Coronavirus (COVID-19): care home outbreaks - root cause analysis

10. Relationships

Individual care homes operate in the context of a complex network of relationships. They may have parent companies and other homes within a group. They have to work with health boards, local authorities, health and social care partnerships and the care inspectorate among others. From the homes we looked at it seems clear that where local networks were strong prior to the current emergency this provided a positive platform which could be built upon to provide support and solve problems. We heard very positive accounts of these relationships working well in some areas, as well as accounts of poor working relationships, which were put under additional strain by the demands of responding to the impact of COVID-19. 

It is inevitable that larger care home groups with multiple sites will seek consistency in the approach of their homes, however it is also a fact that homes need some latitude to operate as a part of their local network and the wider system. It is therefore important that the benefits that being part of a larger group can bring, do not discourage homes from the kind of positive local engagement that they are likely to have to rely on in times of crisis. Individual unit managers should be encouraged and assisted to develop the local network that they feel is appropriate to their unit and their circumstances. They need to be proactive in ensuring that positive working relationships exist and equally they need to feel supported by the statutory agencies to deliver the highest standards of care. 

The strength of local relationships will be put to the test in response to a COVID-19 outbreak and all parties need to take active steps to build strong working partnerships that can be called upon in the event of a significant outbreak. Crucially the local networks are likely to be a route to resources, including advice and guidance, but also tangible supports like access to bank staff. Every care home should be considering whether its networks are robust and taking active steps to remedy deficits. The benefits of doing this before, rather than during, a crisis should be obvious.    

Other than acknowledging the importance of continuing to develop these relationships across the system, no specific recommendation is made.