The much-awaited Guidance for Visiting was published by Scottish Government on Thursday. I know that there are many diverse views on whether or not we have got the balance right in relation to opening care homes up. There will be many diverse views but the fact that we are now entering the 17th week of effectively preventing citizens from accessing their family in a direct way is something which, in my opinion, increasingly untenable and leaves the sector open to vexatious accusation and allegation. It is imperative that we have a staged and iterative development of visiting. The Guidance was co-produced with members of Scottish Care and whilst it demands a lot in terms of preparation I consider that it is better to be cautious and prepared than the opposite. It is Guidance produced by Government and as with all Guidance a care home would have to evidence in a scrutiny exercise why it chose to not adopt such Guidance. I know the 28 days issue is a real concern but that was beyond our influence having been determined on Monday by the UK SAGE Group following evidence of significant infection increase after Northern Ireland opened up care home visiting. Before that evidence it had been 14 days. I will bring to SG the issue of this timeframe impacting on the desire to admit new residents. See https://scottishcare.org/reintroduction-of-care-home-visits-2/
The following is a summary of some of the main issues in the week that has passed.
Finance and sustainability
We continue to gather evidence of the Partnerships which have not followed through with payments and Karen held a meeting with COSLA and CCPS to discuss what can be done with particular areas. The next round of these meetings are to be held on Wednesday coming and it is imperative that you feed information to Scottish Care staff either the Independent Sector Leads or national staff so that we get an accurate and up to date picture. We have been assured that if we provide information then action will be taken and that if there is LA resistance then this will be actioned by Government. I think we are all very tired by this stage that so many providers have not seen an iota of the £51 million.
You will remember that the initials Principles from COSLA re sustainability payments were due up on the 23rd June. I am pleased that these have been re-issued with Scottish government approval and that this period has been extended to the 31st July. See https://scottishcare.org/cosla-updated-provider-sustainability-principals/
The critical issue is what will happen after that. We have requested the commencement of discussions on the NCHC for care homes.
In the coming week we will also be meeting the Chair of the Fair Work in Social Care Working Group, the former Finance Secretary Andy Kerr, who has started the process of early discussion on national air work terms, reform of commissioning and resourcing of the social care sector.
We have finally had the terms of the Social Care Support Fund published – this will deal primarily with SSP payments. We have over the last couple of days presented some practical issues to SG and they have deceived to develop a Q and A in relation to some of these questions. Please communicate to me what some of these might be. I have already answered some on the Discussion Boards. https://scottishcare.org/the-social-care-staff-support-fund/
Unfortunately, there has not been equivalent progress in terms of Death in Service, and we have been led to believe that the legal and technical difficulties in allocating monies will be sorted by the beginning of next week. The slowness of progress in this area is a considerable disgrace.
Care Home issues
The death rate in care homes has just about reached the seasonal norm but we are still having about 20n new cases a day in care homes. There are still 170 homes with an active outbreak. So, as I stated above there is a very real desire and need to exercise caution in the opening up of care homes.
As I stated last week I am concerned about the deterioration of many residents as a result of inactivity and the process of the lockdown itself. The national Clinical and Professional Oversight group has a small working group looking at developing best practice in rehabilitation and related areas as well as developing Guidance for AHPs. I hope this work will conclude soon and I can assure you that there is a strong presence of providers on this working group.
I am very aware from many of you that the enhanced visiting to provide ‘support’ is not feeling like support coming as it does on top of huge demands and pressure son senior staff and homes. In some parts of the country they are going well as reflected in the discussion on last week’s webinar – in others not so well. I had hoped that the Care Inspect orate document ‘Guidance for Professional Visitors’ would have been published by now, but it has been delayed till at least next Thursday. I think what we are seeing here is a wider power-play for who has responsibility and scrutiny and the Care Inspectorate is at times fighting a battle against the clinical models of Public Health and the NHS. I think it will be critically important that we return to a sense of balance as quickly as possible even if we will have some enhanced engagement from clinical colleagues for some time.
This week also saw the sending out to workers and to managers two letters of thanks from the Cabinet Secretary. I am not sure how these will be received but at least it is an indication of a degree of awareness that the sector is under immense pressure and that in many care homes the work undertaken has been astonishingly excellent. See https://scottishcare.org/letter-to-care-home-staff-and-managers-from-the-cabinet-secretary-cosla/
There is also a growing move to articulate the lessons learned from the Covid pandemic and some of our staff have been invited to take part in these exercises run by locals HSCPs though not all HSCPs have invited staff. Scottish Care colleagues are gathering intelligence in this area as it is very important that we influence any ‘lessons’ and what that might mean for the short-term response. I have been invited to join the NHS Mobilisation Recovery Group which meets for the first time on Monday and which is chaired by the Cabinet Secretary. I think it is at last a recognition that social care needs to be involved in the recovery of the NHS not least in terms of the lessons learned re the clinical abandonment of our care homes at the start of the pandemic.
There continues to be a backlash in the media around care homes and the desire for a National Care Service. This has moved on a bit and alongside the public running care homes there is beginning to be fostered suggestions that care should be only delivered by ‘not for profit’ organisations. Clearly we will keep a close watch on these developments. However, as I have articulated before the critical set of issues is to get commissioning and resourcing right and these conversations tend to have a sobering effect on those who are more ‘pie in the sky’ in their thinking.
Ongoing work involving providers on the Safety Huddle tools is still not concluded and is becoming an unacceptable pressure for all organisations where duplicated returns are still being required.
The Care Inspectorate published their latest reports on visits which they have undertaken in the last fortnight. This is now a requirement of the Emergency powers and they have to be laid before the Scottish Parliament. The reports were the subject of media comment because some of them illustrated real challenge. Needless to say, they pick the negative rather than the positive. https://www.careinspectorate.com/images/documents/coronavirus/Scottish_Parliament_fortnightly_CI_inspections_report_24_June_2020_1.pdf
PPE
At the risk of tempting fate, we might have e come to an end of ‘glove-gate.’ The CEO of NHSFV has met as requested with other CEOs and Directors of Nursing and they have agreed that the position as described in the NES statement is accurate – i.e. that nitrile gloves should not be worn in all care encounters. If you know of any Health Board which is still requiring this please contact me as a matter of urgency. I have been assured if we provide the intelligence along these lines that steps will be taken as a matter of urgency to address this.
Members will be aware of the statement around universal masks and their use in care homes. We have been assured that there is sufficiency of supply with NSS and the Hubs. I know that some folks have been expressing concern that they feel that these masks will act as a barrier to residents with dementia. We worked with SG to ensure that the guidance enabled a degree of professional judgement both in dealing with distress and also with people who may have hearing impairments. However, this should be seen as executional and whilst this is a major change in the delivery of care it is developed against very clear scientific evidence from the WHO that asymptomatic spread of the virus is a major risk in our care homes. See https://scottishcare.org/covid-19-interim-guidance-on-the-wider-use-of-face-masks-in-health-social-care/
I have been having discussions on Brexit this week and am concerned that there is a very real risk to the already stretched and fragile supply chain. As I stated on the webinar if providers are able to access materials and thus able to stockpile t a degree then this should be encouraged.
On a wider note we will be working at Scottish Care with colleagues and others to ensure that we are prepared for what could potentially be a nightmare scenario of a second wave, a flu season and Brexit! We will refresh our Brexit Guidance especially in relation to non-PPE but medical consumables as soon as possible.
Stefanie continues to monitor the availability of PPE and every Monday the members’ section of the website will act as a signposted and comparator to the costs we have been offered.
Testing
The challenges around testing still continue with a real postcode lottery of both systems, frequency, level of return and engagement. Finally, we have established a regular meeting with the staff in the Directorate but undeniably their unwillingness to work directly with the sector has resulted in a lot more confusion than was necessary. We are aware that this week that has passed we have had far too many ‘inconclusive’ tests and are pursuing this with SG. We are also gathering intelligence on the issues which you are raising with us including the Social Care portal – from its English based texts to having to pay for the helpline if you are based in Scotland. We will communicate responses on all these issues in the members area. number one issue both politically and operationally is testing. We are still awaiting the promised FAQs from the Directorate.
I am acutely aware of the very real workforce implications of testing, around capacity, the time it takes within a working day, the resource used re PPE and staffing, the regularity of the process, the stress and distress of waiting for results upon staff etc . We need to have an honest discussion with SG on the evidence of frequency of testing etc.
Care at Home
At long last there are signs of a slow realisation on the behalf of the Scottish Government that as we move into late summer and into autumn/winter that the very real risks of the Covid2 second wave will git our local communities and folks who are receiving homecare. We have been mapping the extent to which packages are still not being replaced – sitting in some areas at 15% in others at 5%.
I am pleased to report that the Care Inspectorate brought a proposal to the Rapid Action group to review the withdrawal of packages process, whether people were properly informed, supported and what is happening now. This is being further developed but I and others are pushing for the creation of a Rapid Action Group solely dedicated to the issues facing care at home and housing support including the lack of testing, consistent use of PPE and financing etc.
Communication
We held one Surgery on Tuesday at 12 and next week’s one again on Tuesday will be hosted by Caroline Deane our Workforce Lead and myself as Karen is on leave for a fortnight.
We are very aware that the image of care homes in the public consciousness is very fragile. The 15th July is Care Home Day and we will be releasing materials shortly to try to encourage members to fully engage with this day. It is a day to celebrate not just the astonishing work of the last few months but throughout the year and to try to address some of the public negativity which is out there. I am pleased that colleagues in Government, the Care Inspectorate and local HSCPs want to get around the day and support it through their own messaging. We are also aware that this needs to be part of a longer-term process of re-building confidence which goes beyond social media to a wider media and public messaging. I am in discussion with Scottish Government about this.
May I also draw your attention to the Summer issue of the Bulletin. This will again be in an online format – a downloadable PDF – it is jammed full of excellent articles and information. Please read and share. https://scottishcare.org/summer-bulletin-2020/
We continue to use the Discussion Boards so please refer to them when you can.
And finally,…
We held a successful interview yesterday (Friday) for the funded post for a Human Rights Project Officer for the Rights Made Real Project which is fully funded by Life Changes Trust. We will announce the successful candidate after references are cleared etc, but I hope they will be a positive addition to our team in these challenging times.
I am very aware that for many individuals the relaxing of visiting has come too late – throughout the pandemic I have been in frequent communication with a respected retiure3d consultant geriatrician who has expressed real concern over the damage lockdown has been doing to residents – including his wife. Sadly, he wrote to me in the early hours of Friday morning hours after the announcement to say that she had died. It was a touching letter of real pain and absence and convinces me that as we move into a new stage of dealing with this virus we have to come up with a more humane way of supporting our care home residents and people living with dementia in the community tan the current blanket long-term exclusivist approach has to lockdown. More of that I suspect in the days and weeks to come…
In the meantime, I will light a #candleforcare at 7pm on a Tuesday – along with others to remember and to thank.
Thank you as always.
Donald
27th June 2020
