It has been a busy week during which I have had the pleasure of meeting many of our members. On Tuesday we held a meeting of branch chairs which saw 37 of our branch chairs coming together. I am delighted that 20 of the branches have new branch chairs which shows a real vibrancy and engagement with the organisation. I would want to express my very real and sincere thanks for our chairs and all the work that they do on a voluntary basis. Scottish Care is so very fortunate in having a system of local branches which enables us to not only engage with members but to be able to get a real sense of what is going on across the country which directly influences our lobbying and work with other stakeholders.
On Thursday we also held another virtual meeting of the Scottish Care Executive and then in the afternoon a meeting of the National Committee which again saw over fifty people from across Scotland come together and discuss issues of importance. Thank you to everyone for giving so freely of your time in the week that has passed and throughout the last few months.
The following is a summary of some of the main issues in the week that has passed.
Care at Home
Thursday saw the publication of the Care Inspectorate’s report on Care at Home and Housing support services during the pandemic. This is a critical and important report highlighting as it does some of the real challenges which the sector faced and continues to experience as a result of the pandemic. We issued a media statement which received some coverage in the media and in it we sought to argue that there is a very real sense in which we feel that the sector is the Achilles heel in the pandemic response and that urgent work needs to be undertaken over the next few weeks to both ensure the sustainability of the sector, to introduce testing to enable staff and families to be safe, to address the real issues of carer and family fatigue and to end the corrupt and broken system of commissioning which sees even today some councils continue to operate electronic all monitoring systems in parts of Scotland. The media statement can be accessed here https://scottishcare.org/scottish-cares-response-to-the-care-inspectorates-enquiry-report-on-care-at-home-and-housing-support-services-during-covid-19/
There was a full discussion on the issues raised during the Pandemic Response Group at Scottish Government and it was agreed that further work needed to be undertake in relation to the specific issues of rehabilitation , the need to undertake robust re-assessments of clients in response to deterioration, as well as the issue of testing and PPE for homecare staff. I will update in the next few weeks on what I would hope would be progress on each of these areas.
The recommendations of the Inspectorate reports are important and are as follows:
- All partners, at national and local HSCP levels, should ensure new or emerging guidance on infection prevention and control measures address the unique challenges of providing care at home and support in people’s homes.
- HSCPs should work with care at home and housing support service providers to ensure there is adequate contingency planning for PPE supply, access and distribution in the event of a future peak in infections.
- HSCPs should prioritise rehabilitation and reablement in their recovery plans. This should seek to limit the potential for adverse impact on health and wellbeing from extended periods of lockdown or other restrictions for people who experience care.
- HSCPs should seek to better understand the experience of healthcare for people who used services and their carers, during the pandemic, to inform how care at home and housing support services could work more effectively with primary care in the future.
- HSCPs should update their workforce plans for the care at home and housing support labour force. These plans should be set in the context of health and social care integration, be cross-sectoral and reflect the pivotal role of care at home and housing support staff in meeting critical needs
- HSCP’s should prioritise the assessment and review of people’s needs, taking into account their wishes and preferences. People who experience care should be fully involved in their assessments and reviews which should be person-centred and focused on individual outcomes.
- HSCPs and service providers should research, reflect on and learn lessons from the positive experiences of people who used services and carers during the pandemic, of the increased use of technology and alternative approaches to support. These lessons should inform new service responses that can deliver equally successful or improved outcomes for people who experience care.
- Service providers should engage with their staff, people who experience care, carers and HSCPs to explore opportunities to deliver more person-centred approaches building on the creativity and flexibility shown during the pandemic.
- HSCPs should update their eligibility criteria for accessing services, to ensure that they are equitable and transparent and clearly explain the prioritisation of services during this pandemic.
- HSCPs should consider incorporating into their eligibility and priority frameworks, the emerging lessons about the impact of social isolation and restricted movement on the physical and mental health and wellbeing of people who experience care.
- The Scottish Government, HSCPs and service providers should review the processes for accessing Scottish Government sustainability funds for current or future COVID-19 related costs, to facilitate access for service providers, where relevant, to such funding.
- Partners at national and local levels should acknowledge that routine use of PPE is an ongoing necessity and ensure the associated costs are reflected in the cost of care at home and housing support.
- HSCPs and service providers should consistently engage with people who experience care and carers to understand the impact of actions they took in response to the first peak of infections, to inform future practice and improve outcomes for individuals.
- HSCPs should further engage with carer centres and carers representative groups by routinely including them in planning for care at home and housing support services to ensure carers receive the support they need.
- All partners, at national and local HSCP levels should work together to streamline data collection and monitoring systems for care at home and housing support to minimise the administrative burden on service providers.
- Nationally and locally, health and social care partners should build on the findings of this enquiry and bring these together with other emerging information about care at home and housing support services to inform planning for the ongoing pandemic response, but also more widely to inform the agenda for adult social care reform.
Testing.
I met the Cabinet Secretary for my fortnightly meeting with her and underlined just how critical getting the testing system was especially in light of the pressures from some politicians that testing should be prioritised for students. She is due to write to care providers to describe the intention to move all care home testing to a three regional hub model. Four working groups are being established to support this and a survey has been sent to members asking for views on the testing experience thus far.
Caroline continues to attend the weekly meetings on social care testing and since the meeting last Monday there has been some indication of improvement not least in those areas where the NHS testing system has taken over.
As I said Caroline attended the Social Care Testing meeting with others and key points are:
- At the moment health boards are identifying their capacity to move testing to them.
- SG has purchased testing equipment and is setting up NHS Regional Hub Testing Centres and the tests for care homes will use this system, logistics of this currently being worked out.
- Group is looking for feedback into what has previously worked well and what has not so this can be built into the new system.
- Looking to get this up and running in 6 – 8 weeks.
- There will be DHSC mitigation during that period to improve system as much as possible.
- Looking to urgently transfer approximately 8000 tests back to NHS boards
- Mitigation plans – Health Boards shifting tests: Glasgow pilot took place last week to transfer 1000 tests to health board and looking to expand this further. Lothian 1000 tests; Forth Valley 700 tests next week; Grampian (potentially) 2500.
- Each board has different arrangements in place, and they are trying to do this including logistics and IT with minimum disruption to care homes as possible.
- A proposed high-level model will be coming out to stakeholders for comment.
- Currently establishing governance and sub-groups around logistics, portals and links to NHS labs.
- The shifting of tests to NHS local boards as the interim mitigation until hubs can be put into place will focus on larger care homes to ensure highest numbers can be transferred as easily as possible.
- A number of sub-groups will be established which will include provider representation to ensure ongoing practice input and feedback from the sector.
Please continue to support and get staff to download the new Protect Scotland test and trace app – this has now been downloaded by over a million and it will be a critical tool in the weeks and months ahead to protect our staff and communities. Please encourage folks to download it. See https://scottishcare.org/test-protect-protect-scotland-app-launch/
Homecare Festival. WEDNESDAY 7TH – FRIDAY 9TH OCTOBER.
At the various meetings this week I highlighted just how critically important it is for us all to support the Homecare Festival which is just over a week and a half away. As an organisation, we depend a great deal on the income we receive from our conferences. Without this income we will be facing a major deficit in our funds in the coming year. What can address that and plug that gap is if everyone supports both our homecare event and the care home 3-day event in late November. By supporting these events we not only address our financial challenges but just as importantly we provide a boost for those who participate in what is a dynamic programme and help to portray the best of the sector to media and other stakeholders.
More details are available at https://scottishcare.org/cah-conference-2020-2/
Please support it by buying tickets. Tickets are effectively £15 a day.
Care at Home Awards
We are delighted to announce the finalists in this year’s Care at Home and Housing Support Awards. Thank you to all who submitted nominations and congratulations to all who have been shortlisted!
Winners will be announced at a virtual Awards Ceremony, hosted by Michelle McManus and Dr Donald Macaskill on the evening of 9 October 2020. Tickets are available for sale at a very reduced price on the website. See
https://scottishcare.org/finalists-announced-for-care-at-home-housing-support-awards-2020/
National Care Review
As indicated in my update last week the National Review chaired by Derek Feeley wishes to engage with the sector. As part of this we have arranged two webinar sessions for members to meet Mr Feeley and share thoughts, views etc. these have been arranged as follows:
Wednesday 30th September 1.00-2.00 Care at home and housing support members
Friday 2nd October 11.30-12.30 Care home members
Details to join are now available on the Members Area of our website.
If you haven’t registered for access to the Members Area yet, please do so using the links below. If you have any problems accesssing the Members Area or the webinar sessions, please contact [email protected].
General Covid Care Issues.
Sadly as I write this I am hearing of further outbreaks and even more sadly deaths in our care homes. After such a brief period of respite the perniciousness of this virus has returned.
We continue to work with the Pandemic Response Group and the Clinical and Professional Advisory Group to improve practice both in care homes and in the community.
The work on hospital admissions is due to be published this coming Wednesday and Scottish Care will issue a media release at the time. In relation to this we have been asked to assist this work by giving a perspective of the experience behind the data which will show the extent of admissions to care homes.
We received the following message from Dr Jenni Burton who is involved in the research on hospital admissions into care homes. She is asking for confidential information. This is not time-limited to the 30thSeptember deadline as is the rest of this research.
‘Thanks to those who were able to join us to hear about the data-driven work to describe hospital discharges to care homes during the period March to May 2020.For the wider membership, the focus of the Public Health Scotland statistical publication on 30th September will be the information obtained from NHS and HSCP data. However, we recognise there are broader insights and experiences than the numbers alone and work on the data will also continue after the initial publication.
If any provider wishes to share their experiences of receiving residents from hospitals during this period, please get in touch with the team via [email protected]
This will be helpful to support the ongoing analysis work and learn lessons.
We will collate and use this information on an anonymous basis
Many thanks for your consideration and your time
Dr Jenni Burton, Honorary Secondment to Public Health Scotland Discharges to Care Home Analysis Team, Clinical Lecturer and Specialist Registrar in Geriatric Medicine, University of Glasgow/Glasgow Royal Infirmary
The Clinical and Professional Advisory Group did not meet this week but rather a subgroup met to discuss the Visiting Guidance and the next stage four Guidance. It has been decided to write a letter to providers to consolidate and give further detail on Stage 3 visiting. This Guidance will advise on new encouragement to extend visiting to one hour, to enable more familiar engagement and to increase the ability of family to have physical contact with their relatives. This is as you can imagine an exceptionally hard and challenging balancing act and Public Health officials will support care home providers in this regard. However, it is clear that there is a desire to change the assessment of risk based on assessing the risk of visiting to assessing the risk to individuals of not allowing safe and protected visits. I have made it clear and will continue to do so that one of the major concerns, apart from fear of the return of the virus, is the capacity of the care home sector to facilitate visits given the intensity of staff time and arrangements involved. I hope we can arrive at very clear fiscal support for this as a matter of urgency.
Finance and sustainability
There has been a growing number of concerns from members around sustainability not least the ending of supports for care homes and homecare organisations. Karen has reconstituted the weekly meetings with COSLA, and we will be writing a joint letter with COSA to Scottish Government to urgently request further support for the sectors as we move into the autumn and winter. I have also requested urgent discussions on the NCHC given we have still not had response other than an acknowledgment to our initial requests.
Communication
Next week the Tuesday Surgery will be at the changed time of 3.00 pm. I apologise for this alteration. It will be hosted by Karen Hedge and myself.
Please read the latest blog from Jacqui Neil our Transforming Nursing Lead at https://scottishcare.org/getting-the-balance-right-latest-nursing-blog/
Care Home Event
Just a reminder for your diaries.
We will be going online with the Care Home Conference and Awards and will be holding a Care Home Event over three days from Wednesday 25th November till Friday 27th November with an Awards Ceremony in the evening of the 27th. We will be starting the Awards application process at the start of September.
And finally,…
My blog this week reflects on the fact that we are now 200 days into care home and homecare restrictions on Monday coming . See https://scottishcare.org/200-days-of-emptiness-waiting-and-yearning-a-reflection/
… in keeping the issues of care and the sector at the forefront of the concern of many please join me in lighting a #candleforcare on Tuesday at 7.00pm
Many thanks
Donald
26th September 2020
