The Cabinet Secretary for Health and Sport has issued the following letter to all health and social care staff.
Marking the 72nd Anniversary of the NHS in Scotland - Cabinet Secretary for Health and Sport - 2nd July 2020
The social care sector is heading towards a period of reflection, that is not to say that the battle against Covid-19 is over for them and care homes in particular would tell you that they are still fighting on the front line. Managers and staff are understandably anxious over any reemergence of the virus and its impacts for their residents. Discussions are ongoing over the safest possible way to emerge from lockdown and to have that successful balance between safety measures and the real concern of the impact from lockdown and social distancing on those they care for.
However, we are starting to evaluate what care looks like now and how it will continue to be delivered in the coming months and years. The reflection that is needed is for policy makers to take the time to really understand the social care sector and its workforce which has been missing in the past when policies have been formed. This has resulted in the sector feeling that decisions are made that are not reflective of their experience, knowledge, and day to day roles. That is why it is imperative that this time the learning comes from front line staff and is shaped and formed by those who have already developed innovative ways of delivering care services within new and extremely strict guidance around infection control, wearing PPE and social distancing.
For many years we have talked about the importance of upskilling the workforce, creating new ways of learning and development and sharing of good practice which is of course extremely important however we must recognise that a great deal of that experience and knowledge is now held by the workforce particularly around dementia and palliative and end of life care. Managers of services, social care nurses and care and support workers who are providing care for those with complex dementia and with palliative care needs on a daily basis. They are hugely aware of the challenges of their roles and in their understanding of the individuals they support are able to provide high quality and tailored person-centered care.
We talk about care inductions and the wide variety of ways in which providers train and develop new staff members with the assumption that once an induction has been undertaken the staff member is then ready and able to work. Indeed, this is one of the qualifying reasons that the role of care worker sits on the Regulated Qualifications Framework (RFQ) at level 2. Unskilled staff are defined as those who require less than two to three months training prior to commencing a role and this is the definition that is used to describe front line care workers. This cannot be further from the truth which can be clearly evidenced in the staff mobilisation plans that have been developed in response to Covid-19.
Initially in March when a group was set up to discuss how best to support staffing levels and the social care workforce it was decided that SSSC would facilitate a recruitment portal alongside the portal being developed by NES for the NHS workforce returners. This was with a view to getting staff back into the sector quickly and to remove some of the difficulties and barriers of recruitment for providers while they were under huge pressure responding to the pandemic. This portal has been successful in that it set out to contact recent leavers of the sector, encourage them to come back into care, carry out the necessary preemployment checks and support the social care sector during the crisis. What was less successful was the ability of providers to access staff with the right levels of experience and knowledge that was required to fill these positions. The care home sector has seen the greatest impact of Covid-19 for a variety of reasons that I will not get into here however what has become clear is that it is not possible for staff to receive a short induction and commence work in a highly complex care setting such as a nursing care home.
The level of knowledge and skills that are required cannot be replaced with a week of training and the pathways that were subsequently created to deal with staff shortages came from bank staff at the NHS health boards and other care providers. Local networks provided much needed connections between care providers for example care at home staff were redeployed into care homes to provide the backfill support that was needed when staff were absent. This utilised staff who were already working in the sector and had a level of skill and experience that was required when supporting individuals with complex health needs and dementia support.
This lack of understanding of the social care sector and the assumptions that are made around the skill set of staff has been hugely detrimental to the recruitment and retention of the workforce that is needed. A lot of consideration has been placed on the difficulties of recruitment including the lack of decent pay, poor job security and poor terms and conditions all of which is true however this is also against a situation where the job itself is highly skilled with a great deal of responsibility which still goes unrecognised. SSSC data shows large numbers of new staff leaving the sector within the first six months as they realise that the role is complex and requires a great deal of learning and development. New staff coming into the sector must wait six months before applying to register with SSSC due to the recognition of a high percentage of leavers within that time frame.
The high level of staff vacancies and the pressure on care providers to recruit much needed staff has led to this message that individuals can walk into a care role and be ready for work shortly thereafter. This is clearly not the case and even when applicants can demonstrate the understanding and importance of person-centered values there is still a great deal of practical skill that must be learnt. This is actually the best case situation as practical skills take time but certainly can be taught, what is much more difficult is obtaining staff with the right attitude and emotional intelligence skills such as motivation, compassion and empathy that are vital for this role. In addition, as providers are taking on staff who require greater support and development this requires increased supervision and mentoring from experienced staff to ensure that the quality of care being delivered remains high.
The nature of care and the complexities of individuals needs often mean that care staff work in pairs and this enables the employer to match new staff with experienced staff to give that ongoing support and learning while recruiting the workers they need. This demonstrates the ways in which care providers have maximised the use of their existing staff to support new staff and provide ongoing mentoring to pass on experience where possible. If the sector is going to become more attractive to younger workers and grow the workforce to the numbers of people that we will require to work in care in the future this must be taken into account and the necessary support and development should be available along with the funding required.
The Fair Work report gave five dimensions that are important to individuals when contemplating and choosing their work and career. These include; effective voice, opportunity, security, fulfilment and respect. Previous labour market surveys have shown that social care employees give fulfilment as one of the main reasons they work and remain in the sector. We can also see from SSSC intelligence that there are huge opportunities for career progression within the sector and a great deal of staff movement between the different areas of the register show a high percentage of upwards promotion with care workers moving on to become supervisors and supervisors becoming care managers. However, we also know that the workforce in general feel that they do not have a voice, their contributions to policy making that would work for them is low and they certainly on many occasions do not have job security or are treated with respect in their professional capacity.
It is these areas that must be changed in order to build the social care workforce of the future. Those who are in positions of making policy and decisions must revaluate and speak with the workforce providing the care and learn from their experience if we wish to reach the highest level of care possible.
It is imperative that we find a structured way in which to define the so called “softer skills” that we have seen are so important particularly during the confines of lockdown and social distancing where care and support workers have provided that much needed end of life support and comfort when families have been unable to do so. That is a skill and it is something that many would be unable to do effectively to give that comfort when needed. We must also ensure that in the decisions being made for the future around keeping individuals safe that we do not lose sight of the importance of caring for that individual and what makes their life worthwhile to them.
Therefore, we come to the new normal that faces social care workers, the restrictions on movement, the additional personal protective equipment requirements that are affecting both staff and service users and the increased infection prevention control measures now in place. As a result of the pandemic there is a greater understanding of the role of social care and its impact and benefits on communities and the people being supported within them. This must now be taken forward and with that greater respect in mind it is imperative that the workforce is involved in these important conversations. Staff need to be asked what has been helpful and what has worked during the crisis and then time should be taken to understand these measures so that we can replicate these where possible. These conversations must be meaningful, we cannot ask staff to give of their even more precious time for a tick box exercise and so that people can reassure themselves that they did consult with the sector and involve front line workers. These must be conversations where real change is going to be actioned, where respect for the skills and knowledge of the workers must be acknowledged and the changes be driven by the workforce. We can do this by reviewing what changes to practice have already been implemented to look at what has been working for both staff and those they support. It is very clear that while policy makers have been talking the social care workforce has been creating changes that they can work within and is still in line with the many iterations of “helpful” guidance that has been published for them to follow.
Social care has certainly increased its number of allies and supporters over the last three months including individuals from within the NHS and our wider communities that can see the amazing work that goes on both in care homes and in people’s homes where they are supported. The general public has had a greater understanding of social care and what is actually required in the role due to the increased profile the sector has been experiencing. We must not lose this opportunity to build on this now, to amplify the voice of social care and to build on the promises that have been given to these essential key workers of their importance and contribution to society and the economy that has been for so long overlooked.
Caroline Deane
Workforce Policy & Practice Lead
Scottish Care, alongside other colleagues and organisations, has co-signed a letter today (2 June) by the British Institute of Human Rights. This letter was sent to the Scottish Parliament, Equalities and Human Rights Committee to raise our human rights concerns of the use of Emergency Powers in Scotland without transparent communications and robust monitoring.
You can read the letter here: https://www.bihr.org.uk/Handlers/Download.ashx?IDMF=1a4b163f-1ad1-4d47-b91c-352c732f1fc7
The Expert Advisory Group (EAG) on Migration and Population has updated their report which looks at how the new UK immigration policy impacts on Scotland.
The report warns that the proposed new immigration system could halve the number of people coming to Scotland, which risks labour shortages in key sectors.
The new immigration requirements mean that migrants from outside the EU will need a job offer with a minimum salary threshold of £25,600. This would mainly affect female migrants, who will only be able to access around 37% of available jobs.
Previous research indicates that 53% of roles filled by migrants in Scotland earn less than £25,000 – including up to 90% of jobs in the care sector.
Dr Donald Macaskill, Chief Executive Officer of Scottish Care commented:
“There have been few individuals who have more dedicated their lives to the fight against Covid19 than those working in frontline social care roles across Scotland. We know that a significant number of these women and men come from the European Economic Area.
This independent report shows that the proposed UK immigration policy risks shutting the door on the ability of social care providers to recruit talented, skilled and dedicated workers from Europe and elsewhere.
The proposed lower salary threshold of £25,600 simply fails to recognise that the vast majority of those working in social care in Scotland earn less than this figure.
Social care providers are deeply anxious that at a time of very real threat to the sustainability of the sector in Scotland that we are at the point of risking a substantial reduction in the ability to freely recruit from Europe and elsewhere. This is frankly policy devoid of practicality, ignorant of implication, and hugely damaging to our ability to protect and sustain lives at a time of pandemic threat.
I urge the UK Government to give serious consideration to the reform of their proposals, to appreciate the distinctive needs of Scottish social care providers and to prevent the damaging consequences which will inevitably ensue were this policy to be implemented.”
The report can be found here: https://www.gov.scot/publications/uk-immigration-policy-leaving-eu-impacts-scotlands-economy-population-society-july-2020-update/
Care Home Day is taking place this year on Wednesday 15 July.
This day is a largely online event which aims to raise awareness and promote care homes. We hope to share good news stories to bust myths about care homes and recognise the role they play in communities.
We understand that the Covid-19 pandemic has been difficult for everyone, and during this time, events like Care Home Day may not seem significant. But this makes it even more important that we share positive stories to shine a light on social care and the care home sector. This is the perfect opportunity to showcase the amazing work that staff have been doing not only during this pandemic but all the time.
The theme of Care Home Day is ‘Care Community’. You can help us commemorate the day by sharing any good news stories, resources, projects blogs or an example of an innovative practice which shows:
As part of the theme, we encourage care home providers to consider doing some sort of virtual activity during the day between residents, staff, families and the community. If you do decide to take part in any activities, please remember to share them with us on social media.
Please share and get involved on Twitter using the hashtag #carehomeday20
This is a term we have heard mentioned often over the years, but what is the answer?
Back in 2010, we saw the Caring Together Carers Strategy published, promising support and recognition for the role unpaid carers provide, building on the recommendations made within the early Care 21 report: The Future of Unpaid Care in Scotland.
Most recently in 2019 NICE (National Institute of Clinical Excellence) published new draft guidance which aims to improve the wellbeing of adults who provide unpaid care for people over 16 years old. The recommendations made tasked the local authorities and health and social care partnerships (HSCP) to identify how they provide support to carers. In the main, this was to assure that they would direct people to the appropriate financial, social and emotional resources that are available.
This month saw Carers’ Week celebrated and at no other time was this more poignant.
New figures show that 392,000 became unpaid carers in Scotland in a matter of weeks, caring for older, disabled or seriously ill relatives or friends during the pandemic.
This is on top of the 729,000 unpaid carers in Scotland who were already caring before the outbreak, bringing the total to 1.1 million.
Throughout the pandemic, we have celebrated the contributions of all health and social care staff but sadly there was not the same celebration provided for informal carers, with many having had to continue to manage with the limited supports available during the lockdown, but at what cost?
Being an informal carer may sometimes be a choice and can be very rewarding, but for many, it simply is a result of circumstance where people are left feeling duty-bound to step up and take care of their loved one. Some people may feel emotionally pressured whilst others simply do not wish to involve others. It is therefore important that we advocate where possible for those who feel powerless, who feel that they have no voice and that their concerns are not being heard. Despite recommendations, many continue to feel they are not listened to, which may make some reluctant to ask for help.
This undertaking is difficult enough when you are supported in this role but for a significant number of people, they simply are trying their best in an extremely difficult situation and often at a huge detriment to themselves emotionally, physically, financially and psychologically.
As the age of our population increases so does the age of those finding themselves in a caring role. We recognise that promoting healthier lives and living longer increases the possibility of caring duties.
Older people, some even retired themselves may have to look after their parents, who will be living to significant old age, as well as their own partners and perhaps even caring for grandchildren.
As time goes on, if no services are involved in supporting the care needs, the carers can often experience burnout which can result in finally asking for some help or for some making the difficult decision not to carry on.
Sadly sometimes the first that services realise someone is in a caring role is when either the carer or one they are caring for becomes unwell and appears at hospital.
Unfortunately, this was something I witnessed far too often over the years as a nurse and as a social work manager within the hospital, a sharp reminder that we are continuing to fail the most vulnerable people within our communities when you see an elderly man has lost his life and his wife that he cared for having to be placed in care. There are too many invisible vulnerable people within our neighbourhoods. We must promote the need to ensure people’s wishes are adhered to and facilitate the use of the power of attorney and welfare and financial guardianship to avoid the sad indignity that results when these protective measures have not been addressed. Having a relative sit for months in a hospital bed because they have no capacity and no legal rights to place someone in a homely setting is a real injustice.
As we move on from the impact of the pandemic this may be the case for many, as we have noted the traumatic effects of being confined as a carer during the lockdown, highlighting the responsibilities in caring for someone you love with limited resources and lack of social interaction.
We know that respite for some allows that time out, to recharge batteries to continue, however respite is not accessed by all for a number of reasons, with some feeling they are failing the person they care for, or that the person being cared for would become distressed at the thought of it.
This highlights the importance of firstly to offer this resource and secondly to ensure that the respite experience is one that gives benefit to both the carer and the person requiring care.
Respite care in Scotland has thankfully now changed and does not now necessarily mean the person has to leave their home, which provides greater flexibility. I can recall a young father who had a degenerative condition who simply wanted to allow his wife and sons a break but to have respite in his own home. Unfortunately, bureaucracy prevented this at that time and that sense of failure stays with you. Everyone should have the right to have care around the personal outcomes, especially with a life-limiting condition.
Older carers who are looking after someone with dementia can also find it difficult to cope with the changes in the personality of their loved one. People with dementia can become easily frustrated, aggressive, and suspicious of other people. This can be extremely damaging to the carer’s emotional wellbeing. We can all think of someone who has experienced this distress.
In 2015, an estimated 47 million people were living with dementia throughout the world, with this number expected to triple by 2050. Several studies have highlighted respite support is an unmet need for people caring for someone with dementia, this may be due to limited specialist places who offer respite, alongside the difficulties around this being communicated to the carer, and at times the carer’s inability to seek this information out. In addition, as mentioned earlier respite may not cause further distress and behavioural upset.
During the pandemic, this may have been compounded by a reduction in social work assessments, alongside some councils making the decision to change the criteria for access to care, which left many without additional support and only limited new care packages, with families requiring to step. Closure of daycare facilities has been viewed as a particular hit for many carers who have previously relied on the respite these services provides.
Scots who have started caring since the outbreak may have been able to simply because they were shielding or furloughed. We know many were new to this but some are also juggling paid work alongside their caring responsibilities, highlighting the need for working carers to be supported as they return to work. Estimates show that the care provided by friends and family members to ill, frail or disabled relatives is equivalent to £119 billion every year.
It is without question that services could not manage the demand if informal carers did not exist.
The six charities supporting Carers Week – Carers Scotland, Age UK, Carers Trust Scotland, Motor Neurone Disease Association, Oxfam GB and Rethink Mental Illness – promoted the need for further reform to happen which recognises and raises awareness of the role unpaid carers are playing during the pandemic and ensure they are supported through it, and beyond.
One success, however, was the recognition of unpaid carers as key workers with the right to access testing.
As reported by The Princess Royal Trust for Carers 65% of older carers have long term health problems or a disability themselves, with 69% saying that being a carer has had an adverse effect on their mental health. Older carers also report that their role makes it hard to find time for social life and isolates them from friends. We must also acknowledge that illness and disability in old age can create a large financial burden for some people. Carers may have to find the additional money to pay for specialist care or necessary equipment.
Over the next 30 years, the number of carers will require to increase by 3.4 million (around 60%). Much has been spoken about this over the years but as carers become older themselves the ability to cope is likely to decrease significantly and result in crisis situations. Contingency planning and the need for more investment in community capacity building must be at the forefront of social reform.
As we acknowledge the fact that services will need to look different moving forward it is fundamental that we ensure that we don’t forget those within our communities who have undoubtedly been affected by the pressures of COVID and lockdown.
We need to move away from crisis management to avoid the unnecessary and distressing results that bring for carers and their families. People should continue to have choice and control and remain within their own homes for as long as possible even if they have 24 hr care needs.
The whole criteria of assessment of need, needs to be reviewed to ensure clarity and intrinsically have a preventative measure to avoid further failures in the future.
We must ensure greater recognition of the responsibilities carers are under ensuring their health, wellbeing and personal protection, especially as there is a significant potential risk of a second wave, bringing with it an additional loss of lives, as we move into the flu season.
We must advocate for reform and ensure personalisation, equality, respite and support that has a direct benefit to carers health and well -being or we are undoubtedly failing this country’s unsung heroes.
Jacqui Neil
Transforming Workforce Lead for Nursing
Following last week’s announcement on the phased reintroduction of care home visits, Scottish Care has developed an infographic with details on Stage 2.
Stage 2 will begin from 3 July – care homes with no Covid-19 cases or which have been Covid-19 free for 28 days will be able to allow outdoor visiting. This phase of visiting will include a single nominated visitor, who will be required to wear a face-covering for the duration of the visit. Physical distancing, hygiene and other appropriate safety measures should also be in place.
The infographic and guidance are available to view below. We hope that care home providers, staff and family members will find this useful.
I read probably more than my fair share of reports and official research and if truth be told I often struggle to get beyond the Executive Summary for most of them and probably hold very few in my memory. There are exceptions and one was ‘Let Glasgow Flourish’ a report in 2006 describing the health inequalities of the city of Glasgow and what was needed to address these. Written by Prof Phil Hanlon and colleagues it was an articulate, impassioned, reasoned and convincing argument of what needed to be done to address that city’s health and social care woes. Sadly, a lot of what was called for is still resonating as an echo.
As a former citizen of Glasgow, I have always treasured the motto of the city ‘Let Glasgow flourish ….’ The idea of flourishing resonates with the sense of springing into life, of growth and renewal, of resurgence and success. Its organic positivity is at the heart of all human health and care. Clinical and social care have a shared desire to see the individual grow and develop, become whole and achieve potential; in other words, to flourish to the fullness of their humanity. Something of this is captured by the idea of thriving which I know is now much beloved by public health thinkers. But there is something about flourishing that appeals to this west coaster!
The concept of flourishing may seem a strange one to reflect upon as we are struggling to still deal with a pandemic which has destroyed so much in its wake, and has brought havoc and despair, loss and death to tens of thousands. But I think it is important in the days, weeks and months ahead to start reflecting on what it is that will help individuals, communities and organisations start to flourish again.
This week we received the thankful news that slowly and safety we will see the start of care homes enabling family members to visit their relatives. The abnormal exclusion of contact and presence is coming to an end boundaried by the need to protect and keep safe. But alongside this is the urgent requirement to support residents and staff to start to flourish again. Work is ongoing and has a new urgency to address the very real deterioration and decline that has occurred as a result of measures designed to protect, through self-isolation and social distancing during lockdown. This will not be easy either on a personal level or for organisations, but we must give as much energy to coming out of lockdown as we have to protecting it. The role of our Allied Health professionals, physiotherapists, podiatrists, nutritionists, speech and language therapists, optometrists and so many more will be critical and central as we seek to let care and people flourish again. I have often heard folks say that people got a new lease of life when they went into a care home and were cared for, met others and felt as if they belonged. We all have a lot of work to do to restore that sense of joy at the heart of our care homes and to let them flourish once again.
But care also needs to flourish by restoring the well-being of nursing and care staff who are understandably spent and exhausted by the struggles and demands of the days and weeks which have passed. Without the traditional routes for relaxation and renewal offered by a flight to the sun, we will need all of us to support staff and frontline nurses and carers to be able to deal with the emotional and physical challenges of the last months.
On a wider front we have a real opportunity to let care flourish. Yesterday I took part in a webinar with hundreds of primary care colleagues which was both a reflection of the lessons learned during the pandemic and the real positive work that has been underway. I have written elsewhere that over time we have fragmented the critical interface of how primary care and social care relates. If there is one thing we need to do better after Covid it is to ensure that we get this right. Part of that is the painful acceptance that we did not get it right all the time, in every place and in every way, at the start of the pandemic to the extent to which social care staff have voiced a sense of abandonment. There is little point dwelling on this – but we have to learn from it and need to move forward to recognise that where we got it right it was of immense benefit to resident and professional alike. The tremendous examples of GPs, palliative and end of life practitioners, pharmacy colleagues, community nurses working alongside social care nurses and social care staff should be the ultimate memory that changes things in the future.
I believe we need to develop a real partnership of mutual respect, professional understanding and reciprocal awareness that wraps primary and secondary care around our care homes and our homecare services. In some parts of Scotland, the pandemic has helped us to walk in each other’s shoes for the first time and has helped to create real mutuality and respect. We need to build on this systemically, strategically and with sensitivity. These conversations and pieces of mutual work will be essential to enable care to flourish.
To flourish is to have a sense of positive renewal. Now is the time not just to open the gardens of care homes to visitors but for the community to take care homes into their centre; for us to create a system where all citizens, regardless of need or location, of residence or age, of disease or condition, receive equal treatment and care which is built around the needs of the person, enhances the humanity of the individual, and enables them to flourish, and our society to become renewed. We will do that by binding secondary, primary and social care together not so tightly that the distinctiveness of each is diminished, but in a way that each has voice, contribution and creative ability to grow and change.
So, let care flourish.
Donald Macaskill
The Cabinet Secretary for Health & Sport has announced the phased reintroduction of family visiting and communal activities for care home residents today (25 June).
Care homes with no Covid-19 cases or which have been Covid-19 free for 28 days will be able to allow outdoor visiting from 3 July. This phase of visiting will include a single nominated visitor, who will be required to wear a face-covering for the duration of the visit. Physical distancing, hygiene and other appropriate safety measures should also be in place.
The approach to reintroducing care home visits will be done incrementally to protect residents and staff. Further visiting options will only open when scientific and clinical advice indicates that it is safe to do so. The fourth and final phase will see controlled indoor visits and wider use of communal areas by residents.
Scottish Care welcomes today’s announcement. This is an incredibly important piece of news for residents and their families. Lockdown has been difficult for everyone, but especially for our care home residents and those with dementia who have been isolated from their loved ones.
Scottish Care advised care homes members to restrict visiting on 11 March. Some care homes have been in lockdown for more than 3 months. This wasn’t an easy decision but was one that was required as a response to the threat of Covid-19. But as lockdown continued, we recognised this was impacting on both the psychological and physiological health of our care home residents. Residents were becoming more and more isolated and reopening care homes will allow our residents to re-establish connection and belonging.
Alongside families and loved ones, Scottish Care has been calling for the reinstatement of safe care home visiting as a resident wellbeing priority for some time and we are extremely pleased that the Scottish Government has now enabled the first step in this process.
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