Review of the week 17th to 23rd May
This has been the week when the Scottish Government has published their Route map to drive us out from lockdown into the ‘new normal.’ It has also been a week where we have seen a further decline in the number of deaths from COVID19 in our care homes. But on the other perspective it has been the second week in a row where we have seen an increase in deaths in the community. This latter fact underlines our concerns at Scottish Care that just as we may be thankfully reducing care home deaths, as the rest of society opens up we may see a real rise in deaths affecting our homecare sector. We will continue to emphasise the importance of protecting some of our most vulnerable citizens regardless of where they may live.
The following is a summary of some of the main issues in the week that has passed.
Finance and sustainability
You may recall that Karen and I were due to have a meeting with COSLA on Tuesday. Regretfully this was postponed until yesterday because local authorities had still not received the assurance from Scottish Government that the promised funds for social care would be delivered. We are pleased to confirm that this is now the case. The Principles Document which has been signed by Scottish Government and COSLA can be seen at https://www.cosla.gov.uk/__data/assets/pdf_file/0025/17917/Principles-for-Social-Care-Sustainability-Payments.pdf
You will see that it illustrates the principles on which funding around sustainability will be delivered to the sector. We had a meeting with COSLA officials to express concern about some of the wording and are seeking for some edits to this – especially the issue re profit and ‘other costs’. In reality in terms of care home occupancy the 80% is the standard fee which is paid by a LA if a care home bed is unoccupied if someone is in hospital etc. Each HSCP will now send (and some have started) a template to providers to have them complete this in order to release the funds. We have encouraged the use of one template, and this will be underlined by COSLA to the Chief Finance Officers when they meet on Tuesday coming. At this stage it is likely that a template being used in Glasgow (and which was developed with the sector’s input) will be used more widely. We have been assured that despite the statement re open book examination that there is neither a desire nor capacity within the system to do this as a matter of routine. I do believe that our partners are aware of the real and very acute sustainability risks the sector is currently under and that monies will begin to be transferred out from the centre as quickly as possible.
We have particular concerns in relation to the lack of robustness around supporting the homecare sector. We have been assured that the presumption of paying for planned will be enacted. We will be keeping a watch on this. In addition, the agreement only lasts until 23rd June. This is not to say that in what is being termed the ‘recovery’ stage that these monies may not continue but we have started discussions with COSLA on these issues.
There are still concerns around the Scottish Living Wage especially for care at home and housing support. Our colleagues in COSLA have been robustly made aware of the criticality of these matters and are pursuing Scottish Government once again to get the confidence from them that monies will be transferred to enable these payments to start.
Lastly we have met with our colleagues from CCPS and COSLA this week on the issue of how do we support providers to supplement the pay of those workers who have to isolate should they be tested positive for COVID19 as the care home tests are rolled out together with raising the issue of Death in Service Benefits for the 8 social care workers who have tragically died in the last few weeks. On both accounts Scottish Care submitted a paper to Scottish Government, and together with the COSLA political lead I held a meeting with the Cabinet Secretary yesterday. At the time of writing this she has not responded officially to the proposals we put to her but I expect her office to do so today and we will communicate this information as soon as we can.
Care Home Strategy, CI and Public Health Scotland
Last week I commented on the unhelpful political narrative and the level of blame that was being put upon the care home sector. I had an honest and frank phone call with the Cabinet Secretary on Monday and underlined to her the real sense of harm which was being done to the sector and the sense of disappointment and dejection that many working in the sector were feeling both about political finger-pointing and also the media narrative. I have detected a slight change in tone in the last few days and we will keep a watch on this. Nevertheless, it is clear from comments by the FM and others that there is a desire to ‘look at the model’ of current private sector leadership of the care home sector. We will robustly articulate when it is necessary and appropriate the benefit of the ‘mixed economy’ approach to care home provision in Scotland and the fundamental distinction between social care and a health care approach to older persons care and support.
Reduced media interest is also undoubtedly likely to be because as society is opening up we are noting a media refocus on to other areas away from a frenzy around care homes. What we are nothing is more localised stories and we will continue to support members in meeting these. There has also been an appropriate level of increased scrutiny both on the Government’s actions and speed of response and on the performance of the NHS.
The week has seen a debate centred around some of the amendments to the Coronavirus Emergency Powers Act . Both Government amendments were enacted and one opposition amendment to create a Social Care Worker Fund. As we stated before in principle we do not contest these amendments as they merely consolidate existing powers. However, we asked for more detail for the reasoning of these and both it and the response of the Cabinet Secretary is up on the website. https://scottishcare.org/communication-to-and-from-cabinet-secretary-on-emergency-powers/
The Scottish Care Executive met again on Friday and we considered the financial sustainability package together with issues relating to the announcement on Sunday last (17th) of enhanced roles for the Directors of Public Health, Nursing and Chief Social Work Officers. The creation of a local Oversight group in each area mirrors what has been happening already in some areas. However, this letter has been very regrettable both in tone and communication. See https://scottishcare.org/coronavirus-covid-19-care-home-oversight/. We were not sighted on its creation nor were we included in its delivery. Neither I believe were other key stakeholders. It is yet a further illustration of the direct involvement by health professionals in the system with a limited lack of knowledge and at times a lack of clinical respect for the care home sector. The ‘visits’ which are resulting are meant to be supportive and encouraging – the reality is that they have been in some parts of the country dispiriting and focussed on scrutiny and inspection. We are raising these issues as a matter of urgency – untold damage could occur if these do not happen properly. After our complaints Guidance is being prepared for these officers to ensure the balance is an appropriate one. It has also been agreed that there should be a Scottish Care representative on the Groups. We are, to date, not seeing this being universally enacted.
Early feedback seems to underline the professionalism of the sector. However, I am still really disappointed by instances which are being discovered and which are clearly evident in social media of examples where staff are not abiding to social distancing, seem not to be wearing appropriate PPE and where residents are not socially distanced. These illustrations of potential failure to follow Guidance make it really challenging to advocate for the professionalism of the sector.
Both the Rapid Intelligence Group and the Clinical and Professional Advisory Group met again last week. The Clinical and Professional Group received a paper from Dr Jenni Burton, Derek Barron and me on steps and principles to ease lockdown and promote visiting. More work will be done on this in the next weeks. Readers will also be aware of the mention of progressive easing in the SG Exit Strategy – and the creation of a ‘designated visitor’. I am working with a group of others on these issues.
We are hearing of real operational concerns around the role of the Procurator Fiscal and the police in care home COVID19 deaths. We have raised concerns of ‘heavy-handedness’ and the impact on bereaved families with the National Contingency group and with Scottish Government.
PPE
Positively there is a continued stability in terms of the hubs and Triage. Again, if you have any issues please either tell your Local Independent Sector Lead or Swaran.
Then we had what has become known as ‘glove gate.’ Towards the end of the week uncertainty over the appropriateness of vinyl gloves began to appear and then NSS issued a statement to ask members to begin to use nitrile gloves. After a frustrating day seeking clarification from HPS and PHS we believe that the status quo is to continue – that is the verbal reassurance that has been given to Karen. I believe that a statement will be made by HPS imminently to clear this issue up. We will put this up on the website when sent.
This is yet another illustration of local Health Boards making decisions without recourse to normal channels and to provider bodies. This is the tale of this pandemic to date!
We continue to monitor the availability of PPE and from Monday next our website will act as a signposted and comparator to the costs we have been offered. Stefanie has done a great deal of work to try to sort the wheat from the chaff in some of these offers.
We are also acutely aware of profiteering and are working to address and challenge this through the media.
Testing
On Monday and Tuesday (18th /19th) the Cabinet Secretary announced the extension of tests to all staff regardless of care home. It is believed this will commence next week. We continue to be profoundly concerned about some of the practices around testing to date and the extent to which there will be capacity to fulfil future testing. Becca has presented a paper to the review of Testing being carried out by Parliamentary Committee.
Testing is still a patch-work around the country with diverse practices, timescales and prioritisation.
Care at Home
As I mentioned in my opening paragraph we are continuing to be concerned about the rate of transmission in the community. We are determined to try and keep the real pressures of the care at home sector to the forefront. Karen has joined a group which is reviewing the Clinical Guidance for care at home and community nursing to ensure consistency of experience by those supported in the community. She will be engaging with providers in the next few days on this.
We also intend to have a meeting of the Care at Home and Housing Support National Committee in the near future.
As many of you will be aware yesterday should have been the Care at Home Conference and Awards. We are aware that this is a real loss to the sector as well as to us as an organisation and we want to spend some considerable time trying to not just ensure that the sector has a future and is sustained in that but that we can use this time as an opportunity to re-focus, underline and enhance the role of services. We need to celebrate the value of work undertaken in the community which at times is being lost with the focus elsewhere.
Workforce
Real attempts have been made in the week that has passed on the SSSC portal including the use of postcodes to make selection and allocation easier. We hope that though the numbers remain small that we can start to see greater usage. Caroline is working hard both on this and in developing training materials for new entrants and others. We are aware that as we move forward training becomes imperative and that re-design will be necessary as we face the reduction in face to face training opportunities. In addition, and more positively we are seeing in some parts of the country an upsurge in applications of people wanting to come to work in the sector. A re-purposing of the national TV campaign is being considered.
Can I remind you again of the National Wellbeing Hub which has received positive feedback from workers and managers in the sector. It can be accessed at https://www.promis.scot
We held a very different Surgery on Thursday on the theme of bereavement and grief so a huge thanks to Sandra Campbell and Andrew Gillies.
Please also check the developing parts of the website showing resources for staff wellbeing , including from Scottish Ballet. See https://scottishcare.org/scottish-ballet-health-at-hand/ and Help for Heroes https://scottishcare.org/help-for-heroes-mental-health-wellbeing-resources/
Nursing.
The Nursing Strategy group met on Friday morning and considered some of the developing support and practice across the country. We are very grateful to colleagues for joining this forum which provides an opportunity to raise issues of concern and best practi8ce. If you are interested in joining this group then contact Jacqui Neil.
Communication
We are going to hold another two Surgeries this coming week but will reduce them to 45 minutes. The details are on the website. They will this week be facilitated by Karen Hedge and me.
Please continue to send positive good news stories to us so that these can be put up by Shanice on the Good News Stories. See https://scottishcare.org/good-news-stories/
Please continue to use the members Discussion Boards not least to share thoughts and ideas.
Becca and Shanice have started to create a daily timeline of documents and statements so that we get a full picture of the pandemic and its impact on the sector. This is important not least in challenging the collective amnesia of some in terms of what happened and when.
And finally,…
This week through the work of Tara French and Becca Young we have launched a new research project. Everyone and their granny has been talking about what the future of care needs to look like. It is imperative that we represent the choice of the sector and its workforce in that highly politicised debate and to remove the politics from the narrative. So please read about the Building our Collective Care Future and please get involved. See https://scottishcare.org/project/collective-care-future/
Thank you for all your continued work and engagement.
Donald
23rd May 2020
