In this blog piece, I share some thoughts about the most recent Department for Health and Social Care Infection Prevention and Control guidance but before we get into that, I just wanted to say a few things about my recent visits to members’ services.
At Kent Autistic Trust, I met Chief Executive Christine Edwards and her team, along with some of the folk they support, then at Real Life Options I met with CEO David Sargent, the Chair of RLO David Wilkin, several members of staff and Anjum, who is supported by RLO in Newcastle (pictured right).
These are very different services in a number of ways – their size, the numbers of people employed and the numbers of people supported – but I was struck most by the things they have in common.
The first and most obvious aspect, which struck me immediately on arrival and throughout the visit, was the energy, commitment and vibrancy of the staff and managers. In both visits, the colleagues I met were hugely proud of the work they are doing and wanted to share with me all the ways in which they are making a positive difference in the lives of the people they support.
Also, during both visits I saw tangible examples of the ambitions that these two providers have for the people they support and for their organisations.
At RLO, this came in the form of the purpose-built facilities they are working on which will provide supported people with the opportunity to learn how to take care of themselves. This includes a fully fitted kitchen with all the facilities needed to support people to learn how to cook a meal, a fully kitted out bedroom where people can learn how to look after their living space and a beautifully equipped room where people can manage their sensory needs.
At Kent Autistic, their ambition came in the form of fully costed plans for a stunning new service which Christine and her team are pressing ahead with regardless of the challenging times the sector is in. She is going ahead simply because she knows local people need and want this service and any risks that this approach brings and any challenges that need to be overcome will be managed as they come up.
Perhaps the most important aspect which was common to both of these services, and to my other visits to members’ services, was the care, compassion and warmth that leaders, managers and every member of staff so obviously offers to supported people. I think that seeing this is what allowed me to leave services feeling so energised about what is happening every day in our members’ organisations and positive about the future despite the very challenging times we are working through.
New Infection Prevention and Control guidance – has the Department listened?
Turning to the more prosaic topic of the new IPC guidance, my overriding sense as I read through this was that there is real evidence that the Department has listened to and understood some of the concerns we and others have been raising and has acted to address these.
The guidance covers a wider range of topics and, without turning the resource into an unmanageably long document, it pulls these together into a more coherent single piece of guidance which providers will welcome. This means that, as a resource, the new guidance is more comprehensive, but at the same time it seems to have been ordered and structured so that it flows in a logical way and provides enough content without going overboard.
With the revocation of the Vaccination as a Condition of Deployment regulatory change, it was pleasing to see that the ‘strongly encourage’ vaccination position of most ARC England members is reflected in the guidance. This fits with a shift away from a prescriptive and occasionally directive approach which previously included a lot of detail that, by its very nature, was not going to be applicable in many of the settings our members operate.
The DHSC does seem to have moved towards an approach where risk is locally assessed and where providers overseeing and managing risk in their services are now supported by the higher-level departmental guidance we have been asking for.
The word ‘should’ appears frequently in the guidance, where previously there was often a more directive tone. Where previous guidance published during the pandemic attempted to cover all bases and all scenarios, when the new guidance reaches the threshold of a regulation or the boundary with a different piece of guidance, it stops with a reference when previously it sometimes strayed into these other spaces.
This approach is also reflected in the way the guidance acknowledges the roles of others such as the local Director of Public Health; it had sometimes seemed to us that the guidance was trying to do too much, including attempting to offer a view when an area of responsibility lay elsewhere.
There is pragmatism where previously there was rigidity (eg. in relation to masks which can cause some supported people difficulties and in respect of staff returning to work on day 15 even with a positive lateral flow test result) and the guidance makes reference to the needs of the supported person more often.
These shifts are consistent with the approach that we have been advocating and reflect the representations made by ARC England on behalf of our members, so whilst we acknowledge the challenges of writing and providing the sector with appropriate guidance at the height of the pandemic, we are pleased to see these improvements.
Additionally, learning from the pandemic (eg. about the difference between PPE and source control and the differences between social care settings) is evident in the new guidance. Whilst some of these developments will be related to the relaxation of the need to apply rigid procedures and the move towards a steady-state condition, some nevertheless do appear to suggest that the Department has a better understanding of the sector and has listened to our feedback. We at ARC England welcome this more collaborative approach.
There is a bit of an issue, however, with the approach to Covid-19 symptoms. The Infection Prevention and Control Guidance lists these as ‘a new continuous cough, a high temperature and a loss of or change in sense of taste or smell’ whereas the Covid-19 testing in social care guidance links to the NHS list of ten symptoms. This difference of approach is unhelpful and giving employers and staff a list of ten symptoms to choose from at a time when workforce pressures are acute and just covering shifts is a daily challenge is not great. We would like to see this resolved, perhaps in a way which is in keeping with the less prescriptive approach that certainly characterises this new guidance now.
ARC England Director