Review of the week 3rd to 9th May
This is the fourth in a series of reviews of the Week written to update members on activities and actions. It is intended for Scottish Care members only.
Another week of hard headlines and sad statistics detailing the number of deaths in our care homes and in the community. The one positive note is the reduction in the number of deaths, but it is only a small glimmer in an otherwise challenging and hard week. Interestingly there has been a decline in media attention – almost as if the rest of the world has already moved on to lockdown ending expectation…
The following is a summary of some of the main issues in the week that has passed.
Finance and sustainability
We have been gathering data from members for both Care Home and Care at Home sustainability. There has been a hold up this week when it became clear that Cosla needed to gain reassurance from the Cabinet Secretary that monies which were ‘promised’ for the sector would be brought through. We believe that there was a positive outcome to a meeting on this matter on Thursday evening and it is our intention to meet with COSLA officials and Scotland Excel early next week. In the meantime, we are aware that there are a growing number of authorities asking for details of costings. Nevertheless, until we get a national clarity there remains uncertainty both for care homes and homecare providers. Rest assured we will keep thumping the tub about this and I have already given interviews for the Sundays about the issue of sustainability.
We continue to argue for the extension of tax breaks to frontline care workers or the adoption of an ex gratia payment as has happened in Wales. The Cabinet Secretary has written to both me and the President of Cosla for discussions early next week on death in service benefits for care staff, but the clear presumption is that this is the employers role.
PPE
Yet again there seems to be a decrease in major issues of concern.
The Hubs are now operating – if you have any issues please either tell your Local Independent Sector Lead or Swaran.
We issued a statement following the comments of the Cabinet Secretary re providers paying back to the NSS. This was as follows:
“Care providers always anticipate having to purchase PPE but the nature of the pandemic has been such that all global markets shut down manufacturing and the costs rose rapidly. One of the additional reasons costs rose rapidly was the ring fencing and prioritisation of PPE to the NHS across the UK, to the detriment of social care. This has made it even harder for the care sector to get supplies. Added to this is the fact that the nature of the pandemic means that approximately 75% of PPE being used today would never normally be used by the care sector.
It is the responsibility in ‘ordinary’ times for providers to source their own PPE. Whilst providers continue to do this and have done so since the beginning of the pandemic, we are not in ordinary times. We are therefore grateful for the support of Scottish Government and the NHS NSS supply route to supplement supply shortages that are out-with the control of care providers.
The amount of money paid by the State for each care home resident supported by charitable and private providers is negotiated annually and is premised on ‘ordinary’ times. Clearly with cost rises in the region of 2,500% for PPE, there will need to be a re-negotiation which accepts the provision of additional supply from the NHS and recognises the increased costs and use of PPE by providers. Any payments or reimbursements agreed from those negotiations will require to be fair and equitable, not least given the reality that the lack of supplies for social care is in part a result of the actions of central UK Government. We look forward to taking part in those discussions at an appropriate time.”
We remain very concerned indeed about growing evidence in the last few days of real difficulties in accessing some lines and intend issuing media statement to this effect at the start of the week so that the public is aware of the continued difficulties and the likelihood that these will become sharper as more and more individuals seek to source from limited supplies as we come closer to the end of lockdown.
Again, I would want to pay tribute to Stefanie for all her work. This is a changing picture and I appreciate that some of our larger providers will be able to access supply at cheaper costs. We are hoping to be in a position to announce some bulk collaboration in the next week.
What this all does highlight is the need for Scottish Care to urgently consider whether we need to establish a procurement route for PPE which would enable bulk orders/rates, but this is not without significant risk and operational costs. We will hold discussions the coming week at the Executive meeting on Wednesday 13th.
A growing number of Health Boards and Public Health Scotland officials 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 local level. We continue to press for consistency which was clearly not even evident in our webinar with PHS officials. We will continue to argue in lines of our statement of Wednesday 25th April that universal masks are the optimum.
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. Once again we are struggling with a tone of NHS expertise and care home lack of knowledge. In some parts of the country this is getting better but the tone including statements from the Cabinet Secretary is wholly unacceptable. I had a very open and robust exchange with the interim DG of Health and Care to indicate that if blame is becoming the political focus then we will respond with appropriate public comment.
We continue to monitor instances where physical visits are happening where there seems to be no justification for such visits to care homes.
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. Late yesterday the latest version of SG Guidance for Care homes was published. See https://scottishcare.org/updated-scottish-government-guidance-for-care-homes-8th-may-2020/ It is much more sensitive to reality.
We held a second meeting of the Scottish Care Clinical and Dementia group in the middle of last week and we will be working together on proposals to improve contact for care home residents, greater sensitivity to dementia management etc. I have written again about these issues. See https://scottishcare.org/finding-a-way-through-achieving-a-balance-between-risk-and-protection/ I am pleased that the SG Clinical Group has indicated an openness to receive a report based on our own work on these issues of access, visiting, emotional and behavioural management and professional flexibility etc
Testing
Testing and the proposed changes are the major issue of the moment. We have made it clear that there is a real stability and safety risk if testing takes place without there being an appropriate workforce contingency plan being in place. I am pleased to see that most authorities have recognised this risk and are working with providers and individual homes on these issues. I remain concerned that the scope and scale of workforce planning is not as appreciative as it should be of the risks following testing of asymptomatic staff. In addition, when data becomes more public we are likely to evidence further backlash when it becomes clear (as it did in Skye last week) that many more residents are Covid positive than is generally believed.
We indicated last week our concerns around homecare providers and that we would raise this issue with media which we did yesterday. There remain real issues of access to homecare staff both in terms of flexibility and capacity. I am concerned that as the permissions re who can be tested are extended that there is a risk that the priority thus far for social care staff will be diminished, especially for our homecare members. It is really important that homecare providers keep us in the loop in relation to any challenges in getting staff tested and indeed any challenges you come across re those who are being supported in the community.
Care at Home
With the understandable focus on care homes it is still proving very difficult to get distinct airtime for the issues facing homecare providers. We will continue to do this as I did in my blog last weekend. See https://scottishcare.org/the-forgotten-frontline-homecare-during-the-pandemic/. My concern is that people are failing to realise the issues of transmission in the community and that as we ease out of lockdown we need to be very clear that we have adequate robustness in the community or our citizens are at real risk, not least because of the current massive threats to survival itself faced by our homecare organisations. The nature of community threats is well expressed in this piece from the Guardian. See https://www.theguardian.com/society/2020/may/08/more-people-dying-at-home-during-covid-19-pandemic-uk-analysis
Swaran is fixing up local care at home meetings and Karen and I hope to join as many of these as possible.
Workforce
The SSSC portal is busy but we are concerned that latest data suggests that of the 418 matched that only 6 have been employed. We are hearing that both this and the NES portal have sufficient staff volunteering but there is a growing reluctance for those to staff care homes where the primary challenge and need is. I will be calling this out in the media in the next few days because if people are prepared to put their lives at risk in acute hospitals why not be prepared to face the same challenge caring for our old?
Jacqui and Caroline are working on the practical issues with NES and SSSC not least around access to training resources.
We recognise the critical importance of psychological support for the workforce both in care homes and in the community. After some delay it is hoped the wellbeing hub for our sector will be launched by the Cabinet Secretary later tomorrow (10th May.). We will have details of this on the website together with any bespoke support around grief support which continue to discuss with partners. I hope one of our webinars in the next couple of weeks will focus on bereavement and grief support.
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 is now up online. https://scottishcare.org/letter-from-scotlands-national-chef-to-catering-staff-across-scottish-social-care-services/
Nursing.
We have now entered the International Week of the Nurse and there are daily video blogs highlighting the amazing work of social care nurses. Can I remind you that ‘International Nurses Day’ is on Tuesday 12th May, and that Jacqui Neil 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/
Palliative Care
One of the real positive outcomes of this Pandemic has been the engagement with the palliative care and pharmacy communities and their enhanced appreciation and advocacy for the work of care homes and homecare organisations. This week it was decided to undertake some speedy work to develop a set of core principles for ACP work in care homes especially for those parts of the country which are not utilising the current four models which are available. We will keep folks up to date on this.
It is also envisaged that early next week new Guidance on the Reuse of Medicines will be issued by the Care Inspectorate and SSSC. We will put this on the website when it become available.
Communication
We held another two webinars this week and these were facilitated by colleagues from Public Health Scotland , and the second with Karen Hedge and me. The number of participants remains high and I hope providers continue to find them beneficial.
Please send positive good news stories to us so that these can be put up by Shanice on the 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.
Thanks to Shanice and Becca for developing a media support toolkit for members. This can be accessed at https://scottishcare.org/scottish-care-media-toolkit/
Please continue to use the members Discussion Boards not least to share thoughts and ideas.
We continue to put additional resources onto the members area of the website – in the last week these have included:
Information from Disclosure Scotland:
https://scottishcare.org/disclosure-scotland-update-7-may/
Information on oral health: https://scottishcare.org/mouth-care-advice-for-care-services-during-covid-19/
Guidance which we co-wrote with the Care Inspectorate on Near Me for use as a consulting tool:
https://scottishcare.org/update-on-near-me-video-consulting-system/
Information on the Football Memories Reminiscence project for care homes:
https://scottishcare.org/football-memories-free-online-reminiscence-resources-for-care-homes/
Becca is working on a number of responses to a range of parliamentary and other consultations that have been launched. We have written to the Convenor of the Health and Sport Committee questioning whether the time is right for an Inquiry seeking to engage frontline staff and families in care homes.
And finally,…
A thank you to all my colleagues who are still expending huge energy to keep people informed and contacted, to challenge the negativity, to promote the excellence of care in our homecare and care homes across Scotland.
Please 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 (ISL) who are critical link and resource for you locally. Janice Cameron and Jim Carle can be contacted with any national issues and by those members who do not have a local ISL.
Thank you for all your work at this time
Donald
9th May 2020
