The world has started to re-orientate itself to a new reality of meeting and household contact. Clearly this is not the experience of those of us working in social care. Nevertheless, there is still a slow improvement in the impact of the virus upon the care home and homecare sectors. The concern is that with new measures and approaches that there is a risk that there may be a second viral outbreak. Without being unduly pessimistic I am convinced that this is not a matter of if but when. The next few weeks and months should afford us with some opportunity to be better prepared. But for the moment the sad reality is that we are still seeing too many die in our care homes and too much finger-pointing and blame shifting. It may be the case that the virus has left some with a visual impairment, but it is also leaving some of our politicians with amnesia.
The following is a summary of some of the main issues in the week that has passed.
Finance and sustainability
The Principles are now published and what we have seen in the previous week is an increasing number of local authorities sending out the templates to start getting payments to providers. We have even had an instance of some going beyond the principles with Edinburgh for instance agreeing to pay all voids at the NCHC nursing 80% rate rather than the residential. Again, as we have often said the proof of the pudding in all this is when providers actually start to see the money. Costs are increasing and PPE in particular is becoming prohibitive. Please keep us up to date about when you are starting to see payments come through. https://www.cosla.gov.uk/__data/assets/pdf_file/0025/17917/Principles-for-Social-Care-Sustainability-Payments.pdf
What we have seen is a growing set of issues around the announcement last Saturday from the Cabinet Secretary re SSP and also Death in Service. This announcement follows discussions with Scottish Care and COSA. See https://scottishcare.org/statement-on-testing-and-death-in-service-benefit/ There has bene one meeting to explore the practical outworking of these statements and Karen will be sending out a survey to ascertain what is happening in relation to Death in Service benefits and any enhanced sickness terms and conditions. We argued strongly that the analysis of what was happening needed to follow the immediate response to the current situation. However, our colleagues in Government and other provider bodies wanted to pursue this route. We will be working over the next week to tie folks down to the practicalities of both the DiS payments and the SSP post testing additionalities.
There are still concerns around the Scottish Living Wage especially for care at home and housing support. Once again we are getting weeks into a political announcement and pressure is being put on our member. Cosla hope to have political sign off by Thursday. We will keep you updated. They are fully aware of the extent of our frustrations.
Care Home Strategy, CI and Public Health Scotland
Over the week there has been a general improvement in the tone and narrative around care homes with less focus on the issues both from the media and politicians. The political focus seems both to be on the issue of a Review/Inquiry and the failures around testing and early hospital admissions.
Reduced media interest is also undoubtedly likely to because of the moves on Thursday to start Phase One of the exit to lockdown. We have added a draft statement for homes or organisations where they have had media enquiries. https://scottishcare.org/guidance-on-drafting-a-media-statement-for-covid-19-confirmed-cases-deaths/
There has been growing anxiety of the issues relating to opening up visitors and I have led a small group working on Guidance. I very much hope this will have sign off in the next week so that at the very least we can give people a date when some routine visiting can be restored. I have to re-iterate that anyone engaging in visiting which is not as described in the current guidance is taking a considerable risk both reputationally and in oopearti9nal sense should there be an outbreak.
Can I again underline that the media is searching around for any story which suggests that care homes have not been abiding by Guidance including use of PPE as appropriate and the keeping of social distance. We have to be whiter than white at the current times not least as the eyes of media and others – for their own ends – are very much on the social care sector as a whole and care homes in particular.
The new enhanced support from the roles of the Directors of Public Health, Nursing and Chief Social Work Officers have now been started. In some areas of the country it is clear that these visits, both real and virtual, have been supportive and enabling. In other parts – and Midlothian stands out – it is quite clear that these visits have been damaging, intrusive and disrespectful of professional and clinical colleagues in the care home sector. Most of the local Oversight groups have a representative of Scottish Care in the form of one of the ISLs – there is a conflict of interest issue for it to be a provider and this has been resisted by others. Significant work has been undertaken through the Deputy Chief Nursing Officer with a number of our care home provider to develop a clinical tool which can be used – this is due to be rolled out in the next week and a surgery focussed on this will be held on the coming Tuesdays. This is something created with the sector and which should hopefully address some of the issues and concerns being raised by others.
It is clear from the analysis of the Directors of Public Health that we are slowly but surely getting on top of the pandemic and that practice overall is of a high quality. Nevertheless, it is also clear that some homes have a distance to go and our hope is they will be supported and assisted in this journey.
Overall I am increasingly concerned as we enter the 11th week of lockdown that we need urgently to address the issues of continued lockdown and isolation of residents in their own rooms in care homes. This cannot be allowed to continue for too much,. It was proportionate and reasonable at the start – I no longer think it is.
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.
The infamous ‘glove gate’ seems to have been settled and the statement confirming this is on the website. https://scottishcare.org/updated-statement-on-the-use-of-gloves/
We continue to monitor the availability of PPE and from Monday next 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.
As the rest of the population (including schools and construction) begins to use and seek to access masks and gloves we will keep a watchful eye on the impact of this upon supplies.
Please also note the information on protecting your voice whilst wearing masks. https://scottishcare.org/how-to-take-care-of-your-voice-when-wearing-ppe/
Testing
Testing remains an area of real uncertainty. There is still considerable divergence on practice and there is absolutely no consistency of the approach to Whole Home testing for staff. We are continuing to try to escalate concerns in relation to this.
We have also raised practical issues around the way in which test and P[protect will impact upon the social care workforce including instances where a worker may be told to isolate or may themselves be tested positive through a non-work route.
Again, it remains really challenging to get information from the testing Directorate and yet again we cannot seem to get into their inner sanctum – as a sector!
Please note the testing training videos on the website. https://scottishcare.org/non-face-to-face-covid-19-testing-training-videos/
Care at Home
There will be a meeting of the Care at Home and Housing Support National Committee on the 11th June.
We continue to have very real concern that the eye has been taken off the ball within the homecare sector. There is now signs of increased demand upon the e sector as people start to end lockdown and think about return to work. Our concern is because of significant delays in payments not least around the ASLW that we may not be in a position to respond.
Karen is working with the group which is drawing up new Clinical Guidance for care at home and also for day services.
Workforce
There have been real improvements to the portal, and this is beginning to show positive outcomes. Caroline is working with SSSC and BNES colleagues on a range of packages of support and will shortly be turning her focus to the re-establishment of the Workforce groups.
Over the next few weeks and months we will need tom undertake a great deal of work to ensure that when the inevitable second wave of the pandemic comes around that we are in a batter resilience position in terms of workforce than where we have been in the last few weeks. Lots of lessons to learn and share with our colleagues. Caroline will be in touch with providers in the weeks to come.
Jacqui Neil our Nursing Lead has written a moving and very personal blog on some of the grief and bereavement impacts of Copvid19. Please read it at https://scottishcare.org/a-new-taboo-latest-nursing-blog/
Communication
We are now going to be holding one Surgery a week which will be on a Tuesday at 12 and will last an hour. The coming one will focus on the clinical assessment tool. There will also be an opportunity to raise the usual questions with Karen and myself.
Please continue to 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/
Please continue to use the members Discussion Boards not least to share thoughts and ideas.
We have also been running a lot of local Teams Member sessions – please get in touch with Swaran to find out where and when your nearest Members session is. National staff try to join these as do the local Independent Sector Leads.
Consultations.
We are beginning to get a lot of demands for consultation responses. Becca has developed these and we have responded to the Testing Inquiry and most recently the Lockdown Inquiry. We will put these up shortly onto the website.
And finally,…
Many of you will know Verity Monaghan our Human rights Worker went off on maternity leave a few weeks ago. We are delighted to say she has given birth to a baby girl Eden and we wish her well.
In the rhythms of time we are now also advertising a 9 month post as maternity cover. This is fully funded by life Changes trust and is a really good opportunity for someone to come and work with us in embedding a human rights-based approach to care at these challenging times. Please pass the advert to those you think might be interested. See https://scottishcare.org/job-opportunity-human-rights-project-worker-maternity-cover/
I have been touched by the response to my last blog on the wellbeing of our exhausted staff. I think it fair to say that for every negative comment in media and on political lips there are a hundred voices saying thank you, recognising the energy, efforts and work of frontline carers and also of managers, supervisors and owners.
For that reason, as we end ClapforCarers we have started #candleforcare at 7pm on a Tuesday – a small start to say thank you, to remember and to reflect.
Thank you for all your continued work and engagement.
Donald
30th May 2020
