In the week that has just passed we have had a paper published by the National Registers of Scotland which evidences an appalling increase in the number of ‘excess’ deaths during the pandemic period amongst those living with Alzheimer’s, dementia and diabetes. In terms of dementia we have seen a 25% increase in excess deaths which are not ‘Covid’ related or ‘Covid’. The report has indicated that more work needs to be undertaken to understand why this is the case and what lies behind it. I would argue that this work is absolutely critical and that included in that there needs to be an examination of whether or not the withdrawal and limiting of homecare services in the community has had a direct effect on the deaths and deterioration of hundreds of individuals.
The following is a summary of some of the main issues in the week that has passed.
Testing.
Last Friday evening the Cabinet Secretary wrote to stakeholders to indicate the work that had been initiated to address the very real and concerning systemic issues facing providers in terms of testing both in care homes and in the community. In the last week Caroline has attended a meeting with the Testing Directorate which has sought to address the critical issues of inconclusive tests, delays in pick up and delays in the return of results. It is clear that the fundamental problems with the UK portal are ongoing and are likely to get worse as stated by the UK Health Secretary. In this context we have welcomed the willingness of the Scottish Government to build the capacity of the NHS through purchase of new equipment etc but we cannot stress strongly enough that on the edge of autumn and winter if we do not get this right and get it sorted very, very quickly then we will be back to the nightmare which we are slowly coming through. Added to that is the direct impact that testing failures will have on the ability of families to visit which as weather worsens is unthinkable. I can assure members that we will keep on this issue as a matter of real urgency and priority.
National Care Review.
As readers will be aware the Review group is now up and running under the leadership of Derek Feeley who is a former Director General of Health and Social Care in the Scottish Government and also a former Chief Executive of NHS Scotland and former Chief Executive and President of the Institute for Healthcare Improvement.
The panel of experts for the review includes: Malcolm Chisholm, former Scottish Minister for Health and Community Care, Anna Dixon, chief executive of the Centre for Better Ageing, Caroline Gardner, Auditor General 2012-2020, Councillor Stuart Currie, Ian Welsh, chief executive of the Health and Social Care Alliance and Göran Henriks, Chief Executive of Learning and Innovation in Jönköping, Sweden. Jim Elder-Woodward, appointed at the start of the week has lived all his life requiring support, is a Doctor and the Independent Chair of Inclusion Scotland with an interest in human rights.
I met Derek Feeley on Tuesday in what was a constructive and positive encounter. This brief overview of the meeting might be useful, but I should stress I was in general impressed with his desire to learn from the sector, get our ideas and to positively engage.
The overarching aim of the Review is to provide Government with a paper describing what social care should look like and provide models and ideas to realise it. It is his primary intention to start with and focus on people who access services. Although he stated a commitment to a human rights based approach I did indicate the challenge of achieving this, especially in that it might be hard to engage with people living with dementia and their families at home and in care homes with such short timescales and in the current Covid landscape.
The review will also look at employment, training, workforce, and the critical area of funding including models, commissioning and procurement and areas around ownership and whether profit or return should be allowed, the full gamut from a fiscal perspective. He will also look at assessment consistency including SDS, how social care links in with other agencies such as housing, mental health and criminal justice as well as links to scrutiny and delivery related to current legislation and policy plus anything else to help redesign the system to make it more meaningful for those accessing social care
I also met with the Cabinet Secretary on Monday, and I raised my concerns about the timing of the Review. I stated that this will land badly on the sector and feel like a kick in the teeth after the last few months. Her response was it is not meant to be a criticism, but that the sector has been calling for reform for a while. She asked me to tell members not to consider a national care service as equivalent of or same as nationalisation. She hopes the providers in the third and independent sector will engage and use it as an opportunity for voices to be heard.
Derek Feeley very openly stated that the primary voice of the review will be service users, secondary are service providers but he knows he cannot do the work without Scottish Care and CCPS. He has already downloaded our reports and papers and we will provide him with the additional and new information that Tara and Becca have been collecting over the last few months. In short, his 3 priority areas are:
- Outcomes – these are very confused for social care in general with disjoint between policy and practice. He wants to know what are the outcomes that people and providers want.
- Funding – he wants ideas from the sector, practical solutions and practical ideas. Realistic concepts based on consultation and engagement. How should people pay for social care? What about cost of care and fees, commissioning models and also what models of ownership should exist? His primary aim is not to deliver a national care service, even although Scottish Government has stated a sympathy to a national care service they have given little detail. The primary position is not to create a national care service but to reform adult social care.
- Quality, Regulation, Scrutiny, and Improvement –quality and improvement oversight are fundamentally flawed, over regulated, over inspected and there is little relationship between inspection and improvement. He sees no point in scrutiny and inspection without improvement.
After the meeting the Scottish Care Executive met and we have committed with Mr Feeley’s approval to do the following:
- Derek would like to hold two engagement events with Scottish Care one for care homes and the other for care at home and housing support. We will arrange these shortly.
- He has asked Scottish Care to prepare an ideas paper for him to influence discussion and engagement. This will be developed from and around the meetings.
- Mr Feeley will separately meet with the Scottish Care Executive.
As I have stated I found Mr Feeley open and engaging, he wants us to be in touch with him and though he agrees the timing is not ideal he sees it as a once in a generation opportunity for reform. It is equally clear that the report will be his and that the Advisory committee is there to advise.
In addition, I hope to arrange a meeting between Mr Feeley and the finance and insurance sector in Scotland who are both critical to the development of social care.
Homecare Festival. WEDNESDAY 7TH – FRIDAY 9TH OCTOBER.
Tickets will be on sale at the start of the week!!!
We have published the programme for our three-day Homecare Festival. We believe we have achieved a good mix of debate, discussion and innovative input with speakers from across the UK and hope you will all join the event. More details are available at
https://scottishcare.org/cah-conference-2020-2/
The themes are
Wednesday 7th October:
Theme 1: Re-shaping Homecare – issues of vision, sustainability and practice
Thursday 8th October
Theme 2: Maximising potential: the critical role of the homecare workforce
Friday 9th October:
Theme 3: Home is where the rights are: homecare and human rights
We will culminate the week with an Awards Evening on the Friday 9th October evening at 7.30 pm which will be hosted by Michelle McManus and myself.
General Covid Care Issues.
Thursday saw the first meeting of the Pandemic response Group at Scottish Government which is being established (ending the Care Home Rapid Action Group) to be more inclusive of the widest interests of social care (including Homecare) and to prioritise preparation for the winter period.
The group will meet weekly and be co-chaired by COSLA and Scottish Government and its focus is described as:
Specific objectives of the Group are to:
- enhance existing collaborative working across adult social care sector leaders;
- identify key issues for resolution (where appropriate supported by relevant data/metrics/evidence);
- as a result of key issues make proposals to the Scottish Government and the adult social care sector leadership as appropriate for other national level actions;
- ensure relevant links are made with other groups for example, Clinical Professional Advisory Group (CPAG)
Scope of PRASCG considerations in adult social care
Adult Social Care Homes
Care at Home
Supported living arrangements
Day Care and Respite provision
Citizens in receipt of direct payments and employing personal assistants
Support for unpaid carers
This list is not exhaustive
Areas of work for deliberation and action
1) System resilience on such issues as PPE, Testing, Vaccination programme, workforce, finance (this list is not exhaustive);
2) Current and ongoing assurance, inspection and improvement;
3) Implementation and performance.
The first meeting confirmed membership and terms and addressed the immediate issues of testing which I raised especially the fact that the UK Portal Helpline is indicating that tests will take 6-7 days to be returned. Needless to say, I underlined the urgency of this issue. I also raised – and this will be discussed next week – the urgency of extending testing or at the very least establishing some sort of system to allow it to happen for the care at home and housing support workforce as we move into autumn and winter. Community transmission risks a real impact on the total workforce not just in care homes.
The Clinical and Professional Advisory Group met again and a lot of the time was focussed on the need to think urgently about re-shaping the guidance to take account of the growing clamour and anger from family members re access to care homes and as we move into winter to try and get a better and more proportionate illustration of what safe visiting will be especially in situations of lockdown. I have been assured that the clinical staff will be presenting new suggestions to politicians. I remain concerned, however, that there is a lack of appreciation that the impact of restricting visiting is having on the sustainability of the care home sector as well as the mental health of those who are resident and their families.
In addition, can I remind folks about the new Guidance which relates to the restoration of professional visits. See https://scottishcare.org/coronavirus-covid-19-adult-care-homes-visiting-guidance-3-sept/ In relation to this I have received a plea from GPs about thew need for care home providers and staff to understand that if a GP visits ion an urgent or emergency situation that a proportionate screening through questions is more than adequate providing appropriate PPE etc is worn. We have to get the balance right but at no time should we put people at risk by seeking more information from a clinical colleague than is necessary.
The group also spent some time reflecting on the development of work around IPC. In the last week I have heard instances of contradiction between what providers are being advised by health colleagues and from Care inspectorate. I have brought these issues of inconsistency up and the Chair of the NHS Chief Executives Group is organising an urgent meeting so we can try and get some consistency into the system.
Finance and sustainability
To remind members that we published the COSLA and Scottish Government letter detailing their new arrangements on the website last week. See: https://scottishcare.org/sustainability-announcement/
We have also had sight yesterday of a letter from a HSCP Finance Director indicating that they do not have sufficient funds to meet all the requests for sustainability funding which they have received. This is a matter of fundamental concern to us especially as we will be seeing the diminution of funding support over the next few months. We will be dealing with this as a matter of urgency.
We are still keen to get a sense from members of where you are with receiving sustainability payments and what work we still need to do.; Please feed this information through Swaran, Jim Carle or your local Independent Sector Lead should you have one.
Communication
Next week the Tuesday Surgery will be at the usual time of 11 am and will be hosted by Karen Hedge and myself.
In addition we will be hosting a further webinar specifically for care home members.
Webinar: National analysis of hospital discharges into care homes – 17 Sept, 10 – 11am
Public Health Scotland are undertaking a review of hospital discharges into care homes (March-May 2020), commissioned by the Cabinet Secretary for Health Secretary for Health and Sport.
This work will identify those who were discharged from an inpatient hospital setting into care homes during this period, describing their COVID-19 status and relationship between discharges and COVID-19 outbreaks and mortality.
The data included in the publication will be aggregated and reported at Health and Social Care Partnership or Health board level.
The team are keen to engage with care staff, managers and providers about the work which is underway and future potential insights, sharing their methods and plans moving forward.
During this webinar, Scott Heald (Head of Profession for Statistics, Public Health Scotland), Fiona Mackenzie (Service Manager, Public Health Scotland) and Jenni Burton (Clinical Lecturer, University of Glasgow) will provide a short presentation and welcome dialogue to answer any questions.
Joining details will be available on the Members Area of our website.
Bulletin
Our quarterly Bulletin is again online this Autumn and the latest version was published yesterday. Safe to say it is full of reflection, practical insight, and lots of information. So please read it and share it with as many people as you can. Because copies are not available in physical format we are aware some folks may not get access which they used to, so we are very reliant on our members to spread the pdf. Thank you See https://scottishcare.org/autumn-bulletin-2020/
Workforce
On Wednesday the Workforce event A Salute to Care Managers: recognising the importance of your own wellbeing will be held. I am very aware of the real strain and stress that managers in care home and homecare have been under over the last few months. These two sessions provide individuals with a real opportunity to discover sources of support and share perspectives. Please support them. There is no charge for these events.
The event will focus on the wellbeing of home care managers and the challenges being faced providing ongoing support for staff and caring for your own personal wellbeing at this time. We aim to give those participating the opportunity to discuss their own experiences dealing with COVID and to gain feedback from care managers in the social care workforce as to their specific needs in this area.
- Session 1 – NES Psychological 1st aid module – how this can benefit managers with their own wellbeing and supporting their staff.
- Session 2 – Care provider wellbeing initiative – introduced during COVID, how this has been implemented and the impact on staff wellbeing.
- Session 3 – SSSC manager wellbeing and support – this will be an interactive session for managers to feedback what wellbeing resources / initiatives have been most helpful and effective and where this work can continue to focus to best effect.
If you wish to attend please email [email protected]
This event will take place in two parts.
10am – 12pm Home Care and Housing Support organisations and managers
2 – 4pm Care Home organisations and managers
Staffing
Many of you will know that over the last few years that we have been funded by many HSCPs to develop the role of the Independent Sector Leads. These critical posts support the sector in our relationships at local levels and in improving quality if service delivery. As a result of some departures and additional funding I am pleased to be able to announce some new (and familiar) faces coming to join us. If these new colleagues are local to you please get to know them.
East Renfrewshire – Independent Sector Lead: Heather Molloy will move to this as her only area commencing on 21st September.
Glasgow – Independent Sector Lead 21 hrs: Katharine Ross, (whom I am sure most of you will know) is coming back to Scottish Care as the ISL for Glasgow on 21st September.
Dumfries & Galloway Development Officer 21 Hrs: Susan Duffy joins us in D&G. Susan’s previous role was with Sense Scotland where she has recently led a project to reorganise Adult Services. She commenced her new role on 1st September and she has slotted straight into the team.
Aberdeen City – Independent Sector Lead Full time: Gosia Duncan who many you will know has not only become a mum for the second time but was the successful candidate for the full time ISL post.
Aberdeen City – Independent Sector Lead P/T: Wendy Henderson has previously worked in Edinburgh City Council and is an experienced Care Manager, Policy Lead and Health Improvement and Diversity Manager. Wendy will begin her new career with Scottish Care on the 1st of October.
Aberdeen City Development Officer P/T: Francis Loughrey began her career with Scottish Care this week. She has her own coaching business and has worked in Australia for a number of years.
Can I welcome all new colleagues.
Care Home Festival
Just a reminder for your diaries.
We will be going online with the Care Home Conference and Awards and will be holding a Care Home Festival over three days from Wednesday 25th November till Friday 27th November with an Awards Ceremony in the evening of the 27th. We will be starting the Awards application process at the start of September.
And finally,…
On Thursday I gave evidence at the House of Commons Scottish Affairs Select Committee on a range of issues relating to the pandemic including workforce, Guidance, testing and the issue of immigration and Brexit. If you want to follow up then please see https://parliamentlive.tv/Event/Index/074ddb10-f94c-44a1-a618-6a3acc607a23
In keeping the issues of care and the sector at the forefront of the concern of many please join me in lighting a #candleforcare on Tuesday at 7.00pm
Many thanks
Donald
12th September 2020
