This week has yet again seen a particular national political and media focus upon care homes with the sobering and sad statistics around death and infection rates. There has been a change in media and to an extent political focus which has inevitably moved from a degree of support for care providers to one of finger pointing and accusation. As I write this I acknowledge that the next few weeks will be one of particular challenge for both the care home and care at home/housing support sectors. But when all is said and done the focus of all our attention, regardless of squabbles and competing priorities, is the maintenance of life and the assurance of a quality of life for those we care for.
The following is a summary of some of the main issues in the week that has passed.
Finance and sustainability
I start with this theme because it has been an increasing area of concern and focus in the last week. On Monday and Tuesday, we put out a strong message in the media focussing on issues of sustainability being faced by both the homecare and the care home sector in Scotland. It will ill fit if we get through the pandemic to discover that on the other side care homes are having to close and that homecare organisations have gone to the wall and staff are being made redundant. We have spent the last week gathering intelligence in terms of what is happening in relation the COSLA Commissioning Guidance. It is clear that there is an unhelpful diversity across the country with some partnerships paying for planned and supporting providers re PPE, in other partnerships such as North Ayrshire we still see the obscenity of providers being held to electronic call monitoring payment systems.
I had a one to one meeting with my COSLA equivalent on Wednesday following my letter to COSLA last Friday. As a result of this meeting Karen and Janice have been gathering evidence for homecare as I mentioned above. On Friday the Scottish Care Executive met and spent some time exploring issues of sustainability including what we would be seeking in terms of settlement for the care home sector on top of the current NCHC rates and on issues of occupancy especially where there is a real issue of a dramatic drop in admissions as a result of the virus as well as the exorbitant cost rises due to PPE and staffing. A meeting is to be held with COSLA early next week to address some of these issues.
Karen has attempted to bring illumination to both Unison and the GMB who are acting under the assumption that on issues such as SSP that it is providers who are holding money back from workers. We continue to try to be polite to our trade union colleagues despite the aggressive door-stepping tactics they have been using on distressed staff.
Last weekend saw the start of the roll out by direct delivery of 5 days supplies to care homes. This has been well received by members. Karen has led our dialogue on PPE with other stakeholders and has argued strongly that this roll out needed to be extended into homecare with a direct delivery. This has to date fallen on deaf ears. The intention is to use the hubs as the main distribution route. Scottish Care has made it robustly clear that we want to see clear evidence of resolution of the issues we had previously faced when the hubs were in use. A very clear set of principles and guidance has now been developed for the hubs. At the present time the glitches are being worked on and we will keep a keen eye on this as it progresses. In the meantime, if ANY provider has significant and critical shortage please go straight to the Triage. The Triage continues to be responsive to issues which Karen and I raise on a daily basis not least in our nightly phone-call with them.
We continue to work hard to try to source PPE. The public and political narrative has changed on PPE to the degree that we are being strongly urged that we have as social care providers to use our normal routes of supply. We have made it clear that these routes are shutting down or are empty thus the greater use of the Triage and NSS. However, we have in the last couple of weeks been approached by over 100 organisations and companies and it is down to the immeasurable skill and focus of Stefanie Callaghan that we now have a substantial number of verified PPE offers on the Scottish Care website in the members areas. A story covering this can be found at https://scottishcare.org/scottish-care-works-with-local-organisations-to-address-ppe-shortage/
We need to make it clear to the general public as well as politicians that the sector is busting a gut in order to get PPE – BUT that the cost of this is exorbitant and having a profound impact on sustainability.
As part of our efforts I have written to the Finance Secretary to ask her to intervene with the Chancellor to request both the removal of VAT on PPE and the extension of tax breaks to frontline care workers.
The added complication is the growing number of Health Boards and Public Health Scotland officials who are instructing care providers to use masks in all care encounters. This is contrary to the last published HPS Guidance and has caused considerable anxiety at care face level;. I have brought this up directly with the Cabinet Secretary and we are working with NSS to ensure they are modelling this additional need when it will inevitably happen, not least because of our concerns over workforce anxiety that this change will precipitate.
We will continue to highlight the sheer impossibility of getting some stock and will underline this in our media exchanges.
Care Home Strategy, CI and Public Health Scotland
Members will be aware that as a result of the announcements made by the Cabinet Secretary that Public Health Scotland officials have been carrying out ‘visits or contacts’ with care home providers to ascertain the level of infection control responsiveness etc. I have stated quite clearly that the tone of the initial correspondence in relation to this and the enacting of this requirement by some officials has been extremely unhelpful. In this we have had the full support of the Care Inspectorate. The whole process is meant to be ‘supportive and collaborative’ but it has not felt like that in some parts of the country. I am well aware of the irritation and anger caused by individuals who have no idea about the nature of care home delivery and have never had contact before with the sector in any meaningful way. I have also had to address directly with senior officials the fact that in one part of the country there were actual physical visits. The risk of infection is explicitly clear and together with the CI we have clearly stated that such visits would ONLY be undertaken were there identified areas of concern.
I hope to join a call with PHS officials this week and it is our hope that the Director of PHS will join us on a webinar at some point.
Optimally the role of PHS and other clinical colleagues is to provide support not an extra burden and distraction. In relation to which we hope to finally this coming week sort the nonsense of multiple reporting points over data gathering which is becoming absolutely burdensome for so many providers.
Following the Cabinet Secretary announcements two groups have been established. The first is an overarching group chaired by a Director of Health and Social Care at Scottish Government and this Task Force has oversight of all strands impacting the sector. The second group is a Clinical and Professional Group which is jointly chaired by Prof Graham Ellis of the CMO and Diane Murray the Depute Chief Nursing Officer. We are represented on both.
The first group has identified reporting duplication; PPE, testing, the nature of partnership working; addressing negative media comment and communication as some of its priorities. The second Clinical group is developing a one clear set of Guidance documents to incorporate the confusing plethora of guidance that is now out there. There will also be a particular focus on admission, testing of residents, infection control etc.
I am very aware that at latest data count we still have 64% of homes with no infection. The aim is to ensure that we keep this figure as high as possible and to support clinically those care homes where there has been an outbreak.
This weekend it is still clear that there is insufficient consistency in testing across Scotland with some clear examples of really good practice such as Tayside and Fife and some woeful examples such as Glasgow, Aberdeen City and Highlands. These were the same as last weekend! There is indeed evidence of increased staff return as a result of testing and people coming out of self-isolation with providers reporting figures closer to a 10-15% average.
However, I am very concerned that the promise to test those who are symptomatic in care homes is not one that is going to be realistically achieved to the scale that is necessary both to manage the distress of residents, free up staff and effectively reduce the risk of virus spread. If we are as a total only talking about a 3500 ‘capacity’ by the end of April that is simply not sufficient. We will continue to press on the need for testing to be closer and more flexible to enable many staff who do not drive to get access to the testing centres and to argue for staff to be properly trained if they are required to undertake these tests on care home residents.
Care at Home
It has become increasingly clear that we need, whilst still maintaining the focus on care homes, to get both media, society and political leadership to focus on the pressing issues affecting the care at home organisations and workforce. There are significant issues of PPE availability together with a poor level of access to tests. Whilst sadly 33% of the total national death rate is in care homes we acknowledge that the vast majority of community cases and thus in hospitals are individuals who have had home care supports and care. This population cannot simply be forgotten to say nothing of the crippling issues of loss of work by many providers as individual family members cancel contracts because they are now at home. Scottish Care has issued two statements in the last week on these issues, but we are struggling to get media airtime on these issues. We will keep pressing and keep highlighting.
The SSSC portal is now up and active and already has placed 126 individuals with social care providers. This seems to be working but we need members to use both this and the RAG system to address shortage of workers. In particular we are aware of the sheer exhaustion being faced by existing staff – this route is a potential real benefit for the sector. We will be issuing further information on this in the days ahead . Caroline remains the main point of contact for issues relating to the wider workforce. Jacqui is the point of contact for nurses. We are delighted that we are now being supported by over 80 2nd year student nurses. This is a real asset and benefit to the sector.
We recognise the critical importance of psychological support for the workforce both in care homes and in the community. Caroline has been closely involved in the development of a portal to support the workforce which is due to be launched next week. We will have details of this on the website together with any bespoke support around grief support.
Can I encourage you to read the honest and real blog which Caroline has written on the impact of coronavirus. https://scottishcare.org/latest-covid-19-blog-from-our-workforce-lead/
Supporting communities and individuals
The Technology Devices Network project continues to get a lot of media attention and we are very grateful to those who have donated items. Please encourage the wider awareness of this project and thanks to Becca and Jenn for their commitment to this work. It is really important – indeed increasingly so as we get deeper into lockdown – that we keep people connected. The impact and distress of exclusion is becoming more acute.
We held another two webinars this week. The first was with Caroline Deane, our Workforce Lead and me and the second was with Peter Macleod, Kevin Mitchell and Heather Edwards from the Care Inspectorate. Again both were well attended, and we hope to hold another two next week. The first of these will be divided equally between care at home and care home issues. All the webinars are available on the website.
We continue to put significant amounts of material on the website and I want to thank Shanice and Becca for doing amazing work yet again this week.
It has been a busy media week but one which has been more defensive than before as the media turn both against the sector and away from it. Colleagues in Government and Health Boards recognise this is an issue of particular challenge, and we are starting to co-ordinate the message.
I am grateful to Becca and Shanice for developing statements on particular media issues which are put up with regularity on the website, such as the response to the admissions stories in the media last Sunday. They are also developing a media pack to support our members when they are approached by the media. You will be aware that some journalists have been falsely claiming to be from the Care Inspectorate or the BBC in order to get access and stories. Please approach us if you have any concerns or go to the Care Inspectorate.
I continue to have a weekly 1 to 1 with the Cabinet Secretary and Karen, Becca and I continue to have dialogue with opposition party politicians to indicate to them what our stance is on particular issues.
Palliative and end of life care
Jacqui Neil and I continue to be involved in national discussions on palliative care in the community and in care homes. We are grateful to colleagues in Pharmacy who have developed a Palliative Care pack to support producers within the restrictions of Home Office legislation. This is now available on our website for those who might be interested. https://scottishcare.org/palliative-care-toolkit/
The ‘new care normal’
The First Minister published the Scottish Government strategy for coming out of lockdown on Thursday and encouraged a public debate on the issues which the document raised.
For the social care sector coming out of lockdown is likely to be very challenging. If as it is envisaged that there will be a phased and incremental removal of restrictions it is highly likely that this will mean that care settings will be amongst the last to be back to familiar patterns of conduct and access. Even when this happens it is likely that social distancing will continue for some time and that staff will be required to continue to utilise a high level of PPE. Apart from the obvious implications that all this might have for the sustainability and indeed survival of the sector this will have massive impact on those we care for.
It is already clear that levels of distress and psychological harm upon those living with dementia is indeed becoming more acute. My concern is that we need to get a better balance between proportionate restriction of freedom of movement in order to attain infection control and a diminishing of normal life to the extent to which it is causing psychological and physiological damage e.g. through increased falls, impact on nutrition etc. I am concerned that too many assumptions have been made by colleagues who have little or no understanding of the nature of care homes and of the population that is supported within them. I am intending to host a clinical and professional group this coming week to examine some of these issues which include isolation of people with dementia in their own homes in the community where they have only paid support in their lives especially with the loss of day activities.
Within the community I am also concerned that some of the narrative is presumptively assuming that there will be the use of age restrictions so for instance those over 70 may be in lockdown for a longer period of time. Just as withdrawing treatment based upon age was unacceptable as an ethical choice so I would contend such restrictions would be equally unacceptable.
Everyone at the Scottish Care team is working hard on your behalf. Please continue to be in touch with your local Independent Sector Lead as the intelligence which they get from you is crucial in our ability to understand the issues and to communicate them to Government. Their details are on the website.
Yesterday we said a fond au revoir to our colleague Verity Monaghan who has started maternity leave. Verity has been working for us with monies provided by Life Changes Trust on embedding human rights in seven care homes as part of the Rights Made Real project. She has written up a full report and resource on this work which we hope to publish in June. The work continues but because of the current situation we will not be recruiting cover for her post until September when phase two starts. We wish Verity all the best. Her latest blog came out yesterday. https://scottishcare.org/the-journey-thus-far-blog-from-verity-monaghan/
Please also continue to use Swaran as your members’ link and to contact Laura, Cath and Colette at the ‘office’ with any issues.
Do get in touch if there are any issues you feel we need to be focussing on. We will continue to give regular updates on the website.
Thank you for all your work at this time
25th April 2020