This afternoon (18th March) I had a meeting initially with Jamie Macdougall, Deputy Director Social Care Support Division and Elinor Mitchell, the Director at Scottish Government followed by a meeting with them both and the Cabinet Secretary, Ms Jeane Freeman.
The meetings were both constructive and I thought it useful to summarise some of the issues raised.
Admissions to care homes
I explained the concerns of providers that we needed to be reassured that anyone entering into a care home was Covid negative. I was honest in saying that the previous relationships between the acute and care home sector had sometimes not been as good as it might have been. I also reflected that some families are giving kickback to providers for ‘allowing in new people’ into the care homes.
Following a positive discussion with the Clinical Lead who has developed the Guidance, one Graham Ellis, new and updated guidance will be issued shortly. This will make it clear that the seven-day self-isolation period will need to be in place as a clinical test. This might be 6 days in acute and 1 in a care home; 4 in acute and 3 in care home or all 7 days in the care home etc. There will be a robust clinical discharge assessment detailed noting which. Either way it should be clear after seven days that the person is Covid negative.
The refreshed Guidance will also contain information on Shared Information protocols and practice.
I must stress in the strongest terms that we must remain open to new admissions – to fail to do so will bring the whole system grinding to a halt.
We are exploring with some technology companies ways in which it might be possible to take vital observations and monitoring signs more remotely to free up staff.
Undoubtedly THE major issue in communications and in our webinar has been workforce. This included the pressure envisaged as a result of staff who may develop Covid-19, staff who are self-isolating and part of families who are self-isolating and staff who may be away from the workforce because they belong to an at risk group especially those with underlying conditions and who have received the flu vaccine in the past. It is not an exaggeration to say that many providers fear they would lose a substantial part of their workforce especially with the latter classification.
So, given the First Minister and Cabinet Secretary’s emphasis on the importance of testing the health of ‘essential workers’ as a priority – I have been assured by the Cabinet Secretary that she sees social care staff as such an ‘essential workforce’. She observed that not all health employees are in essential roles and it may be the case with social care workers. We have been tasked to identify the roles which we consider to be ‘essential.’ I will shortly put up a question to that end on the discussion board and would be grateful if you could complete the survey there.
Practically this will mean at some point when capacity is assured and after there is an announcement from Government that our staff WILL be included in such screening. I indicated that the public messaging on this needed to be sharpened and much louder.
I am going to be liaising with the SG official who is co-ordinating this and the modelling to ensure we are clear of timeframe, locations, etc. This will enable workers who have self-isolated for seven or 14 days to quickly return to the workforce. You will be aware that at the moment this will only show they are NOT Covid positive but that the PM announced significant advances in the development of a ‘green lighting’ test which will show that a person HAS HAD the coronavirus. We are not there yet.
We will continue to explore with SG the possibility of consideration being given to those with non-respiratory conditions, e.g. diabetes, who may have been screened and had the flu vaccination and whether they might be able to return to the workforce sooner.
All in all, workforce shortage is the number one concern – I stressed this to the Cabinet Secretary. You will be aware of the decision to close schools. The Cabinet Secretary made it clear that children of social care staff would be included in the categories of children who would be looked after in schools by education staff. The practicalities of this are being worked out with the Deputy First Minister.
Some providers have suggested to me a shared care home/creche models. Please, please do not consider this – as it enhances risk considerably.
I am confident that the proposals outlined with the proposed triage and telephone/email helpline will address this issue. More information should come out on this this evening or first thing tomorrow (19th )
Some of you will be aware of the work being undertaken by Deeside Distillery to use alcohol to develop alcohol gel. This has really taken off across the country. The stumbling block has been HMRC tax – the Cabinet Secretary has agreed to unblock this and link the project with other Cabinet colleagues. This will dramatically enable this work to scale up.
Resources for CAHHS – sustainability issues
COSLA is developing guidance based on the LGA Guidance in England. This has been a very slow process and I pressed upon the Cabinet Secretary the critical issues of sustainability facing providers in homecare and housing support. This includes but is not limited to the need to be flexible with contracts and contract monitoring including an end to the use of electronic call monitoring as a payment mechanism; the move from hourly purchase to block contracts; clear rules in relation to supplementing the pay of workers who self-isolate and are paid the SSP; the end or halting of tender and framework exercises; addressing the issue of call offs, missed visits, SLW uplifts from HSCP 20-21 etc. We will continue to urge COSLA to expedite these issues not least at the National Contingency Meeting tomorrow afternoon.
On wider sustainability issues facing the sector, I suggested the extension of business rates relief to the sector and she agreed to take this up with the Finance Secretary. She also agreed that she would make it clear together with Cabinet colleagues that community care providers should be able to access the small business relief schemes which Scottish Enterprise have established. She promised that after this was exhausted she would listen to instances where there was criticality over sustainability and address this proactively. She did caveat her words with saying that the sector needed to address the issue of zero hours contracts as a quid pro quo upon which I highlighted was a comment that needed to be directed to COSLA given it was their members that commission services which necessitate such contracts!!
We had a frank discussion on the status of negotiations on the NCHC and I believe that her discussions with COSLA will lead to a positive outcome which at least will enable us to move forward into 2020-2021 with a contract as the basis of further mediation and conciliation.
Palliation and Just in Case Boxes and development of Covid ACP
A small team led by the Palliative Care Lead at the CMO and including myself put forward an SBAR proposing the use of Just in Case Boxes and developed guidelines. This has been positively received and is being worked on with immediate effect. More information on these issues will be communicated as a matter of urgency.
We have had approaches from various tech companies to support response and communication into care homes – Scottish Government have agreed to allocate an individual to support Scottish Care and a private organisation in co-ordinating this work which would enable donations of tech into individual homes and to individuals in receipt of care both in care homes and the community. This is being linked to other work in SG.
Wellbeing and activity
Luminate Scotland and Scottish Care presented a proposal to enable activities to be communicated directly into care homes and older individuals living in self-isolation in the community. This was well received and will enhance well-being and emotional/psychological health. More detail will follow over the next few days.
Dr Donald Macaskill, CEO
18 March 2020