CEO Review of the week 25th  to 31st October.

It has been an interesting and a busy week. Wednesday saw the publication of the delayed Public Health Scotland report on discharges from hospitals into care homes during the first wave of the pandemic. Members will no doubt have read the report and made up your own mind about its analysis that there was no ‘statistically significant; risk posed by outbreaks when compared to other factors. What we have attempted to do as an organisation has been to recognise the nature of this work as a robust statistical analysis on the one hand whilst at the same time calling for additional work to be undertaken which is reflective of the qualitative experience of those on the frontline. In other words the report only gives part of the picture and had a narrowly defined remit. All care home providers will have had different experiences of the process of admissions during the pandemic and indeed before. Our public response in our statement was an attempt to describe the nuance behind both the report , the experience and critically what needs to happen in the future. See https://scottishcare.org/scottish-care-statement-on-discharges-into-care-homes/

Regretfully upon the Report’s publication and in subsequent days there resulted a media torrent and fervent need to apportion blame. One national newspaper, The Times, shamefully represented the report’s findings in a way that singled out hard-working care staff as the main vector for the virus. This lazy journalism was illustrative of some of the political simplification of these issues and ill serves the dedicated workforce we all know.  In all my radio, TV and published comments what I have attempted to do is to move us away from blaming staff to needing to explore wider issues. This includes the analysis that the size of the care home was a significant factor in transmission. The authors of the report themselves make it clear that whilst that analysis may be reasonable to conclude – the ‘why’ needs significant work. Is it about staffing numbers, use of agency, nature of acuity and need because most larger homes are nursing homes, or about the issues of isolating people with dementia in larger environments etc.? Or is it many other factors including environment and design? There are no black and white answers and no simple solutions. If only our media would develop the art of nuance.

The following is a summary of some of the main issues in the week that has passed.

Finance and sustainability

As I write this, other than the knowledge that there will be political discussions on Monday,  we still have no clear answers about critical issues of sustainability. These issues were raised by both us and CCPS during the weekly Scottish Government Pandemic Group. I am very aware that especially for care at home members at this time the drop off for payments at the end of October presents very real risks to survival. Organisations may need to start making people redundant at a critical point because of a lack of clarity around the continuation of payments. We have called for an urgent meeting of key players to get the political commitment that is needed to continue to support the sector throughout the coming weeks. This was again raised at the Mobilisation meeting chaired by the Cabinet Secretary which met yesterday. At time of writing there has been no resolution. All we can do is hope there is some resolution on Monday but this is another illustration of the way in which independent care providers are left like Oliver Twist with a begging bowl going back for more with little of the respect suggested by partnership.

I can assure everyone that Karen and myself will continue to robustly address these issues for both care at home providers and also around issues of sustainability and occupancy for care home providers. It is nonsensical in the extreme that we are still squabbling over continuation of fiscal support to say nothing of a complete failure to fund a huge number of sustainability payments to date. Time is running out in every sense.

We are holding two urgent meetings in the next week dedicated to the issues of sustainability and finance. Karen will be leading on these and they will take place on Wednesday 4^th and Thursday 5^th. Details including pass codes are on the members area of the website. Please see https://scottishcare.org/sustainability-roundtable-4-5-november/

It has also been a matter of real despair in the week that has passed that there is no movement from the Westminster administration on the imposition of PPE on PPE – this will have a profound impact on providers – regardless of the ability to access PPE hubs. We are all working to utilise business as usual routes for PPE and other supplies and the imposition of the tax is hugely damaging even if it may be possible for some providers to re-claim the VAT at a later date. I include the Westminster justification at the end of this statement. It should be noted that Scottish Government ministers and officials were not notified or consulted on this decision before the Chancellor announced it.

Dates have been identified for meetings with COSLA and Scotland Excel on the National Care Home Contract and we will as I have previously stated keep you informed on this. The first date is in a fortnight.

Care at Home and Housing Support

The Pandemic Response Group met again this week. I expressed disappointment that despite a commitment the previous week to do some urgent work on care at home and housing support that this had still not commenced. I have been assured it will be a priority this coming week and I again mentioned it in the Mobilisation meeting  to make sure the Cabinet Secretary was aware of the critical issues facing the sector which include, the issues of sustainability, testing and Track and Protect relationship, the need to quickly develop testing for asymptomatic staff, lack of Guidance specific to the sector especially around PPE. The one positive there seems to have been is a slight improvement on issues relating to Disclosure Scotland.

Other Covid issues.

Members will be aware of the new Tier status and the location of each area in specific tiers. Members should note what has been modelled for particular areas from the 8^th November which will result in some areas moving upwards and downwards. Together with Chief Officers of HSCPs we have asked for there to be a clear statement about what the Tier system means for care home visiting – we hope this will be forthcoming over the weekend. However the Clinical group underlined the general position which is that there is a desire to ensure that visiting continues and is not interrupted.

I was also pleased that there seems to be an increased commitment to the extension of testing including rapid testing devices for care home professional visitors and family members. We are seeking clarity on how and when this commitment will be translated into practice and what this effectively means.

The TURAS Safety Huddle has 100% sign up but it is still sitting at between 85-90% daily inputting. We held a webinar in the last week which is online, and which is a useful practical walk through. It is clearly in everyone’s best interest to maximise input. I have raised with SG the importance of moving to a stage that providers and staff are not just inputting materials but are gaining appropriate access so the tool and the data it is producing can influence decision-making, service design and planning. I hope we will move with some speed to this stage. See https://scottishcare.org/covid-19-webinars/

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 although we have heard of at least one residential home being contacted. We are aware that these contacts have started and it would be good to get some sort of indication as to how these are going.

RCA

 You will remember last week I mentioned the Root Cause Analysis work that had been established by the Cabinet Secretary to bring independent conclusions about some of the recent outbreaks of Covid in care homes especially in those where there had not been previous outbreaks. The publication of the findings of this group will be on Tuesday 3^rd.

Testing.

Testing – and I even hesitate to type this down – seems to be slightly improving though there still seems to be the clear experience that if staff get tested earlier in the week then they are more likely to get the results of the test faster. We are still holding the weekly meeting with Testing colleagues so if you have any updates or concerns please pass on to Caroline.

We believe that there has been a gradual increase in the number of tests being transferred to the new NHS labs as they are being established – at just over 10,000 of the total 37/38,000

National Care Review

I am pleased that there was a good turn out and what seems like a healthy exchange between care at home and housing support providers when we held the latest on-line consultation between Derek Feeley on Thursday last.

Next week there will be an opportunity for care home members to share ideas and views with the Chair of the National review. As more and more people seem to be assuming we will be getting a National Care Service this is a critical time for the independent sector to put our views forward as to what that might look like and to defend models of acre and support which have been brought into sharp political and media critique.

Please join. And share

Care Home Members 
Monday 2^nd 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.

Communication

Last week the Tuesday Surgery saw Karen and I answer questions to over 75 members – we continue to be grateful for such a high level of attendance.

Next week the Tuesday Surgery will l start with Dr Jenni Burton and colleague from the team which wrote and published the Public Health Scotland report on admission to care homes. They will attend and answer any questions from members for the first part of the Surgery. Thereafter there will be a general Q and A session. The Surgery will be at the usual time of 11.00 am.

Winter Planning Workshop.

Scottish Care are hosting a Winter Planning Workshop on Thursday the 5^th of November from 2pm until 4pm.

This will include an update from the Scottish Government and the Care Inspectorate which we are sure will be invaluable support as you plan for the months ahead. There will also be speakers from Care Home and Care at Home providers and an opportunity to take part in the workshop which will give you the chance to discuss the core components of an effective Winter Plan, how we will take into account our response to the pandemic, what difference this will make to your planning, what you can do to mitigate risk and what actions can you take if problems still occur.

At this time, we will capture any additional support requirements you may have and any actions you need to take and following the workshop we will develop an information page to support you.

The first ever Scottish Government Adult Social Care Workplan is scheduled to be published on the 3^rdNovember.

Please join the webinar – details for joining at https://scottishcare.org/winter-planning-workshop/

Please note change – Care Home Conference: 26-28 January 2021

 You will remember we had taken the decision to postpone the Care Home Conference until the new year. This event will now take place between 19-21 January. That means it will be on the Tuesday to Thursday. The Care Home Awards will be a standalone event on the 22^nd January.

Please put these new dates in your diaries. More information to follow.

 Care Home Awards 22^nd January 2021.

 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.

Workforce issues.

Please note the updated Guidance on car sharing by staff which has been revamped in light of the growing number of cases which are being traced back to the issue of staff sharing cars either as part of their work or travelling to work.

Please see

https://scottishcare.org/car-sharing-guidance-30-october/

The latest edition of the Workforce Matters Bulletin has been sent out. This contains a huge amount of information on a wide range of issues relating to workforce -= and huge thanks to Caroline Deane for pulling this all together and leading our work in this area.

Please look at the link in full but I want to draw attention to one item in particular. See https://mailchi.mp/scottishcare/workforce-matters-ebulletin-october-12905083?e=8b93fe8b46

Scottish Care proposal to start a General Workshop Group

 Scottish Care Workforce Matters will be creating a network for care providers that will focus on general workforce issues including recruitment and retention, learning and development and any other relevant workforce concerns.

This group would be in addition to the Regulatory Forum meetings that are currently co-chaired with SSSC and could discuss issues that may escalated to the Regulatory group or indeed other relevant stakeholders.  It would offer a protected space for care providers to discuss their ongoing workforce priorities and could also be used as a platform to inform care providers of current projects and initiatives that may be helpful to become involved in.

Further information will be forthcoming around meeting dates and agenda’s, please get in touch with Caroline at the following email address if you are interested in participating in these groups. [email protected]

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

31^st October 2020

 UK TREASURY STATEMENT AND BACKGROUND

An HM Treasury spokesperson said:

“The VAT relief on PPE was designed to accelerate supply of PPE to the health and social care sectors, saving them around £200m when they needed it most.

“Now, we have committed to provide free PPE for Covid-19 needs to adult social care – the main beneficiaries of this tax incentive – until March 2021.”

Background

• This relief was designed specifically to relieve the burden of VAT on sectors particularly affected by coronavirus while supply did not match demand (care homes, health care providers etc). Now that the Government is able to supply Covid-related PPE to these sectors, the burden of VAT will still not fall on frontline providers for all Covid-related PPE and demand will be met. The Government is committed to ensuring that PPE costs do not become a burden on affected sectors and is confident in ability to supply demand.
• The Government is confident in its ability to deliver Covid-related PPE. For example, in the 7 days to 4 October 2020, DHSC distributed over 149 million PPE items for use by health and social care services in England through the PPE Dedicated Supply Channel, NHS Supply Chain and other routes. Providers will still be able to access free PPE from either their Local Resilience Forum or their local authority if needed. See here for Winter Plan
• The temporary zero-rate of PPE was appropriate for the situation the UK faced at the beginning of this crisis. Now that the supply of PPE, and demand for it, has stabilised, the situation has changed, and this relief is no longer the most effective policy solution. The Government is confident the measures in place will ensure that PPE supply is not disrupted/overwhelmed. We have stabilised the UK PPE supply chain and are building a stockpile which will be in place by the 1st November.
• The zero rate of VAT for PPE only applies to PPE for protection from infection of a type recommended in guidance published by Public Health England (PHE) dated 24th April 2020 in connection with the coronavirus emergency. (The zero-rate will not apply to face masks that do not meet the criteria outlined by PHE.)
• Most businesses (that make taxable supplies) can recover any VAT they will incur on purchases of PPE as business expenses. They will therefore be able to reclaim VAT on purchases of PPE made after 31 October.
• The Government has centrally funded the purchase PPE for all of the UK – specifically to maximise value for money. The Government is committed to provide support as required to all parts of the UK.
• DAs receive funding direct from HMT for procurement and distribution of PPE – as they requested. DAs are now self-sufficient, and all four nations receive the same per population funding. Furthermore, intelligent and dynamic systems are place for the exchange of PPE where supplies run low to ensure no nation runs out. We therefore believe this relief is no longer required.

Our own statement on PPE

Scottish Care statement on PPE

The decision by the UK Government to re-introduce VAT on PPE from the 1^st November has caused real dismay amongst social care providers in Scotland.

The removal of VAT was brought about by campaigning from care providers in the spring at a time at which there were real shortages of PPE and prices had risen considerably. Over the summer and autumn, the market has stabilised, and the availability of PPE has increased. In addition, the Scottish Government has throughout the pandemic supported the care sector through the creation of PPE hubs which have offered PPE to providers unable to access their normal supply routes. This commitment continues until the spring of 2021.

However, Scottish Care believes it is both short-sighted and illogical now that we are in the Second Wave of Covid19 for the Government to add 20% to the cost of purchasing life-saving PPE. Many care organisations in Scotland are small-scale family run businesses who do not have the economy of scale to make large purchases of PPE and will be economically disadvantaged. In addition, whilst claiming back the VAT costs might be an option for some, the added administrative burden on small organisations is not inconsiderable to say nothing of the months it will take to get these costs back.

Dr Donald Macaskill, CEO Scottish Care stated:

“This decision by the Chancellor is both insensitive and reckless at a time in which tired and exhausted care staff should be focussed on saving lives rather than filling in paperwork. The additional cost will result in some organisations struggling to pay the additional sums not least as we move towards the uncertainty over trade which will be brought about by Brexit. It is regrettable that the UK Government once again has failed to listen to social care providers in Scotland and our pleas to continue the support.”