It’s been another challenging week with some very sad statistics being surpassed both in terms of the numbers of new cases but also the number of people in hospital and iCU. There can be little doubt that we are in the heart of a vicious period made worse by the news about both the South African and now the Brazilian strains which are causing anxiety and concern. Whilst there is a positive indication that there seems to be a stabilisation of the growth in cases we are all I am sure aware that we have two to three weeks before the dull impact of the festive easing will come to the fore.
The following is a summary of some of the main issues in the week that has passed.
Care Home Gathering: 19-21 January 2021
I am starting with this as we are only a handful of days away from this event. I know that the timing of the Gathering is not exactly ideal with all the new pressures that are being faced by care homes but when it was planned I think few of us could have anticipated a new strain. It is an important event not least in that it is a virtual shop-window to our colleagues in Government, IJBs and local authorities. This is a very challenging time indeed for the se tor and I would encourage you to come and support Scottish Care in getting our wider message out there so that all the talk of reform and change can be influenced by our message and voice.
I know that the Gathering is probably the last thing that people have on their minds at the moment but I hope you can find time to support it not only by buying tickets but by attending part of it.
Tickets are priced at £45 + VAT and gives you access to all three days; attendance is flexible, and delegates can join whichever sessions they find interesting. Please see the programme and details at:
https://scottishcare.org/tickets-now-available-for-care-home-gathering-19-21-jan/
I should also add that I am due to meet the Chair of the Review Group, Derek Feely late on Tuesday when I hope to be able to learn both of the date of publication of his Review and the direction of their thinking and proposals.
Care Home Awards Postponed
The Care Home Awards were due to take place virtually on the evening of Friday 22 January 2021. However, due to current restrictions, we are unable to undertake filming for this. Therefore we have decided to postpone the awards until it is legally possible for us to start filming the ceremony. We hope to proceed with this in Spring 2021.
We want this event to be a special occasion and for it to be a true reflection of all the hard work from the care home sector this year. We hope that you understand and we will let you know the new date for the Care Home Awards as soon as we can. A full list of those shortlisted is available at https://scottishcare.org/care-home-awards-finalists-announced-ceremony-postponed/
Vaccination.
Once again there was positive news about the roll out of the vaccine. It was reported on Wednesday that 80% of residents and 55% of care home staff had been vaccinated with 50% of health and social. Are staff in general. Since then, I am aware that NHSGGC and NHS Fife have stated that they have completed care home resident vaccinations for all who are able to be vaccinated. We have also had clarity given re the issue of vaccination during an outbreak and this has hopefully helped enhance protection. During the week I have sought to answer questions as to why it is possible for an outbreak to happen after vaccination – I have asked for a response to this and related post vaccination questions to be added to the FAQs that have been produced by the Scottish government Pharmaceutical Advisors. We have put these onto the website. They mainly relate to questions around dosage and the Pfizer vaccine. See https://scottishcare.org/faqs-re-vaccination-dosage-changes/
During the week it has also become clear that there has been a co-ordinated mailout to care homes and to many care staff both in care homes and the community to encourage people not to be vaccinated. I have shared this with Government, and we are in discussions with them about developing a webinar or platform for staff to be able to ask and have answered questions of concern etc. It is imperative that we maximise the number of people protected. It is hoped we can do this webinar in 2 weeks’ time and we will get details out as soon as possible. In the meantime we have issued a media statement on this anti-vaccination campaign. See
We have also spent a great deal of time in the previous week trying to make sure that appropriate priority and focus is given to the vaccination of care at home and housing support staff. We have been assured especially by those NHS Boards who have been slow off the mark in this regard that this is their priority and that all staff will be vaccinated within the promised period. You will note the wider Scottish Government vaccination plan has been temporarily removed in order for some data to be edited!
Care at Home
Colleagues especially Caroline Deane and Karen Hedge have spent a great deal of time this week in relation to care at home and housing support issues. We are aware very sadly that a staff member of one of our organisations has passed away as a result of Covid and our thoughts are with that organisation, colleagues and friends. Scottish acre has consistently been arguing at many Government for a about the critical importance and very real vulnerability of the workforce who are working in our community and in and out of individual homes. The lack of updated bespoke guidance, a complete failure to focus on the need to test this workforce has been lamentable.
At last, there seems to be a move towards a more systematic plan for testing and there are now a series of training sessions/webinars which are made available to providers and staff so that this testing can start. We have made it clear that presuming that testing is going to happen overnight – as no doubt will be the assumption on the part of our politicians – is completely erroneous. It will take time but at last – and far too late – there will be some added protection for this most valuable and most vulnerable workforce.
Please see https://scottishcare.org/scottish-government-care-at-home-testing-workshops/ for a list of dates for the workshops being provided together with sign in details.
Late on Friday new additional Guidance for Care at home on testing including LFTs and PCRs was published by the Scottish Government and is now available on our website. See https://scottishcare.org/guidance-for-care-at-home-on-testing-incl-lfts-and-pcr/
Care home issues
Very sadly we continue to see both the number of outbreaks and the number of cases affecting care homes continue to increase. As of Wednesday past we had 108 deaths reported in care homes which was an increase from 81 the previous week. There were also a total of 180 care homes with an active outbreak – again an increase of 10 from the previous week. At 588 cases this is the highest number since April.
We are aware of the strains in the system being placed as a result of the requirement to do 3 tests a week. We have also reported – as have Public Health officials – the impact of frequent testing and swabbing on the health of some of the workforce.
It is now clear despite uncertainty that care home staff require to double swab for the LFTs on the requirement of the MHRA. We have asked that this be looked at urgently given that the same requirement is not necessary for health colleagues.
In addition, it is becoming very clear indeed that our absence records for staff are at the highest for some time. Now whilst this is undoubtedly down to issues not untypical at this time of year we are aware that a significant number of absences are due to sheer exhaustion and fatigue and the never-ending. Nature of the response. We have highlighted the importance of stressing mental health and wellbeing not just for NHS colleagues but all our colleagues working in social care at this time. I was pleased to see this noted at the Daily briefing yesterday. But be that as it is what we desperately need is not just a financial resource but a targeted ability to recruit into the sector. At long last there was a meeting focussing on workforce and resilience this last week which Caroline and Karen attended. The hope is it will not just be a talking shop.
Insurance
I am very aware of the ongoing issues in relation to insurance. These have been raised again with Scottish Government and a formal letter has been sent to Matt Hancock from the UK Government to ask for joint intervention with the insurance sector. I will update members of any progress.
Visiting
The issue of visiting is as I have continuously said perhaps the thorniest we have to deal with as it is causing so much trauma to both staff, managers and to family and residents. There is now growing political pressure – across all the parties to consider introducing emergency legislation to appoint a nominated person to visit. I know the Scottish Government is resisting this evidencing that the Ontario provision which is often mentioned has not resulted in the outcomes which people wanted. However, they may have no choice if the majority of the parliament vote to introduce this. A petition is due to come before the parliament in the coming days. This is a very challenging issues not least in that members are divided in opinion on this.
My hope is that with vaccination, testing, PPE and IPC we can get to the stage that members are confident that there is enough assurance in place to enable indoor visiting. That will inevitably be on an individual care home basis and I hope we can avoid emergency legislation. I have made it clear to officials and politicians that if that comes about then the indemnity of such a measure rests with the Government and they have to deal with the issues of insurance which may arise.
At the same time as the above I find myself again needing to underline – after a week of cases where essential visits have been refused on no substantive grounds – that essential visiting should continue and that members should seek to enable such visits in a pro-active manner. I believe further guidance on what constitutes an essential visit is likely to be forthcoming.
Workforce
The long-term effects of what has become known as ‘long-Covid’ are now becoming increasingly prominent in awareness. Sadly, the social care workforce is one that is disproportionately affected by these.
A guideline has been developed collaboratively by SIGN, the National Institute for Health and Care Excellence (NICE) and the Royal College of General Practitioners (RCGP) which looks at managing the long-term effects of COVID-19 (also known as long COVID).
This covers the care of people who have signs and symptoms that develop during or after an infection that is consistent with COVID-19, which continue for more than four weeks and are not explained by an alternative diagnosis. These recommendations will be of interest to general practitioners (GPs) and members of the primary care team, healthcare professionals in specialist secondary care services, occupational therapists, rehabilitation medicine staff, and social workers. It will also be of interest to people experiencing long-term symptoms of COVID-19, their family and carers, supportive organisations in the voluntary sector and policy makers. The guidelines can be found here.
Communication
Because of the Care Home Gathering we are changing the time of the weekly Surgery to Monday at 12 noon. This will last an hour this week. The first half hour will be dedicated to care at home and housing support issues and the second half hour will be on care home issues. Karen and I will be in the hot seats once again.
And finally,…
In what often feels like a challenging time please join me on Tuesday at 7pm in lighting a #candleforcare. This will be on the day that we will hold a moment of remembrance for all those care home residents and staff lost to Covid19 at the care home gathering in the morning. At the same time we will also be remembering the growing number lost to Covid19 in the community and the staff who have cared for them who have died.
Many thanks
Donald
16th January 2021
