If anyone doubted the ability of this virus to continue to wreak havoc upon hope and community it has been seen in the past week with a growing number of positive tests, increased admissions to hospitals and sadly a return to daily mortality. This has for the first time in a period of time included an increase in both the number of cases occurring in care homes and sadly deaths of residents. It has been like a return to the pain of the past but this time with a sense of knowing what to expect and all that comes with that diminishing of energy and hope.
But this week past has also been a week when we have looked forward and beyond the pandemic to what the future might be and needs to be both in our meetings with Derek Feeley and in our working towards the Homecare Festival.
The following is a summary of some of the main issues in the week that has passed.
Homecare Festival Wednesday 7th-9th October.
On Wednesday we will be starting our Homecare Festival. A great deal of work has been put into making this a successful event.
It is enormously important for us all to support the Homecare Festival which is now just a few days away. Numbers for attending are not as we would like, and all efforts will be put in over the next few days to change that. AsI stated last week 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. We can plug that gap is if everyone supports both our homecare event and the care home 3-day event in late November. More 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. Winners will be announced at a virtual Awards Ceremony, hosted by Michelle McManus and myself – promise n singing from me! – on next Friday evening. 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/
Care Inspectorate
I have had some discussions with the Care Inspectorate this week in relation to the Inspection reports which have been being undertaken. We are seeking a roundtable between strategic staff in both Scottish Care and the CI because we have real concerns about the nature of the inspections and their IPC focus. I believe the Care Inspectorate will shortly write to remind all providers of their IPC obligations being of the view that recent inspections have highlighted them areas of concern. We continue to assert that a care home or any service is not an acute sector environment.
Testing.
We have undertaken a bit of an analysis of whether or not things are changing on the testing front. Our clear conclusion – despite the rhetoric from our politicians – is that there are still huge problems both with the current system and a slowness to migrate over to the Regional hub models to be run by the NHS. I cannot underline enough and continue to do so to the media the importance of testing for our care workforce, that is both our care home and homecare workforce. The latest data shows that an astonishing 37,000 people underwent the test in the last week which is a remarkable level of commitment and consistency given all the problems!
Caroline continues to attend the weekly meetings and to input the perspectives of the sector and to deal with practical issues. There are still too many staff waiting 7-10 days for their results despite what the data from the UK portal seems to be telling. We know that there is a critical relationship between getting to test right and enabling fundamental activities like getting indoor visiting working and most importantly keeping both staff and residents safe. I have also stated that ideally, we need to move to a situation where testing is undertaken not only on a weekly basis but at least twice weekly.
Having brought the issue of homecare testing up for the nth time at the Pandemic Response group I have been informed that the scientists and analysts have started work on the proposal to roll out testing to staff in homecare and housing support. I have indicated the urgency of establishing a system as we move into winter which is robust. I have also stated that
National Care Review
We have held three sessions with the chair of the National care Review Derek Feeley. These were all useful – one for homecare, one with the Executive Committee and the last with care home providers. The discussions, I would reflect, were honest, real and at times emotional and raw. It is critically important that he hears the contribution of the sector as I have a fear that there is a danger that both he and others will rush to pre-baked ideas without knowing and understanding the issues as they really are rather than through a prism or health perspective. Scottish Care will be submitting a full report in the near future which we will make available to all. Transparency during the Review is a matter of some concern to me – it would be important to know who he is meeting and what he is being told lest the loudest are heard above truth and reality.
Derek Feeley has also indicated that he is willing to have a further meeting later in the process and I have written to him yesterday following the last of our engagements this week to see when this might be possible. We will keep members informed about this through the usual channels.
General Covid Care Issues.
This last week has seen the highest death rate both in the community, hospital and care homes for some time and illustrates the way in which the virus seems to be taking hold in parts of the country.
The Pandemic Response Group met this week and spent a great deal of time reflecting on a paper – as yet unseen – which has been developed by civil servants with health and statutory social service input on the Winter Plan for Adult Social Care. I have to confess to a sense of real anger and frustration that this process – albeit in draft had got to the state it has without and the direct engagement and involvement of providers either through ourselves or CCPS – yet another example of planning and preparation being undertaken without the experience and expertise of those who are actually doing the job! There has been an agreement to re-visit this and yesterday some of our members together with Karen took part in a planning exercise, as did others on Tuesday last although that was directed at planning around PPE availability given certain scenarios. At the risk of twisting a phrase – if we do not plan to succeed together, we plan to fail apart.
We also spent some time reflecting on the inconsistencies within the Covid Occupational Health guidance in specific regard to pregnancy and we have escalated provider concerns on these issues and the risks which may or may not be present to pregnant staff. As soon as we get information on this there will be a response in the discussion boards.
At the start of the week there were instances where it became clear that a number of Health Boards had advised providers that residents would need to wear masks following new Guidance issued by the Chief Nursing Officer on mask wearing. We quickly got clarity on this issue which stated that masks were not necessary for residents.
It is yet another example of the inability to communicate directly with the sector and to understand the implications of diverse and inconsistent messaging on frontline care delivery.
The Clinical and Professional Advisory Group also met and considered a number of issues.
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.
You will also have noted that Public Health Scotland took the decision to hold off on the publication of the data on hospital discharge into acre homes. This will now be published on the 20th October. This critically enables providers to give ‘anecdotal and confidential’ information to the Review. I know there are huge sensitivities around this whole area for care homes and for staff but any assistance in getting the real story and experience of the sector told would be helpful. You may remember that Dr Jenni Burton who is involved in the research on hospital admissions into care homes wrote to us last week asking for this information. Can I encourage you to respond to her letter, which stated:
‘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
CPAG also considered changes to an enhanced Guidance for Stage 3 visiting. I anticipate a letter will come out early next week which will seek to consolidate Guidance 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.
I am very aware that there are a number of providers who have taken the decision to end indoor visiting because of failures around testing and for fear of introducing the virus into the care home due to increased community prevalence. As I have privately stated to organisations this whole area has become exceptionally politicised. Providers need to be aware that there will be an inevitable media backlash not least brought about by families and politicians on measures which may be seen as restricting visiting in parts of the country where there are no increases in community transmission. There is a desire for the sector to move towards local decision-making rather than blanket and national positions.
This is a hugely sensitive and challenging area but there are real reputational risks, real risks around health and well-being and real fears caught up in all of this. Included in this are the very real fears of family members who are choosing not to visit their loved ones because of the fear of carrying the virus into care homes and the concomitant upset and anger they feel about family who are visiting.
We will continue to support, advocate and represent the diversity of views within the membership on these hard issues.
Other issues we have raised with the CPAG include concerns which have been raised by providers around the inconsistency of practice in relation to the flu immunisation programme – these include a lack of knowledge in some areas, contradictory advice in others and a failure to recognise the role of non-direct care staff. As someone stated if we lose backroom staff for instance a care co-ordinator then this can have a critical impact on a service’s ability to function and deliver.
We also raised the issue of Vitamin D with growing evidence of the benefits of this upon both care home and isolated older individuals in the community.
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 the next one will take place on Tuesday. If you have any specific issues re sustainability please send them to Karen by then.
We are hearing from a number of people very real concerns around occupancy. One of the major ways we have of influencing further support around care home occupancy is if members fill in the Turas Digital Huddle. There is 99.3% compliance with the tool but unfortunately there is only 83.6% of providers filling in the daily input. If we get this increased well first of all the double counting of using paper can stop but equally important, we will be able to get a true picture of occupancy which we can then use to push arguments for support.
Members will have seen the announcement of over a £1bn into health and social care. Part of this is to meet the substantial shortfall for local authorities on sums they have already paid out and part is to get us through the winter. It is critical for continued support that we need data, and this means filling in the occupancy field on Turas for care home providers.
I have again re-written to COSLA re the NCHC given we have still not had response other than an acknowledgment to our initial requests.
Social Care Staff Support Fund- non furloughed staff survey
Early in the COVID-19 crisis some organisations were advised they could not furlough staff who were shielding. Scottish Government has now recognised this as a problem and are keen to understand the costs incurred by providers in supporting this group financially.
Scottish Care and CCPS have jointly issued a short survey on this. We would be grateful if you could tell us about your experience by filling out this survey.
Survey deadline: Friday 2 October, 5PM
Survey link: https://deefraser.typeform.com/to/I2JfN3ol
Covid-19 Guidance Notifications
We have set up a new system to allow members to subscribe to receive email notifications every time we post new or updated Covid-19 guidance on the Members Area.
You can find instructions on how to subscribe here: https://scottishcare.org/wp-content/uploads/2020/09/Subscribing-for-Covid-guidance-notifications.pdf
Disclosure Scotland
As noted last week I wrote to the Director General of Social Care asking for a return to the former system given the length of delays. This was discussed at the Pandemic Group and resisted by disclosure Scotland who argued there were few problems. An urgent meeting has been arranged for the coming week to address these issues. Clearly, we are not convinced by the arguments from DS.
Please also note a message from Laura re DS:
We have an ongoing issue with counter signatories who are under the Scottish Care Registered Body Code for Disclosure Scotland ticking ‘invoice’ payment rather than inserting their credit/debit card details at the point of application. The invoice is then attributed to Scottish Care rather than the individual service/provider. We then have to forward notifications to members to make payment to Disclosure Scotland. Please ensure when you are making online applications that you pay via the Disclosure Scotland payment portal.
Care Futures Programme – latest insights
The latest insights for the Care Futures programme is now available. This insight is the second in a series of emerging insights on the theme of Care Practice and looks at what we are learning about regulation during Covid-19.
Available on: https://scottishcare.org/wp-content/uploads/2020/09/Care-Futures-Emerging-Insights-Care-Practice-Regulation.pdf
There is still time to complete the Care Future surveys, available on: https://scottishcare.org/care-future-surveys/
Communication
Next week the Tuesday Surgery will be at the usual time of 3.00 pm. It will have Prof graham Ellis and Hugh Masters from the Clinical And Professional Advisory Group in attendance.
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 Awards opening.
We’re delighted to announce that the 2020 Care Home Awards are now open for entries. Never has it been more important to support the amazing work done in our care homes. Please support and enter:
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 submit your nomination here
And finally,…
Can I encourage you all to support the Homecare Festival and the night before to join me in keeping the issues of care and the sector at the forefront by lighting a #candleforcare on Tuesday at 7.00pm
Many thanks
Donald
3rd October 2020
