Telemedicine is a general term that refers to the provision of medical care at a distance through telecommunications technology.
Synchronous telemedicine is performed in real time, such as a video call between a patient and a provider. It can also be provider-to-provider such as when an A&E doctor consults with a remote cardiologist on the best treatment for a patient.
Asynchronous telemedicine includes “store-and-forward” technologies, such as online portals that allow patient–provider or provider–provider communications. It also includes chat bots such as those designed to help a patient decide whether to get tested for the virus that causes COVID-19 and remote monitoring of patients through wearable or implantable devices.
Telemedicine comes in many shapes and sizes and offers many advantages over the traditional healthcare visit. Two key drivers of health and social care policy in the UK over the last decade have been related to patient convenience and controlling the growing budgetary pressures.
According to reports in the media this week, Whitehall sources are saying it is shortly about to be announced that vaccination is to be made compulsory for care home staff caring for the elderly and vulnerable and looked at for NHS staff.
This move follows a consultation by the Department of Health and Social Care (DHSC) launched in April amidst concerns raised by figures showing there have been over 40,000 deaths in care homes due to COVID-19 and a low uptake of the vaccine amongst care home staff.
International Trade Secretary Liz Truss has told the BBC that the government’s announcement of its decision on mandatory vaccination for care home staff was “very imminent.”
The Care Quality Commission (CQC) has announced that it is to publish data concerning the number of COVID-19 deaths in care homes between 10 April 2020 and 31 March 2021. The data will be published at its July public board meeting.
The Queen’s speech was delivered to both Houses of Parliament on 11 May 2021 with a focus upon protecting the health of the nation and economic growth. Criticism has been made however, of the lack of a concrete commitment to address the long-standing funding issues that have plagued the care sector with a brief mention only made within the speech that “proposals on social care reform will be brought forward”. This appears to follow a lack of agreement between No 10 and the Treasury regarding a strategy to limit the amounts pensioners have to pay towards their own care.
From 12 April 2021 new guidance was brought in by the Government on care home visiting. It applies to care homes for working age and for older adults in England.
Every care home resident can nominate up to two named visitors who can enter for regular visits and those visitors are to be subject to rapid lateral flow testing before each visit. The visitors are also required to wear PPE and follow infection control measures whilst in the home. Physical contact is to be kept to a minimum.
Whilst this guidance is a change from the guidance in place prior to 12 April 2021, the Joint Committee on Human Rights (JCHR) questioned whether the care homes regulator, the Care Quality Commission has sufficient awareness of compliance with visiting guidance and, in fact, has gone as far as suggesting that the CQC has had an ‘astonishing’ lack of awareness on compliance following the JCHR’s own investigations into compliance.
As the pandemic continues, more statistics are coming to light in respect of the wider impact COVID-19 has had, not least on the mental health of frontline care workers. A survey undertaken by the trade union GMB found that 75% of care workers said that their work during this pandemic has led to their mental health being negatively affected. The survey found that many felt their mental health had declined during the second wave of the pandemic, with whose who were only entitled to statutory sick pay reporting lower mental health scores.
The Worldwide Health Organisation (WHO) Regional Office for Europe recently produced a short film with healthcare workers discussing the impact the pandemic has had on their mental health, as well as the challenges they have faced, whilst providing care throughout for their patients. The main mental health consequences raised were loneliness, elevated stress levels or anxiety, insomnia and depression. There is no doubt that those providing frontline care throughout, have borne the brunt of the pandemic. Care workers have continued to provide care and support to their patients and the wider public throughout the pandemic, bravely facing the challenges this has thrown at them.
The CQC has completed its review of ‘do not attempt cardiopulmonary resuscitation’ decisions during the coronavirus (COVID-19) pandemic and has published its findings on 18 March 2021 CQC report – Protect, respect, connect. It has, rightly, received much publicity which will hopefully mean that the recommendations contained in the report will be followed.
In the last few weeks we have seen a number of well known care providers introducing new policies, whereby new staff will be required to have the COVID vaccine prior to starting work. Some care providers have gone as far as requiring current care staff to be vaccinated, unless they are unable to on medical grounds. Some care providers have seemingly made it clear that if staff members refuse, purely out of choice, then this will make them ‘unavailable to work’ within frontline care settings. It seems that this decision has been made, amid concerns over the uptake of the vaccine amongst care workers across the UK.
No doubt, these decisions have been made to ensure the protection of those being cared for, as well as for staff members. However, with more care providers deciding to take this step, the question is now whether this raises employment concerns, for discrimination and unfair dismissal, amongst other things.
In our previous blog of 17 December, we considered the potential employment law implications for care homes where staff refuse to be vaccinated against COVID-19. The vaccination programme is now picking up pace across the country, with the Government announcing earlier in the weekthat more than 4 million people had received their first dose. However, the daily figures for COVID-19 related deaths reached a peak of 1,820 on Wednesday, amid serious concerns that the vaccination programme is not being carried out quickly enough to stop the increasing number of deaths in care homes in recent weeks.
As was highlighted in this blog, the Vaccines Minister Nadhim Zahawi has announced a ‘targeted and time limited state backed indemnity’ for care homes which are registered as Designated Settings or intending to register as a Designated Setting, and which are unable to obtain commercial insurance. The question is, will this relatively short-term move have the impact that is needed right now to protect the NHS and care sector?
So what is a Designated Setting? It is essentially a care home which has applied and been assessed by the Care Quality Commission (CQC) as an appropriate setting to care for COVID-19 positive patients who are discharged from the NHS and who no longer require an acute hospital bed. The objective is of course to relieve pressure on the NHS as it copes with the winter crisis.
The aim is that there is at least one Designated Setting in each local authority ‘as soon as possible’.
How are the care homes assessed? The care homes are assessed by the CQC using its Infection Prevention and Control framework (IPC). Assessments are made to ensure patients are being physically separated, that there is a dedicated workforce and appropriate emphasis on ventilation.
The CQC is using an ‘eight ticks‘ approach in order to give the public an overview as to factors such as the availability of adequate PPE, that staff are properly trained to deal with outbreaks and the appropriate processes needed, that shielding is being complied with and hygiene practice is promoted.
How many Designated Settings are there currently? As at 12 January there were 135 approved Designated Settings providing a total of 1,624 approved beds. The coverage across the country is however currently variable – there are only 87 approved beds for instance in London, but 381 in Yorkshire and the Humber.
Testing of CQC inspectors Up until now CQC inspectors were not tested for COVID which was a source of concern for many. It is now proposed that inspectors will be tested weekly with the testing being rolled out in the coming weeks. It is not clear however why there is to be a delay since care home staff are already being regularly tested.
What is the state indemnity scheme going to cover? The indemnity will cover claims for clinical negligence and employers’ and public liability where the care home provider operating a Designated Setting has been unable to secure such cover in the commercial insurance market..
The clinical negligence aspect will be covered by the Clinical Negligence Scheme for Trusts (CNST) supervised by the DHSC and NHS Resolution.
However, as things stand this indemnity will be in place only until March 2021 and is to be reviewed in mid-February.
How helpful is this scheme going to be for the care home sector? One of the concerns for care home managers seeking to participate will no doubt be the ability to provide a dedicated COVID- 19 workforce, particularly given the pressures on staffing already apparent.
If Designated Settings are to be contained within care homes also containing those who have not been exposed to COVID-19, reassurance around dedicated staff, PPE provision, social distancing and adequate ventilation may not be enough to convince service users that they are in fact completely safe.
It remains to be seen how successful the scheme will be for care home operators who have difficulty in obtaining commercial insurance cover for COVID related claims. The impact on the NHS of course will depend on just how successful this scheme actually is in freeing up acute beds.
Given however that the indemnity scheme is limited in its time frame and scope the concern must be that it will simply be insufficient to make any real impact on the problem.