Improving continuity of care and team working into 2021 - Message from HFH


Thank you to you, our hard working and dedicated care team members, you have positively impacted the lives of some of the most vulnerable in our communities this Christmas.

Your continued commitment and team work during the pandemic has allowed our clients to remain safe at home, where care belongs.

This update is to reconfirm our approach to the best continuity of care and team working into 2021.

Topics covered:

  • What are Core Teams?
  • Why establish core care teams of the right size?
  • Working Time Best Practice and Safety
  • Continued Communication Improvements

What are Core Teams?:

  • Carers who are recruited and introduced to a client, matching the carer’s profile with the client’s preferences.
  • Trained to work with the specific client, each carer is assessed and deemed competent by the Nurse Case Manager.
  • All Team Lead carers are of equal standing in the core team, responsible for delivering care only as directed in the Nurse Case Manager’s care plan.

Important: Please notify the office if you are asked to carry out duties or tasks not contained within the commissioned care plan.

⚠ Core care team members who work shift patterns, should not work more than 3 shifts with one client each week to allow an appropriate core team size for the cross cover of sickness and annual leave. Carers are free to accept other work with HFH but ideally limited to 2 or 3 separate packages of care. All working hours must not exceed the hours cap set by HFH working time best practice (see below).

Why establish core care teams of the right size?

Core teams should be staffed by sufficient carers to manage the commissioned hours of the client plus contingency cover for sickness, self-isolation and holiday requirements amongst the team.

As a guide to sufficient core team size: Clients needing 24hr care require 8-10 Team Leads within their core team. Live-in care packages should have 3 live-in carers on rotation.

The benefits of matching client and carer in Core Care Teams further enhances the delivery of care by:

  • Increasing carer satisfaction and income stability, through more appropriate matching of carers to suitable clients (environment / geography / relationship) and better visibility of sustainable, regular shift patterns.
  • Increased client satisfaction through improved personalisation, increased stability, fewer “strangers”, better understanding and empathy of client’s circumstances
  • Increasing client safety. Core carers have greater experience and understanding of their client’s clinical needs and are better equipped to pick-up on “signals” of changes to a client’s condition.
  • Reducing operational complexity, risk and cost, through reduced team member churn, where churn leads to increased demands on recruitment, training, clinical supervisions, increasing operational risk.
  • Increased Pandemic Protection by reducing travel between clients, client specific PPE distribution and fit testing, efficient C-19 weekly test kit distribution (launching Jan 2021)
  • Reducing incidents and safeguarding events.

Working Time Best Practice and Safety

Tiredness can kill. Experiencing fatigue at work can massively increase your chances of being in a serious or fatal incident.

During the initial wave of the pandemic we agreed for the Regional Care Coordination Teams to risk assess longer working patterns for both live-in and shift carers to reduce foot traffic through client homes. Following the government guidance at the time, we anticipated that the first intense lockdown period would halt the virus. As we now continue through the second C-19 wave our approach to assignment lengths has to been reviewed to ensure the most professional care maintaining the safety and wellbeing of our carers and clients.

HFH are legally obliged to comply with The Working Time Directive 2003/88/EC which gives UK workers the right to paid holidays each year; rest of at least 11 hours in any 24 hours; restricts excessive night work; and provides a right to work no more than 48 hours per week. Employees can opt out of the 48 hour upper limit to provide emergency cover but due to the vulnerability and complex care needs of our clients, best practice prevents this from becoming a normal shift pattern.

Regarding Live-In Carers: Maximum live-in duration will be 6 consecutive weeks with an enforced rest period of two weeks between blocks.

⚠ Any emergency/ad-hoc shifts outside of the working patterns outlined above will need to be individually risk assessed by HFH Regional Care Coordination Teams to ensure clients and carers are safety.

Continued Communication Improvements

Effective communication is the ‘golden thread’ of our service and in 2020 we have learned that no one communicates 100% effectively 100% of the time.

As healthcare professionals the future success of our team working requires our continue focus on learnings and improvements into 2021. To keep us talking we have planned:

  • Early in the New Year you will be asked to give some constructive feedback on the Care Coordinators and Nurse Case Managers you work with
  • We will continue with our new programme of supervision between Carers and Care Coordinators, designed to check-in on your wellbeing, improve working communication, identify things you are doing well and any areas to focus on.
  • Early January we will launch the new phone system which provides a number of new benefits including; call recording for training and accountability purposes, direct dials for CC’s & NCMs, easier call transfers when staff our working away from the office and better call volume management to reduce your waiting time.
  • HFH Clinical Governance Team will continue to keep all staff updated via email with any amended C-19 guidance as government legislation changes.


We trust you can see the long term benefits of this team work approach and the support and it offers to you and our clients.

Should you have any questions, please contact your care coordinator for the package that you work.

Wishing you all a happy new year!

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