Review of the week 26th April to 2nd May
It has been another exceptionaly hard week with yet more tragic numbers of those who have died as a result of the virus and in particular the statistic that more people died in care homes than in hospitals for the first time in the pandemic. We have also seen a real sense of blame being expressed towards social care providers and in particular care homes. A sense of searching for answers alongside a belief that someone should have done something different in order to preserve life.
The following is a summary of some of the main issues in the week that has passed.
Finance and sustainability
Karen Hedge and I held a constructive meeting with COSLA and Scotland Excel officials on Monday to outline our areas of concern and this was followed by their input of these to a meeting of the Chief Finance officers on Thursday. On Friday morning we held another positive meeting and we agreed to undertake some urgent baseline work over the weekend and to meet again with data on Wednesday. We are hopeful that there will be for care homes an uplift on the NCHC and local provisions re occupancy and additional costs; and for care at home more robust financial support for additional costs and loss of contracts/business. We will keep members informed as quickly as possible as we fully understand the immediacy and urgency of financial sustainability across the sector.
PPE.
We have had a decrease of issues in the last week but the system of using local hubs still seems remarkably fragile with inconsistency across the country. Can we underline that if any organisation has concerns over access then they should approach the Triage as a priority. Karen has been working on a Minute of Understanding with all stakeholders.
We continue to work hard, and again this is down to Stefanie Callaghan, on accessing the best deals for members. I appreciate that larger organisations will doubtless source better deals, but we are seeking to support all members in a stressed environment when demand and shortage of supply are key factors in the high prices. We are in serious discussions to supply in bulk to the sector and we hope over the next week or so that these will help to reduce unit costs. Please keep accessing the members area of the website where there are daily updates on PPE.
As I said last week we need to make it clear to the general public as well as politicians that the sector is busting a gut in order to get PPE – Bas there is a growing narrative that private businesses should be getting their own PPE.
Positively after a letter to the Scottish Finance Secretary and a meeting with the UK Government Under Secretary of State for Scotland the Chancellor has announced the removal of VAT on PPE for a six-month period. We continue to argue for the extension of tax breaks to frontline care workers.
Yet again this week we have seen a growing number of Health Boards and Public Health Scotland officials who are instructing care providers to use masks in all care encounters. This is contrary to the last published HPS Guidance and has caused considerable anxiety at care face level. Despite what feels like daily letters and calls to raise this with Government there has been no movement as it is allowable to a Health Board to determine its approach based on ‘risk assessment.’
We will continue to highlight the sheer impossibility of getting some stock and will underline this in our media exchanges.
Care Home Strategy, CI and Public Health Scotland
Both the Rapid Intelligence Group and the Clinical and Professional Advisory Group met last week, the latter twice. The tone seems to have become less about scrutiny and more about support from PHS but I accept that this is not what it feels like at local level in some parts of the country. Having now examined many of the reviews undertaken by PHS it appears that the care home sector has been responding well and with good overall reports. This is as we had stated and expected! One major issue is the duplication of reporting and I hope that in the next few days this pressure will ease with some understanding between the CI and PHS officials.
We continue to monitor instances where physical visits are happening where there seems to be no justification for such visits to care homes. However, I think the longer we are in lockdown the greater the desire to enable inspection to assure the public.
We will be joined by three Public Health Scotland staff on the first webinar of the week on Tuesday 5th.
The Clinical and Professional Group which is jointly chaired by Prof Graham Ellis of the CMO and Diane Murray the Depute Chief Nursing Officer met twice and is focussed on getting clearer Guidance to the sector with the now multiple copies of Guidance documents. I am pleased that this Group has now been supplemented by frontline care home experience in the person of Derek Barron from Erskine.
I am very aware that at latest data count we still have 50% of homes with no infection which is a decline from 64% the previous week. The aim is to ensure that we keep this figure as high as possible and to support clinically those care homes where there has been an outbreak.
Testing
Testing of staff remains inconsistent around the country but where it is happening it is going well l and efficiently. The overall picture is improving, and our hope would be that we move to a much more mobile model. Mid-week Scottish Care issued a call for there to be testing of all residents and staff where there had been a single case moving towards routine testing. This was accepted and announced by the FM on Friday. The practicalities of this and how it is to be achieved should be sorted out by the middle of the coming week. There are obviously issues of capacity and prioritisation. In addition, there will be a series of surveillance testing approaches to care homes where there has been thus far no recorded outbreak.
It is also clear that the testing of homecare staff and their families has not been sufficiently prioritised, and we will continue to push on this I the week that lies ahead.
Care at Home
I have this weekend written about the degree to which the homecare sector has become the forgotten frontline. See https://scottishcare.org/the-forgotten-frontline-homecare-during-the-pandemic/. Last week we issued clear statements to the media on the issues of loss of contracts, the nature of infection prevalence in the community,. The extent of financial fragility within the sector. All of these are simply failing to land in the media. However, we have had some discussions with journalists in the last few days which gives us cause to hope they will begin to focus on the issues faced in homecare. Karen hopes to call a meeting of the National CAHHS Committee over the next few days and I know Swaran is keen to have local providers meetings, a process which he has started in some areas.
Workforce
The SSSC portal is now up and active and already has placed over 200 individuals. There is still a need to address some issues of allocation especially of nursing staff, but Jacqui and Caroline are working on these issues with officials every day. I am c concerned that there is much talk of slowing the process and there has been a halt to additional volunteers being called for. There may indeed no longer be the threat to the acute sector in terms of workforce but the independent care home and care at home sector is still highly vulnerable to staffing issues, not least as we move towards more testing of staff. This will in all likelihood, perhaps mostly in care homes, result in more and more staff having to be self-isolating. We need to ensure there is sufficiency of trained and skilled staff to fill these aps in a sustainable and safe way.
We recognise the critical importance of psychological support for the workforce both in care homes and in the community. Caroline has been closely involved in the development of a portal to support the workforce which is due to be launched by the Cabinet Secretary later today (3rd May.). We will have details of this on the website together with any bespoke support around grief support which we are discussing with partners.
We are grateful to Scotland’s National Chef, Gary Maclean for providing us with a support letter to the staff working in the sector. This will be available shortly.
Nursing.
Many of you will have seen the notice that from the 6th we will be starting International Week of the Nurse. Scottish Care hopes to highlight the amazing work of social care nursing not least at this time during this week. The theme for this year is compassion and Jacqui Neil is looking for good news stories from individual care homes. We require a short vlog on a story you feel highlights compassion shown by your staff. This is a real chance to get some positive media out there to challenge some of the negativity and I would strongly encourage you and your staff if you can to participate in this.
‘International Nurses Day’ lies on Tuesday 12th May, and Jacqui has developed the concept of Take a T break day , with T referring to Thank you as well as Team and Timeout to recognise the amazing work of our nurses, carers and everyone within the sector.
More details on all this at https://scottishcare.org/international-nurses-week-6-12-may/
Can I encourage you to read the latest blog which Jacqui has written at https://scottishcare.org/new-nursing-blog-with-change-comes-new-beginnings/
Supporting communities and individuals.
The Technology Devices Network project continues to gain ground and with new support coming in. We are very pleased that one company has donated 15 iPads and Becca who is managing this will be writing up this story in the next few days. The impact and distress of exclusion is becoming more acute. Please continue to support this.
https://scottishcare.org/scottish-care-launches-initiative-to-connect-people-through-technology-2/
Ethical Guidance
Readers of these updates will be aware of the concerns that I had raised re the former CMO Ethical and Clinical Guidance and its discriminatory and ageist characteristics. I am pleased to say that after a meeting this week it was decided that the re-write of these documents (which I considered to still be inadequate) are now to be freshly re-written and that representatives of the Scottish Human Rights Commission, Inclusion Scotland and the Equality and Human Rights Commission will be involved. Whilst thankfully the feared situation of resource restriction has not arrived it is critically important that such documents are right and correct lest we are faced with these challenges perhaps in a second wave of the pandemic.
Communication
We held another two webinars this week and these were facilitated by Karen Hedge and me. The number of participants remains high and I hope providers continue to find them beneficial. Next Tuesday we will be joined by PHS colleagues and on the following Thursday Karen and I will return. All the webinars are available on the website.
It has been mentioned it was an astonishingly busy week on media not least around the figurers relating to care home deaths. The tone was sharper, harsher and more accusatory.
Becca and Shanice have developed a new section on the website to tell Good News Stories. See https://scottishcare.org/good-news-stories/
This is a very deliberate attempt to challenge the noise of negativity by having members contribute good news stories of excellence, upbeat stories showing the sector at its best despite all the challenges. Please consider contributing.
We continue to witness wholly unacceptable behaviour on the part of the media. We will reflect on whether we need to put a statement out re some of these behaviours but I am watchful of getting the balance right especially at times when the public are increasingly feeling – unjustly I might add – that the sector is not sufficiently transparent and that they cannot get access to information on people.
I am grateful to Becca and Shanice for developing statements on particular media issues which are put up with regularity on the website. They have also developed a pack to support our members when they are approached by the media.
I continue to have a weekly 1 to 1 with the Cabinet Secretary and Karen, Becca and I continue to have dialogue with opposition party politicians to indicate to them what our stance is on particular issues. I also met with the Under-Secretary of State at the Scottish office this week.
The ‘new care normal’
Last weekend I wrote about the continued impact of lockdown on people with dementia both in our care homes and in the community. See https://scottishcare.org/the-new-care-normal/. In the piece I called for thought to be given to how we can reduce the stress and distress and address the sense of dis-connection with families and friends. I held a Scottish Care Clinical and Dementia group in the middle of last week which has involved external dementia voices and specialists and this group will meet again. There needs to be a better balance between safety and good infection control practices and the rebuilding of relationships. I am pleased in conversation with the Cabinet Secretary that she recognisers this and wants to work with the sector in moving towards a better balance not least in the weeks ahead as we move towards easing of restrictions.
We will keep members updated on these developments, but I think we are all realising not least through communication with families and individuals that we must address these issues including how we staff a more flexible approach as matters of some urgency.
And finally,…
I am very aware that folks are getting tired but despite this the staff of Scottish Care at national and local level are performing way beyond expectation and I want to thank them all on your behalf.
Last Friday I was pleased to welcome to our number Dr Tara French who joins us from Glasgow School of Art to become our Technology and Digital innovation Lead. This is a post funded by Scottish Government. Many of you will know Tara from her work on homecare and care homes over the last few years and we are absolutely delighted that she has joined us. It is a strange time to join any organisation but especially one in the ‘eye of the storm’ but we very much look forward to the creativity and challenge that Tara will bring to our work and the advancement of the sector in its care of people.
Please also continue to use Swaran as your members’ link and if you are interested in holding local meetings do get in touch with him. Please also contact Laura, Cath and Colette at the ‘office’ with any issues and your local independent Sector Lead who are critical in a twice weekly call for giving feedback and insight on local issues.
Do get in touch if there are any issues you feel we need to be focussing on. We will continue to give regular updates on the website.
Thank you for all your work at this time
Donald
3rd May 2020
