likely to increase in areas such as residential and domiciliary services, we are having to review fees for the duration of the outbreak as we look at how staffing and supplies can be sustained.
Day services priorities are different: they have been forced to close through Government restrictions as they are designed as social gatherings. The need for this is understandable, but has left a significant gap in our care services, as pressure on unpaid carers and alternative services is growing.
Our market for day services is made up almost entirely of SMEs, many in the third sector. In a fast-moving critical situation we had to make plans quickly, while at the same time reviewing the changing national picture. Day services have been assured to some extent by the Government changes to statutory sick pay and employee wages, but we decided to maintain their current payment levels on the understanding that we can use their staff as emergency assistance within the voluntary, community and other care services. This ‘mutual aid’ approach ensures they are able to re-open when the pandemic has passed.
We have also instigated several other emergency measures, such as asking social workers and domiciliary providers to urgently prioritise calls to service users, where a family may be able to assist or call times could be reduced, to aid market capacity.
The key for our work has been in getting the communications right – both internal and external. Our teams have been working at a rapid pace to make crisis provision effective, while a large number of providers – we contract with over 250 across care homes, domiciliary and day services – have had questions and concerns about the ongoing outbreak and its effects. How we effectively sync with social work and operational teams in the current emergency has also been key to effective management.
I am now involved in planning the next stage of the response. This involves setting up a virtual hub of key officers and managers across health and social care to monitor our markets and respond to crisis issues daily.
While our integrated working is advanced in Durham we are operating at pace to have this implemented within the next week – something that would have taken significantly longer under normal circumstances.
There are some positive elements to the current crisis as plans, teams and providers come together to work much more closely. Balanced against this is the high human cost, with the sad reality of many of our residents being at significant risk.
Neil Jarvis is strategic commissioning manager for adult and health services at Durham CC