Adult social care: COVID-19 winter plan 2021 to 2022

Q: Executive summary

Building on last year’s adult social care winter plan , here we set out the key elements of national support available for the social care sector for winter 2021 to 2022, as well as the principal actions to take for local authorities, NHS organisations and social care providers across all settings, including those in the voluntary and community sector. By working together, we will ensure that high-quality, safe, and timely care is provided to everyone who needs it, while we continue to protect people who need care, their carers and the social care workforce from COVID-19 and other respiratory viruses.

Question 1

Executive summary

Accepted Answer

Building on last year’s adult social care winter plan, here we set out the key elements of national support available for the social care sector for winter 2021 to 2022, as well as the principal actions to take for local authorities, NHS organisations and social care providers across all settings, including those in the voluntary and community sector.

By working together, we will ensure that high-quality, safe, and timely care is provided to everyone who needs it, while we continue to protect people who need care, their carers and the social care workforce from COVID-19 and other respiratory viruses.

Question 2

Our plan for adult social care this winter

Accepted Answer

The last 18 months have been a difficult time for everyone involved in receiving or providing adult social care (ASC) and this coming winter will present new challenges. The Joint Committee on Vaccination and Immunisation (JCVI) has advised that this winter will be the first in the UK when COVID-19 will circulate alongside other respiratory viruses, including the seasonal flu virus.

Through our regular conversations and dialogue with people and organisations across the sector, we recognise there are many challenges facing adult social care in addition to the winter-specific pressures covered in this plan. That is why on 7 September 2021, the Prime Minister set out an ambitious plan for adult social care reform, alongside other measures to support recovery in the NHS. This plan commits to investing £5.4 billion over the next 3 years into adult social care, and includes funding for the social care workforce and for local authorities to enable them to move towards paying providers and individual employers a fair and sustainable rate of care.

Over the coming weeks and months, we are working with people who draw on social care, providers and other partners to co-produce more detail on our plans for reform of adult social care, and we will publish further detail in a white paper for reform later this year.

Winter 2020 to 2021 was a particularly difficult time for the country as a whole as we were gripped by the second wave of the pandemic.

In September 2020, we published the first adult social care (COVID-19) winter plan outlining how the sector would overcome the challenges it faced. Sir David Pearson (former Director of Adult Social Care in Nottinghamshire) and the Stakeholder Group (that consisted of many members of the Social Care Sector COVID-19 Support Taskforce that met between 15 June and 28 August 2020), undertook an independent review of the implementation of that winter plan as part of our ongoing efforts to constantly review and adapt our response to the pandemic.

The review found that:

While COVID-19 accounted for around 40% of all deaths of care home residents between April and June 2020 in the first wave of the pandemic, it accounted for only a quarter (26%) of all care home resident deaths between September 2020 and February 2021 in the second wave. This compares with a global average of 41% between March 2020 and January 2021.

Whilst cause and effect is difficult to unpick, the evidence strongly suggests that the actions taken since the beginning of the pandemic, including those outlined in the winter plan, have had a significant impact in reducing risk.

The review also found that, of the 123 commitments that we made in last year’s winter plan, the vast majority (113 or 92%) were implemented in full.

The review made 33 recommendations for the Department of Health and Social Care (DHSC), as well as other sector partners, to action in preparation for this coming winter, and Annex A of this paper details our progress in implementing them.

We are entering winter 2021 to 2022 in a better position than last year because:

according to NHS England statistics on COVID-19 vaccinations, over 95% of residents in older adult care homes, who were designated by the JCVI as the highest priority for vaccination, have now been fully vaccinated – there is clear evidence that this provides significant protection (according to the Office for National Statistics’ COVID-19 latest insights: vaccines), and the government accepted the JCVI’s advice to roll out a booster campaign for COVID-19 vaccinations, which began on 16 September 2021
a very high proportion of staff working in adult social care are double vaccinated. 88% of staff working in older adult care homes, and 85% of those working in care homes for younger adults or Care Quality Commission (CQC)-registered home care providers are now fully vaccinated (according to NHS England statistics on COVID-19 vaccinations. From 11 November 2021, anyone working or volunteering inside a CQC-registered residential care home will need to be fully vaccinated unless they are exempt

The success of the vaccination programme has meant that we have been able to remove most of the restrictions in care homes and all restrictions across the rest of the population. We continue to support prevention measures across the sector, including personal protective equipment (PPE), testing, and infection prevention and control (IPC).

The 1.5 million people who make up the paid social care workforce and the 5.4 million people who provide unpaid care have worked tirelessly to support people in all circumstances. Their willingness to adhere to strict testing and infection prevention regimes, and engage so positively in the national vaccination programme has had a huge impact on infection and mortality rates over the last few months.

Winter 2020 to 2021 saw significantly fewer deaths in care homes from all causes than the first wave; this was furthered once the vaccination programme started in January 2021 and the picture improved significantly.

We have been successful thanks to collaborative working between national government, local partners and providers. We will build on this collaboration, engaging with partners and providers in all parts of the sector so that we are best prepared to face this winter’s challenges, including:

an increasingly stretched adult social care workforce, with recruitment continuing to be difficult in many places
the infection risk posed by the possibility of a new COVID-19 variant of concern, as well as other respiratory viruses, despite the improved IPC practice across the sector since the pandemic began

Many of the most clinically vulnerable individuals in our society receive care and support, and it will be important that we help them protect themselves in a context where restrictions in the wider society have been lifted.

To support the health and social care system to meet these challenges, this winter we are:

providing £388.3 million in further funding to support IPC, testing and vaccination uptake in adult social care settings; this is in addition to a further £478 million to continue enhanced hospital discharge support until March 2022
providing eligible frontline social care workers and carers with free flu vaccination this season, ensuring that pharmacists are able to vaccinate staff and recipients of care in care homes, and that frontline social care workers can continue booking their first and second dose of the COVID-19 vaccine through the National Booking Service
continuing to provide free PPE for COVID-19 needs to the adult social care sector until the end of March 2022, with sufficient stock to cope throughout winter. Regular asymptomatic COVID-19 testing will be maintained, with availability of more intense testing regimes for higher-risk settings. UK Health Security Agency (UKHSA) health protection teams (HPTs) are prepared to arrange multi-virus testing when required for respiratory viruses in care homes
continuing to support care providers to make best use of technology to support remote monitoring, enable secure online communications, and enable people within care homes to remain connected with friends and families

We will provide workforce recruitment and retention funding to support local authorities and providers to recruit and retain sufficient staff over winter, and support growth in workforce capacity of the existing workforce. This will be subject to conditions for local authorities to ensure it is used to address local workforce pressures, which will be published shortly.

Alongside these commitments, we have worked with our partners across the health and social care system to set out the national support we are providing, and our recommendations and expectations of local authorities, NHS organisations and adult social care providers. The remainder of this plan sets out those commitments and recommendations in more detail.

Question 3

Preventing and controlling the spread of infection in care settings

Accepted Answer

Personal protective equipment (PPE)

Use of PPE in care settings has always protected staff and individuals against a range of infections. We have a stable PPE supply chain with sufficient stock to cope with future spikes or waves, and to see us through winter.

National support

We will continue to provide free PPE for COVID-19 needs to the adult social care sector until the end of March 2022.

For CQC-registered providers, this will be via the PPE portal and for adult social care providers who are not CQC-registered (including personal assistants, unpaid carers who do not live with the person they care for, supported living, extra care, shared lives and day services), this will be via local resilience forums (LRFs) or local authorities where LRFs have ceased regular distribution of PPE.

We are currently consulting on extending free PPE to the health and care sector after the current end date of 31 March 2022. Government will respond to the findings of this consultation and announce any decisions concerning PPE provision post-March 2022 before the end of the year.

We have worked with care sector representative bodies to produce tailored PPE guidance for home care (sometimes called domiciliary care) and care homes. This guidance is applicable to a range of adult social care settings, is kept under constant review, and DHSC and UKHSA will continue to update the guidance as new evidence emerges.

Actions for local authorities

Local authorities should:

promote use of the PPE portal for CQC-registered care providers
maintain a system for provision of free PPE to non CQC-registered providers, either directly or through the LRF
report any shortages of local authority and LRF PPE supplies to DHSC

Actions for providers and individual employers

Providers and individual employers:

COVID-19 and flu testing

Regular asymptomatic COVID-19 testing will be maintained throughout winter for all staff and unpaid carers in adult social care, as well as more intense testing regimes in settings deemed higher risk, in line with clinical advice. To date, we have sent out more than 41 million polymerase chain reaction (PCR) swab test kits and 113 million lateral flow devices (LFDs) to care homes.

UKHSA HPTs and regional public health laboratories are prepared to arrange multi-virus testing when required for investigation of suspected outbreaks of respiratory viruses in care homes, enabling the right treatment pathways. See our guidance on managing outbreaks of influenza-like illness in care homes.

In addition, we are using the experience and learning from COVID-19 testing to continue to improve testing for other viruses, including flu. Community, general practitioner (GP) and hospital indicators of influenza are reported in the weekly national influenza surveillance reports.

National support

We will provide a further £126.3 million to continue to support the sector to deliver COVID-19 testing from October 2021 to the end of March 2022. Over £520 million in testing funding has been provided from December 2020 to March 2022 to help support the sector with costs associated with ongoing testing. We will keep our guidance on the COVID-19 testing strategy for adult social care up to date.

We will continue to make COVID-19 testing data available to the sector. This will be available to organisations managing care homes, home care, extra care and supported living, and day care, who are accessing testing in line with our guidance. Care home and home care organisations can access this data through the Capacity Tracker, and other organisations receive regular emails containing their data.

The existing systems for multi-virus testing (including flu) of care homes remain in place and can be deployed when required for outbreak investigations, based on the risk assessment of the responsible HPT’s consultant in communicable disease control or consultant in health protection and in line with UKHSA guidance.

Actions for local authorities and NHS organisations

Local authorities should:

make sure care providers, as far as possible, carry out COVID-19 in line with the guidance on the COVID-19 testing strategy for adult social care
provide local support for testing if needed, working with local NHS organisations as required
monitor their local COVID-19 testing data to identify and act on emerging concerns as advised by public health authorities, including following up with care settings that are not undertaking regular testing
pass on the Infection Control and Testing Fund (ICTF) to care homes and parts of the wider adult social care sector, and report regularly on how this funding is being spent by providers
support providers in managing multi-virus testing (including for influenza) where need is identified by the HPT

UKHSA HPTs should:

in an outbreak area, refer to the COVID-19 contain framework and follow the local outbreak plan as directed by their director of public health
refer to the UKHSA care home outbreak standard operating procedure (SOP), which is used by operational HPT staff, as well as sections 4.2 and 5.2 of the guidance for managing outbreaks of influenza-like illnesses in care homes
support settings in managing suspected and confirmed influenza cases and outbreaks, including testing when reported by providers in accordance with previous guidance

Clinical commissioning groups (CCGs) should ensure that the mechanics and practical arrangements for securing supply, delivery, prescribing and dispensing of flu antivirals for care home residents and staff are in place. These arrangements should be robust and tested as being able to provide antiviral medication to residents and staff within the timescales set out in NHS England’s localised community outbreaks of influenza template procedure and related guidance.

As CCGs may have been merged and therefore reconfigured since these functions were last used at scale in the winter of 2019 to 2020, the CCG regional flu or winter planning lead should ensure that their CCG has arrangements in place suitable to their current configuration.

Actions for providers

All care providers should ensure all staff are aware of how to use and access the testing regimes for people with and without symptoms, including for people who have been in contact with a case of COVID-19 – staff need to understand or know how to find out when different test types or kits should be used (for example, PCR tests or LFDs)

All residential care settings should engage with HPTs where suspected or confirmed cases of influenza have been identified and take the appropriate action in accordance with guidance on the recognition and management of cases and outbreaks. This may include antiviral treatments, which are most effective the earlier they are taken, and therefore early engagement with HPTs is important for accessing these promptly.

COVID-19 and seasonal flu vaccines

This year, we face another challenging autumn and winter, with COVID-19 still in circulation and an increased risk during flu season. This season, the JCVI indicates that this risk could be up to 50% larger than typically seen in the UK because the level of population immunity against influenza is expected to be lower than usual as a result of how little flu circulated last winter.

With the majority of the UK population now having received a COVID-19 vaccine, the success of the COVID-19 vaccines programme has had a significant impact on reducing the risk to death and serious illness during this coming autumn and winter.

There is, however, early evidence that the levels of protection offered by COVID-19 vaccines reduce over time, particularly in older individuals who are at greater risk from the virus. The JCVI has consequently advised that those in priority groups 1 to 9 should be offered a COVID-19 booster no earlier than 6 months after completion of their primary course.

It is, therefore, more important than ever that frontline health and social care workers are vaccinated against both COVID-19 and flu, in order to protect themselves and the people to whom they provide care.

National support

Protection against COVID-19 will be boosted following the JCVI’s advice on COVID-19 boosters. From 16 September 2021, the government began rolling out booster vaccinations to those in JCVI cohorts 1 to 9 who received their second dose more than 6 months ago, and boosters are now being delivered and administered to older adult care home residents and staff within their homes.

The NHS is maintaining its evergreen offer, ensuring that all frontline social care workers can continue to book their first and second dose of the COVID-19 vaccine through the National Booking Service.

We have made frontline social care workers and carers who are unable to get the vaccine through their employer eligible for a free flu vaccination this season. UKHSA has published guidance on flu vaccinations for social care workers.

We have also ensured that GP practices and pharmacists are able to vaccinate staff and recipients of care in care homes at the same time. In some cases, both COVID-19 boosters and flu vaccinations may be co-administered during the same appointment.

We have made regulations so that, from 11 November 2021, being fully vaccinated against COVID-19 will be a condition of deployment for people working or volunteering in care homes, unless they are exempt. These requirements will apply to all CQC-registered care homes in England that provide accommodation for persons who require nursing or personal care.

We launched a consultation on whether or not to extend the requirement for people to be fully vaccinated against COVID-19 (and flu) across the health sector and other social care services, which closed on 22 October 2021. We are in the process of carefully considering the responses and feedback received.

Actions for local authorities and NHS organisations

Local authorities should:

support communications campaigns encouraging eligible social care workers, unpaid carers and people who receive care to receive a free COVID-19 vaccine, and flu vaccine, as appropriate
work with local NHS partners to facilitate and encourage the delivery of COVID-19 vaccines (and flu vaccines where appropriate), in line with the UKHSA HPT standard operating procedures, to social care workers, unpaid carers and residents in care homes
provide consolidated information on vaccination uptake via the national Capacity Tracker
ensure all care homes in their area are able to meet the new requirement to make vaccination a condition of deployment. They should work with care homes to support them to review and strengthen their contingency plans, as well as reviewing their own contingency plans; clarify the potential impact on services locally; and be able to respond, escalating risks where necessary via LRFs and NHS regional teams
ensure any NHS and local authority staff who are visiting a care home for work purposes are fully vaccinated – from 11 November 2021, it will be a requirement for NHS and local authority staff to be fully vaccinated in order to work inside a care home, unless they are exempt

Actions for providers

All care providers should:

support and promote to all staff the importance of receiving a free flu vaccination, as well as COVID-19 vaccines (including boosters for those eligible)
ensure that, from 11 November 2021, only workers or volunteers who are fully vaccinated or are exempt from this requirement are deployed into care homes
report seasonal flu vaccination rates, alongside COVID-19 vaccination rates, for staff and residents in the Capacity Tracker
encourage social care workers to get the flu vaccine as soon as they are offered it to protect themselves and the people they look after
consult the flu vaccination guidance for social care workers
encourage (where possible) all visitors to care homes who are eligible for the flu vaccine to get it ahead of visiting – the annual flu letter sets out who is eligible for a free NHS flu vaccine

Infection prevention and outbreak management

Good infection prevention and control (IPC) practice will continue to be essential in all settings, but particularly in those at high risk of larger outbreaks, such as residential care. This includes taking steps to improve ventilation.

The same non-pharmaceutical interventions that successfully reduce transmission of COVID-19 also work against influenza (flu). Flu is cross-transmitted via secretions and will require contact and droplet precautions. Hand hygiene, respiratory hygiene, social distancing, environmental cleaning, use of PPE, waste disposal (as clinical waste) and other COVID-19 precautions are useful for the prevention of flu transmission. Ventilation of rooms and regular cleaning is also effective against influenza and other viruses such as norovirus.

Over the coming months, further steps will be taken to support improved ventilation, including the:

launch of the IPC Champions Network, led by the Chief Nurse, to provide a forum for the sector to share ventilation best practice
publication of a good practice guide covering best practice examples on improving ventilation and other IPC measures
updating of existing guidance to ensure ventilation is included

National support

We provide a guidance portal specifically for adult social care providers, including guidance and support on IPC (in order to prevent COVID-19, influenza and other infectious illnesses), testing, PPE, COVID-19/flu vaccines and staff movement.

On ventilation, there is guidance from UKHSA on mitigations to tackle poor ventilation in adult social care settings.

The National Institute for Health and Care Excellence (NICE) have also published clinical guidance on managing COVID-19, including for suspected or confirmed pneumonia in adults in the community.

An IPC Champions Network, hosted by the Queen’s Nursing Institute (a forum composed of IPC experts across the adult social care sector) is due to be launched in November 2021, which will share and disseminate best practice on IPC and ventilation.

We have published guidance on the control of respiratory tract infections.

Actions for local authorities and NHS organisations

Local authorities should:

work with all relevant partners, including UKHSA and local health protection boards, to control local outbreaks in line with the contain framework
refer to the IPC best practice examples and case studies published alongside the IPC Champions Network launch – for example, local authorities and providers can collaborate with NHS IPC nurses to ensure robust IPC practices are in place within adult social care settings

Actions for providers

All care providers should:

continue to follow all relevant guidance on how to prevent, control and manage infections and outbreaks in their care setting , liaising fully with their UKHSA local HPT and other local partners as needed
ensure all care staff have ongoing training on infection prevention and control, and the appropriate use of PPE, and can engage with online CQC and Skills for Care training resources for learning reviews when available
not routinely deploy staff to provide nursing or personal care if those individuals are also providing a regulated activity in another health or care setting, to reduce the risk of infections and outbreaks in care homes. However, in order to allow providers and local authorities to plan proactively for potential staffing capacity issues, and to ensure continuity of care, some limited movement of fully vaccinated staff may be necessary. UKHSA and DHSC are updating the staff movement guidance to set out the circumstances in which such staff movement can take place, and the steps providers should take to manage the infection risks

Visiting in care homes

It is critical to support all people who receive care to safely meet with their loved ones, even in the most high-risk settings. Residents should have visiting opportunities throughout the winter, in line with current government and local guidance, as outlined below.

National support

We regularly update our guidance on care home visiting to outline how providers can take a dynamic risk-based approach to support safe visiting in and out of care settings, with the support of their local director of public health (DPH) where required.

We have strengthened the recognition of the role of essential care givers to ensure residents can have visitors in most circumstances, including during an outbreak.

Actions for local authorities

Directors of public health (DPHs) and directors of adult social services (DASSs) have an important role to play in supporting visiting, and in supporting the care home to deliver safe visits into care homes. This may be through a dedicated care home outbreak management team or group, often in partnership with local social care commissioners. The DPH should work with the local DASS in developing and communicating their advice to care homes.

Local authorities should support visiting, recognising its importance for resident welfare – any decision to take a more restrictive approach should be proportionate, targeted and time limited.

In all cases, exemptions to any local restrictions should be made for visits to residents at the end of their lives.

Local restrictions should also respect the role of essential caregivers, including allowing them to visit in most circumstances.

Actions for providers

Care home providers should:

develop and update visiting policies that enable visiting, where it is possible to do so, while keeping residents safe – this should be done in line with published guidance on care home visiting (which covers testing, PPE and individual risk assessments)
ensure that all residents can nominate an essential caregiver
encourage visitors to get the COVID-19 vaccine and flu vaccine before visiting, if eligible
advise visitors to stay away from care settings if they have any flu symptoms
in the case of an outbreak, stop visits in and out of the care home, unless from an essential caregiver or for an end-of-life visit

Question 4

Collaboration across health and care services

Accepted Answer

Preventing avoidable admissions

Pressure on the NHS this winter is likely to be significant, so it’s more important than ever for the adult social care sector to continue their fantastic collaboration and support for their local NHS partners – such as primary care services and local community health services – to prevent avoidable hospital admissions from occurring, and to keep people well, independent and out of hospital. DASSs have a central role to play in helping to achieve this aim.

National support

The Better Care Fund (BCF) is the national policy driving forward the integration of health and social care in England. The BCF policy framework: 2021 to 2022 includes details on funding, national conditions and metrics. As set out in the framework, from October 2021, systems will be asked to set ambitions for reductions in avoidable admissions (classified as the rate of emergency admissions for chronic ambulatory sensitive conditions), and for metrics related to discharge. NHS England’s BCF planning requirements for 2021 to 2022 set out further operational guidance for local areas.

NHS community health services are providing crisis response care to prevent avoidable hospital admissions and accelerate the treatment of people’s urgent care needs. In line with NHS England’s national community crisis response services guidance, all integrated care systems (ICSs) in England are working to ensure delivery of the national community 2-hour crisis response standard by 31 March 2022.

From October 2021, as part of the:

Cardiovascular Disease (CVD) Prevention and Diagnosis primary care network (PCN) service specification, PCNs will undertake activity to improve coverage of blood pressure checks and diagnosis of patients with hypertension
Tackling Neighbourhood Inequalities PCN service specification, practices are expected to deliver an annual learning disability health check for at least 75% of patients identified as having a learning disability on the learning disability register. Practices within PCNs will also identify and include patients with severe mental illness on the severe mental illness register, and are expected to deliver annual comprehensive physical checks for at least 302,000 people with severe mental illness in 2021 to 2022

Specifically for care homes:

Actions for NHS organisations

CCGs should work with care home providers to continue to support home oximetry, including identifying local need for oximeters.

PCNs should continue to deliver the EHCH service requirements and ensure that all their partner care homes know who their clinical lead is and the support available to them, including home oximetry.

Actions for providers

Care home providers should:

familiarise themselves with the EHCH service requirements and what they can expect from NHS agencies – the Care Providers Alliance published helpful EHCH guidance for care homes in January 2021
work collaboratively with clinical leads to deliver optimum care and support to their residents
work with the local CCG to determine local need for oximeters
link up with local community health services to enable referrals from care homes into urgent community response (UCR) teams and ensure all staff understand what support is available locally

Home care staff and social workers should understand how UCR services work in their respective area and professional setting to enable speedy referrals if there are concerns about the people they care for who may be struggling at home with their health and approaching a crisis.

Technology and digital support

During the COVID-19 pandemic, there has been an unprecedented shift towards digitally enabled health and care services. Improvements in the technology available have helped people stay in contact with loved ones more easily and have made it easier for the social care workforce to access the information they need to deliver care.

National support

NHSX, a joint unit of DHSC and NHS England, will provide a package of support over the winter to help care providers make the best use of digital tools, safely and securely. This will include:

a new ring-fenced care provider Digitising Social Care fund of up to £8 million. This will be available to ICSs and will fund – but is not limited to – improved internet connections, devices, acoustic monitoring, digital social care record solutions and other care technologies. This is part of NHSX’s Unified Tech Fund (UTF) and was launched on 18 October 2021. ICSs can find out how to apply in the UTF prospectus
continued provision of guidance and support for the safe adoption of products that enable care providers to access GP record information for people within their care – this will continue to support the GP proxy access roll-out, giving staff the ability to order medications online on behalf of their residents and access information in the GP record as locally agreed
providing implementation funding support to all 7 NHSEI regions to significantly increase levels of technology-enabled remote monitoring within care homes. Plans have been agreed for over 100,000 people living in a care home to receive digitally enabled support by March 2022
expanded direct support to care providers to meet minimum cyber standards in every local authority area in England, responding to the elevated cyber threat caused by the pandemic and rapid digitisation
continued support for all social care providers in accessing NHSmail and Microsoft Teams. Those providers registered for NHSmail but not meeting Data Security and Protection Toolkit (DSPT) requirements as of 30 June 2021 will also be supported to meet these requirements by 30 June 2022
an extended support offer for the NHSX iPads in care homes beyond December 2021

NHSX will also provide access to online guidance and training for care providers. This will include:

guidance on safe use of technology, digitisation in the workplace and appropriate internet connections in care on the Digital Social Care website
a range of online training resources to support remote consultations for health and social care staff via Health Education England’s e-learning for healthcare hub and Learning Hub
a pilot digital champion programme to support care workers to improve their basic digital skills, and give them the confidence to share what they have learnt with their peers and within their own organisations

Actions for NHS organisations

ICSs should:

engage with local authorities and care providers to consider their requirements for access to digital and technology solutions, using this information to develop a robust case to apply for the Digitising Social Care Fund as part of the UTF
continue to support all care providers in their local area to access NHSmail, online collaboration tools and remote consultations for people receiving social care in all settings
ensure care providers understand and are practising information governance when sharing health and care data between settings

Actions for providers

All care providers are asked to:

consider how technical or digital solutions may help them to protect the people they support from COVID-19 or other respiratory infections, and connect them to their loved ones
work with their service commissioner, if appropriate, and their ICS to develop a strong bid for funding from the Digitising Social Care Fund as part of the UTF
review any inactive NHSmail accounts for their organisation, informing NHS Digital’s service desk if they are no longer required so licences can be reallocated by emailing helpdesk@nhs.net

Care homes are advised to:

engage with their ICS, feeding in their requirements, so that ICSs can provide a high-quality business case for the Digitising Social Care Fund
work with their regional leads to ensure they can access any scaling of remote monitoring that is being delivered in their locality
work with NHSX and local partners to ensure they have an appropriate mobile device management system, and sufficient data to continue to be able to use iPads and meet DSPT standards

Safe discharge from NHS settings

It is our priority to ensure that people are discharged safely from hospital to the most appropriate place, and that they receive the care and support they need.

Since March 2020, we have made nearly £3.3 billion available via the NHS to support enhanced discharge processes and the implementation of the discharge to assess model. This approach means people who are clinically ready and no longer need to be in hospital are supported to return to their place of residence where possible.

Long-term social care needs assessments take place at a point of optimum recovery so that individuals have the long-term support they need. As per the national framework for NHS continuing healthcare and NHS-funded nursing care and DHSC reintroduction of NHS continuing healthcare guidance, issued in August 2020, which also aligns with the discharge to assess approach, screening and assessment for NHS continuing healthcare and NHS-funded nursing care should happen at the right time and location for the individual, and when the individual’s ongoing needs are known.

National support

As part of the above enhanced discharge funding, we have made £478 million available to continue hospital discharge programmes through the winter until March 2022. Funding will be provided for up to 4 weeks of post-discharge recovery and support services, for new and additional care needs during the second half of the year, for care delivered on or before 31 March 2022. The programme will not fund care delivered after 31 March 2022.

Any patient who has tested positive for coronavirus within the last 14 days should not be admitted to a care home.

This winter, we will continue the designated settings scheme to provide appropriate care for those infected with COVID-19 in a COVID-secure environment. The continuation over the winter will continue to support safe and timely discharge, and protect care home residents and staff from COVID-19.

We have provided £87 million specifically for discharge from mental health settings from April to December 2021 to help with recovery from COVID-19 and also potential pressures this winter.

Specialist and integrated care, support and accommodation improves health outcomes, reduces pressure on the NHS and contributes to the government’s commitment to end rough sleeping by 2024. We have provided £16 million from January 2021 to end of March 2022 to help end the cycle of people leaving hospital, becoming homeless and then quickly being readmitted. This funding will enable us to draw out best practice models, which in turn will enable local areas to inform their own approaches to supporting this population.

Actions for local authorities and NHS organisations

While we expect demand for the settings to remain low, local authorities should continue to make decisions about the provisions of designated settings so that no local authority area is without a designated setting facility. Therefore, where current arrangements are working well to meet local demand for designated settings, local areas are encouraged to continue to deliver designated settings as they have been.

As set out in the BCF policy framework: 2021 to 2022, areas should agree a joint plan to deliver health, social care, housing and other public services that work together to support improvements in outcomes for people being discharged from hospital, and the implementation of a ‘home first’ approach. Commissioners should ensure that a collaborative approach to commissioning the support for people being discharged from hospital makes the most effective use of social care capacity. Further details are set out in the BCF planning requirements.

Local NHS organisations and local authorities should work together to support discharge from mental health settings, such as to step down beds or longer-term supported housing, or with enhanced social care support in people’s homes (such as help with daily living activities like cooking and shopping or support with tenancies and other home adaptations).

Health and social care staff should always involve family and carers in discharge planning, and provide information and advice on who to contact if the individual’s condition changes, how their needs will be assessed and the follow-up support they will receive.

Upon admission to hospital, all people who are homeless or at risk should be identified and referred to local authority homelessness services as per the government’s hospital discharge and community support policy.

Actions for providers

All care providers should:

work with adult social care contract leads to identify capacity that can be used for hospital discharge purposes or follow-on care from reablement services
work collaboratively with NHS primary and community care services
follow the latest COVID-19 provision of home care and supported living guidance on managing discharges (as relevant)

Care home providers should accept people discharged from hospital only when able to do so safely.

Social prescribing has played an important role during the pandemic by supporting the health and wellbeing of individuals, carers and their communities, and will continue to do so over the upcoming winter. Social prescribing will continue to require close collaboration between the NHS – including social prescribing link workers (SPLW), PCN teams, local authorities, and voluntary, community and social enterprise (VCSE) organisations – in order to ensure appropriate support is in place in line with local needs.

National support

Social prescribing services offer a wide range of support, including:

supporting people in regaining independence, tackling isolation and coping with the loss of support networks
co-ordinating with health and social care colleagues
offering a blend of virtual and face-to-face support and activities
connecting people to a range of physical, nature-based and creative opportunities to stay physically active and mentally well, as well as to improve mobility, strength and balance where appropriate
supporting local COVID-19 recovery plans and playing a key role in COVID-19 recovery, including supporting individuals on elective care waiting lists or those waiting for treatment to maintain their independence and wellbeing
connecting people with financial and housing needs to local support organisations

NHSEI implemented a rapid recruitment offer to support PCNs to recruit at least one SPLW. Over 400 new SPLWs were recruited between December 2020 and June 2021.

In line with the requirements of the network contract DES specification for 2021 to 2022, each PCN must ensure that individuals have access to a social prescribing service.

Actions for local authorities and NHS organisations

Local authorities and NHS organisations should:

work closely with SPLWs and VCSE organisations to co-ordinate support for people identified by health and care professionals as most needing support, especially those impacted by health inequalities, autistic people, people with learning disabilities, carers and those with dementia
ensure SPLWs have the support and equipment to work remotely and access GP or social care IT systems as needed
ensure SPLWs have access to high-quality supervision and support

Actions for providers

All care providers should work closely with social prescribing services, including SPLWs and the VCSE sector, to co-ordinate support for people identified by health and care professionals as most needing it, especially those impacted by health inequalities.

End-of-life care

The opportunity to receive high-quality, personalised palliative and end-of-life care is of vital importance to individuals and those close to them. This should include meaningful, person-led discussions – if appropriate – that consider the person’s priorities, and physical, emotional and spiritual needs.

National support

NHS England have shared their palliative and end-of-life care delivery plan, which describes their focus on improving access, quality and sustainability in line with the NHS Long Term Plan. They have also set up a system of Palliative and End of Life Care Strategic Clinical Networks, which have clinical leadership as a key priority, working across boundaries of commissioning and provision as engines for change and reducing variation. Further information and guidance can be found on the NHS England website.

The Ambitions for Palliative and End of Life Care: A national framework for local action was refreshed and relaunched in May 2021.

Action is also being taken across health and care systems to ensure healthcare professionals understand the importance of delivering personalised approaches to care planning, advance decisions and care delivery, and that best practice guidance is available to support this in all care settings.

Following concerns raised about the inappropriate application of do not attempt cardiopulmonary resuscitation (DNACPR) decisions, we commissioned CQC to review how DNACPR decisions were being made during the first wave of the pandemic. Their Protect, respect, connect – decisions about living and dying well during COVID-19 report was published in March 2021. DHSC has established a Ministerial Oversight Group on DNACPR decisions that is responsible for the delivery and required changes of the recommendations in the CQC report. We remain clear that it is unacceptable for DNACPR decisions to be applied in a blanket fashion to any group of people.

Public-facing information has now been published by NHSEI, which sets out what a DNACPR decision is, how it should be applied, who should be involved and what to do if an individual or their loved ones have concerns. This information can be found on the NHS England website. The Resuscitation Council UK has also published updated 2021 resuscitation guidelines.

CQC will urgently raise cases of inappropriate use of DNACPR, as it becomes aware, with the relevant bodies, including the General Medical Council, and take action where registered providers are responsible.

Actions for local authorities and NHS organisations

All organisations should put in place resources and support to ensure that, wherever practicable and safe, loved ones should be afforded the opportunity to be with a dying person, particularly in the last hours of life.

NHS organisations and local authorities should:

ensure that discussions and decisions on advance care planning, including end of life, take place between the individual (and those people who are important to them where appropriate) and the multidisciplinary care team supporting them. Where a person lacks the capacity to make treatment decisions, a care plan should be developed following, where applicable, the best interest checklist under the Mental Capacity Act 2005.
implement relevant guidance, and circulate, promote and summarise guidance to the relevant providers. This should draw on the wide range of resources that have been made available to the social care sector by health and care system partners and organisations, including those published by:
- the NHS
- Skills for Care
- the Royal College of General Practitioners

Actions for providers

All care providers should:

follow the above guidance in delivering personalised approaches to care, in all settings, including where care is being provided in an individual’s home
ensure they make every effort, wherever practicable and safe, to enable a dying person to be with their loved ones, particularly in the last hours of life

If a care provider is concerned about pressures to put in place DNACPRs, they should escalate, in the first instance, using their internal whistleblowing policies.

Question 5

Supporting the people who provide care

Accepted Answer

Unpaid carers and respite care

We recognise the vital role all unpaid carers play, especially during this difficult period, and the demands the coronavirus pandemic has placed on those caring for relatives and their loved ones.

Day and respite services are an important form of support for people with care needs and their carers. Local authorities have a duty under the Care Act 2014 to provide or arrange services that meet the social care needs of the local population. Decisions around the closure, opening and delivery of day and respite services lie at local authority level, in line with local risk assessments and the latest public health advice.

National support

We are:

Actions for local authorities

Local authorities should:

make sure carers, and those who organise their own care, know what support is available to them and who to contact if they need help. Local authorities have a duty under the Care Act 2014 to provide or arrange services that meet the social care needs of the local population
ensure that carers’ assessments are reviewed and updated to reflect any additional needs of both carers and those in need of social care
continue to follow the direct payments guidance, ensuring that they take a flexible approach so that those receiving all forms of direct payments continue to have flexibility in how they receive their care and support
continue to work with day and respite service providers to ensure the safe re-opening and extended opening of their services, where appropriate, and continue to support those who require services to ensure identified needs are met in the interim of some services re-opening

Actions for providers

All services are provided on the basis of need, and therefore all providers should be proactively considering how to meet those needs in a safe and secure way. We have worked with the SCIE to publish guidance to help decisions on the safe continuation and re-opening of day services.

Supporting the workforce

The social care workforce is a large and diverse group, with around 1.5 million people working across 38,000 settings. It includes:

personal assistants
self-employed carers
paid care workers
registered managers
regulated professions, such as social workers and nurses
staff in many ancillary roles

The workforce have put in extraordinary effort over the course of the pandemic to keep the people they care for safe and well, and it is of central importance that we continue to support the workforce through this next period by keeping them well, increasing workforce capacity, and providing high-quality training and guidance.

Recruitment and retention across the adult social care workforce is a significant challenge. We recognise the ongoing hard work by providers and local authorities – working with system partners such as the NHS – to address difficult workforce capacity issues.

The government will continue to work closely with the sector to monitor the situation over the winter period and to consider what further action may be necessary.

Workforce wellbeing

National support

We have made available to staff national resources and guidance, including guidance on health and wellbeing of the ASC workforce providing advice on how staff can manage their personal mental health in light of the current pandemic. This also provides employers with guidance, tools and advice on how to take care of the wellbeing of staff at work.

The Chief Social Worker has, in partnership with the Tavistock and Portman NHS Trust, issued guidance on the support and wellbeing of adult social workers and social care professionals.

Our Frontline, a collaboration between Samaritans, Shout, Hospice UK and Mind, provides information, emotional support and access to a crisis text service. The Samaritans and Hospice UK have also extended their support lines to provide support to social care staff.

A package of support for registered managers is available via Skills for Care, recognising that they are facing particular challenges. This includes a series of webinars and a dedicated advice line. Further wellbeing support is available from Skills for Care, including the wellbeing resource finder.

Staff mental health and wellbeing hubs have been set up to provide health and social care colleagues with rapid access to assessment and local evidence-based mental health services and support where needed. Hubs are confidential and free of charge for all health and social care staff.

Actions for local authorities

Local authorities should:

maintain, where possible, the additional staff support services that they put in place during the first wave of the pandemic
review current occupational health provision with providers in their area and highlight good practice
promote wellbeing offers to their staff and allow staff time to access support, as well as promoting to providers in their area

Actions for providers

All care providers should:

reinforce the message that staff mental health and wellbeing remains of the utmost priority. There are tips and advice on how employers can take care of the wellbeing of staff at work in the previously mentioned guidance
investigate the provision of dedicated occupational health services for staff
undertake a workplace risk assessment with a view to protecting the health, safety and welfare of all staff. Employers should have individual conversations about COVID-19 with all members of their workforce who may be at increased risk. A risk reduction framework for adult social care has been published to provide employers with guidance on how to sensitively discuss and manage specific risks to their staff; this includes risk by ethnicity, but also age, sex and underlying health conditions. This guidance will be reviewed as new evidence emerges

Workforce capacity

National support

We will provide £162.5 million through the workforce recruitment and retention fund to support local authorities and providers to recruit and retain sufficient staff over winter, and support growth in workforce capacity of the existing workforce, until 31 March 2022. This will be subject to conditions for local authorities ensuring it is used to address local workforce pressures.

We will continue with our national recruitment campaign across broadcast, digital and social media, highlighting the vital work care workers do. The next phase of the campaign started running from the end of October 2021.

RecruitmentReady recruitment guidance for local authorities and employers have been published by Skills for Care, supported by the department.

Free and fast-track Disclosure and Barring Service (DBS) checks, and the barred list service, remain in place for providers recruiting staff and volunteers to health and social care services in response to coronavirus. This is supported by interim guidance on DBS and other recruitment checks published by CQC.

We are continuing to offer free rapid online induction and refresher training through Skills for Care to induct and train redeployed staff, new starters, existing staff and new volunteers in social care services so that people can start work quickly or continue to access essential refresher training, including IPC awareness.

DHSC funds the Care and Health Improvement Programme (CHIP), which is jointly delivered by the Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS). One of the priority areas within that programme is workforce, with bespoke support provided to specific regions and local authorities to address workforce challenges. The programme also supports:

all regions to have strategic workforce plans in place
national and local recruitment drives
improvement of staff retention and wellbeing
the development of professional practice in social care

We expect the introduction of vaccination requirements for care home workers from 11 November 2021, and the possible expansion to other social care settings (subject to consultation) to help address reductions in capacity that would otherwise arise due to staff becoming ill from the virus or needing to isolate, though we recognise the potential for staffing issues where affected care home workers chose to leave the sector. We are working with Skills for Care to ensure that resources such as COVID-19 vaccination guidance and best practice are available to support providers and local authorities with capacity and workforce planning, recruitment and wellbeing.

This is in addition to where we have worked with Skills for Care to publish guidance to support care staff, managers and employers with delegated healthcare tasks. We will keep the support available to the sector with delivering delegated tasks under review and consider further actions where necessary.

Our regional assurance team will continue to work closely with local authorities to support their workforce planning and encourage robust contingency plans. The team also works with funded partners such as Skills for Care to provide guidance and support to local authorities on recruitment and retention issues, including disseminating best practice across the sector. The team, through its close engagement with local authorities, provides valuable intelligence on local workforce pressures to DHSC and government.

The Department for Work and Pensions (DWP) will ensure that Jobcentre Work Coaches are equipped to effectively promote adult social care careers to jobseekers.

The legislative, vetting, regulatory, and pay and conditions frameworks have been put in place to ensure the temporary registration of returning regulated staff and students who have already registered can continue, and that they can contribute to capacity in the health and care workforce throughout the winter period. View the registers and a list of social workers with temporary registration.

Skills for Care have produced a range of case studies and information looking at initiatives that can be established within social care to support staffing resilience and workforce capacity. These include staff banks, recruitment support and other initiatives to help boost staffing supply this winter.

Actions for local authorities

Local authorities should:

Actions for providers

All care providers should:

access recruitment support to fill vacancies via the DWP’s Find a Job service, as well as using local recruitment methods. Free recruitment campaign materials are available on our campaign website. Top tips for retention have also been developed with the Care Provider Alliance and published by the LGA and ADASS Care and Health Improvement Programme (CHIP)
review arrangements in place to ensure they have sufficient staff to provide safe high-quality care, even in the event of increased staff absence – for example, by using the Skills for Care’s case studies and examples
continue to ensure staff receive normal wages while self-isolating in line with government guidance. The government has provided funding to support this through the ICTF
ensure they complete the Capacity Tracker and update their ASC-WDS records to ensure effective data for planning for local, regional and national capacity issues

Our plan for the delivery of health and social care over winter will remain reliant on the ability of professionals in the sector to support people, ensuring delivery of the duties set out in the Care Act 2014 and maintaining good-quality practice. Social workers, occupational therapists, nurses and other professionals have specific statutory duties and professional responsibilities, and we recognise the pivotal role they will play in leading local response planning and the organisation of care to support people locally.

Social workers, nurses, occupational therapists and other professionals will work flexibly to:

address seasonal health and care challenges
encourage and support people and their carers to access opportunities to have COVID-19 and flu vaccination
ensure that care and support plans address IPC requirements

National support

We will continue to support principal social workers (PSWs) to lead social work teams at a local level, including hosting regular national webinars to address issues and risks as they arise.

We will offer continued support and resource to the PSW networks, to ensure the availability of peer and bespoke support and interventions.

We are providing national leadership by the recent appointment (on 2 September 2021) of a permanent Chief Nurse for social care who will work alongside the Chief Social Worker for Adults to raise the profile of the social care nursing workforce, and provide professional leadership to the social care workforce and social care practice.

We are ensuring that the social work workforce has the right capabilities to carry out its roles safely, which includes commissioning Skills for Care to deliver development programmes for PSWs, supervisor-level social workers, and both principal and lead occupational therapists. The Chief Nurse will promote the sector to registered nurses.

We are encouraging the collection and sharing of learning on a national level to identify and embed good practice by working with the National Institute for Health Research (NIHR) to influence research priorities on social work that deliver better outcomes for people.

We are working with other national professional bodies to ensure that their members have similar opportunities.

We will publish guidance for safeguarding professionals to encourage systemic change and a consistency in responding to safeguarding concerns.

Actions for local authorities

DASSs and PSWs should:

ensure that their social work teams are applying legislative and strengths-based frameworks, and support partner organisations such as the NHS to do the same. See, for example, the Care Act 2014 and Mental Capacity Act 2005
continue to ensure social work practice is fully cognisant and acts on the issues of inequality and deprivation, and the impact this has on communities and people’s access to health and social care services
ensure they understand and address health inequalities across the sector, and develop actions with partners, where required, considering the implications of the:
- higher prevalence of COVID-19 in Black, Asian and minority ethnic communities
- inequalities experienced by people with learning disabilities, autistic adults, people with mental health difficulties and people who provide unpaid care
consider a review of their current quality assurance frameworks and governance oversight arrangements to ensure that winter and COVID-19 pressures do not reduce the ability to deliver high-quality practice
develop and maintain links with professionals across the health and care system to ensure joined-up services
lead local application of the ethical framework for adult social care, ensuring that NHS partners fully understand their responsibilities to apply the ethical principles and values as part of discharge delivery
ensure that the application of new models and pathways is offering the best possible outcome for individuals, their families and loved ones, advocating for them, and advising commissioners where these pathways cause a conflict
review any systemic safeguarding concerns that have arisen during the pandemic period, and ensure actions are in place to respond to them, enabling readiness for any increased pressures over the winter period
support and lead social workers and safeguarding teams to apply statutory safeguarding guidance with a focus on person-led and outcome-focused practice

Actions for providers

All care providers should continue to support regulated and qualified nurses, occupational therapists, social workers and other qualified staff that they employ by ensuring they are aware of professional duties, the latest guidance and training opportunities, and by supporting them to protect their wellbeing.

Question 6

Supporting the system

Accepted Answer

Funding

Since the beginning of the pandemic, the government has provided almost £2.4 billion of grant funding to adult social care for IPC, testing and workforce capacity. This is in addition to over £6 billion in un-ringfenced grant funding made available to local authorities to enable them to address the pressures on local services caused by the pandemic, including in adult social care.

The ICTF is currently supporting the implementation of infection control measures, including relevant recommendations from the care home support package. We have extended the fund to ensure it continues to provide support through the winter to March 2022, making an additional £388.3 million of funding available to support providers. This will be subject to conditions for providers and local authorities that we will set out in full in due course.

Following closure of the Workforce Capacity Fund (WCF) earlier this year, we will provide workforce recruitment and retention funding to support local authorities and providers to recruit and retain sufficient staff over winter 2021 to 2022, and support growth in workforce capacity of the existing workforce. This will be subject to conditions for local authorities to ensure it is used to address local workforce pressures. We have also published evidence from the WCF which has been used to inform the design and planned implementation of the Workforce Recruitment and Retention Fund (WRRF).

National support

We have extended the ICTF to:

Actions for local authorities

Local authorities should continue to meet the conditions of the extended ICTF, including ensuring providers in receipt of funding continue to complete the Capacity Tracker, provide timely reports to DHSC on spending of the grant, and repay any unspent amounts by the deadline set out.

Actions for providers

All providers should:

Market and provider sustainability

Under the Care Act 2014, local authorities have duties to shape local provision of care and ensure services remain sustainable and continuity of care is maintained. Alongside this sits the CQC’s Market Oversight scheme, which monitors the financial health of the largest and most difficult-to-substitute providers, so that there is early warning of emerging risks.

COVID-19 has added to the cost and revenue pressures that care providers face, and we recognise the need to take steps to maintain the continuity of services. The exit from the market of providers within the scope of the Market Oversight entry criteria, as specified in legislation, requires national oversight and co-ordination because of the potentially high level of commercial complexity and the geographical spread of affected areas.

National support

We are providing funding support and improvement work in the sector, including funding the CHIP, delivered by LGA and ADASS, to produce a suite of tools and support for local authorities to manage their markets, including responding to current pressures and managing the transition to new models of care.

The DHSC regional assurance team will work alongside CHIP to ensure the best possible understanding of local market challenges.

We are working with other government departments and the insurance industry to better understand the route towards the restoration of a fully functioning adult social care insurance market, where care providers can access a range of insurance products which meet their needs.

We have committed over £6 billion to local authorities since the start of the pandemic through un-ringfenced grants to address the pressures on local services caused by COVID-19, including adult social care. Local authorities are best placed to understand and plan the care and support needs of their local population, and therefore to decide how they can best use this funding. For example, some local authorities have used this funding to help providers manage the increased costs of insurance and compensate for lost income from temporary reductions in occupancy.

We introduced the Designated Settings Indemnity Support (DSIS) in January 2021 to provide temporary, state-backed indemnity cover for designated settings within the care home market that were unable to obtain sufficient insurance to accept COVID-19-positive patients on discharge from hospital. Following a review of DSIS, the indemnity support has been extended to cover the winter period until 31 March 2022 to maintain the current level of support for these vital settings. DSIS will be kept under review throughout this period and there will be no further extension to the indemnity support beyond this date.

We are continuing to work with the sector and CQC to monitor the sustainability of providers within the sector, and to review actions that may be needed nationally and locally to reduce the risk of provider failure, as well as ensure continuity of care for service users and wider implications (such as for unpaid carers).

Actions for local authorities

Local authorities should:

continue to work to understand their local care market; and to support and develop the market accordingly including promoting financial support available
continue to work to understand consumer demand and need, and where there are potential stresses in the market
make full use of tools developed by the CHIP to identify, understand and assess risks in their local markets, and draw on CHIP support as needed
continue to review and update contingency plans for managing service interruptions, including those that arise if a provider is unable to carry on because of business failure
try to identify and communicate key issues affecting the industry and the market in their local area, and draw any concerns to the attention of regional and national DHSC representatives

Actions for providers

All care providers are asked to:

leading into winter, review and update their business continuity plans, and proactively engage with relevant local authorities or NHS commissioners and CQC if they have concerns or need support
consider their insurance arrangements and any associated risks as part of their business continuity planning. This should include engaging with their insurance providers and/or brokers well in advance of their renewal date. Further guidance on accessing employers’ and public liability insurance in the care sector is available to view on the Association of British Insurers website.

CQC’s regulatory model

During winter 2021 to 2022, CQC will continue to apply a risk-based approach to inspection, using information from a range of sources, including from people using services and their families, to shape their inspection activity, which will allow them to adapt and respond to the challenges that winter brings quickly.

National support

CQC will (on regulation):

continue to develop their monitoring approach to capture a broad range of information about a service, including from members of the public via their give feedback on care process, and using this information to target regulatory activity where it is most needed
continue to schedule inspections based on risk, where people may be at risk of harm or where a closed culture could develop, by focusing on high-risk providers where there are, for example, safeguarding concerns or where the provider has an overall rating of inadequate
ensure that all inspections of care providers consider how well services are managing infection prevention and control, taking swift regulatory action where provider-level performance requires rapid improvement. This will include monitoring compliance with vaccinations as a condition of deployment within its inspection activity
ensure that information about additional risks and pressures, including on staffing and visiting, are raised with national government and relevant system partners

CQC will (on best practice) continue to collect examples of best practice, ensuring that they are shared with the sector either as a standalone publication or as part of CQC’s regular provider bulletins, as required.

Actions for local authorities

Local authorities should continue to share information about registered services with CQC and promote best practice.

Actions for providers

All care providers should proactively approach their local authority or CQC if they have concerns or need support.

Local, regional and national oversight and support

Throughout the pandemic, central and local government departments have continued to review local data from care providers, and work with health partners to address issues and review support to the care sector in places where data from COVID-19 testing shows increased rates of transmission.

DHSC will continue to use its regional assurance teams to disseminate best practice and provide support to local authorities, while highlighting emerging themes and delivery challenges to inform sector support.

Local authorities should also build on other existing resilience planning (for example, local outbreak plans and cold weather planning). Planning should be as transparent and inclusive as possible, involving collaboration across health and care agencies, the voluntary sector, people who need care, and carers. Providers should also review and update their business continuity plans leading into winter.

National support

Over the following months, we will:

continue engagement with local authorities and providers, through the DHSC regional assurance teams, on winter contingency and business continuity planning, review key social care data through the Capacity Tracker and other sources, and work to ensure that national, regional, and local data and information-gathering is consistent, effective and proportionate
continue to develop the Adult Social Care Dashboard (which brings together data from multiple sources and allows it to be viewed in near-real time at national, regional and local levels by national and local government). This has allowed timely cross-sector action to be taken to manage and mitigate emerging risks and issues at all levels
continue to publish monthly statistics on testing, vaccinations, and other relevant topics as part of the adult social care in England statistics
continue with plans for the Client Level Data project to collect data from 2023 onwards that will allow consideration of waiting times, as we view this as the most appropriate route to collect such information with sufficient nuance
continue to work with CQC and across the whole ASC sector to clarify data needs and collection guidance, for example Capacity Tracker and other regulated data collections
incorporate some assurance of providers’ plans in their Corporate Provider and Market Oversight work, which covers approximately 30% of the adult social care market. CQC will identify whether winter plans exist and provide a high-level view on their suitability. They will not monitor their ongoing implementation but, when necessary, will report and escalate any significant concerns to system partners

Actions for local authorities

Local authorities should:

continue to engage with DHSC regional assurance teams and NHS partners, where appropriate, on contingency planning
continue current oversight processes, including delivery of care home support plans and engagement with regional feedback loops
continue to champion the Capacity Tracker and promote its importance as a source of data to local providers and commissioners
establish a weekly joint communication from local DASSs and DPHs to go to all local providers of adult social care, as a matter of course, through the winter months

Actions for providers

All care providers should:

review and update their business continuity plans leading into winter, and proactively engage with the relevant local authorities or NHS commissioners and CQC if they have concerns or need support
continue to complete the relevant sections of the Capacity Tracker

Annex A – David Pearson’s review of the winter plan 2020 to 2021 recommendations

Number	Theme	Detail of recommendation	Government response
1	Workforce	As a part of stage 2, the efficacy of the workforce measures put in place should be further reviewed to more clearly identify which individual interventions were effective. This is to inform the decisions about what measures should be continued or introduced, and the resources that would need to be available for the forthcoming winter.	Following closure of the £120 million Workforce Capacity Fund (WCF), we conducted a process evaluation to explore its design and use. This includes exploring local authorities’ perceptions of the impact of activities funded by the WCF on workforce capacity, as well as the opportunities and challenges faced by local authorities and care providers. The data used comes from monitoring information, workshops with stakeholders, a survey of local authorities and other feedback by the sector. Some of the learning from this evaluation has now been published and has helped identify the strengths and barriers to inform the design and implementation of the WRRF. During winter 2020 to 2021, we launched a national recruitment campaign to drive recruitment into the sector. We will be taking lessons learnt from the previous campaign forward into the design of our upcoming recruitment campaign this autumn and winter. In February 2021, we launched a national call to care to encourage people to consider short-term paid opportunities to work in the adult social care sector. While it is difficult to assess how many recruits joined the sector as a result, the campaign secured over 3,500 expressions of interest, resulting in a number of recruitment leads being passed on to local authorities and providers. We keep all guidance under review to assess opportunities to ease or lift any of the guidance we make to the sector regarding workforce measures. This includes assessing how the current measures, along with any potential changes, affect the support that we need to provide the sector to support implementation of any IPC measures. Owing to the complex nature of IPC, it is difficult to ascertain the impact of each component part. However, based on SAGE’s review of the measures, the cumulative effect has been beneficial in terms of minimising the spread of infection, thereby minimising outbreaks in care settings.
2	Workforce	Identify the specific risks to workforce capacity, supply and quality over the coming year, and develop and implement workforce contingency arrangements to reduce the risks and help to ensure workforce supply and safe working practices. The findings of this process should be further considered in the broader work on reform.	We recognise that the sector is facing significant recruitment and retention challenges. We continue to monitor workforce capacity, supply and quality in the adult social care sector, bringing together available data with frontline intelligence from the DHSC’s regional assurance team and the sector. We are engaging with the sector regularly to understand capacity concerns and what is driving any challenges. The government’s adult social care: coronavirus (COVID-19) winter plan 2021 to 2022 sets out the actions that government, local authorities and providers should take to address workforce capacity risks over the coming months. This includes providing a further £162.5 million workforce recruitment and retention funding to local authorities to support them to manage recruitment and retention in their area. We will continue to monitor the situation with a view to taking further action if appropriate. In September 2021, the government announced a historic investment in the adult social care workforce in recognition of the vital role it plays in delivering high-quality care. We will invest at least £500 million across 3 years to deliver new qualifications, progression pathways, and wellbeing and mental health support. We anticipate this will help to ensure continued workforce supply in the future. We will work with the sector to co-develop more detail on our workforce reform plans and publish further detail in a white paper for adult social care reform later this year.
3	Workforce	Undertake further investigation to provide more information on why some people who were COVID-19 positive were working during the winter period and address those issues prior to autumn 2021.	In winter 2020 to 2021, DHSC received reports that some care workers who tested positive for COVID-19 were continuing to work in breach of legislation. The number of substantiated cases was extremely low, and all confirmed cases were referred through local authority safeguarding processes. While information was not routinely collected on the reasons why people who were COVID-19 positive continued to work, we understand that a significant factor was acute staff shortage, where there were limited alternative options to safely staff care homes. DHSC and CQC have been clear that COVID-19-positive working is not acceptable in any circumstance. Since our joint publication on this matter in January 2021, CQC has received no new notifications or allegations of any cases that occurred after December 2020. The department’s position remains that COVID-19-positive working is not acceptable in any circumstance, and local authorities should ensure any confirmed cases of COVID-19 positive working are considered through local safeguarding processes, including referring to the police if appropriate. The government’s adult social care: coronavirus (COVID-19) winter plan 2021 to 2022 sets out the actions that the government is taking to address workforce capacity risks over the coming months. These include the ICTF, which providers are able to use to pay for a number of measures, including ensuring that staff who are isolating in line with government guidance receive their normal wages and do not lose income while doing so. Throughout the pandemic, we have made available almost £2.4 billion in specific funding for adult social care. This is made up of £1.75 billion for infection prevention and control, £522 million for testing and £120 million to support workforce capacity.
4	Workforce	Extend the time-limited workforce wellbeing support put in place during the pandemic.	Core elements of the government’s wellbeing support offer, including helplines, guidance and a bespoke package for registered managers, will remain in place over the 2021 to 2022 winter period.
5	Workforce	Providers to place a greater focus on wellbeing and mental health support, including investigating the provision of a dedicated occupational health service to all staff.	Communications campaigns have been underway since spring with the sector including providers, via Samaritans, Our Frontline and Hospice UK, on the importance of staff wellbeing and accessing or promoting mental health support. Significant government funding for workforce was announced as part of the adult social care reform package in September 2021, and this will include support for providers to access workforce mental health, wellbeing and occupational health initiatives.
6	IPC	Given the uncertainty around future risks in light of vaccine efficacy and variants of concern, all key elements of IPC should remain in place until such time as the clinical advice is that they can be removed. The associated financial support from government should continue until it is safe to reduce the measures and the cost.	The advice from UKHSA is for current IPC interventions to remain in place. Financial support for this will be provided through the extension of the ICTF, which has been confirmed until March 2022.
7	IPC	Publication of an IPC strategy for all social care settings, which should include clear, easy-to-understand IPC guidance, training and best practice for the frontline; be inclusive of reasonable adjustments in exceptional circumstances; be supported with a comprehensive training programme championed by the Chief Nurse for Social Care; and be aligned with all relevant equivalent NHS guidance.	We are not publishing a standalone IPC strategy following feedback from the sector about frequent changes in guidance and messaging. Broader IPC strategy is integrated into the adult social care: coronavirus (COVID-19) winter plan 2021 to 2022. We are publishing best practice to coincide with the launch of an IPC network and improving training with the support of the Chief Nurse.
8	IPC	IPC measures are required beyond the current funded period (June 2021; PPE until March 2022). IPC funding should be extended appropriately and made available at the same time as the release of guidance to provide certainty and security to providers, and allow them to continue to implement IPC measures.	We have announced a further £388 million of funding to support the sector to implement measures in the adult social care: coronavirus (COVID-19) winter plan 2021 to 2022, which will run for a 6-month period from October 2021 to March 2022. This includes £237 million for IPC measures and £126.3 million for testing. We will also provide £25 million to support with the associated costs of COVID-19 and flu vaccinations and boosters. This is a significant amount of additional funding to support the vital work the care sector is doing to help stop the spread of COVID-19. It will bring the total specific funding to adult social care during this pandemic to almost £2.4 billion. The 6-month duration of this funding will help to bring security and certainty to the social care sector over the winter months. Decisions on any future funding will be kept under review.
9	PPE	There should be further consideration to making PPE for the ASC sector exempt from VAT, in line with the tax status of the NHS.	We have considered this recommendation with colleagues in HM Treasury. Tax reliefs are an important element of a functioning tax system; however they need to be fiscally sustainable, represent value for money for the taxpayer and be coherent when set against other reliefs and rates. It was not recommended that this proposal was pursued further.
10	PPE	Review future PPE policy in the light of ensuring that social care staff and recipients of care are better protected against other viruses, as part of the IPC strategy.	UKHSA is conducting a review of IPC, including PPE use, to determine the future approach to guidance. This will include considering flu, respiratory syncytial virus and other viruses. We will take this into account when determining future policy on PPE in adult social care and the next iteration of ASC PPE guidance will reflect other respiratory illnesses.
11	Testing	A regular testing regime should continue for 2021 to 2022, while developing a strategy for being able to step down and step back up testing intensity (as the level of transmission allows) as driven by emerging evidence, infection prevalence and variants of concern. Work should continue to develop a clear strategy to achieve this.	Regular asymptomatic testing is available to the entire ASC workforce, with more intense testing regimes for residents, visitors and visiting professionals in higher-risk settings. It is expected this testing will continue over winter; however, the regime is constantly being reviewed in light of the changing shape of the pandemic and clinical advice to ensure a proportionate balance between the burdens of testing and mitigating the risk for staff and residents. The delta variant and increased prevalence has meant testing intensity has remained unchanged; however, work is continuing to develop a clear strategy for testing in the longer term.
12	Vaccines	The operational arrangements are reviewed to ensure effective implementation in the next phase of vaccinations.	In preparation for COVID-19 booster vaccinations, the standard operating procedures applicable to vaccinating the ASC sector were refreshed and published by NHSEI, with support from DHSC in October 2021.
13	Vaccines	Continue work on improving vaccine take-up through access and reducing vaccine hesitancy across the ASC workforce. Continue to monitor and review progress of this work, its focus and its success.	DHSC, NHSE, regions, systems and local authorities are working together to encourage vaccine uptake. This includes regularly reviewing available data to identify focus areas for targeted activity. To address vaccine hesitancy, the Minister for COVID-19 Vaccine Deployment hosted a webinar in May 2021 in which clinical experts Professor Jonathan Van Tam and Dr Nikki Kanani answered social care workers’ questions about the vaccines. Furthermore, over spring and summer 2021, DHSC offered direct support to all care homes for older adults in England reporting less than 50% uptake among staff. DHSC continue to update and share a vaccines toolkit for the sector which includes shareable resources and Q&A documents.
14	Data	That the NHS ensures that there is point-of-care data for social care cohorts in time for the next phase of vaccination and launch of the 2021 to 2022 flu vaccination programme, and that there is local/national access to the data in appropriate form.	NHS systems for point-of-care data capture do not capture ASC vaccination records to the level that the Capacity Tracker vaccination data collection can currently offer – this level of detail is needed for monitoring uptake and to support focused action by local and national programme leads.
15	Vaccines	That detailed planning takes place with the NHS vaccination programme for the next phase of vaccinations for COVID-19 and flu, taking account of the successes and challenges in the vaccination of care workers and unpaid carers.	In preparation for COVID-19 booster vaccinations, the standard operating procedures for vaccinating the ASC sector (including unpaid carers) have been refreshed by NHSEI, with support from DHSC. The refreshed drafts have been shared with sector stakeholders and will be published in September 2021.
16	Funding	As it will be necessary for critical IPC measures to be in place for the course of this financial year, government should continue to ensure that these measures are financially supported and incentivised. It is also advised that decisions are made as soon as possible and in advance of winter.	Please see responses to recommendations 6 and 8, which jointly cover this recommendation.
17	Insurance and indemnity	Government should continue to review the state of the adult social care insurance market, including the impact of COVID-19 restrictions on providers, and consider whether further action should be taken.	We have been reviewing the state of the adult social care market since the beginning of the pandemic and acknowledge the pressures many care providers are presently under as a result of its contraction, including those facing increasing premium costs and restricted cover for COVID-19. We are committed to supporting local authorities and providers to maintain continuity of services through the pandemic and beyond, and will continue working across government and with the insurance industry to better understand the route towards the restoration of a fully functioning adult social care insurance market, where care providers are able to access insurance products that meet their needs.
18	Regional teams	The regional assurance team to provide further information to the sector on their current role and future priorities.	We have been working with ADASS and CHIP to clarify ways of working for the regional assurance team at a national and regional level. We continue to work with the sector to be clear about our ongoing priorities across adult social care while maintaining our flexibility to respond to emerging challenges for the sector.
19	Visiting	Further work is undertaken to extend the level of care home visiting and residents going out across the country with the appropriate IPC measures to mitigate the risk of infection.	Work is constantly undertaken to extend the level of care home visiting. There is currently no nationally set limit on the number of visitors that care home residents can receive. However, clinical advice is that testing, PPE and other IPC measures continue to be needed to prevent infections in care homes. This may impact the duration and frequency of visits that care providers are able to accommodate. For visits out of care homes, clinical advice is that residents need to self-isolate following very high-risk activities (for example, an emergency hospital stay). These requirements for visits in and out of care homes will be removed as soon as the data shows it is safe to do so.
20	Day services	That further work takes place to understand the degree to which day services and related support services have reopened or replaced and what further actions are necessary, nationally or locally.	Day services are an important form of support for people with care needs and their carers. Local authorities have a duty under the Care Act 2014 to provide or arrange services that meet the social care needs of the local population. Decisions around closing, opening and delivery of care lie at local authority level, in line with local risk assessments and the latest public health advice. We are continuing to work with local authorities, in collaboration with ADASS and the Ministry of Housing, Communities and Local Government, to ensure, where possible, the safe resumption of these services.
21	Unpaid carers	Communication and contact with carers and those who draw on care and support is strengthened, such as regular/frequent contact/calls made to carers to check in with how people are coping as we progress through the Roadmap.	The Care Act 2014 gives local authorities a responsibility to assess a carer’s needs for support, where the carer appears to have such needs. This assessment will consider the impact of caring on the carer. The local authority and the carer will agree a support plan, which sets out how the carer’s needs will be met. We have made available almost £2.4 billion in specific funding for adult social care through the pandemic, including the £1.75 billion Infection Control Fund (ICF), which local authorities are able to use part of to support day and respite services to re-open safely. During the pandemic, the government has funded a number of charities to support carers, including over £150,000 of funding to extend Carers UK’s helpline opening hours, and £500,000 to Carers Trust to make onward grants to provide support to unpaid carers experiencing loneliness during the pandemic. Government has also produced COVID-19 guidance tailored to carers and taken action to help carers self-identify.
22	Unpaid carers	Local authorities to strengthen local support provided to carers, including accessing day care service opportunities and respite services, to ensure they are better able to remain open and continue to operate.	During the pandemic, we have worked with local authorities to understand barriers to further re-open day and respite services. We have also worked with the SCIE to publish guidance to help local authority commissioners and providers make decisions on the safe continuation and re-opening of day services. We have supported day care services in implementing good IPC by providing them with PPE and testing, and have made available almost £2.4 billion in specific funding for adult social care through the pandemic, which includes the £1.75 billion ICF. Local authorities are able to use part of this funding to support day centres to re-open safely, which has been used for the deep cleaning and reconfiguration of day centres, training staff in good IPC measures and increased staff provision.
23	Guidance	Guidance should be clear, easy to understand and aligned. All guidance should be co-produced and tested with end users to ensure its comprehensibility and accessibility. It should also align across government, so that DHSC ASC guidance is aligned with equivalent NHS or UKHSA guidance. Where possible, equivalent guidance should be published at the same time to ensure alignment. These tests should be built into the process before publishing. Where guidance is updated, it should identify what iteration is the most up-to-date version and what has changed compared with the version it has replaced.	We are conducting a full review of all adult social care guidance to ensure that it is clear and consistent. The department is engaging with stakeholders as part of this review process to ensure that our guidance is tested with the end user before publishing and to ensure that the messaging is accessible for the sector. The department will also ensure that guidance is accompanied by a summary of changes table for each guidance update.
24	Guidance	In the longer term, that a project is undertaken to determine the most appropriate structure for co-production at national level and how this links with local arrangements.	Work is currently underway to produce an appropriate process for the co-production of guidance at a national level with a focus on closer working with key stakeholders including UKHSA. Through collaboration, we aim to quality assure and evaluate adult social care guidance production and support the implementation of guidance while also addressing health inequalities.
25	Guidance	Guidance should be sent to all statutory and regulated organisations (providers, commissioners and local authorities) immediately and directly. In order to do this, ways should be developed to compile and maintain up-to-date lists of all the organisations in the sector.	We have a well-developed comms channel to disseminate guidance to statutory and regulated organisations once guidance has been updated. We will continue to review this list to ensure it remains accurate and up to date.
26	Guidance	Clarify and confirm the arrangements for disseminating of guidance to non-regulated settings (including personal assistants and unpaid carers).	Guidance for unpaid carers is disseminated via gov.uk and is continuously updated following any changes to guidance.
27	Digital	Increase digital inclusion support for ASC providers and people who use services, so that those without access are supported to get online, and to ensure that the digital aims of the ASC winter plan are achieved in every setting.	We have partnered with Barclays Digital Eagles to support the sector to get the most out of their digital tools, and are developing a pilot digital influencer programme to support care workers to improve their basic digital skills, and give them the confidence to share what they have learnt with their peers and within their own organisations. Greater digital skills within the workforce mean that staff will also be better able to support the digital inclusion of people with care and support needs, who are more likely to be older members of the population or those with a disability. Through our work, we will also ensure that digital guidance and training materials are fully accessible and translatable for the workforce and others who may wish to access the materials.
28	Inequalities	Local authorities and NHS organisations should ensure they take steps, in line with the public sector equality duty of the Equality Act 2010, to ensure they evidence and address the inequality of outcomes for people affected by COVID-19. DHSC should make available further specific advice for the sector in addressing inequalities and there should be appropriate oversight to ensure these steps are taken.	We will continue to actively engage with our partners to ensure that meaningful evidence is being captured, both on the ‘what’ and the ‘how’. Where necessary, we will support with a bespoke programme to strengthen the capture and analysis of this data, and lead the conversation on activities to support the implementation of meaningful programmes and steps. We will also ensure full oversight is maintained as well as the scope and means to step in and/or deploy support as needed.
29	Data	To continue work with the sector to review data needs and data burdens, and to progress increased data transparency over 2021 to 2022. To progress the development of an ASC data framework that provides timely, comprehensive and robust data for the longer term.	We are continuing to work with the sector and with system stakeholders to develop and agree a data framework.
30	Research	That the contribution of research is reviewed, and further plans made for the extension of research and evaluation for the coming year, including extending to the wider social care sector.	We have a substantive research programme across the social care group, which includes support from policy research units – for example, the National Institute for Health Research (NIHR) Policy Unit in Adult Social Care (ASCRU). Policy colleagues are routinely engaged in setting the direction for research and agreeing priorities or workplans as new pressures emerge. As well as the existing programme of policy research that NIHR commissions through its policy research units (including ASCRU), the NIHR School for Social Care Research and open call through the Policy Research Programme, NIHR have also funded Dr Comas at the London School of Economics (who also leads the LTC Policy Network COVID-19 work referenced in the taskforce’s final report) to undertake a project looking at recovery and resilience in the social care sector, as well as other COVID-19 projects looking at the impact of easements and the implementation of guidelines in care homes. Alongside our COVID-19 and policy research, boosting social care research is a priority for NIHR. This includes bridging the gap between academia and the social care sector, supporting practitioner-researcher models and facilitating the use of evidence by those working in the social care sector. We are currently scoping options for commissioning a social care rapid evaluation team and are working closely with the Economic and Social Research Council and Health Foundation-funded IMPACT centre, which aims to support the implementation of evidence in the adult social care sector.
31	Discharge	To review if the CQC-assured designated settings for discharge scheme is the best option for the future or if there are alternative options that are as safe.	We have undertaken a feedback exercise with key stakeholders, including UKHSA, CQC, LGA, sector representative organisations, professional leaders and individual providers, to assess the effectiveness of the CQC designated settings scheme. Their feedback has informed our advice on the future policy direction for designated settings. A decision has been made to extend the designated settings scheme over the coming winter, with an additional £478 million funding package announced to support the hospital discharges programme until 31 March 2022.
32	EHCH	Further work to take place with the NHS to ensure consistent application of the EHCH model across the country.	NHSEI has a central national team dedicated to the roll-out of the EHCH framework, working with regional leads to support quality improvement and consistent implementation across the country. Progress is monitored through the PCN contractual requirements as well as other data available to the NHS.
33	Mental health	Undertake a standalone review of the support that adult social care provided for people experiencing mental ill-health this past winter, with a view to strengthening the support offered in winter 2021 to 2022.	We worked with the Mental Health and Wellbeing Policy and Oversight Group and made a number of recommendations for the adult social care: coronavirus (COVID-19) winter plan 2021 to 2022, and we will continue to work with them to take those recommendations forward as appropriate. The key areas for the ASC winter plan in regards to addressing the care and support needs for people seeking support for their mental health include planning for workforce pressures; promoting improved safeguarding assurance for people subject to risk of abuse; application of prevention strategies; development of local resilience arrangements across communities to reduce isolation and loneliness; and strengthening of partnerships across integrated care systems to alleviate pressures on NHS and acute hospitals and psychiatric hospitals. Strategic and legal reform in the context of the community mental health framework for adults and older adults and the implementation of the Mental Health Act white paper are important workstreams that will be delivered concurrently alongside the adult social care: coronavirus (COVID-19) winter plan 2021 to 2022.

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Executive summary

Our plan for adult social care this winter

Preventing and controlling the spread of infection in care settings

Personal protective equipment (PPE)

National support

Actions for local authorities

Actions for providers and individual employers

COVID-19 and flu testing

National support

Actions for local authorities and NHS organisations

Actions for providers

COVID-19 and seasonal flu vaccines

National support

Actions for local authorities and NHS organisations

Actions for providers

Infection prevention and outbreak management

National support

Actions for local authorities and NHS organisations

Actions for providers

Visiting in care homes

National support

Actions for local authorities

Actions for providers

Collaboration across health and care services

Preventing avoidable admissions

National support

Actions for NHS organisations

Actions for providers

Technology and digital support

National support

Actions for NHS organisations

Actions for providers

Safe discharge from NHS settings

National support

Actions for local authorities and NHS organisations

Actions for providers

Social prescribing

National support

Actions for local authorities and NHS organisations

Actions for providers

End-of-life care

National support

Actions for local authorities and NHS organisations

Actions for providers

Supporting the people who provide care

Unpaid carers and respite care

National support

Actions for local authorities

Actions for providers

Supporting the workforce

Workforce wellbeing

National support

Actions for local authorities

Actions for providers

Workforce capacity

National support

Actions for local authorities

Actions for providers

Social work and other professional leadership

National support

Actions for local authorities

Actions for providers

Supporting the system

Funding

National support

Actions for local authorities

Actions for providers

Market and provider sustainability

National support

Actions for local authorities

Actions for providers

CQC’s regulatory model

National support

Actions for local authorities

Actions for providers

Local, regional and national oversight and support

National support

Actions for local authorities