Last week when I wrote this update, I reflected a great deal on the issues facing care at home and housing support and the Awards and Festival that we had just concluded. This week the lion’s share of my time has been spent on issues – and a growing number of them – facing the care home sector across Scotland.
The primary one which has caused such concern and such a divergence of views is the publication of the Enhanced Guidance for visiting into care homes which appeared on Monday morning.
In the days that followed I have heard directly and sometimes indirectly from a range of members expressing a real diversity of perspectives. I have written a more public facing blog this week so that the position is able to become more nuanced.
However, I wish to state one or two things in this space.
The first is that some providers were involved in giving feedback during the development of these enhanced proposals and many of you also attended the Surgery a week past where Profs Ellis and Masters who have been behind the document came and answered questions on the proposals. After that meeting with over 80 members elements of the proposals were altered and adapted. We have continually asked for an improvement in the way in which any Guidance especially visiting Guidance is consulted upon, published and communicated.
On Tuesday our weekly Surgery will have Profs Ellis and Masters back to answer any questions including ones related to the new Guidance.
Despite our entreaties that it was important that there was a period to enable the sector to prepare and respond we were faced with an announcement of publication for Monday lunchtime at the Daily Briefing. On that day I expressly asked officials to ensure that the announcement was nuanced, indicated that care providers would need time and that the decisions would be made at local level. None of this was forthcoming and what we were then faced with was a barrage of instances where family members were demanding access.
In the days that followed a number of members publicly stated that they thought the timing was inappropriate, that the testing system was inadequate and was a basis for their refusal for visits and called for the requirement that family be tested before visits.
As I have continuously said throughout this experience care homes are in an invidious position of damned if they do and damned if they do not. Some family members are desperate to return to normal visiting and others are terrified and do not want to visit at all in the care home. Exhausted staff and managers are having to deal with yet more pressure.
Scottish Care has issued several statements in the week that has passed, and I have myself appeared on both radio, television and in print. In all that I have said I have sought to try to be nuanced to reflect the diverse range of views amongst our members. However, there are several things I am clear on. I have formally requested a clear statement of financial support for additional staffing /volunteers to enable visiting to happen; have requested that the rapid test machines be urgently procured for the care home sector so that visitors can be tested and improvements in any future consultation developments and changes. I am pleased that the First Minister in her briefings has clearly stated that the new Guidelines are not mandatory, that they are looking at the review of testing to include relatives of care home residents, and that there has been an agreement to explore consultation and communication around any future changes and developments.
Can I also take this opportunity to make it very clear that Scottish Care will continue to listen to the diverse views of members, seeking to uphold practical concerns with resident rights and to present a nuanced view whilst at the same time being pragmatic in a political and media environment which is both ambivalent and directly hostile to the sector in many ways. We will not always agree with one another, but I hope over what will be a challenging few months we are able to talk and communicate with each other. If any member has any concern with any statement made either by myself or the organisation, then I would very much appreciate a direct communication.
I should also note that a number of the Scottish Care Executive and National Committee met with representatives of the 1100 strong Care Home Residents Scotland group on Thursday evening. It was an honest and constructive meeting and in the light of this we will be exploring some joint work to address mutual areas of concern.
The following is a summary of some of the main issues in the week that has passed.
Care Home Outbreaks and RAC
Sadly, as has become clear we are the beginnings of a second wave in the virus. This was evident with a sharp increase in the number of positive deaths in care homes in the previous week – sadly 12 individuals died. This is the place which none of us wanted to ever to return to. However, what is also clear is that the virus is affecting care homes which had previously not been impacted by outbreaks. This is obviously concerning, and a short-term Root Cause Analysis Group has been established by the Cabinet Secretary. This independent group is exploring outbreaks in four homes and is seeking to hold dialogue with stakeholders at local level to learn some urgent lessons and input these as we enter winter. The Group is numbers three individuals, Prof Jacqui Reilly, from the Royal College of Physicians and Surgeons, David Marshall, ex Head of Social Work in Glasgow, and Donna O’Boyle who is from the Chief nursing Directorate and an expert on incident investigations and RCA models. The Group appointed a small reference group and I was interviewed by them on Friday – they will report by the end of October.
The Care Inspectorate.
The Care Inspectorate is continuing to publish its fortnightly reports into Q7. These have received significant political and media attention this week – indicating as they do that a significant number of acre homes are scoring weak or average in their inspections. These underlines yet again the mismatch over IP{C within the care sector. I have made my views known to both the Inspectorate and to others. Members may have seen the Open Letter in the Nursing Times highlighting concerns from some IPC specialists and experts about and around the use of IPC requirements in care homes, not least in relation to visiting. I have a meeting with the President of the IPC Society this coming week. See https://www.nursingtimes.net/opinion/open-letter-infection-prevention-and-control-should-never-be-at-the-expense-of-compassionate-care-16-10-2020/
Testing.
Last week it would appear that there has been a decline in the improvement of the UK portal. It is also clear that it will not be until December before we see a full transfer over to the NHS Scotland testing regional hubs. This is all deeply concerning. We have continued to highlight this issue in the media this past week and to call for extending testing to care at home and housing support staff as well as care home family members.
One new development is a growing number of cases where Test and Protect is demanding that care staff who have been told to isolate do so for a fourteen-day period. We have raised this with the Scottish Government, and they hope to issue clarification into the system as a matter of urgency. The impact on workforce sustainability is self-evident.
National Care Review
We have just received three new dates to meet with the Feeley review but are still in the process of checking these – we will put these up on the website at the start of the week.
General Covid Care Issues.
The Pandemic Response Group met this week and most of the time was spent on emerging concerns around the flu vaccination. I had spoken quite extensively this week to our concerns around the programme, not least the sense that we need to learn urgent lessons if this is to be the model that we hope to use when a Covid vaccine becomes available – which increasingly is being talked about in either December or February.
We have stated our concerns as:
Summary of some current flu immunisation issues.
- Lateness of communications coming out to staff from partnerships around the local arrangements
- Limited allocated timeframes given to staff to be vaccinated
- High demand put on pharmacies which has resulted in delays for staff to be vaccinated
- Low rates of peer vaccinations
- Good use of OCC health /clinics to vaccinate staff in some board areas. i.e NHS AA
- Favouring of teams going in and providing vaccinations for residents and staff which we feel is very disappointing indeed and serves to under-valuing the RGN role and levels of competencies of care home nurses to have other external nurses vaccinating residents.
- Some variations also noted in board criteria with some including staff who do not provide direct care which may result in limited availability of vaccine for those who are eligible. Equally we have strongly advocated that ‘backroom’ staff are critical to service delivery in CAHHS and care homes.
- Capacity and coordination issues being raised in areas were Public Health were asked or attempted to pick this up, with in one area PH pulled out due to lack of capacity.
- Coordination an issue due in the main to a lack of understanding about the sector – staff turned up at a care home in an attempt to inoculate all staff not recognising shift patterns, no account taken of the late shift or night shift. Covid -19 testing team arrived at the same home at the same time completely uncoordinated approach.
- Questions being ask prior to any issues, as to what action can or should be taken if staff refuse the vaccination.
- From the top down ethnic, human rights and ethical issues not being taken seriously as vegetarian vaccines are not being offered unless you have a sympathetic GP, but that individualised approach creates more issues.
We anticipate that the 22nd October will see the publication of the long-awaited data on hospital into care home admissions.
Finance and sustainability
As stated last week we are continuing to monitor the issues of sustainability and now have a clearer picture of what the general situation is in relation to occupancy levels and their effects on sustainability.
We have finally heard from Scotland Excel re the National Care Home Contract – a pre-negotiation meeting will take place in the coming week. This will need to map out the areas for proposed discussions – of which there are many given the significant changes that have occurred to the sector and that have impacted upon expenditure and sustainability.
We continue to hold dialogue with partners over sustainability payments for both care at home and housing support and the care home sector beyond the periods currently defined.
Covid-19 Guidance Notifications
We have set up a new system to allow members to subscribe to receive email notifications every time we post new or updated Covid-19 guidance on the Members Area.
You can find instructions on how to subscribe here: https://scottishcare.org/wp-content/uploads/2020/09/Subscribing-for-Covid-guidance-notifications.pdf
Communication
Next week the Tuesday Surgery will be at the usual time of 11.00 am. We are grateful for the attendance of Prof Graham Ellis and Hugh Masters at this event again. This coming week we will also be hosting an Webinar on issues of insurance on Wednesday.
Care Home Awards.
We’re delighted to announce that the 2020 Care Home Awards are now open for entries. Never has it been more important to support the amazing work done in our care homes.
We have taken the decision to postpone the Care Home Conference into January and are considering an extension to the awards.
Please support and enter:
There are 13 award categories:
- Ancillary & Support Staff Award
- Nutrition & Eating Well Award
- Meaningful Activity Award
- Training, Learning & Staff Development Award
- Emerging Talent Award
- Outstanding Achievement Award
- Management & Leadership Award
- Palliative & End of Life Care Practise Award
- Nurse of the Year Award
- Carer of the Year Award
- Specialist Service/ Unit of the Year Award
- Care Home Service of the Year Award
- Positive Impact Award
Find out more about the awards and submit your nomination here
And finally,…
Join me as we enter autumn and as things started to become more challenging in keeping the causes and concerns of the sector before a wider audience by lighting a #candleforcare on Tuesday at 7.00pm
Many thanks
Donald
17th October 2020
