‘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.

I am unashamedly an enthusiast for technology and gadgets. I may not have the latest phone or gizmo, but it is likely if you do I will look on with more than a modicum of jealousy.  As part of this fascination I have always been intrigued about the role of technology and digital in our care and support services.

This interest led me two years ago to write a report exploring the role of human rights in the developing fields of Artificial Intelligence, the Internet of Things and Big Data. Now before you scroll away, my central premise and interest in doing so was to explore the extent to which we can keep the human and especially rights at the heart of our use of technology in health and social care.

I have had quite a few conversations in the last week around technology, in part because along with colleagues, I am preparing for the Scottish Care Care Tech3 event next Friday. This virtual event will bring together those who have been using technology and digital in the delivery of care services and will include designers and developers as well as frontline staff and users. The equivalent event last year saw the launch of a Human Rights Charter for Technology and Digital and this year my colleague Dr Tara French will be sharing the Scottish Care Tech Vision rooted in the human rights and autonomy of individuals.

For me technology at its best is explicitly an art or a craft (indeed that’s what the word tekne means in its Greek root). Its potential is immense in that it can deepen and enrich human encounter and experience, can foster connection and enhance relationships. However, too often, I feel, we get so caught up in the mechanics and the technicalities of new technology, that we lose sight of the art, the creativity and the humanity. Equally we can get so obsessed with using technology as a cost-saver and as an efficient alternative to the human that we endanger the willingness of citizens to adopt and trust.

The Covid pandemic has seen the most amazing advances in the use of technology not least in the health and care sectors. The pace and speed of intervention and design has been breath-taking. The launch in the last week of an app to help care home providers share critical data and information on a national level has been astonishing, moving as it has from wire-design to delivery within weeks.  We have witnessed a massive increase in the use of video and tele-consultations between GPs and their patients not least through the Near Me technology supported by Scottish Government. Remote diagnostic tools have been developed and many more practical and helpful innovations including the use of virtual reality have enabled technology to come off the paper and change lives, indeed, probably to save lives.

Perhaps most importantly, on a very human level the experience of many of the residents in our care homes has been that through the use of tablets and other video devices they have been able to keep in touch and remain connected with their family members during the forced lockdown when physical contact has not been possible.

But it is as a result of my many conversations with families and residents and those who used health and care services during the pandemic that I feel that my own enthusiasm and evangelism about technology needs to be more balanced.

Now I am not suggesting that we are in danger of some dystopian nightmare where automaton have taken over and that as a result we need to develop a fear of the technological future. Covid19 whilst it has highlighted the real progressive power of tech and digital has also served to underline the critical importance of embedding a human rights and ethical framework in its use in health and social care.

Technology within a care context should primarily be about enabling the betterment of interaction and facilitating the intensity of relationship. It should always be about improving outcomes for the person rather than simply making life easier for the professional. A GP who uses Near Me to consult with someone in a care home is positively providing an immediacy of response and especially during a pandemic reducing the risk of virus transmission. However, few would deny that the subtleties of body language, the dynamic of inter-personal relationship, the signs and signals of encounter can be equally achieved through a virtual encounter compared to a face to face meeting. Video consultations are fundamentally important, but we have to acknowledge their limitations. We have to appreciate that there are those with visual and hearing impairments, those with advanced dementia and other neurological conditions ( i.e. the majority of care home residents) who struggle to engage with such tools and who are dis-empowered by any sole dependency upon them, to say nothing for the effects on their personal privacy and autonomy. We have equally to acknowledge the reality of digital poverty which if not adequately recognised will serve to exacerbate and compound the very real health inequalities which have scarred Scotland.

I know from practice that one of the most important things I learnt was to give space to ‘doorknob’ conversations. These were the conversations which happened as someone got to the door, placed their hand on the handle, and turned around and said to me ”Oh there is something else I meant to say…”  And you just knew that this interaction was the primary reason they had come to see you but just could not get up the courage to talk about face to face.  Not much chance for the occasional, by-the-way alongsideness of such conversations in a video consultation. So too those of us involved in talking to others about hard and emotional subjects recognise that it is not just what someone says that communicates their truth and feelings but also the way they say it, the timbre of their voice and the silence between the sounds of their words.

But there has been one conversation more than any other during the last few months which has helped to balance my digital enthusiasm. It was with the daughter of a care home resident who had provided a tablet for her mum to speak to her and keep in touch. After weeks of growing frustration with both the device and her mother’s inability to comprehend what was happening and to use it –she said to me – “I want to hold her and hug her, I want to touch her not give her a digital kiss.”

As I researched the report I mentioned earlier I spoke to many around the world from California to Tokyo, Edinburgh to Oxford, about what the future of technology and care might look like. At the end of six months of Covid I believe we are closer to that future than we could ever have imagined at the start of the year. But for all the immense progress in the last six months I am left with the conviction that my concerns in that original report over data privacy, citizen disenchantment and the intrinsic value of human presence are now more valid than ever they were before.

We need to work together to create a Digital Plus world where we celebrate and appreciate the contribution of technology and digital to change our lives and improve our health alongside  the critical importance of enhancing human interaction and developing models which are right for the individual rather than appropriate for the system. We need to assure those who are anxious about how their data will be held and accessed and be confident in ethical principles and the human rights of privacy and personal control. We need to address the fear that human touch and contact will be marginalised by electronic encounter and exchange.

In a world of robotics and care bots, in a realm of accelerated data and machine learning, we dare not lose the human at the heart of the machine. Technology can enhance connection but can never replace touch; a machine can foster memory but can never give the feeling of a hug, held close, warm and affirming full of a depth of meaning beyond calculation.

So I will continue to be enthusiastic about the potential of technology but I will balance that with the lessons of Covid which more than anything else have taught me that when it matters most we want to be present, to feel we are heard, to recognise the rhythm of another’s concern, and to be held. If we get the balance right then we will really experience the touch of technology.

Dr Donald Macaskill

I have been thinking a lot this week about the weather.

The weather has always fascinated me, which is probably just as well for someone born in Scotland and with my surname (that latter observation will be lost on anyone born after 1980!) My love of all things meteorological was renewed when in Skye two weekends ago I saw the weather continually change in the distance with the regularity of a dance, one minute bringing torrential rain and the next blazing sunshine. Skye is a place where  Crowded House’s ‘Four Seasons in One Day’ should be the theme tune of existence. With a wide vista and far horizon, it is indeed possible to ignore weather forecasts and simply look out of the window and know what you need to wear – at least for the next hour.

This last week for many of us has been a reminder of the unpredictability of the weather with torrential thunderstorms and searing heat bringing with it destruction and devastation alongside sleepless nights and irksome hot working days.

One weather phenomenon I fell in awe of was something I witnessed years ago when on another island – the storm. Living in Holm, Orkney for a year gave me the experience of feeling the intensity of the ‘calm before the storm’, that stilling of life and sound before the flick of a celestial switch brought roaring power and breath-taking energy raging down upon you.

There is a sense for me that the recent past, these present days and what the future might hold feels a bit like experiencing an Orcadian storm.  

The last few months have been a time of unreality. It is hard to remember what life was like in pre-Covid times. Indeed, when I see on television a programme filmed before March my instant reaction is to recoil at the lack of social distancing and question the absence of masks and PPE! Our worlds of perception have changed markedly.

Life as we know it has been interrupted, whether you are a young person aspiring to a career dependent up certain grades or someone wanting to go on holiday to France or Spain; whether you are simply wanting to be with your mates in a pub, go to the football, travel to visit family, have that operation and procedure you have been waiting for, life has been put on hold. The rhythms of our ordinary living have been interrupted and removed by coronavirus. We yearn for a return to ordinariness and yet we are told by our leaders that we should not be feeling and doing things as if life was ‘normal.’

But the last few months have for countless thousands also been a period of real pain, loss and hurt.

It feels as if now we are in a hinterland, in a waiting time. The focus of so much of my time in the week that has just passed has been spent on preparing. Preparation for a resurgence of Covid, for the impact of the winter flu, for the unknowability and the uncertainties of our Brexit exit. Preparation to ensure that the social care and health systems are able to withstand the barrage of another assault, a different battle and a new challenge.

But as with a sense of calm before the unknown we have time to reflect and think, to recollect and to change. So, what should we be doing in this hinterland time? I think we have to in this liminal space between our past and unpredictable future prepare to do better and to be better.

There are aspirations I have for restoring a better way of interrupting life and normality so that we can come through future challenges in a way which is closer to who we want to be both as individuals and as a society.

So, in this hinterland of life interrupted let us prepare to do better.

Let us prepare to listen to those who are experiencing the agony of aloneness and mental health fatigue and breakdown. We have to attend better to the issues that  mean that people are struggling in their mental health with the interruption of the normal – we are all creatures of habit to a greater or lesser extent and the habits of our humanity have been thrown out of kilter. There are countless who have suffered in isolation and who today are anxious over the prospects of their future, potentially being unemployed or unable to achieve their dreams and aspirations.

Let us prepare to do better in supporting those who have lost loved ones during the pandemic and who might do so in the future. We have to do better at talking about death and dying, to stop ourselves becoming numb to the statistics of death and start finding a vocabulary that enables us to speak and to share grief with one another. In England hundreds have died from this virus in the past week yet their deaths are diminished by political silence and absence from media comment. We have to do better at working at the solace of comforting one another.

Let us prepare to do better in our care homes by really listening to what residents and families want in these changed times. We have to start to really include and involve people whose lives have been turned upside down by the pandemic. Emergency response may have justified non-inclusive action and decision-making, but in these times and moving forward we have to find better ways at making sure the autonomy and individual rights of those who reside in care homes and their families are considered just as important as the views of ‘experts’, professionals and staff.

Let us prepare for the future by making sure that we really learn the devastating truth of deterioration and decline in the health and wellbeing of care home residents by better managing measures taken to protect but which have stopped people living a life which is theirs by imprisoning them from contact and relationship, from movement and activity in their care homes. We need to do better at protecting and advancing holistic care and support including making sure in the future health professionals are physically present in care homes.

Let us do better and prepare to change a system of community social care commissioning which treats individual citizens as packages of commoditised care and let us start to re-discover the essence of relational support. There is a wave of unmet need and family carer breakdown in our communities about to overwhelm us.

Let us prepare to ensure the physical realities of ventilators and stand-by hospitals, of PPE and medical supplies are in place but let us also remember we need to continually do something about the health and wellbeing of an exhausted and sometimes demoralised staff. In particular let us face up to the reality that many working in leadership and management in social care are at breaking point with exhaustion not least from the continual demands from an insensitive system over which they have no control. We need to appreciate that we are at risk of haemorrhaging managers from the care system because of a lack of professional respect and understanding or simply because they are spent and knackered by the weeks and months that have passed.

I could go on, but I am convinced in this time and space we have to not just learn lessons but to start working on doing better.

And perhaps the biggest challenge is one we all face and one which I think only now we are beginning to truly appreciate – and that is that we are all of us needing support in order to live this life less ordinary. We need support to learn to live with a lack of the familiar and routine; whether that be working from home, coping with different models of learning for our children; not being able to be as autonomous as we once were, or simply how to ‘be’ healthy in a world of social distance and physical detachment. In a sensual physical world, we have to learn to give assurance and affection without touch and presence. We all of us have to live in our mid-Covid hinterland between past lives and future uncertainty.

In the fragmented space of our normality, in that hinterland between ordinary days and unknown future, we have to work together to create a response which roots us in our shared humanity and our collective need to be compassionate and to care. As we yearn for the familiar and the ordinary, we have to support each other to find our ways through the fractures of feelings which for many are raw and painful, confused and conflicted.

On the other side of the storm the world is forever changed. There is a freshness of air and a breath which invigorates. As we gather up the driftwood of our past we find a new purpose and direction for our present. I hope that will mean for many of us the finding of beauty in the ordinary and meaning in the mundane. We will be able to look out and see the clouds and the sun gathering on the horizon and feel at ease with who we have become as individuals, as a care system and as a community, and we will find the clothes we wear are dignity, care and compassion. It is a future we have to prepare for just like the Scottish weather.

Donald Macaskill