International Nurses Week 2020 Stories

Scotland launches its first human rights-based Charter for Bereavement

A Bereavement Charter for Children and Adults in Scotland

www.scottishcare.org/bereavement 

After eighteen months of development including consultation and engagement with individuals and groups across Scotland, on Wednesday (15th April) Scotland’s first Bereavement Charter for Children and Adults will be launched.

 

The Charter together with Guidance notes has been developed by a coalition of individuals and organisations. It contains 15 statements which describe what the best bereavement care and support should look like. It has been developed to support individuals and communities who struggle with the death of someone they know or someone in their community.

 

Today, the need for such a Charter has become even more important due to the unique circumstances we currently find ourselves in as a result of the COVID-19 pandemic. People who are bereaved may not have been able to be with a person as they approach the end of their life and may be isolated from their usual networks of support. It has also changed the traditional ways we are able to mark our grief. Traditional bereavement rituals and funerals have changed with many people now unable to attend funerals in the way that they might have in the past. Many deaths have become sudden with little or no time to prepare.

 

The Charter is designed to help us understand not only the importance of bereavement support, but what that support needs to look like.

 

Whilst accepting that every death is unique and that the way we each come to terms with a death is individual, this Charter and Guidance attempts to describe what good bereavement support can look like and what difference it can make.

 

The authors of the Charter hope that it will begin to appear in locations across Scotland and will be used by diverse groups and individuals. It is therefore hoped that the Charter will help us as a nation become more effective at supporting people to grieve.

 

Dr Donald Macaskill, Chair of the Bereavement Charter Group and CEO of Scottish Care, commented:

Bereavement support is an intrinsic part what it means to be a citizen in modern Scotland. Good bereavement support is not an optional extra, it is fundamental to a society basing its character on dignity and human rights. Good bereavement support renews and restores, it can give a sense of purpose and direction, for many it is what has literally saved their lives.

“I have been deeply honoured to lead the work on developing the first Charter on Bereavement for Children and Adults in Scotland. Dozens have given their time to create this unique document in the earnest hope that we will become better at talking about death and dying, and better at supporting the women and men who grieve in our communities.

“We are launching this Charter in very unusual times. The weeks and months ahead will require us all as a society to support one another to grieve for those who have died – our family, friends, neighbours and acquaintances. I hope that this Charter and its Guidance will help Scotland to be able to grieve.”

 

Dr Janice Turner, Principle Educator: Medical Education at NHS Education for Scotland commented:

‘’It has been an immense privilege to work with so many individuals and organisations in the development of Scotland’s first Bereavement Charter for Adults and Children. We collectively hope that it will make a real and positive impact on the quality of bereavement care in Scotland, both now, and for many years to come’’.

 

Notes:

The Charter has been developed by a wide coalition of individuals and organisations including the Care Inspectorate, Childhood Bereavement Network, CHAS, Cruse Bereavement Care Scotland, Healthcare Improvement Scotland, MND Scotland, National Bereavement Alliance, NHS Education for Scotland, NHS Fife, NHS Forth Valley, NHS Greater Glasgow and Clyde, Northumbria University, St Columba’s Hospice Care, Scottish Ambulance Service, Scottish Care, Sue Ryder, University of Glasgow and the University of the West of Scotland.

There is a short film further summarising the rationale for the development of the Charter available at: https://vimeo.com/395685686

The Charter, a FAQ Sheet and a Guidance document can all be found at www.scottishcare.org/bereavement 

 

Scottish Labour letter of thanks to health and care staff

Please find attached a letter from Richard Leonard MSP and Monica Lennon MSP of the Scottish Labour Party..

The letter is to thank all the NHS and social care staff who are working through these challenging times.

With today (7 April) being World Health Day, it seems even more appropriate that the enormous contribution that those in the health and care sector are making is recognised.

The hardness of COVID ethical choice

Nelson Mandela in a speech in 1998 stated:

“A society that does not value its older people denies its roots and endangers its future. Let us strive to enhance their capacity to support themselves for as long as possible and when they cannot do so anymore, to care for them.”

Like many others I have been waiting with interest for sight of the ethical guidance which would be made available to our frontline clinicians who are engaged in the struggles against the Coronavirus epidemic. I read the ‘COVID-19 Guidance: Ethical Advice and Support Framework’ with considerable expectation and hope for a clear grounding for hard decision making. When I finished I was left with more questions than answers and no small sense of disappointment.

The reason for such a document is self-evident. Despite all the best efforts of planners and politicians we may get to situation where there is insufficiency of resource to be able to provide the optimum clinical care and treatment to every citizen.  As the document itself states;

‘if immediate need exceeds what is required and there is no additional capacity, changes to healthcare delivery and scope may be necessary.’

It is in this context when we are clearly not in ‘normal times’ that we need to be able to give our frontline clinicians the ethical, moral and rights-based tools to allow them to do their harrowing job with dignity and authority. I am afraid this document fails to give that sense of grounding and raises fear and concern for many of us. It fails to live up to its declared self confidence that ‘This guidance is considered both clinically sound and on firm moral ground.’

Some of my concerns include:

The Guidance describes the role of Ethical and Advice Support Groups at both a national and local level. Whilst the membership is delineated as including clinical professionals, academics, lawyers, religious groups, social workers and lay persons, it does not describe for us HOW these individuals will make their decisions. What will be the moral and ethical boundaries, principles and framework which will guide them? What will be the clinical criteria to enable them to make impossibly hard recommendations? Will these be based on utilitarian views? How will we be assured that their decisions and advice will be non-discriminatory and based on a robust human rights critique? To what extent will characteristics of age, co-morbidity and frailty influence decision criteria? What indeed will be considered the interests and obligations that this decision-making has to the ‘wider population.’

Secondly, the Guidance uses a lot of ‘feel good’ language but does not illustrate how that assurance is going to be played out in reality. It states that:

‘Everyone matters…

Everyone matters equally…

the interests of each .. are a concern for all of us

Harm suffered by every person matters…’

All undeniably laudable aspirations and statements but how are these fulfilled in practice in an emergency, resource constrained environment?

The Guidance describes the principles of Respect, Fairness, Minimising Harm, Working Together, Flexibility and Reciprocity, but again one is left asking what it means to state that

‘Patients should be treated as individuals, and not discriminated against.’

Perhaps more challenging is the statement:

‘No active steps should be taken to shorten or end the life of an individual, however the appropriate clinical decision may be to withdraw life prolonging or life sustaining treatment or change management to deliver end of life care.’

Thirdly the use of certain phrases beg more questions than they deliver answers:

‘Where there are resource constraints, patients should receive the best care possible, while recognising that there may be a competing obligation to the wider population.’

‘Under normal circumstances, these decisions would be made of the basis of patient choice and anticipated clinical benefit to the patient. In the context of increased demand, it may also be important to consider fairness of healthcare distribution within the wider population.’

What in this context is meant by the ‘competing obligation of the wider population’? If we are to supplant patient choice and anticipated benefit for an individual what does ‘fairness of healthcare distribution’ actually mean not just at a theoretical level but in raw reality for individual citizens? Care is to be rationed- I can understand – but ethically what does the needs of the majority mean for the care of the vulnerable minority?

Fourthly, I am really concerned that issues of equality and human rights are mentioned explicitly only in two footnotes. I have stated before that Scotland should be rightly proud of its articulate defence of the human rights which have framed both our legal and parliamentary process, not least since Devolution. To present a document which articulates some of the most challenging ethical choices of our generation, perhaps of any time since the Second World War, and to have that devoid of a robust human rights articulation is wholly inadequate. How are we going to make an ethical decision which upholds the right to life and the right not to be subject to inhumane and degrading treatment? How is the State going to fulfil its duties to the Human Rights Act or the European Convention of Human Rights? I see no robust articulation of this within this document. If human rights are to be more than rhetoric in easy times they have to be real in hard times.

All this matters a great deal and it matters now.

Already we have stepped into questionable territory.

I can fully understand that for many frail and older people who develop Covid19 in a care home that the best place for them to be supported is within the care home, that transfer to an acute setting is likely to be over traumatic and result in little effective clinical outcome.

I can accept and know at first hand the astonishing professionalism around palliative and end of life care delivered in Scotland’s care homes which makes them in ordinary time hospices in the heart of our communities.

What I am deeply uncomfortable with is a blanket presumption that there will be no transfer of any individual (except in the instance of large-scale fractures) from a care home into the acute context. This leaves me disquieted because it presumes that all individuals within a care home are old and frail and it assumes a sufficiency of resource in care homes which would potentially enable some individuals who have a severe infection to respond well.

What I am equally appalled by in the last few days is the numerous instances of DNACPR being demanded as routine and automatic from care home residents by some general practitioners up and down Scotland. Quite rightly the Chief Medical Officer has robustly challenged this.

I am equally dismayed at the number of GPs who have in recent days intimated that they will not visit care homes. I fully understand that the risk of infection has to be taken into account but a presumption of non-attendance to meet the needs of individuals, even with the best use of video diagnostics, is wholly unacceptable.

If equality of access and treatment mean anything then we must not abandon our care homes, their residents and staff to an unequal level of clinical support.

The next few days and weeks must surely be those where both the clinical community and wider Scottish society needs to have a proper debate about ethical treatment and care in the face of reduced resources. It is simply too important a set of decisions to be left to a document which though it tries hard is too subjective, too generalist and lacking in a foundation of human rights and equality.

The way we respond to harrowing issues of choice will determine the society we will be as a nation after Covid-19. In Mandela’s terms decisions which are potentially based upon an over-reliance upon age and do so in a discriminatory manner endanger the rootedness and the future of the whole of our society. I trust that over the coming weeks by our actions and decisions we will all create a future we will be proud of.

Dr Donald Macaskill

Criminal record checks for coronavirus (Covid-19) response workers

Disclosure Scotland will prioritise checks for the workers Scotland needs to deal with the coronavirus, they will prioritise roles in the sectors:

  • Healthcare
  • Phamaceutical
  • Childcare
  • Social work
  • Social care
  • Prisons and justice

Urgent applications for priority roles

Ministers have suspended fees for urgent disclosures. You do not have to pay for forms emailed before midnight on 11 May 2020. 

Use these forms to apply for urgent disclosures in the priority sectors:

Organisations must have their countersignatory send applications. You cannot apply by email on behalf of a countersignatory.

They are not taking any paper applications. Email completed forms with the cover sheet to [email protected].

You can follow this website for more updates: https://www.mygov.scot/coronavirus-disclosure/

 

Disclosure Scotland helpline update – 27 March

Unfortunately due to the impact the COVID-19 situation has had on the business and the high volume of priority applications for critical sectors, we made the decision to temporarily close the helplines in order to maximize the number of staff processing applications.

You can prioritise any critical role applications already submitted by emailing the details, including barcode & ‘role applied for’ to our COVID Priority mailbox; [email protected]. NB General enquiries and application updates will not be handled via this channel.

Any other enquiries can be sent our normal enquiry mailbox; [email protected].”

Whilst we anticipate this situation temporary it is the channel we are signposting customers to at this time. We thank our customers for their patience during this on-going difficult situation.

Regards

Jillian [Customer Engagement Manager]

Disclosure Scotland applications update – 27 March

Scottish Care has received the following letter from Disclosure Scotland with a Covid-19 update on PVG applications.


Disclosure Scotland is making a temporary change to how applications are processed.

We have been working closely with the Scottish Government and key stakeholders on our response to coronavirus (COVID-19).

In addition to our prioritisation of checks for those who have the most vital roles supporting the country during this time, as of Monday we will no longer be accepting paper applications.

On Monday (30 March) a new page will go live on our website with all the materials you need to continue to submit applications.

Please note; this process should only be completed by countersignatories.

  • you can submit an application via email using the template on our website
      • electronic signatures (typewritten or scanned) from the applicant and countersignatory will be accepted
  • we will process the application through a priority service
  • where possible we will email you a notification of the outcome, prior to receiving the paper certificate in an expedited timeframe
  • when this is not possible there will be two other outcomes:
      • you will not receive any advance notification and will have to wait on the paper certificate which will still be in an expedited timeframe
      • you will receive a notification advising that we are unable to prioritise your application at this time and will be unable to give a timescale for completion

If we do not send you a disclosure, either by email or certificate, please do not assume this is because we are late or have made a mistake. A small number of applications need us to be fully operational to process and that is impossible at this time. At this critical time, we are providing a safeguarding service to ensure the vast majority of applicants can get cleared to help with coronavirus.

If you are submitting urgent applications related to coronavirus in the following weeks please contact our dedicated helpline on 0141 302 8511. We will want to plan with you how we go about doing this most efficiently.

As it stands the list of prioritised roles remains:

  • Healthcare
  • Pharmaceutical
  • Childcare
  • Social work
  • Social care
  • Prisons and justice

As the situation develops and evolves, the list of prioritised sectors may change as Disclosure Scotland identifies other sectors with roles critical to supporting the Scottish Government during this crisis.

Thank you for your patience during this critical time,

 

Gerard Hart

Chief Executive