many care providers. Indeed, for those homes fluent in co-production, it would have simply been a case of picking up the phone and booking an appointment with an outside expert such as a dietician, a tissue viability nurse or a podiatrist. However, with PPE and testing both in short supply, access to health care has suddenly been severely restricted. That would have been an impossible

barrier for both social care and health providers to negotiate in the past, but thanks to video technology, we have witnessed a profound step change in how services are being administered. Suddenly, it is as if the pace of technological change has quickened. GPs and NHS nursing staff are assessing service users via video link. Being present on calls, not only adds

another dimension to a care worker’s skillset and knowledge base, it also ensures that the care plan they produce is even more detailed than before. That said, there will be times when a

care worker does not have the clinical training to assist. On these occasions, technology can play a key role by directing a care team to an online resource that may be able to provide them with the necessary guidance.

People, premises and their environment Infection control is a pre-requisite for any provider, but the highly infectious coronavirus has placed infection prevention in the spotlight like never before. Homes must be hastily remodelled, rooms repurposed, and social distancing markers placed in communal areas to prevent cross infection. Yet before any redesign takes place, it is

important that it is properly thought through. Where are the bottlenecks in your service? Can communal areas continue to be used or do they need to be

cordoned off? Which rooms will be reserved for those diagnosed with or symptomatic of with Covid-19? Are the barrier nursing techniques you employ robust enough to prevent cross-infection? Is there enough PPE to allow at least one relative to visit a dying loved one?

Consent With around a third of UK Covid-19 deaths recorded in care homes, services must ensure that they have a copy of a service user’s advanced care plan. This means knowing what a person’s end of life wishes are and that they have been properly recorded and communicated to loved ones. Without face-to-face contact, this can be challenging. If a person with Covid-19 lacks the

capacity to communicate or make decisions, staff must ensure that the Mental Capacity Act 2005 is followed. That means acting in a person's best interests. But this requires a multi- disciplinary approach with senior staff, family and GPs meeting together to discuss end of life care. With the lockdown preventing the

usual procedures from taking place, video conferencing, which enables all stakeholders to collaborate virtually, should be embraced. Where it is not possible, however, picking up the phone is an equally effective option. In addition, it is imperative that care

staff can strike the correct balance between ensuring that the rules of lockdown are followed and not breaching resident’s liberty. It is no good simply shutting people in their rooms. That might prevent service users from contracting Covid-19 but it may be extremely harmful for their mental health. Why? Because those living with

dementia may not understand why, suddenly, they cannot have physical contact with their peers, or that they cannot touch door handles. Furthermore, they may become frightened when they are approached by staff in full PPE. ‘Effective’ homes employ staff who understand the need to gently explain the dangers of the virus to those living with dementia. Also, the longer-term effect on all staff

must be recognised. The best providers will not only take this on board but also provide ongoing support for carers. They may suffer many different forms of post- traumatic stress disorder due to continuing to deliver high quality care in the face of such unprecedented emotional, challenging and pressured environments. Finally, I think it is important to


understand that this pandemic will pass, but social care will be changed forever. I truly hope that there will be higher societal and monetary value accorded to social care workers and services. My hope too is that technology will be more ingrained into practice and the organisational split between the NHS and the social care sector will narrow. TCHE

Useful resources

QCS coronavirus hub: updates/

CQC coronavirus information: providers/all-services/coronavirus- covid-19-pandemic-information- providers

Ed Watkinson

Ed Watkinson is director of Watkinson Consulting and consults for QCS on a freelance basis. In a career spanning 25 years, he has been a care assistant, registered manager, area manager, care manager and senior commissioner. Watkinson’s passion is regulation and has worked for the care regulator as an inspector, methodology developer and in 2014 was on secondment assisting the policy team in the development of the CQC’s most recent inspection framework. He has also worked as a regulation manager for Barchester Healthcare, and until setting up his own consultancy was the Director of Care Quality for QCS. Ed can be contacted through his website,• June 2020

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