I was struck during a meeting this week of the Clinical and Professional Advisory Group of a comment made by one of the clinicians., It was to the effect that people should stop talking about ‘when’ the Second Wave will start but rather that we should all be recognising the fact that we are right in the middle of the Second Wave. This conclusion is hard to avoid when we see cases rising , when we learn that NHS Lanarkshire now has more patients in hospital with Covid19 than during the peak of the first wave , and tragically when we note the statistics of both outbreaks and deaths in care homes. The CI data published on Wednesday showed a dramatic change from previous weeks with confirmed Covid deaths of residents sitting at 15 and suspected at 5. 20 deaths are a significant rise and sadly I suspect the start of another dark period. When this is matched with very clear evidence of increased staffing infection and absence in the care at home and housing support communities, we cannot but escape the conclusion that across our membership we are facing a hard Second Wave.
Care Home issues
We continued as an organisation to present a more nuanced approach to the issues of visiting in the week that has passed. Our position is to advocate for care home relative testing, and we are pleased to note that this was included within the Strategy Framework published yesterday by Scottish Government. See http://www.gov.scot/publications/covid-19-scotlands-strategic-framework/ . What is clearly missing is the detail of the how and when! It was also good to note the emphasis upon the creation of the three regional hubs to make testing for asymptomatic staff in care homes delivered by the NHS a matter of some urgency.
We are grateful to Profs Ellis and Masters who attended the Surgery on Tuesday and answered some specific questions in relation to the new enhanced visiting Guidance. I know that these continue to be issues of real concern and variation within our membership and I have tried to articulate that in last week’s blog.
Operation Koper continues to have a significant impact on care homes and upon staff across the country. The reality behind this investigation was partly exposed during a Channel 4 news story on Thursday and there has been a degree of media reaction to this. We will continue to underline the inequity of these investigations and the extent to which they are causing real harm to organisations who are actively seeking to address the threats of the pandemic. A media statement can be found at the end of this update.
The CPAG also heard an update on the Care Home Digital Action Plan. We have described how members can engage with this Plan and its proposal and I would encourage you to give your feedback. See https://scottishcare.org/draft-care-homes-digital-action-plan-engagement-process/
Care Home Outbreaks and RAC
As I mentioned last week the Scottish Government have established a Root Cause Analysis Group to explore lessons which could potentially be learnt from the outbreaks in four care homes but also more generally in homes where there had previously been no prior outbreaks. I am sitting on the Reference Group of this work and it is due to report on the 30th October. The aim is to support learning and practice across the sector through the sharing of learning identified and approaches to improvement. I trust that having heard for a range of stakeholders they will be able to identify the supports and interventions which will support the sector but also reduce the likelihood of similar incidents during this current wave of the pandemic. The full terms of reference can be found at
Next week also sees the publication of the final report into discharge from hospitals into care homes during the first wave of the pandemic. This is due for publication on the 28th October.
Health and Safety Executive
As I mentioned last week the HSE has decided to inspect 100 care homes across Scotland. These include both statutory and independent sector nursing homes. Together with others we held a meeting with HSE staff and underlined our concerns about their proposals – we attach an information sheet from HSE. As a body of the UK Government and with clear statutory duties we are aware of their role and have underlined the critical importance of them undertaking this process in a sensitive manner. Together with others we will seek to establish support for providers involved in this process.
See https://scottishcare.org/health-safety-executive-care-home-spot-checks/
Testing.
The Scottish Government yesterday published a review of the testing strategy which when summarised by the CNO Fiona Macqueen stated that:
“It is also vital that additional testing capacity is used to protect the most vulnerable, this includes prioritising additional routine testing to reduce the risk of asymptomatic transmission within care homes. This could include extending routine testing to visiting care home staff, and designated care home visitors as well as to those who provide care at home services.
“We are also recommending the expansion of testing healthcare workers, with a focus on those caring for high risk patient groups and potentially in areas where there is higher community prevalence.”
Now we would welcome this as I stated earlier but are keen to get the detail. This is especially important as it has become clear that last weekend’s problems with the UK system have left many care homes vulnerable. Whilst the picture is improving, we still have cause for concern recognising that transfer over to the NHS regional ;abs will not inevitably go without incident.
The three hubs will be located in space previously occupied by the Scottish National Blood Transfusion Service (part of NSS). This includes sites at Gartnavel Hospital in Glasgow, Lauriston Place in Edinburgh and Foresterhill in Aberdeen. All three are scheduled to open between mid-November and December.
The full review of testing includes important information about some of the rapid testing machines and can be found at
http://www.gov.scot/publications/coronavirus-covid-19-review-of-testing-strategy-october-2020/
Further Guidance has been produced in regard to the Test and Protect system and how it relates to the workforce in care homes and homecare.
National Care Review
We now have additional dates for meetings with Derek Feely. I cannot emphasise just how important these meetings are – they are a real opportunity to share ideas and views with the Chair of the National Review and to help shape their thinking of what services will look like in the years ahead.
The webinar sessions are organised for:
Care at Home & Housing Support Members
Wednesday 28th October 2020: 2pm–3pm
Care Home Members
Monday 2nd November 2020: 1.15pm-2.15pm
These webinar sessions will take place in a meeting format so that members can interact with Mr Feeley.
Details to join will be available on the Members Area of our website.
Scottish Care is preparing a response, and this will be presented to the Executive before it is submitted and published more widely.
General Covid Care Issues.
The Pandemic Response Group met again this week. Along with Peter Macleod from the Care Inspectorate I raised a whole set of issues relating to care at home and housing support. As has been said by some – many of the issues facing care home providers at the heart of the pandemic are now being experienced by our homecare embers. With increasing community transmission there is a lack of clarity in relation to Guidance; confusion over the interrelationship with Test and Protect; issues of recruitment and retention; and critical issues which are obviously growing with Disclosure Scotland and PVG checks. Whilst the commitment to include the care at home and housing support workforce in testing is to be welcomed – the practical outworking of this needs a robust response and partnership[ with the sector. To that end it was agreed that ta Short Life Working Group focussed on homecare will be established. I hope this will happen timeously. We will update you on its work and terms of reference.
The Clinical Group spent some time reflecting on the level of risk being faced by frontline workers. It is clear that a significant number of the cases which have led to positive tests and in some cases to hospitalisation have been as a direct result of people travelling – often in coaches – to Blackpool. Indeed 515 of the positive cases in the last few weeks have had a direct link to Blackpool. It is important that all staff are reminded of the need to keep safe and to follow the Guidance regardless of where they are.
Finance and sustainability
The Scottish Care survey has been completed and we have held various meetings this week on issues of sustainability. Our research has shown that of those who completed our survey (some 80 organisations) that over 25% are still waiting for payments from the start of the pandemic and that 64% of organisations believe that if sustainability support is not continued from its present end points then there are real concerns for them being able to sustain the quality of their care and support. We will use this evidence and other responses to argue forcibly for the need to give assurance on sustainability to the sector at least until the end of the current financial year.
We will also be raising the issue of the end to the current support re PPE – VAT is due to be returned to PPE purchases from the 1st November. We will write to the ministers involved and would urge members to seek to influence their elected representatives.
Karen and I held a useful meeting with COSLA and Scotland Excel on the issues we are facing and what this means for the NCHC. We hope to begin formal conversations in a couple of weeks and will issue an indicative timetable as soon as is practicable. I do not think anyone is in any doubt that these are critical and crucial discussions not least in the face of a call for significant and radical changes to the way in which the sector is funded, alongside a clamour to improve the terms and conditions of frontline staff.
Communication
Last week I hosted a webinar with two colleagues from the Association of British Insurers – this is on the members area and will be useful for providers.
Next week the Tuesday Surgery will be at the usual time of 11.00 am. Karen Hedge and I will be in the hot seats!
This coming week we will also be hosting a Webinar on Turas – the Digital Safety Huddle Tool.
This will take place on Thursday 29th October at 1:00 PM. This session will have more focus on the purpose of the safety huddle tool as well as the clinical content and technical aspect.
This webinar is open to all care home providers, including those who aren’t currently members of Scottish Care.
Please register via this link to access the webinar: https://us02web.zoom.us/webinar/register/WN_YGuTihKdQ66zo1YEIpd-8Q
If your registration gets approved, you will receive an email from Zoom with details to join this session.
Care Home Conference: 27-29 January 2021
We have taken the decision to postpone the Care Home Conference until the new year. This event will now take place between 27-29 January.
Please put these new dates in your diaries. More information to follow.
Care Home Awards.
We’re delighted to announce that the 2020 Care Home Awards are open for entries. As the Care Home Conference is now taking place in January, we have made the decision to extend award entries for the Care Home Awards.
The new deadline is Monday 16 November 2020, 9.00 am.
Never has it been more important to support the amazing work done in our care homes.
There are 13 award categories:
- Ancillary & Support Staff Award
- Nutrition & Eating Well Award
- Meaningful Activity Award
- Training, Learning & Staff Development Award
- Emerging Talent Award
- Outstanding Achievement Award
- Management & Leadership Award
- Palliative & End of Life Care Practise Award
- Nurse of the Year Award
- Carer of the Year Award
- Specialist Service/ Unit of the Year Award
- Care Home Service of the Year Award
- Positive Impact Award
Find out more about the Awards and enter here.
Nursing
The experience of newly qualified nurses is the theme of a new blog by Jacqui Neil our nursing lead – this is a sensitive blog which not only recognises the immense work under real pressure undertaken in 2002 by our new nurses but gives practical hints about how both they can keep well, but how employers can support them at the start of nursing careers in very uncertain and strange times for any new nurse. See https://scottishcare.org/transition-from-student-to-qualified-nurse-october-nursing-blog/
And finally,…
Join me as we enter autumn and as things started to become more challenging in keeping the causes and concerns of the sector before a wider audience by lighting a #candleforcare on Tuesday at 7.00pm
Many thanks
Donald
24th October 2020
Operation Koper statement
Scottish Care recognises that it is absolutely right for families of those who have died from Covid in care homes to be assured that all precautions were taken, and their loved ones were cared for in the manner that they should have been and that at all times care homes were following the Guidance provided by the Scottish Government at any specific time.
However, as we have stated before, we believe this right of re-assurance should be given to all those who have lost a family member or friend to the pandemic. We regret the fact that deaths occurring in hospitals especially in wards and areas which were not directly Covid-related are not receiving the same focus. In addition, we regret that deaths from Covid in the community are not being investigated.
We cannot avoid the conclusion that this process is treating the care home sector, regardless of whether operated by a local authority, charitable or private provider, in an unequal and disproportionate manner. This is made worse by the reality that the care sector, whether in care homes or more widely, is actively fighting the pandemic.
The process of gathering significant amounts of information for the investigations is particularly distressing. There is a considerable amount of information which each care home has to communicate, and it has to be done in a relatively limited period of time which in itself is a burden to staff.
Added to this is the realisation that for many of the staff involved the deaths of former residents is the loss of individuals who they have known for some considerable time. The re-visiting of traumatic incidents is causing particular distress and affecting the ability of staff to grieve.
We hope that the Crown Office and Police Scotland will continue their investigations in a manner which is both sensitive and appreciative of the stress and of the reality that care homes are actively dealing with the pandemic.
