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Scottish Care responds to the Adult Social Care Winter Plan

Scottish Care welcomes the first ever Winter Plan for Adult Social Care as an indication that there is now a recognition of the importance of social care for all citizens. We are pleased to see that there is a particular emphasis upon collaboration and look forward to future plans more directly engaging with and involving those with operational and frontline responsibility.

We are pleased to see within the Plan a real sense of value of and an emphasis upon the dedicated and professional social care workforce who not just during COVID-19 but throughout the years have been professional and highly skilled in supporting individuals regardless of locations.

Details of the Winter Plan:

We welcome the additional £7 million allocated to Nurse Directors to enable IPC support and training and want to underline the critical and distinctive nature of IPC in care homes and community settings. We will work closely to ensure that IPC training and models are appropriate to the setting and that we do not simply embed acute hospital and NHS based IPC practice. Such adoption of IPC has not only to be context specific but enhancing of the rights and autonomy of individual care home residents or those who live in their own homes.

The majority of care homes already undertake a daily review of COVID-19 symptoms, and we note this in the Plan and look forward to sharing the clinical experience of care home staff with the Clinical and Professional Advisory Group.

We support the imperative around the flu vaccination whilst urging all stakeholders to learn the lessons of what has at times been an ineffective and haphazard implementation of the vaccination strategy, failing at times to recognise the distinctive realities of care at home and housing support staff and the skills and experience of care home nursing staff. We look forward to closer collaboration as we plan the roll out of the COVID-19 vaccine.

The care home sector is fully supportive of ensuring that visiting guidance is implemented in a manner which maximises safety and reduces risk. Providers recognise and value the truth that family members are intrinsic to the mental and emotional wellbeing of residents. However, there is both an understandable desire on the part of providers to protect residents and a fear about introducing infections. We acknowledge that the introduction of a robust and effective testing system will help to allay the fears of providers of care. This urgently needs to include family members alongside staff, and all those who visit care homes for whatever reason, in a manner which is as timely and effective as possible in terms of testing access and turnaround of test results. As a whole system we need also to address the challenges brought about by emerging difficulties in gaining insurance and indemnity, the stresses and overwork created by Operation Koper, and the capacity of a stretched workforce to support visiting in practical ways.

We note the evidence of staff movement in relation to outbreaks. We recognise the desire to create cohorts of staff regardless of settings. Achieving this outcome will not be easy. Individuals who work in social care are amongst some of the lowest paid within our society and they frequently have multiple jobs not because they want to but because they need to. This is especially true in homecare where we are already noting a drift from full-time employment to part-time working because staff are exhausted by the efforts of the last few months.

Great care needs to be taken that to ensure that restricting the right to employment and requiring individuals to isolate for 14 days between employment does not disproportionately penalise individual workers.

In addition, there has to be a realistic appreciation that there is a limited supply of workers. Before the pandemic providers of care – regardless of sector – struggled to recruit, most especially nursing staff. We have all to work closely at local level to ensure that there is adequacy of workforce supply to ensure safety and quality practice. The roles involved are highly skilled and cannot simply be undertaken by individuals without experience, skill or training.

Further the creation of any legislation which effectively limits employment opportunity within a sector which has struggled to recruit, and which is likely to be negatively impacted by future immigration restrictions, will require to be carefully considered and thought through. The consequences of disproportionate restriction regardless of the robust grounds for their introduction may be hugely damaging.

We note the allocation of £50 million to meet these proposals but want to understand how this figure has been calculated and whether it is sufficient, what it will be used to pay for and how we will collectively compensate workers and organisations faced with additional restrictions on staffing.

Testing remains critical. In addition to our comments above we want as a sector to see urgent and immediate plans as to how care at home and housing support staff will be prioritised for asymptomatic testing. It is now seven months since we called for this to become the norm and we still have not seen this commence.

In the community we welcome the emphasis on ensuring people remain independent and at home for as long as possible. With others we continue to urge the re-introduction of care packages for those who have not been supported for a long period of time. We remain concerned that there needs to be significant improvement in practice around communication and information for homecare providers when an individual with COVID-19 is released from hospital. We continue to be concerned that effective winter care in the community will not be achieved as long as some local authorities continue to insist on 15-minute visits during which personal care and other tasks are required and the staff member has to don and doff PPE in a safe manner. Such restrictive packages of care together with the electronic monitoring of homecare staff should stop. They are hardly illustrative of our shared aim for Fair Work.

We welcome the continuation of the Social Care Support Fund which goes some of the way towards plugging the unfair terms and conditions within publicly commissioned social care contracts.

We are also grateful for the continued commitment to the supply of PPE where providers are unable to access these through business as usual routes, and especially in light of the reprehensible re-introduction of VAT on the 1st November.

We look forward to continuing to work with colleagues in the roll out of digital devices to care homes to improve connection and welcome the commitment of £500k to support this work.

Any Plan is only as effective as the commitment and resource to enable it to be enacted. Social care providers continue to prioritise not just keeping people safe and well but ensuring individuals achieve their fullest potential and live life to the full. We agree with the aims of the Plan and commit to demonstrating integrity to resolve challenges in a supportive and empathetic manner in the months ahead.  Its success will be premised on true and meaningful partnership with social care providers at national and local levels.

The Adult Social Care Winter Preparedness Plan 2020-21  is available here.

Find out more about the Plan on the Scottish Government website.

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Job Opportunity – Independent Sector Lead: Scottish Borders

INDEPENDENT SECTOR LEAD – Scottish Borders

PARTNERS FOR INTEGRATION AND IMPROVEMENT

SCOTTISH CARE

Health and Social Care Integration

£43,622 (pro rata) per annum – 14 hours per week

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.

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To Absent Friends – a festival to remember in times of covid

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

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The harvesting of hope through Covid solidarity: a personal reflection for Halloween.

Perhaps it’s because I have the blood of generations of Gaels coursing through me that I have always been fascinated by Halloween, or should I say, Samhain. Samhain is the ancient Celtic festival which culturally we have by in large turned into Halloween, in turn whose connection with the Christian festival of All Hallows is probably lost to many. Samhain was believed to be a time when the veil between the real world and the other world of witches, the wee people and the departed was at its thinnest. In times gone by our forebears would leave an empty chair and food on the table to satisfy any passing ancestors. Traditionally celebrated on 31stOctober -1st November it marks the end of harvesting and the start of the ‘darker half’ of the year.

I am writing this in the early morning of a day which is dark beyond dawn, wild and wet with the threat of gale and damage in the air. The atmosphere could not be more apposite for the day. What holds my fascination for this time is not the monsters and ghouls, the ‘dooking’ for apples or the endless carving of turnips or pumpkins – but that the day offers an opportunity to celebrate the harvest of the earth and to prepare and reflect for the darkening of the season.

But this year everything is different. There will be no knocks on the door, questionable poetic renditions or feigned childish shyness. Restrictions have limited traditionality, the streets will be much quieter tonight. But probably more than in any other recent year the original purpose of the day is all the more necessary  – a time to reflect on the year and to carry hope into the dark days to come.

One of the things that we have probably largely lost in our modern celebrations is the sense in which Samhain and its Celtic successors was a collective and shared experience. It was a time when people recognised their binding into each other, their connection in community and belonging , their rootedness in the earth and to the soil on which they stood, all of which would be to them so important in the coming days of a hard winter. It was a time to celebrate togetherness and to re-commit to being concerned and committed to each other in the days of dark.

This past week has been a strange one. I have spoken and written enough about the Public Health Scotland report on the discharge of people from hospitals into care homes so I will not mention the substance of its contents here. What I do want to reflect on in is the reaction both in the media and within politics. I have to confess to a real sense of disappointment and dismay. One national newspaper used language and description which maligned frontline staff, debates I have heard have been heated and vexatious, argumentative and dismissive. Now I am no shrinking violet and have been as robust as the next person when I have seen injustice or behaviour which is unacceptable. But the level of blame, the point-scoring and the desire to apportion guilt has been quite shameful . The reason for my disappointment is that many seem to have too readily lost sight of the fact that behind every statistic and number, is a human person, is broken grief and heartfelt hurt.

In the spring when we experienced the first wave of the virus there was an amazing degree of political, media and societal togetherness. There was a real sense of solidarity. That all seems to have disappeared in the heat of the summer and to lie in tatters in the empty harvest fields around us. The days of ‘In It Together’, of rainbows on windows thanking staff and key workers, of clapping for carers, of a sense of mutual regard seem a distant dream away.

Solidarity is a wonderful concept. In its French original it’s definition means a   “communion of interests and responsibilities, mutual responsibility,” a sense of demonstrating real interdependency.

In the first wave of the pandemic there was a real sense that we had consciously put aside personal and political ambition and put on a mutual resolve to determine through common action our regard for one another, our desire not just to protect ourselves but those around whom we lived. I remember the scenes of neighbours helping one another, of strangers becoming friends, of unity across garden fences, and a real growth of community at its best. The harvest of those actions was a real literal suppression of the virus. We need to re-discover our solidarity in this coming season.

When I speak to folks around me, whether carers or families, workers or clinicians, there is a real and palpable fear and anxiety. Unlike the days of spring, we know about this virus, we know the pain and distress, the loss and grief it can cause. There is fear in knowing what we know. Unlike the first wave in a spring that reached out into the warmth of summer, we know this second wave is coming at us in a winter which at least in Scotland can sometimes feel as if it is never-ending. So, it is all the more important that we hold each other up, that we re-discover the solidarity of the spring, as we enter into the darkening days of winter.

This day teaches and tells us that darkness is always followed by the dawn, it reminds us that in the cold hard barren earth that seeds of growth and renewal are already dormant waiting to struggle into life. This day should show us that through collective action, mutual aid and support, that we do and will meet the struggle, and come through the other end. We will not do so by creating islands of self-interest or reverting to a narcissism in politics or social discourse, we can only do so by leaning on the humanity of each other, by bringing friend and stranger close into our company. This is the solidarity which alone will beat this virus.

So it is that we have to re-discover the sense that the only way we protect those who are most vulnerable is by our own individual action. IPC, PPE, testing and vaccines are all critical tools in the fight against this virus, but most important of all are the individual actions we all have control over. What I do impacts on my neighbour. We all of us need to be responsible for each other.

And that is where the hope really is. Because we know deep within our bones, that the fear never truly overwhelms, that the warmth and light of new beginnings will spring into being, and that constraint and restriction will be replaced by renewal and reconnecting.

So it is that through careful determination, by linking our arms in the solidarity of common interest and concern, that I am optimistic that all our sacrifices, that all the separation and loss, the pain and anxiety, the death and emptiness,  will bear a fruit of renewal. But only if we seek to be a community rather than a collection of individuals.

The night of Samhain  helped our forebears in their beliefs to glimpse the past and the present, to be in touch with meaning beyond understanding, so our actions in the coming days will show us the future of our being together, as individuals, as families and as a nation.

I leave you with some of the elegiac words of the American poet Annie Finch whose love of Scotland in all seasons comes through so much of her work:

Samhain

In the season leaves should love,

since it gives them leave to move

through the wind, towards the ground

they were watching while they hung,

legend says there is a seam

stitching darkness like a name.

 

Now when dying grasses veil

earth from the sky in one last pale

wave, as autumn dies to bring

winter back, and then the spring,

we who die ourselves can peel

back another kind of veil

 

that hangs among us like thick smoke.

Tonight at last I feel it shake.

I feel the nights stretching away

thousands long behind the days

till they reach the darkness where

all of me is ancestor.

 

I move my hand and feel a touch

move with me, and when I brush

my own mind across another,

I am with my mother’s mother.

Sure as footsteps in my waiting

self, I find her, and she brings

 

arms that carry answers for me,

intimate, a waiting bounty.

“Carry me.” She leaves this trail

through a shudder of the veil,

and leaves, like amber where she stays,

a gift for her perpetual gaze.

@ Annie Finch

 

Donald Macaskill

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Scottish Care statement on discharges into 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 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:

  • 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)

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.

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Urgent request for care homes regarding CHAT

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

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‘Get up, stand up for your rights’: a call for an Older Peoples’ Commissioner. A blog for United Nations Day.

Heroes come in all shapes and sizes. At different stages of our life we probably most of us need heroes. For some they will be the celluloid stars of imagination, sporting greats or fashion and style icons. For many they are the famous and extraordinary, the remarkable and amazing. Our heroes will doubtless change over time but at the risk of exaggeration most of us need a few heroes in our hearts. They are the people who inspire and motivate us, who are exemplars of something we admire and whose lives push us to be someone we want to be. Regular readers of this blog will probably have guessed that most of my heroes are individuals who are not well known, many of them folks I have met along the way, but all of them people whose compassion and care, humanity and sensitivity have made them for me heroes of our humanity. That’s why during the first wave of the pandemic I spoke about ordinary frontline carers as being the real heroes of this year.

But in a more traditional way there are some people who have always inspired me and who have taught me something important about the essence of what matters. For most of my life I have found the story and example of Rosa Parks to be truly inspiring. Many of you will know her claim to fame and the heroism of her actions.

On December 1, 1955, in Montgomery, Alabama, Rosa Parks when travelling home from work on a bus refused to give up her seat in the “coloured section” to a white passenger after the whites-only section was filled. Bus segregation was part and parcel of the law at the time and was a physical embodiment of the race laws that existed in the United States. She was arrested for civil disobedience in violating Alabama’s segregation laws. Her quiet dignity led to many in the black community to boycott the Montgomery buses for over a year which became the first major direct-action campaign of the post-war civil rights movement. Eventually in November 1956 the courts decided that bus segregation was unconstitutional. She became in many senses the ‘mother of the civil rights movement’, spent her life thereafter fighting for equality and now even has a day named after her to commemorate her actions.

After years of struggling to achieve justice , after her retirement, Parks wrote her autobiography and continued to insist that the struggle was not over and there was more work to be done. In her final years, she lived with dementia and spoke and wrote with passion about the rights of older people and those with dementia.

Today is the 15th anniversary of the death of Rosa Parks in 2005. It is with a real synchronicity of time that today is also the 75th anniversary of the founding of the United Nations.

On October 24, 1945, 51 countries came together to create the United Nations. Its purpose was to promote peace and cooperation around the world.

The 75th anniversary is happening at a time of massive upheaval and uncertainty for the world living as we are through the  global health crisis which is the COVID-19 pandemic. The pandemic is resulting in severe economic and social turmoil. But as the UN has said this week it is also a reminder that times of struggle can become an opportunity for positive change and transformation. It is at such times that we learn what is intrinsic to life, why collective action and inter-national co-operation are so important, and perhaps why most of all peace is what remains the aspiration at the heart of the founding Charter of the UN.

There may be occasions when we can be tempted to forget the way in which the actions of others impact on our own story, but the global pandemic has shone a light on the way in which we are all inter-connected, one with the other, co-existing in our humanity and on our planet.

The COVID-19 pandemic for many of us has become a watershed. Even as we now respond to a second wave and no doubt prepare for future waves of the virus; even as we accept the reality that pandemics will become part of the pattern of our future, we are now being presented with opportunities to do better and be different.  These are the times when the lessons of our heroes can come off the page of our imagination and be written into action and response.

So, it is on this United Nations Day and in recognition of those who have stood up to injustice that I want to argue that Scotland needs to urgently decide to commit to creating the role of an Older Peoples Commissioner.

There has been much debate over the years about whether or not the time is right for Scotland to join Wales and Northern Ireland in the UK, and many other countries across the world in appointing an Older People’s Commissioner. I would argue that the time for such debate is over and that the pandemic response requires such a role to be created.

Ageism has been at the heart of so much of what has been the experience of older people during this pandemic. Whether it has been the suggestion that Covid19 was a ‘baby boomer harvest’ and only affected the old, all the way through to comments in the media this past week about the requirement to ‘segregate the old and vulnerable’ in order to protect and safeguard them. Throughout the pandemic there has been an obscene , conscious and at times unconscious, ageism at the centre of much social and media commentary. In practical actions, from a questionable ethical Guidance document which used age as a proxy for decision making, through to the inappropriate use of DNACPRs, to unequal treatment of older people in terms of access to social care packages, to the lack of agency and voice to those who receive care at the table of decisions – this pandemic has been a shameful enactment of profound age discrimination right across Scotland.  It is time for that to change. It is time for Government and political leadership across the parties in Scotland to take older age seriously and create a post for a Commissioner.

Scotland does indeed have a Minister for Older People but that is not enough – that is part of the structures of government, an Older People’s Commissioner is someone who is appointed by a parliament, responsible both to it but primarily to the older people of a nation, and who is enabled to speak and act with independence, able to hold those who rule and decide to account for responsible human rights based actions. She/he becomes an advocate for older age.

In the last few months I have had the privilege to work alongside Helena Herklots and Eddie Lynch, the Older People’s Commissioners in Wales and Northern Ireland respectively. Their ability to champion the voice of older people, to challenge and remind, to articulate and to speak out has been inspiring. Scotland needs such a voice to hold all of us to account, to remind all of us of our responsibilities. The election in 2021 should offer us that as a legacy to all who with older age have struggled in these last few months. I recognise  the creation of such a post is in itself no panacea but it is the first step in a journey to equality regardless of age. As a people, as communities and as a nation we must challenge the pernicious acceptance and allowance of age discrimination.

Growing up I was very aware that others had heroes who sat alongside those I held important. It felt to me that every night in my teenage years that I feel asleep to the sounds of the music of Bob Marley, the undoubted super-hero of my older brothers’ world. Over time – perhaps with sleep appreciation – I have grown to appreciate the awesome power of Marley’s words. One verse in particular resonates today as I remember those who have stood up for equality, justice and peace throughout the 75 years of the United Nations, including Rosa Parks who literally refused to move, and as I continue to work with others to create for Scotland an Older Peoples’ Commissioner.

Get up, stand up, stand up for your rights
Get up, stand up, stand up for your rights
Get up, stand up, stand up for your rights
Get up, stand up, don’t give up the fight

 

Donald Macaskill

 

 

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Transition from student to qualified nurse – October Nursing Blog

Crossing the bridge

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:

  • autonomy – the need to have control over their work lives, and to be able to act consistently with their values  
  • belonging – the need to be connected to, cared for, and caring of others around them at work, and to feel valued, respected and supported 
  • contribution– the need to experience effectiveness in what they do and deliver valued outcomes.

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

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Homecare Festival – recordings available for purchase

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.