Balancing the scales: Covid19 discrimination and future promise

In early March at the beginning of the Covid19 pandemic I wrote an opinion piece for The National which I concluded with the words:

‘Coronavirus will be a test not just of the infrastructures of health and care, of business and commerce, it will be a test which will determine the nature of our nation. Will we be a Scotland that cares for the old or will our compassion be limited by discrimination?’

That piece was written on the back of statements which suggested that we did not need to worry about the disease because it would only kill the old. Both social media and some wider media comment at the time was full of comments which articulated a view that Coronavirus was a ‘boomer harvest’, one of the many sickening references to the baby-boomer generation. The public health message across the United Kingdom at the time was ‘wash your hands and catch your cough.’

Twelve weeks on the truth is that this pernicious virus has indeed taken a devastating toll of the older age population with nearly three quarters of all deaths in Scotland and worldwide amongst those over the age of 75. It is also the sad truth that those who were most vulnerable as a result of age, frailty, dementia and other conditions, and who have been residents in our care homes, have been the hardest hit. This is the story of this pandemic as it has crossed the face of the world, its hurt has taken away from us our memory and soul, its scars have left a mark which will take long to heal.

So has our response been one of inclusiveness, of valuing all, of non-discrimination or has the pervasiveness of age discrimination and bias, subjects I have often written about, been evidenced in our pandemic response as a Scottish society, as a political, health and care system?

I will leave you to make your own mind up on that. But …

In recognising the evidence, we were getting from China in January, South Korea and Singapore, Italy and Spain in February, France and Germany in March, did we sufficiently protect our older citizens? Did we ‘contain’ for too long out of a desire to ‘bring people with us’ and lessen harm to the economy which meant that the entry into lockdown made our older population all the more vulnerable?

In noting the relative success of a strict test, trace and isolate model in some parts of the world with the continual echo of the World Health Organisation stating ‘Test, test, test’ to anyone who would listen,  did we as part of a Four Nation collective response abandon that safeguard too early?

In our desire to prevent our acute NHS system from being over-run did we so encourage the discharge of hundreds of older people from hospitals into the community and care homes where they were to be at greater risk or was staying in hospital an even higher threat?

In our requirement to protect the NHS at all costs did we fail to recognise the importance of ensuring that social care providers and their staff were to be an equal frontline so that requisitioning PPE supplies for the NHS would make their battle all the harder to fight?

In our desire to be prepared for an overflow did the indiscriminate phone-calls and letters about the importance of ‘Do Not Resuscitate’ orders serve to put older and vulnerable citizens into a state of real fear, leaving them with the feeling that they were of lesser worth or value?

In our requirement to support frontline clinicians to make hard treatment decisions if we should face resource constraints and run out of equipment did our ethical framework not give the impression that age would be used as a primary proxy for decision-making?

In our desire to reduce unnecessary admissions into hospitals in order to prevent the anticipated surge did our official Guidance give older people in care homes the impression that they were not to be admitted but were to be cared for and die in situ?

In our withdrawal of packages of care and support from some of the most elderly in our communities did we not place them at even greater harm not just from the virus but from dying alone, without contact, potentially hungry and disconnected?

I have my own views on each of the above but one thing I am clear of is that the attitudes of age discrimination which existed in Scotland before this pandemic have not been wiped away with its pain rather they have been magnified and lit large.

For years I have written about the way in which we have failed to value our older citizens in many disparate ways. But I see very little point in recounting these. Rather as we leave lockdown we have an opportunity to leave behind systems, models and approaches which have not worked and have failed our older citizens. We have the opportunity to cast off attitudes and behaviours which have served only to limit our humanity by dressing ourselves up into a pretence of equality.

Social care is still fighting this virus. It has not gone away and there is much more still to be done. But this is also a time for re-formation and reflection, renewal and re-orientation.

We have the opportunity to finally have honest discussions about how we will value and celebrate the reality that we have one of the fastest ageing populations in Europe. Faced with the gift of longevity and a growing life expectancy, how are we to enable those living longer even with conditions such as dementia to live until the end in the fullest and richest way possible?

We have the chance to change the way in which we value social care and those who work in it. It is not acceptable that we consider that being paid the minimum or living wage should somehow be the summit of our collective aspiration. It is not acceptable that there should be such disparity in what the State funds and what we expect citizens to pay. It is not acceptable that if you are struck down by cancer your care is largely paid for but if you live with dementia you and your family end up being charged.

We have the chance to take some really hard decisions about how as a society we pay for the potential of age which is in our midst. We need to have these grown up national discussions which we have all shied away from especially the closer we get to an election season.

We have the chance to challenge the gender segregation which equates care as being a woman’s work and thus accords it less status where the reality is that care should be the challenge of all, for all and by all. A society that does not care is not a community but a collective assortment of individual egos.

We have the chance to see those who are old as vital contributive individuals. Life does not end until you take your final breath. Let us stop viewing our humanity as if it has a use by date. Let us seriously work at inter-generational levels so that we harvest the knowledge, creativity, skill and ingenuity of all our citizens.

We have the chance to create a system which enables real choice rather than blanket solutions, gives respect and autonomy to our citizens and which takes seriously the human rights and dignity of everyone.

There will be many legacies left by this pandemic. Tragically for many of us there has been raw pain and loss at the heart of the last few weeks. But we owe it to everyone today and tomorrow to make sure that we seize the opportunities we have been given and to really build a social care system and a Scottish society where all are valued and included regardless of chronological age. This will not be achieved by point-scoring, by political fundamentalism, by defensiveness or entrenchment, but by real collaboration, honest humility, and a shared passion that we can and must do better.

Donald Macaskill

 

Review of the week  24th May to 30th May

 The world  has started to re-orientate itself to a new reality of meeting and household contact. Clearly this is not the experience of those of us working in social care. Nevertheless, there is still a slow improvement in the impact of the virus upon  the care home and homecare sectors. The concern is that with new measures and approaches that there is a risk that there may be a second viral outbreak. Without being unduly pessimistic I am convinced that this is not a matter of if but when. The next few weeks and months should afford us with some opportunity to be better prepared. But for the moment the sad reality is that we are still seeing too many die in our care homes and too much finger-pointing and blame shifting. It may be the case that the virus has left some with a visual impairment, but it is also leaving some of our politicians with amnesia.

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

Finance and sustainability

The Principles are now published and what we have seen in the previous week is an increasing number of local authorities sending out the templates to start getting payments to providers. We have even had an instance of some going beyond the principles with Edinburgh for instance agreeing to pay all voids at the NCHC nursing 80% rate rather than the residential. Again, as we have often said the proof of the pudding in all this is when providers actually start to see the money. Costs are increasing and PPE in particular is becoming prohibitive. Please keep us up to date about when you are starting to see payments come through.  https://www.cosla.gov.uk/__data/assets/pdf_file/0025/17917/Principles-for-Social-Care-Sustainability-Payments.pdf

What we have seen is a growing set of issues around the announcement last Saturday from the Cabinet Secretary re SSP and also Death in Service. This announcement follows discussions with Scottish Care and COSA. See https://scottishcare.org/statement-on-testing-and-death-in-service-benefit/   There has bene one meeting to explore the practical outworking of these statements and Karen will be sending out a survey to ascertain  what is happening in relation to Death in Service benefits and any enhanced sickness terms and conditions. We argued strongly that the analysis of what was happening needed to follow the immediate response to the current situation. However, our colleagues in Government and other provider bodies wanted to pursue this route. We will be working over the next week to tie folks down to the practicalities of both the DiS payments and the SSP post testing additionalities.

There are still concerns around the Scottish Living Wage especially for care at home and housing support. Once again we are getting weeks into a political announcement and pressure is being put on our member. Cosla hope to have political sign off by Thursday. We will keep you updated. They are fully aware of the extent of our frustrations.

Care Home Strategy, CI and Public Health Scotland

Over the week there has been a general improvement in the tone and narrative around care homes with less focus on the issues both from the media and politicians. The political focus seems both to be on the issue of a Review/Inquiry and the failures around testing and early hospital admissions.

Reduced media interest is also undoubtedly likely to because of the moves on Thursday to start Phase One of the exit to lockdown. We have added a draft statement for homes or organisations where they have had media enquiries. https://scottishcare.org/guidance-on-drafting-a-media-statement-for-covid-19-confirmed-cases-deaths/

There has been growing anxiety of the issues relating to opening up visitors and I have led a small group working on Guidance. I very much hope this will have sign off in the next week so that at the very least we can give people a date when some routine visiting can be restored. I have to re-iterate that anyone engaging in visiting which is not as described in the current guidance is taking a considerable risk both reputationally and in oopearti9nal sense should there be an outbreak.

Can I again underline that the media is searching around for any story which suggests that care homes have not been abiding by Guidance including use of PPE as appropriate and the keeping of social distance. We have to be whiter than white at the current times not least as the eyes of media and others – for their own ends – are very much on the social care sector as a whole and care homes in particular.

The new enhanced support from the roles of the Directors of Public Health, Nursing and Chief Social Work Officers have now been started. In some areas of the country it is clear that these visits, both real and virtual, have been supportive and enabling. In other parts – and Midlothian stands out – it is quite clear that these visits have been damaging, intrusive and disrespectful of professional and clinical colleagues in the care home sector.  Most of the local Oversight groups have a representative of Scottish Care in the form of one of the ISLs – there is a conflict of interest issue for it to be a provider and this has been resisted by others. Significant work has been undertaken through  the Deputy Chief Nursing Officer with a number of our care home provider to develop a clinical tool which can be used – this is due to be rolled out in the next week and a surgery focussed on this will be held on the coming Tuesdays. This is something created with the sector and which should hopefully address some of the issues and concerns being raised by others.

It is clear from the analysis of the Directors of Public Health that we are slowly but surely getting on top of the pandemic and that practice overall is of a high quality. Nevertheless, it is also clear that some homes have a distance to go and our hope is they will be supported and assisted in this journey.

Overall I am increasingly concerned as we enter the 11th week of lockdown that we need urgently to address the issues of continued lockdown and isolation of residents in their own rooms in care homes. This cannot be allowed to continue for too much,. It was proportionate and reasonable at the start – I no longer think it is.

PPE

Positively there is a continued stability in terms of the hubs and Triage. Again, if you have any issues please either tell your Local Independent Sector Lead or Swaran.

The infamous ‘glove gate’ seems to have been settled and the statement confirming this is on the website. https://scottishcare.org/updated-statement-on-the-use-of-gloves/

We continue to monitor the availability of PPE and from Monday next our website will act as a signposted and comparator to the costs we have been offered. Stefanie has done a great deal of work to try to sort the wheat from the chaff in some of these offers.

As the rest of the population (including schools and construction) begins to use and seek to access masks and gloves we will keep a watchful eye on the impact of this upon supplies.

Please also note the information on protecting your voice whilst wearing masks. https://scottishcare.org/how-to-take-care-of-your-voice-when-wearing-ppe/

Testing

Testing remains an area of real uncertainty. There is still considerable divergence on practice and there is absolutely no consistency of the approach to Whole Home testing for staff. We are continuing to try to escalate concerns in relation to this.

We have also raised practical issues around the way in which test and P[protect will impact upon the social care workforce including instances where a worker may be told to isolate or may themselves be tested positive through a non-work route.

Again, it remains really challenging to get information from the testing Directorate and yet again we cannot seem to get into their inner sanctum – as a sector! \

Please note the testing training videos on the website. https://scottishcare.org/non-face-to-face-covid-19-testing-training-videos/

Care at Home

 There will be a meeting of the Care at Home and Housing Support National Committee on the 11th June.

We continue to have very real concern that the eye has been taken off the ball within the homecare sector. There is now signs of increased demand upon the e sector as people start to end lockdown and think about return to work. Our concern is because of significant delays in payments not least around the ASLW that we may not be in a position to respond.

Karen is working with the group which is drawing up new Clinical Guidance for care at home and also for day services.

Workforce

There have been real improvements to the portal, and this is beginning to show positive outcomes. Caroline is working with SSSC and BNES colleagues on a range of packages of support and will shortly be turning her focus to the re-establishment of the Workforce groups.

Over the next few weeks and months we will need tom undertake a great deal of work to ensure that when the inevitable second wave of the pandemic comes around that we are in a batter resilience position in terms of workforce than where we have been in the last few weeks. Lots of lessons to learn and share with our colleagues.  Caroline will be in touch with providers in the weeks to come.

Jacqui Neil our Nursing Lead has written a moving and very personal blog on some of the grief and bereavement impacts of Copvid19. Please read it at https://scottishcare.org/a-new-taboo-latest-nursing-blog/

Communication

We are now going to be holding one Surgery a week which will be on a Tuesday at 12 and will last an hour. The coming one will focus on the clinical assessment tool. There will also be an opportunity to raise the usual questions with Karen and myself.

Please continue to send positive good news stories to us so that these can be put up by Shanice on the Good News Stories. See https://scottishcare.org/good-news-stories/

Please continue to use the members Discussion Boards not least to share thoughts and ideas.

We have also been running a lot of local Teams Member sessions – please get in touch with Swaran to find out where and when your nearest Members session is. National staff try to join these as do the local Independent Sector Leads.

Consultations.

We are beginning to get a lot of demands for consultation responses. Becca has developed these and we have responded to the Testing Inquiry and most recently the Lockdown Inquiry. We will put these up shortly onto the website.

 And finally,…

Many of you will know Verity Monaghan our Human rights Worker went off on maternity leave a few weeks ago. We are delighted to say she  has given birth to a baby girl Eden and we wish her well.

In the rhythms of time we are now also advertising a 9 month post as maternity cover. This is fully funded by life Changes trust and is a really good opportunity for someone to come and work with us in embedding a human rights-based approach to care at these challenging times. Please pass the advert to those you think might be interested. See https://scottishcare.org/job-opportunity-human-rights-project-worker-maternity-cover/

I have been touched by the response to my last blog on the wellbeing of our exhausted staff. I think it fair to say that for every negative comment in media and on political lips there are a hundred voices saying thank you, recognising the energy, efforts and work of frontline carers and also of managers, supervisors and owners.

For that reason, as we end ClapforCarers we have started #candleforcare at 7pm on a Tuesday – a small start to say thank you, to remember and to reflect.

Thank you for all your continued work and engagement.

Donald

30th May 2020

 

 

 

 

 

 

 

 

 

Statement on Testing and Death in Service Benefit

Statement

Scottish Care is pleased that following a submission to and meeting with the Cabinet Secretary Ms Freeman and Cllr Stuart Currie from COSLA on Friday 22nd May that the Scottish Government has decided to use the powers within the Public Health Act 2008 to ensure that no worker is disadvantaged if they are identified as requiring to isolate following a positive test for Coronavirus.

We are further grateful that the Scottish Government has taken the decision that the dedication of frontline social care staff who have tragically died from Covid19 should be recognised by means of a one-off ex-gratia payment of £60,000 to the families of those so bereaved.

Scottish Care will work with colleagues in COSLA, the Health and Social Care Partnerships and relevant Health Boards to expedite the practical arrangements of both these commitments in the coming days.

 

Ends./

Coronavirus exhaustion – upholding the mental health of the care sector.

 

We are on the penultimate day of Mental Health Awareness Week. It has been a week when there has been a great deal of focus on the mental health and wellbeing of all our citizens as we live through these strange Covid days. Lockdown has added to and created considerable mental health distress and ill-health for tens of thousands. For many help has come from support they have found online or on the other end of the phone. For many others help simply has not come and at best will be delayed. How we look after ourselves mentally as individuals and as a nation matters now more than ever before.

In my thoughts today, however, I want to focus on some of the conversations which I have been having this week with folks in the care sector. These have been conversations which have shown me the real fragility which exists out there in terms of the mental wellbeing of our care sector. They are conversations which have changed quite considerably in tone and concern.

I suppose the first thing to say is that I am detecting a real change in the spirit and the morale of people delivering care in our care homes and in the community. I am detecting a depth of emotional exhaustion which I have never seen before.

It is probably a truism to say that whenever we are faced with a challenge in life the adrenaline of initial encounter, the support of those around us, the sense of collective endeavour can serve to energise and renew us. I think that was what many people felt in the early days of the Covid nightmare. Undeniably some of this collective camaraderie was on the back of a failure on the part of the rest of society to value the role of carers at the start of the pandemic. There was the constant focus in media and politics upon the NHS and its workforce. I am not – lest I be accused of it – denying the importance of our NHS colleagues at any time far less in recent weeks – but undeniably whether it was by being barred from special shopping times or refused offers from companies for ‘NHS only’ employees – social care staff felt ignored and put aside in the early days of the pandemic.

That changed and the ‘Clap for Carers’ movement – a response which may come to an end this coming Thursday – helped to underpin the central role and critical contribution of social care and other key workers to the rest of society. In the midst of battling this virus there was a growing sense of us all being ‘In It Together.’ Political point-scoring was put aside, and we entered a no-man’s land of consensual support, collective solidarity and focussed attention on beating the virus not least in the care home sector where it was beginning to have a dreadful impact.

But over time I have detected a change in the mood. The uneasy political peace gave way to the articulation of blame and the apportioning of responsibility for action or inaction. Personalities began to dominate rather than community consensus. The media began to focus negatively and critically on the care home sector and the inevitable finger-pointing started. Workers were literally door-stepped and followed home by a media sensing a story and with little concern for the aching pain and loss frontline workers and families were living through. But despite all this there remained an astonishingly sacrificial professional commitment on the part of the care workforce focussed on saving lives, being present, consoling and comforting.

But there is no doubt 9 weeks into lockdown that people are exhausted.

There is a type of tiredness which is so intense that it reaches deep inside the marrow of our bones. It is an exhaustion which is more than physical, it encompasses our spirit and our very being, it removes the energy which keeps us going even when we are tried beyond imagining. It is this emotional and total fatigue which is happening to care workers, managers and providers across Scotland.

I have never before had to hold so many conversations with individuals who have been on the edge of emotion, who are simply drained of energy and very tired at the constant barbed criticism which they feel is being directed at them from all quarters.

There is a coronavirus burnout happening before our eyes across Scotland. It is an exhaustion which is emotional, mental, and physical and it has been fed by excessive and prolonged stress. The stress of keeping going, saving lives, granting compassion and simply being present. And all the time there is a ticking clock of critique in the background. And accompanying this there is an emerging individual guilt – however misplaced – of ‘Could I have done better? Did we do everything we could have?’

 We need to be alive to the reality of a burnout care sector, of workers, managers and others feeling they have lost purpose. This does not just necessitate a response at an individual level it requires a real ‘putting our arms’ around care homes and home care. It is imperative that the potential of support for social care is achieved and maximised, that there is a mutual appreciation of the professionalism of the care sector by health colleagues and vice-versa.

It is well known that although we may expend all our energies getting to the summit of a challenge it is in the process of descending from the peak that most harm and injury is caused. The care sector in Scotland has exhausted every energy in fighting this virus and is still doing so – unlike the rush to lockdown seen elsewhere and the silence of unclapped hands  – the battle is still going on; lives are still being saved and cared for.

The last few weeks have been a collective effort and it is imperative that the next few weeks are ones where health and social care, where worker and manager, where politician and commentator, continue to uphold the care sector as we work collectively to meet the challenge of this virus.

There is a burnt-out exhausted care sector in our midst, but it is also one which is strong. It is strong in its talent, its creativity, its compassion and professionalism. It will grow stronger still if it is really supported, truly valued and deeply cherished.

As we end Mental Health Awareness week, I hope we can all collectively continue to remember and focus on the amazing care in our midst. So, every Tuesday at 7pm I will try to light a candle and spend a minute to remember those who have died in our care homes, in our hospitals and communities; to remember those who care beyond calculation, those who go out from comfort to give compassion; those who work tirelessly even when exhausted and burnt out. I will remember until that day when we hear of no deaths from Covid19. May that day come soon.

Please join me in lighting a #candleforcare.

 

Donald Macaskill 

CEO Review of the week  17th to 23rd May

Review of the week  17th to 23rd May

 

This has been the week when the Scottish Government has published their Route map to drive us out from lockdown into the ‘new normal.’ It has also been a week where we have seen a further decline in the number of deaths from COVID19 in our care homes. But on the other perspective it has been the second week in a row where we have seen an increase in deaths in the community. This latter fact underlines our concerns at Scottish Care that just as we may be thankfully reducing care home deaths, as the rest of society opens up we may see a real rise in deaths affecting our homecare sector. We will continue to emphasise the importance of protecting some of our most vulnerable citizens regardless of where they may live.

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

Finance and sustainability

You may recall that Karen and I were due to have a meeting with COSLA on Tuesday. Regretfully this was postponed until yesterday because local authorities had still not received the assurance from Scottish Government that the promised funds for social care would be delivered. We are pleased to confirm that this is now the case. The Principles Document which has been signed by Scottish Government and COSLA can be seen at https://www.cosla.gov.uk/__data/assets/pdf_file/0025/17917/Principles-for-Social-Care-Sustainability-Payments.pdf

You will see that it illustrates the principles on which funding around sustainability will be delivered to the sector. We had a meeting with COSLA officials to express concern about some of the wording and are seeking for some edits to this – especially the issue re profit and ‘other costs’. In reality in terms of care home occupancy the 80% is the standard fee which is paid by a LA if a care home bed is unoccupied if someone is in hospital etc.  Each HSCP will now send (and some have started) a template to providers to have them complete this in order to release the funds. We have encouraged the use of one template, and  this will be underlined by COSLA to the Chief Finance Officers when they meet on Tuesday coming. At this stage it is likely that a template being used in Glasgow (and which was developed with the sector’s input) will be used more widely. We have been assured that despite the statement re open book examination that there is neither a desire nor capacity within the system to do this as a matter of routine. I do believe that our partners are aware of the real and very acute sustainability risks the sector is currently under and that monies will begin to be transferred out from the centre as quickly as possible.

We have particular concerns in relation to the lack of robustness around supporting the homecare sector. We have been assured that the presumption of paying for planned will be enacted. We will be keeping a watch on this. In addition, the agreement only lasts until 23rd June. This is not to say that in what is being termed the ‘recovery’ stage that these monies may not continue but we have started discussions with COSLA on these issues.

There are still concerns around the Scottish Living Wage especially for care at home and housing support. Our colleagues in COSLA have been robustly made aware of the criticality of these matters and are pursuing Scottish Government once again to get the confidence from them that monies will be transferred to enable these payments to start.

Lastly we have met with our colleagues from CCPS and COSLA this week on the issue of how do we support providers to supplement the pay of those workers who have to isolate should they be tested positive for COVID19 as the care home tests are rolled out together with raising the issue of Death in Service Benefits for the 8 social care workers who have tragically died in the last few weeks. On both accounts Scottish Care submitted a paper to Scottish Government, and together with the COSLA political lead I held a meeting with the Cabinet Secretary yesterday. At the time of writing this she has not responded officially to the proposals we put to her but I expect her office to do so today and we will communicate this information as soon as we can.

Care Home Strategy, CI and Public Health Scotland

Last week I commented on the unhelpful political narrative and the level of blame that was being put upon the care home sector. I had an honest and frank phone call with the Cabinet Secretary on Monday and underlined to her the real sense of harm which was being done to the sector and the sense of disappointment and dejection that many working in the sector were feeling both about political  finger-pointing and also the media narrative. I have detected a slight change in tone in the last few days and we will keep a watch on this. Nevertheless, it is clear from comments by the FM and others that there is a desire to ‘look at the model’ of current private sector  leadership of the care home sector. We will robustly articulate when it is necessary and appropriate the benefit of the ‘mixed economy’ approach to care home provision in Scotland and the fundamental distinction between social care and a health care approach to older persons care and support.

Reduced media interest is also undoubtedly likely to be because as society is opening up we are noting a media refocus on to other areas away from a frenzy around care homes. What we are nothing is more localised stories and we will continue to support members in meeting these. There has also been an appropriate level of increased scrutiny both on the Government’s actions and speed of response and on the performance of the NHS.

The week has seen a debate centred around some of the amendments to the Coronavirus Emergency Powers Act . Both Government amendments were enacted and one opposition amendment to create a Social Care Worker Fund. As we stated before in principle we do not contest these amendments as they merely consolidate existing powers. However, we asked for more detail for the reasoning of these and both it and the response of the Cabinet Secretary is up on the website. https://scottishcare.org/communication-to-and-from-cabinet-secretary-on-emergency-powers/

The Scottish Care Executive met again on Friday and we considered the financial sustainability package together with issues relating to the announcement on Sunday last (17th) of enhanced roles for the Directors of Public Health, Nursing and Chief Social Work Officers. The creation of a local Oversight group in each area mirrors what has been happening already in some areas. However, this letter has been very regrettable both in tone and communication. See https://scottishcare.org/coronavirus-covid-19-care-home-oversight/. We were not sighted on its creation nor were we included in its delivery. Neither I believe were other key stakeholders.  It is yet a further illustration of the direct involvement by health professionals in the system with a limited lack of knowledge and at times a lack of clinical respect for the care home sector. The ‘visits’ which are resulting are meant to be supportive and encouraging – the reality is that they have been in some parts of the country dispiriting and focussed on scrutiny and inspection. We are raising these issues as a matter of urgency – untold damage could occur if these do not happen properly. After our complaints Guidance is being prepared for these officers to ensure the balance is an appropriate one. It has also been agreed that there should be a Scottish Care representative on the Groups. We are, to date, not seeing this being universally enacted.

Early feedback seems to underline the professionalism of the sector. However, I am still really disappointed by instances which are being discovered and which are clearly evident in social media of examples where staff are not abiding to social distancing, seem not to be wearing appropriate PPE and where residents are not socially distanced. These illustrations of potential failure to follow Guidance make it really challenging to advocate for the professionalism of the sector.

Both the Rapid Intelligence Group and the Clinical and Professional Advisory Group met again last week. The Clinical and Professional Group received a paper from Dr Jenni Burton, Derek Barron and me on steps and principles to ease lockdown and promote visiting. More work will be done on this in the next weeks. Readers will also be aware of the mention of progressive easing in the SG Exit Strategy – and the creation of a ‘designated visitor’. I am  working with a group of others on these issues.

We are hearing of real operational concerns around the role of the Procurator Fiscal and the police in care home COVID19 deaths. We have raised concerns of ‘heavy-handedness’  and the impact on bereaved families with the National Contingency group and with  Scottish Government.

PPE

Positively there is a continued stability in terms of the hubs and Triage. Again, if you have any issues please either tell your Local Independent Sector Lead or Swaran.

Then we had what has become known as ‘glove gate.’ Towards the end of the week uncertainty over the appropriateness of vinyl gloves began to appear and then NSS issued a statement to ask members to begin to use nitrile gloves. After a frustrating day seeking clarification from HPS and PHS we believe that the status quo is to continue – that is the verbal reassurance that has been given to Karen. I believe that a statement will be made by HPS imminently to clear this issue up. We will put this up on the website when sent.

This is yet another illustration of local Health Boards making decisions without recourse to normal channels and to provider bodies. This is the tale of this pandemic to date!

We continue to monitor the availability of PPE and from Monday next our website will act as a signposted and comparator to the costs we have been offered. Stefanie has done a great deal of work to try to sort the wheat from the chaff in some of these offers.

We are also acutely aware of profiteering and are working to address and challenge this through the media.

Testing

On Monday and Tuesday (18th /19th) the Cabinet Secretary announced the extension of tests to all staff regardless of care home. It is believed this will commence next week.  We continue to be profoundly concerned about some of the practices around testing to date and the extent to which there will be capacity to fulfil future testing. Becca has presented a paper to the review of Testing being carried out by Parliamentary Committee.

Testing is still a patch-work around the country with diverse practices, timescales and prioritisation.

Care at Home

 As I mentioned in my opening paragraph we are continuing to be concerned about the rate of transmission in the community. We are determined to try and keep the real pressures of the care at home sector to the forefront. Karen has joined a group which is reviewing the Clinical Guidance for care at home and community nursing to ensure consistency of experience by those supported in the community. She will be engaging with providers in the next few days on this.

We also intend to have a meeting of the Care at Home and Housing Support National Committee in the near future.

As many of you will be aware yesterday should have been the Care at Home Conference and Awards. We are aware that this is a real loss to the sector as well as to us as an organisation and we want to spend some considerable time trying to not just ensure that the sector has a future and is sustained in that but that we can use this time as an opportunity to re-focus, underline and enhance the role of services. We need to celebrate the value of work undertaken in the community which at times is being lost with the focus elsewhere.

Workforce

Real attempts have been made in the week that has passed on the SSSC portal including the use of postcodes to make selection and allocation easier. We hope that though the numbers remain small that we can start to see greater usage. Caroline is working hard both on this and in developing training materials for new entrants and others. We are aware that as we move forward training becomes imperative and that re-design will be necessary as we face the reduction in face to face training opportunities. In addition, and more positively we are seeing in some parts of the country an upsurge in applications of people wanting to come to work in the sector. A re-purposing of the national TV campaign is being considered.

Can I remind you again of the National Wellbeing Hub which has received positive feedback from workers and managers in the sector. It can be accessed at https://www.promis.scot

We held a very different Surgery on Thursday  on the theme of bereavement and grief so a huge thanks to Sandra Campbell and Andrew Gillies.

Please also check the developing parts of the website showing resources for staff wellbeing , including from Scottish Ballet. See https://scottishcare.org/scottish-ballet-health-at-hand/ and Help for Heroes https://scottishcare.org/help-for-heroes-mental-health-wellbeing-resources/

Nursing.

The Nursing Strategy group met on Friday morning and considered some of the developing support and practice across the country. We are very grateful to colleagues for joining this forum which provides an opportunity to raise issues of concern and best practi8ce. If you are interested in joining this group then contact Jacqui Neil.

 Communication

We are going to hold another two Surgeries this coming week but will reduce them to 45 minutes. The details are on the website. They will this week be facilitated by Karen Hedge and me.

Please continue to send positive good news stories to us so that these can be put up by Shanice on the Good News Stories. See https://scottishcare.org/good-news-stories/

Please continue to use the members Discussion Boards not least to share thoughts and ideas.

Becca and Shanice have started to create a daily timeline of documents and statements so that we get a full picture of the pandemic and its impact on the sector. This is important not least in challenging the collective amnesia of some in terms of what happened and when.

 And finally,…

This week through the work of Tara French and Becca Young we have launched a new research project. Everyone and their granny has been talking about what the future of care needs to look like. It is imperative that we represent the choice of the sector and its workforce in that highly politicised debate and to remove the politics from the narrative. So please read about the Building our Collective Care Future and please get involved. See https://scottishcare.org/project/collective-care-future/

Thank you for all your continued work and engagement.

 

Donald

23rd May 2020

 

 

“Emptiness I have never felt.” – the trauma of caring in the pandemic.

We are now eight weeks into the Covid19 pandemic in Scotland’s care homes and the extent of distress and trauma being felt by many residents, staff and families is really hard to bear.

I was going to write something positive this week about the way in which infections are declining, about the amazing  work that frontline staff, managers and owners are doing to keep spirits up and positivity going, and about the news that in one Health Board there are hardly any Covid positive cases in the care homes in the area. So yes, there is at last a sense in which we are turning a long slow corner … hope is on the horizon.

But on Thursday I received a letter of such honesty and beauty that I need to share  some of its content with you in this blog.

Mary is a nurse in a care home run by a family who have owned the home for many decades. It is a good home with plenty of individuals wanting to come in as residents and with very good and consistent Care Inspectorate grades. The staff are skilled, empathic, kind and committed. There really is, in Mary’s words, a home from home feel about the place. From her description this is a care home which is doing precisely what all good care homes do, providing life and energy and safety for those who need additional support due to frailty or age. Sometimes in all the debate and necessary focus on infection control of the last few weeks people have forgotten that a care home is not a ward, a unit or an institution but someone’s home. Places where people are encouraged to bring in possessions and furniture to make the loss of their own homes and spaces less acute and hard. Places where you are encouraged to wander and chat, to settle and be still, to dance and play, be active and alive.

Mary has worked in the home for nearly 13 years and she has nursed individuals through the rhythms of pain and parting, has given solace at times of sickness and celebrated when people have recovered and been restored to health. This is the nature of care home life, a life in tune with the seasons of humanity, comfortable with living through older age and enabling not existence but life to the fullest in the face of mortality.

Then the virus struck in Mary’s care home. Like the thousands of other nurses and care staff in Scotland’s care home sector Mary is skilled and experienced in dealing with viral outbreaks not least norovirus and seasonal flu. But Coronavirus is unlike any other. Its silence creeps and kills, it’s invisibility touches and destroys. Despite very stringent efforts, with adequate PPE and a well-trained staff the virus got into the care home. No-one knows how but it did. Mary writes:

“We have been living with this virus eating away at the heart of our home. In a matter of days, we have lost so many people it is just too hard. We have lost real characters  – people who made the place what it is with their laughter and jokes. We have lost folks who have been here for so long. And when I say lost that doesn’t even tell it as it is. The deaths were really hard. They were sudden and horrible. People need to know about this. No-one is talking about the horribleness of this disease… No one wants to know the real fear we feel as we sit there holding the hands of people as they pass… It is all just numbers out there read out every day. It is all about getting back to normal. I can never get back to normal… But it is our friends, people we know like a family.. I have lost so many… I cannot sleep at night because of the sadness I have… it is an emptiness I have never felt. I can’t even say goodbye to them.”

Mary is not alone. Others have written to me or reached out through social media to say the same thing that we are not telling the full story of the deep sadness that is being caused by this virus. That as a society we have become inured to the statistics turning them into data analysis, projections and comparisons.

All of us who have known and lost someone to the virus will live with that memory for ever. We have not had the chance to grieve. We have not had the moments of hearing the story of a life lived because there is no one to tell it to us. But those who have had to be present at the bedsides of residents and friends, those who have experienced multiple deaths in such a short period of time, their trauma is acute and aching.

It is each of our responsibility over months and years to uphold and support these people. We will need to be very alive to the reality that what some will suffer will be post-traumatic stress. We will as a whole society, from Government to provider, from neighbour to family, require to be present to listen, console, support and cradle their grief.

But it is not just for care staff. Our cradling and solace-giving needs to be for the families and friends unable to be present, for fellow residents who have lost friends, and indeed for ourselves.

I hope that in the coming days and weeks the increasing words of harsh criticism, of finger-pointing and blaming, will be quickly worked through. I accept that they are often a understandable response to grief and trauma and that they are sometimes necessary to assure and to hold accountable all of us for what we have done and not done. But they ill-serve us if we want to move forward as a nation, as a community and as individuals. We need to learn again how to be kind.

I really do hope that we are all able to be increasingly present for those who feel like Mary, emptied of hope and life. I hope we will remember that true community is when we work, act, sit and rest in a spirit of open honesty and togetherness.  

There are hundreds of stories which have been left untold. As we come out of this cruel time it is up to each of us to give space for their hearing, soothing for the sorrow felt, and comfort in the emptiness. Mary and others in our care sector deserve no less.