Thursday saw the announcement of Scotland moving to the next stage of our exit from lockdown and dealing with the suppression of the Covid19 virus. This has been a hard bit of news for many in the care sector to hear – not because we do not welcome the news but because the reality is that the care sector is still in lockdown, whether that be for care homes still dealing with a level of deaths and infections as a result of the virus or homecare services still slowly getting back to something close to what ‘normal’ might have been. It is hard when the world re-orientates itself to feel that we are still upside down.
I had a meeting with the Cabinet Secretary yesterday where we discussed a number of the issues of concern to the sector and I will reflect these in what follows.
The following is a summary of some of the main issues in the week that has passed.
Finance and sustainability
It has become clear that payments are slowly beginning to get out t providers but that we have now a situation of real geographical diversity across the country with poor performance in places like Highland and Lothian. I have seen the terms in the NHS Highland document which seem totally at odds with what is being said and declared by political leaders nationally. It is also clear to me that Borders is failing wholeheartedly to pass on payments using a pathetic excuse that ‘we have spent the money.’ Karen and I are gathering this intelligence for a meeting with COSLA and partners on Monday afternoon and please know we will be robust in pursuing this.
We are very aware that the 23rd June deadline is almost upon us. COSLA Leaders have voted to extend the current Principles and agreements to the end of July but we have not had clarification from the Scottish Government upon this. Cabinet Secretary indicated that this was in ‘train.’ We have also highlighted to COSLA that we urgently need to start planning for what is going to be necessary after the 31st July because the social care sector will not be in ‘recovery mode’ as so many others are and that we have been profoundly impacted by Covid and remain so, whether that is as a result of ongoing voids or people not taking up packages of support in the community or Councils refusing to re-introduce or pay for former packages. The Cabinet Secretary still seems to be fixated in spending money on the profitable ‘offshore’ private care sector. I have assured her of the falsity of this narrative, and we will provide evidence of things as they are. It is nevertheless clear that we will have to present in a robust manner the reality of costs as they are now and as they have been. I also appeared on STV News this week to try to underline that every provider in Scotland is struggling and that there are too many myths of the money creaming private sector. You may have noted the BBC pieces last weekend by Douglas Fraser which, following conversations with us, were much more nuanced and reasonable – to a degree!
In relation to the payment of SSP and Death in Service the technical sage of both of these continues. For the former the issue has been that there needed to be parliamentary technical permission to adjust the terms of the special fund that has been created. I was informed yesterday in my call with Cab Sec that this is now done, and that Comms and release of funds will be from Tuesday next week. I hope so.
In terms of Death in Service again there was a hold up as a result of needing to be reassured that these payments would not impact on anyone in terms of any pension liabilities and assurance re liability in general. This has now been achieved and again am informed that this should be sorted with appropriate Comms by the end of the coming week. I will make sure that we get information on both out to members as quickly as possible.
There are still wholly unacceptable instances where Councils are not following through on the commitments in relation to the Scottish Living Wage despite a robust letter from the Cabinet Secretary. We will be meeting with COSA as stated on Monday and Karen is collating evidence of Council areas such as North Lanarkshire where this is not being followed through for care at home and housing support providers. Again, if your area is affected please let us know quickly so that we can work with COSA and the HSCPs to address this issue.
Care Home issues
There is a continued improvement though perhaps not as dramatic a decline as one might have hoped both in terms of the number of infections and also in terms of mortality. Once again evidence published by Government and the CI on Wednesday seems to show that no sector has been immune to the impacts of Covid19. There is growing robustness in evidence that larger care homes have been disproportionately affected – I suspect an issue to do with increased footfall from the community and higher likelihood of use of agency staff rather than a simple issue of design and IPC. There is also clear evidence of rural and urban splits but again these would seem to mirror the virus impact in the wider community. What we continue to press for is a disaggregation of data to show which homes had higher levels of acuity and need (nursing and residential) rather than the business model being utilised.
Perhaps the dominant issue of the week and one which after the announcements of Thursday is becoming really urgent has been the need to get information on visiting and the desire of families to re-connect. Last week I had hoped there would have been an announcement before the general announcement – there was not. I write to clinical and other stakeholders before meetings on Thursday to indicate our own concerns on this issue in light of what I have been hearing – that letter is at the end of this document.
Yesterday when I met the Cabinet Secretary she indicated that she was aware and sensitive to the issues, but that scientific advice had urge real caution on these issues. She has indicated that either she or the FM will make an announcement early next week to remind people they have not been forgotten, to publish the Guidance and emphasise that this is a Get Ready process for something that will happen soon. Outdoor visiting then a slow iteration will be required. My own estimation is that this will be at the end of the month.
I am very aware that some homes have started to open up outdoor visiting. I have been asked for comment about the legality of such moves. What I would say is that the Guidance is to have no visits – and I am asking folks not to do so. Is it legal? I think that that is a moot point – if someone went ahead and did it would they be prosecuted? – I suspect not but there would be an inevitable focus from CI, PHS, DoN and others which might be unhelpful. Equally if something did happen there could be a contested legal situation re indemnity in that an organisation did not follow Govt Guidance. The best thing I am advising is that homes can make a case under the existing Guidance for situations where there is distress to a resident in order to allow a visit and use that justification as the basis of following the Guidance but that they should take appropriate precautions re PPE, physical distancing, no contact etc and should not seek to make such visits routine but ‘exceptional essential’ in nature.
I remain particularly concerned that the continued isolation and lockdown of individuals in their own rooms with little social intercourse or engagement is having a profound impact on the health and wellbeing of residents. I know that these thoughts are shared by many GPs and others who have written to me this week. I highlighted the importance of developing a clear rehabilitation strategy to the Cabinet Secretary and the how we need to prioritise de-conditioning which may include additional staff resource to enable this to happen.
More and more of the enhanced visits are taking place and there remains disquiet about role and the status of those entering the care home. The robust stance of HPS is that staff do not need to be tested as ‘inspectors’ and ‘visitors’ as long as they wear appropriate PPE. I have argued back against this and the general consensus us that our managers and staff need reassurance rather than just to be told what best IPC policy states! The Care Inspectorate have very helpfully written a Guide for External Professional Visitors – this is being finalised and commented on – I think it is absolutely fair and addresses our issues – and will go to the Care home rapid Action group on Thursday for what I hope will be sign off.
The confusion over what should be in or out and whether it is required or not still circulates around the Safety Huddle tools and associated materials. As stated before the application of this Tool is meant to reduce reporting, but we are still hearing of some HSCPs demanding providers fill out additional data. I live in hope but there are key meetings on this in the coming week where it should be made clear that this is required and to streamline the amount of reporting which is becoming an overwhelming burden on parts of the system in some parts of the country.
PPE
Another week and another degree on stability with the hubs and Triage. Again, if you have any issues please either tell your Local Independent Sector Lead or Swaran.
The latest clarification on ‘glove-gate’ is that the CEO NHS Forth Valley has had discussion with directors of Nursing in the Boards and the NSS Guidance re use of nitrile only in specific situations stands. We have been asked to communicate directly with her – through us- if there is any Health Board mandating that nitrile must be used in all instances. Please advise if this is the case. They have assured us they will address this issue directly.
Following my statement last week that I thought there would be an announcement re universal mask wearing this was delayed until there was sufficient and robust data to indicate this. I believe this will be announced early next week. We have been assured that there is sufficiency of supply and that NSS and the Hubs are aware of this. Can I stress that especially as there is likely to be considerable demand for gloves that you try to ensure that you have sufficiency of stock for the medium term. You will be aware of the mandatory use of face coverings in public transport from Monday 22nd – this will act as some assurance to care staff who use public transport to travel to work.
Every Monday the members’ section of the website contains the top three suppliers from a list of 37 who feed in their data on key PPE lines. Please use this as a source which is up to date.
Testing
Testing continues to be a challenge with diverse approaches and systems. I am very aware that with more and more Health Boards expecting in-house testing that this places a not inconsiderable degree of pressure upon providers in an already stressed and exhausted situation. We are undertaking some work to map and gauge the amount of time and resource (including PPE ) that is required in these circumstances. We will feed this into Scottish Government and COSLA and have already fed in information to NSS around PPE demand. Related to this I am very aware of the stress that is being placed on individual staff through the expectation of weekly testing and the upset that this and waiting for test results is causing. I have raised this with Scottish Government and the Cabinet Secretary.
The loss of a significant batch due to faultiness last week did not help the range of coverage. We have finally managed to hold a roundtable Q and A with the Testing Directorate, and they are preparing responses which we will make available to key questions which we and others have raised. It is hoped this will become a regular feature not least as we see the roll out of Test and Protect and the interaction of the two systems.
Workforce
You will be aware that the Care Inspectorate have stepped down their RAG system. This was because no care home had indicated their status as red for over two weeks. We highlighted that this may change and have been assured that if local resilience planning indicated an issue re staffing that they would start up the system with immediate effect.
One of the issues which has been raised with me a number of times is the sheer level of exhaustion being faced by our managers and senior managers as a result of their sacrificial professional efforts and energy in response to the pandemic. Caroline, myself and the Chair of the HSCPs together with a senior SSSC colleague are hoping to meet to discuss what we can collectively do to support our senior staff who are being pressured from all sides.
Care at Home
The Care at Home and Housing Support National Committee met yesterday (Friday afternoon) and shared a range of issues of concern to the sector. One of the major issues is that of sustainability and the extent to which it is becoming clear that a number of authorities are not returning to business as usual in terms of taking up packages of support. It is also clear that a number of authorities North and South Ayrshire, North and South Lanarkshire, Moray and Highland and others are way behind where they need to be in terms of passing on payments to the sector. It is pleasing that the majority are paying for work on planned but we have some way to go. We will continue to work with COSLA on this issue as it is clear that there are significant fiscal pressures as well as pressures in terms of workforce across the system.
Communication
Karen and I held a Surgery on Tuesday at 12 and this lasted an hour and was well attended. Next week we will do the same but will reduce the surgery to 45 minutes which seems to be more manageable for folks. We are planning a future finance Webinar and will get the details of this fixed as soon as practicable.
We continue to use the Discussion Boards so please refer to them when you can.
And finally,…
May I draw your attention to a partnership which we have develop0ed with Ability Net which is offering free tech support to our members. Thank you to Jim Carle for arranging this. Please see https://scottishcare.org/tech-support-from-abilitynet/
Tara French is still looking for folks willing to join a Technology Advisory group. This is a critical area of work for Scottish Care now and into the future so please consider coming on board and sharing your experience. Technology has never been more important for the sector so please considering offering your involvement. See https://scottishcare.org/technology-advisory-group/
We continue to hold our #candleforcare at 7pm on a Tuesday – and are pleased that it is starting to gain wider take – up – as the weeks go by we need to continue to be the presence and voice of those who have died, those who are struggling and those who are caring.
Thank you as always.
Donald
20th June 2020
Dear colleagues
I am writing directly to you before our meeting(s) today to put on record my growing concern about the lack of any communication to the care sector, families and the wider public about the restoration of visiting into care homes. I know a great deal of work has been going on behind the scenes to prepare Guidance for commencement of visiting and that this is nearly complete. What I am concerned about is the lack of any public messaging and indication of movement on this critical issue.
Today marks the start of the 15th week of lockdown for most of our care homes during which time there has been minimal visiting other than for essential purposes and end of life. Today is also the day when it looks as if the First Minister will move the rest of the community to the next stage of leaving lockdown. The complete lack of any public messaging on care homes is causing a real loss of confidence and distress in the sector.
Over the last week both I and colleagues have been deluged with a growing volume of emails, telephone calls and letters from family members, frontline staff and others asking for information on when visiting can start. As an organisation Scottish Care has held to the Government line that visiting will commence when it is safe to do so and that the perceived risk is so great that when visiting does commence that it will first of all be outdoors and then be a slow iterative process to fuller restoration. We have discouraged those organisations who have tried to start their own processes under immense pressure from families and residents in real distress.
I am writing to indicate that we have very real concerns about our ability to hold back the not unreasonable demands of our members, staff and families. They have been stating the following:
- Is it right to treat all people in all care homes as one homogeneous group? There are many care homes where there has been no outbreak, many others where residents are not receiving any nursing care or support but are purely residential. Yet we continue to consider all homes as a single entity.
- Is it not discriminatory to treat people who reside in a care home and who are shielding in a manner which is less favourable than those who are shielding in the community?
- The Scottish Government response to the SHRC yesterday speaks about it being the responsibility of care services to uphold the human rights of individual residents and to not treat everyone the same but according to their personal needs and wishes – since that statement our members have been asking how is this achievable when they have clearly little flexibility in the exercising of this care given the current Guidance? We are very concerned that we are at risk of compliance with behaviours which would be deemed to be in contravention of EHRC Articles 2,3 and 8.
- Some staff report that families are threatening to take measures into their own hands and to come into the care home regardless of attempts to stop them – clearly care homes do not want to engage the police, but families are using emotive language like their relatives are ‘being held hostage.’
- Some staff are also reporting that the lockdown measures, especially lack of communal engagement, social isolation etc are having a profound and ‘abusive’ impact on the physical and emotional health of residents and are leaving them more vulnerable as a result. There is growing anecdotal evidence on the frontline that the current measures and restrictions are having a hugely negative impact resulting in early death.
- We are receiving many more reports of families actively beginning to take steps to remove residents from their care home.
All in all, we are in an extremely challenging position. There is a real danger that the trust and confidence families have had in care services over the last 14 weeks (and broadly in the political response) will be lost unless we do not take action to at least give an indication of when things might change. We urgently need the Cabinet Secretary and First Minister to give such an indication of hope.
Personally, I am increasingly of the view that the current restrictions are no longer proportionate and reasonable, and that they are at risk of failing to achieve their intended legitimate aim which is the preservation of life.
I would value consideration of these issues at our meetings.
Kind regards
Donald
