Review of the week: 9-12 April

Review of the week: 5^th -12^th April

 

It hardly needs to be stated that this has been an immensely busy time across the sector. At the start of this update I would want to pay a personal tribute to all the organisations and staff who are out there delivering essential care in community and in care homes. Your work is rightly being applauded for the excellence in compassion and commitment it is portraying.

I thought it might be helpful to summarise where I think we are on certain key issues:

 

PPE

Last weekend we were in the midst of the period of the ‘push’, the sending out by the Triage of basic packs of PPE after the establishment of the HSCP led Hubs which had taken place the previous weekend. By Friday 3^rd it was already becoming clear that there were major issues with the hubs. This culminated in discovering that on Friday 3^rd four of the hubs had effectively shut up shop for the weekend and were refusing to give essential PPE equipment out to providers. On that evening I wrote to senior Government officials calling for a re-consideration of the use of the hubs and began to call over the early part of last week for the use of the logistics experience of the Army to be brought to bear.

In my meeting with the Cabinet Secretary on Tues 7^th I made it clear we needed to urgently address the PPE issue. Matters had not been helped by the change in the PPE Guidance on the 3^rd which meant an increased demand and some confusion over the type of PPE which should be worn in particular contexts. At a further meeting with officials an in-principle decision was taken to move from a hub model to direct delivery to care homes and homecare organisations and to only use the hubs for in-house and PA, carer distribution.

At the time of writing this update after discussions yesterday (13^th) I believe the Cabinet Secretary to be at the point of instructing the direct distribution model.

It is imperative that we increase the scale and volume of PPE not least since the emphasis in the public statement from the First Minister alongside the Trade Unions on Friday 10^th to enable professional decision-making around the use of PPE by individual staff.

 

Testing

There is a growing urgency for the need to extend testing. Whilst the Cabinet Secretary has made that commitment we need this to be evident. We are probably seeing between 25-30% absence from the sector at this stage. A new testing co-ordination unit has been established at SG and Karen has been liaising directly with officials and with others to improve both the scale and methodology – in particular to try to enable it to be more flexible and local. Our emphasis has been and will continue to be a particular focus this coming week on testing for three purposes:

• Testing related to enabling staff to return to work from self-isolation to address issues of absence.
• Testing related to individual residents – both to enable the better management and use of resource for those who are Covid+ and to reduce the stress and distress of those with dementia etc who are being isolated and nursed as ‘suspected.’
• Testing to build public assurance that staff are not increasing the risk of infection both in homecare and in care homes.

Whilst we appreciate the issues of capacity re testing we want to see real progress on this in the coming week.

 

Workforce

Caroline, Jacqui and Karen have been working tirelessly with colleagues in SSSC and the CNOD to make progress on workforce issues.

We now have over 2000 individuals who have ‘volunteered’ through the SSSC led portal. They have undergone basic employment checks by SSSC and Disclosure Scotland have accelerated checks and processes to enable them to be ready for training. Caroline is working with SSSC to develop and roll out a basic training pack.

The key in the coming week will be to move to a distribution model for those who are available which ties into the RAG model which the Care Inspectorate has developed, and which identifies developing and real workforce risks.

We are also attempting to influence arrangements around transport to make it easier for workers to get to work.

On a positive note we are grateful to Police Scotland who issued a statement around policing and thanks to Karen for this which has resulted in a reduction in the number of workers being stopped. See https://scottishcare.org/police-scotland-update-on-travelling-during-covid-19/

Karen has also been working with colleagues to reduce the volume of duplicate reporting demanded by HSCPs and other bodies like the CI. This has been a hard activity, but we hope to see progress in the next few days. We simply have to reduce the demands on the frontline.

 

RAG

The early alert system for providers has now been running for a week. Can I urge every provider to use this. Yesterday (11^th) we had to deal with a potential issue where staff had become distressed following the admission of a colleague to ICU. It is imperative we keep the Care Inspectorate aware of risks to continuity of staffing in order that escalation and mobilisation of support can take place.

 

COSLA Commissioning Guidance

Whilst we accept that all organisations are under pressure it has taken a wholly unacceptable period of time for COSLA to finally publish their refreshed Guidance for Commissioners. This is available on our website. See https://scottishcare.org/cosla-commissioning-guidance/ . Karen has been spending a lot of time in seeking to influence this Guidance. We do not consider this document to be anything like as helpful as its equivalent from the LGA in England. It is evidence of the obsessive localism which is crippling Scotland’s response to the pandemic.

This is true especially of homecare where we are seeing really poor proposals from some HSCPs although we have also seen better approaches from Borders and Argyll and Bute. We will continue to argue robustly against the poorest of these local arrangements and to seek to achieve good practice across the board.

The document is further very weak indeed in terms of what it says about care homes.

I am planning to write a letter to the COSLA CEO today (13th) to ask for an urgent escalation of local mobilisation plans specifically to include the independent sector. We have given very clear evidence of what we consider to be the cost impacts of the pandemic on both homecare and care homes. We also want a clear national articulation of an increase in the NCHC to meet these costs or clear evidence of local mobilisation which meets the same requirement.

We propose to raise the profile of financial risk and unsustainability facing the sector in the media in the week ahead.

 

Supporting communities and individuals

We recognise with many the impact upon those receiving support as a result of ‘lockdown’ and self-isolation. Becca has been working solidly in our Technology Devices Network project which is seeing real evidence of scale up. The importance of maintaining contact is self-evident. I would encourage you to engage with this work. https://scottishcare.org/scottish-care-launches-initiative-to-connect-people-through-technology-2/

I would also encourage everyone to start to use the Luminate@Home offer which I know is benefitting so many. See https://scottishcare.org/luminatehome/

 

Communication

You will be aware that we held another two webinars this week and are now following that pattern – one for members only, the other which is open. We were pleased to have Prof Graham Ellis back and next week will have a webinar for members which will focus on the Triage with attendance by one of the lead co-ordinators. We had an amazing 240 folks engaging with the Webinar on Thursday last and I hope you have found them to be useful. All are available on the website.

We continue to put significant amounts of material on the website and I want to thank Shanice for doing an amazing work in making information accessible.

The Discussion Boards continue to be well-used and I hope members will use them to share not just questions but insights on how you are dealing with the pandemic.

We also have had an unparalleled interest and coverage from the media. Most of this has been generally positive and has enabled us to get key messages out as well as raising the profile of the issues facing the sector. We are, however, noting a slight change in that as journalists seek for the negative within the events that are occurring. In addition, our social media presence has been very high.

 

Ethical Guidance

Members will be aware that we have raised concerns about both the Ethical Guidance and the Clinical Guidance for Care Homes. In meeting with the Cabinet Secretary on Tuesday last it was decided to address the first in a collective manner. Over the weekend I have been contributing to this process to ensure that older people will not to be discriminated against when clinical decisions might have to be made under resource constraint. I have been linking with colleagues across the UK in video-calls focussed around ethical Guidance and with my colleagues in the Five Nations on this and other matters.

We have also contributed to the re-writing of the Guidance for Care homes across the whole gamut from admission, PPE, self-isolation, etc. This should be re-issued soon and thankfully removes any sense that admission to acute from care homes will not happen.

Together with the RCGP we have published a statement underlining the commitment to in-reach from community NHS including GPs and have contributed to statements on the inappropriate use of DNACPR.

 

Emotional and psychological support

We fully recognise the risks being faced by staff dealing with such a high level of trauma and death. We have worked with Marie Curie and the hospice sector across Scotland to put a proposal for a distinct care helpline to the Cabinet Secretary. We are awaiting response. We are also working with Scottish Government mental health colleagues on wider support. We note with thanks the work of local hospices such as St Columba’s in Edinburgh and Highland Hospice to support local providers at this time.

 

Bereavement

Members may be aware that I have been chairing a national working group creating a Bereavement Charter over the last 18 months. This work including the Charter and associated Guidance has been accelerated – thanks to Caroline for her involvement – and is due to be published on Wednesday this coming week. I consider it will be important both now and into the future in supporting staff and communities in dealing with the pandemic and the grief associated with it.

Alongside this is work that is being undertaken on enabling appropriate visiting to take place around end of life – it is hoped that a joint Guidance document on this will be published this coming week alongside the Royal Colleges.

 

Palliative and end of life care

We have been very much at the heart of national discussions with clinicians and others around palliative care in the community and in care homes. A new COVID-19 ACP document has been published together with refreshed Scottish Palliative Care Guidelines – both available on the website. See https://scottishcare.org/new-covid-19-palliative-care-guidance-3-april/

Three video-calls are held each week to give up to date information on the pandemic spread and PEOL care impacts. Please watch the website for updates on these. We are currently undertaking work related to the use of oxygen in the community.

Members will be aware we have been doing work on the role of Just in Case Boxes for care homes. We continue to work closely with the Chief Pharmaceutical Officer at SG on addressing current Home Office restrictions.

 

Resources and member offers

I am grateful to Stefanie who has been collating some of the offers to members both in relation to PPE, food supply and technology. We are doing our best to assess the robustness of each of these offers and these are displayed in the members area of the website.

We continue to try to influence some of the supermarkets and have seen positive progress both for access for workers and care home/homecare services seeking to buy for others. Iceland is the latest to start to value our workforce.

 

And finally…

All in all, a busy week. Laura is staffing the Scottish Care direct number which has never been more busy. Please understand we try to get back to calls as quickly as possible. Thanks to Colette and Cath who are working tirelessly to keep ourselves as an organisation financially solvent in a time when we have lost our main conference and a key source of income.

We continue to try to influence the other political parties and the wider agenda on human rights not least in terms of support with the emergency changes to legislation as a result of the pandemic. Thanks to Verity and Becca in this regard.

In addition, Swaran is available for distinct approaches from members.

I want to end by giving a particular thanks to our amazing Independent Sector Leads across Scotland who have been remarkable in working with providers at a local level and feeding in intelligence to us at the national office. Their value is incalculable, and we share a twice weekly video call to update on local issues. Please be in touch with your local Lead.

I also want to welcome Jim Carle who has joined Janice Cameron as the new joint National Lead for the Partners programme. A strange time to join the team but welcome. Huge thanks to Julia for acting as interim lead.

Please do get in touch if there are any issues you feel we need to be focussing on. We will continue to give regular updates on the website.

 

Thank you for all your work at this time.

 

Donald

13^th April