In the first full week out of Lockdown it is clear from busier streets, parks and shops that the rhythm of something closer to normal life is beginning to be felt by many people. We all know that this is certainly not the case in the care sector. Tragically this week we now have data to show that more people have died in our care homes from coronavirus than in our hospitals and it is likely that this figure will widen. There has also been much talk and even an outbreak of cross political party agreement over the idea of what is being called a National Care Service.
I held a meeting with the Cabinet Secretary on Friday and she indicated that she was aware of the concern that talk of a NCS would result within the sector and that she was hoping to continue/hold a Review that was inclusive of all options, aware of the resource implications, but at the same time tried to bridge the priority given to NHS services with what needs to happen in social care. I took away a sense that nothing is decided by any means and that we are in the very early days of a lot of discussion, dialogue and doubtless dispute. It is clear we will have to be robust in our articulation how reform of the present is more realistic than chasing after political dreams and slogans.
The following is a summary of some of the main issues in the week that has passed.
Finance and sustainability
I am aware that there has been ongoing inconsistency across the country around the approaches from local authorities. We are mapping this, and it would be helpful if you could communicate with your Independent Sector Lead if you have not had an approach either on additional funding, occupancy or paying for planned visits from your HSCP or LA. I will be meeting with COSLA and SG on Monday afternoon and this intelligence would be invaluable.
In relation to the payment of SSP and Death in Service at the time of writing I am aware that yesterday (Fri) there was a confirmed agreement between Scottish Government and COSLA over the financial allocations for such payments. The fine detail is being worked on and I initially had hoped this would be sorted soon. I have just been informed, however, this will be sorted by Friday. I have impressed strongly the urgency of this. I have also impressed upon them the need for transparency now that monies are to be routed through local authorities and the need for there to be clear assurance both for providers and frontline staff re payments on both issues. I am very aware of the engagement of the trade unions at local level – though they seem to have missed the reality that their senior national representatives have also been part of the discussions to finally release the monies. A degree of duplicity methinks!
There are still concerns around the Scottish Living Wage. However again yesterday (Fri 5th) I received communication that following a meeting of COSLA Leaders on Thursday evening that this has now been signed off and all authorities should start to commence payments. This is primarily for care at home and housing support contracts. Again, we need you to tell jus if this is not starting to happen. After all it has only taken 2 months from the point of political announcement to get to a practical realisation!
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. However, there has been a growing focus on the National Care Service. We are collating our considered response and I have already addressed this in some of my most recent media comment. We are focussing on the one size fits all reality which limits choice, citizen control, economic benefit etc.
Our statement to the media on this issue was as follows:
There has been much talk about reform in the adult social care sector. Scottish Care has been working with the Scottish Government and other colleagues on the Reform of Adult Social Care for some 18 months. The desire for reform is not new and has included discussions on how we finance the growing costs of care both individually and as a nation.
The debate around a National Care Service should not be a knee-jerk reaction to trauma but should first of all help people understand what such a service might look like. Social care should not be conflated with the NHS. Making it sound similar does great damage to social care. The creation of a National Care Service should not be based on the premise of the NHS model. Doing so fails to recognise the differences between social care and healthcare, which whilst integrated and related, need to be acknowledged as requiring quite distinct forms of support.
Scottish Care believes that the creation of a National Care Service would pose significant challenges, not only in its inception but also what type of care it would deliver. At the heart of social care is the importance of giving people choice and control over the care they want. A one size fits all model or organisation might be suitable for emergency and acute NHS healthcare but has no place in services which are about the whole of life. The danger of a National Care Service is that it could potentially remove options for individuals in relation to their social care, removing citizen choice and control, both of which are central to our human rights. There is also a risk of this ultimately removing positive opportunities for competition and diversity between care providers based on quality and distinctiveness of the care offered.
Sadly, the data on Wednesday showed the reality of care homes being the sector with most deaths. This is compounded when one realises that 9% of all hospital deaths were in care homes. However with unfair comparisons with England it should be noted there that 27% of hospital deaths were care home residents. Yet even if this is taken into account the death rate in Scotland is still as a % less than in for instance Ireland at 62% and Canada at 82%. Such comparisons are risky and dangerous but much beloved of the media. As too are the comparisons with organisation type and impact of Covid19. We have tried to stress that it is still too early to tell, and that simplistic analysis is ill-served. We have described this in a recent media statement. On the latter issue of location and business type, we have communicated the following:
Media Statement:
As we continue to learn about the virus, it is too early to make assumptions or deduce reasons for variations in terms of infection and death rates in different areas and settings. In all likelihood, a range of factors will contribute to these differences and it will be important for us all to fully explore, understand and learn from these in reviews of the pandemic response.
There will be local variation in the pandemic response, including aspects such as support to care homes and testing implementation. This can be both extremely helpful and very damaging, depending on where that variation lies.
The figures published about infection incidents, mortality, size and Health Board location all have to be considered in light of other factors and knowledge. What is clear is that regardless of size, who runs the home, or its location the virus has impacted across the board.
The public sector runs residential and not nursing care homes in Scotland. Most of the nursing care homes are in the Independent sector. What this means in practice is that residents with higher needs and who are more frail, those with multiple health conditions, and who are likely to be in a palliative and end of life stage, are being cared for and supported not in public sector care homes but in the Independent sector. As a result, because of what we know about the virus it is reasonable to expect that unfortunately there will be a higher mortality rate in nursing care homes as opposed to residential care facilities. In light of this the figures are evidencing differences we would broadly expect. But on their own a blanket read across the data without knowing the acuity and level of need of the residents in a care facility makes little sense.
Scottish Care welcomes any debate on the future of care home provision. A key part of this will be consideration of size which an initial review would seem to show that smaller homes are less likely to be affected. However, this also means that these smaller homes are more expensive to run regardless of who runs them. We imagine such a review will include the fact that the public purse funds a care home place in a public care home at nearly twice the fee allocated to an independent sector care home.
Ends./
Since lockdown ended there has been an increased pressure upon care homes to open themselves up to visitors even if only in garden and outdoor areas. We have to advise extreme caution in this regard. The national Guidance preventing visiting is still in operation – it has not changed.
I have chaired a group of colleagues and providers and we submitted a final draft of Guidance last week. The Cabinet secretary is considering it. However, it is fair to say that there is NO intention to relax the restrictions anytime soon as a result of the concerning advice of the scientific officers advising the Government. I have urged the Cabinet Secretary to make a statement on this matter in order to ensure that people are aware that restrictions are in place and that they can only be lifted should there be clear scientific evidence for this, and it is safe to do so.
In order to speed the eventual opening up of visiting can I remind care homes that under HPS current advice that a home has to be 28 days since the last symptom of the last affected person AND have public health sign off that their outbreak is over before visiting would be allowed. This would make it not possible to allow even garden visiting in a home that has a live outbreak. If you are in the category of the former it is important that if you have not closed the loop on your status to do so as it may hold you back when it comes to opening up.
I am personally increasingly concerned about the impact of continued and ;prolonged isolation on residents, their families and indeed frontline staff. The physiological and psychological impacts are now becoming acute and again I have urged colleagues in Government that we need to urgently consider action to ‘release’ people from what increasingly feels like solitary confinement.
Can I again underline that the media is still 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. Pleas ensure that all staff are following stringent practice.
There has been much disquiet this week around the enhanced visits which are taking place and scheduled to take place into care homes. I brought these concerns to the Scottish Government and they have indicated that they will draw up Guidance for health, public health, social work and Care Inspectorate colleagues to reduce the risk of infection spread and to encourage the use of virtual visits most especially in care homes where there has been no infection outbreak and where there are no practice concerns. I will keep pressing for this to be developed with urgency. However, I think it is safe to say that these visits will not stop. For some they have been enabling and encouraging, for others they have been a hugely negative and dispiriting exercise. Nevertheless, the Care Inspectorate under the Emergency Powers Coronavirus 2 legislation have to now report the outcomes of all their inspections to the Scottish Parliament every week. I have been informed that a sizeable number of the initial inspections (albeit of homes considered to be at risk) have identified ‘significant areas of concern’. As long as such evidence is the outcome of inspection then there is an almost inevitability that the multiple ’ scrutiny’ will continue as too will the inevitable negative publicity for the sector which results from reports.
Associated with the above is the decision of the Care Inspectorate to add elements to section 7 of the normal care home inspection process. See https://scottishcare.org/new-care-inspectorate-covid-19-scrutiny-criteria/. I made it clear that whilst it is understandable in terms of the emergency legislation why they are looking at these specific areas that the lack of consultation and engagement (the normal process) is unfortunate and challenging. I impressed upon the Care Inspectorate that it is difficult practically to imagine how some of the elements of a quality service as envisaged in the criteria can be achieved by a service which is operating under national Clinical Guidance which restricts movement etc and with staffing ratios which are far from enabling of some of the criteria. In response the Care Inspectorate Chief Inspector indicated that they would seek to be proportionate and to work with the sector to adjust any criteria as a result of feedback. We would encourage you to give such not only to the CI inspectors but to Swaran, your membership manager.
This week saw the publication of the Safety Huddle tools and associated materials which have been developed alongside provider representatives. See https://scottishcare.org/covid-19-care-home-safety-huddle-staffing-and-escalation-resources/ . We held a webinar on this on Tuesday and the response has been relatively positive. There is justifiable concern about a one size approach and it important to stress that there is an openness to modifying the tools. However, the overall aim is to reduce the level of reporting rather than to add to it. As a result Scottish Government is considering mandating the use of these tools. This should assist in providing some national data and addressing some of the unfortunate data gaps which make planning and development in the sector particularly hard. They are not perfect, but we hope that providers will begin to use them and contribute feedback so that they can be improved. Jacqui Neil our Nursing Lead will be interested in receiving feedback.
The Edinburgh Inter-Faith Association has launched a Time to Talk listening and counselling service for care home residents and families. It is for those of faith or no faith. Details can be found at https://scottishcare.org/time-to-talk-covid-19-listening-service/
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’ seemed to have been settled and the statement confirming this is on the website. https://scottishcare.org/updated-statement-on-the-use-of-gloves/ However it is also clear that there are several Health Boards which are still insisting on the use of nitrile gloves. I have raised this with Scottish Government, and with the lead for the NHS Board Chief Executives and also the Cabinet Secretary – yet another example of national HPS Guidance being variously interpreted by NHS Boards and making your life a nightmare!
Stefanie continues to monitor the availability of PPE and every Monday the members’ section of the website will act as a signposted and comparator to the costs we have been offered.
If you feel that you have been the victim of price gouging in this period re PPE can we encourage you to give this information to the CMA who are holding an inquiry. This will potentially prevent this sort of profiteering if we have another viral wave. See https://scottishcare.org/request-for-social-care-sector-feedback-on-increase-in-ppe-pricing/
Testing
Testing has now become a real concern for us. This is in no small measure due to the inconsistency of the application of Testing Guidance. Some Health Boards have not started testing; others are only doing 10%, others 25% of staff in ‘green’ homes. We need consistency and I am pleased the Cabinet Secretary wrote in the strongest terms to Health Boards in order for this to happen. They will now report the level of testing which has happened in their area on a weekly basis.
We are also beginning to try to influence the use of antibody testing and top argue that it should be a priority for all social care staff.
It equally remains our considered view that whole home testing necessitates the testing of residents. It is clear that even in locations where residents are asymptomatic that they are ending up being tested positive. There is little, in my opinion, point in testing all staff for residents to be positive.
The new Test and Protect system is rolling out and we have asked for clarification on a whole range of issues. Some of the responses we have received are understandable but in general there is a lack of clarity on the inter-relationship between T and P and social care testing.
We will continue to keep a watch on all this, not least the lack of consistent practice, including in the homecare sector where we are still getting too many returned from hospital to their own homes without any clear testing having been undertaken. This also includes as return to own home from care home ‘safe havens’.
Please note the testing information on test and protect on the website. https://scottishcare.org/scottish-covid-19-contact-tracing-programme/
Workforce
A useful Staff Wellbeing Check has been developed to check the health and wellbeing of staff. See https://scottishcare.org/staff-wellbeing-resource-team-status-check-how-are-you-doing/
Can we also draw your attention to new resources for staff on the PROMIS website.
A new partnership resource has been developed by NHS Education for Scotland (NES) and the Scottish Social Services Council (SSSC) which serves to highlight the essential skills to respond to and care for people living in care homes or their own home, who have acute care needs due to COVID-19. See https://scottishcare.org/new-covid-19-resource-by-nes-sssc/
Care at Home
Unfortunately, we have had to reschedule the meeting of the Care at Home and Housing Support National Committee on the 11th June. This will be held as soon as possible.
I am, however, pleased to note that there has almost been a light turned on at Scottish Government re care at home and housing support. There is an increased understanding of the fact that there are many individuals now highly vulnerable and living without adequate support in the community and that this is made worst by the sheer fragility of the sector at this time. Karen and a number of members are involved in reframing the Clinical Guidance and this also includes work which is being done on the opening of day opportunities.
Stirling University have launched a project to discover how people are staying active during Covid19 – more information at https://scottishcare.org/university-of-stirling-project-on-staying-active-during-lockdown/
Communication
We are continuing to hold one Surgery a week, and this will be on Tuesday at 12 and will last an hour. The coming one will be on any subject and as Karen is on leave it will be just myself answering any questions.
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.
And finally,…
Can I remind you of the vacancy we have at Scottish Care. This is for 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/
With all this talk of reform please remember to come and join us to shape the future in the Collective Care Future project. We need you all to engage or other voices will dominate the debate! See https://scottishcare.org/project/collective-care-future/
We held the second #candleforcare at 7pm on a Tuesday – and are pleased that it is starting to grow including some media interest. A time for reflection, silence and thanks.
Thank you for all your continued work and engagement.
Donald
6th June 2020
