Well talk of entering the second stage of Lockdown exit seems to be dominating the media, as too the focus on the restoration of tourism, transport and small businesses. The impact of the virus upon the economy has also been the subject of much understandable comment. This in turn impacts upon the care sector. The statistics around deaths in care homes show that 47% of the total death rate has occurred in our care homes, but worryingly there is still evidence of a significant number of deaths in the community. In care homes whilst the death rate has flattened it still seems to not be declining at the rate one might expect so we are keeping an eye on this.
I am scheduled to meet the Cabinet Secretary next week but have this week had a direct call with the new Director General of the NHS and the new Director of Health and Social Care. The focus of this call and what will now be a weekly call is on issues related to testing.
The following is a summary of some of the main issues in the week that has passed.
Finance and sustainability
By now I would have expected that all members across the country should have been in receipt of the template on which to claim additional costs in homecare and care homes and care home bed voids. It is clear that in some parts of the country this process is already working well, and I have even heard some providers getting payments within 72 hours of sending in their claim forms. It can therefore be done. But at the time of typing this I am, also very aware that there are some authority areas in Scotland where the forms have not been sent out never mind that payments have been made. We are hearing of issues in Inverclyde and Highland to name but too. It is very important that we get this intelligence from you so that we can bring these matters up with our colleagues in COSLA – I would be grateful of any comments either directly or onto the discussion boards.
In relation to the payment of SSP and Death in Service the technical details of both of these were the subject of much discussion in the week that has passed. The COSLA Leaders were due to meet yesterday (Friday) to sign off on these protocols. I hope that we will get Comms out about this in the next few days. Basically, the scope is for most of the care at home and care home workforce and the time frame is back to the 23rd March. A worker will have their SSP payments ‘topped up’ to their full pay level should they require to be off work during the pandemic as the result of a suspected or confirmed Covid. The payments will be re-claimed through the local HSCPs by the employer. We will put the details up on the website asap.
There should be a diminishing number of concerns around the Scottish Living Wage. The Cabinet Secretary confirmed in a letter to COSLA what the terms of the individual settlements for each local authority should be . Again, we need you to tell us if this is not starting to happen. See https://scottishcare.org/scottish-living-wage/
Care Home Strategy, CI and Public Health Scotland
A quieter media week but again a lot of chat about a proposed ‘National Care Service’ which we have been addressing directly in the media when this has arisen.
One of the major issues has been a growing clamour for visiting and I know a good number of homes have started to hold outdoor visits. A lot of work has been done on this and also in addressing the issue of supporting staff to help people to no longer be isolated for long periods of time. I hope that there will be the launch of the final Guidance document together with a timeframe on this issue into next week. It cannot come soon enough for many. I appeared before the Scottish Parliament’s Cross Party Group on Ageing on Thursday and this was the number one issue of concern.
I also appeared before the Covid-19 Emergency Committee at the Scottish Parliament last Thursday. This session was focused primarily on ending lockdown and the issue of testing. I am very aware that there is a real caution on the one hand around opening up visiting evidenced in a fear of introducing the virus especially into care homes where there has not been an outbreak. I am equally aware of the volume of people – including a national petition- who are wanting care homes to be opened to family visits. Getting the balance right between the two demands will be critical in the days and indeed weeks to come. Our evidence is accessible here: https://scottishcare.org/scottish-care-responds-to-covid-19-committee-inquiry-on-easing-lockdown/ . Thank you to Becca for this submission.
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 14 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. We have started to explore what it would take to enable visiting to take place in a home that has a live outbreak. The reason for so-doing is that it could take weeks for this to happen if a single case was the predicator of exclusion.
There continues to be much disquiet around the enhanced visits which are taking place and scheduled to take place into care homes. In particular there is justifiable concern around professionals coming in (non CI ) who have little understanding of the care home environment, are overly emphatic of IPC from a clinical perspective, unappreciative of the nature of social care; concern over lack of testing of those on these visits especially if they have been on multi-site visits, and the lengths of the visits. A frank meeting was chaired by the CI Chief Executive Peter MacLeod yesterday afternoon (Fri) and I hope that later next week we will get explicit guidance to reduce the very real risks of transfer of the virus into care homes. It is simply not acceptable.
The growing clinicalisation of the care home sector and the lack of appreciation of the social care dimension has been well articulated in a letter expressing concern written by the Chief Social Work Officers and sent to the Scottish Government on Thursday. See. https://socialworkscotland.org/wp-content/uploads/2020/06/Care-Home-Assurance-11.06.2020-CSWA-Scottish-Government.pdf This is an important contribution and adds a necessary weight to our own previously voiced concerns. I would have to indicate that the Care Inspectorate is expressing similar concerns.
It is important in the midst of a political desire for scrutiny and assurance that we do not lose the essence of what care homes are and return to the dark days of institutionalised environments with little autonomy, control and choice.
There is ongoing uncertainty over the use 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/ . The application of this Tool is meant to reduce reporting but we are aware that some HSCPs are demanding providers fill out additional data. There is a meeting to explore this in some detail next week, but it would appear that there is a majority of those involved, including providers, who want there to be one set of data collected by this tool and used by others. We are about reducing data collection not multiplying it and the associated ridiculous reporting demands that are being placed upon staff at this time. I hope there will be final clear direction this coming week.
The Care Inspectorate published their reports on 12 visits which they have undertaken in the last fortnight. This is now a requirement of the Emergency powers and they have to be laid before the Scottish Parliament. The reports were on the whole positive and showed very good examples of care and support as well as infection control and nursing practice. See https://www.careinspectorate.com/images/documents/coronavirus/Scottish_Parliament_fortnightly_CI_inspections_report_10_June_2020.pdf
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.
But alas we are no further forward with ‘glove-gate’ as it remains the case that there are several Health Boards which are still insisting on the use of nitrile gloves. As I noted last week I have raised this with Scottish Government and with the lead for the NHS Board Chief Executives, but I am afraid that NHS Chief Executives have still not made their mind up about this issue! I have continued to emphasise the impact of this inconsistency and have been reassured that the majority view is that vinyl for non-fluid encounters is sufficient. We await the smoke signals!
It is likely that there will be an announcement from the Cabinet Secretary on Sunday that masks will be required in all care encounters both in the community and in care homes. I 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.
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.
Testing
The number one issue both politically and operationally is testing. Following the robust letter from the Cabinet Secretary Health Boards have to submit their data to Scottish Government and this was published for the first time on Wednesday. Moving forward this will be testing data which includes not just the tests undertaken in each area but also a comparison against planned tests. It is clear that there is a sharp diversity of both practice, capacity and focus across the 14 Health Board areas. You just need to look at the data to see this is the case. I am now meeting the NHS Director General on a weekly basis, as noted above, but we are still struggling to get access into the Testing Directorate. On Monday morning I will be taking part in a roundtable Q and A where we have testing officials present to answer any questions. If you have specific issues re testing can I ask you to put these up on the Covid discussion boards and I will attempt to raise these on Monday and thereafter respond to queries on the discussion board so all can see the responses.
There are real workforce implications of testing, around capacity, the time it takes within a working day, the resource used re PPE and staffing, the regularity of the process etc. Yet again there is little consultation and engagement with the sector by some Boards (e.g. Highland) and in others there is evidence of on the whole reasonable collaborative practice and planning (Forth Valley).
The new Test and Protect system is rolling out and we have continued to ask for clarification on a whole range of issues.
Please note the testing information on test and protect on the website. https://scottishcare.org/scottish-covid-19-contact-tracing-programme/
Workforce
The Strategic Nursing Group met again on Friday and this was once more a thorough and good conversation which was well attended. If you would like to join the next meeting on the 30th June then please get in touch with Swaran or Jacqui Neil. It is a good opportunity not only to hear about current issues but to learn about new developments and opportunities within and beyond the sector.
I am very aware that many of our managers are absolutely exhausted and this is not only from weeks of demands from Covid19 but also increasingly from the disproportionate reporting requirements and scrutiny under which services are being placed. I have made this point known to the Rapid Action Group at Scottish Government. There is a real risk to the system if we continue to place impossible demands on managers and others.
There is an opportunity to take part in a webinar on improving vaccine uptake. As we have reported before Scottish government have agreed that all frontline social care staff should be able to get the flu vaccine for free. This is a really positive step and one we have been campaigning for for some considerable time. Jacqui Neil is on the implementation and planning group. The webinar can be accessed at https://scottishcare.org/improving-vaccine-uptake-in-scotland-webinar/
Care at Home
Last week I noted that Scottish Government has begun to focus a lot more on care at home and housing support. There has also been an increased focus this week on the importance of re-establishing day centre and day opportunities. I remain very concerned indeed with the scale of cancelled packages and growing evidence that there are Council areas which are not exactly rushing to restore these. I have a real fear that we could lose some of the CAHHS workforce unless there is an urgent focus on the sector. I have held discussions with the Care Inspectorate on this issue and we will be jointly raising our concerns with COSLA and the HSCPs.
Communication
We held one Surgery on Tuesday at 12 and this lasted an hour and was well attended. We will be holding another Surgery next week at the same time on general issues and both Karen and I will be in attendance.
We have returned to issuing our tri-weekly E-Newsletters which is a good way of keeping members updated on issues.
I should also note that Shanice has updated the public facing section of the website to make this easier to access. See https://scottishcare.org/information-on-coronavirus-covid-19-2/
We continue to use the Discussion Boards so please refer to them when you can.
And finally,…
Can I remind you that there are a few days left with the vacancy we have at Scottish Care. This is for a 9 month post as maternity cover. This post for a Human Rights Project Officer is fully funded by Life Changes Trust and is a really good opportunity for someone to come and work with us. Closing date on Friday. 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 which aims to provide an opportunity to reflect and share experiences of responding to and managing COVID-19 in the context of care homes and care at home. There has been a tremendous response but there are certain categories which are especially needed to make the project a success. The project is especially looking for the voices and engagement of frontline staff:
- CAH providers/managers
- CAH frontline staff
- CH frontline staff
Staff can be involved in the programme through a series of online group sessions and through weekly surveys starting from late June and running for 6 weeks. This work is critical to shaping the future of the sector not only through Scottish Care’s work, but also more widely in building the foundations to influence the national debate on social care.
Tara French is also 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. See https://scottishcare.org/technology-advisory-group/
We held the third #candleforcare at 7pm on a Tuesday – and are pleased that it is starting to grow including some media interest. A ‘slow burner’ (apologies ) but one which we hope to keep going to keep appropriate focus on those who have died and those who continue to care.
Thank you as always for your energy, enthusiasm and professionalism.
Donald
13th June 2020
