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Should you go to A&E? – Stakeholder Toolkit

People are being asked to continue following the public health guidance issued during the first phase of the coronavirus (COVID-19) pandemic by using their local pharmacy, GP practice, local minor injuries unit or NHS 24 to get advice and help when they need medical care.

A new public information campaign titled Should you go to A&E? launches 15 July to ensure people continue to get the right care from the right place.

The campaign will run from 15 July – 6 August 2020.

This campaign is the first in a series of communications planned for the coming months to explain how health and social care services are remobilising following COVID-19.

20-21 - Coronavirus -Stakeholder Toolkit - NHS Remobilisation - Final - 17 July 2020
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Launch of the Health and Social Care Workforce Wellbeing line – 20 July

The Scottish Government is funding a national mental health wellbeing helpline to support health and social care workers in Scotland. This will be available 24 hours a day, seven days a week.

Trained practitioners at NHS 24 will offer callers a compassionate and empathic listening service based on the principles of psychological first aid, as well as advice, signposting and onward referral to local services if required.

This support line is available at 0800 111 4191.

For more information please click here.

Health and Social Care Workforce Wellbeing line within NHS 24’s Mental Health Hub
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Highland Senior Citizen Network – Highland Hello

Highland Senior Citizen Network (HSCN) has produced a short trailer for their Highland Hello Films. A ‘Highland Hello’ is an initiative created by HSCN to allow people to share experiences and keep in touch during the Coronavirus lockdown.  

You can view this video here.

 

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Dementia-proofing future care

(Text of an article published in Caring Matters Magazine, July 2020)

Dementia as we all know is a crippling illness. It robs people of so much in their life not just their memory. It creates a world narrowed down in on itself where routine and familiarity, pattern and predictability become all the more important. It is a world where loss of function and ability has to be matched by caring support, maintaining relationships and adapting communication.

Lockdown has forced change upon most of us. In the care sector it has brought about undeniable challenge and trauma not least in our care homes which have witnessed the distress of deaths at a rate of frequency that we have been left silent in its wake. In our communities the stripping away of packages of support by councils and the ending of contracts by private individuals have left many individuals, organisations and staff vulnerable.

There will be time and space for much reflection on our pandemic response and actions as a whole society, as politicians and scientists, and as health and social care systems. But I hope that at its core that such a reflection includes the experience of those living with dementia. Statistically we know that over three-quarters of those who have died as a result of Covid19 have been individuals over the age of 75, and that a sizeable majority of these have been individuals living with dementia and frailty. 

The story of Covid19 in our country is the story of dementia. Have we acted in a manner that has protected the most vulnerable or have we been expedient and mis-calculating in our efforts to protect the majority at the expense of the life and care of those with dementia? It may be too early to answer that but personally I consider our response to those with dementia has been wholly inadequate if not deadly.

We live in a country which enshrines human rights as the basis of our interactions one with the other. Even in times of national emergency and crisis we agree that there are fundamental behaviours and actions which are necessary to take, and which underpin our response. Conversely we acknowledge that there are approaches and decisions which are deemed unacceptable because of their contravention of the basic rights which we have come to hold as fundamental to what it means to be human and who we are as a community and nation. For people living with dementia upholding their human rights should be the barometer of the care and support they should ordinarily expect. So, any human rights analysis of our response to Covid19 should explore the impact of our actions for those people living with dementia.

In that regard how have we done? Have we enabled the preservation of life at all costs or has there been an expeditious decision taken to prioritise some more than others? Has the overt policy and practice focus of preventing the NHS from collapsing resulted in a failure to adequately support the very social care systems (especially care homes) which are the mainstay of support for people with dementia? Have we so focussed on the need to reserve resource for the acute sector that we have drained local authorities of the abilities to adequately resource people being supported at home? Have we included and involved older people living with dementia at key points of decision-making and our Covid19 response, for instance in decisions around shielding?

Life in a care home under lockdown, with enforced isolation and social distancing has been viewed through the strict lens of infection prevention and control. But have we given enough serious focus to how it is possible to undertake such measures in settings which are non-clinical, non-institutional and personalised to enable them still to be familiar and homely?

Life for anyone receiving care and living with dementia during this pandemic has been brutal and hard, emotionally empty and traumatic. I am not using hyperbole but stating fact as I see it. We have instructed workers and providers to ‘isolate’ individuals whose very agitated behaviour often results in them needing to be active; we have expected from people who are confused and distressed a compliance which is wholly unreasonable; we have put our staff in masks in the midst of a community for whom recognition and remembrance are fundamental requirements of assurance and comfort, leaving many terrified by appearances. We have stopped using common spaces for people whose routine and pattern of behaviours have meant being in the same space and place, alongside the same people and doing the same activities had become for them the boundary of safety in their confused and conflicting worlds. And perhaps worst of all we have restricted visiting of family and friends, except in a few instances, which has meant for everyone their loss of the relational, of touch, physicality and presence.

The shame of so much of our Covid19 response as a society is not the shame of the care sector but an indictment against some politicians and strategists, against a fundamentalist approach to infection prevention and a failure to embed humanity and person-centredness in our implementation of lockdown measures. Covid19 has brought a challenge undoubtedly but it has shone a light on the failures of our care and support for people with dementia.

I believe that as we reform and reshape ourselves moving out of our immediate response to the pandemic and into a stage of restoration and reform that we need to do much better in the future than we have to date. We have to be better at balancing the human right to a quality of life with dementia over and against the right to the preservation of life. Our care homes hold in care the lives of thousands living at the end of their days, the vast majority with dementia. They do not have weeks, months and years for us to continue to deny them relationship and encounter, memory and engagement. In the future we cannot accept the frequent long-term imprisonment of citizens in the name of their own protection without their willing articulated agreement. Initial protection measures were undoubtedly proportionate and reasonable to achieve the legitimate aim of the wider preservation of life. Every week that has passed, with witnessed deterioration and disintegration of life, with increasing numbers wasting away not from the virus but from the experience of protection, has brought a toll which cannot be acceptable. We have to find a better approach than the adoption of the imperatives of a model of infection control and prevention developed for the clinical, antiseptic environment of a cold hospital ward into the spaces and places people are encouraged to call their own home. A care home is not an institution and we need to develop non-institutional responses. We cannot rip up carpets, remove personal possessions, strip rooms of individuality, replace comfort with clinical compliance – simply in the name of protection. Life is more than existence – it has to be about quality, meaning, purpose and individuality.

Coronavirus will be with us for some considerable time. We have to ensure that our ongoing response to its threat is based on an understanding of human dignity and not solely one of scientific dictate.

Dr Donald Macaskill

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The essence of hope: the dangers of Covid19 optimism.

 

Hope is not optimism,

which expects things

to turn out well,

but something rooted

in the conviction

that there is good

worth working for.

 

– Seamus Heaney

 

Hope is one of these intangible commodities. If we lack or lose it we diminish our abilities both individually and collectively to achieve and to continue. It is an emotion which has been very present in a lot of the conversations and exchanges which I have had this week.

Hope was there when with others I attended the NHS Mobilisation meeting chaired by the Cabinet Secretary. It was a hope that through deliberate and focussed action we could begin to restore NHS and social care services to where they had previously been, learning lessons from the pandemic response and ensuring that we are as prepared as possible for the coming winter. It is a hope not based on day-dreaming but solid hard work which through a cautious ending of lockdown and opening up of society means that we will meet the current and future challenges of Covid19 with as much preparedness as possible.

Hope was there when I spoke to a manager who had to deal with the family of a co-worker who had died as a result of Covid19. It was there when I spoke to the family themselves. It was a hope that tomorrow would be better, that they would slowly be able to put back together the shattered pieces of their lives and find a new way of living without the strong presence of their loved one. It was a hope which they desperately needed to pull them through into their future  because right now they are drowning in the emptiness of loss and the pain of grieving.

Hope was there when I read a beautiful pain full letter from a mother unable to hug and hold her adult daughter because she lives in a residential home and is subject to the current restrictions on visiting, including the wearing of PPE and social distancing. The mother’s poignancy was the hope that the time would come soon when they could be properly together as once they had been in an intimacy of touch and belonging.

Hope was there when with so many others I was moved by the hundreds of stories which flooded Twitter and Facebook on Wednesday during Care Home Day as folks took time to share stories of amazing compassion and care; as they reminded us all that care homes are places of life and vibrancy, places where individuals are enabled to life to their fullest and when the time comes to end their days surrounded by dignity and solace. There was a real sense on Wednesday of a hope that sometime soon we will return to something like normal and that sounds of laughter and song, of banter and memory will fill the silence that has enveloped so many care homes. But in doing so without forgetting the pain and sadness of the last few months and with a desire to hold in fragile memory those who have been lost.

Hope is an essential requirement to enable all of us to find the energy to deal with challenge, whether professional or personal. I recognise that there are countless thousands who need to believe that there is hope. I know that too many have lost their jobs and their sense of self and personal worth as a result of this pandemic. I know that too many have been deeply scarred by the effects of lockdown on their mental health and wellbeing. I know that there are countless families who will never be the same because they have lost someone to the virus. I know too that there are thousands who fear for the future because they run a business or work for an organisation and are uncertain about how or when they can get back to ‘business as usual.’

So, hope is an essential commodity to enable life to flourish and for purpose to have direction.  

But and it is a big but – that hope has to be grounded in some degree of reality. Hope has to be rooted in truth and grounded in carefulness. As the poet Heaney says it is a hope that has to be worked for. So, it was with a sense of real despair I heard yesterday some of the words of Boris Johnson, the Prime Minister. I am deeply concerned that by suggesting that ‘It will all be over by Christmas’ that he is in danger of echoing the mistakes of those of a previous generation who thought that resolution and restoration would result with a quick victory over an enemy in 1914 and that all would be well by Christmas.

Covid19 will not be over by Christmas. We will live with it for many years to come. We will have to live with its pernicious ability to destroy lives and shatter love. But with discovery and ingenuity we will discover how to control and lessen its harm and how to heal those whom it hurts. But we are not there.

A false hope is a dangerous illusion because it prevents caution and fosters reckless action. Anyone who has lived through the hell of these last few months in the care home sector, who is still not able to freely see and be with loved ones, will know the huge sacrifices that have been made by so many. We risk throwing all that away, we risk the escalation of danger, should we be deluded into thinking that things are about to be sorted and solved. Hope has to be rooted in sense rather than expediency, lives matter more than anything and we cannot use them as the vehicle for populism. Hope has to be worked for.

So, I end the week with hope. It is a hope grounded in the knowledge that by safe and slow steps we are edging forward as communities and as a nation. It is a hope that we will support one another through the days ahead in a way that affirms our humanity, recognises the pain of others and upholds those who are most in need of support. It is a hope that by collective support and cautious planning rather than naïve rhetoric we will meet the challenges of the autumn and winter ahead.

For one thing I am sure of is that Covid19 has changed us all in ways which are unimaginable.

“The world is indeed full of peril, and in it there are many dark places; but still there is much that is fair, and though in all lands love is now mingled with grief, it grows perhaps the greater.” 

― J.R.R. Tolkien, The Fellowship of the Ring

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Bereavement Charter Webinar – 30 July

Dear colleague,

You are invited to the first webinar to support the implementation of the first Bereavement Charter for adults and children in Scotland on Thursday 30th July between 15:00 and 16:30.

Chair: Dr Donald Macaskill, CEO of Scottish Care

Guest speaker: Mr Derek Feeley, former CEO of the Institute for Healthcare Improvement and of NHS Scotland

The aims of the webinar are to:

  1. Encourage buy-in to and support for adopting the Bereavement Charter within organisations
  2. Establish if/build a consensus for making the case to Scottish Government for national leadership and resourcing of infrastructure for bereavement support, especially reflecting anticipated growth in need due to Covid-19

To register and receive further information please reply to [email protected]

We look forward to meeting you there.

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Camphill Scotland and Partners respond to post-Brexit plans for social care workers

The UK Government’s decision to exclude care workers from the proposed new fast-track Health and Care visa is reckless and will have far reaching impacts on both the health and care sectors across the UK, and on those people who rely on quality, human-centred care.

Camphill Scotland along with 50 partner organisations from across the UK including the ALLIANCE, SCVO, the Association of Camphill Communities, Scottish Care, Disability Wales, the Northern Ireland Council for Voluntary Action and UNISON, have raised serious concerns regarding post-Brexit impacts on the health and social care sector for some time. Brendan O’Hara MP lodged Amendment NC1 to the Immigration and Social Security Co-ordination (EU Withdrawal) Bill on their behalf, which was debated and subsequently defeated on 30th June by 344 votes to 247 votes.

The amendment called for an independent evaluation to determine the full impact of the ending of freedom of movement and of the introduction of a points based immigration system on the care, support and safeguarding for disabled adults, children and young people, and people with long term conditions or other support needs.

The announcement made by the Home Secretary earlier this week confirms the worst fears of the partnership of 50 organisations, and leaves the care sector confused and concerned as to how they will retain and recruit skilled, committed staff. Carers continue to be undervalued despite the incredible work they do and the positive life changing impacts they can have on the people who they care for and support.

Emma Walker, Director, Camphill Scotland said:

“This is a devastating blow to the care sector and the people who depend upon it most. The points-based immigration system places Camphill communities and care providers across the UK in a vulnerable position. Many questions remain unanswered but one thing is certain, and that’s the detrimental impact this decision will have on care provision.

For Camphill communities and other organisations who have international voluntarism embedded into their working practice, it’s a double-whammy. Cost of care will increase and the connections between our international volunteers and those that they work with will be lost.

Despite statements to the contrary, it is clear that the incredible commitment and work shown by our carers during the coronavirus pandemic has gone unnoticed by those who have made this decision. Clapping for carers each week is deeply insulting if the next act of government is to announce the curtain call.”

Professor Ian Welsh OBE, Chief Executive, Health and Social Care Alliance Scotland (the ALLIANCE) commented:

“Dedicated and committed social care workers provide invaluable support that enables disabled people and people living with long term conditions to enjoy their right to independent living and participate equally in – and contribute to – Scottish society. By excluding care workers from the proposed new fast-track Health and Care visa, the UK Government demonstrates a lack of understanding of the skilled and vital role played by the social care workforce.

This decision further perpetuates the lack of parity between health and social care, and underlines even more the need for an independent evaluation of the impact of the Immigration and Social Security Co-ordination (EU Withdrawal) Bill on the health and social sectors, as called for by the ALLIANCE, Camphill Scotland and 50 partners.”

Dr. Donald Macaskill, Chief Executive, Scottish Care said:

“It is a matter of the deepest regret that the Home Office has failed to take into account the representations made by the care sector in Scotland. The failure to recognise the distinctive social care needs of Scotland both in terms of its ageing population and workforce and the shortage of workers in Scotland in general is a matter of incalculable folly.

To initiate such dramatic restrictions on the ability of social care providers to recruit from outwith the United Kingdom and to fail to identify social care in the Shortage Occupation List beggars belief in the midst of a global pandemic.”

Alison Thomson, Chair of trustees, Tigh a’Chomainn Camphill remarked:

“The international volunteers that support our Camphill Community and many others across the UK provide a unique and very valuable support network to the vulnerable adults that we support. Over the last few months they have shown their true colours through their dedication and commitment to our Community. Despite pressures to return home they remained in the country and have played a key part in ensuring the good health and wellbeing of everyone at Tigh a’Chomainn Camphill.

Their efficacy speaks for itself – to date we have had no cases of Covid-19, and our care metrics indicate that despite the immense uncertainty people supported by Tigh a’Chomainn Camphill remained well and in good spirits. Good care must include health and social care. We call on the government at Westminster to reverse its decision and include all health and care workers in the health care visa scheme.”

Camphill Scotland, ALLIANCE, SCVO, the Association of Camphill Communities, Scottish Care, Disability Wales, the Northern Ireland Council for Voluntary Action, UNISON and our partners totalling 50 organisations across the UK will continue to pursue the issues raised by Amendment NC1 to the Immigration and Social Security Co-ordination (EU Withdrawal) Bill with Peers of all parties and groupings in the House of Lords.

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Care Home Day 20

Welcome to Care Home Day 20!

Catch up on the day here:

Care Conversations - Social Media Musings with Dr Tara French & Jenni Mack
Care Home Day blog from our CEO - Dr Donald Macaskill
Care Home Day blog from our Workforce Lead
The 'Glamour Girls' of Lizdean Care Home
Care Home Student Reflection 1 - Katy
Care Home Student Reflection 2 - Vinny
Care Home Student Reflection 3 - Natasha
Care Home Student Reflection 4 - Courtney
Intergenerational Work - Abbotsford Tayside View
Spiritual Care and Connecting during Lockdown - Abbotsford Tayside View
Gifts for staff at Crossgate Care Home
Jade - Activities Coordinator from Renaissance Care's Jesmond Care Home
Casey - Care Nurse and Acting Home Manager from Renaissance Care's Meadowlark Care Home
Activities from Thorntoun Care Home
Transforming Workforce Lead - New nursing programs
Examples of good practice in care homes in Lanarkshire
FHSCP and Scottish Care give thanks to Bandrum Care Home

Here are some pictures and videos from last year’s Care Home Day that we would like to share:

Torrance Lodge Care Home
Dalmellington Care Centre
West Park Care Home
Grange Care Home (Part 1)
Grange Care Home (Part 2)
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Care Home Day blog from our Workforce Lead

Constantly Adapting – The Changing Nature of Care Homes

Care homes have, for many years now, been changing how they operate, and this has been well documented throughout these years although it was still not widely known among the general populace.  Covid-19 has started to highlight this work to a far greater degree, and it has also created a time of rapid change within these care homes to adapt again to the ‘new normal’ that we are currently experiencing.

At the heart of these care homes are the workforce, social care nurses, care and support workers, care managers, kitchen staff and domestic workers.  Today on Scottish Care’s Care Home Day we are looking to thank these workers and take time to really reflect on the work that they do and most importantly the work they have done in the last few months since Covid-19 arrived.

Thankfully now we have the platform of social media to really highlight the kind of dedication, commitment, and compassion that the social care workforce has embedded in their nature and in their practice when delivering care services.  This has shone through in the actions of those workers who have for example stayed for periods of time in their care homes with residents to reduce the risk of the virus being brought into the care home.  There was the ‘Dedicated Dozen’ made up of 12 care workers who made the decision to move into their care home for a #32dayshift to protect their residents and the wonderful stories that came from their experience.  Other care homes had staff make the same commitment and the overwhelming theme of their stories was the increased closeness of relationships they had built during those times with each other in their staff teams and with the residents.

These examples and others show the huge dedication of social care staff who continually make personal sacrifices, not seeing their own family members and being away from home to deliver that care and to best protect those most vulnerable at time they greatly need it.  In general care home staff have worked tirelessly coordinating shifts and ensuring that the amount of footfall within care homes has been reduced as much as possible.

Staff have continued to adapt to the necessary confines of the guidance that has been produced to ensure peoples safety.  This has been extremely difficult for care staff who have had to make sure that residents stay in their rooms to comply with social isolating.  Given that most of these residents are extremely fragile with various comorbidities and often complex dementia this has been a hugely emotional time for both staff and residents and care staff have remained the staunchest of defenders of those they support.  Care Home staff have continued to highlight that the importance of a good quality of life, of meaningful relationships and human contact for older people remains the same as for everyone else and that the removal of this contact has had such a significant impact on individuals who live in care homes.

This is another reason that Care Home Day is so vitally important to recognise this work and to offer reassurances to people that care homes remain safe and dedicated to the importance of inclusion and good quality of life for everyone.  Those currently supported in care homes and their families have seen firsthand and can attest to the dedication of these staff.  Care workers who have stepped up and taken further that role of providing comfort, support and care when needed and when families have been unable to be there particularly for those at the end of their lives.

This same energised approach is now being used to plan and set up visiting with family members desperate to see their loved ones after so long.  Gazebos have been purchased and risk assessments carried out, another great deal of work undergone to ensure residents can be supported to safely make contact again with the outside world.  Dealing with additional problems of wind and rain and those gazebos being chased down streets, the care sector somehow always manages to laugh at their challenges along the way.  Once again I cannot express how much of a fight care homes have put up to ensure equality as much as possible for their residents and have highlighted the unfairness and disparity of approach against those simply because of the setting in which they live.

Care home activity coordinators have been working hard to come up with new ideas of entertaining residents and providing much needed stimulation within the restrictions of social distancing and all with the use of extra PPE such as face masks.  Technology is being increasingly explored to see how it can be used to its fullest and the workforce has responded with enthusiasm for the task ahead, introducing innovative ideas and approaches to working with people.  White boards have been used by residents to write messages on and then shared through social media and tech devices such as ipad’s.  This has helped with staying in touch and connecting to family and friends and has also reminded the world that the residents in care homes are still thriving.  The sentiment has definitely been that keeping distance from each other is not ideal but there are still plenty of laughs and fun to be had.

Care Managers especially should be shown heartfelt gratitude and appreciation for the manner in which they have held everything together and during a time when they were experiencing their own high levels of anxiety while giving much needed reassurance to their staff teams.  Care home managers have shouldered the bulk of the responsibility, making tough decisions on a daily basis and putting into place the strict measures needed to keep residents and staff safe using guidance that was constantly changing.  These managers should receive awards not scrutiny for how they have risen to the many challenges and have kept the morale of staff, and those they care for, going through this complicated and frightening experience.

In light of all this, it is my request that the same dedication, compassion, and support is given to these workers.  Staff who are hitting a point of exhaustion, who need to talk through their experiences and make sense of what they have been through and have witnessed.  The health and wellbeing of these workers is of paramount importance and there is stark evidence to show the ongoing impact of the pandemic on the workforce if these supports are not made readily available when needed.

Thankfully, there is a great deal of work going on in the space of staff wellbeing and Scottish Care will continue to actively participate in these conversations and to fight for support and appropriate resources for the social care workforce.  We aim to show how much regard and respect we hold for care workers, care managers, social care nurses and other members of the care home workforce who truly epitomise the meaning of the word care.

Caroline Deane

Workforce Policy and Practice Lead

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Care Home Day blog from our CEO

Care home as community.

If you look up the dictionary you get loads of definitions for what a community is. Its described variously as a unified body of individuals who have common interests living in a particular area; or its defined as the geographical area itself or pictured as a body of persons of shared and professional interests scattered through a larger society, and so on.

But actually, when I think of the word community it combines all that sense of space and place, of people and belonging. When I picture community, I see faces and folks, a sense of togetherness and attachment; a sense of arrival and coming home rather than travelling to a destination. For me a care home is a superb living example of what a community is all about.

Today is Care Home Day and I am very pleased to be able to write a few thoughts on what a care home community is all about.

In the last few months we have seen witnessed in our care homes a story which has shown the absence of the characteristics which make up a normal care home. These are places of interaction and engagement, full of banter and gossip; spaces where people come and go, of busyness and belonging. If you want to seek solitariness and silence your average care home is probably the last place you should go.

In the last few months, however, as the pernicious Covid19 virus began to impact upon the whole world, care homes have become places of quiet; of curtailed activity and limited engagement; locations which have sought to isolate individuals in a desire to protect and keep them safe. Far from being places of busyness they have become withdrawn, far from being places which reach out and pull the wider community in, they of necessity have had to shut their doors and seek to keep out family and friend, young and old alike.

That is one story of the last few months. It is a hard story whose lessons we must learn and whose pain we must feel. But care homes even in these hard times have still been places of community. They have seen and heard words of love, care and compassion; they have witnessed the gentle presence of comfort in the midst of fear; solace at times of sadness and reassurance in moments of anxiety.  The staff in our care homes have gone beyond calculation in their dedication to those they support and residents themselves have sought to support one another in these challenging days.

A community is not just a physical place or even the gathering together of people with shared interest. A community is a place where you can be wholly who you are without pretence or mask, where your humanity can be honest, and you can be comfortable in your own skin. I have lost count of the folks who have said to me that moving into a care home was the best thing that they had done in their life. From loneliness they have found company, from isolation they discovered a sense of togetherness, from mental distress they gained restoration. That is the real sense of community in care homes in ordinary times.

It is hard to think of normal times when we are still in these strange days but despite all attempts of Covid-19, there is a beating heart within a care home which is pulling us back to those better times. There is a rhythm of comfort and care which despite challenge reminds us that care homes are communities where the best of what it means to be human is on display every day. Care homes will again become places where song and togetherness, exercise and competition, encounter and memory sit together and ruminate over time. They are places where people dream not solely of the past but of what tomorrow might hold. They are places where there is such brilliant original artistic and literary creativity. They are places where the young learn the lessons of age and where those old in age are enabled to become young in heart. This is the real story of community in our care homes.

So today as we recognise Care Home Day, we thank all involved in the last few months, we remember the sadness , loss and the hurt, but we also promise to work together in all our local communities to place our care homes in the heart of not just our concerns but of our daily living. Let us wrap round our care homes and let them find a place in the centre of all our communities.

Dr Donald Macaskill.