Stepping stones
I’ve been asked to summarise for Scottish Care members some of the steps we’ve seen taken in the social care sector in the last week in response to the Coronavirus. These thoughts are ‘stepping stones’ to cross the currents of uncertainty we are now experiencing confident that if we support one another we will get to the other side.
Care homes
Guidance for care homes facing coronavirus were issued at the end of last week and Health Protection Scotland has issued further guidance last night. Together both make clear the actions which care home organisations and staff need to take in order to ensure as much protection as possible. I have recorded a brief video blog to explain the key measures.
It is of course wholly unnatural for places which are first and foremost home for the 40,000 residents across Scotland, to adopt measures which restrict normal life, exchange and encounter. Sadly, these measures are essential to ensure that folks remain healthy, safe and secure. The key measures include steps to reduce the number of non-essential visits into our care homes and approaches to create social distancing within the care homes to reduce the risk of cross infection.
Everyone acknowledges that this is not going to be easy. We are asking families to have a nominated individual who will visit but on a much-reduced frequency and for shorter times. We are asking those individuals to be prepared to have their temperature taken, to sign a declaration that they are not symptomatic and if requested to wear PPE equipment. Can I stress – because there has been some uncertainty over this – that we are encouraging ALL care homes to be open to family members visiting a relative at the end of life. This is extremely important for everyone’s sake and I know that care homes are taking steps to ensure this vital support is continued. We all need to show compassion to one another.
The past week has also seen great strides in working with partners and others who have volunteered supports into our care home sector. Next week Luminate Scotland’s national arts body for older citizens, hope to launch sessions which will bring exercise, participation and activity back into care homes and into the wider community to support those unable to have physical contact. More information in the coming days on this and on plans to link up technology to ensure folks keep in contact will appear on our public section of the website.
Homecare
Over the next couple of days, it is hoped that we will – with colleagues in Government – be able to issue specific Guidance for those working in the homecare sector across Scotland. It is the women and men who work by going into the homes of our fellow citizens who are often isolated and lonely at the best of times – it is they who are undertaking one of the hardest challenges in facing this pandemic. We are working hard to ensure that these workers are adequately supported and trained to ensure not only their own personal safety but the safety of those whom they visit.
Supply chain
Since Thursday morning at 8 am there has been a triage system in place to enable, through a telephone helpline, social care providers to access PPE equipment and other essential supplies. A huge debt of thanks goes out to NHS National Services Scotland (NSS), Scottish Government and my Scottish Care colleagues in establishing this system. At the moment priority is being given to ensure that equipment is targeted at instances where there is a confirmed or suspected case of Covid-19. I very much hope that a preventative approach to equip staff where there is no confirmed case will commence in the next few days. Scottish Care has surveyed our members to identify where the shortages are and has fed this information into those organising the supply system. It is clearly in everybody’s best interests to ensure that we not only keep our care staff safe but that we can reduce the spread of this virus by the use of appropriate PPE equipment.
Economic sustainability
The economic impact of this outbreak has been the focus of much of the attention in the media in the last 24-48 hours. The social care sector in Scotland is far from immune to these same pressures and indeed before this outbreak Scottish Care and others have been shouting loudly about how fragile the homecare and care home sectors have been. Meeting the challenge of the present and future weeks will cause huge economic impact on care organisations. We have been working with Government to ensure that social care providers have access to the business support schemes which have been established. Equally importantly we await Guidance for Commissioners from COSLA, the local government umbrella body, which we very much hope will ensure that in these challenging times there will be appropriate support, partnership and financial alleviation for the homecare and care home sectors. This simply has to happen, or dedicated care organisations will not be able to continue working.
Workforce issues:
Perhaps the biggest set of issues being faced by providers are those related to workforce. The institution of the 7 then the 14-day self-isolation periods is already having a significant impact on the availability of care workers. We are an older workforce with the majority of workers being over the age of 50 and are also a female dominated workforce at 86%. Taken together with the introduction of requirements for pregnant women, staff with underlying conditions for which they receive the flu vaccine and workers over the age of 70, many of our members are deeply concerned about the inability to have sufficient staff to continue operating. We are working actively with Scottish Government to ensure that there are potential routes into care for those who are being called back, who are in non-essential public sector roles and those who have volunteered their skills. We are grateful for the work of the Scottish Social Services Council and NHS Education Scotland in this regard.
Some of the greatest uncertainty in the last few days has been in relation to childcare for social care workers following the decision to close schools. We are pleased that the Deputy First Minister has prioritised social care staff as Category 1 to ensure that children are looked after. However, we are disappointed that many local authorities are making decisions for cover based on the need for ALL adults in a household to be in an essential service. Whilst we acknowledge that these support measures have to balance the need for social distancing for children and are not there to provide free childcare we would point to the reality that social care staff are often poorly paid and are unlikely to be the main bread-winner in the household. The risk is that a household may prioritise the work of other adults which will mean the carer cannot get out to work because he/she is looking after children especially as older relatives if they are around are rightly unavailable. We hope that we can address this in the days ahead.
It is an absolute truism to say that the women and men who work in our care homes and homecare services are the life-blood of the sector, they enable us to do absolutely everything that we deliver and without prioritising their care and support we will fail to meet the challenge presented by coronavirus. Over the next week it will be a particular focus of Scottish Care to signpost ways in which we can support the emotional, mental and physical well-being of women and men who will be facing untold challenges in the next few weeks.
Regulation
Over the last week we have seen responsive and practical help offered by both the Care Inspectorate and by the Scottish Social Services Council and professional bodies such as the Nursing and Midwifery Council. Whilst there may still be areas where we are concerned that there is unnecessary reporting and duplication of red tape at a time in which providers need to be able to be responsive – it is our hope that these can be positively addressed in the next few days.
Food access:
It has become clear in the last few days in particular that food and the ability to access food has become a major issue. Together with NHS colleagues care staff have been working long shifts and at the end of these have been unable to purchase food in the supermarkets and local shops because of the ‘over-zealousness’ of the general public. We have called upon the major stores and others to prioritise health and social care staff – and I might add informal carers – and yet at the time of writing only Sainsburys has come up to the plate. We are working with Scottish Government colleagues to try to address this issue.
A related issue is the increased inability of care homes to access local food stock because they are being offered small quantities. The care home sector is a diverse one in Scotland. There are larger groups and organisations who utilise national supply companies for food delivery, but the majority of care homes are smaller, often family run SMEs. It is these care homes which have built up the practice to be local and sustainable in their purchase of food especially in rural communities. Ironically it is these organisations that are currently struggling because the local sources and now the supermarkets cannot support them. We have called for these issues to be urgently addressed.
Transport
In the last 24 hours transport companies both on road and rail have intimated that they are going to be running a reduced timetable. Whilst some like Scotrail have indicated that they will run more trains during peak times, we are really very worried indeed that our workers will not be able to get to their work places because of the reduction in public transport. This especially affects homecare workers who do not follow a traditional shift pattern because care is delivered to individuals when they need and want it. They also frequently use transport to get to different homes. It is these workers who often finish – with their care home colleagues – very late at night and are now faced with the possibility of not being able to get home. We urgently need to address this and potentially to create systems where we can utilise taxi services which are being negatively impacted by the loss of other earnings. We need carers to be able to travel or they cannot care.
Palliative care and ethical choice
Over the last few days a lot of work has been undertaken with palliative and acute specialists to re-design palliative and end of life care guideless to face the challenge of Covid-19. This includes the importance of developing Anticipatory Care Plans for Covid which communicate the wishes of individuals who might become seriously ill as a result of the virus. It also includes the desire for flexible access to medication in our care homes. Over the next few days these Guidelines and associated practice will be much reflected upon and discussed. Readers will have seen some of the heart-wrenching images which have come from Italy and will be aware of some of the extremely challenging clinical decisions which have had to be made in Italy.
Scottish Care would wish to clearly state that we consider the use of age as the ‘sole criteria’ for any decisions on accessing respiratory or other life-saving supports to be wholly unacceptable and inadequate. The next few weeks and the decisions we take on clinical life-saving intervention and the extent to which we enable palliation of the dying will mould us not just in our Covid response but as a society and as human beings. An approach which is ethically based, human rights respecting and validating of the citizenship and autonomy of all regardless of age needs to be at the heart of palliative and end of life care during the Covid outbreak.
Positive partnership
It would be inappropriate to finish this brief update without noting that across Health and Social Care Partnerships, Scottish Government, NHS Boards and local authorities there has been a real collective desire to remove barriers and obstacles and to focus on quick , appropriate and practical responses to issues as they arise. This last week at its best has evidenced what the integration of health and social care can look like and in the weeks ahead it is this understanding of the other perspective, listening with respect, leadership which is collaborative and honest, and authentic human integrity which will see us through to the other side.
And lastly alcohol or to be more precise alcohol gel.
Many of you will have read the story of Mike Bain from Deeside Distillers who has single-handedly got together distillers to use alcohol in order to make alcohol gel. This has been a brilliant example of how citizens create change and challenge systems for the greater good. I have no doubt that in the next weeks we will face obstacles and challenges, but I have equal certainty that there will be folks like Mike who will help us overcome them.
Thank you
Donald
