Home: a place of shielding and freedom: our CEO’s weekly blog.

I’m writing these words from the Isle of Skye where I arrived yesterday to visit family for the weekend. Every time I come to Skye I have a sense of coming home.

As the child of two Skye parents my life-story is punctuated by journeys ‘home’ to Skye; not least the activity of packing and going on the seemingly never-ending journey north from Glasgow. Decades ago, it did indeed feel like an intrepid adventure taking as it did an inordinate 12 hours for one large family to travel by buses and taxi and arrive at the place which for generations my family had called theirs. I possess memories of ridiculously hot summers spent with grandparents who seemed to me already ancient beyond years; I resurrected my Gaelic by listening in on the latest gossip; I gained insight into the strong cultural dialects of church and tradition, of music and poetry; I have memories of the rituals of crofting as my eldest son father took his part in shearing sheep, repairing byres and erecting fences.

As I grew up I recognised that deep within me was an inner truth that I sensed a wholeness of self only when I was in that space of open glens and brooding mountains, breathing in a beauty so raw it’s reality caught your breath, witnessing the vibrant power of nature in daytime storm and evening calmness. I also sensed a need to be away, to be distant, to be free and far. I now know that this was a sense of ‘home’ which despite all efforts I did not have away from this space.

To return home restores and renews, it re-invigorates, and it gives balance. I know acutely that this is not true for all and I am not blind to the brokenness of my own story. Home is not always a place of happiness but can be a harbour of hurt and a painful prison. But I also know from years of conversations with those who have never found a space to be themselves, and to feel secure and safe, that there remains a yearning and a desire to find that space which we often call ‘home.’

In this last week I have been reflecting with many others about the value of home.

I am especially mindful today of those who have spent months shielding themselves from Covid and who are being ‘allowed out.’ That is the phrase used by someone who wrote to me this past week. Fiona is receiving treatment for cancer and has been unable to go and see her father in a care home not just because the care home has been closed but because she has been shielding herself in her own home. She reflected in her letter the way in which she feels safe and secure, protected from harm and the unknown of this virus behind her windows and doors. She reflected that she was concerned about how she would cope with being away from that place of protection; a place where in her own words she has ‘cocooned herself from harm’.

Our home is a place of memory and belonging. It is not just a construction of brick and mortar, of stone and wood, though the physicality is part of what makes a place special. Home is a place and space which enables us to be authentically who we are as a person. It should be a place that we feel protected, able to be who we are without mask or pretence, able to be at ease inside our own skin.

But I also recognise that the best homes are places which enable you to have a sense of confidence and freedom to go out into the world to be changed and to grow, to fail and to flourish, and in both to be able to return with the confidence of acceptance, welcome and warmth.

So, I am thinking of those who are making that journey out today for the first time from the place of shielding to encounter and engagement with others. It is one which will no doubt be faltering at first but which I hope the rest of society will support not least by adhering to the safe practices which will keep us all safe from this virus.

But I am also thinking today about what home has felt like for those who have been caring for a loved one in their own homes. Many of them lost the packages of support which they had before the pandemic and these are only slowly getting back. Others chose to cancel care packages because they feared that workers would bring in the virus and these have still in most instances not been renewed. I am very aware from conversations this week that family and ‘informal’ carers across Scotland are exhausted and at the stage of really needing immediate support. The task of caring for a loved one is draining and depleting even of the energies of loving. Yet day centres remain closed and many sources of traditional respite are shut off to carers, including many care homes. There are older Scots at home who today are anxious about getting access to their GPs, unsure about when the podiatrist or community physiotherapist will next see them, who know that their own health has been affected by lockdown whether as an individual or as a carer or as someone who has been technically shielding.

Lastly when I reflect about ‘home’ today I am thinking of all those who I have spoken to and been in communication with in the last week about the place which their mother or father, wife or husband, grandparent has called home – their care home.

Yet another week has passed, and we still have not had an announcement about what date residents will be able to be visited inside their care home. I have said before and I fully acknowledge the need to carefully balance the risk of the virus getting into our care homes with the desire and urgent imperative to restore the rights of family and residents to be re-united. I am not naïve to the hardness of these decisions, but I am increasingly concerned that our scientists and others are not aware of the damage and effects of separation.  There are thousands who have not seen a family member for 21 weeks. Their care home is their home, a place of security and safety, a place which they have been protected in despite the ravages of this disease. There is a growing sense of anger and frustration that as the rest of society prioritises children going back to school and as snooker halls and bingo, funfairs and casinos are given dates for opening, we still do not have a date to restore life to our care homes, to allow indoor visiting, to inch closer to making our care homes back into real ‘homes.’

Home is a space and place,  a feeling and sense of being at ease and secure, of being able to become who you are and be what you dream of. Home is a place of memory and dreaming, of creating and growing. But home does not just happen – it is a work of heart and soul, of sinew and sacrifice.

Today we need to work with even greater energy to ensure that family homes are spaces where the old and ill, those shielded and in need of extra protection, feel they have the level of support and care, guidance and assurance that they need. Today we have to renew our efforts to ensure that our care homes do not become antiseptic units of infection management devoid of presence and humanity but are restored to being places of encounter and life. We need to get family back to start re-creating home not least for those whose time is in days and weeks, not months and years.

Home is the labour of those who feel the need to root their loving and compassion into a place and space, to create a cradle of belonging for family and friend, stranger and guest . When I close my senses there is only one place which webs me together. In that I am lucky. For at least a couple of days I am ‘home’ but with the conviction that we must restore and affirm that sense of home to and for all.

“In the distance day was dawning,
Comes to me the early morning,
Something tells me that I’m going home

The brand new sun shining bright
From the darkness fields of light
Something tells me that I’m going home

Going home
When the summer’s coming in
And the moonlight on the river
Shows me where I’ve been

Soft the rain is gently falling
Lightly cross the city morning
I get the feeling that I’m going home

Across the moorlands, past the mountains,
O’er the rivers, beside the new streams,
Something tells me that I’m going home

Going home
When the summer’s coming in
And the moonlight on the river
Shows me where I’ve been

As the train is rolling nearer
Ah, the feeling just to be there,
Something tells me that I’m going home

Now the skylines reach my eyes
The ridge stands out in highland skies
I just can’t believe I’m going home.”

(Lyrics of ‘Going Home’ by Runrig)

 

Donald Macaskill 

 

CEO Review of the Week 27th July to 1st August

The announcements made on Thursday by the First Minister detailed the return of the schools in August. They also have a timeline for opening of various indoor activities from bingo, to snooker halls and casinos. Positively there was progress on the status of individuals who had to shield during the first phase of the Coronavirus. Regrettably amongst all the statements there was no announcement of the immediate restoration of indoor visiting for our care homes. This is very disappointing and there is a growing sense of anger, upset and resentment building up amongst families. Up until  now with some few exceptions there has been support from family for providers and staff. I detect that the longer this waiting goes on that that is changing and have even seen a tweet suggesting families should withhold fees from care homes until they open up. I have made my view3s very clear to Scottish Government.

The pace of the week just past has been quieter with more and more people taking the chance to have a break but nevertheless the following is a summary of some of the main issues in the week that has passed.

Finance and sustainability

We continue to put a great deal of energy and focus into the issue of finance sustainability for you our members. It is very unfortunate indeed that we have been given data to suggest that less than 40% of providers have made an application for any monies. In some areas, this number is as low as 14%. This presents us with a real challenge in that Scottish Government will not follow through with additional funding unless there is a clear need from the sector that that money is indeed needed.

At the time of going to type I have no further news on the continuation of the Principles and the payments beyond the end of July. Cllr Stuart Currie, COSLA Health and Care Lead and the Cabinet Secretary met on Wednesday and a meeting of COSLA Leaders was held yesterday. To say the lateness of these discussions is deeply offensive is an understatement.

Karen and Jim Carle continue to work intensively with senior officials including finance staff to unpack and address specific issues which you have highlighted through the spreadsheet. Karen has issued an urgent message and a summary spreadsheet to detail where we – according to the intelligence you have given us – continue to believe that there are real problems. See these at https://mailchi.mp/698b588eedcd/urgent-newsflash-social-care-sustainability-payments?e=8b93fe8b46 and

https://scottishcare.org/sustainability-concerns-response-spreadsheet/

In relation to the Social Care Support Fund we hope that Scottish Government will shortly issue clearer communication on this so that providers again can be encouraged to apply. Some readers may have noted that the Cabinet Secretary in an appearance before the Covid Committee at the Scottish Parliament this week stated that providers were not coming forward for ‘free monies’. This is, of course showing that she completely misses the point – providers have no or little assurance that monies will be speedily turned around – it is not that we have not engaged it is that we have no trust in the system which has so brilliantly failed us to date.

We have also heard this week that disappointingly there are difficulties in relation to the Death in Service Fund which affects some of our members. We gather that HMRC have indicated that they wish to tax the sum of £60,000 given to next of kin. We understand that Scottish Government are dialoguing with them as a matter of urgency and it is our hope that this can be settled as quickly as possible.

Care Home issues

COVID19 deaths in care homes remain low at 2 to the week ending 26th July (down from 3 in the previous week).

Many of you will have seen the two documentaries which aired this week, the first focussing on Scotland – BBC Disclosures on Tuesday and the second on the UK with Panorama on Thursday evening. In many senses these documentaries presented many of the arguments which the sector has been presenting over the last few months. The failure of real political response to them – at least in substance – other than arguing  the ‘hindsight’ argument and ‘mistakes will have been made’ stance is disappointing. It underlines the importance of a coherent and consistent response from Scottish Care when the public and national Inquiries commence.

We issued two statements this week in response both to the Cabinet Secretary’s comments on the Social Care Fund and her argument that there was no ‘pressure’ to accept hospital discharges. Anyone listening into our webinars in March or reading what we were saying on Boards could not come to the latter conclusion. Please see https://scottishcare.org/scottish-care-comments-on-pressure-on-care-homes-to-accept-hospital-patients/ and https://scottishcare.org/scottish-care-response-to-social-care-support-fund/ for these statements.

Data related to the care home sector continues to inform and influence the work of the Care Home Rapid Action Group.  Included in this is the analysis that the number of deaths by the 26th July 2020 was 7.2% lower compared to the 5-year average for the same point, the fifth week running deaths are lower than the 5 year average. Weeks 11 – 29, excess deaths in care homes are 51% over the 5-year average in Scotland, compared to 66% in England & Wales. Of these excess deaths, 83% were Covid-19 related in Scotland, while in England & Wales the figure was 58%.This is one of the reasons why the media seems to think that the sector in Scotland has performed less well than that in England and Wales. The number of staff absent due to Covid-19 is 4% with shielding continuing to be the most common reason and with a slight decrease in staff isolating due to instructions from contact tracing.

As noted last week we have also raised directly concerns which members have been expressing about the status of residents who wanted to go out of the care home and visits family, friends or simply to do some shopping. The Care Home Clinical and Professional Group considered a new Guidance on this at its meeting on Thursday. I hope this will be published at the same time as the other Guidance. However, it looks almost certain that this will not be allowed until Stage 4 – I really do question whether this accords with legality. It is almost like the enforced confinement of an individual and raising significant human rights issues.

A paper to restore ‘visiting’ from both clinical professionals such as AHPs, OTs etc and other visitors such as hairdressers, therapists etc has also been prepared and was substantially agreed last Thursday – but this awaits sign off too – we have made it clear that it cannot come before the enabling of visits from family inside. It might come at the same time!

The Digital Daily Huddle tool was discussed – and there is a webinar on this below. Consideration is being given to making this a required tool for care homes and I think this is likely. However, the Care Inspectorate has made it clear that it will not regulate on its use until it was assured systems worked, were consistent across Scotland and that staff and homes were properly resourced and trained to enable this to happen.

Homecare Festival. WEDNESDAY 7TH – FRIDAY 9TH OCTOBER.

 SAVE THE DATE:

In light of the fact that we are not going to be able to hold our annual Care at home and Housing Support Conference as we had planned in September we will be holding a virtual Homecare Festival. This will highlight issues faced by care at home and housing support. There will be various sessions over a three-day period, culminating in an Awards Evening on the Friday 9th evening.

Fuller details will be made available as soon as possible. We are looking forward to this opportunity to focus upon  and celebrate the amazingly creative and compassionate work being undertaken across Scotland by services.

 Testing

Testing has progressed the past week and it would appear that rates remain high across the country. At least 33,911 care home staff were tested in the week ending 23rd July. At least 1,893 individual residents tested. There were 2,700 staff declining. Work is being undertaken to determine the reasons for this level as it is important as we move to a situation of potential vaccination for the flu and a future Covid vaccine.

We have heard that there have been issues with tests arriving without all the parts and have raised this. In addition, there have been concerns about the experience of agency staff seeking to use the UK Portal and being denied this – again this has been raised with the Testing Social Care subgroup and we hope that we can arrive at a solution to this before long. In addition, a video has been produced by the National Clinical Director Jason Leitch in order to encourage frontline staff to recognise the importance of testing and to keep going through what is a hard process.  See https://twitter.com/scotgovhealth/status/1286632222074605568?s=20

A lot of work has been done and continues on the issue of false positive tests. There is a real awareness of the distress and anxiety caused when this happens and hopefully with a refined system and protocols this can be reduced.

Despite numerous reminders there is still no progress on the issue of ‘compliance’ and what the stance of the Care Inspectorate and SSSC will be to those who refuse to be tested. This matter is being considered by Ministers and I hope we will get final Guidance soon.

Care at Home

 The issue of Care at home and Housing Support  was considered in some depth at the Thursday meeting of the Care Home Rapid Action Group and it has been decided to revamp the CHRAG to include all adult social care. The terms of reference and structure of this will seek to prioritise care at homer and housing support. These are currently being drawn up by the Director General and her staff. It is intended that the format will be approved next week.

Collective Care Futures
 

The Collective Care Futures project is now entering its final stages with just two weeks to go. Please consider taking part by filling in one of the surveys or questionnaires. It is really important that members engage in this research as it will be a major vehicle in the next few weeks to get our voice heard. We appreciate that folks are under a lot of time pressure but if you have even a spare ten minutes to fill in one of the surveys it would be invaluable – you do not need to do them all. We are trying to get at least 50 surveys per theme which should be possible out of 900 members services. This week’s theme has been wellbeing but previous themes have covered issues such as technology, care practice , partnership and the workforce.

If you or any of your staff/colleagues would prefer to share your experiences in a short online call, on a certain theme or across a range of themes, you can email [email protected] to arrange a convenient time.

Becca and Tara would also be extremely grateful if you could share details of the programme with your networks and contacts, who are also welcome to take part via surveys (hard copies can be downloaded) or in an online call.  Please see full details at https://scottishcare.org/project/collective-care-future/

 Care Tech 3 :

 Save the Date: Care Tech 3 – 28 August

Can I remind you yet again of the fact that we will be holding our third technology event ‘Care Tech 3’ – ‘Tech that Cares: making tech personal in post-COVID social care’ on Friday 28 August 2020.

The event will take place virtually and will bring together a range of perspectives to discuss developments and impacts of technology, particularly during COVID-19, and the future potential of technology across the Scottish social care sector. More details soon.

PPE

 We are  still keen to get some sense of whether or not members would be open and supportive of the NHS NSS becoming a PPE supplier to the social care sector. We are starting to map in broad terms the extent to which members might be interested in a situation where NSS offered its services to social care providers at rates which are likely to be highly competitive. Once again can you please answer this question on the Discussion Board.

Bereavement Charter Webinar – 30 July

 This event was held on Thursday and well over 50 people attended and heard a thoughtful presentation from the former Chief Executive of the NHS in Scotland, Mr Derek Feeley. There were also discussion groups and a vote to decide on further action to promote the Bereavement Charter which Scottish Care has been closely involved in. Please have a look at the Charter at: https://scottishcare.org/bereavement/

Communication

Next week there will be two surgeries. The first one is a focus on the new Digital Daily Huddle and will be held on Monday at 1.00 pm. This is an open session.

The Digital Safety Huddle Tool will be rolled out in care homes in some parts of the country from 8th August. Therefore, we strongly encourage care home providers to attend this webinar.

This will take place on Monday 3 August at 1:00 PM. Derek Barron (Erskine) and the NES Digital Team will be available to do a demonstration on this tool and answer any questions you may have. The webinar is open to all care providers and not just Scottish Care members, registration is required to access this webinar.

Registration link: https://us02web.zoom.us/webinar/register/WN_NgzXcTELRi-LzAJCJx9J4g

After you register, you receive an email from Zoom with a unique link to join the webinar (subject to approval). Please contact [email protected] if you have any problems accessing this webinar.

The second Surgery will be the usual Surgery on Tuesday at 11 am.

Workforce

 Occupational Health Risk Assessment Guidance.

 Risk assessment guidance and an accompanying toolkit have been developed, with clinical advice and input. This will be of particular relevance to social care workers who are returning to work from shielding. Letters were issued to Health Boards to raise awareness of the Guidance from the Scottish Government on 27th July. See https://www.gov.scot/publications/coronavirus-covid-19-guidance-on-individual-risk-assessment-for-the-workplace/

 SSSC, SG, CCPS, Scottish Care, COSLA, Care Inspectorate and SPDS are working together to review the NHS quarantine guidance to see if social care employers want to put in place something similar. The NHS document will be used to form the basis of quarantine advice to the social care workforce, but it needs to be made suitable i.e. working from home is given as an option for NHS staff who are required to quarantine on return from a holiday, but this is not an option for most social care workers.

Members will also be aware of the extension of the self-isolating 7-day period to 10 days. This will inevitably influence workforce planning and resilience. See https://www.gov.scot/publications/coronavirus-covid-19-test-and-protect/

 Nursing

Our Transforming Nursing Lead, Jacqui Neil has written another excellent blog on nursing which can be found at  https://scottishcare.org/new-nursing-blog-for-july-from-our-transforming-workforce-lead/ These are particularly happening times for nursing in the sector and Jacqui reflects on the challenges we have with an ageing workforce and the potential of building on joint work during the pandemic in order to attract more nurses into the social care sector. Well worth a read,.

 And finally,…

In an attempt to keep the issues facing the sector to the fore, not least the waiting for internal visiting once again we continue to light a #candleforcare at 7pm on a Tuesday – along with others to remember and to give thanks.

Many thanks

Donald

1st August 2020

Dying of a broken heart: the pain of care home deaths. A personal reflection.

I interrupted one of my many Zoom meetings this week to go outside briefly and stand with others as the hearse carrying the remains of a neighbour left his home for the last time accompanied by the small family group able to attend his funeral. I was saying goodbye to a man of quiet dignity and constant smile who had left his home for the last time just before the pandemic as his dementia worsened to the extent that he needed to enter a care home.

As I stood there clapping with others in memory and thanks I could not get out of my mind the words his now widow had spoken to me a few days earlier. I had met her and as I expressed my condolences she told me of how she had been unable to see him for four months until his last few hours. She had nothing but praise for the care home staff but she was deeply upset about restrictions that prevented them from being in contact as they had for virtually every day of their married lives. I parted with her words ringing in my ears. “Donald you have to sort it. His death certificate said he died of his dementia, but I wanted them to write in it that he died of a broken heart, but they wouldn’t. He died of a broken heart. I just know it.”

As the weeks have gone on fewer and fewer people thankfully have died from Covid19 in our care homes and this past week we have seen the lowest level since the start of the pandemic. But sadly, in the rhythm of time there are still people dying in our care homes as there always has been and always will be. Care homes as I have said elsewhere are increasingly hospices in the heart of our communities; places of living in fullness and love until the end; places which give solace, comfort and care as folks come to the end of their days. So, there is nothing new about death and dying in our care homes. Indeed, over the years the ability to get to know residents as individuals, especially those wracked with dementia and its horrific hold, have made care homes places capable of giving people as personal and as appropriate an end as possible.

During Covid19 the natural humanity of caring has been interrupted. Part of the rhythm of a death which is expected is the necessary and essential presence of family and friends, to give assurance, offer comfort and to simply be present. Being with the dying is our greatest gift to a human life; surrounding a life with love and memory, holding one another in our first steps of grieving are intrinsic to good bereavement. The times I have been privileged to be with someone as they have died will forever be etched in my soul, without diminishing the aching sadness and emptiness that those moments brought. I have learned more about life in the presence of death than from any textbook or any teacher.

“He died of a broken heart.” Living is not just the intaking of breath into the frame of a physical body of flesh and bone; living is not just the occupying of space and earth; living is not just being there. Living is about relatedness,  knowing that you are part of a story, being assured that you matter, that your voice is heard and your personhood upheld. What is the point of simply continuing to be here when all that is of worth and meaning, of value and heart, is absent and held back from you. The number of our days are as nothing without a quality within those days.

So it is that I do indeed believe that there are many others just like my neighbour who have died and are dying in our care homes not because of the vicious virulence of a virus but because of the measures put in place to protect and save their lives.  I am definitely not saying that actions taken to protect are misplaced or wrong, certainly not in the earliest days of this virus. But now we have entered the 20th week of lockdown in our care homes and with regretfully no immediate move to visiting indoors, I have to with all honesty and I hope with integrity and sincerity, question whether we are now doing more harm than anything else.

I cannot imagine what it is like to have been in love with someone for decades, to have so become inter-twinned with another, that your steps are as one, your memories wrapped up in an alongsideness so intimate that there is nothing to separate them – and then to be separated, kept distant, only able to touch through glass, or speak through a machine. I cannot conceive the agony that it has been and still is for so many hundreds of not being able to touch and hold and be with those you love. I dare not imagine what it is like not to be with those I love.

There are loads of attempts to find a vaccine for this virus. But what I want – in the sad awareness that this virus will be around for many many years to come and that a vaccine may not work for all – is that we put equal effort into finding ways in which we can  better balance protection and presence; that we can devise ways in which families can be with their loved ones so that the scar of separation is removed from our care homes.

I have seen it before, and I know deep inside myself the truth that my neighbour spoke. It is possible to die of a broken heart; to turn your face to the wall because the voice that gives you confidence is not heard; the hand that strokes you in assurance is not felt; the smile that lightens your soul is not present. There is no science for such an assertion only the evidence of experience and the truth of knowing.

In the weeks and months ahead, we have to get better systems of Infection prevention and control for our care homes which are appropriate to their nature as a home first and foremost and not simply adopt measures and approaches from an acute hospital setting. In the coming weeks we have to give very serious consideration as testing techniques develop to appointing at least one relative for each resident to enable the continuation of contact and human presence throughout any future outbreak. Over the next few weeks we have to really start to hear and listen to the voices of those who have autonomy and rights. We have to stop doing to and for and start listening to the voice of resident and family.

We cannot mend a heart which is broken; we cannot bring back a life which is lost or fill the emptiness of the days which hundreds have experienced, but moving forward we all, I believe, need to commit to responding better and doing differently in the future of this pandemic.

There are few poems about loss and dying more beautiful than Maya Angelou’s ‘When Great Trees Fall.’ I end this piece with the last stanza of her poem because it reminds us that when anyone dies they leave not just a memory but a call to action based on their living. The hundreds who have died in care homes in the last few months, my neighbour amongst them, need action not memorials, they deserve change so that no more hearts may break, and to that I for one will commit.

‘And when great souls die,


after a period peace blooms,


slowly and always


irregularly. Spaces fill


with a kind of


soothing electric vibration.


Our senses, restored, never


to be the same, whisper to us.


They existed. They existed.


We can be. Be and be


better. For they existed.’

 

Donald Macaskill 

CEO Review of the Week 19th-25th July

Following  a tweet by Jason Leitch the National Clinical Director many of us were working to the assumption that the Stage 3 Guidance and start of visiting inside care homes would be commencing next week. Unfortunately, this will not be happening, and Guidance will we hope now be published in the next week. This is yet another example of poor communication at the heart of Government and at the centre of the Covid response which not only damages the preparation and plans of care home providers but also upsets and causes distress to families who have waited so long to see their relatives especially given that many have been unable to see family because they could not see them outside.  I hope this will be solved in the next week and things will become clearer. The Cabinet Secretary has written a letter to services on this issue. https://scottishcare.org/letter-from-the-cabinet-secretary-on-visiting-in-adult-care-homes-23-july/

It has been another busy week with many folks on holiday which untypically seems to mean no lessening in work.

The following is a summary of some of the main issues in the week that has passed.

Finance and sustainability

It is now several months on from commitments around the Scottish Living Wage and the publicised willingness of the Government to pay what needs to be paid to frontline providers. There is a complete lack of trust in the system which is coming close to breaking the already fragile relationships between providers, commissioners and local and central government. Local authorities and IJBs do not trust that they will get money from central Government, the same central Government (especially health finance colleagues) do not trust that monies already allocated have been used for COVID purposes; and this leaves providers at the bottom of the heap as per usual with high levels of distrust at local level. The amount of data and forensic examination being demanded by some HSCPs is completely and utterly out of proportion to what is being asked for. This not only acts as a disincentive to providers, but it places some on the verge of going out of business.

Throughout this week Karen, Jim Carle and myself have been involved in discussions with senior colleagues. I think it is fair to say that Scottish Government is now very aware of the very real risks to sustainability within the sector. Jim and Karen together with CCPS colleagues have complied a list of the outstanding issues and have identified the Council areas where these are the issues. This list is being taken to Chief Finance Officers and to HSCP Chief Officers to get them addressed as a matter of priority. I have put this spreadsheet up on the website here.   Please, please look at it and see if it reflects your own situation. We will be having further meetings on Monday to address the specifics but put simply we have to get money flowing into the sector.

We also critically continue to need intelligence from you as to what is happening at local level. Again, this is a plea – if you have not received sustainability payments and if you are not being able to access the Support Fund to pay staff then we need to know about this. We will continue to work hard to see progress on all these issues, but we need you as they membership to engage with us and to keep us informed. Please look at https://scottishcare.org/wp-content/uploads/2020/07/sustainability-Covid-e-bulletin-July3.pdf

Specifically, in relation to the Support Fund we now have a campaign being launched by the trade union Unison which is arguing that providers and employers are choosing not to pay staff what they are due. I hardly need to say that this is the sort of negative publicity which we can very much do without at these challenging times. If you are having difficulty re the Fund then please come to us and we will liaise directly with Government to address your particular issues.

Lastly we have learnt this week that COSLA and the Cabinet Secretary are not now meeting till next week in order to address the issues of continued funding after the 31st July. The timing is shocking in that we know very well that there are numerous members who are utterly dependent upon the continuation of this support beyond the end of the month. We will keep pressing and will keep you informed.

Overall in all these issues we are getting closer to the point at which we need to develop a much more public and media strategy to try to get things moving unless we see real change happening in the next week.

Care Home issues

As I said above we are very disappointed that the  commencement of stage 3 visiting has been handled in such a poor way. It is important given that as there is likely to be the usual short period of time for people to get prepared for opening to indoor visiting that folks are as ready as they can be to submit their RAS forms to Public Health for sign off. At the time of writing the anticipation is that we will have a situation where there will be a limit of 3 visitors outdoors – they can be of the same family or different but if the latter then social distancing measures which would apply in any other context would apply here to the visitors and of course there must be PPE, screening, sign in and distance from the resident. One nominated person can visit indoors for up to 30 mins and with appropriate PPE. Ideally this will be in a specific space/room which can be cleaned between visits. There will also be greater clarification on what is considered to be an ‘essential’ visit so that this can be lessened to enable people to meet their relatives in their own rooms if they have incapacity issues. It was also envisaged that there would be a lessening of restrictions re the use of communal spaces, dining  etc. However, on this latter point there seems to be a row-back. I think this is highly regrettable given the levels of deterioration that we are seeing in residents.

As noted last week we have also raised directly concerns which members have been expressing about the status of residents who wanted to go out of the care home and visits family, friends or simply to do some shopping. The Care Home Clinical and Professional Group considered a new Guidance on this at its meeting on Thursday. I hope this will be published at the same time as the other Guidance.

A paper to restore ‘visiting’ from both clinical professionals such as AHPs, OTs etc and other visitors such as hairdressers, therapists etc has also been prepared and I hope this will come into play at the same time as we move to stage 3 with the wider family visiting.

We again raised the issue of professional visitors being tested as they entered the care home with a growing number of instances where professionals coming in for scrutiny or clinical purposes are refusing to state whether they have been tested or not. The Executive considered what the status of the Health and Safety Act is in relation to such visits. Whilst inspection might trump these considerations we need to be able to evidence that we have undertaken all reasonable measures to protect the workforce and the residents. It has been agreed to draw up a clear protocol. However, it is also clear that HPS is standing robustly on their line that those visiting a care home for inspection or clinical purposes should only be required to wear PPE, hand-wash, socially distance etc.

Testing

Over 34,000 care home staff were tested in the last week and at least 2000 residents in care homes were tested. This is  around about the same figure as the previous week. Work is being undertaken on the issue of  false positives and it has become clear that the UK portal only undertakes a basic test on samples whereas the NHS test is more robust with two elements of sample examination. We have made it clear we need consistency in this regard and SG is taking this up with the UK Portal.

Feedback on issues raised as follows:

  • No further issues raised on costs for calling the 0300 helpline number which can be claimed back via the social care fund.
  • Staff who decline testingwas discussed at Care Homes Oversight Group and further discussion to be had at the workforce senior leadership group, update will be given next week.
  • Agency workers – communication has now been issued for agency staff testing via the Care Inspectorate. Agencies will be advised that staff should be tested using the UK Government Employer referral portal.Staff who are on long term contracts with agencies can be tested as part of care home weekly staff testing in the care homes via the social care portal.
  • Uptake of staff testing –There is a potential for a higher decline this week than 3% of staff who refused last week. Feedback still continues to be reported with how uncomfortable the test is, some staff doing it wrong, inconclusive test results, worries about loss of income etc. Jason Leitch has recorded a video clip which is going through a SG clearance process and will be shared soon.
  • No indication of when less intrusive tests may be available e.g. saliva tests. In the meantime, staff could test themselves if that was preferred.
  • TURAS and HPS have video available for staff to watch – https://learn.nes.nhs.scot/28247/coronavirus-covid-19/practice-in-the-community-setting
  • Four weekly testing – Issues with UK portal which cause backlog and number of care homes had orders declined. More guidance to be issued on learning of four weekly testing.
  • People being admitted to care home without a test – A letter was issued to DPH which directly quotes from HPS guidance. The expectation is that everyone admitted to a home will have a test done first. A communication has been sent to public health directors to remind them of the policy and to ask for assurance that processes are in place for all residents to be tested prior to being admitted to a care home and that all clinicians who may be asked to test individuals are aware of the process.
  • Randox Testing – DHSC press release highlighted for Care homes in England to use King fisher not ‘Randox’ testing. This should not affect Scottish Care homes as we don’t use ‘Randox’ but some tests in Scotland are called ‘non randox’ which can cause some confusion.

Once again there has been no final decision on the ‘mandatory’ nature of the tests following the unhelpful intervention from SSSC – discussions between various parties on this issue are ongoing and ultimately this matter has to be addressed by the Cabinet Secretary.

Care at Home

The Care Inspectorate Inquiry process is well under0-way and I would strongly encourage members to get engaged with this.

In principle CHRAG has decided to re-form its structures to include a specialist focus on care at home and housing support. Scottish Government has brought in the specialist services of KPMG to support them in this re-orientation and I have been interviewed to give perspective of the sector on the urgency of creating a place to bring CAHHS issues and concerns. The Director General has been on leave this past week and I believe will focus upon this as a matter of some urgency in the week that she returns.

Collective Care Futures
 

The Collective Care Futures project is over its half-way point and I continue to encourage members to get involved in the sessions being led by Becca and Tara. Equally filling in the online questionnaires will be of huge value.

You can choose to take part by completing the survey series.  There are currently 4 surveys available – technology, care practice , partnership and for this week one on workforce – with 2 more to become available in coming weeks. You can take part in as many or as few of the surveys as you wish. 

If you or any of your staff/colleagues would prefer to share your experiences in a short online call, on a certain theme or across a range of themes, you can email [email protected] to arrange a convenient time.

Becca and Tara would also be extremely grateful if you could share details of the programme with your networks and contacts, who are also welcome to take part via surveys (hard copies can be downloaded) or in an online call.  Please see full details at https://scottishcare.org/project/collective-care-future/

 Link to survey on workforce can be found at: https://www.surveymonkey.co.uk/r/carefutures-workforce

Link to previous surveys:  https://scottishcare.org/care-future-surveys/

Find out more about the Collective Care Future programme:

https://scottishcare.org/project/collective-care-future/

Executive meeting and AGM.

The Scottish Care Executive met on Wednesday and this was followed by the AGM. The AGM was presented with an Annual Report for the first time and I delivered a general address which is at the foot of this update. See the Annual Report with thanks to Karen Hedge for its development at  https://scottishcare.org/wp-content/uploads/2020/07/annual-report-19.20.pdf

We are very grateful to all the Branch Chairs, IJB representatives and individuals at local level who help to ensure that the organisation has the local and national reach that it needs and that is urgently required especially at the current times.

We hope that you continue to feel the benefit of being a member of Scottish Care.

 Care Tech 3 :

 Save the Date: Care Tech 3 – 28 August

We will be hosting our third technology event ‘Care Tech 3’ – ‘Tech that Cares: making tech personal in post-COVID social care’ on Friday 28 August 2020.

The event will take place virtually and will bring together a range of perspectives to discuss developments and impacts of technology, particularly during COVID-19, and the future potential of technology across the Scottish social care sector.

The event will feature a range or panel discussion and opportunities to hear the latest developments around technology in social care.

More details to follow.

PPE

 We have raised concerns with colleagues at Government over what appears to be increased use of nitrile gloves not least in that the cost of these has risen in one 48-hour period last week by over 250%. We also gather that over 1 million gloves were sent out to the Hubs last week. We are very clear that the HPS Guidance on usage remains the same as it has been but believe that there are still some Health Boards making it a requirement that nitrile gloves are used in all encounters. This is simply not acceptable or sustainable. But again, we need to know if you have been told to use them in all instances. Please use a specific section on the Discussion Boards to share this information – i.e. which Health Board(s) so we can take action on this matter.

The universal wearing of face masks announcement has led to the need to give additional information on their use in clinical and care settings. Please find a FAQ on the website produced by Scottish Government. https://scottishcare.org/faq-interim-guidance-on-wider-use-of-face-masks-in-health-and-social-care/

We are also wanting to get a sense from members on whether or not there would be an openness and support for NHS NSS becoming a PPE supplier to the social care sector. We are starting to map in broad terms the extent to which members might be interested in a situation where NSS offered its services to social care providers at rates which are likely to be highly competitive. Once again can you please answer this question on the Discussion Board.

Bereavement Charter Webinar – 30 July

 You are invited to the first webinar to support the implementation of the first Bereavement Charter for adults and children in Scotland on Thursday 30th July between 15:00 and 16:30.

Chair: Dr Donald Macaskill, CEO of Scottish Care

Guest speaker: Mr Derek Feeley, former CEO of the Institute for Healthcare Improvement and of NHS Scotland

The aims of the webinar are to:

  • Encourage buy-in to and support for adopting the Bereavement Charter within organisations
  • Establish if/build a consensus for making the case to Scottish Government for national leadership and resourcing of infrastructure for bereavement support, especially reflecting anticipated growth in need due to Covid-19

To register and receive further information please reply to [email protected]

Communication

Our next Surgery will be this coming Tuesday with again Karen Hedge and myself for 45 minutes at 12 noon. Please join us on a range of topics.

There will also be a separate webinar on Monday 3rd August, time TBC which will be a follow-up webinar to the Safety Huddle demonstration in May. The tool will be moving towards the second phase of testing. In this webinar, the digital team from NES will do another demonstration on this tool and will be available for any questions. Details will be available shortly on our website.

 Workforce

 Caroline Deane has produced another information filled Newsletter so please make sure you are signed up to get all the information that you need and that is up to date on all matters Workforce related.

See https://mailchi.mp/7982ce366598/workforce-matters-ebulletin-october-12588279?e=8b93fe8b46

 The Scottish Government is funding a national mental health wellbeing helpline to support health and social care workers in Scotland. This will be available 24 hours a day, seven days a week.

Trained practitioners at NHS 24 will offer callers a compassionate and empathic listening service based on the principles of psychological first aid, as well as advice, signposting and onward referral to local services if required.

This support line is available at 0800 111 4191.

For more information at https://www.gov.scot/news/more-mental-health-support-for-health-and-social-care-staff/

 And finally,…

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

25th July 2020

 

AGM  Address

 

Well to misquote a well-known Scottish footballer – it has been a year of two halves – pre Covid and Covid.

In the year before Covid all the challenges facing both Scottish Care as a membership organisation and social care in general in Scotland were there and becoming larger. From April 2019 we were as an organisation in both our research and media output, in our dialogue with local and national Government and in our work with Integrated Boards, highlighting the vulnerabilities of the care sector. Over-stretched, under-resourced, with massive issues of  commissioned contracts which were unsustainable, a National Care Home rate which did not give adequate levels of return and tied people into unfair terms and conditions; a growing issue of recruitment challenge not least as a result of the slowdown of migration; declining numbers entering from nursing into social care – all of them added up into a heady cocktail which inevitably meant that the social care sector which was faced with a global pandemic at the start of March – was not a sector which was fit for purpose or ready for the weeks that ensued.

That is not to deny all the positives which had happened during 2019 – excellent research continued to give solid ground for our arguments, a transformed digital and online offer helped to improve our communication with members, two great events and Awards evenings in May and November despite the growing challenges; a dynamic  presence in workforce and in a new nursing role; and the growing confidence and appreciation of the Independent Sector Leads across the country. We were fortunate too in our staffing with Stefanie Callaghan coming on board, to be later joined by Jim Carle and Tara French in 2020, and most recently Jim Baird.

We had worked well in contingency planning through Elaine Rae and NHS NSS and thankfully that Brexit preparation for shortages meant that we were able to be much faster in being ready for the global meltdown in the availability of PPE.

We had gained an additional presence and voice through the Integration reform process, the Fair Work in Social Care Group, the developing groups around Adult Social Care Reform – all of which moving forward will be critical and valuable. But…

The dominant features of resource, staffing and non-inclusion were there in January. So, as we started to respond to the emerging global challenge posed by Coronavirus it is not surprising that social care was not included, that we were not on the ‘experts’ group of advisers mapping our early stages.

There will be plenty of time to respond in a formal way through the many Inquiries and submissions to Parliament about the handling of the Covid19 crisis. This is not the time to do so other than to say that I promise we will be an honest, critical and authentic voice for the sector as we move on to the next stages of response.

Some things worked well, as I have said chief amongst them the PPE response, though even that was initially faltering because of an inability of partners to listen to what we were saying’ ; but there is much that failed to work and much that the sector is unfairly being derided for.

The prioritisation of the NHS at all costs, the failure to test resident sand staff as we had demanded much earlier than was originated, the failures over repeated and contradictory Guidance, the failures of DNACPR forms and a presumption that care home residents should be treated in the care home and not transferred to hospital; the failures of what some have described as the ‘clinical abandonment’ of the primary care sector in parts of the country; the failure to continue appropriate care and support for people in their own homes; the failures around the attempts to ‘support through oversight’ ; the failures around lockdown measures which have effectively resulted in massive deterioration and loss of life in care homes beyond Covid; the failures around the handling of visiting in care homes and the opening up of our care homes; the politicisation of the sector by knee jerk reactionism from some politicians etc.  The list goes on – but be assured it is a list that is being calculated, it is a response that is being analysed and it is a truth that will be told.

For now we work to address the current challenges of massive sustainability risks caused by the withdrawal of contracts in the community and the gaps in occupancy in care homes coupled with obscene additional costs; we work to build confidence in the wider public – and thank you to everyone involved in Care Home Day last week; we work alongside Government to prepare for the three potential peaks of a second wave, an upsurge of flu and a potential negative impact from Brexit and immigration plans.

It remains for me to say thank you. Thank you to everyone across the country who has been and still are shining lights of compassion and care for all at this time and during harder times. Thank you to all my colleagues at Scottish Care whom I am sure you will agree have excelled in dedication, energy and professionalism. Thank you to national and local colleagues especially the Independent Sector Leads who have been so invaluable. Thank you to our Branch Chairs and IJB Reps. A particular personal thanks to our National Director Karen Hedge who has shared leadership of the organisation at this key time. But to every single one of my national and local colleagues –  thank you.

And today a special thank you to Cath Balmer who is to retire finally in a couple of weeks. Scottish Care has been centred around Cath Balmer through thick and thin- a quiet, strong, disciplined and highly committed individual who has the care of membership and those we support running through her veins. It is strange to be saying goodbye in these uncertain times, but one thing remains constant and that is the sincerity and heart-feltness of the Thank you.

In the months ahead, regardless of the challenges we will seek to rise to them with the rights, dignity and humanity of those we care for and all that we seek to do running through all our actions.

Thank you and keep safe.

Dr Donald Macaskill

The essence of hope: the dangers of Covid19 optimism.

 

Hope is not optimism,

which expects things

to turn out well,

but something rooted

in the conviction

that there is good

worth working for.

 

– Seamus Heaney

 

Hope is one of these intangible commodities. If we lack or lose it we diminish our abilities both individually and collectively to achieve and to continue. It is an emotion which has been very present in a lot of the conversations and exchanges which I have had this week.

Hope was there when with others I attended the NHS Mobilisation meeting chaired by the Cabinet Secretary. It was a hope that through deliberate and focussed action we could begin to restore NHS and social care services to where they had previously been, learning lessons from the pandemic response and ensuring that we are as prepared as possible for the coming winter. It is a hope not based on day-dreaming but solid hard work which through a cautious ending of lockdown and opening up of society means that we will meet the current and future challenges of Covid19 with as much preparedness as possible.

Hope was there when I spoke to a manager who had to deal with the family of a co-worker who had died as a result of Covid19. It was there when I spoke to the family themselves. It was a hope that tomorrow would be better, that they would slowly be able to put back together the shattered pieces of their lives and find a new way of living without the strong presence of their loved one. It was a hope which they desperately needed to pull them through into their future  because right now they are drowning in the emptiness of loss and the pain of grieving.

Hope was there when I read a beautiful pain full letter from a mother unable to hug and hold her adult daughter because she lives in a residential home and is subject to the current restrictions on visiting, including the wearing of PPE and social distancing. The mother’s poignancy was the hope that the time would come soon when they could be properly together as once they had been in an intimacy of touch and belonging.

Hope was there when with so many others I was moved by the hundreds of stories which flooded Twitter and Facebook on Wednesday during Care Home Day as folks took time to share stories of amazing compassion and care; as they reminded us all that care homes are places of life and vibrancy, places where individuals are enabled to life to their fullest and when the time comes to end their days surrounded by dignity and solace. There was a real sense on Wednesday of a hope that sometime soon we will return to something like normal and that sounds of laughter and song, of banter and memory will fill the silence that has enveloped so many care homes. But in doing so without forgetting the pain and sadness of the last few months and with a desire to hold in fragile memory those who have been lost.

Hope is an essential requirement to enable all of us to find the energy to deal with challenge, whether professional or personal. I recognise that there are countless thousands who need to believe that there is hope. I know that too many have lost their jobs and their sense of self and personal worth as a result of this pandemic. I know that too many have been deeply scarred by the effects of lockdown on their mental health and wellbeing. I know that there are countless families who will never be the same because they have lost someone to the virus. I know too that there are thousands who fear for the future because they run a business or work for an organisation and are uncertain about how or when they can get back to ‘business as usual.’

So, hope is an essential commodity to enable life to flourish and for purpose to have direction.  

But and it is a big but – that hope has to be grounded in some degree of reality. Hope has to be rooted in truth and grounded in carefulness. As the poet Heaney says it is a hope that has to be worked for. So, it was with a sense of real despair I heard yesterday some of the words of Boris Johnson, the Prime Minister. I am deeply concerned that by suggesting that ‘It will all be over by Christmas’ that he is in danger of echoing the mistakes of those of a previous generation who thought that resolution and restoration would result with a quick victory over an enemy in 1914 and that all would be well by Christmas.

Covid19 will not be over by Christmas. We will live with it for many years to come. We will have to live with its pernicious ability to destroy lives and shatter love. But with discovery and ingenuity we will discover how to control and lessen its harm and how to heal those whom it hurts. But we are not there.

A false hope is a dangerous illusion because it prevents caution and fosters reckless action. Anyone who has lived through the hell of these last few months in the care home sector, who is still not able to freely see and be with loved ones, will know the huge sacrifices that have been made by so many. We risk throwing all that away, we risk the escalation of danger, should we be deluded into thinking that things are about to be sorted and solved. Hope has to be rooted in sense rather than expediency, lives matter more than anything and we cannot use them as the vehicle for populism. Hope has to be worked for.

So, I end the week with hope. It is a hope grounded in the knowledge that by safe and slow steps we are edging forward as communities and as a nation. It is a hope that we will support one another through the days ahead in a way that affirms our humanity, recognises the pain of others and upholds those who are most in need of support. It is a hope that by collective support and cautious planning rather than naïve rhetoric we will meet the challenges of the autumn and winter ahead.

For one thing I am sure of is that Covid19 has changed us all in ways which are unimaginable.

“The world is indeed full of peril, and in it there are many dark places; but still there is much that is fair, and though in all lands love is now mingled with grief, it grows perhaps the greater.” 

― J.R.R. Tolkien, The Fellowship of the Ring

CEO Weekly Update 12th to 18th July 2020

There is almost a sense of return to some degree of normality with the tremendous news that we have gone for at least one whole week with no deaths from Covid19. This has been a real fillip to many people and has been received with  a very emotional response not least in the care sector which has so taken the brunt of this pandemic.

The following is a summary of some of the main issues in the week that has passed.

Finance and sustainability

At the risk of tempting fate following yet more meetings this week I am getting the sense that there is now a collective desire on the part of central and local Government to get to the bottom of why so much of the sustainability payments are still not out there. This week the Director General of Health and Social Care co-ordinated a meeting with senior local authority, COSLA and HSCP figures which was an honest consideration of some of the specific and strategic challenges. There is still nonsense – so for instance in Glasgow we have been told that less than 50% of providers have applied for additional financial supports. I find it hard to believe that this can be the case, but I would re-iterate again that applications need to be made in order for monies to be delivered. That said we held two meetings this week. Karen, Janice and Jim are leading on this work and the spreadsheet which was put up last week detailing the problem areas is still there. We are seeing progress in some areas such as Borders and Moray but there is a real block in others, e.g. North Ayrshire. Once again we have meetings planned for Monday and Wednesday in the coming week in order to look at the detail of specific issues in particular areas – please send information to us or your Independent Sector Lead – without it we simply cannot change things or advocate on behalf of members.

I held a meeting with the Cabinet Secretary on Thursday afternoon, and I raised the issue of sustainability payments beyond the end of July. You will be aware that the current commitment from COSLA is to this date. She indicated that she was due to meet with COSLA leaders on Friday and that they would discuss what support was needed. She indicated that she needed to be convinced that there was a need. For my part I said that providers are certainly feeling that there was a need, even on the  basis of PPE costs alone. We will inform members about any news on this front as soon as possible.

Can I remind everyone that if you have issues around the Social Care Support Fund that you should post these on the Discussion Board where you will find some answers which have already been provided. 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

Again to remind everyone that the terms of the Death in Service Scheme are available at  https://www.gov.scot/publications/coronavirus-covid-19-social-care-worker-death-in-service-payment

Care Home issues

As stated above there has been positivity with the decline in deaths and the slow-down in positive tests. There has been suspected Covid-19 cases in 694 adult care homes, 64% of the total. There have been deaths from suspected Covid-19 in 339 adult care homes, 31% of the total.

Last week I indicated a real sense of disappointment about the handling of visiting and these points have been brought to the attention of the Directors of public health. Unfortunately, Jason Leitch the National clinical Director intimated in a tweet that indoors visiting  with one person and outdoor visiting with multiple people would commence on the 24th. He somewhat jumped the gun in that any decision will have to be confirmed but scientific advisers. I hope he will rectify this tweet. We have also asked for any change to  Phase 3 to commence on the 27th – on a Monday to give people plenty times to get Risk Assessments signed off. In addition, the Guidance for Indoor visiting is still to be finally signed off and will mention a limit of 3 visits outdoors not ‘ multiple.’ We are not off to a good start!

I have also raised directly concerns which members have been expressing about the status of residents who wanted to go out of the care home and visits family, friends or simply to do some shopping. There seems to be a belief in some parts that folks in care homes never go anywhere and are virtual prisoners. Some urgent work is being done on this issue and I hope to have something to communicate at the end of the week.

A paper to restore ‘visiting’ from both clinical professionals such as AHPs, OTs etc and other visitors such as hairdressers, therapists etc has also been prepared and I hope this will come into play at the same time as we move to stage 3 with the wider family visiting.

More positively there has also been a decision  taken to set up a small group including with provider representation to look at the issue of IPC in care homes. The constant drumming from myself and others that care homes are not units or hospitals seems to have been recognised and there is an appreciation that acute sector IPC measures need to be adapted. I hope that this group will develop approaches and models which are more sensitive and reflective of the reality that a care home is someone’s home whilst still keeping in balance the need to protect and reduce infection risk.

One of the other issues that we are increasingly aware of are the post-viral impacts of Covid on those who have had the disease. It is now clear that we are dealing with an ‘underlying deep disease’ and one that is a vascular virus as well as a respiratory virus. As growing evidence shows there are profound ongoing  impacts related to coronary health, respiration, COPD, falls, diabetes, frailty and dementia. This will have an especial influence on residents ion  care homes and many of those being supported in their own homes.

Last week I reported on our concerns about Operation Koper. These remain. The Director General Donna Bell reported a meeting she held with staff from the Lord Advocates Office and Police Scotland. She highlighted our concerns over time and s cope of the information requests from police Scotland. As I feared there is a limited extent to which we can influence these investigations but Donna Bell is now exploring whether it might be possible for me to speak directly to senior investigators to make them aware of the sensitivities and concerns which are being felt in the sector on this particular issues and to see to whether or not we might be able to  improve this.

Testing

At least 34,017 individual care home staff were tested in the last few weeks and at least 1,989 individual residents in care homes were tested. However, there were 3,500 staff who refused and some care homes as a whole either refused or did not access the portal. We are going to work with Scottish Government to explore some of the reasons behind this.  I am aware of the risk of false positives when there is such low prevalence in the community and issues of the sensitivity of the test and inconclusive results. I am aware that there are reasons of shift patterns, rostering, etc but we need to explore the issues. We are also now part of the Social Care and Testing Working Group. This meets on Monday mornings and is a practical opportunity to bring up issues of concern. Caroline Deane represents Scottish Care at this group and if members have issues please highlight these to Caroline.

Once again there has been no final decision on the ‘mandatory’ nature of the tests following the unhelpful intervention from SSSC – we believe that discussions between various parties on this issue are ongoing at the time I write this.

Care at Home

 The Care Inspectorate has started their process of an Inquiry which in relation to care at home and housing support. The issue of wider concerns over care at home and housing support was again brought up by us at the CHRAG and the in-principle decision was taken to extend the membership of CHRAG to include care at home perspectives and to create what are effectively going to be a range of subgroups on Adult Social Care.  The process for this  has just commenced and we will ensure that there is Scottish Care representation on the various groups. But at long last there is an acceptance that despite the understandable focus on care homes , that adult social care is more than just care homes, and that the risks to the rest of the sector are real and immediate.

Collective Care Futures
 

The Collective Care Futures project is well under-way, and I continue to encourage folks to get involved in the sessions being led by Becca and Tara. Equally filling in the online questionnaires will be of huge value. It is critical we engage in a week which has seen the Labour Party promoting its idea of a National Care Service.

You can choose to take part by completing the survey series.  There are currently 3 surveys available – technology, care practice and partnership – with 3 more to become available in coming weeks. You can take part in as many or as few of the surveys as you wish. 

If you or any of your staff/colleagues would prefer to share your experiences in a short online call, on a certain theme or across a range of themes, you can email [email protected] to arrange a convenient time.

Becca and Tara would also be extremely grateful if you could share details of the programme with your networks and contacts, who are also welcome to take part via surveys (hard copies can be downloaded) or in an online call.  Please see full details at https://scottishcare.org/project/collective-care-future/

Care Home Day

Care Home Day happened on Wednesday and I would want to thank everyone who shared stories and took part in this day. There was a remarkable degree of buy in by many of our partners in Health Boards, local authorities and Health and Social Care Partnerships. There was a real sense of positivity on the day. This is shown in the remarkable data which has been analysed on the use of the hashtag #carehomeday20.

Total posts: 2,043

Users: 219

Reach: 351,355

Impressions: 1,424,644

Retweet rate: 93.40%

Reached No 2 trending in Scotland

I would want to take this opportunity to express my particular thanks to Shanice Shek and Becca Young for the amazing work they did on the day and prior to it to make this the success it was.

In the midst of all the negativity it was good to – at least on social med9ia – see some positivity and the fact that the Cabinet Secretary recorded a video message and that the first minister mentioned it in the Daily briefing were both positive indicators.

PPE

 It may seem strange to raise this as an issue here because in large part there has been considerable stability of supply. However, a number of members have communicated to us a concern that prices are rising and that there are suggestions from suppliers that there may also be shortages. We are starting to map in broad terms the extent to which members might be interested in a situation where NSS offered its services to social care providers at rates which are likely to be highly competitive. We will develop a question on the Discussion Board, and it would be helpful for members to give opinions on such a suggestion.

Communication

Our next Surgery will be this coming Tuesday with again Karen Hedge and myself for 45 minutes at 12 noon. Please join us on a range of topics.

And finally,…

This week I have commented a great deal on the very disappointing news from the home office that they will not make social care a distinct category on the Shortage Occupation List. The loss of the ability of providers to recruit from overseas will have a profound impact on many of our members and we will continue to speak out and campaign on this issue. It is lamentable and bizarre that these restrictions will come in in January at a time when we might be facing a second viral peak, a flu upsurge and the challenge of supply through Brexit.

On a  more positive note we are delighted to have welcomed Jim Baird to the team at Scottish Care as the Rights Made Real Human Rights Project worker. Jim comes with many years of experience of working in the field of dementia and we are pleased to have his wealth of experience at such a critical time. We look forward to his insights and contribution over the next few months.

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

18th July 2020

Infrared Thermal Imaging Technology

We are posting some information from Health Protection Scotland on infrared screening because we are aware that many providers are considering such machines. They are a considerable expense and it would appear of limited value. 

Individuals presenting with atypical COVID-19 symptoms (i.e. no fever) and those in which fever has passed but are still infectious, will not be identified by fever screening. This, combined with the issues regarding sensitivity, and the impact of antipyretic medication on sensitivity, indicate that health and care settings should not implement infrared thermal imaging as a means of detecting COVID-19 patients.

 

1_covid-19-rapid-review-thermal-imaging

Autonomy and choice in pandemic times: the importance of empowerment in care decisions.

Recently I happened to be discussing being a parent with someone who had become a father for the first time. One of the comments I made to him was that parenting was a process of discovering that true knowledge is learning what you do not know. For despite all the books and videos you can read or watch nothing can prepare you for the real experience. It is a journey of self-discovery; a process of un-learning all the suppositions and thoughts you initially felt were true and allowing yourself to be changed for ever. There is a real truth in the sense that the best parents are those who have been willing to be taught by their children. From the first moment when you return from the hospital into the fearful state of total responsibility for a fragile life all the way through to the faltering first steps, through toddler tantrums and on to teenage expressiveness parenting is something that not only leaves an indelible mark but changes you forever. It is full of ebbs and flows, shallow pools and torrid currents.

As any parent will probably attest one of the hardest lessons you learn is the art of letting go. From the desire to protect and guard with suffocating love you have to learn to let go, trust, and empower individuality. Whether it is allowing a toddler to climb beyond your own risk analysis or allowing someone to miscalculate in fledgling relationships – it seems a constant balance between the desire to intervene and protect and the realisation that autonomy and individuality can never flourish in the shadow of a dominant parent.

Autonomy is a concept that has been much in my thought in the last week. I recognise that autonomy is critically important in the nurturing of a child through its early life. The skill of enabling a child to develop so that it is able to make its own decisions, develop its own moral and ethical framework for action, and to do so with an emotional maturity is perhaps the greatest gift of parenting. Without it we would create a society devoid of creativity, ingenuity, expressiveness and soul.

The autonomous child learns to understand that they that they have control over themselves and the choices that they make. That their actions and interactions have consequence and purpose, effect and outcome. Autonomy is developing the abilities to think for yourself rather than merely replicate the views, opinions and thoughts of others, especially your parents! It is the sense of control, agency and responsibility critical to making us into human beings capable of being truly who we are and in relationship with others.

Sadly, there are a whole host of factors that can limit autonomy and prevent the development of the essential characteristics of self-worth, self-regard and self-love. The things that limit our personal autonomy can be the barriers that society places in front of us in terms of our socio-economic status, its disabalism or racism or classism. But equally our autonomy can be restricted by impairments of body or mind that may constrain us.

Those who work in social care know that the essence of good care is enabling an individual to exercise the fullest possible autonomy. It is the realisation that regardless of any cognitive or physical impairments that every human individual has the right to exercise choice, control and autonomy to the best of their abilities and capacity. Good care is about removing or limiting the barriers that prevent human autonomy and control.  It is about enabling an individual to be as independent as possible, it is about reducing dependency rather than fostering it.

That is why our legislation in Scotland recognises that whilst there are indeed some who may have limits on their mental capacity there can be no automatic presumption of incapacity rather there is always a presumption of capacity. I have the right to make decisions about my own person, body and life unless under very strict criteria it is deemed I no longer possess the mental capacity to do so. But even then there is an awareness that capacity can fluctuate and be episodic so there is a duty on those who care for me to continually seek to enable me to exercise autonomy, choice and control.

Without a sense of autonomy, we would feel continually under the control and agency of others; we would not be able to make decisions about what matters to us in our lives. So, in social care the fostering of autonomy is central and critical.

As a whole society we have an obligation to respect the autonomy of other persons, which put simply is to respect the decisions made by other people concerning their own lives. This is what lies at the heart of human dignity, the ability to allow others to grow  into the fullest expression of their own humanity and individuality, without us forcing them to be someone they are not, to do something they do not want to do. All of which is boundaried by the laws and obligations of the whole community and society.

That last point is important because of course no one of us is wholly autonomous. We cannot just do what we want without appreciation that we live in relationship one with the other in a society. When we make decisions and act on those decisions, our decisions and actions are at least partly autonomous.

In social care and health care it has become one of the core ethical standards that an individual must be involved in decisions about their own health and wellbeing.

Autonomy is regarded as a fundamental ethical principle. Put simply it is the acknowledgment that patients who have decision-making capacity have the right to make decisions regarding their care, even when their decisions contradict their clinicians’ recommendations. Autonomy is the principle which underlies the requirement to seek the consent or informed agreement of a patient before any investigation or treatment takes place.

So, what about autonomy in the time of a pandemic?

It is because we are part of a wider community, society or nation that during a period of national emergency that as autonomous individuals we are willing to accept the instruction and laws of our Government in order to protect both ourselves and others. We have seen this in the remarkably high level of compliance during lockdown and in the initial stages of removing ourselves from lockdown.  Managing public behaviours and expectations has been critical. A citizenship without a sense of consensual autonomy would never have supported the restrictive measures which we have all had to live under in the last few months.

But the reason behind me thinking about autonomy this week is the number of people who have written and spoken to me about the extent to which, perhaps especially as we come out of lockdown, we have failed to give adequate respect and cognisance to the autonomy and rights of older people.

Jane wrote to me to say, “I have the right to make decisions over my own life.”  She is in her 90s and in a care home which has been affected by Covid19 and because of that even outdoor visiting is not happening because of the requirement to be virus free for 28 days.  Jane has mild dementia and is in a residential not a nursing home. She is there because of issues to do with mobility and frailty. She has full cognitive ability and mental capacity, yet she feels that she has no control, diminished rights and no autonomy. She feels in her own words “as if I am being treated like a child.”

Her letter was heart-felt and I have to be honest in saying I find it hard to answer her because I think she is right. I do think that we have now reached a state in our pandemic response where we are in danger of limiting the human rights and personal autonomy of individuals ‘solely’ on the basis of where they happen to live or on the basis of their age.

The loss of autonomy and individual agency brings about profound psychological impacts on an individual. This sense of not having control and choice robs us of our identity and purposeless, our individuality and freedom.

Atul Gawande in his brilliant book ‘Being Mortal’ argued that this lack of respect for older people and their exercising of individual autonomy can ultimately mean that as a society we can conclude that prolonging longevity is more important than quality of life. We are so preoccupied with minimising risks in the way our elderly are cared for that we strip them of their autonomy  and control (even with reduced capacity) by treating them like infants unable to make decisions and take actions for their lives.  

Studies across the world are recognising the emotional and psychological toll which lockdown has brought to care home residents, including the loss of interaction with family members. I am increasingly convinced that we need to urgently look at the way in which we have approached the need to balance infection control and prevention and the quality of life of those in our care homes. This in essence has to do with autonomy.

When someone enters a care home regardless of whether or not they have a life-limiting condition such as dementia they do not lose autonomy, they have not left their rights to choice, control and individual agency at the front door. Yes, we have as a whole society  consented to restrict ourselves as part of our belonging to that society, but now that we are removing these restrictions we cannot treat one group less favourably than others simply in the name of infection prevention. This is a subtle and hard balance, but I am not sure we are getting it right.

Moving forward it will be critical that as a whole society and as a care system that we find better ways of ensuring that individuals in care homes and indeed individuals who are dependent upon support and care in our communities have a better mechanism and means to influence decisions taken on their behalf. Part of autonomy is the right to exercise voice and influence, the need to be heard and have your distinct needs addressed.

Any future ‘lockdowns’ will risk a failure of compliance if there is not a greater sense of engagement with and involvement of those affected by measures ostensibly designed to protect but which by default rather than design may actually lead to greater harm. We need to empower people to exercise their autonomy in decisions made about their care most especially when the extent of restrictions have such a dramatic impact on their health, well-being, and autonomy as human beings. We have to stop treating care home residents as children and restore their adult autonomy.

“A few conclusions become clear when we understand this: that our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.” 

Atul Gawande, Being Mortal: Medicine and What Matters in the End

 

Donald Macaskill

CEO Review of the week  5th to 11th July

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.