It has been an interesting week with the first vaccinations for workers in some of our care homes and the start of vaccinations for people over the age of 80 in care homes. It has also been a week where we have had a particular focus on homecare organisations with a very successful Homecare Day on social media which at one stage led to the trending of the hashtag #homecareday. Huge thanks to Shanice Shek and Becca Young for all their work in making the day such a success.
But it also remained a week of real challenge and sadness. There was a total of 81 deaths in the week leading up to the 9th December which although lower at 27% than the previous week’s 30% of all deaths is still a high figure. Equally the number of care homes where there is an active and confirmed case of Covid19 remains the same as the previous week standing at 142. Further we have seen in the media the reporting of four major outbreaks which have caused devastation in specific care homes. So, whilst there is hope on the horizon, I think we all know that both in community and in care home we are facing a challenging few weeks. Not least I am increasingly concerned that the rates of infection will increase significantly as a result of the Christmas bubble arrangements.
The following is a summary of some of the main issues in the week that has passed.
Social Care Bonus Payment.
The precise mechanics and scope of these payments are still being worked on. The announcement may have given the impression that these payments would be speedily dealt with, but it appears that the timeframe is up until the end of March.
On a disturbing note, a member informed us that a frontline care worker was duped into disclosing personal bank details by someone pretending to be from the Government. Whilst the individual has thankfully been recompensed please can I encourage you to make colleagues aware that they will never be contacted directly in regard to the £500 payment. They will never be asked to disclose persona details over the phone. I gather this scam has also started to involve NHS staff and to have an email dimension to it.
Care at home issues
As I stated above, we had a successful Homecare day including a Twitter conversation between myself and the CEO of the UKHCA. We have struggled despite all our efforts in the last few weeks to raise the profile of the issues facing the sector, including last week’s blog. The focus is so much upon care homes that I fear the very real threats to the sustainability of the care at home and housing support sector are not being fully appreciated. In addition, there is an almost collective failure to recognise the very real impact which results from the withdrawal or restriction of care packages upon some of our most vulnerable citizens. We are working with Scottish Government to urge and push them to prioritise testing for care at home staff now that there seems to be some system being completed for care home visitors.
Vaccination.
Tuesday saw the glorious sight of the first vaccinations of individuals over 80 and the start of care home staff vaccinations in different locations across Scotland. This truly is I hope the beginning of the end… On Friday morning there had been some 10,000 people already vaccinated.
Having attended a number of meetings this week I think it is important that we all manage expectations. The supply of the Pfizer vaccine is not going to be significant for the foreseeable future and we have to remember that half of what we received will be kept back for the second dose and as with all vaccines there is around about a 20% wastage.
A huge amount of work is being done to persuade and encourage and I would like to thank members who have been using social media to promote the uptake of the vaccine The uptake of the flu vaccination for social care staff was only 60% so we need to do a lot better- in this includes honestly answering questions and addressing concerns be they related to allergies or pregnancy. I am appalled at some of the targeted anti-vac social media posts which are being directed at social care and health staff. These mistruths have to be challenged and addressed head on.
Care home issues including testing
The pilot homes which have been trialling the lateral flow devices have been engaged throughout the last week with Scottish Government officials and have greatly helped to influence the training pack and resource. A huge thanks to our members who have been involved. Care home members will have started to receive the devices. We receive communication in the following terms to describe this roll out:
Using Care Inspectorate data, 1074 Care Homes across Scotland will receive 8523 boxes (213,075 lateral flow test devices) to cover the period 14.12.20 to 11.1.21.
The boxes (of 25 devices) are being delivered in two batches, with an initial 4-day batch due to arrive over the weekend of 11-13 December for use from 14 to 18 December. The second batch will arrive in early week commencing 13 December and will provide supply up to 11 January 2021.
From 12.1.21, Care Homes will order additional devices via the NHSScotland COVID testing portal (www.covidtestingportal.scot) with orders fulfilled by Sykes Global.
Please note Care Homes will also receive an embargo letter from Scottish Government instructing Care Homes not to use Lateral Flow Test devices until all staff have been trained using training material supplied by SGov. There will be information on TURAS and an FAQ will be sent out.
All care homes will be supplied with documentation (Guidance, Training material, user guide etc)
There has also been comment on disposal and waste because clinical waste disposal will not take used tests as they are considered chemical waste. The current plan is to put into a clear plastic bag which can be identified and picked up via domestic waste. Scottish Government and NSS are going to discuss this issue with Partnerships as they are responsible for a lot of domestic waste disposal.
Following a positive test the visitor will not gain entry to the care home and will be asked to arrange their own PCR test which then ensures they are picked up by Test and Protect if positive
I have stated before that I think that in the face of hugely negative media, and with adequate support that this could be a very positive game-changer for the increasingly poor image of the sector to say nothing of the health and wellbeing of residents.
There is a recognition that not all care homes will be able to make use of lateral flow tests available before Christmas, and so it is also planned to make PCR testing of visitors available – when that is necessary – over the festive period.
The three care home visitor testing workshop sessions in the last week were very well attended and the general feedback from members has been that they were very helpful not just on testing but on indoor visiting in general. At time of writing some 700 care homes took part in these sessions. I am also grateful to Karen Hedge our National Director who facilitated a Surgery with Scottish Government colleagues last Tuesday where over 100 members attended.
There has been an increased narrative around the accuracy of the lateral flow devices. The oft quoted BMJ article is of dubious robustness and refers to a cohort from the general public rather than care home family members. As I continue to re-iterate on their own any device will never provide the assurance needed but combined with PPE and good IPC and especially with frequent use these devices are highly effective. Indeed I think in the next few months once we are assured a robustness of supply then we might find their use for frequent staff testing on site to become more commonplace.
We are already seeing some evidence of benefit following the decision to reduce the requirement for a care home to close after an outbreak from the previous 28 days to 14 days from the last date of COVID symptoms subject to a Health Protection Team (HPT) assessment and confirmation of safety.
The Christmas Guidance is now in the system. It has generally been well received – Christmas trees are now back as are decorations. However I note that there is still some confusion with the associated negative publicity in the media. At the Clinical and Professional Advisory Group I raised the issue of what happens to those who are over 65 who may wish to leave the care home in order to spend time with their family during the Christmas period. There is guidance for those under 65 and members are asking for clarity for older residents. I am assured this clarity will be forthcoming soon.
Wider Covid issues.
Like many I am concerned at the very real pressures on the health and social care workforce, not least the unknown of Brexit. We know absence rates at this time of year usually sit at about 4-6% and the Covid absence rate in health and care is currently sitting at between 1-3.5%. Combined this is really troubling. We will through all our work not least Caroline keep an eye on what is happening.
We are also many of us worried about the impact on the virus which will result from the Christmas ‘bubbling’ in wider society. One piece of encouragement is a SAGE survey which seems to suggest that since news of the vaccine came out that nearly 50% of those surveyed are now not planning to create an extended household bubble this Christmas. This is encouraging because it is not so much the numbers that will be involved but the fact that there is a risk of what SAGE describes as the ‘mixing of different networks of infectivity.’
It also good that Scotland has adopted the reduction in the days of isolation to 10 days as has happened in England. This will assist issues of workforce sustainability both through direct staff having to isolate but also the impact of young people becoming infective and family isolation having to occur.
A letter has come out from the Cabinet Secretary and COSLA encouraged all health and care staff from the EEA to apply for settled status as soon as possible. Details of this are on the website.
Finance and sustainability
I am not sure that everyone has seen the new announcement on the continuation of sustainability payments and what these cover. This came out last weekend and we have had some queries on this in the last week. Please see the detail and Guidance at https://scottishcare.org/financial-support-for-social-care-providers-from-dec-2020-mar-2021/ and Guidance around these new arrangements are also available on: www.gov.scot/publications/coronavirus-covid-19-financial-support-arrangements-for-social-care-providers
Karen is continuing to meet with colleagues from COSLA and the HSCPs to iron out any specific issues re sustainability payments. There is a pro forma in the members area and members are encouraged to fill this in having followed the necessary steps so any specific issues can be raised. This is critically important especially for providers who have been waiting a long time for payments.
We had a further meeting on the NCHC yesterday. This was focussed on Covid impact and associated payments post March. We have agreed that there is a necessity for intensive meetings on some issues in January and we will keep you advised of any progress.
Care Inspectorate
Members will be aware that the annual returns are shortly due. We did try to impress on the inspectorate that there were particular pressures in. the system for providers at this exceptionally busty and stressful time. The one alteration is a slight extension.
Annual returns open online at eforms.careinspectorate.com on 18 January and will close on 28 February 2021.
All services registered before 1 October 2020 must complete an annual return. If your service registered on or after 1 October 2020, you should still try to complete an annual return this year.
We continue to be concerned about issues affecting our relationship with the Care Inspectorate including inspections, and any likely developments around design etc. It has been agreed that there will be a senior level meeting between Scottish Care and the Inspectorate, and we will inform you of any outcome when that occurs.
Communication
The Surgery this coming week will be held at the usual time, Tuesday at 11am. Karen will join me in hosting the session. Remarkably this will be the 50th Scottish Care Covid Surgery since March and I want to pay tribute to the hundreds of members who have come to these sessions and asked questions but equally importantly shared experience and insight.
The latest version of the Scottish Care Bulletin has just been published and is available on the website to download at https://scottishcare.org/winter-bulletin-2020/. This edition is full of a whole range of articles – some from the usual suspects and others relating to issues of inspection, infection prevention; as well as a whole section introducing our members of the Scottish Care Legal Panel. It is well worth the download and read.
Nursing
To end the International Year of the Nurse, our Transforming Workforce Lead, Jacqui Neil has been working with NHS Education for Scotland to compile some positive stories on nursing.
This features positive feedback from student nurse placements in care homes during the first wave of the Covid-19 pandemic. Please see https://scottishcare.org/wp-content/uploads/2020/12/Nursing-good-news-stories.pdf
Care Home Gathering: 19-21 January 2021
I am delighted to say that the programme for this Gathering went online yesterday. I hope you agree that we have managed to get some impressive contributors. We have tried to get the balance right between reflection and consideration of the future. I hope you will buy tickets and support the event. This has been a hard year for everyone involved in care in Scotland not least our care home members. These three days – and you do not need to come to all the session! – will be an opportunity for us to share, explore and reflect. Please support it as it is a critical contributor to the sustainability of Scottish Care as an organisation.
Tickets are priced at £45 + VAT and gives you access to all three days, attendance is flexible and delegates can join whichever sessions they find interesting. Please see the programme and details at:
https://scottishcare.org/tickets-now-available-for-care-home-gathering-19-21-jan/
And finally,…
On Tuesday as on every Tuesday at 7.00 pm I will be lighting a #candleforcare to think of all who are working in care at these times. Please join me and light a candle.
Many thanks
Donald
