Huge thanks to Dr Jenni Burton and Fiona Mackenzie from Public Health Scotland for coming onto our members surgery today (03 November) to talk through the report that was recently published by PHS on Discharges to Care Homes from NHS Scotland Hospitals. This report is available here.
We hope that members found this session useful, presentations slides and the recording of the surgery can be accessed via the buttons below.
For further discussion and queries, please contact:
Fixed term contract funded till March 2021 (initially) subject to funding may be extended to March 2022
Do you have an interest in improving the quality of care, can you COLLABORATE, INNOVATE AND COMMUNICATE, and would you like to join a successful, committed and highly motivated team? This could be the opportunity you have been waiting for.
We are seeking to engage an Independent Sector Lead to support the Integration of Health and Social Care in the Scottish Borders. Hosted by Scottish Care and working closely with care providers and partners, the post involves ensuring sector involvement in the delivery of the integrating of health and social care in Scotland’s HSCPs
The post holder must be highly motivated, be able to use initiative, possess excellent communication and networking skills, demonstrate success and experience working at strategic level with policy makers, providers, regulators, people supported by services and carers. Qualifications and experience at a senior management level would be a significant advantage.
The post holder will be expected to create and support significant collaborations across the independent care sector while contributing to the development of new care pathways which will result in the delivery of improved outcomes for people who access care and support. The post holder will ensure the Independent sector’s contribution is fundamental to integrated services and transformational change and be able to evidence their impact. The role requires considerable and skilful collaboration with our key partners in the NHS, Local Authority, Carers, third sector organisations and other forums.
The post is home-based with travel where necessary, based and is hosted by Scottish Care.
To request an application pack, please contact Colette Law at Scottish Care by email [email protected]
Closing date 4pm on Thursday 12th November 2020. Interviews will be held by video conference – date to be confirmed.
A collective of charities and interested organisations will shine a light on bereavement this week, as they launch the To Absent Friends festival 2020. Heralded as a ‘people’s festival of storytelling and remembrance’ the festival takes place from 1-7 November across Scotland – online, in public spaces and in people’s hearts and minds.
The festival will see the launch of the To Absent Friends Cookbook – a collection of recipes and stories for those loved and lost. (https://www.toabsentfriends.org.uk/cookbook/) The virtual book has been put together by Cruse Bereavement Care Scotland, Macmillan Cancer Support, Marie Curie, Scottish Care, Scottish Partnership for Palliative Care and Sue Ryder.
“Working to support people who are bereaved, we see how important it is to make time in our lives to remember people who have died. 2020 has brought loss and grief to many, while also preventing people from getting their usual support from friends and family. We’ve seen how hard this has made life for people who are grieving. The To Absent Friends festival is an opportunity and an excuse for people to take a moment in their busy lives to remember people who have died, whether recently or long ago.” said Nicola Reed of Cruse Bereavement Care Scotland, who shared a her Dad’s special stew recipe for the Cookbook.
The To Absent Friends Cookbook brings together stories of people who have died, alongside recipes that have special significance for the people they left behind. A mother’s recipe for stovies, a friend’s delicious traybake, a much-loved daughter’s favourite pie.
“When we were compiling the cookbook, we noticed that most of the food people connect with loving memories is delicious, homely and comforting, like a shepherd’s pie, or a simple occasion cake. And the stories that come with the recipes are a delightful mix of love, laughter and tears. It is particularly poignant to be publishing this book this year, in times of covid-19, when so much loss has been suffered by so many.” said Rebecca Patterson, Director of Good Life, Good Death, Good Grief.
The launch of the To Absent Friends Cookbook is just one of many activities taking place as part of the festival this week, as communities from across Scotland hold local remembrance events. With most face-to-face gatherings out of the question this year, much is taking place online and planners are finding innovative ways of creating time and space for remembrance.
For example people living in Willowbrae, Edinburgh are creating a ‘wanderland’ of home window displays in memory of people who have died; Action Porty are providing individual kits to enable households to have beach bonfires of remembrance; and North Argyll Carers Centre has invited bereaved carers to contribute to a beautiful light installation which will be suspended within North Argyll Carers Centre to be viewed from the windows during the festival.
“I think that this year most of us have been craving human connection. And that is what this festival is about – connecting with each other over shared memories and stories. Perhaps this year, when it is hardest to organise a festival, it is more needed than ever before.” said Richard Meade, Head of Policy and Public Affairs Scotland at Marie Curie.
To Absent Friends is a reminder, an opportunity and an excuse to create time and space to remember the important people in our lives who have died. Festival organisers are inviting members of the public to get involved, even at short notice, from the comfort of their armchair.
They invite people to visit the festival website www.toabsentfriends.org.uk to share their memories on the online wall of remembrance, add songs to the Remembrance Playlist, or tweet #ToAbsentFriendss throughout the week. A full list of this year’s events is available here: https://www.toabsentfriends.org.uk/blogs/festival-events-2020/
For more information, contact Rebecca Patterson on [email protected] or find out more via the website www.toabsentfriends.org.uk
Huge thanks to everyone who joined us for our Digital Safety Huddle webinar and demonstration yesterday. And thank you to Nancy from NES who hosted this session.
The recording for this webinar can be found below.
For any queries, please contact: [email protected]
We have created a handout that providers can download with guidelines on car sharing.
The guidance says:
In the early days of the pandemic the wider societal and political concern was the risk that the NHS acute sector would not be able to deal with a massive increase in patients requiring treatment for COVID19. It was at this time that there was a concerted focus on creating capacity within NHS hospitals by ceasing routine non-essential treatments, by maximising the availability of respirators, etc. At the same time there was a push to discharge individuals who were fit for discharge either to their own homes or to care homes.
In ordinary circumstances an individual is discharged when they are clinically fit. Before Covid-19 this was often a process which was delayed as a result of the non-availability of care home beds. This was not because the beds were not available but because funding from public authorities was not sufficient to enable these transfers to take place.
Even before Covid-19 there were circumstances where the eagerness to discharge from hospital in some locations had led to a strain or breakdown in relationships with the care home sector. The most commonly cited instance for these tensions was where a clinician considered someone capable of being supported in residential care, whereas after they were discharged it became clear to care staff that they required nursing and not residential care.
Before the pandemic, therefore, the process of clinical discharge into care homes was one which was not always smooth and frequently problematic. As a result, there was often a local distrust in the discharge system and process.
This level of challenge was reflected in the Clinical Guidance issued by the Scottish Government on 13thMarch which stated:
‘Transitions from hospital.
There are situations where long term care facilities have expressed concern about the risk of admissions from a hospital setting. In the early stages where the priority is maximising hospital capacity, steps should be taken to ensure that patients are screened clinically to ensure that people at risk are not transferred inappropriately but also that flows out from acute hospital are not hindered and where appropriate are expedited.’ (page 4)
Because individuals were not routinely tested at the point of discharge at this stage of the pandemic, despite the requests of the care home sector at the time, there was a real concern that people who entered care homes might be infectious. It should also be noted that the Guidance from Health Protection Scotland issued on 12th March made no reference to any process to be undertaken during admission from hospital.
Scottish Care’s CEO, Dr Donald Macaskill held a meeting on the 18th March with the Cabinet Secretary for Health and Sport and highlighted that care home providers were expressing concern over discharge procedures and that some were refusing to admit new residents. During the meeting he stated that the previous relationships between the acute and care home sector had sometimes not been as good as they might have been. As a positive result of the meeting the Clinical Guidance was revised and re-issued on 26th March.
This Guidance made the process of admission much clearer. It states:
‘4.2 Admissions/transfer from hospital to care home facilities
HPS updated guidance states that if the individual is deemed clinically well and suitable for discharge from hospital, they can be admitted to the facility after:
Decisions about any follow-up will be on a case by case basis.
If a patient being discharged from hospital is known to have had contact with other COVID-19 cases and is not displaying symptoms, secondary care staff must inform the receiving facility of the exposure and the receiving facility should ensure the exposed individual is isolated for 14 days following exposure to minimise the risk of a subsequent outbreak within the receiving facility.
Individuals being discharged from hospital do not routinely need confirmation of a negative COVID test. Facilities will be advised of recommended infection prevention and control measures on discharge. It is recommended that this includes a documented clinical risk assessment for COVID-19.’ (pages 4-5)
This general approach was followed which meant that there was a presumption that it was not necessary to test an individual prior to them being discharged and admitted to a care home. This is stated clearly in the Health Protection Scotland Guidance of 17th April:
‘As part of the national effort, the health and care sector plays a vital role in accepting individuals who have COVID-19. Such individuals can be safely cared for in a health and care facility, if this guidance is followed.
Individuals who have been confirmed as having had COVID-19 but no longer have symptoms and have completed their isolation period prior to arrival, whilst still in hospital, home or another facility, can have care provided as normal.’
Scottish Care during this period continued to call for mandatory testing of individuals at the point of discharge whilst at the same time recognising the importance of residents returning to their care home and the strategic need to ensure that people were not unnecessarily delayed in hospital.
We further recognise that from 21st April it became a requirement for all patients being transferred from hospital to receive a negative test. Before this date, no such requirement was in place.
Before 21st April it is impossible to determine the extent to which care providers were made aware of the testing status of individuals upon admission to care homes.
Today’s report is an extremely thorough statistical analysis based on a diverse set of data and a triangulation exercise and presents a conclusion that hospital discharges per se were not a significant factor in outbreaks in a care home. It does state that the admission of some residents in some instances would statistically increase the risk especially if they had been untested.
More reassuring is the analysis that the use of testing reduces the risk of an outbreak in a care home. The report’s recommendation on the importance of discharge planning involving the person themselves, their families and care homes as partners, and on the need for clear communication of an individual’s testing status, is welcome.
More work needs to be undertaken to better understand the reasons why the size of a care home is proving to be a factor in relation to outbreaks, including what particular factors relating to size have an impact.
Dr Donald Macaskill, the CEO of Scottish Care states:
“Today’s report makes for detailed and robust reading and yet it is only part of the story. The statistical analysis is thorough and highlights that the risks to care homes in terms of outbreaks are related to the size of a care home. This is because larger care homes tend to be nursing homes, dealing with more frail residents and those living with dementia; they have larger numbers of staff members and environmentally because of size present greater IPC risks.
What is missing amongst all the data and statistics, the numbers and charts, is the story of those who cared for residents in our care homes. Their experience of discharge, of residents arriving home or coming for the first time to the care home, is missing and requires to be told. Some of our members and staff who work in care homes in a few cases believe that Covid-19 was introduced into their care home community as a result of discharges. I hope the researchers can take some time to listen to the experience of staff in care homes where there have been significant outbreaks. At the moment we have one side of the story, what is missing is the frontline experience of our care sector and its staff, the voices of those who received care and their families.
At the start of the pandemic all the emphasis was on the preservation of the NHS. Our politicians and medical advisors stood in front of posters which read ‘Protect the NHS’. The care home sector and its workforce played its part in that protection, and can be assured that in the majority of instances that support through enabling people to come home or be admitted, was not a significant risk factor for outbreaks. However, we need to ensure that where people are convinced there was a direct relationship between discharge and outbreak that this belief needs to be investigated.
We should have initiated testing for all discharges much earlier than we did. The report makes it clear that there are real benefits from this testing process.
We know those of older age, the very frail and those living with multiple co-morbidities remain at particular risk – we all of us need to do everything we can to protect our most vulnerable, regardless of where the live or are cared for.
We expected and still do expect that care homes, which are places of contact and community, become isolation units for those leaving hospital or coming in from the community, almost to become specialist infection control environments against the most virulent disease we have witnessed in decades. Care homes, regardless of the sacrificial dedication and skill of staff, cannot completely protect against the virus. It is quite clear that during the summer we had virtually no outbreaks but as transmission rates increased in the community, then the risk of asymptomatic spread into our care homes has increased at a disturbing level.
The report is a reminder of the pain we have all endured. Its insight should become the energy to ensure that the whole health and care system really does support the care home sector in the weeks ahead, that it becomes each of our responsibilities to protect by our everyday action, putting the needs of the residents rather than the protection of any system or organisation at the heart of that shared focus.”
Public Health Scotland has published its findings on discharges from hospitals to care homes during the COVID-19 pandemic. The report is split into two sections: one presents statistics on people aged 18 and over who were discharged from a hospital to a care home between 1 March and 31 May 2020, while the other defines and describes care home outbreaks of COVID-19 with an analysis of the factors associated with those outbreaks, specifically including hospital discharges.
Dear Care Home Providers/Managers
Some of you may be aware that collaborative work is underway to progress of the implementation of the CHAT (Care Home Assessment Tool) Covid app. In line with this, we are requesting assistance to inform the progress of Phase 2 work. It would be helpful if care home providers could share the escalation tool carers currently use for recording the deteriorating residents in residential homes. We are aware that care homes with registered nurses will use tools such as News and Restore 2 to support this. We appreciate that there is likely to be variation around this and would appreciate your input to inform this work so we can consider the best triage tool to support carers to escalate and get medical support. If you could contact me re this directly on [email protected] as soon as possible to allow us to determine the best way forward.
Many thanks,
Jacqui Neil
Transforming Workforce Lead
In the last few months in Scotland, (NQNs) newly qualified nurses joined the register and took up posts across health and social care. Although this year saw a further increase in applications to nursing programmes across the country, vacancies remain high and are increasing.
Making the transition from student nurse to registered nurse is something no nurse forgets; it is etched in their memory as one of the most terrifying and memorable times in their career. Imagine how it feels then to qualify in the ‘International Year of the Nurse’, in the middle of a global pandemic and no graduation ceremony.
The world was very different when I qualified. When all I thought about was how proud I felt to get my epilates and replace my 3 striped card nurse hat with the thick blue stripe that showed I was now a qualified nurse. I was also grateful when these were phased out soon after I qualified, as by the end of the shift most nurses looked like they had been dragged through a hedge backwards. Anyone out there who trained in the 80’s will echo this sentiment, I’m sure. This however meant I no longer could hide behind my student name badge with an expectation by patients, families and colleagues to be competent and confident to carry out this new role.
I felt that I had to know everything about everyone in an instant and I remember struggling to get my tongue around some of the conditions, terminology, and medications, feeling like I had to learn a new language, which I am glad to say I’m pretty fluent in now. Everyone else on the ward seemed so in control and confident with me the only NQN on that ward, which definitely added to the pressure. Back then I was confident that the staff had my back, we were a team and I was part of it. I had transformed into the nurse who held the keys on shift when my probation period was over.
My point in raising this is that everyone has been that nurse, although this time is exceptional for all staff, each nurse will understand your fears and it’s so important that you realise that being newly qualified doesn’t mean you will be left without support , and more importantly you can speak up. There really is no such thing as a stupid question when it comes to safeguarding patients and staff. Being assigned a mentor during this time to keep balance and perspective will allow you to grow and develop your skills alongside a preceptorship programme in place. Three or four years of study to get to this point, but no foresight could’ve prepared any nurse for what it would be like to be a NQN in 2020.
Unfortunately for our 2020 nurses who have just qualified, they are faced with a greater transition complicated by workforce issues, infection control and high-risk challenges at a time when even the most qualified of staff have real concerns and deficits. Working in an ever-changing landscape adds to the feelings of uncertainty. This is compounded by the potential for witnessing increased loss of life both for patients and for some, potentially colleagues too. Feelings of isolation and vulnerability although common are often overwhelming whilst ensuring adherence to the nursing codes, which highlight the pressures of accountability in clinical practice. The NMC describes Delegation and Accountability as “the principle that individuals and organisations are responsible for their actions, and may be required to explain them to others” (NMC, 2018b). There remains limited research in relation to transition but key areas are around the preparation for this change in identity, status and future career. Higher education institutions do and will continue to play a significant role by working with students to plan for a successful transition and develop strategies to better manage their work.
But this year we must recognise that there will without question be potential for work-related stressors. Complexities due to workplace changes will occur as a result of the pandemic and the physical exhaustion being felt by all staff are added to the requirement to keep working in the knowledge of this.
There are many interventions across the country being developed to ensure this transition results in improved staff retention and attainment of skilled practice. The STAR project funded by the Burdett Trust for nursing is an example of this. It is so important that all staff but especially NQNs at this time have a sounding board, a safe open culture and access to compassionate leadership to ensure the attrition rates improve, because we know this is significant within the first 3 years of post- registration. Professional socialisation is often stated as fundamental to limit staff stress, forming identity and understanding personal and professional beliefs and values that form a nurse identity. To ensure wellbeing and motivation at work, and to minimise workplace stress, recent research evidence by the Kings Fund (commissioned by RCNFoundation) suggests that people have three core needs:
In recognition of the strain on nursing staff during this pandemic there will be without question the need for extra funding to support staff well-being and mental health if we are to achieve the 2030 vision for nursing, and we can’t have our students or NQNs the greatest victims of this.
So many of our student nurses are going above and beyond, being involved in so many additional support networks, debates, demonstrating strong leadership skills well in advance of registering.
The hope is that this resilience will continue and create a real determination for the recognition of the job they do and more importantly, what they could do in the future to ensure sustainability of the profession.
If you have a NQN – what are you doing to recognise their fears, their potential and ensure they feel part of the team? If you are a NQN – what do you feel you need to cope with this transition? It is important not to exploit newly qualified staff and although this is done often without intention, it is a real issue for some. I was saddened to hear through a friend that her daughter who had recently qualified as Mental Health Nurse was asked to stay on shift for an additional 2 hours on top off a 12hr shift because of staff shortages. This resulted in her missing her last train home, as she doesn’t drive. She had only started 15 days before in her new post and felt she could not say no. This is unacceptable on a number of levels and I do hope this is an exception.
We can’t extinguish the enthusiasm of our new staff; they have worked hard to get to where they are, and this is just the start. Remember not all staff have the confidence to challenge decisions or deal with conflict, it’s not easy for anyone to stand up for themselves when they feel vulnerable.
It is important to find your cheerleader, ensure you have a voice and start as you mean to go on, as you have already shown by being a nurse in 2020 that you have what it takes and we can rely on you to achieve the 2030 vision.
Jacqui Neil
Transforming Workforce Lead
@TransformNurse
Thank you to everyone who joined us for our first-ever virtual care at home and housing support conference. The Homecare Festival took place between 7-9 October and delegates had the opportunity to hear from expert speakers on the themes of workforce, human rights and issues of sustainability, vision and practice.
Delegates will have been sent session recordings from the event. We have also made recordings available for purchase for those who missed the event. The recordings are priced at £15+VAT and can be purchased here.
More information on the Homecare Festival can be found here.
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