We recognise the enormity of challenges faced by health and care providers in responding to coronavirus (COVID-19). At very short notice, services developed new procedures and ways of working. They looked at how they work with others and how people they care for can stay in touch with family and friends.
We asked providers to send us examples of changes they made. We did not visit them to capture the stories. The response was overwhelming, particularly from adult social care services. Here we look at some themes from the examples provided. We felt that in this time of rapid change, sharing examples may help other providers with the same issues.
Our regulatory approach will not be influenced by providers submitting examples.
Adult social care
Adult social care providers have embraced new ways for people who use services to stay in touch with family and friends while personal contact isn’t possible.
- Technology alone isn’t always the answer. Mill House also tried to keep a level of personal contact. Relatives came to the care home window while on the telephone to residents.
- More traditional methods are also being used. Horizon Healthcare Homes sends weekly newsletters to family members, as well as using Skype. Tailored to each resident, the newsletters are like a postcard with personalised pictures.
- Sandford House highlights good examples of people’s recovery and community kindness as a reminder it is good to share good news.
- Valerie Manor Nursing and Residential Care Home arranges Skype calls for residents to keep in touch with families.
- Mill House Nursing Home set up a relatives/friends WhatsApp group. This keeps them informed to reduce their anxiety about their loved ones. They use this for video calls if they want.
Many activities for people in residential settings needed re-thinking due to lockdown. This is because external contact is limited. Lots of examples were given of activities provided remotely.
- Rusthall Lodge is live streaming exercise and entertainment to residents.
- Birtley House holds ‘virtual physio’ sessions.
- a member of staff from Riverside, Laurel Court who is self-isolating due to underlying health issues, Skypes residents to chat and play games like Connect 4.
Infection control is more important than ever during the pandemic.
Examples of changes providers have made include:
- Highland House installing a sink in its entrance hall.
- Staff at Maplehurst Nursing Home wear different coloured T-shirts depending upon which area of the home they work in.
- Swillbrook House made a video of staff showing how to put on and take off personal protective equiment (PPE) to songs 'Get it on' by Marvin Gaye and 'You can leave your hat on' by Tom Jones.
Services have told us about some of the things they have been doing to share information with people who use services and others.
- Headway Birmingham and Solihull's leaflet shows which services are operating remotely throughout the pandemic.
- Carebridge clients received easy read information about Covid-19, promoting resources in different languages.
- Christadelphian Care Homes created and issued 22 guidance documents on subjects including:
- residents FAQs
- families FAQs
- colleagues FAQs
- use of PPE
- Fast Track Employment crib sheet
- dying well during COVID-19.
- Valerie Manor held a ‘stakeholder’ day. The owner discussed what the home was doing about COVID-19, and why, with key stakeholders.
Services have been taking steps to keep staff safe from infection.
- Sandford House set up a staff transport service so they do not have to use public transport. An allocated safe driver is taking them to and from their shifts.
- Rosecroft Care Ltd and Tamarisk Services Ltd organised a car pool share using company vehicles. Staff can be taken to and from home and work to avoid using public transport. The company also organised child care support for one of its carers so that she can continue to work.
- G&P Healthcare told us staff can feel alone as they often do 12 hours alone with the same client. Staff can self-refer to a clinical psychologist, access a supportive video call and same day consultation.
Remote working can also protect staff and people who use services.
- Chantry House's administrator works from home. All calls to her number divert to her mobile.
Primary medical services
Services responded quickly to the challenges presented by COVID-19.
- Church Street Partnership set up a community team. Their social prescriber for vulnerable patients runs the team. The partnership identified patients who could self-refer for help with activities like shopping.
- The D Parys Group’s practice nurses run a home visiting service.
- North Street Medical Care created lead roles for important clinical and non-clinical areas. For example, the social care lead manages its list of extremely vulnerable people.
As they need to avoid face-to-face contact where possible, practices have accelerated ways of supporting people who use services remotely.
- GP Rachel Buckley did a ward round to two care homes by video call. Rachel used the care home managers mobile phone as contact. She saw every patient in the homes registered on the practice list to find out about their well-being. Rachel reassured them all that primary care was available and open for business as usual. She phoned the next-of-kin for each patient to reassure them that their loved ones were being supported.
- Tower Hamlets GP Care Group and Bikeworks provide patients with COVID-19 home monitoring kits. Kits include:
- a pulse oximeter
- a thermometer
- blood pressure monitor where appropriate
- instruction leaflet, and
- a bag to return equipment.
- Pioneer Medical Group’s sheltered housing and learning disability homes were set up with a SATs monitor and video consulting.
- Links were made from practices in Five Lane Community Partnership primary care network to local care homes. This was to:
- improve continuity
- reduce social contact and
- build better relationships with care homes.
- Staff at Rosegrove Surgery in Burnley pledged to phone a vulnerable patient every day during the pandemic for a chat. This has now been rolled out to the PCN. All GP practices within this PCN are contacting their vulnerable patients.
We heard from practices about the steps they had taken to keep people informed.
- HIYOS (Healthy In Your Own Skin), an NHS GP practice, conducted a survey. The survey asked patients how the practice could support them. It asked what patients wanted from the practice during the COVID-19 pandemic. The survey had nearly 2,000 responses. Of these, 20 - 30% of patients from a range of vulnerable groups said they wanted to know more about COVID-19 and how to stay well. As a result:
- staff created ‘COVID-19 Mins’ - a series of webinars on topics chosen by patients. Clinicians and experts answered live questions from patients, on topics they worried about.
- they identified preferred communication methods for different population groups.
- Church Street Partnership emailed videos to at-risk patients to watch before appointments. This was to help reduce their anxieties and help them understand the process.
- Accessible Orthodontic patients receive a weekly text message. The text reminds them about the importance of good oral health and points to information on the partnership's website.
- To keep staff informed about rapid clinical and legislative changes, North Street Medical Care produces a weekly practice bulletin.
- Holbrook & Shotley Surgeries told us of initiatives to reduce the risks to staff. They reviewed activity which enabled clinicians to work remotely where possible.
- North Street Medical Care said they developed a rota to promote social distancing in the practice environment.
Hospitals, mental health and hospices
Services made rapid changes, such as:
- Western Hospital NHS FT, acted swiftly. It separated the COVID-19 Assessment Unit from emergency department and urgent care centre.
- Trinity Hospice increased its inpatient unit bed capacity by 10 beds. This supported rapid discharge of frail, elderly end of life patients.
- St Wilfred’s Hospice repurposed its Wellbeing Centre therapy rooms. This provided six extra inpatient rooms.
- South West London and St George's Mental Health NHS Trust set up a 24/7 mental health emergency department for patients in crisis. This service is for patients of all ages. A dedicated phone line enables people to attend the mental health emergency department. This supports people who need urgent mental health care to avoid acute hospital emergency departments.
- West London NHS Trust reconfigured an acute mental health ward to care for patients with COVID-19.
- The Hillingdon Hospital set up a neuro outreach service. This supports patients with neurological conditions who were:
- discharged early from a neuro rehabilitation unit, or
- would have been referred to an inpatient neuro rehabilitation service.
- Many of Cornwall Hospice Care’s community-based activities had to close when lockdown came into force. The charity now offers:
- phone support
- information and signposting for patients, carers and relatives who are dealing with terminal illnesses. The service is also those who are isolated and vulnerable in the community.
- St Richard’s Hospice reorganised its community team to provide a 24-hour rapid response team in the community. The team links closely with NHS neighbourhood teams.
One of the main themes to emerge is how providers have introduced ways people can stay in touch with loved ones when visiting is almost impossible.
- For example, at Addenbrooke’s Hospital, a new Relatives Communications Team comprises:
- critical care nurses who have had to stay at home
- critical care nurses working on site
- the chaplaincy.
Home-based staff operate by telephone, Skype and email. They share important information and practical advice with families of patients admitted to the hospital’s four ICUs. They can set up virtual meetings between families and loved ones using a range of technology.
Other initiatives include services finding new ways to communicate with people who use services.
- To help patients stay in contact with friends and family, over 30 devices were issued by Birmingham Community Healthcare NHS FT. These were issued to inpatient areas across five sites.
- Similarly, St Wilfred’s Hospice provided tablets and mobile phones to patients in its inpatient unit.
- The Hillingdon Hospital’s NHS FT’s ‘loved one’s communication project’. Anyone with a relative as an inpatient can send in a letter, a picture or a photograph to a dedicated email address. The emails are printed and delivered to patients. Western Sussex also has a personal messaging service.
- Portsmouth Hospitals NHS Trust introduced a new role of Family Liaison Officer (FLO). The FLO support patients, their families and loved ones, and teams across Queen Alexandra Hospital. The trust also set up a drop-off and collection station. People can drop-off items for delivery to loved ones on the wards by the FLO.
- Services for substance users at NRP Northumberland are providing mobile phones. The phones are provided to high risk service users who are homeless. This is to ensure the service can contact them to discuss and review their needs
Providers have recognised and responded to the pressures on staff.
- Royal Wolverhampton NHS Trust, Great Western Hospitals set up ‘wobble rooms’ where staff can relax.
- West Middlesex Hospital set up ‘energy pods’ for staff in the hospital’s indoor garden, with support from the hospital charity.
- The Hillingdon Hospitals NHS Foundation Trust uses a luxury vehicle. This is one used by musicians when touring the UK and Europe. Staff can relax in it away from the workplace.
- St Richard’s Hospice offers staff support sessions by Zoom.
- Trinity Hospice is working locally with the NHS to provide staff counselling support.
- The Chief Executive of University Hospital of North Midlands wrote a letter staff can download and personalise for their children. In letter, the CEO thanks children for their help supporting their parents to work at the hospital during the pandemic.
We were told of a range of initiatives to share skills and train staff.
- St Richard’s Hospice is supporting nursing in care homes. They provide online teaching about COVID-19 management and end of life palliative care. Its also providing bereavement training online to other organisations.
- Central and North West London NHS FT redeployed seven sexual health clinic nurses into prison healthcare teams. This supports staff shortages due to self-isolation.
With staff suffering from COVID-19, or needing to self-isolate, managing staffing levels is a challenge for many providers.
- The Hillingdon Hospitals NHS Foundation Trust has introduced a sickness absence hub. The hub is for all sickness and absence across the Trust to effectively manage staffing levels. The hub enables accurate reporting of all staff sickness absence. It also enables tracking and management for COVID-19 related absence. The hub provides well-being support for staff during absence. It helps staff's transition back into the work place. It also provides timely support to fill shifts from the temporary staffing team as required.
We were told of several examples of organisations working closer together as a result of the crisis.
- North East London NHS Foundation Trust, in partnership with UCL Partners, Care City and Basildon and Brentwood CCG, has launched ‘Significant Care’. This is free tool designed to help carers. The tool helps them spot early signs of deterioration in the health of those they care for. It helps carers make good decisions about what to do to help. The tool aims to help carers at home and in care homes identify the signs of deterioration and take prompt action.
Independent health providers moved quickly to work with partners in local systems.
- East Suffolk & North Essex Foundation Trust Oncology department moved to Nuffield Health Ipswich Hospital. Oncology patients requiring chemotherapy treatment were being seen at the new location.
- St Michael’s Clinic, a specialist dermatology unit in Shrewsbury, turned into a super cold centre. This provides blood tests for ‘at risk’ people advised to shield.
- Parkside Private Hospital in Wimbledon is being used as a step-down facility. The facility is for ambulatory trauma cases, plastics and diagnostics for St George’s Hospital.
- Hundreds of patients with cancer received urgent treatment at Spire’s Southampton Hospital. This followed a partnership of University Hospital Southampton NHS Foundation Trust (UHS) and Spire Healthcare.
- Ramsay’s Oaklands Hospital hosts Salford Royal NHS FT’s Intestinal Failure Service.
- HCA is working with NHS partners in North London to care for maternity and urgent gynaecology patients at The Portland Hospital. The Portland Hospital supported safe delivery of more than 100 NHS babies at the hospital by mid-May.
- InHealth repurposed its breast screening centre in Surrey. It provides a diagnostic service for women with breast cancer symptoms. This allows the clinical pathway for those women to continue.
- Peninsula NHS Treatment Centre has mobilised a new series of surgical specialities and provides:
- general surgery
- breast cancer surgery
- plastic cancer surgery
- plastic and orthopaedic ambulatory trauma
- vascular surgery.
With ‘normal service’ on hold, providers have looked for new ways to promote the well-being of people using services.
- The Mid Yorkshire Hospitals Trust Chaplaincy provides ‘Qur’an cubes’ to Muslim patients. More poorly patients can access the comfort faith brings, when worshipping in the usual way may not be possible.
- Mental Health provider, Livingstone House, adjusted its therapeutic programme. This allows service users to access faith meetings. For example, a Sunday church service by video link and to allow for PE classes on YouTube.
Technology plays a vital role in connecting services with people, and connecting professionals across the system.
- Physiotherapists and occupational therapists from St Richard’s Hospice are providing online sessions. The sessions are on coping with illness and managing breathlessness.
- Trinity Hospice has expanded its ‘online support’ service to all GPs and all care homes on the Fylde Coast. This provides expert palliative care support for patients with COVID-19 in their care.
- Some MH trusts are using a digital care assistant (DCA). The DCA is based on an optical sensor that can monitor a service user’s movement, pulse and respiration in their bedroom. It is used to monitor COVID-19 patients when they are isolated in rooms. The system can monitor people’s vital signs in a way that reduces the need for staff to enter the room.
- An iPad app has been developed by Addenbrooke’s speciality registrar, Dr Tim Baker. The app is specifically designed for patients who cannot communicate because they are on ventilators. Patients who are too weak to write or gesture, can tap on iPads and specially designed icons to tell clinicians anything from where they are feeling pain to if they have a dry mouth. This reduces frustration and misunderstandings between patients and clinicians. In turn, it helps with more effective treatments and recovery.
Community health services
The COVID-19 pandemic has seen community health services across the country step up to the plate. They have:
- redesigned services
- supported other providers in their areas and
- innovated at pace to support timely care and treatment.
Before the pandemic Prem Singh, chair of Derbyshire Community Health Services told us:
“Community trusts are the glue that connects services together across the system, keeping people out of hospital and getting them home early… we have to respond across the system to tackle clinical variation, hand-offs, prevention and self-care. We must support our communities together”
We have been impressed by the way many trusts have responded to the pressures of COVID-19. Here we present examples from three trusts. They illustrate the kind of work that’s been going on across the country. We welcome examples from other trusts.
Derbyshire Community Health Services
Changes to service design and delivery:
Speech Language Therapy service
Screening of initial referrals by telephone contacts has been extended. It has increased initial assessments and follow ups by telephone and video consultation. The number of face-to face-contacts has reduced. This allows the service to continue and links to management of risk in care homes.
Physiotherapy and Musculoskeletal services
Within days of national advice to stop all but essential face to face services the Physio and MSK services adopted a virtual service model. All consultations were immediately changed to telephone consultations. This reduced the risk to patients and staff. This included a new model for delivering the First Contact Practitioner (FCP) service with Primary Care Networks (PCNs). The new virtual model supports GPs to provide an FCP service across large areas.
DCHS School Aged Immunisation Service (SAIS)
SAIS normally delivers immunisations in schools during term time. They developed a drive through service to deliver HPV vaccine for local year 8 and 9 children. The service used of e-booking for drive through instead of a relying on schools "booking" children into sessions. They maximised their resources against demand for the service.
Community Podiatry Teams - system collaboration
Community Podiatry Teams supported University Hospital Derby & Burton (UHDB) in its response to COVID 19. The rapid expansion of shared care used Silhouette 3D wound imaging and information system. This resulted in many follow-up diabetes foot ulcer treatments and freed capacity of acute providers. This consultant led collaboration facilitated patient care. Care was appropriately escalated and de-escalated between community clinics and acute providers.
The trust urgent action to protect its BAME staff, who represent 4.7% of its workforce. The trust used Microsoft Teams meetings to set up staff engagement sessions. After consultation, a bespoke COVID-19 risk assessment tool and training was introduced. Managers could be supported to do individual risk assessments with their BME direct reports.
Use of technology
Covid-19 has been the catalyst for digital transformation at pace. To continue its community services to patients, the trust was innovative. It searched for digital solutions to support patients and maintain their care.
Internal communications adopted a multi-channel approach. They use new channels such as Facebook Live. They created a closed Facebook group. Staff had a choice of channels to access key updates, information and to ask questions. Teams maintained ongoing wellbeing and support. Teams use secure messaging to keep in touch. They have a regular virtual meeting by MS Teams using video calls.
DCHS trialled various technology platforms. They promote and support teams to enhance a patient self-care model with appropriate clinical support and intervention.
- The use of photo diagnosis in Sexual Health services.
- Children services introduced Chathealth texting service. This supports young people (10-19) and parents of children aged 0-5.
- School nurses supported virtual safeguarding conferences to make sure the child was represented. They also conducted health and sexual health assessments by video link.
- Community nursing teams rapidly adopted virtual handovers by MS Teams.
- The Pulmonary Rehabilitation team now provide virtual patient group sessions as part of its service offer.
- The Speech Language Therapy service adopted telephone or video calls for all initial assessments and follow ups. This built on the service it had already developed.
- The immunisation team used a new online e-booking system. They introduced drive-through sessions.
- DCHS Community podiatry teams working with acute providers introduced the Silhouette 3D wound imaging and information system. Along with collaborative working this enabled greater follow up of diabetes foot ulcer treatment to be delivered in the community instead of acute.
- Using virtual platforms to maximise collaboration with partners. This maintained effective, safe and timely discharge planning. It worked well in the Early Supported Stroke Discharge Team.
Hounslow and Richmond Community Health Trust (HRCH)
The response to the pandemic helped quickly break down barriers between teams. This resulted in more multi-agency, multi-disciplinary (MDT) ways of working. Patients were better supported in the community. This included establishing MDTs with health professionals across:
- acute, community and primary care
- social services
- mental health providers and
- social prescribing
HRCH gave additional training to the established care home support service in Richmond. Richmond Response and Rehabilitation Team and the night community nursing team provided additional support. This helped keep residents safely cared for in their homes.
In the last 18 months, the trust has been working closely with the local acute providers. It worked with Kingston Hospital NHS Foundation Trust (KHFT) and West Middlesex University Hospital (WMUH). This is part of the Chelsea and Westminster NHS Foundation Trust. They worked to improve system flow and speed up discharges.
The discharge hub in Hounslow (enabled patient assessments in the community rather than in hospital. The hub made sure patient discharge was efficient and safe in increased numbers.
Mutual aid with system partners helped redeploy staff. Kingston Hospital NHS Foundtation Trust provided a resident medical officer. The officer was available to HRHC's community inpatient ward at Teddington Memorial Hospital. With remote consultant overview, they were available 24 hours a day, seven days a week. This enabled the community trust to give safe care to sub-acute patients. The ward turned into an inpatient setting for patients with COVID-19. The trust’s infection, prevention and control (IPC) team provided significant support. The microbiology team at Kingston Hospital NHS Foundation Trust also provided support. HRCH's facilities and estates team made sure urgent refurbishments met IPC standards.
Birmingham Community Healthcare NHS Foundation Trust
To help patients stay in contact with friends and family, over 30 devices were issued by Birmingham Community Healthcare NHS Foundation Trust. These were issued to inpatient areas across five sites.
Using social media
If you are posting photographs or videos on social media, you must:
- make sure you respect and protect the privacy and dignity of people who use your service
- give everyone (residents, visitors and staff) a free choice about whether they wish to be photographed or filmed and how their images will be used.
If people are identifiable, the recordings will be their personal data. You must:
- comply with GDPR when posting on social media
- obtain consent or to meet another ‘lawful basis for processing’ and to meet your other data protection obligations.
You must not:
- post images or information that are likely to be privacy-intrusive on social media without explicit and freely given consent
Be very careful if you post images and videos of people who do not have the capacity to consent. It may help people to stay visible and engaged within the community, but this must only happen when it is clearly in the best interests of that person. You should:
- communicate with the person, as far as possible, to understand their wishes
- seek guidance from their family or representatives.
Social media posts that unduly impact upon the privacy and dignity of vulnerable people are likely to be unlawful.
The Information Commissioner’s Office gives guidance on GDPR and other aspects of data protection.
About these examples
Providers have shared these examples with us. They represent a cross-section of the work they are doing in response to the coronavirus pandemic. We do not endorse any provider, product, supplier, service or approach included in the examples.
We assess the quality of care, including against our fundamental standards. Following the examples may help improve the quality of care. But it will not guarantee this.
The content of these examples is subject to our website terms and conditions.