NEL worked in partnership with North Central London Local Authorities and NHS/CCG partners, as part of a wider project reviewing care providers’ experience, resident and family feedback and a review of data and literature. As part of this NCL wide programme of work, NEL participated in the programme steering group and conducted a series of After Action Reviews across care homes, domiciliary care, extra care and supported housing.

During July 2020, six After Action Reviews were undertaken with a total of 43 participants across a range of providers, with one representative per group from the CCG and/or local authority.

Local authorities, the NHS and the care sector responded to COVID-19 in unprecedented ways across all areas of service to enable NCL to respond to the pandemic and meet resident needs. This included rapid development of new forms of support, such as establishing new supply chains for personal protective equipment (PPE); developing local testing capacity and targeting this to population health needs (NCL were one of the first areas to test social care staff; and they continue to support social care settings such as extra care and supported housing that are outside of the national scheme) and setting up a range of new workforce support, such as peer groups, regular webinars, infection prevention and control training and a WhatsApp group for social care managers with clinical advice available. Despite everyone’s best efforts, it was known that the care sector was hugely impacted by COVID-19 and the system wanted to learn from their experience to support continuous improvement and increase involvement of care providers in shaping our system.

Participants shared some experiences which were challenging and required a level of adaptability in response to COVID-19. They were flexible and adaptable in response to lack of clear guidance (and rapidly changing government guidance), with guidance coming from multiple sources, initially inadequate PPE, and delayed as well as inconsistent access to testing and clinical support. Many felt they were not integral to system discussions on discharges into community care from the acute trusts and many lessons were learned. However, all providers adapted and introduced innovative ways to provide safe services, such as sourcing their own PPE, when supplies were limited, distributing surplus to other providers, setting up virtual visiting/ward rounds using electronic devices and establishing COVID-areas. All in addition to maintaining regular contact with relatives and families who were unable to visit during lockdown. Despite the challenges, providers also highlighted that they appreciated the increased contact from their local authority and that relationships on the ground were strong. Many highlighted improvements after the initial surge of COVID as support was reconfigured.

The top six proposed areas for ongoing development, and also in planning a second wave were:

  • Strengthening the co-ordinated approach to ordering and the distribution of PPE across NCL
  • Coordinate and develop summary of guidance across NCL where appropriate for local cascade
  • Consistent access to clinical and medical advice/support and better information to support discharge (including pathways for COVID positive residents)
  • Infection control training, support and guidance as part of business as usual
  • Access to digital technology to facilitate virtual ward rounds and virtual relative and family visiting
  • Establishment of local networks to enable support systems to be readily available, such as to redeploy staff to where required.

These areas have all been incorporated into a system wide action plan to support continued improvement through collaboration, and ensure vulnerable residents access excellent health, care and wellbeing support. One key action has been reaching system wide agreement that we will not admit anyone that is COVID infectious into a care home, supported housing or extra care facility, which goes further than national guidance in protecting vulnerable residents.

Jan Annan, Head of Improvement and Service Transformation at the NEL said “It was a real pleasure to work with some really passionate staff from across the social care sector, who put their clients and residents before themselves and went the extra mile to ensure staff, residents and clients were safe during a time of real uncertainty”.

Nita Bull, Improvement Manager at the NEL said, “I felt privileged to hear powerful stories of how the sector adapted and overcame huge challenges through the early stages of the pandemic. It was great to be able to set this feedback and learning in a wider review of literature and data including from residents and family, and see this take shape in a system owned action plan”

Richard Taylor-Elphick, Adult Social Care Programme lead for NCL councils said, “We knew that to genuinely learn lessons from the first wave of COVID-19,  we needed to really understand the experiences of care providers and work with them to develop the best solutions possible using our local health and care resources and tapping into our system’s creativity. NEL’s After Action Review workshops were an excellent tool to help us do this effectively.”

Dawn Wakeling, Director of Adults, Communities and Health, London Borough of Barnet and Chair of the Programme Steering Group, said “COVID presented an incredible set of challenges for all of us working in health and care and our care providers and those working for them have really risen to the challenge remarkably. The After Action Reviews were a way of us learning from the initial experience and putting in place processes to continuously improve how we support our residents. I want to thank NEL for their skilled and committed support with this project.”

For more information contact Jan Annan – jannan@nhs.net.