August nursing blog – ‘To vaccinate is to care – our new moto?’

‘To vaccinate is to care’ – Our new moto?

There is nothing like a global pandemic to make you rethink what is important to protect ourselves and others. In recent months we have witnessed the efforts of all front-line healthcare staff to promote infection control through the strict measures laid out within infection control guidance, by ensuring PPE is in place, alongside social distancing and hand hygiene practices to reduce the spread of infection amidst an ever changing landscape.

Earlier this month the expansion of the flu programme was announce in Scotland and within this was that all social care staff providing direct care would have the opportunity to receive a free flu vaccine. This has been welcomed by all providers as it offers a further safeguard at a time when infection control has been the highest priority in preventing loss of lives. This has come as excellent news to staff as the disparity over this protection from flu between NHS and independent care sector staff was one that had been fiercely contested. It therefore seems fitting that this has been agreed in this particular year when we must ensure everything is being offered to staff to ensure their health and well-being.

We know that the uptake in previous years has been variable across the NHS workforce despite having this access to vaccination and arguably the most preventative way to reduce cases. The availability to social care staff was patchy and often resulted in a cost to the employer or the staff member. This will undoubtably improve in light of the current pandemic, both through the uptake of the vaccine and the infection control measures currently in place. As we start to move into remobilisation and recovery plans across the NHS and community, it is important that we do everything possible to reduce the burden on the NHS and social care this winter, especially in light of a potential second wave of Covid-19. Our hospitals will have reduced beds and staffing due to the post Covid measures put in place, therefore preventing unnecessary admissions is key.

NHS boards will choose their own delivery option and this year it is hoped that care home nurses will self-vaccinate their own staff, which would hopefully allow a better uptake. This year’s national campaign will be fully inclusive of the care sector to promote the value of the work staff do with  adults who require care and support and the importance of getting vaccinated, as well as to demonstrate how we recognise the importance of  the health and well-being of staff alongside the protection of residents.

We have also ensured that flu campaign signage will be visible within each of our care homes across Scotland to ensure a strong message about  the need to be vaccinated and that this is being promoted and offered to our staff and residents alike. In addition to this we will record the uptake of the vaccine by staff as part of our daily safety management tool.

As we approach the winter months in a year where the loss of lives within our most vulnerable groups has been staggering the focus to ensure every safeguard is in place is paramount.

Within health and social care, the safeguarding of our patients and residents has always been at the forefront of all staff endeavours but perhaps they have neglected themselves in the process. Staff may perceive themselves to be invincible, healthier than they actually are and therefore not at risk

I go to the gym and take daily vitamins so don’t need the flu vac’.

We recognised that during the pandemic many frontline staff have experienced significant burnout which ultimately has a detrimental effect on staff well-being and immunity, therefore, potentially putting them at a greater risk of being susceptible to the flu .In addition to this many health and social staff are approaching the higher risk age groups and may already have a long-term condition (LTC). Even in healthy adults, the risks associated with the transmission of the flu virus have the potential to be life threatening. We know that clinically the vaccine does not provide full protection, but it could save your life.

Presenteeism has been cited as a common cause for the spread of the flu virus with staff going to work when having some mild symptoms but not sick, but actually harbouring the virus, therefore potentially spreading this within their workplace.

This obviously presents significant risk to patients, residents and staff alike. We also have people who have been diagnosed and survived Covid-19 which has resulted in the need for specialised rehabilitation and recovery care plans for some and has weakened and progressed the ability to recover for others. Some people may have been asymptomatic therefore it is unlikely to fully know the extent of those who had Covid19 which raises the potential that some people may have a weakened response or will be more susceptible to this year’s flu virus.

Over recent years there have been several pushes to have the vaccination of frontline staff made mandatory but this presents many moral, religious and ethical questions. Respecting staff choice is important as some staff are simply not able to take the vaccine, although the risk of adverse reactions is low they can exist, and vaccination should always require consent for that reason alone. Some countries such as the USA have chosen to make this mandatory in a number of states to ensure the decline of the incidence of flu and subsequently reduce the numbers who die from this. The arguments for this approach are ones which are still currently being explored in the UK.

There is no question that prevention is better than cure, especially in this year when the risk of a second wave of Covid-19 continues to be a real potential threat. Perhaps then the standpoint should be not whether we agree or disagree with enforcing a mandatory approach for all healthcare workers, but that we adopt a mutual benefit response to reduce loss of lives at a time when  residents, staff and families may still be in a recovery phase from the pandemic. What is ultimately important is ensuring we create awareness, provide factual information, dispel the myths and provide easy accessibility to the vaccine and ensure we properly record the uptake to assist in the future vaccination programmes.

With this year’s flu expansion programme, I am confident that social care staff with fully embrace this opportunity and that the uptake by staff will be high across both NHS and the independent care sector.

This really is everyone’s business and the reduction of the age to receive a vaccine this year for the people of Scotland highlights that we all want to prevent further loss of lives. Our flu campaign will launch in the coming weeks and I hope everyone gets behind this and does everything to play their part.

 

Scottish Care’s statement on care home visiting

Scottish Care warmly welcomed the announcement to increase the number of outdoor visitors and to start indoor visitors when it was made by the Cabinet Secretary. Care homes were asked to develop plans and submit them by the 24th August. This has meant that in many parts of Scotland indoor visiting has now started. Unfortunately, in some parts of the country this has not been the case. In some places local sign-off has not been achieved  and in others care homes have been unable to satisfy local risk assessment requirements. We are working intensively to address issues at a local level. For specific local reasons there has been a ban on indoor visiting in NHS Tayside and NHS Lanarkshire because of local outbreaks and clusters, and NHS Grampian because of the extended period of lockdown.

We consider that visiting is of fundamental importance in ensuring that residents are able to exercise their human rights to be with family and friends. It has been harrowing and hard for families, residents and indeed staff to be forced to live under such restrictive circumstances over the last six months. This is not a normality that either the sector or families can live with much longer.

Scottish Care has always sought to ensure that we get the balance right between the protection of individuals from the pernicious disease which Covid-19 is and the rights of residents as citizens to be able to make decisions about themselves and live their lives as they would want. More than anyone else we can appreciate and know the horrors of this virus and never again want to witness the loss of life we have seen. We are very well aware indeed of just how vulnerable the care home population is. However, care home providers want the restoration of visiting as urgently as families do.

Looking forward Scottish Care believes that we must all work together to:

  1. Increase (with appropriate protection) the ability of individuals to visit indoors as we come closer to winter.
  2. Increase the use of communal spaces and activities in care homes.
  3. Ensure that family members and relatives are fully involved at national and local level in decision-making and developing Guidance.
  4. Consider the formal designation of a family member as a priority individual who has the right to gain access (with protection and testing ) to the care home as would be the case of other professionals and staff.
  5. Give serious consideration to using testing (especially new salvia tests as they develop) to enable families to visit more frequently.

Dr Donald Macaskill, CEO stated:

“First and foremost, care homes are a home they are not a hospital unit or institution. We are all of us working hard to getting back to re-creating care homes as a place of home, where families can be with their relatives without having to make appointments, be restricted to time, and be limited in what they can do. This will be a slow process, but we must as a society give equal priority to our older citizens in the weeks and months ahead as we do to other sectors and age groups within our community.”

 

RGU – Return to practice module

Please see below some key information on Robert Gordon University’s Return to Practice Module. This can also be found on their website by clicking the link  here

Study Days

There will be mandatory study days for this module provided virtually and/or  face-to-face and the relevant NHS Board will require your attendance at their specified induction days.

Module Theory

Most of the theory is provided in an online format; studied over 7 weeks, equivalent to 35 hours per week study time.

Placements

Placements are normally between 300 and 450 hours and will be determined at interview in discussion with the student, health board and RGU. Please note some placements may be longer or shorter depending on student need. Placement can be completed full-time or part-time (the least amount of hours per week whilst a student is normally 22.5 hours).

Module Route

You can undertake 1 of the following 2 routes:

  1. Apply directly to your local health board.  The application form will be made available on their vacancies website.  Please keep an eye on the relevant vacancies website on a regular basis as we may not be advised when the vacancies have been advertised*. Then also apply to RGU.

*please note that NHS Grampian applications are now open, please us Job ID NW027053 to locate the vacancies / NHSG Application form.

These collaborative model posts are where there are vacancies within the NHS Board.  In addition, you can apply for funds to pay for the module from NHS Education for Scotland (NES), please access their website for the terms and conditions: http://www.nes.scot.nhs.uk/ .  You only need to apply for funding once you commence the course.

  1. Apply directly to RGU only and self-fund (this may be the option for you if you cannot commit to the NES conditions of employment or if you are still on the register).

All 2 routes follow the same recruitment, selection and interview procedure.

RGU Application

Regardless of which one of the above 2 routes you opt to undertake, we are required to register you on the module with RGU.  Therefore, I would be grateful if you could complete the attached form and return it to the School of Nursing, Midwifery and Paramedic Practice by e-mail to [email protected].

Please ensure that you include the following with the application form:

  • Evidence of NMC PIN Number
  • Copy of Nursing qualification(s)
  • Proof of ID x2
  • 2 references – please give the attached template to 2 referees for completion and return to me.  The referees should preferably be 1 academic and 1 professional.

Requirements

You will be required to provide your previous/ current NMC PIN number and date of birth and successful applicants will be subject to occupational health and PVG clearance.

If English is not your first language, please also provide evidence of your English language, a minimum of IELTS 7 or equivalent is required.

If you are currently living overseas, please contact our International Office to check your eligibility to study this module before submitting an application.  They can be contacted at [email protected] .

Closing Date

There will be a closing date but this date is to be advised, however please do not hesitate to submit the RGU paperwork at any time until this date is announced.

If you would like to discuss the module in further detail, please contact  by email the Module Co-ordinators to arrange an informal chat  [email protected]  or Fiona Gibb  [email protected]

Active Age Activity DVD – The Fair Play Foundation

Funded by:

The charity, the Fair Play Foundation, have been working with funders throughout lockdown to produce an Active Age activity DVD. The DVD was created to maintain the physical and mental wellbeing of the residence and staff of care homes across Scotland during the unprecedented and hugely difficult time in lockdown. The DVD was sent out, free of charge, to 200 care homes across Scotland. The Active Age DVD has been specifically designed by a team of highly trained and qualified staff for low mobility residents, with all the activities being seated and low impact. The DVD consists of three activity videos, each lasting 20 minutes and is set against some popular music tracks to keep it upbeat and enjoyable. The DVD also includes a video contributing from the Wright Foundation, providing “top ten mental help tips” as we know through research the detrimental effect of poor mental health can have on individuals. We hope the Care Home residence and staff find the DVD useful and enjoyable. Any care homes that have received the DVD and have any feedback from their residents taking part would be greatly appreciated to provide to the funders as a thank you. Finally, if any Care Homes wish to receive an Active Age DVD that did not, or wish to find out more about the charity please don’t hesitate to get in touch.

The Fair Play Foundation would also love your feedback on this DVD, please email [email protected] or [email protected] with your comments.

Contact Information:

The Fair Play Foundation

New Alderston House

3 Dove Wynd

Strathclyde Business Park

ML4 3FB

Charity No: SC048552

Email: [email protected]

Telephone: 0141 319 8927

Web: www.thefairplayfoundation.org

Twitter: @FairPlayFound

Facebook: @FairPlayFoundation

Digital Safety Huddle Webinar – 27 August

Scottish Care is organising a follow-up webinar on the Digital Safety Huddle Tool. 

This will take place on Thursday 27th August at 12:15 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.

Care Home providers should have received an email from NES with invite to use the Safety Huddle Tool, if you haven’t received this email, please contact:

[email protected]

Please email with your name, role, email and the name of care home/group you are in or responsible for.

For online help and guidance please follow this link:https://learn.nes.nhs.scot/34427/turas-care-management-user-guides

This webinar is open to all care providers. Registration to this webinar is required. Please register here:

https://us02web.zoom.us/webinar/register/WN_5JZfgIdJQUmrfGtzSIatNQ

After you register, you will receive an email with details to join the webinar (subject to approval).

 

 

Scottish Care’s statement on hospital transfers to care homes

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 as a 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 the funding from public authorities was not sufficient to enable these transfers to take place. Yet even before Covid-19 there were circumstances where at best the eagerness of hospital discharge had led to a breakdown in relationships with the care home sector. The most commonly cited instance was where a clinician considered someone to be able to be supported in residential care, they were then discharged and within hours it was clear they required nursing not residential care. So, looking back from this position we have to be clear that the process of clinical discharge into care homes before Covid19 was one which was not always smooth and frequently problematic. As a result, there was often a local distrust in the system.

This level of challenge was reflected in the Clinical Guidance issued by the Scottish Government on the 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.

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 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 it might have been. As a positive result of the meeting the Clinical guidance was revised and re-issued on the 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:

  • appropriate clinical plan.
  • risk assessment of their facility environment and provision of advice about self-
  • isolation as appropriate (See NHS Inform for details). (page 4)
  • there are arrangements in place to get return them to the facility

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)

We recognise that from the 21st April it became a requirement for all patients being transferred from hospital to receive a negative test.                                                             

Dr Donald Macaskill, the CEO of Scottish Care states:

“It is important to state that amongst those who were Covid positive and who entered care homes in March and April there would be some who were no longer infectious because of the length of stay in hospital. In addition, there would be others who were returning ‘home’  because they could no longer benefit from acute sector care and who were on a palliative and end of life care trajectory. For those individuals it was important that they were able to die in familiar and supportive surroundings. In all cases of knowingly accepting a Covid positive patient as a resident the care home would have instigated robust care and support to ensure the protection of staff and other residents.”

 

 

Update on death in service indemnity cover – students on supernumerary placement

We have been made aware of an update relating to students on supernumerary placement in health and care settings.

In order to provide students and their families peace of mind at this time, the Scottish Government has confirmed that it will provide a temporary COVID-19 related death in service scheme to students of Higher Education Institutes on clinical placements in health and social care settings. This provides a single lump sum payment of £60,000 to the next of kin of any student of a higher education institute, should the worst happen.

The cover is now in place and further detail on the scheme will be circulated next week. If you have any questions, please do not hesitate to get in touch via the CNOD Education mailbox: [email protected]

 

Forthcoming UK IPC guidance for the remobilisation of health and care services

Please see letter below from Scotland’s CNO, CMO and National Clinical Director regarding the UK IPC guidance for the remobilisation of health and care services which is due to be published. The letter provides an overview of the key messages and outlines the Scottish Government’s expectations in terms of implementation.

CNO CMO NCD Letter_IPC remobilisation guidance COVID-19_14 August