HFH Healthcare Update: 2nd Edition 22.06.20

HFH Healthcare Update: 2nd Edition 22.06.20

HFH Healthcare Update: 2nd Edition 22.06.20

Welcome to our second HFH Healthcare Update in which we share case studies and information with the MDT to demonstrate how we work in partnership with commissioners to support our clients with complex clinical health care needs.

We would like to share two things with you:

  • We have updated our Care Partnership Agreement
  • Case study. HFH have been working in partnership with the London CHC Teams/CCGs and hospitals to ensure safe and timely discharges from hospital during the corona virus pandemic, creating additional bed capacity and providing a safe and financially viable alternative to nursing home placement.

We ask our clients to agree to work in partnership with us in the best interests of their care. Our collaborative relationship is based on mutual respect and the care teams’ skills and knowledge which is focused on placing the client at the centre of our support

  • HFH Care Partnership Agreement v2.0: attached to this email for your review

  • Safe Care Case Study: Infection Prevention & Control, appropriate provision and use of PPE

Who we are:

HFH Healthcare is a specialist pan-London provider for CHC adults and children with complex medical conditions in their own home. Our objective is to provide our clients risk managed, personalised support, empowering them to live the life they choose beyond their clinical care needs.

Our value proposition to CHC Commissioners is high quality, patient centred care with significant savings when safely stepping down nurse delivered packages to HFH Core Carer Teams. The client cohorts we support includes, but is not limited to:

  • Ventilator Care
  • Tracheostomy care
  • Gastrostomy care (PEG, PEJ)
  • Continence Care (catheter, bowel and stoma)
  • Most of our clients need 24/7 support

Alongside our personalisation and risk management approach, we have adapted our assessment and onboarding process to accommodate COVID-19 precautionary measures. Over the next few weeks we will be sharing some of our client and safe care case studies with you.

We hope they will give you an increased insight into how we work with you to support our clients. If you have any questions or wish to discuss any potential referral assessments, please do not hesitate our experienced Lead Nurses via our referral contacts:

Safe Care Case Study:

Infection Prevention & Control and Appropriate provision & use of PPE

Due to the vulnerability of our clients we always place a strong emphasis on infection prevention and control and appropriate use of Personal Protective Equipment as a core aspect of safety.

In “normal” times our approach is based on infection prevention and control principles, interpretation of public health guidance and appropriate use of PPE. Good hygiene, bare below the elbows, hand washing and cleaning are core to carer and client safety. PPE usually consists of disposable aprons and gloves, delivered by the supplier directly to the client homes.

COVID-19 presented a new situation, with guidance changing as understanding of the virus and mode of infection progressed.

HFH have implemented a clinical risk assessment approach which aims to:

  • Maintain the client in their home environment unless they develop significant complications
  • Protect and minimise the risk of infection for clients
  • Protect and minimise the risk of infection for the carers supporting the client 
  • Protect and minimise the risk of infection to other HFH clients

Underpinning from the start has been the importance of good hygiene, social distancing, self-isolation, appropriate use of PPE. The importance of carers changing clothes at the client’s home, safe laundry and waste disposal have also been reinforced and emphasised. Immediate reporting of even the mildest of potential symptoms of COVID-19 in client or carer households was underlined as critical so that we could assess and take appropriate self-isolation actions. These included ring-fencing carers who had worked with the client over the previous 7 days to limit the potential for cross infection.

Initial guidance from Public Health England was, provided there were no symptoms of COVID-19 in the client household, to continue use of normal infection control and PPE procedures and to contact PHE if a client developed potential symptoms of COVID-19.

In the early days of social distancing guidance, one of our clients with Live-in carers developed mild potential symptoms. All had been living in the same household together and therefore all were at likely risk of having an infection. We sought Public Health England advice and agreement was the client and Live-In carers would be a self-isolating household unit. Advice and guidance was provided by our nursing team and all went well.

With clarity on the required PPE for carers should a client, or a member of their household, develop potential symptoms of PPE we sought to source direct supplies of ffp3 masks, gowns and eye protection. Our regular supplier did not have access to these products. As we worked our way through direct contact with suppliers, national supply chain and national recommended suppliers it became evident direct supply was hard to find. Through our South West London Commissioners, we were introduced to and built a relationship with the South West London Procurement Partnership. They provided us with 4 days’ supply of ffp3 masks, gowns and eye protection to urgently introduce into a household should COVID-19 symptoms develop, with agreement that should such a situation develop urgent additional supply would be accessed. This gave HFH initial protection for carers involved but did not remove significant levels of PPE from the acute sector supply chain.

We have kept up to date with Public Health England and government advice, developing and updating policies to ensure all staff are informed about and following current advice.

We communicate the changes guidance to clients and staff, encouraging questions and clarifications, alongside our nursing team providing client and carer specific advice and training.

With the introduction by PHE of ffp2 fluid resistant face masks and eye protection for carers supporting shielding clients and those with aerosol generating procedures we risk assessed, sourced with the help of SWL procurement, and provided the additional protection.

Normally PPE supplies are delivered direct from supplier to client homes. All additional supplies were delivered to our central office, so we have had to adapt and introduce an internal logistic and delivery service. Our administration, clinical and operational team have been critical, and much appreciated in making this happen.

An unforeseen challenge has been a lack of understanding of policy makers related to the numbers of complex care clients in the community and the type of support they receive from providers such as HFH. This became increasingly evident with guidance released in late April on protecting carers supporting clients with aerosol generating procedures (AGPs) who were showing no potential symptoms of COVID-19.

HFH, and many other providers in the sector, with the understanding and support of the UK Home Care Association (UKHCA), applied a risk assessed approach to infection control and prevention and PPE. By this time all our clients had been self-isolating with only household members, health and social care worker contacts for 3-4 weeks. Within HFH only one client out of nearly 100 with AGPs, had developed potential symptoms of COVID-19, and extra PPE protection had been deployed quickly and effectively in line with our arrangements with SWL procurement. All was well.

Towards the end of April one of our Commissioners questioned our risk assessed interpretation and expressed interpretation of PHE guidance that all carers working with clients with AGPS should have PPE protection - including ffp3 respirator masks, long sleeved gowns and eye protection, gloves and aprons. They gave direct instruction as commissioners and provided 4 weeks of the required PPE for their one client.

Our concerns regarding this approach were based firstly on clinical risk assessment:

  • The PPE guidance on use of gowns, ffp3 masks and eye protection for non-symptomatic clients with AGPs makes logical sense for hospital and care home settings where there are multiple potential carriers and the risk of transmission to patients and then from patients to staff is high
  • This PPE guidance makes less sense in home care where patients and households had been social isolating and shielding for 3-4 weeks. HFH had only one client over this time who exhibited very mild symptoms of COVID-19 during this period, the emergency PPE was dispatched to the carer team immediately and there were no reports of carer illness.

During this time, we were endeavouring to access direct supplies of PPE, without success. We were also acutely aware that colleagues in care homes and, reportedly, within the NHS were experiencing similar supply chain issues. We therefore also questioned the proportionality of diverting this PPE to a client group with prolonged self-isolation, therefore low risk of having COVID-19 and low risk of transmitting to their Carers via AGPs.

We engaged in informed, practical discussions on that interpretation with UKHCA, public health, commissioner and sector colleagues and raised concerns with London Commissioners and CQC via daily situation reports.

A few days later the PHE guidance for the social care sector was published and recommended full PPE for protection of carers working with all home care clients with AGPs. We continued to engage with commissioner, public health and sector colleagues on how to achieve this.

Through one of our Regional Lead Nurses we were introduced to a group making eye protection visors with the proceeds going to charity. The quality was good and we were able to source full supply. We doubled the price they originally requested.

Ffp3 masks and long-sleeved gowns were impossible to source directly. We asked for help from our 36 Commissioners, some of who were able to channel small amounts. We escalated to London Resilience, who provided an initial supply and raised questions with PHE about the proportionality of the advice.

By 7th May:

  • We had secured a 4-week supply of a combination of ffp3 and ffp2 masks which we distributed to all our clients, based on clinical risk assessment.
  • Long sleeved gowns could not be sourced. We had 84 long sleeved gowns in stock from our emergency supply. These we have kept as emergency supply to be dispatched to care teams if a client develops symptoms of COVID-19.
  • We issued revised instructions to Carers: in addition to good hand washing, bare below the elbows, cleaning and use of gloves, aprons, masks and eye protection, and changing clothes on arrival, they should now also change clothes on leaving the client home, bagging their clothes immediately and only emptying directly into clothes wash.

This is a clinically risk assessed approach based on infection prevention and control principles, public health guidance and effective use of available PPE.

Since the start of the pandemic, just one of our circa 100 clients with aerosol generating procedures has developed mild potential symptoms of COVID-19.

We are by no means the only provider to have faced this challenge, it is our hope that going forward specialist complex home care providers will be recognised for our knowledge and the amazing work we do and engaged earlier in policy discussions.

HFH continue to be alert to, clinically risk assess our individual clients and apply changes in PPE guidance as they emerge.

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