I know it is probably a day late but a Happy new Year to everyone.
The first week of 2021 has brought about a great deal of activity with the announcement of what is effectively Lockdown 2 on Monday by the First Minister. As every day of the week has passed we have seen yet more disturbing data around both cases, hospitalisations and sadly deaths. There can be little doubt that the perniciousness of this latest strain of the Coronavirus is extensive and alarming. The challenges for the care home and care at home sector in the coming weeks will be as they have been for the last ten months significant. I can assure you that colleagues at Scottish Care will continue to do all that we can to support your work and to ensure that the voice of the sector is heard amidst all the inevitable politicking and point-scoring that we will see in the weeks and months up to the Scottish elections in May.
The following is a summary of some of the main issues in the week that has passed.
Vaccination.
Monday was another positive day with the first vaccinations using the new approved Oxford AstraZeneca vaccine. Itys ease of use and mobility will be a significant contributor to the roll out of the vaccine. At the time of writing I believe that 62% of care home residents have so far been vaccinated and about 45% of staff in care homes. This is a massive achievement and credit is due to not only pharmacy and health colleagues but to all the work that has been undertaken by care home staff and managers in meeting this challenge. As weeks progress we believe that the Oxford vaccine will be able to be dispensed by social care nursing staff. The stated aim of the Government is to have all residents that are able to, to be vaccinated by the end of January and to have all others in Phase One of the JCVI list (that is the first seven categories) by the end of March. We are concerned this may be overly ambitious as it is dependent on supply of the vaccines and whilst yesterday saw the approval of the Moderna vaccine that will not arrive till the spring.
Undoubtedly there has been a significant amount of concern about the decision of the JCVI to adjust the second dose of the vaccine to move it to a 12 week period from the initial 21-28 days. I have been in a number of meetings with Scottish Government on this in the week that has passed. At the one level this whole issue has been very poorly communicated – albeit with letters from the CMO and then the joint CMOs detailing the reasons for the change which I know have been sent to managers.
In light of the meetings I gather that new evidence is to be published validating the use of the 12 weeks. This will contain the MHRAs detailed research and assessment both of data which Pfizer has produced which evidences a 89.5% protection after the first dose and also research papers from the WHO – they have stated that the media pick up of the line that they are not supportive of the 12 week delay is inaccurate. They have accepted the necessity of the change due to the critical issue of the new strain. The increase in protection provided by the second dose is 4.5% but the main benefit is the elongation of the protection.
All in all both the Scottish Royal Academies, now the BMA (having changed their stance) and the British Society of Immunology are behind the change as are the Oxford AstraZeneca group and the JCVI.
This is a challenging situation for members and I know there is a diversity of views. There is understandable anxiety and upset from those who are expecting their second dose and see it disappear into the future. Alongside all this is very clear and substantive evidence that unlike the first wave there has been an exponential increase in the numbers of those over 80 dying in the community. Indeed communication from our members has been highlighting the urgent need to start vaccinating this group (currently we have only vaccinated 1% compared to 62% of care home residents).
We were grateful that Dr Syed Ahmed from the CMO office attended the Surgery on Tuesday and answered some questions relating to the vaccine and its roll out.
A further issue which developed during the week was that it would appear that different Health Boards have adopted diverse policies in relation to vaccinating during an outbreak. Some have refused any vaccination in a home with an outbreak and others are doing so but only on those who test negative/are not showing any signs etc. Given the growth in homes with outbreaks this is a critical issue to ensure protection of the most vulnerable. Wednesday’s data shows 173 homes have an active outbreak, up from 155 the week before.
NHS England re-issued Guidance on 31st December relating to this and evidencing a more flexible approach. We have been led to believe the Scottish Guidance being followed by many Health Boards was presuming th4 data re the virus from the time before the new Kent strain. We have been assured following meetings on Thursday that the CMO and others will re-examine this issue. We hope pragmatic flexibility will be shown. The English Guidance can be found at https://www.england.nhs.uk/coronavirus/publication/guidance-for-covid-19-vaccination-in-care-homes-that-have-cases-and-outbreaks/
We have highlighted how critically important the roll out of the vaccination to care at home and housing support staff is and have been assured that this is being seen as a priority. Our concern is that clearly there are major issues with care at home and housing support which have failed to be prioritised during the last ten months and do not want this to be another one.
Care home issues including testing
Members will be aware that on the 24th December a new letter came from Scottish government changing the testing arrangements to require effectively three tests a week – two using the lFTs and one using the PCR. Further the transfer of the PCR tests to NHS Scotland continues as detailed in the earlier letter. The timing of all this is singularly unhelpful and the Scottish government accepted this but have responded that the evidence of the new strain is so worrtying that they could not hold off and wanted to maximise protection as much as possible .
We know that many have been attending webinars on the LFTs and been raising issues with those delivering them. We would encourage folks to continue to engage with these sessions. Equally to remind people that should you run out of supplies that the NSS helpline is there to address any practical problems.
Visiting
Obviously one of the consequences of the whole nation going into Phase 4 lockdown (apart from the islands) on Boxing Day and then the extended lockdown last Monday has been an end to visiting indoors. This has been devastating to manty residents and especially their families.
I want to underline in the strongest possible terms that essential visiting should continue and that members should seek to enable such visits in a pro-active manner. There is some considerable and unfortunate evidence that people are being denied these visits. The returns from the Daily Huddle Turas tool will be examined over the next week by Scottish Government officials along with ourselves to assist providers who may be having challenges with essential visiting so that these can be addressed.
I attended a meeting with clinical representatives, the Cabinet Secretary and members of Care Home Relatives Scotland on Thursday. It was a frank exchange and the CMO Office indicated that they were undertaking work on what vaccinations mean in practice to enabling visiting. With us coming very close to it being nearly a year since residents have been able to meet their family everyone is eager to ensure that we maximise the protection given by vaccination along with additional testing, PPE and IPC to enable visiting to happen as speedily as it can when the situation stabilises. It is clear from the number of media stories of families withdrawing relatives from care homes and those not entering care homes that this is a central and critical issue to address.
Admissions
Again members will be aware as I am that the NHS is under immense pressure, London effectively went into a state of emergency yesterday with triaging at the door of a and E. In truth in Scotland, we are only 2-3 weeks away from the capacity of ICU and hospitals being overrun unless we address the growth in cases. I know that there is a growing pressure on care homes to admit from hospital and I have witnessed some media alarm and stories over this. With vaccination, clear double testing, isolation for 14 days and appropriate IPC/PPE there may be circumstances where admission from hospital is possible . I am equally aware of the very real sensitivities and challenges that that statement has contained.
Testing professionals.
The process of testing non health professionals seems (a dangerous assumption) to be settling in but there appear to be challenges with GPs with some not wanting to use LFTs, others saying they are not mandatory etc. This was raised at the Clinical Group on Thursday and we have been assured that there is ongoing dialogue with the BMA and GPs to ensure that a system is developed so that they can give the assurance to care homes that they have been tested. Otherwise the myth will propound that GPs are somehow so sanctified that they are immune from the virus!
New Community Health and Care settings IPC addendum.
Many of you will be aware that this has recently been published at http://www.nipcm.scot.nhs.uk/scottish-covid-19-community-health-and-care-settings-infection-prevention-and-control-addendum/
This addendum is for use in the following settings:
- Health and social care services provided in peoples own homes
- Community based settings for people with mental health needs
- Community based settings for people with learning disabilities
- Community based settings for people who misuse substances
- Supported accommodation settings
- Rehabilitation services
- Residential children’s homes
- Stand-alone residential respite for adults (settings not registered as a care home)
- Stand-alone residential respite/short break services for children
- Sheltered housing
- Hospice settings
- Community Optometry
- Community Pharmacy
- Specialist palliative care in-patients units/hospices
- Prison and detention settings
It is the Scottish Government expectation that this addendum is mandatory and is therefore the Scottish standard that is to be applied in the settings listed above and which national bodies can inspect against.
In addition please see the list of NES Infection Prevention and Control Webinars on the website.
https://scottishcare.org/nes-infection-prevention-control-covid-19-webinars/
Care at Home
Caroline Deane met with a number of our care at home and housing support members this week and both she and I raised some of the issues identified at the Pandemic meetings on Thursday. To be truthful I was immensely disappointed at the failure of others to recognise the very real and critical challenges being faced by the sector. We know that people are getting seriously ill because of a failure to prioritise testing, to address issues of funding and packages of support and a tardiness around the prioritisation of vaccination. We have already highlighted these issues to the media and hope a story will come from it in the next week.
The issues include:
- Mixed experience for homecare providers around the roll out of the COVID vaccination depending on HSCP area
- Some areas including D&G, Falkirk and Forth Valley have commenced social care staff vaccinations
- Other HSCP’s have sent out no communication regarding testing or vaccinations to date
- Areas with poor communication also have poor roll out of testing and vaccinations and measures in place such as ensuring tests are done prior to discharge and informing the homecare provider of the result
- Hospital discharge into community still very concerning due to lack of communication around individuals COVID status in some areas
- Managers are extremely concerned about staff safety – currently 4 organisations who attend the forum meetings have or have had staff seriously unwell in hospital with COVID
- Testing so poor in some areas for social homecare staff they are going directly through the government online portal as quicker – no sense of priority for homecare staff
- All this having impact on other social care staff particularly office staff who are concerned about staff in the field
- Outwith concerns over family visits at Christmas, homecare still experience situations where family members live with SU and they unaware of COVID status of people living in the house
- Information around roll out of vaccinations being sought by social homecare managers using google and by checking NHS websites
Communication
We held the Surgery last with Dr Ahmed and this is available to watch as all the others are. This coming Tuesday we will be holding the Surgery at the usual time and Karen and myself will be present.
In addition we will be holding a Webinar on Thursday at 2pm. The webinar is in partnership with Fever Free Zone. It is entitled Challenges and Opportunities and Risks for the care sector in an era of Public Health Risk: Protecting the vulnerable as we emerge into a new normal.
Public Health Consultant and Clinical Epidemiologist Dr Paul Nelson presents a perspective on the challenges of the next 6 to 12 months and the likely new normal and offers a forum for discussion.
Dr Paul Nelson is a Clinical Epidemiologist and Public Health Consultant leading on the health protection of the Care Home Response for Herefordshire Council and is founder of Fever Free Zone.
Webinar Link: https://us02web.zoom.us/j/89131075432
Webinar ID: 891 3107 5432
Collective Care Future
On the 1st January Care Futures launched the ‘Social Care Mosaic’ for 2021
You may remember in November 2020, we developed the concept of a ‘Social Care Garden’ through our Collective Care Futures programme as a way to imagine and share our vision for the future of social care in Scotland. This was included as part of our ‘What If & Why Not’ submission to the Independent Review of Adult Social Care. We are now taking this a step further by inviting people to be part of this collaborative vision for the future to capture our collective aspirations. To do this we are curating a ‘Social Care Mosaic’ for our Care Futures Garden.
Through the ‘Social Care Mosaic’ we aim to capture the imaginations of the people of Scotland to better understand the values of social care and generate collective action to support the wishes and dreams people have for this context for the future. We intend to create a dedicated online space on the Scottish Care website to share these anonymously. We would appreciate your support in getting our mosaic started.
We invite you to share your ‘tile’ for our mosaic by sending us a virtual postcard: https://scottishcare.org/social-care-mosaic/
You can also take part in Phase 2 of our programme where we are continuing to collectively build a vision for the future that enables wider dialogue around key actions, people and infrastructure required to enable change.
Help us build an aspirational vision, by taking a couple of minutes to share your ambitions for the future of social care: https://studioandthen.typeform.com/to/oHbVvDUN
And/or take part in a 2-part futures workshop which will take place in January 2021. Spaces are limited so please sign up to the workshops here: Care Futures Phase 2 Engagement Sessions – Scottish Care
Care Home Gathering: 19-21 January 2021
We are just over a week till the Scottish Care Home Gathering. I know that the Gathering is probably the last thing that people have on their minds at the moment but I hope you can find time to support it not only by buying tickets but by attending part of it.
It has been a traumatic and hard year for everyone but these three days – and you do not need to come to all the sessions! – will be an opportunity for us to share, explore and reflect. Please support it as it is a critical contributor to the sustainability of Scottish Care as an organisation.
Tickets are priced at £45 + VAT and gives you access to all three days; attendance is flexible, and delegates can join whichever sessions they find interesting. Please see the programme and details at:
https://scottishcare.org/tickets-now-available-for-care-home-gathering-19-21-jan/
And finally,…
Over the festive period I continued to light a #candleforcare to think of all who are working in care at these times and those we have lost, both on Christmas Day and on New Year’s Day. This coming Tuesday at 7pm please join me.
Many thanks
Donald
9th January 2021
