Yesterday saw the opening of care homes to garden and outdoor visits. This has been much welcomed and in typical disappointing reality in many parts of the country the weather was atrocious. It was also a hard day for members in Dumfries and Galloway where following Government advice there was an extension of lockdown conditions. It has been very disappointing that the days running up to the opening have been illustrated by the chaos and lack of co-ordination we have seen in so much of the response to Covid19. In some parts of the country we had some PH officials indicating that they were not going to sign off visitor protocols because they had not been told or did not think it their role, in others they had still not developed these systems hours before the openings and yet in other parts they were managing to turnaround things in a matter of hours!
There has been further information in response to issues members have raised in the last week posted in the form of an FAQ sheet. See https://www.gov.scot/binaries/content/documents/govscot/publications/advice-and-guidance/2020/06/coronavirus-covid-19-adult-care-homes-visiting-guidance/documents/care-home-visiting-faq-3-july-2020/care-home-visiting-faq-3-july-2020/govscot%3Adocument/Coronavirus%2B%2528COvID-19%2529%2Bcare%2Bhome%2Bvisiting%2BFAQ%2B-%2B3%2BJuly%2B2020.pdf
Shanice and colleagues at Scottish Care have developed an infographic which members may find useful. See https://scottishcare.org/stage-2-care-home-visiting-infographic/
The following is a summary of some of the main issues in the week that has passed.
Finance and sustainability
I start each of these updates with a section on finance and sustainability because I realise just how critical these issues are. It is clear to me that there is a growing though far too slow dawning of an awareness on the part of officials that we are in an exceptionally precarious situation. This is not hyperbole I have a very real fear that there will be the loss of care homes and also home care organisations because of failures to disperse the monies allocated through the mobilisation funds. We are now working on a weekly basis with COSLA and the Partnerships to identify specific areas where there are challenges. But we need your intelligence to inform us. In addition, I held with others a very frank and honest meeting with COSLA and SOLACE on Monday. There is a clear disjoint – and this should come as no surprise to readers – between the promise of monies from Scottish Government and the delivery of these to HSCPs and LAs. We have stressed that whilst we are sensitive to that, the fact they manage to sort their own services and staff T&Cs out before coming to us is unacceptable. Nevertheless, we now have a CEO who will act as a go-between between ourselves and local authorities to address specific issues. I hope it will bear some fruit and not just be an attempt to ameliorate.
Positively I am getting intelligence in the last week that finally payments – after weeks of waiting – are beginning to trickle through to providers and that in some parts of the country there has been a conclusion to issues. Let us hope this becomes the norm rather than as it is at the moment the exception.
I also held a meeting with the Cabinet Secretary this week and I included finance and sustainability as one of the key issues to discuss. Care home members will be aware that the settlement this year on the NCHC discussions was extremely challenging. I highlighted to the Cabinet Secretary that we need to seek a settlement as a matter of urgency to prevent a collapse in the sector and that Scottish Government needed to be around the table with COSLA and ourselves. She indicated she was aware of the financial challenges although she is still convinced that large UK providers are ‘creaming profits’ from the sector! She indicated she would talk to officials to see if it would be appropriate for them to be involved. I again stressed to her that we have to sort out a fee that is sustainable. In terms of care at home and housing support she is again portraying the line that the settlement of contracts should be at LA level and that monies have been made available. The clear reduction in contracts is a matter of grave concern.
In the discussions with her I noted the meeting that I and colleagues held with the Chair of the Fair Work Convention earlier in the week. The stress and emphasis upon fair work terms and conditions is only going to be achievable if there is fair commissioning. We will be presenting a paper to the FW Group and it will make clear that providers are more than open to improved T&Cs including extension of benefits re sickness etc but only when and if we are enabled to do so through an adequate contract in homecare and an adequate NCHC.
I hope in the coming week that COSLA will commit to starting discussions on what happens after the 31stJuly as a matter of urgency.
We have also spent the week dealing with a whole range of very legitimate questions in relation to the Social Care Support Fund – despite asking on Monday for clarification on issues and again on Wednesday and Thursday we have still not had response to many of the issues we have raised. I have collated a set of questions and sent these to SG – if you wish to add to these please do so on the Discussion Board. Again, this is a sign of more inefficiency in that the lead civil servant co-ordinating all this went off on leave two days after the Scheme was published. See the Discussion Board. https://scottishcare.org/members-area/topic/social-care-fund/
Unfortunately the final terms of the Death in Service Scheme have still not been published. We have been told that this will finally be done on Tuesday following sign off from COSLA Leaders. I should underline that there is an expectation for providers if possible to make the payment. If this is not possible there will be an ability to work around this. It is tragic that last weekend we lost another social care worker to the virus and it goes without saying that our thoughts are with all those who in their care and compassion for others have lost their lives.
Care Home issues
Again, there has been another week of stability in the data relating to deaths in care homes and the totals have reached what is close to a seasonal norm.
In my meeting with the Cabinet Secretary I indicated our growing concerns about the physical and psychological health of residents given this prolonged period of lockdown and indeed there growing international evidence that is supporting our very real concerns. See https://ltccovid.org/2020/07/01/detrimental-effects-of-confinement-and-isolation-on-the-cognitive-and-psychological-health-of-people-living-with-dementia-during-covid-19-emerging-evidence/
A Group has been established at Scottish Government as part of the Clinical and Professional Advisory group to explore how we can get AHP and other visitors back into the care homes so that we can improve health and wellbeing. We also need to give consideration to improving the general support of individuals in care homes from both primary and secondary care and for secondary care support in people’s own homes. There is a growing appreciation that we need to both improve the sense of clinical abandonment that many felt at the start of the pandemic and the relatively patchy support from primary care before the virus hit our sector. I reflected on some of this in my blog last week. See https://scottishcare.org/let-care-flourish-reflections-on-primary-and-social-care/
I had hoped that the Care Inspectorate document ‘Guidance for Professional Visitors’ would have finally been published but further work is required on the testing protocol, part of this – I hope earnestly that this will be out by the time I write another one of these as we continue to have concern about some of the visits.
There continues to be a narrative not least from the trade unions but also from some providers about the benefit of a National Care Service. I have tried to stress that now is the time for reflection rather than knee jerk reaction. I spoke to the Cabinet Secretary directly about this and the extent to which all this is risking a destabilisation of the sector at a critical time. Her response was that she had not determined whether the Adult Social Care Reform Group will continue in its present format, but it was her opinion there was not the bandwidth nor time available to do much about reform before the next Scottish elections. She indicated that there would be no overnight changes despite the rhetoric about a National Care Service – which mirrors what the FM this week and that the sector would be fully involved not just consulted after decisions were made.
Care Inspectorate
The Health and Sport Committee have announced that they are to carry out an Inquiry into the role of the Care Inspectorate during the pandemic. Now whilst it might seem an opportune moment to tell some home truths about the Inspectorate I personally consider this as a not very subtle attempt by some politicians and others in the system to get their own back at the CI as a means of getting to providers. There is a political sense that the CI have been too soft on the sector and that their collaboration model needs to revert back to a compliance model of strict instruction and penalty. Clearly that is in no one’s interest and we will give an honest reflection of what members have suggested has been a generally positive contribution from the Inspectorate, including holding back some of the worst excesses of clinical colleagues. I know care at home members may have had a diverse view.
Brexit
I indicated last week that we were getting evidence from some suppliers that they considered there may be shortages as a result of a potential no-deal. Given we are now beyond the stage of any extension we must as a sector, I feel, begin to consider the need to plan for all eventualities. I have had discussions with colleagues about what this might mean in terms of dusting down the work we had done at various stages last year. I suspect there will very soon be requirements to evidence resilience and contingency plans.
One area where we have commented in the week that has passed has been following the publication of a disturbing report relating to the changes which are likely to result as a consequence of the Westminster Government’s decisions re immigration. See https://scottishcare.org/uk-immigration-policy-impact-on-scotland-report-july-update/ This will come as a particular concern both for existing EU workers and for future recruitment. We have started discussions with Citizens Advice Scotland about how they might be able to support individual staff members who are concerned about their status and I will send information out when this is available.
Testing
Perhaps more than any other topic issues are abounding about testing. These are numerous including what I have now termed couriergate – the fact that couriers were turning up late or not at all to collect tests and tests having to be re-done; inconclusive tests; the strain and demand on staff time and resource etc. At long last we have finally secured a weekly working group to explore some of the issues (meeting on Monday) and there is to be published a FAQ of key issues and questions. I am pleased that we will have three of the senior staff from the Testing Directorate including the Depute Chief Nursing Officer attending Tuesday’s Surgery. In addition yesterday further changes to the Social Care Portal have been made in response to feedback from members. Information on this is now on the website. See https://scottishcare.org/new-information-on-the-uk-gov-social-care-testing-portal/
There has also been huge disquiet caused by the notice from the SSSC that if staff refuse to undertake a test that this ‘will’ have an impact upon their registration. After much discussion this has been reduced to ‘may’ and a group at SG has been set up to explore the issues behind this. Clearly we all want individuals to be tested but this is hugely complicated in terms of employment status – it is not simply a matter of re-assigning an individual to other duties where these ‘other duties’ do not exist. It is neither simply a matter of instructing as the individual has the right to assent to any medical intervention which is not part of their own care and treatment but is for preventative reasons. A complex issue which we hope some resolution can be reached upon as a matter of urgency.
Care at Home
The Care Inspectorate have brought a paper to the Rapid Action Group and this has outlined an Inquiry which they are to commence in relation to care at home and housing support. Personally, I consider that this is to be entirely welcomed as some of the actions which we saw on the part of LAs and HSCPs at the start of the pandemic are far from excusable or understandable. Scottish Care will put a formal communication to the Inspectorate as part of their Inquiry and there will also be opportunities during it for individual providers to be consulted and interviewed should they wish. The Care Inspectorate will be communicating details shortly.
In broad terms the Enquiry will explore consideration of:
- Decision making about and prioritisation of care at home and housing support services to be delivered
- Monitoring of impact of any changes to care and support packages delivered
- Engagement and partnership working with providers
- Contingency planning for potential impact of test and protect strategy
- Recovery plan for care at home and support services
Care Futures – Technology Survey
We’re pleased to announce that the first phase of the Collective Care Future programme is now underway, focused on understanding the pandemic experience across many different areas of practice both in care homes and care at home.
We invite you to take part in this survey series to share your experience. This week the survey is focused on the theme of ‘Technology’. In this theme, we are interested to explore experiences of technology – including digital applications and platforms that you may have used before and those which you have used for the first time during the pandemic.
We would appreciate your support in circulating the survey as widely as possible across your networks, including to any individuals who access care and support and their families who may like to share their experiences.
Link to survey: https://www.surveymonkey.co.uk/r/carefutures-technology
Find out more about the Collective Care Future programme: https://scottishcare.org/project/collective-care-future/
Communication
We held one Surgery on Tuesday at 12 and thanks to Caroline Deane our Workforce Lead who joined me at the session. I hope we will be able to have staff from the Testing Directorate alongside us at the forthcoming Surgery this coming week.
Our plans for Care Home Day are now up on the website. See https://scottishcare.org/care-home-day-2020-15-july/
The theme of Care Home Day is ‘Care Community’. You can help us commemorate the day by sharing any good news stories, resources, projects blogs or an example of an innovative practice which shows:
- Creating a sense of community within and around care homes
- Fostering relationships with local communities
- Health and wellbeing of residents and staff
- Person-centred care
- Staff supporting each other and residents
- The local contributions of care homes, staff and residents to their communities and vice versa
- Care homes as essential parts of the health and social care community
In addition, we are pleased to say that we have held meetings with Scottish Government and the Care Inspectorate to attempt to get national coverage for the day and potentially for work to follow it which is not solely social media related. Please do try to encourage folks to take part in the day. We are at a critical stage for the sector in that we must rebuild public confidence and trust in care homes and the Day offers us an opportunity to star that process.
May I again draw your attention to the Summer issue of the Bulletin. This will again be in an online format – a downloadable PDF – it is jammed full of excellent articles and information. Please read and share. https://scottishcare.org/summer-bulletin-2020/
In addition, we have had two excellent blogs produced this week. The first is by Caroline Deane our Workforce Lead and is a reflection on the importance of capturing the voice and insight of the workforce as we plan for a new care future, see https://scottishcare.org/latest-blog-from-our-workforce-lead/
The second by Jacqui Neil our Nursing Lead is a reflection on the role of family and informal carers. See https://scottishcare.org/who-cares-for-the-carers-new-nursing-blog-for-june/ Both are a great read so please look at them.
We continue to use the Discussion Boards so please refer to them when you can.
And finally,…
I have become very aware this week through conversation and correspondence that there is a very real and raw sense of grief in the sector around the impacts of the virus and the ongoing emotions that are being felt. We are working with others to address some of this at a practical level and hope to be able to communicate some information in the near future. However, I am personally convinced that we need to hold a National Day of Mourning and that it is not inappropriate for us to take the lead in calling for this and so have written in those terms in my weekly blog. https://scottishcare.org/we-need-a-national-day-of-mourning-and-remembrance-a-personal-reflection/
Sunday night sees an opportunity to thank all those working in the NHS on the 72nd anniversary of the NHS – there has also been a recognition of social care in this act. Details can be found at https://scottishcare.org/marking-the-72nd-anniversary-of-the-nhs-letter-to-health-and-social-care-staff/
I will also continue to light a #candleforcare at 7pm on a Tuesday – along with others to remember and to give thanks.
Yours aye,
Donald
4th July 2020
