Review of the week 9th to 16th May
This is the fifth in a series of weekly updates and it isn intended for Scottish Care members.
This has been another difficult and hard week for those delivering care to some of our most vulnerable citizens. As the rest of society seems to be trying to grab normality we know the truth of the pain still being felt.
It has also been an unfortunate week in which the politicisation of social care and the move towards a medicalisation approach with more direct oversight from the NHS has been playing itself out. I hardly need to say that the timing of some interventions has been hugely inappropriate and unhelpful. I also probably do not need to say that this is massively destabilising for both care homes and the homecare sector in Scotland. Political point scoring need to be overtaking sense and reason.
The following is a summary of some of the main issues in the week that has passed.
Finance and sustainability
At long last Karen and I have a meeting with COSLA on Tuesday. We are aware that the Chief Finance Officers of the HSCPs and LAs have started to send out pro formas in different parts of the country but not in all and we hope that this is a positive indication of intent. Members will have noted the extra financial commitment made by the Cabinet Secretary to allocate £50 million to the care sector through HSCPs. We want to make sure that this gets to the frontline in its entirety. However, it is clear from reports from COSLA that they believe they are facing a £100 million shortfall in what they have been allocated by Scottish Government to meet the pandemic costs.
We are also still hearing that several week son that there are some HSCPs who have still not allocated the Scottish living Wage uplifts and may take several weeks so to do. We will be raising this issue with COSLA on Tuesday .
We are continuing to push for equity in terms of death in Service. There initially seemed to be an indication and political statement made by the First Minister that those who died in social care would receive the same amount as those in the NHS. However, the Cabinet Secretary has written to both us and COSLA asking for a meeting – which we will hold after we have discussed the financial settlements with COSLA – and has made public statements that as ‘employers’ Scottish Care and our members will need to contribute. We will robustly indicate the costs of the pandemic on the sector and the extent to which there is fiscal fragility. We will also point out that in England there has been an immediate commitment and in Wales a willingness to ay every worker an extra £500.
There has also been an unhelpful developing narrative played out by the Cabinet Secretary in the media on Friday night that it is the responsibility of care home providers to give fair terms and conditions to workers fearing loss of earnings if they go off having been tested positive. This has been stirred by Unison and others and does present a challenge re testing. We will be arguing that the Cost of Care Model is not predicated on a pandemic and that we need to work with local and national Government to ensure that staff are paid, and organisations survive. I will be reminding the Cabinet Secretary – through the media – that she and I met at the start of the pandemic and I noted how fragile the care home and homecare sectors were to the immense financial pressures they are under. I will also note for her the reality that she cannot on the one hand recognise financial distress which may lead to a provider having to close and on the other say the sector is being paid enough by Government and self-funders to pay up.
Care Home Strategy, CI and Public Health Scotland
The developing political narrative has been aggressively played out this week. This has resulted in two amendments being tabled for inclusion in the Coronavirus Emergency Powers Act – these will be debated Tuesday and Wednesday of the coming week. One embeds in law the right of the State through the NHS and Local authorities to buy any financially distressed service with agreement. The other allows the Cabinet Secretary to make an emergency application to the Sherriff’s Court to take over the running of any care service where there are real and active risks to life and wellbeing. In principle we are not contesting these amendments as they merely consolidate existing powers. However, we are asking for more detail and have sent a letter to the Cabinet Secretary yesterday (Friday) which details our concerns. This is attached to the end of this report. We are very concerned that these vey public actions far from bringing assurance will cause anxiety and instability not least in that as we know many of our care services are heavily indebted to the banks and other financial bodies. Reducing the likelihood of investment in our care sector is not something which is to the benefit of anyone.
The Scottish Care Executive met on Wednesday and amongst other business discussed our responses to both the Lord Advocates Letter and the proposed amendment (only one at that stage) from the Cabinet Secretary.
Both the Rapid Intelligence Group and the Clinical and Professional Advisory Group met last week, the latter twice. Despite the evidence that only 3% of care homes are in the Red category in the RAG score from Public Health Scotland there is an ongoing narrative around the medicalisation of services, failures around infection control. It is almost as if there is a need to blame the social care sector and that is becoming a sharper narrative even in the absence of evidence to justify it.
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. You will remember last week in this update I had a link to the new Guidance. Then on Sunday on the behest of the Cabinet Secretary it was withdrawn only to be re-published yesterday with very few changes. The link https://scottishcare.org/updated-clinical-and-practice-guidance-for-care-homes-15-may/.
We held another meeting of the Scottish Care Clinical and Dementia group yesterday and heard about different approaches providers were using to try to restore visiting and normality. Dr Jenni Burton and I are going to write up a short paper on these issues for the Clinical Group when it meets on Thursday. It would be of immense help if folks have any approaches or models they are using or thinking about if these can be shared with me as soon as possible.
A further intervention was made by the decision to investigate all Coronavirus related workplace deaths and all deaths in care homes. Given that this is the restoration of the virus as a notifiable disease this is a return to normative approaches but yet again the tenor of the response has been politicised. We have called for a Public Inquiry and also for such approaches to be extended to include all deaths regardless of where they occur. `our media statement at https://scottishcare.org/reporting-of-covid-19-deaths-to-procurator-fiscal/
It should also be noted that the Care Inspectorate is restoring inspection visits as from the 16th May.
PPE
Positively there is a continued stability in terms of the hubs and Triage. Again, if you have any issues please either tell your Local Independent Sector Lead or Swaran.
A Memorandum of understanding was signed which should secure the role of the triage. At some stage there will need to be negotiations as time passes on any costs to providers. It is likely that given the purchasing power of the NHS that any supplies will be cheaper from this source than those that can be sourced through BAU routes. We will absolutely be naming clear that this will be from a negotiated position and not retrospective.
We continue to monitor the availability of PPE and from Monday our website will act as a signposted and comparator to the costs we have been offered. Stefanie has done a great deal of work to try to sort the wheat from the chaff in some of these offers.
We are also acutely aware of profiteering and are working to address and challenge this through the media.
Testing
Testing continues to be the major challenge at local level. Early evidence is that whilst there are some homes which have a high level of pre-symptomatic and asymptomatic presentations in resident and staff there are some where the results are very low. Once more there is a political and in this case union narrative to suggest the sector is on point of collapse. We continue to argue for the extension of such testing to all care homes and have started to argue for prioritisation of those who are relatives of individuals in care homes and in the community.
We have also seen – finally – the publication of Guidance for Testing. There are elements especially on page 13 which are causing real concern. Yet again this was Guidance which was published 13 days after the political announcements and in an environment where there is a haphazard approach to testing. It is clearly happening well in some areas with collaboration and mutual joint working – but it is not in other areas. See https://www.hps.scot.nhs.uk/web-resources-container/interim-guidance-on-covid-19-pcr-testing-in-care-homes-and-the-management-of-covid-19-pcr-test-positive-residents-and-staff/
Care at Home
We are determined to try and keep the real pressures of the care at home sector to the forefront. Our growing concern alongside financial instability is the early evidence that some councils are reviewing packages where there has been a cancelle3d support and now considering that it is unnecessary to continue. This has occurred in the Borders to our certain knowledge.
Both Karen and I are joining Swaran in provider meetings around the country and I trust you will join us on these platforms.
I continue to be very concerned as recent BMJ articles suggest 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.
Workforce
The SSSC portal has the numbers but is not working for our sector. The individuals on it who are available are either not suited or withdraw when faced with the prospect of working in care. Caroline is working hard to tr to get our fellow stakeholders to realise that the portal is in its current form not fit for purpose.
Jacqui is also working hard in terms of nursing provision but if any provider is at a critical stage or anticipates being so in relation to nursing please contact Jacqui and she will work with colleagues to try to identify resource.
The National Wellbeing Hub has been launched and early indicators are that this has been well received by staff and providers. Thanks to those who contributed and to Caroline for co-ordinating our work in this area. It can be accessed at https://www.promis.scot
We are very aware that issues of grief and bereavement are impacting on staff. I am therefore pleased to be joined by two of the National NHS Bereavement Leads, Sandra Campbell and Andrew Gillies, on the webinar on Thursday. Sandra has been working supporting care homes during the pandemic and has many years’ experience in Palliative care in the care sector.
The Cabinet Secretary has also written a joint letter with I to thank staff and detail support. This was framed a couple of weeks ago but at least it is now public. It can be accessed at https://scottishcare.org/letter-to-all-care-home-staff-in-scotland-from-the-cabinet-secretary-and-the-ceo-of-scottish-care/
Nursing.
We have had a hugely successful ‘International Nurses Day’ on Tuesday 12th May. There was real engagement from folks across the country and despite the challenges people I hope did manage to stop to say a thank you to our nurses. Please look at some of the great videos which are up online. There is a real positivity in them from many who are new to the sector and it is a point of optimism at these times to hope that their commitment will continue to grow. I want to thank Jacqui for all her work in collating and in gathering these stories, and to Shanice for putting all these materials online in an already very stretched work schedule.
Palliative Care
Colleagues may find it useful to access a Webinar on PEOLC issues being held on the 21st.
See https://scottishcare.org/peolc-thinking-ahead-using-a-person-centred-approach-to-acp-webinar-21-may/
The Care Inspectorate and SSSC have developed Guidance and a Decision Making Protocol and principles for the Reuse of Medicines. These can be accessed at https://www.careinspectorate.com/images/documents/coronavirus/Guidance_for_repurposing_medicines_May_2020.pdf
Communication
We held another two webinars this week and these were facilitated by Karen Hedge, prof Graham Ellis and Myself. The number of participants remains high and I hope providers continue to find them beneficial. Next week we will hold the Tuesday webinar with Karen and myself, and on Thursday will be joined by bereavement colleagues.
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.
Please continue to use the members Discussion Boards not least to share thoughts and ideas.
Consultations
There are a growing number of consultations now being held, including the Health and Sport Inquiry into Care Homes and Covid which they are very much directing; an inquiry into measures as we exit Lockdown; one on Visa restrictions and social care and several others.
I am grateful to Becca for keeping on top of these and for writing and compiling our responses. We will publish these when developed before each Committee.
And finally,…
This week I have veered from frustration to anger to disappointment to disbelief. I am determined to make sure that the care sector in Scotland does not become the scapegoat for the failings of national policy. The almost febrile atmosphere at Government level and in some parts of the media urgently needs to be calmed but it is increasingly becoming difficult not to address the falsehoods and inaccuracies which point fingers. The good news of a reduction in deaths and a sense of turning a corner in some parts of the country seem to have been lost in the noise.
I know that you and your workforce are doing everything you can to maintain life and preserve the sector, I can assure you that all of your colleagues at Scottish Care will continue to do our utmost to contribute to your work.
And to those colleagues I want to extend a huge thanks for working beyond hours and energy to continue the work of Scottish Care.
Thank you
Donald
16th May 2020
15 May 2020
Jeane Freeman MSP
Cabinet Secretary for Health & Sport, Scottish Government
Via email
Dear Cabinet Secretary,
Thank you for your letter received on 11 May. I am writing to seek clarification on the Government amendments that have been introduced at Stage 2 of the Coronavirus (Scotland) (No.2) Bill.
Scottish Care and our members wish to highlight our continued commitment to the health and wellbeing of individuals supported by social care services and the workforce who provides this care. Never has it been more important than in a pandemic to ensure that services are safe, sustainable and responsive to the changes required through emerging understanding of the impact of COVID-19.
We welcome the measures introduced by Scottish Government to provide the recognition and support these services need to tackle the virus effectively and to help the individuals and organisations who are doing their utmost to provide high quality, personalised care in unprecedented times. We share your concerns around the distressing ways in which COVID-19 has impacted care homes and remain committed to working with the Scottish Government and other key partners on any measures which can prevent, reduce and minimise these impacts.
The points of clarification we wish to request relate to the following proposed amendments:
- Powers of local authorities and health bodies in relation to certain care services
- Care homes: emergency intervention orders
These points are as follows:
- What is the rationale for the decision to introduce these particular amendments to this legislation? As you outline in your letter, Scottish Ministers already hold common law powers to enter into acquisition agreements for services where this is required to maintain provision. Measures also exist for additional COVID-19 support to be given to care home services by Public Health, health boards and local authorities, including in relation to leadership, management and care provision. You highlight the important need for those requiring care to have security of continuity and quality of care, which we share your desire for. However we do not believe these particular measures achieve this aim and instead risk the opposite effect of creating alarm and distress for individuals and families in relation to the provision of their care, at a time of already significant challenge.
- What would be the criteria for who determines ‘threat to the life, health and wellbeing of a person’ and what are the thresholds by which this would be determined? These are very subjective criteria, especially wellbeing. Arguably, the measures outwith the control of a service imposed through the pandemic response could contribute to serious financial difficulty or threat to the life, health and wellbeing of a person.
- What is the rationale for not including failures of the above nature and proposed powers in care homes or care at home services currently run by a local authority or health body? To our knowledge, there is no evidence at this stage of the pandemic that such failures of service are more likely or only possible within services operated by non-statutory providers, as a result of the ownership model.
- What evidence exists to provide assurance that local authority, health bodies or Healthcare Improvement Scotland would remove financial distress or threat to life, health and wellbeing of individuals by virtue of their purchase of a service or through an emergency intervention order as set out in the amendment?
- Has consideration been given to the role of external funders’ obligations and likely secured asset positions in any case of distress or acquisition of a service? Institutions such as banks play a critical role in services where lending is involved and may have equal powers in terms of assuming ownership through administration, repossession or other processes in instances of serious financial difficulty.
- What alternative measures have been explored which can offer responsive resolutions in cases of concern or financial difficulty, with the aim of securing and sustaining safe, quality care through a partnership approach?
- Are you confident that enough focus has been given to preventing against the instances described, which represent complete and catastrophic failure and potentially place lives at risk, as opposed to last resort acquisition or emergency intervention order? It is our strong contention that the social care sector and especially the people accessing care require sufficient national and local commitment to the quality and sustainability of their care, through appropriate funding, partnership, recognition and support. Where public sector commissioning, contracting and oversight is in place, there is a shared responsibility between providers, local partnerships and national Government to protect against and address such risks proactively rather than retroactively.
- How would the amendments partner and integrate with the intervention powers and support of the Care Inspectorate, an organisation with specialist skills in care regulation and improvement?
We would additionally contend that the effective implementation of the integration of health and social care, and the oversight of Health and Social Care Partnerships ensures the necessary level of fiscal and clinical oversight by means of existing legislation.
We look forward to hearing from you and to continued collaborative working to support the social care sector throughout and beyond the COVID-19 pandemic.
Yours sincerely
Dr Donald Macaskill
CEO, Scottish Care
