It has been another rather busy week of reports published by the Scottish Government. The first ever Winter Plan was published, alongside the report of the Root Cause Analysis Working Group and the Evidence paper for arguments made in the Winter Plan. It has also been a week which sadly has continued to see growing issues affecting care at home and housing support providers. Sadly, too we have seen across the country a growing number of community cases with a consequential impact on the number of outbreaks and cases in acre homes and amongst those receiving care and support in their own homes. Sadly 31 individuals died from known Covid in our care homes in the week up to the 4th November .
The following is a summary of some of the main issues in the week that has passed.
The Adult Social Care Winter Plan.
For the plan see http://www.gov.scot/publications/adult-social-care-winter-preparedness-plan-2020-21/. An important evidence paper was also produced which highlights lots of the evidence re care homes and infections. See https://www.gov.scot/binaries/content/documents/govscot/publications/strategy-plan/2020/11/adult-social-care-winter-preparedness-plan-2020-21/documents/adult-social-care-winter-preparedness-plan-2020-21-evidence-paper/adult-social-care-winter-preparedness-plan-2020-21-evidence-paper/govscot%3Adocument/adult-social-care-winter-preparedness-plan-2020-21-evidence-paper.pdf
Regular readers of this weekly update will be aware that I have been lamenting the way in which this Plan was developed – by a group of civil servants with little or no knowledge of the realities of adult social care and with the minimum amount of engagement with the sector or at least with us. It was therefore with a degree of irony that I read within its pages the principle that collaboration and engagement with the sector lay at the heart of this first winter Plan. So positively – there are good bits – they include the additional resource allocated to ensure that some of its aspirations are to be achieved. And the other positive is that after years of asking for planning around the sector and social care in general at least we have a document. But we have real issues with some of the proposals. We issued a full media statement on the Plan which can be accessed here.
That statement details our concerns and positives. But in this space what I am primarily concerned about is the issue of restriction upon the employment of frontline staff. As I stated in our statement:
‘We note the evidence of staff movement in relation to outbreaks. We recognise the desire to create cohorts of staff regardless of settings. Achieving this outcome will not be easy. Individuals who work in social care are amongst some of the lowest paid within our society and they frequently take multiple jobs on not because they want to but because they need to. This is especially true in homecare where we are already noting a drift from full-time employment to part-time working because staff are exhausted by the efforts of the last few months.
Great care needs to be taken that restricting the right to employment and requiring individuals to isolate for 14 days between employment does not disproportionately penalise individual workers.
In addition, there has to be a realistic appreciation that there is a limited supply of workers. Before the pandemic providers of care, regardless of sector, struggled to recruit, most especially nursing staff. We have all to work closely at local level to ensure that there is adequacy of workforce supply to ensure safety and quality practice. The roles involved are highly skilled and cannot simply be undertaken by individuals without experience or skill.
Further the creation of any legislation which effectively limits employment opportunity within a sector which has struggled to recruit, and which is likely to be negatively impacted by future immigration restrictions, will require to be carefully considered and thought through. The consequences of disproportionate restriction regardless of the robust grounds for their introduction may be hugely damaging.
We note the allocation of £50 million to meet these proposals but want to understand how this figure has been calculated and whether it is sufficient, what it will be used to pay for and how we will collectively compensate workers and organisations faced with additional restrictions on staffing.’
Again, not enough detail about the show on testing for homecare staff, for family members and visiting professionals. Not enough detail on the issues of support in both community and in care home… but in the spirit of positivity – it is a start! Maybe next time we might actually get to see it before it is published in its final format. I raised these issues as did the RCN at the Pandemic meeting – they are also concerns shared with Chief officers. I believe there will be action groups set up around the Plan next week!
Root Cause Analysis.
This is a robust piece of work undertaken within a tight timescale. Unlike the Plan this work did engage both providers, frontline workers and us as an organisation. It is sensitively written given that some of its conclusions are not easy to hear. Of primary concern is the clear evidence that staff behaviours are a significant impact upon the transmission of the virus from the community into care homes. I am glad that the report expressed this in a sensitive manner, but it remains a clear imperative that staff need to be continually reminded that behaviours around IPC , social distancing etc are critical both in the workplace and outside it. The other area which is worthy of particular note is the recognition of the distinct impact the last few months have had upon the wellbeing of frontline care managers. Whilst recognition is very welcome it is really urgent that these issues are addressed and that yet more pressure is not placed upon an exhausted and now demoralised leadership within the care sector both in care homes and outside. There are a total of 39 recommendations. See report at http://www.gov.scot/publications/root-cause-analysis-care-home-outbreaks/
The four themes of the RCA are summarised as:
- The nature of community prevalence and the issue of risk in terms of staff.
- Issue of testing availability and turnaround times.Testing arrangements over time have improved but need to become more equivalent to NHS testing systems and response.
- Staffing – people have been discouraged from using agency or sharing staff across sites but despite this it was still a factor in the four homes looked at.
- IPC issues were significant.Need to be improvements on the speed of response once problem known and greater consistency in the level of support and advice people have access to.
Their recommendations:
- Testing – work to get CH staff parity of access to testing & speed of results –
- Information & knowledge – 2 important dimensions. 1- staff behaviour outside work and in work (when not directly about work – tea breaks, car sharing, etc). Feeling that part of difficulty arises from human error and people drifting away from guidance and absolute best practice.Need to find ways (complex thought it is) to coordinate and encourage people not to let guard down & be aware of what best practice is. 2 – using a campaign to reinforce best practice messages and how this is disseminated (e.g. from ring-binder in tearoom to sophisticated online intranet which tracks who access)
- Guidance – need to be more thoughtful about how this is provided & how help people.Providing huge tomes of guidance with only small number of changes incredibly unhelpful.
- Leadership – reinforce need to support CH managers in their task – truly difficult job to do in circumstances. Need to develop local networks.
Care Home Inquiry
A vote of the Scottish Parliament on Wednesday resulted in a motion being passed to call for an immediate judge led Inquiry into care home deaths. As Scottish Care has consistently said we want such an Inquiry and that it should be human rights based. Our obvious concerns are how can such an Inquiry be fully transparent, participative and truly inclusive of the voices of the sector when we are as we are today in the midst of lockdowns and dealing with a second wave. Interestingly the Scottish Government now seem to be exploring the option of a four-nation inquiry. My own reflection on this is that the significant issues, including Guidance, treatment options, testing decisions etc were distinctive and devolved. We await illumination on both process and practicalities in relation to this.
PHS Report
There has continued to be fall-out from the PHS Report on hospital discharges which was published last week. We were grateful to Dr Jenni Burton and Fiona Mackenzie for joining the Scottish Care Surgery on Tuesday and not only giving a detailed description of the Report but also answering questions. Our desire to ensure that there is further work on the qualitative experience of organisations and frontline staff remains and we are urging that this is undertaken. In the meantime, it will be very useful if members who have concerns about the relationship between an admission and an outbreak in their own homes would write to me in confidence so that I can prepare ourselves for such a further potential review of experience.
Care at Home and Housing Support
Regular readers of this update will know that it is now two weeks since I indicated that there had been agreement at Scottish government level to establish a group to look at the issues faceting the sector. Caroline deane held a regulatory Group for providers from the sector and that meeting identified a whole range of issues, including the following:
- Guidance still needed around PPE to be clear around when putting on and taking off, in house or outside, winter coming staff wearing winter clothes how do they put on PPE outside? Some families want PPE put on in the house after staff have washed hands. PPE guidance required for staff, service users and families to give clear instructions around putting on PPE and disposal.
- Guidance required for visiting within the community and around family/visitors being required to wear masks when staff attending.
- Questions over when people are receiving COVID tests when being discharged from hospital back into community. Care at home providers do not get informed when people are coming home from hospital and are unable to check if tests been carried out.
- Back to normal business feeling still exists with the return to charging VAT on PPE, homecare providers having some difficulty in getting gloves, aprons and masks. Usual suppliers not always able to provide and local hubs are questioning the requests from CAHHS providers.
- Major concern over 15-minute visits, still being commissioned and for personal care, a meal and medication. Given pressures on staff to comply with PPE this is not possible.
- Significant growth in homecare staff reducing working hours from full time to part time, staff are exhausted.
- Local Authorities are informing care providers at forum/partnership meetings that they are in house recruiting which will have a negative impact on other care providers.
- Decline in the assessment of new care services, environment risk assessments not being carried out. Care packages not meeting people’s needs which is only discovered by the care provider at first visits.
- Need for clear timetable for testing staff.
- Clear pathways required between care providers and partnerships as to where backfill staff will come from when required especially in emergency.
This list was sent on to Government with a call for the Short life Working Group to be established as a matter of urgency. A frank exchange was held at the Pandemic meeting on Thursday and I am pleased that the penny seems to finally be dropping and we received a date for this meeting next week. Karen will represent Scottish Care on this group. At Scottish Care we are acutely aware of the very real risks not just to organisations, but to workers and those who use supports, unless we urgently get some of these issues sorted.
Finance and sustainability
Last week I indicated that we had still not heard from political leadership about the continuation of funding. In a statement in Parliament on Tuesday from the Cabinet Secretary there was a statement which said that monies would continue to be available and that this would effectively mean that for the next month at least that occupancy would continue to be paid as it is now at the 50% level and that payment on plan would continue, as would sustainability payments and PPE costs. The sheer inability to treat the sector as grown-ups is now beyond a joke. It was only late on Friday evening that a letter detailing this was received. Critically it also indicated the need for talks in November for further support which it is clear will be less and will be very much targeted.
“To allow these discussions to take place, Scottish Government and COSLA Group Leaders have therefore agreed that payments for care home voids and planned care will continue at October levels through to the end of November 2020, subject to conditions set out later in this letter. This means:
- · The planned care approach for care and support and community-based services will remain in place until the end of November.
- · Care home occupancy payments will continue for 50% of care home voids caused by the continued impact of COVID-19, at 80% of the National Care Home Contract rate, until the end of November.”
We will within the next week seek to get much more clarity on what this practically means and that we are not faced with another precipice at the end of November at what is likely to be a real time of challenges across social care. It is already clear that for Glasgow is moving off payments for planned and that North Ayrshire, amongst others, have introduced regressive conditions. I am very grateful to Karen Hedge and Jim Carle for taking up all the individual sustainability payment issues from members with COSLA and Scottish Government.
The letter can be seen at https://scottishcare.org/letter-on-sustainability-payments/
Karen also facilitated two well attended meetings on sustainability issues with both care at home and care home providers in the week that has passed, and the evidence gained from these sessions will influence our work in the days and weeks ahead.
Despite efforts the Chancellor has proceeded to introduce VAT onto PPE. It will be useful to get feedback from members as to the impact of this decision upon their ability to access and purchase PPE.
National Care Review
I want to thank all those who attended the care home session with Derek Feeley on Wednesday last week. We had over 50 members in attendance and the discussion was both positive and engaging. The Executive also met with Derek for the second time and held a separate meeting this week to consider the content of our formal response. This has now been submitted and will go online shortly. It is a different type of response given that we were asked to submit an ideas paper, but it is grounded in an extensive array of research and reports. I cannot thank Becca, Tara and Karen enough for doing this work. We will, with others, await the fruit of Mr Feeley’s labours sometime in late January.
Communication
Thank you again to those who came to the Surgery last Tuesday. As noted above the first part took the form of input from Fiona Mackenzie and Dr Jenni Burton on the Public Health Scotland report on admission to care homes. Can I remind members that all the webinars are available online for viewing in the members section. See https://scottishcare.org/resources-from-covid-19-surgery-with-phs-03-november/
Next week we will be holding the Surgery as normal on Tuesday at 11.am. Karen and I will be in the hot seats!
Winter Planning Workshop.
I also want to take this chance to thank everyone – some 100 of you – who attended the Winter planning workshop. It was full to capacity – so much so that even I couldn’t get in! Again, this is available online in the next week. Thanks to Karen , Jim and Janice for co-ordinating this and we will keep members up to date with the work that was agreed from the meeting to support members in the critical planning we all need to do for the coming months.
Please note change – Care Home Conference: 19-21 January 2021
We have decided to alter the dates of the conference to bring it forward a week so that it does not conflict with the likely publication of the National Care Review and so that it is now a Tuesday through to a Thursday. The Awards will still be on the same date.
We are meeting next week to develop the programme and hope to get this out as soon as possible.
Care Home Awards 22nd January 2021.
Time is now running out – the last week in fact and we are still way short of what we would normally have as submissions. I know that this is not an easy time for anyone, but can I encourage everyone to try and submit so that we can highlight the amazing work of the sector in such challenging times.
The new deadline is Monday 16 November 2020, 9.00 am.
Never has it been more important to support the amazing work done in our care homes.
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 enter here.
Insurance
I am very aware that Insurance remains a real challenge for many members. We are continuing to raise this as an issue of concern with Scottish Government and with others. It might be worth noting that there was a Westminster Parliamentary question on this issue last week:
HoC Written Answer: Treasury: Care Homes: Coronavirus
Richard Holden (Con) (North West Durham): (109732) To ask the Chancellor of the Exchequer, what steps the Government is taking to help representatives of care homes to work with representatives of the insurance industry to resolve difficulties caused by rising insurance premiums since the start of the covid-19 outbreak.
John Glen (Con) (Salisbury): The Government appreciates this is a challenging time for the care home sector, and for residents and their loved ones. The Government is in continual dialogue with the insurance sector regarding its response to this unprecedented situation and is encouraging insurers to do all they can to support customers during this difficult period.
Insurers take commercial decisions regarding the products they offer and risks they cover based on their view of the likelihood of a risk occurring. However, different insurers may take a different view, and customers are encouraged to shop around to seek the most suitable cover at the best price.
The Government is committed to ensuring consumers have access to a range of financial products that suit their needs and is keeping this situation under review.
Workforce issues.
Please note the updated Guidance on car sharing by staff which has been revamped in light of the growing number of cases which are being traced back to the issue of staff sharing cars either as part of their work or travelling to work.
Please see
https://scottishcare.org/car-sharing-guidance-30-october/
And finally,…
Members will be aware that Remembrance Day will take place under very different circumstances on Wednesday this coming week, on Tuesday evening at 7.00pm I will continue to light a #candleforcare in remembrance of not only those who have died during Covid19 but all who have lived through the pain and agony of war and violence. Please join me.
Many thanks
Donald
7th November 2020
