Well we are well and truly on the road to and through Phase 3 with pubs re-opening, hairdressers sharpening their scissors and a whole manner of businesses and activities beginning to plan and actually re-commence. In some sense we are now moving into a stage where there is less intensity in relation to the immediate Covid19 response. However no sooner has the foot gone off that pedal than we are seeing real increase in activity in relation to what I have come to term the three peaks – a second wave, a flu upsurge and the impacts of Brexit whether a No-Deal or a Deal not least its influence on workforce.
The following is a summary of some of the main issues in the week that has passed.
Finance and sustainability
We have held several meetings to try to get movement on the sustainability payments reaching providers and in some instances the SLW. Both Dundee and Edinburgh are disputing the SLW payments to care at home providers and this is now in the hands of Scottish Government. We held meetings with COSLA on Monday and Wednesday morning and raised issues of sustainability at the National Contingency Meeting on the Wednesday afternoon. Whilst there was a willingness to move things forward I am increasingly of the view that COSLA is exercising little authority over its members. As a result of pressure both the Director of CCPS and I held a meeting with Scottish Government senior officials yesterday morning and they have decided to involve the Director of Health and Social Care at Scottish Government in a direct intervention to get money out to providers. We have supplied them with a template listing our areas of concern on specific areas and payments. I have placed the latest version of this onto the website. See https://scottishcare.org/?p=11906
The information should be treated in confidence but gives an insight into the areas where we believe there still to be problems. If members think that there is something missing please do add this onto the Discussion Board. I hope that with SG recognising the seriousness of this that we will get movement. Both CCPS and ourselves have agreed to hold off from issuing a media statement on this until we get some sense if SG can make things move.
We are again meeting with COSLA and the HSCPs on Monday afternoon and hope to see some indication of progress then and most certainly by the time of another meeting on Wednesday morning.
I want to underline to members that we are acutely aware of the financial risks not least in relation to the Social Care Fund payments.
COSLA is formally giving consideration to the commencement of the NCHC talks with Scottish Government involvement and I would hope to hear about this after the COSLA Leaders meeting in the coming week.
Members will be aware of the host of issues re the Social Care Support Fund – we have again raised these, and Scottish Government agreed to communicate to us on these issues on Monday – they finally got back on a range of questions late on Friday – I have posted responses up on the Discussion Board. If you have any more questions which are not answered there please do get in touch with me. https://scottishcare.org/members-area/topic/social-care-fund/#postid-430
Finally, the terms of the Death in Service Scheme have now been published. It has been lamentable that officials have taken so long to get this through, but the new Guidance makes it much clearer that Scottish Government will make a direct payment to those individuals involved and this, I hope, will make it easier both for relatives and for employers over the next few weeks. Seehttps://www.gov.scot/publications/coronavirus-covid-19-social-care-worker-death-in-service-payment
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. We have had four deaths in the latest statistics, but caution needs to be noted in that whilst there has been a drop in the number of care homes with an active outbreak this is still at 119 which is 11% of all care homes.
As you will know visiting started last week – and in some parts of Scotland it was a shambles! It was highly regrettable that what should have been a positive experience became a negative one for so many because of inconsistent planning by Public Health Scotland. I submitted a letter (below) to the C are Home Rapid Action Group and a discussion was held on this. It was clear that Public Health felt stretched with – as they stated over a 1000 care homes – I pointed out that some areas managed well and that there was nothing like a 1000 homes seeking to open. I hope that having stated these positions that measures will be much more consistent as we move through the remaining stages. Certainly, Public Health officials heard the sense of disquiet not only from ourselves but also from Chief Officers. The Scottish Government team have provided additional Visiting information in the form of an FAQ https://scottishcare.org/care-home-visiting-faq/
The Clinical and Professional Advisory group also considered a paper which outlined what was needed to move to stage 3 and stage 4 in terms of visiting. At stage three it is envisaged that one indoor visitor will be allowed per resident in clearly defined circumstances and for a specific limited period of time. It is also envisaged that there will be gradual use of communal space and greater socialisation again with limitations and use of PPE. This is a beginning of a return to something like normal. The decision on this will be taken on the 23rd July with a potential move to the next stage the following week. We have made it clear that we need to do much more planning to ensure that we do not make the mistakes of opening to visitors which we have seen at Stage 2.
The whole issue of visiting has raised concern as to the extent to which measures taken to protect individuals during lockdown have been proportionate and the extent to which these are being considered as having a detrimental impact on the health and wellbeing of individuals. Personally, I consider that we need urgently to explore how we get this balance right as I am not convinced that Government Guidance has enabled us so to do and to have the flexibility and room for professional judgement that we needed and deserved as a sector. An article in the BBC explores some of these issues. See
https://www.bbc.co.uk/news/uk-53338139
The Care Inspectorate document ‘Guidance for Professional Visitors’ was finally signed off by the CHRAG on Thursday and I hope will be made available soon.
One of the major issues we have been facing over the last few days has been correspondence about Operation Koper, the unfortunately named investigation of deaths in care homes and amongst professionals, instructed by the lord Advocate and being carried out by Police Scotland on behalf of the Procurator Fiscal Service. Members who have been impacted will have received a letter detailing some 20-30 requirements re information and data. This process has landed in a stretched sector with real insensitivity. On the one hand we all want to ensure that there is public confidence in the sector and that if possible families and relatives are able to get the reassurance they need that all measures were taken to ensure the health and safety of the relatives whom they have lost. However, the mechanism being used to gather data seems disproportionate to achieving that aim. Providers are being asked to provide care plans from the point of admissions which might be several years. These matters were brought up at the Rapid Action Group and it was decided that the Director of Health and Social Cared would liaise with police Scotland. At the very least we would be looking for an extension to the timeframe and an appreciation that records going back no more than one year would be sufficient rather than to the start of residency. We will keep members informed of any movement on this issue. Again, this is about balance because any organisation contrasting such investigations risks a very negative perception amongst the wider public, however justifiable issues of constraint and resource might be.
Care Inspectorate
I would underline again that 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. The political comment this week together with a fairly determined campaign from the Daily Record lays bare what is behind much of these movements against the Care Inspectorate. Now we would be the first to highlight the failings in the scrutiny system, but I would again caution that there is a growing 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. We have to be alive to the very real threats which such an investigation and its hyperbole might pose whilst at the same time calling out failings where they might have existed.
Testing
After many attempts and much effort, we finally held a meeting of the Social Care and Testing Working Group., This met on Monday and going forward Caroline Deane will represent Scottish Care at this group. The meeting was purposeful and attended to a range of questions which Scottish Care had presented. Some issues were outstanding and are to be further explored this coming Monday. These include the ongoing uncertainty over the ‘mandatory;’ nature of tests re the SSSC statement, the ability to carry over data and the various practical issues related to the UK Social Care Portal. A member of UK staff will attend the meeting on Monday. Again, if you have particular ongoing practical concerns please flag these to Caroline by Monday morning before the meeting each week.,
We were also pleased to be joined by Susan Stewart from the Office of the Chief Nurse and then later by Tracy Slater from the Testing Directorate at the Scottish Care Surgery on Tuesday. I hope that members found it useful – this can be located at https://scottishcare.org/covid-19-webinars/ .
I should underline we also had to deal with the story in the media that the HMRC had published that those staff who were tested should be considered as being liable to tax on what they viewed as a benefit in kind. After this was raised in the Commons the chancellor Rishi Sunak requested that HMRC withdraw this – they have done so for now. It felt like Silly Season had finally come. Of equal concern were stories that by being tested staff endangered their personal and life insurance or mortgage applications. We are pursuing this but are comforted by the response to similar concerns raised by the BMA. See https://www.bma.org.uk/advice-and-support/covid-19/your-health/covid-19-your-life-insurance
Five Nations research
Many of you will know of the five Nations Care Group which Scottish Care was a founding member of 11 years ago. The group brings together the Chairs and CEOs of care home and homecare organisations across the UK and Ireland. The Group has been meeting on an occasional basis throughout the pandemic exchanging information and knowledge about each of the ways in which the administrations have addressed the issues of concern. We have commissioned a short and rapid piece of work comparing the pandemic response and identifying lessons learned not least for future events. This is being undertaken by the respected consultant John Kennedy and I had the privilege to be interviewed this week. We hope this will be a useful piece of work ion our future articulation of our own responses to the way in which the pandemic has been handled in Scotland.
Care at Home
The Care Inspectorate has started their process of an Inquiry which in relation to care at home and housing support. As I stated last week we are welcoming this, but I raised at the CHRAG that on its own this was not sufficient. As we move forward I think it is critical that SG established an overarching group to explore Care at Home and Housing Support because to put it simply I do not think that the sector is capable of surviving g the sort of growth in community transmission of Covid or the other peaks of flu and Brexit impacted will keep pushing on this, not least on issues of testing for CAHHS staff.
Care at Home and Housing Support Conference and Awards
This may not come as a surprise to members, but very much on advice in terms of what is likely to be allowed in regard to mass gatherings indoors – we have decided to postpone the CAHHS Annual Conference and Awards which had been rescheduled for the end of September. We are instead intending to hold a virtual conference and are excited about the prospect of showcasing some of the amazing work that is being down in homecare despite the obvious challenges of recent times. A small working group has been established to decide the shape of this event – likely to take place in early October. We will get full details of this out as soon as possible together with details of the Awards and the process that will be undertaken to ensure that this is a real – not just a virtual- success.
Care Futures – Technology Survey
The Collective Care Futures project is well under-way, and can I encourage folks to continue to get involved in the sessions being led by Becca and Tara. Equally filling in the online questionnaires will be of huge value to what I would argue is one of the most critical and time sensitive pieces of research and policy work which Scottish Care has undertaken in our history. It is critical we engage and get our voice out there in the clamouring din of those who want to define and decide the future of the sector for us.
Find out more about the Collective Care Future programme: https://scottishcare.org/project/collective-care-future/
Link to survey: https://www.surveymonkey.co.uk/r/carefutures-technology
Care Home Day
There probably has never been a more important time to celebrate the significance and importance of care homes in all their wide diversity than at the present time. That is why Wednesday 15th is such a critical day.
The aim of the day is to highlight how care homes and their local communities have come together to support residents and staff especially during the Coronavirus pandemic.
We want to be able to celebrate the dedication and professionalism of staff in supporting residents, families and each other throughout this period has been exceptional.
The day is organised by Scottish Care, supported by the Care Inspectorate and the Scottish Government. On the day we are calling for individuals, care providers and partner organisations to join on social media to share good news stories from their local care homes using the hashtag #carehomeday20.
This is the first time we have had such a wide range of engagement and commitment from other stakeholders including the Government so I do hope – even though it is hard – that members will commit to being engaged on the day.
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
Details can be found at https://scottishcare.org/care-home-day-2020-15-july/
Communication
Our next Surgery will see the return of Karen Hedge and myself for 45 minutes on Tuesday at 12 noon. Please join us on a range of topics.
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/
And finally,…
My blog last week raised the suggestion of a National Day of Mourning and Remembrance. I followed this up by writing to the First Minister and political Leaders. See https://scottishcare.org/scottish-care-issues-letter-to-the-first-minister/
A motion has been tabled in the Scottish Parliament in the name of Labour’s Monica Lennon and the first Minister when asked directly about this in the Daily Briefing said that it was a matter of when not if.
Once again can I remind you that we continue to light a #candleforcare at 7pm on a Tuesday – along with others to remember and to give thanks.
Many thanks
Donald
11th July 2020
Letter to CHRAG re Care Home Visiting
8th July 2020
Dear colleagues
I thought it would be useful to send you information on how the opening up of care homes to garden visitors has been handled. Whilst in many places this has happened without issue regretfully in too many locations what should have been a positive process has resulted in poor implementation and fractured relationships both with providers and with family members.
We have had feedback from across Scotland and here is a sample. It illustrates the degree to which there is a clear disconnect in the process of Government issuing Guidance (often after extensive consultation and careful articulation) and its varied interpretation/rejection/counter-manding by local officers. This places providers and others in an unacceptable position.
As a Rapid Action Group, we need not only to be aware of this but the immense strain this is putting on a system already stretched to breaking. There is now heightened anxiety of moving to the next stage of something which should be positive.
Kind regards
Dr Donald Macaskill
Chief Executive
Overview of Visiting Risk Assessment Sign off process.
Area 1:
Public Health (PH) requested risk assessments early W/B 29/6/2020, then changed their mind saying they did not need to see them, then changed it again at 6.30pm on Thursday 2nd July 2020, the day before visiting was due to commence! Most homes who were able to open appeared to do so.
Area 2:
Checklist developed for Oversight Group to sign off – PH did not agree with the checklist in the SG Guidance. All risk assessments for Area 2 were rejected on Friday 3rd July 2020, insufficient extent of outdoor visiting details even though they were using the national template. Public Health commented the template was insufficient. No visits took place. Real upset amongst families.
Area 3:
Public Health rejected all RA’s on Friday but agreed following a meeting in late afternoon. Visits happened.
Area 4:
Very well organised. Monday 29th June 2020 – proposal was presented to safety huddle and agreed they would sign off rather than Public Health. At the provider meeting, protocol and timeframes were submitted. Sc local staff pulled together and checked risk assessments prior to submission with the result all went through first time except one which was a good outcome.
Area 5:
Only a few homes in area had not returned risk assessments but it did not seem to prevent visits. At the beginning of the week designated visitor risk assessments were requested but by Thursday, outside protocol was required. PH nurse apologised for any confusion.
Area 6:
Providers told Public Health did not have capacity to sign risk assessments off. If they were completed and any issues sorted out, they were reviewed at daily huddle. Public health supplied a tick box asking, have you completed the risk assessment, last covid free day etc.
Area 7:
SC staff member joining reps from care inspectorate and public health to look at risk assessments – visits did happen though.
Area 8:
Planning meeting last Monday. So far positive feedback around visits, partnership and public health, very supportive.
Area 9:
Public health not willing to be involved but were told they had to. They then wanted all assessments for indoor visits, risk assessments failed as they were for outdoor visits – PH wanted all stage assessments. It was a bit of a mess. Mixed bag of visits happening and not happening across the area.
Area 10:
Whole area was a debacle. Many care homes had to cancel arranged visits. Initially told cannot do as do not have capacity then changed on Friday.
Area 11:
Providers phoned health protection team to see if risk assessment had been approved, (Submitted previous Monday), told to phone back Thursday – shambles! Telephone call came after 5pm on Thursday giving go ahead but visits had been cancelled due to uncertainty.
Area 12:
3 additional providers meetings WB 29th June 2020 which included H & S advisor for local authority offering support. Worked particularly well. By late Friday afternoon, every care home had been lettered and signed off.
Area 13:
Despite efforts local engagement non-existent. Not many visits, if any went ahead. PH stated only day they could meet was on Friday – feedback half risk assessments were submitted and returned for further information as did not agree with SG approach.
Area 14:
One provider took a week to find out who was doing sign off in this Area as PH/HP said it was not them, finally got sent out a 6-step process from X on the 2nd. Still no answer on Tuesday 7th despite having sent it 3 times! Used the templates at the back of the SG Guidance and used their wording but still it is not correct. They are nit picking at wording and meanwhile families are crying down the phone.
