Following a tweet by Jason Leitch the National Clinical Director many of us were working to the assumption that the Stage 3 Guidance and start of visiting inside care homes would be commencing next week. Unfortunately, this will not be happening, and Guidance will we hope now be published in the next week. This is yet another example of poor communication at the heart of Government and at the centre of the Covid response which not only damages the preparation and plans of care home providers but also upsets and causes distress to families who have waited so long to see their relatives especially given that many have been unable to see family because they could not see them outside. I hope this will be solved in the next week and things will become clearer. The Cabinet Secretary has written a letter to services on this issue. https://scottishcare.org/letter-from-the-cabinet-secretary-on-visiting-in-adult-care-homes-23-july/
It has been another busy week with many folks on holiday which untypically seems to mean no lessening in work.
The following is a summary of some of the main issues in the week that has passed.
Finance and sustainability
It is now several months on from commitments around the Scottish Living Wage and the publicised willingness of the Government to pay what needs to be paid to frontline providers. There is a complete lack of trust in the system which is coming close to breaking the already fragile relationships between providers, commissioners and local and central government. Local authorities and IJBs do not trust that they will get money from central Government, the same central Government (especially health finance colleagues) do not trust that monies already allocated have been used for COVID purposes; and this leaves providers at the bottom of the heap as per usual with high levels of distrust at local level. The amount of data and forensic examination being demanded by some HSCPs is completely and utterly out of proportion to what is being asked for. This not only acts as a disincentive to providers, but it places some on the verge of going out of business.
Throughout this week Karen, Jim Carle and myself have been involved in discussions with senior colleagues. I think it is fair to say that Scottish Government is now very aware of the very real risks to sustainability within the sector. Jim and Karen together with CCPS colleagues have complied a list of the outstanding issues and have identified the Council areas where these are the issues. This list is being taken to Chief Finance Officers and to HSCP Chief Officers to get them addressed as a matter of priority. I have put this spreadsheet up on the website here. Please, please look at it and see if it reflects your own situation. We will be having further meetings on Monday to address the specifics but put simply we have to get money flowing into the sector.
We also critically continue to need intelligence from you as to what is happening at local level. Again, this is a plea – if you have not received sustainability payments and if you are not being able to access the Support Fund to pay staff then we need to know about this. We will continue to work hard to see progress on all these issues, but we need you as they membership to engage with us and to keep us informed. Please look at https://scottishcare.org/wp-content/uploads/2020/07/sustainability-Covid-e-bulletin-July3.pdf
Specifically, in relation to the Support Fund we now have a campaign being launched by the trade union Unison which is arguing that providers and employers are choosing not to pay staff what they are due. I hardly need to say that this is the sort of negative publicity which we can very much do without at these challenging times. If you are having difficulty re the Fund then please come to us and we will liaise directly with Government to address your particular issues.
Lastly we have learnt this week that COSLA and the Cabinet Secretary are not now meeting till next week in order to address the issues of continued funding after the 31st July. The timing is shocking in that we know very well that there are numerous members who are utterly dependent upon the continuation of this support beyond the end of the month. We will keep pressing and will keep you informed.
Overall in all these issues we are getting closer to the point at which we need to develop a much more public and media strategy to try to get things moving unless we see real change happening in the next week.
Care Home issues
As I said above we are very disappointed that the commencement of stage 3 visiting has been handled in such a poor way. It is important given that as there is likely to be the usual short period of time for people to get prepared for opening to indoor visiting that folks are as ready as they can be to submit their RAS forms to Public Health for sign off. At the time of writing the anticipation is that we will have a situation where there will be a limit of 3 visitors outdoors – they can be of the same family or different but if the latter then social distancing measures which would apply in any other context would apply here to the visitors and of course there must be PPE, screening, sign in and distance from the resident. One nominated person can visit indoors for up to 30 mins and with appropriate PPE. Ideally this will be in a specific space/room which can be cleaned between visits. There will also be greater clarification on what is considered to be an ‘essential’ visit so that this can be lessened to enable people to meet their relatives in their own rooms if they have incapacity issues. It was also envisaged that there would be a lessening of restrictions re the use of communal spaces, dining etc. However, on this latter point there seems to be a row-back. I think this is highly regrettable given the levels of deterioration that we are seeing in residents.
As noted last week we have also raised directly concerns which members have been expressing about the status of residents who wanted to go out of the care home and visits family, friends or simply to do some shopping. The Care Home Clinical and Professional Group considered a new Guidance on this at its meeting on Thursday. I hope this will be published at the same time as the other Guidance.
A paper to restore ‘visiting’ from both clinical professionals such as AHPs, OTs etc and other visitors such as hairdressers, therapists etc has also been prepared and I hope this will come into play at the same time as we move to stage 3 with the wider family visiting.
We again raised the issue of professional visitors being tested as they entered the care home with a growing number of instances where professionals coming in for scrutiny or clinical purposes are refusing to state whether they have been tested or not. The Executive considered what the status of the Health and Safety Act is in relation to such visits. Whilst inspection might trump these considerations we need to be able to evidence that we have undertaken all reasonable measures to protect the workforce and the residents. It has been agreed to draw up a clear protocol. However, it is also clear that HPS is standing robustly on their line that those visiting a care home for inspection or clinical purposes should only be required to wear PPE, hand-wash, socially distance etc.
Testing
Over 34,000 care home staff were tested in the last week and at least 2000 residents in care homes were tested. This is around about the same figure as the previous week. Work is being undertaken on the issue of false positives and it has become clear that the UK portal only undertakes a basic test on samples whereas the NHS test is more robust with two elements of sample examination. We have made it clear we need consistency in this regard and SG is taking this up with the UK Portal.
Feedback on issues raised as follows:
- No further issues raised on costs for calling the 0300 helpline number which can be claimed back via the social care fund.
- Staff who decline testingwas discussed at Care Homes Oversight Group and further discussion to be had at the workforce senior leadership group, update will be given next week.
- Agency workers – communication has now been issued for agency staff testing via the Care Inspectorate. Agencies will be advised that staff should be tested using the UK Government Employer referral portal.Staff who are on long term contracts with agencies can be tested as part of care home weekly staff testing in the care homes via the social care portal.
- Uptake of staff testing –There is a potential for a higher decline this week than 3% of staff who refused last week. Feedback still continues to be reported with how uncomfortable the test is, some staff doing it wrong, inconclusive test results, worries about loss of income etc. Jason Leitch has recorded a video clip which is going through a SG clearance process and will be shared soon.
- No indication of when less intrusive tests may be available e.g. saliva tests. In the meantime, staff could test themselves if that was preferred.
- TURAS and HPS have video available for staff to watch – https://learn.nes.nhs.scot/28247/coronavirus-covid-19/practice-in-the-community-setting
- Four weekly testing – Issues with UK portal which cause backlog and number of care homes had orders declined. More guidance to be issued on learning of four weekly testing.
- People being admitted to care home without a test – A letter was issued to DPH which directly quotes from HPS guidance. The expectation is that everyone admitted to a home will have a test done first. A communication has been sent to public health directors to remind them of the policy and to ask for assurance that processes are in place for all residents to be tested prior to being admitted to a care home and that all clinicians who may be asked to test individuals are aware of the process.
- Randox Testing – DHSC press release highlighted for Care homes in England to use King fisher not ‘Randox’ testing. This should not affect Scottish Care homes as we don’t use ‘Randox’ but some tests in Scotland are called ‘non randox’ which can cause some confusion.
Once again there has been no final decision on the ‘mandatory’ nature of the tests following the unhelpful intervention from SSSC – discussions between various parties on this issue are ongoing and ultimately this matter has to be addressed by the Cabinet Secretary.
Care at Home
The Care Inspectorate Inquiry process is well under0-way and I would strongly encourage members to get engaged with this.
In principle CHRAG has decided to re-form its structures to include a specialist focus on care at home and housing support. Scottish Government has brought in the specialist services of KPMG to support them in this re-orientation and I have been interviewed to give perspective of the sector on the urgency of creating a place to bring CAHHS issues and concerns. The Director General has been on leave this past week and I believe will focus upon this as a matter of some urgency in the week that she returns.
Collective Care Futures
The Collective Care Futures project is over its half-way point and I continue to encourage members to get involved in the sessions being led by Becca and Tara. Equally filling in the online questionnaires will be of huge value.
You can choose to take part by completing the survey series. There are currently 4 surveys available – technology, care practice , partnership and for this week one on workforce – with 2 more to become available in coming weeks. You can take part in as many or as few of the surveys as you wish.
If you or any of your staff/colleagues would prefer to share your experiences in a short online call, on a certain theme or across a range of themes, you can email [email protected] to arrange a convenient time.
Becca and Tara would also be extremely grateful if you could share details of the programme with your networks and contacts, who are also welcome to take part via surveys (hard copies can be downloaded) or in an online call. Please see full details at https://scottishcare.org/project/collective-care-future/
Link to survey on workforce can be found at: https://www.surveymonkey.co.uk/r/carefutures-workforce
Link to previous surveys: https://scottishcare.org/care-future-surveys/
Find out more about the Collective Care Future programme:
https://scottishcare.org/project/collective-care-future/
Executive meeting and AGM.
The Scottish Care Executive met on Wednesday and this was followed by the AGM. The AGM was presented with an Annual Report for the first time and I delivered a general address which is at the foot of this update. See the Annual Report with thanks to Karen Hedge for its development at https://scottishcare.org/wp-content/uploads/2020/07/annual-report-19.20.pdf
We are very grateful to all the Branch Chairs, IJB representatives and individuals at local level who help to ensure that the organisation has the local and national reach that it needs and that is urgently required especially at the current times.
We hope that you continue to feel the benefit of being a member of Scottish Care.
Care Tech 3 :
Save the Date: Care Tech 3 – 28 August
We will be hosting our third technology event ‘Care Tech 3’ – ‘Tech that Cares: making tech personal in post-COVID social care’ on Friday 28 August 2020.
The event will take place virtually and will bring together a range of perspectives to discuss developments and impacts of technology, particularly during COVID-19, and the future potential of technology across the Scottish social care sector.
The event will feature a range or panel discussion and opportunities to hear the latest developments around technology in social care.
More details to follow.
PPE
We have raised concerns with colleagues at Government over what appears to be increased use of nitrile gloves not least in that the cost of these has risen in one 48-hour period last week by over 250%. We also gather that over 1 million gloves were sent out to the Hubs last week. We are very clear that the HPS Guidance on usage remains the same as it has been but believe that there are still some Health Boards making it a requirement that nitrile gloves are used in all encounters. This is simply not acceptable or sustainable. But again, we need to know if you have been told to use them in all instances. Please use a specific section on the Discussion Boards to share this information – i.e. which Health Board(s) so we can take action on this matter.
The universal wearing of face masks announcement has led to the need to give additional information on their use in clinical and care settings. Please find a FAQ on the website produced by Scottish Government. https://scottishcare.org/faq-interim-guidance-on-wider-use-of-face-masks-in-health-and-social-care/
We are also wanting to get a sense from members on whether or not there would be an openness and support for NHS NSS becoming a PPE supplier to the social care sector. We are starting to map in broad terms the extent to which members might be interested in a situation where NSS offered its services to social care providers at rates which are likely to be highly competitive. Once again can you please answer this question on the Discussion Board.
Bereavement Charter Webinar – 30 July
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:
- Encourage buy-in to and support for adopting the Bereavement Charter within organisations
- 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]
Communication
Our next Surgery will be this coming Tuesday with again Karen Hedge and myself for 45 minutes at 12 noon. Please join us on a range of topics.
There will also be a separate webinar on Monday 3rd August, time TBC which will be a follow-up webinar to the Safety Huddle demonstration in May. The tool will be moving towards the second phase of testing. In this webinar, the digital team from NES will do another demonstration on this tool and will be available for any questions. Details will be available shortly on our website.
Workforce
Caroline Deane has produced another information filled Newsletter so please make sure you are signed up to get all the information that you need and that is up to date on all matters Workforce related.
See https://mailchi.mp/7982ce366598/workforce-matters-ebulletin-october-12588279?e=8b93fe8b46
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 at https://www.gov.scot/news/more-mental-health-support-for-health-and-social-care-staff/
And finally,…
Once again can I remind you that we continue to light a #candleforcare at 7pm on a Tuesday – along with others to remember and to give thanks.
Many thanks
Donald
25th July 2020
AGM Address
Well to misquote a well-known Scottish footballer – it has been a year of two halves – pre Covid and Covid.
In the year before Covid all the challenges facing both Scottish Care as a membership organisation and social care in general in Scotland were there and becoming larger. From April 2019 we were as an organisation in both our research and media output, in our dialogue with local and national Government and in our work with Integrated Boards, highlighting the vulnerabilities of the care sector. Over-stretched, under-resourced, with massive issues of commissioned contracts which were unsustainable, a National Care Home rate which did not give adequate levels of return and tied people into unfair terms and conditions; a growing issue of recruitment challenge not least as a result of the slowdown of migration; declining numbers entering from nursing into social care – all of them added up into a heady cocktail which inevitably meant that the social care sector which was faced with a global pandemic at the start of March – was not a sector which was fit for purpose or ready for the weeks that ensued.
That is not to deny all the positives which had happened during 2019 – excellent research continued to give solid ground for our arguments, a transformed digital and online offer helped to improve our communication with members, two great events and Awards evenings in May and November despite the growing challenges; a dynamic presence in workforce and in a new nursing role; and the growing confidence and appreciation of the Independent Sector Leads across the country. We were fortunate too in our staffing with Stefanie Callaghan coming on board, to be later joined by Jim Carle and Tara French in 2020, and most recently Jim Baird.
We had worked well in contingency planning through Elaine Rae and NHS NSS and thankfully that Brexit preparation for shortages meant that we were able to be much faster in being ready for the global meltdown in the availability of PPE.
We had gained an additional presence and voice through the Integration reform process, the Fair Work in Social Care Group, the developing groups around Adult Social Care Reform – all of which moving forward will be critical and valuable. But…
The dominant features of resource, staffing and non-inclusion were there in January. So, as we started to respond to the emerging global challenge posed by Coronavirus it is not surprising that social care was not included, that we were not on the ‘experts’ group of advisers mapping our early stages.
There will be plenty of time to respond in a formal way through the many Inquiries and submissions to Parliament about the handling of the Covid19 crisis. This is not the time to do so other than to say that I promise we will be an honest, critical and authentic voice for the sector as we move on to the next stages of response.
Some things worked well, as I have said chief amongst them the PPE response, though even that was initially faltering because of an inability of partners to listen to what we were saying’ ; but there is much that failed to work and much that the sector is unfairly being derided for.
The prioritisation of the NHS at all costs, the failure to test resident sand staff as we had demanded much earlier than was originated, the failures over repeated and contradictory Guidance, the failures of DNACPR forms and a presumption that care home residents should be treated in the care home and not transferred to hospital; the failures of what some have described as the ‘clinical abandonment’ of the primary care sector in parts of the country; the failure to continue appropriate care and support for people in their own homes; the failures around the attempts to ‘support through oversight’ ; the failures around lockdown measures which have effectively resulted in massive deterioration and loss of life in care homes beyond Covid; the failures around the handling of visiting in care homes and the opening up of our care homes; the politicisation of the sector by knee jerk reactionism from some politicians etc. The list goes on – but be assured it is a list that is being calculated, it is a response that is being analysed and it is a truth that will be told.
For now we work to address the current challenges of massive sustainability risks caused by the withdrawal of contracts in the community and the gaps in occupancy in care homes coupled with obscene additional costs; we work to build confidence in the wider public – and thank you to everyone involved in Care Home Day last week; we work alongside Government to prepare for the three potential peaks of a second wave, an upsurge of flu and a potential negative impact from Brexit and immigration plans.
It remains for me to say thank you. Thank you to everyone across the country who has been and still are shining lights of compassion and care for all at this time and during harder times. Thank you to all my colleagues at Scottish Care whom I am sure you will agree have excelled in dedication, energy and professionalism. Thank you to national and local colleagues especially the Independent Sector Leads who have been so invaluable. Thank you to our Branch Chairs and IJB Reps. A particular personal thanks to our National Director Karen Hedge who has shared leadership of the organisation at this key time. But to every single one of my national and local colleagues – thank you.
And today a special thank you to Cath Balmer who is to retire finally in a couple of weeks. Scottish Care has been centred around Cath Balmer through thick and thin- a quiet, strong, disciplined and highly committed individual who has the care of membership and those we support running through her veins. It is strange to be saying goodbye in these uncertain times, but one thing remains constant and that is the sincerity and heart-feltness of the Thank you.
In the months ahead, regardless of the challenges we will seek to rise to them with the rights, dignity and humanity of those we care for and all that we seek to do running through all our actions.
Thank you and keep safe.
Dr Donald Macaskill
