Urgent MHCLG call for info on Supported Housing

As a provider of sheltered housing ( Almshouses) - in addition to a Care Home - all our PPE has been sourced by ourselves from a range of providers across the UK. We had the one delivery of masks for the care home only 2 weeks ago
The sheltered housing service has received no support in regard PPE from the national or local Government and we have therefore had to "Piggyback" on to our care home providers to access supplies for our wardens/ cleaning and other staff and residents ( who we are supporting). The care home commenced receiving information on PPE providers from local authority and resilience forum around 14 days ago but we purchased substantial amounts before then due to lack of information or guidance. Thanks Chris - CEO) Wyggestons

As a provider of care and supported housing services we are having challenges in getting PPE. We work across Surrey, Berkshire, Sussex and South London and also have CQC registered services for domiciliary care. We have got 2 staff almost full time trying to seek PPE especially masks for entering shared housing where people may be self-isolating. The government guidance is clear about when to use PPE but our staff are concerned of course about risks that they are putting themselves in at times. We have tried numerous suppliers based on any information or links that we can find and have even had some success with Facebook posts about PPE. Our concern is that, if/when the government say everyone should wear a facemask the demand will not be able to be met as is currently the case for our staff in supported housing and related services. We really need to get a supplier that can consistently deliver regularly to meet our needs. We accept this is challenging for everyone but the risks that care staff particularly have to face are of a concern as we grabble around to get what is needed.

PPE - we have had issues sourcing fluid repellent face masks and so has our care agency in our extra care schemes. They've also had trouble getting gowns so they can provide full care to residents with Covid 19. Independent living and Extra care schemes aren't being recognised by Government as needing appropriate supplies of PPE, we've had to source a lot of it ourselves.

Staff absence - our issue is our staff in independent living, extra care and Careline services do not have access to testing to enable them to return to work quicker as we have to assume they have Covid 19 and self isolate just in case. I know we are low down the list of priority but it would enable us to manage staff absence more effectively so they can continue to support and help our residents during this difficult time. There appears to be a lack of understanding in Government of what the support services do and therefore we are not getting the support we need.

We run Extra Care and Sheltered Housing and have agreed that it is very important to keep our staff in situ on scheme to provide support and reassurance for tenants and residents while they are being shielded. we have implemented quite stringent PPE instructions and, so far, have just managed to have enough to keep staff and residents safe. Any increase in symptoms or diagnosis of the virus will cause us to have problems as we are sourcing all our PPE kit privately and, as others have mentioned, this is in very short supply. The on site carers with whom we work are really struggling to get enough PPE and are able to comply only with the most basic requirements of the PHE guidance, strictly shielding only people who meet the very vulnerable criteria. In 180 units we have had 2 COVID deaths and 2 symptomatic at the moment. At this level our stocks can cope but we will be unable to provide a service if infection rates in the schemes increase.

We manage extra care and sheltered housing schemes across the Rochdale Borough and whilst our staff do not provide routine care we currently do provide a lifting service for non injured people. At the present moment all scheme managers are working off site however we have a mobile response service operating and attending to no response calls most of which are falls and on occasion scheme managers are also tasked with going to site where a number of attempts have been made to contact people by phone. We have already had 7 seven confirmed cases of Covid - 19 in our schemes and a couple of people displayed no symptoms before they were tested. We have really struggled to get any meaningful PPE apart from the standard gloves and aprons despite orders in with several of our suppliers. This has meant that all falls currently have to have a Paramedic response. Public Health England are currently carrying out an assessment of our PPE needs based on current risk and activity so we are waiting to see what comes back however unless we can protect our staff correctly we don't want to place them at risk by responding to non injured falls and certain no response calls. It is right the NHS and social care staff have the lions share of the PPE available but we feel supported housing staff have been one of the last to be considered for PPE

PPE - like colleagues have mentioned above, we are finding it increasingly difficult to source PPE, particularly masks (even more so FRSM). we do not provide any personal care and have tried to keep our risk assessments for PPE needs as reasonable and proportionate as we can to support the H&SC sector to ensure customer and staff safety and not divert supplies unnecessarily but we do have requirements in place both for staff in SH, our telecare team and trades staff undertaking emergency repairs, in the homes of vulnerable customers in general properties as well as SH. therefore access to supplies is an issue for the whole Organisation re vulnerable customers not just those in SH. We are accessing our usual supply chains and via other RPs who are being really helpful helping each other but its challenging and delivery dates are uncertain. For our extra care support staff, we have relied on care partners to help us thus far but they are also really short in many localities. Councils are doing their best to support but they are really struggling too. we also find that the guidance which is understandably focused on health and social care to be challenging for SH as it is subject to interpretation, the Supported living guidance is "light " and doesn't completely cross-reference with other key guidance notably PPE and IPC (and ambiguous as to where retirement living fits ) . Most recently, we have been advised in one locality by PH that all our staff irrespective of role must wear masks at all times prior to entering schemes with 2+ possible cases (staff and residents) , due to sustained transmission. Whilst we are respectful of their advice, it does put a great deal more demand on limited supplies given its for the wider team of staff not just our scheme managers/support staff eg compliance staff, cleaners, caretakers, trades and H&S contractors working in communal areas and we expect numbers to increase . we were hoping to be able to access social care suppliers for our telecare team but this hasn't come to fruition so we are having to source through our own suppliers as best we can as we are doing for other key staff.

Sickness absences - we are seeing a steady increase in sickness absences amongst our care partner teams. in terms of testing, a couple of local authority partners are including our key worker SH staff into their testing programme albeit our staff provide support not personal care but recognise the value of their continued presence in schemes both to support customers and care partners.

Hi We don't run Extra Care but sheltered schemes. We made the decision to remove the staff and work from home. They do go in once a week to complete the health and safety checks and deal with any scheme issues. We have supplied gloves and face masks at our own expense.
The process is working relatively well apart from an increase in naughty tenants who have no idea of social distancing but they are being dealt with immediately. The tenants have adapted to seeing the officers once a week because they know they can ring them at anytime. We ring our tenants weekly/daily during this pandemic - not our normal service but it reassures them.
Apart from Health and safety weekly checks is there a need to have your housing officers onsite if the tenants are meant to be staying home and you are running out of PPE?

Since posting on Friday 17th April, I have had an email saying that front line staff can be tested if displaying symptoms or a household member is displaying symptoms so things are starting to move forward. Would like residents to be tested now in our extra care and independent living schemes.

PPE - we are supported housing (almshouses). While our single residents (aged 50+) live independently they do so with our support. Many are vulnerable in one way or another with underlying health issues. We are managing to maintain a warden presence on site for a few hours each day to due to warden's locality to the site (5 min walk), to do welfare checks and H&S tests (other warden sick, ops manger working remotely). We are not front line as we do not offer personal care, but we do have contact with residents each day (some have no other support network) and we have no PPE at all now (we had gloves anyway, but these are now exhausted and we have no masks). We have closed all communal areas and enforced a laundry rota, posted guidelines and encourage residents and warden to follow them.

As a provider of sheltered and extra care housing information from GOVT has been very limited. We're managing to keep scheme managers on site for a few hours each day and issuing gloves as PPE to supplement the usual hand washing advice already in place. We purchase our gloves from an online supplier who, unsurprisingly has seen many stock lines become unavailable. We don't provide care so are not affected by the shortages of other PPE experienced by others but are aware that some local care providers are struggling with supplies.

Sickness Absence - as a relatively small provider of sheltered and extra care housing we have taken steps to protect staff and customers, closing communal areas, restricting non-essntial visitors and limiting our scheme managers' time on site. We've had so far, 2 members of staff self isolating following their showing of symptoms but at this point, we've been luckier than many others. In all cases we've communicated our intentions / position to customers.

PPE : As a national provider of sheltered and extra care we have had to piggy back on our care home providers' suppliers to source a very limited supply of PPE. We have issued very clear guidance around its restricted use and as we do not deliver regulated care it is for use in exceptional circumstances. However many colleagues have been concerned about the risks. Some weeks ago the decision was made for the majority of housing staff to be able to work remotely visiting scheme once or twice a week for essential health and safety tests etc. However in our extra care schemes staff are on site every day (reduced hours) and whilst to date numbers of symptomatic residents are low we do not and cannot access the amount of PPE that would be required should that change and more importantly we rely on govt guidance to inform those decisions which has been less than clear particularly in reference to extra care which carries many of the same risks as residential

In Central Bedfordshire, as at 22nd April 2020, the staff working in the Council’s Independent Living/Supported Housing accommodation have some PPE, and there are no significant sickness absences. These issues are both reviewed on a daily basis

The Council’s residential care settings are experiencing some issue with acquiring PPE, however these are being managed at the moment. Staffing levels are being maintained. Both would become an issue if there is a significant increase in cases of C-19 locally.

The wider provider market for residential and Nursing care has also reported issues with PPE in particular. These are being managed through and exchange programme, LRF drops and the council providing PPE on a mutual aid basis. Staffing is broadly at manageable levels in this sector, with one or two care homes experiencing levels that are a particular challenge to operations though these have not led to any specific issues.

Sickness Absence: A key is the issue relating to staff absence, understandable fear of staff, especially where an outbreak of CV has been confirmed. Just testing symptomatic people is a waste of scarce resources. All residents and staff teams should be tested so that people can go to work with confidence that they are safe and protected. Mobile testing is required as the drive through centres are far too distant from many care home and schemes. Thank you Jeremy for leading the sector in these essential discussions at this time. Dan Gaul.

The experience of Beyond Housing is typical of many other providers and whilst we are confident of our short to medium term supplies we feel that there is uncertainty in the longer term in our ability to secure appropriate levels of equipment to maintain effective services.

We moved quickly, on the announcement of the lockdown, to secure appropriate PPE and sought appropriate advice and guidance from the Government and the TSA (Telecare industry governing body) to ensure that the steps we were taking would be effective and suitable, given the circumstances.

Practically this has seen us providing PPE at level 2 guidance and colleagues have been issued with aprons, gloves and facemasks, with visors introduced slightly later as an additional layer of protection. We have endeavoured to identify cases (or potential cases of the virus) through effective data capture and feedback from colleagues and customers. This has helped inform the approach our responders and colleagues have taken when supporting our vulnerable customers and maximized the levels of PPE stocks.

Our supported housing schemes have introduced strict controls to reduce the number of visitors to the schemes as well as limited resident movement in and around the scheme. This has been done in partnership with the commissioned care provider; who we have also worked closely with to ensure that the PPE is available for them to continue to deliver the levels of service we expect. Within the early days of the crisis PPE availability was flagged as a major concern by care and this has been addressed through work with the local authority and is improving.

We feel that sourcing of PPE was difficult in the immediate post-lockdown world, largely driven by a scramble from a large number of sectors looking to secure PPE. In some cases it was evident that suppliers were benefitting from the situation, which ultimately led to delays and increased costs. Whilst we were fortunate to have preferred suppliers who were able to meet our demand, the clamour for products did mean that we had to look elsewhere to buy items that differed/exceeded the requirements set out by Government.

Moving outside of our typical supply chains we did find it hard to source appropriate quantities of masks that met our specification. We had to extend our due diligence given the evidence available of counterfeit items entering the UK market. Whilst we are now confident in the quantity of masks we have available, we continue to be concerned about the increased pressure facing the supply on aprons and gloves. Furthermore we anticipate that this pressure will increase if some lockdown measures are eased and other services/sectors need to introduce a level of PPE for their operatives.

PPE

As a large provider, working across a wide regional area, we have many sheltered schemes, some Extra Care and other specialist supported living (some are CQC regulated). Our colleagues in services providing care and support have been delivering essential care to our residents since government restrictions, working with commissioners around the level of care. Supplies of PPE remain a concern, and we have asked services to report on their self-assessment of risk (Customer, Colleague and Supply Chain) for several weeks. In addition, detailed daily tracking of PPE stock in hand and current orders is now in place, but there are regional variations to stocks and supply. We have identified a range of suppliers, as well as the national supply chain, but those orders have only arrived in the last few days.

We made the early decision that our colleagues in sheltered schemes would work remotely, with daily calls to all residents, to provide reassurance, support and signposting. This has worked well with closure of offices and communal spaces to maintain social distancing. We also have remote call centre working with a dedicated Support Hub to help worried residents navigate available internal support or signposting to the community. We are now starting daily site inspections and non-technical / health & safety checks, so our Housing with Support Managers will be on site and visible once a week. Risks assessments are in place, with letters sent to all residents in each service.

Public perception of the use of PPE and what’s happening about testing is a risk we’re monitoring. We remain concerned that there is a wealth of guidance and support available, but clear guidance from government about these types of services and how PPE should be used would be welcome (an example would be use of public transport between visits and perceived need for PPE).

Absence issues

We have daily tracking from all teams to monitor both levels of absence and Covid-19 issues. Home working is in place, including the distributed contact centre, and we are looking closely at wellbeing concerns, responding with range of support tools and techniques. This will include responding to DSE risk assessments as the lockdown continues. Services, especially those delivering care and support are responding well, balancing load across patches, but there are some regional pressure points.

There is a lot of tracking and reporting at the moment, and it would be good for some more co-ordination of these requests. For example, CQC has a daily return, and contract monitoring from commissioners as well. We look forward to improvements, and perhaps better sharing of this data would relieve operational pressures. Also, coming back better – we must focus on being a better digitally connected business, with greater resilience and simpler processes.

PPE ‘Tell us if you have had any specific PPE issues that you think need to be escalated’:

•Crown Commercial Services and National Supply Disaster Response have been very Central Govt and NHS focused – little in the way of practical support. CCS signposted a ‘construction materials’ framework in one response
•Local Resilience Forums are challenging to identify, as are their contact details
•Some suppliers put forward by CCS for PPE are ringfenced for the NHS and/or have had onerous registration processes e.g. asking for details of CQC registrations which can be found on the CQCs own website
•Masks – surgical/IIR/respirators have been the most challenging piece of PPE to source in our experience
•It is clear in certain circumstances that we are competing with the NHS for PPE stock from the same suppliers – where we have discovered this we have obviously ended our sourcing attempts with these suppliers in order that the NHS can be prioritised. It would be useful to be able to identify NHS suppliers in order to be able to ensure we don’t purchase stock from them or waste time in contacting them.
•In our experience there appears to be minimal excessive commercial exploitation from suppliers but there are a minority of suppliers attempting to make excessive margin (e.g. we have seen a quoted delivery charge of £189 for a few boxes of gloves). As the situation progresses some high level benchmarking information would be useful.
•It would be beneficial to have a prequalified supplier list for PPE – some of the items have an extremely long and complex supply chain making due diligence around the standard of the PPE (and conditions it was manufactured in) challenging.

I am posting as a commissioner from Richmond and Wandsworth Council.

Please see below responses from a range of supported Housing providers; Mental Health, Substance misuse and Single Homeless/Rough Sleeper services to the 2 questions asked on PPE and Staff absence impact

Q1 In regards to PPE equipment, we currently have stock which allows staff to work safely.

Q2 doesn’t apply to us.

Q1 PPE
Have you have had any specific PPE issues that you think need to be escalated?
Yes, I requested PPE from the National Supply Disruption Line, Tel: 0800 915 9964, Email: [log in to view email address]. My order was taken and then I received a response a week or so later informing me that our service was not to be issued PPE from them and that I should contact the Local Resilience Forum. And if I am unable to obtain PPE there then get back in touch with National Supply Disruption. I have not contacted the Local Resilience Forum because I was spending too much time trying to find a contact details for them. In short, is there any way that you can arrange for PPE to be delivered to our supported housing service without further delay? Thanks.

Q2 Sickness Absence
Have you had any Issues about sickness absence of your frontline staffs and those who provide extra care and specialist supported living for people with acute conditions? No staff have sickness absence. 1 full time recovery worker is working from home and 1 casual recovery worker is self isolating in accordance with GP advice to do so to protect underlying health condition.

Q1We have not had any specific PPE issues that need to be escalated.

Q2 We haven’t had any issues with sickness absence.

Q1 PPE
Have you have had any specific PPE issues that you think need to be escalated? No we have managed to secure PPE eventually and have stock that can be accessed from our registered care homes.

Q2 Sickness Absence
Have you had any Issues about sickness absence of your frontline staffs and those who provide extra care and specialist supported living for people with acute conditions? No we are operating well currently and all staff are working in service, reduced service for some people physically face to face. But acess via, text, facetime etc. to ensure that people in the community are well and being supported.

Q1 PPE
As we are support rather than care then the need for PPE is reduced. However it is important to us that all staff are safe and have access particularly to facemasks, gloves and hand sanitiser. Gloves are in short supply and we do need access to a small supply of aprons for ad hoc cleaning rooms and assisting clients with their possessions in their rooms etc.

Q2 Sickness cover
Staff who have been advised to shield for 12 weeks are being supported to stay in work and productive where this is practical. In some cases we have moved case working and keyworking to a phone based system. This does lose some of the human contact but is working OK. Some staff are anxious and we have supported staff in staying at work by offering support to pay for alternative ways of travelling to avoid peak hours or in some cases public transport. If staff are working from home due to their need for self-isolation we do need to pay for more cover in our staffed services.

We are experiencing the tension between being a good employer and also being a good provider of essential services to a vulnerable group of people. However we believe we are succeeding in most cases, though our board are aware this will come at a financial cost.

As XXX has notified you, one of our residents has contracted Covid while on a hospital ward. We will be monitoring this closely to ensure that they are released once they are no longer contagious or they are able to effectively self-isolate within their own property

Q1 PPE
Have you have had any specific PPE issues that you think need to be escalated? XXXX teams so far reporting necessary PPE available

Q2 Sickness Absence
Have you had any Issues about sickness absence of your frontline staffs and those who provide extra care and specialist supported living for people with acute conditions? XXXX does not provide extra care or specialist support for people with acute conditions. However we provide housing related support to otherwise vulnerable young people and adults through commissioned services. One member of staff was off sick with Covid 19 symptoms (not confirmed) for two weeks and is now back, we have two members of staff who are following PHE advice for those with pre-existing conditions which restricts their ability to attend site but they are working from home.

Q1 PPE
Have you have had any specific PPE issues that you think need to be escalated? - No

Q2 Sickness Absence
Have you had any Issues about sickness absence of your frontline staffs and those who provide extra care and specialist supported living for people with acute conditions? - No

Q1 PPE
We have struggled to source adequate supplies of PPE for our staff at XXXXX House, placing them at risk of infection. We continue to have problems with this and have minimal PPE available. In XXXXXhave supplied our staff working in hotel provision for rough sleepers with PPE

Q2 Sickness Absence
Have you had any Issues about sickness absence of your frontline staffs and those who provide extra care and specialist supported living for people with acute conditions?
For STMH we have not yet had issues with sickness absence.

Q1 PPE
Have you have had any specific PPE issues that you think need to be escalated? YES, I AM RUNNING OUT OF GLOVES, FACEMASKS AND HAND SANITIZERS

Q2 Sickness Absence
Have you had any Issues about sickness absence of your frontline staffs and those who provide extra care and specialist supported living for people with acute conditions? YES, TWO STAFF SELF ISOLATED BUT ARE NOW BACK TO WORK.

Q1. No, we are monitoring use and stock daily and have no concerns

Q2. We have been able to maintain staffing levels in all of our services so no concerns at present

Q1. No

Q2. employee 1 - absence: 22.03.20 - 29.03.2020
employee 2 - absence: 26.03.2020 - 31.03.2020
employee 3 - absence: 20.04.2020 - Still isolating

Q1.Thank you for the list of suppliers you sent. However, we are finding that all suppliers do not have stock at the moment. We are on the waiting list internally for PPE. I thought we may receive some from the council but we haven’t received any. We have been reliant on purchasing items from local hardware shops or chemists. We have sourced most things and have built up a small stock of items but now we are low on masks.

Q2. I am just relating this to COVID related sickness
I was off sick last week for 7 days suspected COVID but I have no symptoms now and haven’t been tested. I have 2 staff off sick with suspected COVID. One of the staff members partner was tested last week and it came back positive for COVID. She has been off for 4 weeks so far. The other staff member has been off for 2 weeks. We have managed to cover through bank workers and overtime so have been ok in finding cover.

Q1. In regards to PPE equipment, we currently have stock which allows staff to work safely.

Q2. doesn’t apply to us. If we have any issues, I will ensure that it is escalated.

I am posting further as a commissioner from Richmond and Wandsworth Council.

Please see below responses from a range of supported Housing providers; Mental Health, Substance misuse and Single Homeless/Rough Sleeper services to the 2 questions asked on PPE and Staff absence impact

Q1 PPE
Have you have had any specific PPE issues that you think need to be escalated? – Yes, we have struggled to get aprons and gloves, this is relevant for our refuge accommodation, where staff need to complete regular H&S checks and room turn around. We have approached number of providers who informed that they are out of stock for these items. I have manged to order some aprons and gloves yesterday, but I am unsure when these will be delivered at the moment.
Q2 Sickness Absence
Have you had any Issues about sickness absence of your frontline staffs and those who provide extra care and specialist supported living for people with acute conditions?- All or our staff have been enabled to work from home to minimise any need for travel and then exposing themselves unnecessarily to any risk of catching the virus. However, there is a need for our refuge staff to maintain some presence in the refuges to complete regular H&S checks and also to provide residents with cleaning supplies and where residents are isolating, we provide residents with food as well. At the moment no residents are self-isolating in our refuges. Our refuge accommodation is staffed by 4 refuge workers. All of whom are currently shielding. They are all able to provide telephone support to clients and to follow up on any issues. We have asked staff from our other refuges to support the sites with regular H&S checks and to give residents their supplies.
We have had no issues with staffing in any of our other services.

Q1 PPE
Have you have had any specific PPE issues that you think need to be escalated? We need Masks for our services prioritising our visiting support staff as we visit different houses on daily basis hence risk is slightly higher without adequate PPE.
Q2 Sickness Absence
Have you had any Issues about sickness absence of your frontline staffs and those who provide extra care and specialist supported living for people with acute conditions? We have few staff either shielding or isolating. None of our staff have tested positive although we have not completed any test? The staff absence have been covered by our pool staff and some by agency staff.

Q1 PPE
Have you have had any specific PPE issues that you think need to be escalated? No
Q2 Sickness Absence
Have you had any Issues about sickness absence of your frontline staffs and those who provide extra care and specialist supported living for people with acute conditions? NO

Please find Peabody's reply below

PPE

Generally we have been able to procure the supply of PPE that we need so far. Peabody is fortunate that as a large organisation we can both share stocks across services and have funds to purchase items. The cost of PPE has risen sharply since the start of the pandemic, and we have spent over £300,000 so far. We have funded these costs internally but are seeking to recoup cost by accessing some of the funds allocated to local authorities. We imagine that PPE and additional infection control measures will be in play for a long time to come and would like some clarity on how will this be funded, particularly in terms of contracts and eligible property costs.

However, the picture is changing rapidly and suppliers are often not living up to their promises over what they can deliver and when. For some items getting certification has been challenging. Our main priority is procuring fluid-repellent masks and we have real concerns about obtaining these. We have also had challenges in securing hand sanitiser, anti-bacterial wipes and visors. Local authorities have been supporting us when we have experienced a shortfall in PPE, but as they have provided a limited number of items when requested we believe they are facing their own challenges in obtaining stock.

Finally, we would welcome more guidance for supported housing as we require further clarity to understand what the government recommends outside of care settings. Some types of supported housing present particular challenges as they have communal spaces, several are still receiving new customers and not all customers are following social distancing advice which presents us with particular issues. We believe that for high risk groups communal spaces are likely to be closed for an extended period and welcome guidance on how this affects the rents charged to customers who would normally use those spaces.

The interpretation of guidance also has impact on how much PPE we need, and the way it is written often contains fine nuance which can be difficult to interpret by customer facing staff, particularly where English is not their first language. We have also found the guidance around what is meant by a session of care unclear and would welcome further clarity around this.

Replying on behalf of Peabody

Sickness Absence
During the first few weeks of the pandemic many staff were absent because they, or someone in their household, had symptoms of COVID-19, but things are settling down now, with a small number of staff shielding. Increased testing has been positive as not only are we able to catch people who have it, or who have family members who are unwell earlier, but we are able to pull staff back into work more quickly if we know that they don’t have COVID-19. However, for testing to be effective, it must take place within 3-5 days of developing symptoms; this can be challenging where people feel very unwell or do not have access to a car. Home testing kits would be helpful in these situations.

We do have some concerns around sickness absence. While Peabody pays the real living wage and provides good terms and conditions the sector as a whole is hard to recruit to and some schemes consistently have vacancies which means even a small number of sickness absence has a large impact. We are monitoring rotas and moving staff around schemes where necessary, and have planned contingencies but have particular concern about these schemes.

At one stage some schemes had a fifth of staff absent; this was managed through use of agency staff, but has meant that we have taken on additional unplanned agency costs; as a large organisation we have been able to meet these, but it will have an impact on our service budget.

Some staff are on sick leave due to stress and this is in part because statutory services have pulled out of some of their usual work, leaving providers to pick it up with no additional resource. For example hospital discharge and prison release schemes are referring into our services without providing the usual level of support and needs assessment.

There is also a growing issue around childcare; our experience is that school provision is not consistent and what is there doesn’t support shift work, especially in the evening and night. Affordability is an issue for many especially those who would normally rely on family members for childcare and aren’t able to do so at present owing to social distancing rules.

Peabody response
2020.
PPE
Generally we have been able to procure the supply of PPE that we need so far. Peabody is fortunate that as a large organisation we can both share stocks across services and have funds to purchase items. The cost of PPE has risen sharply since the start of the pandemic, and we have spent over £300,000 so far. We have funded these costs internally but are seeking to recoup cost by accessing some of the funds allocated to local authorities. We imagine that PPE and additional infection control measures will be in play for a long time to come and would like some clarity on how will this be funded, particularly in terms of contracts and eligible property costs.
However, the picture is changing rapidly and suppliers are often not living up to their promises over what they can deliver and when. For some items getting certification has been challenging. Our main priority is procuring fluid-repellent masks and we have real concerns about obtaining these. We have also had challenges in securing hand sanitiser, anti-bacterial wipes and visors. Local authorities have been supporting us when we have experienced a shortfall in PPE, but as they have provided a limited number of items when requested we believe they are facing their own challenges in obtaining stock.
Finally, we would welcome more guidance for supported housing as we require further clarity to understand what the government recommends outside of care settings. Some types of supported housing present particular challenges as they have communal spaces, several are still receiving new customers and not all customers are following social distancing advice which presents us with particular issues. We believe that for high risk groups communal spaces are likely to be closed for an extended period and welcome guidance on how this affects the rents charged to customers who would normally use those spaces.
The interpretation of guidance also has impact on how much PPE we need, and the way it is written often contains fine nuance which can be difficult to interpret by customer facing staff, particularly where English is not their first language. We have also found the guidance around what is meant by a session of care unclear and would welcome further clarity around this.

Sickness Absence
During the first few weeks of the pandemic many staff were absent because they, or someone in their household, had symptoms of COVID-19, but things are settling down now, with a small number of staff shielding. Increased testing has been positive as not only are we able to catch people who have it, or who have family members who are unwell earlier, but we are able to pull staff back into work more quickly if we know that they don’t have COVID-19. However, for testing to be effective, it must take place within 3-5 days of developing symptoms; this can be challenging where people feel very unwell or do not have access to a car. Home testing kits would be helpful in these situations.
We do have some concerns around sickness absence. While Peabody pays the real living wage and provides good terms and conditions the sector as a whole is hard to recruit to and some schemes consistently have vacancies which means even a small number of sickness absence has a large impact. We are monitoring rotas and moving staff around schemes where necessary, and have planned contingencies but have particular concern about these schemes.
At one stage some schemes had a fifth of staff absent; this was managed through use of agency staff, but has meant that we have taken on additional unplanned agency costs; as a large organisation we have been able to meet these, but it will have an impact on our service budget.
Some staff are on sick leave due to stress and this is in part because statutory services have pulled out of some of their usual work, leaving providers to pick it up with no additional resource. For example hospital discharge and prison release schemes are referring into our services without providing the usual level of support and needs assessment.
There is also a growing issue around childcare; our experience is that school provision is not consistent and what is there doesn’t support shift work, especially in the evening and night. Affordability is an issue for many especially those who would normally rely on family members for childcare and aren’t able to do so at present owing to social distancing rules.

RHG members report that availability of PPE is erratic. Regular suppliers are not always able to honour existing commitments and the step change in demand has proved difficult for them to satisfy. Members are working with Local Resilience Forums and National Helplines to address these issues but improved supplies of PPE are definitely needed. Experience has shown that staff in sheltered housing will on occasion need to wear PPE, but these schemes are not registered with CQC and do not receive any of the supplies administered by central government. Sometimes sheltered housing staff can borrow from extra care registered colleagues, but this is not always possible. Sheltered housing providers need access to the Government scheme.

As a support worker myself, I had to buy my own PPE myself to look after a service user that was seriously ill. We weren't sure if he was having Covid-19, however he had all the symptoms including lungs problem and pneumonia. This really scared the life out of me,as we are been sent to the job without adequate information and PPE. Sadly the young man passed away within 2weeks.