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Current key issues for staff and partner agencies

Information about the Government's Adult Social Care Infection Control Fund Grant

Updated 6 July 2020

The Infection Control grant has been allocated by the Government to support care services, primariy care homes, to take further infection control measures.  The Government has restricted how this grant can be used.

The grant has two elements - 75% of it must be allocated on a "per bed" basis to all care homes, and spent in line with tightly-definined national conditions; 25% can be allocated to any kind of care provider, for any infection-control purpose.  The Council  has chosen to allocate the "25% element" specifically to care homes for older people, in proportion to their number of places.  This is because all the evidence that the Council is aware of suggests that residents in these care homes are at greater risk from Covid-19 than users of any other service

The Adult Social Care Infection Control Fund is a Government initiative to suppoort infection control measures in care services - primarily in care homes - during the period between 13 May and 23 September 2020. 75% of the grant must be distributed to care homes on a "per-bed" formula based on the number of registered places in each care home as recorded by the Care Quality Commission at the beginning of May 2020. The remaining 25% is being offered in Northumberland to the 69 care homes for older people in the county, also on the basis of the number of registered places at the beginning of May 2020.

The Department of Health and Social Care has published the grant conditions and answers to some questions about them here.  The detailed rules on the use of the 75% "per bed"  element of the grant can be found there.  For the "25% element" of the grant which is being offered only to homes for older people, the Council has set more flexible rules.  This funding must be spent on infection control, and we have made it a condition of the grant that the care home must not have staffing arrangements which make no use of care workers who also work in other care homes, unless  there is an unforeseen emergency.  This is because of evidence that some Covid-19 outbreaks have been caused by asymptomatic care staff working across multiple care homes.  We have also said that the first call on the funding should normally be to pay for infection control measures which enable residents to have visits from family members and friends.  Otherwise, the council has made some suggestions about uses of the funding which would certainly be acceptable, but has also said that it will agree to any other reasonable proposals.

The questions in the sections below are those which have been asked by local providers, with our answers, based on our best understanding of the grant circular. We will update this advice as necessary.

We need clarification in regards to back dated invoices. Are we right in thinking that we can now claim any invoices that would fall under the categories listed in the previous circular, as long as they were issued on or after 13th May 2020, or can we go further back as long as it is within the pandemic?

The grant conditions say that the funding can’t be used for any expenditure “already incurred”, and it has now been clarified by the Government that this means expenditure incurred before 13 May 2020.  Expenditure is “incurred” at the point when goods are supplied or services are delivered – so counting expenditure as incurred on the date when it is invoiced for would not be correct.

Does Clause 6.6 in the grant agreement mean that on returning the allocated fund received to the local authority we also repay interest of 1% as we don’t receive this in our deposit or savings account and therefore would cost us money to return funds not used to Local Authority?

This clause is not about any funding that you might need to return to the local authority because you cannot spend it within the grant rules.  It would apply only if you were required to pay back the grant because there was found to be a violation of European Union “State Aid” rules (which still apply in the UK at least until the end of December this year). These are rules designed to prevent Government bodies from distorting competition between companies in different member states.  There is a theoretical possibility that funding paid to an economic enterprise on any basis other than a contract for goods or services could be held to be unlawful “State Aid”, and could have to be repaid.  Lawyers have told us we need to warn providers of this theoretical possibility, but our understanding is that it is very unlikely to be a real issue in this situation, for the reasons set out in the grant agreement. We think it extremely improbable that anyone would see this grant as discriminating against competitors in other European states.

Is it the government who have made this criteria so that the money will have to be returned? or is it a decision made by the Council?

The conditions in the grant circular were set by the Government, rather than by the Council.  National representatives of local authorities (and national provider organisations) have complained to the Government that the conditions applying to the 75% "per bed" element are unreasonably rigid, and have been told by the Minister of State for Care that they are “reasonable and necessary to ensure we have a clear understanding of how public money has been spent”.

There are many things the home requires, to assist with and improve infection control - however it is not possible to spend the grant on these improvements under the set criteria.

While we have no discretion over the rules for the “per-bed” element of the grant paid to all care homes, we have set out much more flexible rules for the use of the “25% element” of the grant which we are paying to care homes for older people..

We really need the funding to fight this virus but I feel that the categories given are too narrow.  Do you think this may change?

Our understanding is that similar points have been made to the Department of Health and Social Care by a number of organisations.  If it turns out that a large number of care homes are unable to spend the “per bed” element of the grant because of the restrictiveness of the conditions, when there are other infection control measures which they would like to be able to fund, it seems possible that the Government might reconsider this issue, but we aren’t in a position to give you any reassurances about that.

We have staff members who have second jobs in other care settings, which aren’t care homes.  We have asked the them to not go and work in these second jobs so as to protect all care environments involved from avoidable risk of exposure to Covid 19 infection.  Can we use the grant to make up the income they are losing as a result?

While the wording of the conditions in the grant circular isn’t entirely clear on this point, what you are doing is clearly in line with the intentions of the circular, and we agree that it would be reasonable to charge this against the “per bed” grant.

We do not engage agency staff due to the outstanding support from our staff team.  We currently have not been in a position to offer an enhanced hourly rate when staff have worked overtime.  To promote recognition of their continued invaluable commitment can we use the infection control fund to pay the staff team an overtime rate of 20% during this pandemic.

Unfortunately, the grant circular seems clear that the grant cannot be used to increase rates of pay, except for compensating staff for loss of income if they agree not to work in more than one care setting.

As staff bus journeys are short and rural, they feel the bus is safer than the close confines of a taxi, but the grant conditions encourage the use of the grant to pay for staff to use taxis rather than buses?

Yes, we agree that in Northumberland many bus routes are currently used only by a small number of people, and social distancing may be easier than in a taxi.  This part of the national grant conditions may perhaps have been written with London public transport in mind.  We would certainly advise against using the money to pay for taxis if there is no likely benefit in preventing infections – though the balance of advantage might change for some staff as more people return to work in other parts of the economy, and buses become more widely used.

Would the County deem a cycle to work scheme rolled out to all our staff an appropriate use of the fund?

Yes; if one of the expected benefits of this was that staff would be encouraged not to use public transport, this would be entirely in line with the national grant conditions.

Could we use the money to purchase an electric bike or bike  for our staff to use instead of using public transport?
Could we use grant monies to provide some form of bike shed/place to lock bikes up/locks to encourage people to cycle to work, rather than use public transport?

Schemes like this would be in line with the national grant conditions, so long as you have assessed that they would lessen infection risks by reducing the need for staff to use public transport.

What are your thoughts on using the grant to purchase a static caravan that could encourage staff to sleep over and also reduce time on public transport?

If you decide after discussing this with your care staff that this would be an effective way to achieve the objectives of the grant, we would have no objection to this in principle.  You do need to bear in mind that expenditure may be audited, so you would need to be able to explain to an auditor how this was a way of carrying out one or more of the “measures” set out in the circular and the grant agreement.

Can you please clarify if we are able to claim back for excess PPE that we have purchased during this pandemic?

The national grant conditions for the “per bed” grant don’t permit this.  If you have had additional Covid-related costs of providing your service which exceed the 5% supplementary payments that the Council is already making, and which can’t be covered using the Infection Control Grant, please let us have details of these; we will meet reasonable extra costs.    Care homes for older people can also charge PPE to the “25% element” of the grant which we are paying to them.

We are considering creating a new staff shower room and changing room facility in the home to try and encourage more walking and cycling to work.  Would the costs of creating the new rooms meet the definition of funding for the infection control grant?  How far would this stretch as the room in question needs new windows and flooring to be comfortable for staff use?

This kind of spending is explicitly permitted by the grant conditions.  You would need to be able to explain to an auditor why the expenditure on creating showering and changing facilities was reasonable, so you shouldn’t include any facilities which are clearly being installed for unrelated purposes.  You also might need to consider how long the works will take, since the current Government position is that the grant must be used by 23 September, and an auditor might not accept payments made in advance of carrying out the work.

Our staff team often work both in our care home and also see our outreach clients.  In an effort to prevent our outreach staff returning to the care home to complete paperwork after they see outreach clients,  could we use grant money to purchase an app which allows our staff to record their work remotely?

We would want to talk in more detail to you about any scheme such as this, which doesn’t on the face of it seem to fit with the wording of the grant conditions, though it is clearly trying to achieve the same objective of minimising the potential for cross infection by your care workers.

Are we able to use the grant for changing of flooring in rooms that have carpet, to improve infection control?

This wouldn’t fall within the list of measures which the “per-bed” 75% element of the grant is permitted to be used for. But it would be an acceptable use of the “25% element” of the grant which we are paying to care homes for older people, if the purpose was improving infection control.

Please could you consider if it is possible to use the infection control fund money to purchase an outdoor pod to use for visitors as this would be a more permanent solution for outdoor visits and avoid visitors within the care setting. The pod would be more comfortable than a temporary gazebo as it would have lighting and heat.

This would not be permitted by the national conditions for the use of the 75% “per bed” grant.  However we would encourage care homes for older people to use the “25% element” of the grant which they have been offered to fund infection control measures which would make it safer for residents to receive visitors, though even from the 25% element, only expenditure for the purpose of infection control would be permitted by the national grant conditions.

Has the Council yet decided how it will allocate this grant?

The Council has decided to allocate this element of the grant to care homes for older people, since all the information that we have suggests that these have been more severely affected by Covid-19 than other care services.

We are considering replacing the flooring in the communal areas to a wipeable vinyl as well as the purchase of a steam cleaner to assist in staff cleaning this will also reduce cleaning times as it achieves better outcomes with the correct equipment.  There is a need for some wipeable furniture to replace older material types.  Can we use the “25% element”of the grant for this?

If you’re making these changes in order to reduce infection risks, you can charge them to this element of the grant (though you can’t charge them to the 75% “per bed” grant).  However you can’t charge to the grant any expenditure which is purely about making the running of the home more efficient, rather than improving infection control.  You may also need to check with CQC what their expectations are about consulting with residents before making changes which they might see as making their environment less homely.

Can we claim for the loss of bedrooms which I have had to use as infection prevention areas for staff to ensure we can use all precautionary measures are taken into consideration, and installing other hand washing facilities, new sinks etc.?

It would probably not be acceptable to charge against the grant any loss of income because bedrooms have been taken out of use. However any minor works carried out to these rooms between 13 May and 23 September specifically to improve infection control could be charged against the “25% element.”

We would like 25% of the fund to be allocated for in house activities for all our service users. Our service has spent a significant sum of money in the weeks during lockdown in order occupy, stimulate & reduce behaviours & anxieties surrounding COVID-19

We probably couldn’t approve use of the grant to pay for activities themselves, since the grant conditions are very clear that we must use it only for infection control. But if you have suggestions about ways to minimise infection control risks during activities, please let us have these.  We are very aware of the risk of serious deterioration in the quality of life and wellbeing of residents because of the need for infection prevention and control measures, and we would welcome any suggestions about how better infection prevention measures could help to reduce this impact.

Our specialist bath on the ground floor is obsolete and is no longer supported by spares because of its age.  As a result there is a high risk that should any part of the bath fail it will have to be immediately put out of service.  This would mean residents from this floor would have to access bathing facilities on another floor disrupting our cohorting strategy.  On this basis I think that we should be able to use part of the infection control grant for a new bath to ensure cohorting in this high risk infection control area is maintained.  The new bath is also antimicrobial with built in cleaning functions that make cleaning after each resident easier.  Can you advise if the council would support us that this is a reasonable use of the infection control grant that we have received?

Replacement of existing equipment with new equipment essentially of the same kind seems unlikely to meet the national conditions for the 75% “per bed” element of the grant, which appears to be intended to fund new cohorting, rather than routine repair and replacement of equipment necessary to continue current practices and meet normal regulatory standards.  While the “25% element” of the grant is more flexible, if you were proposing to charge a replacement bath to that element of the grant, you would need to be able to explain to auditors why you think that not replacing the bath would have been a reasonable option if there had been no pandemic.  The grant circular says that both elements of the grant must be used “to tackle the risks of COVID-19 infections”.

Plan for supporting care homes during the Covid-19 pandemic

This page provides information about our arrangements for supporting care homes and other services during the Covid-19 pandemic, including documents which the Government has requested and asked us to publish.
29 May 2020
The Government has asked local authorities with social services responsibilities to send letters describing the joint, coordinated action underway between health, public health and social care locally to support the care home sector and reduce transmission within and between homes. The Government says it also wants to be clear on the delivery of the commitments made by national government (including support for local government and care providers).
We have published here:
  • The letter which the County Council has sent to the Government on 29 May
  • A template which the Government asked the Council to complete alongside the letter, describing our assessment of how many care homes we believe are currently achieving the objectives set out by the Government
These documents set out our initial view of the local situation.  Because of the very tight timetable set by the Government, we have not been able to discuss everything in these documents with as many of those affected by these issues as we would like to have done.  However we understand that both documents are regarded as a “first cut” of a description of the situation, and that there will be an opportunity to revise them as we learn more.
We are publishing them on our website so that anyone who is affected by the very difficult situation currently facing care homes in Northumberland has the opportunity to tell us what they believe we have got right, and what they think we have not yet understood.
As background to these documents, it may be helpful to read the Government guidance which they are responding to.  The most recent Government publications on this issue (which include references to some earlier publications) are:
The Government has also asked local authorities to publish on their websites a summary of the financial support which they are offering to providers of social care services during the Covid-19 emergency.
The main ways in which the Council has so far provided support are as follows:
  • An automatic 5% supplementary payment on top of all fees paid by the Council to care homes, home care services and independent living schemes, which recognises that all providers will have additional costs.  This support began from 1 April, initially for three months; we will review the situation during June.
  • A commitment to pay any additional reasonable costs that individual providers incur because of the Covid-19 emergency which exceed the 5% premium, or relate to the period before the premium started.  We have received a number of claims for funding on this basis; the first payments will be made in early June, so are not included in the figures below.
  • Free supply of fluid resistant face masks procured by the Council
  • Continuing full funding for those day services which have told us that they need that to enable them to remain viable during the period when they cannot operate because their service users do not wish to attend during the lockdown.  In return, we have asked for a commitment that day service staff will be available to provide other kinds of support if required.
  • A similar commitment enabling direct payments recipients to be able to continue to pay the full wages of their personal assistants, even if they are not providing care at present because of arrangements introduced to minimise the number of care workers involved in supporting someone particularly vulnerable to infection.  Again we have asked for assurances in principle that these personal assistants would be available if needed to provide other kinds of support.
The actual amount paid to providers up to 29 May specifically because of Covid-19 (including the cost of PPE supplied in kind) is shown in the table below.  We will update this information to show increases in expenditure over time.
Support to providers that the local authority has contracts with
  Domiciliary care Care homes Other services
5% supplement £281,400 £421,100 £5,100
Day care support - - £312,000
PPE £138,800 £123,100 -
Total £376,000 £544,250 £361,200
Total spent to date since on supporting providers the local authority has contracts with in response to COVID-19. £1,281,600
The Council has not to date incurred any expenditure in supporting care providers who it does not contract with. The number of such providers in Northumberland is small, and does not include any care homes for older people, which are the service which has been most severely affected by the Covid-19 pandemic.
Details of engagement exercise starting May 2019

Last summer, we started a review of how well our current arrangements for coordinating care and support are working. The findings confirmed our sense that we need to stand back and look again at how well some past changes have worked, and consider whether a new approach might be better. 

We think our current arrangements may have gone too far in aiming for efficiency through specialisation and standardisation, at the cost of making service users’ experience more fragmented. 

We have put together a summary of the questions which we are considering, and our provisional answers to those questions.  This is intended as a starting point for an open discussion with staff and partners about what we are trying to achieve, how well it is working and what we might do to make the system work better.

Please address all comments and queries about the issues covered in the paper, or the engagement process itself, to how.better@northumbria.nhs.uk.

Staff engagement events
If you have not already been invited to attend one of these events, and would like an opportunity to tell us your views face to face, please email us on how.better@northumbria.nhs.uk.
In some operational services, managers may not have included all staff on the list for a local meeting because of the need to maintain adequate cover. You may need to check on this – and we will need to manage numbers at some venues – but we want everyone to have an opportunity to have their say, and if necessary we will arrange additional sessions.

South/Central Event 1: 15 May 9 am – 12 noon, Choppington Welfare

South/Central Event 2: 15 May 1pm – 4pm, Choppington Welfare

West Event 1: 16 May 9.30 am – 12.30 pm, Dene Park House

South/Central Event 3: 16 May 1.30 pm – 4.30 pm Choppington Welfare

North Event 1: 20 May 9.30 am – 12.30 pm, Blue Bell Hotel, Belford

North Event 2: 20 May 1.30 pm – 4.30 pm, Blue Bell Hotel, Belford

West Event 2 21 May 9.30 am – 12.30 pm, Dene Park House

South Central Event 4: 21 May 1.30 pm – 4.30 pm, Choppington Welfare