Scottish Care’s statement on hospital transfers to care homes

In the early days of the pandemic the wider societal and political concern was the risk that the NHS acute sector would not be able to deal with a massive increase in patients requiring treatment for COVID19. It was at this time that there as a focus on creating capacity within NHS hospitals by ceasing routine non-essential treatments, by maximising the availability of respirators etc. At the same time there was a push to discharge individuals who were fit for discharge either to their own homes or to care homes.

In ordinary circumstances an individual is discharged when they are clinically fit. Before Covid-19 this was often a process which was delayed as a result of the non-availability of care home beds. This was not because the beds were not available but because the funding from public authorities was not sufficient to enable these transfers to take place. Yet even before Covid-19 there were circumstances where at best the eagerness of hospital discharge had led to a breakdown in relationships with the care home sector. The most commonly cited instance was where a clinician considered someone to be able to be supported in residential care, they were then discharged and within hours it was clear they required nursing not residential care. So, looking back from this position we have to be clear that the process of clinical discharge into care homes before Covid19 was one which was not always smooth and frequently problematic. As a result, there was often a local distrust in the system.

This level of challenge was reflected in the Clinical Guidance issued by the Scottish Government on the 13thMarch which stated:

‘Transitions from hospital.

There are situations where long term care facilities have expressed concern about the risk of admissions from a hospital setting. In the early stages where the priority is maximising hospital capacity, steps should be taken to ensure that patients are screened clinically to ensure that people at risk are not transferred inappropriately but also that flows out from acute hospital are not hindered and where appropriate are expedited.’ (page 4)

Because individuals were not routinely tested at the point of discharge at this stage of the pandemic, despite the requests of the care home sector at the time, there was a real concern that people who entered care homes might be infectious.

Scottish Care’s CEO, Dr Donald Macaskill held a meeting on the 18th March with the Cabinet Secretary for Health and Sport and highlighted that care home providers were expressing concern over discharge and that some were refusing to admit new residents. During the meeting he stated that the previous relationships between the acute and care home sector had sometimes not been as good as it might have been. As a positive result of the meeting the Clinical guidance was revised and re-issued on the 26th March.

This Guidance made the process of admission much clearer.

It states:

‘4.2 Admissions/transfer from hospital to care home facilities

HPS updated guidance states that if the individual is deemed clinically well and suitable for discharge from hospital, they can be admitted to the facility after:

  • appropriate clinical plan.
  • risk assessment of their facility environment and provision of advice about self-
  • isolation as appropriate (See NHS Inform for details). (page 4)
  • there are arrangements in place to get return them to the facility

Decisions about any follow-up will be on a case by case basis.

If a patient being discharged from hospital is known to have had contact with other COVID-19 cases and is not displaying symptoms, secondary care staff must inform the receiving facility of the exposure and the receiving facility should ensure the exposed individual is isolated for 14 days following exposure to minimise the risk of a subsequent outbreak within the receiving facility.

Individuals being discharged from hospital do not routinely need confirmation of a negative COVID test. Facilities will be advised of recommended infection prevention and control measures on discharge. It is recommended that this includes a documented clinical risk assessment for COVID-19.’ (pages 4-5)

We recognise that from the 21st April it became a requirement for all patients being transferred from hospital to receive a negative test.                                                             

Dr Donald Macaskill, the CEO of Scottish Care states:

“It is important to state that amongst those who were Covid positive and who entered care homes in March and April there would be some who were no longer infectious because of the length of stay in hospital. In addition, there would be others who were returning ‘home’  because they could no longer benefit from acute sector care and who were on a palliative and end of life care trajectory. For those individuals it was important that they were able to die in familiar and supportive surroundings. In all cases of knowingly accepting a Covid positive patient as a resident the care home would have instigated robust care and support to ensure the protection of staff and other residents.”

 

 

Update on death in service indemnity cover – students on supernumerary placement

We have been made aware of an update relating to students on supernumerary placement in health and care settings.

In order to provide students and their families peace of mind at this time, the Scottish Government has confirmed that it will provide a temporary COVID-19 related death in service scheme to students of Higher Education Institutes on clinical placements in health and social care settings. This provides a single lump sum payment of £60,000 to the next of kin of any student of a higher education institute, should the worst happen.

The cover is now in place and further detail on the scheme will be circulated next week. If you have any questions, please do not hesitate to get in touch via the CNOD Education mailbox: [email protected]

 

Life interrupted: preparing to do better. A blog from our CEO

I have been thinking a lot this week about the weather.

The weather has always fascinated me, which is probably just as well for someone born in Scotland and with my surname (that latter observation will be lost on anyone born after 1980!) My love of all things meteorological was renewed when in Skye two weekends ago I saw the weather continually change in the distance with the regularity of a dance, one minute bringing torrential rain and the next blazing sunshine. Skye is a place where  Crowded House’s ‘Four Seasons in One Day’ should be the theme tune of existence. With a wide vista and far horizon, it is indeed possible to ignore weather forecasts and simply look out of the window and know what you need to wear – at least for the next hour.

This last week for many of us has been a reminder of the unpredictability of the weather with torrential thunderstorms and searing heat bringing with it destruction and devastation alongside sleepless nights and irksome hot working days.

One weather phenomenon I fell in awe of was something I witnessed years ago when on another island – the storm. Living in Holm, Orkney for a year gave me the experience of feeling the intensity of the ‘calm before the storm’, that stilling of life and sound before the flick of a celestial switch brought roaring power and breath-taking energy raging down upon you.

There is a sense for me that the recent past, these present days and what the future might hold feels a bit like experiencing an Orcadian storm.  

The last few months have been a time of unreality. It is hard to remember what life was like in pre-Covid times. Indeed, when I see on television a programme filmed before March my instant reaction is to recoil at the lack of social distancing and question the absence of masks and PPE! Our worlds of perception have changed markedly.

Life as we know it has been interrupted, whether you are a young person aspiring to a career dependent up certain grades or someone wanting to go on holiday to France or Spain; whether you are simply wanting to be with your mates in a pub, go to the football, travel to visit family, have that operation and procedure you have been waiting for, life has been put on hold. The rhythms of our ordinary living have been interrupted and removed by coronavirus. We yearn for a return to ordinariness and yet we are told by our leaders that we should not be feeling and doing things as if life was ‘normal.’

But the last few months have for countless thousands also been a period of real pain, loss and hurt.

It feels as if now we are in a hinterland, in a waiting time. The focus of so much of my time in the week that has just passed has been spent on preparing. Preparation for a resurgence of Covid, for the impact of the winter flu, for the unknowability and the uncertainties of our Brexit exit. Preparation to ensure that the social care and health systems are able to withstand the barrage of another assault, a different battle and a new challenge.

But as with a sense of calm before the unknown we have time to reflect and think, to recollect and to change. So, what should we be doing in this hinterland time? I think we have to in this liminal space between our past and unpredictable future prepare to do better and to be better.

There are aspirations I have for restoring a better way of interrupting life and normality so that we can come through future challenges in a way which is closer to who we want to be both as individuals and as a society.

So, in this hinterland of life interrupted let us prepare to do better.

Let us prepare to listen to those who are experiencing the agony of aloneness and mental health fatigue and breakdown. We have to attend better to the issues that  mean that people are struggling in their mental health with the interruption of the normal – we are all creatures of habit to a greater or lesser extent and the habits of our humanity have been thrown out of kilter. There are countless who have suffered in isolation and who today are anxious over the prospects of their future, potentially being unemployed or unable to achieve their dreams and aspirations.

Let us prepare to do better in supporting those who have lost loved ones during the pandemic and who might do so in the future. We have to do better at talking about death and dying, to stop ourselves becoming numb to the statistics of death and start finding a vocabulary that enables us to speak and to share grief with one another. In England hundreds have died from this virus in the past week yet their deaths are diminished by political silence and absence from media comment. We have to do better at working at the solace of comforting one another.

Let us prepare to do better in our care homes by really listening to what residents and families want in these changed times. We have to start to really include and involve people whose lives have been turned upside down by the pandemic. Emergency response may have justified non-inclusive action and decision-making, but in these times and moving forward we have to find better ways at making sure the autonomy and individual rights of those who reside in care homes and their families are considered just as important as the views of ‘experts’, professionals and staff.

Let us prepare for the future by making sure that we really learn the devastating truth of deterioration and decline in the health and wellbeing of care home residents by better managing measures taken to protect but which have stopped people living a life which is theirs by imprisoning them from contact and relationship, from movement and activity in their care homes. We need to do better at protecting and advancing holistic care and support including making sure in the future health professionals are physically present in care homes.

Let us do better and prepare to change a system of community social care commissioning which treats individual citizens as packages of commoditised care and let us start to re-discover the essence of relational support. There is a wave of unmet need and family carer breakdown in our communities about to overwhelm us.

Let us prepare to ensure the physical realities of ventilators and stand-by hospitals, of PPE and medical supplies are in place but let us also remember we need to continually do something about the health and wellbeing of an exhausted and sometimes demoralised staff. In particular let us face up to the reality that many working in leadership and management in social care are at breaking point with exhaustion not least from the continual demands from an insensitive system over which they have no control. We need to appreciate that we are at risk of haemorrhaging managers from the care system because of a lack of professional respect and understanding or simply because they are spent and knackered by the weeks and months that have passed.

I could go on, but I am convinced in this time and space we have to not just learn lessons but to start working on doing better.

And perhaps the biggest challenge is one we all face and one which I think only now we are beginning to truly appreciate – and that is that we are all of us needing support in order to live this life less ordinary. We need support to learn to live with a lack of the familiar and routine; whether that be working from home, coping with different models of learning for our children; not being able to be as autonomous as we once were, or simply how to ‘be’ healthy in a world of social distance and physical detachment. In a sensual physical world, we have to learn to give assurance and affection without touch and presence. We all of us have to live in our mid-Covid hinterland between past lives and future uncertainty.

In the fragmented space of our normality, in that hinterland between ordinary days and unknown future, we have to work together to create a response which roots us in our shared humanity and our collective need to be compassionate and to care. As we yearn for the familiar and the ordinary, we have to support each other to find our ways through the fractures of feelings which for many are raw and painful, confused and conflicted.

On the other side of the storm the world is forever changed. There is a freshness of air and a breath which invigorates. As we gather up the driftwood of our past we find a new purpose and direction for our present. I hope that will mean for many of us the finding of beauty in the ordinary and meaning in the mundane. We will be able to look out and see the clouds and the sun gathering on the horizon and feel at ease with who we have become as individuals, as a care system and as a community, and we will find the clothes we wear are dignity, care and compassion. It is a future we have to prepare for just like the Scottish weather.

Donald Macaskill

Forthcoming UK IPC guidance for the remobilisation of health and care services

Please see letter below from Scotland’s CNO, CMO and National Clinical Director regarding the UK IPC guidance for the remobilisation of health and care services which is due to be published. The letter provides an overview of the key messages and outlines the Scottish Government’s expectations in terms of implementation.

CNO CMO NCD Letter_IPC remobilisation guidance COVID-19_14 August

Launch of Turas Care Management Tool

Identifying care home risks earlier

Better information recording for residents and staff.

A new web-based tool, commissioned by the Scottish Government, will allow care homes to monitor coronavirus (COVID-19) trends and identify risks quicker.

The Turas Care Management tool will launch on Friday (14 August) and will allow all private and public sector care homes across the country to record in one place information including COVID-19 infection rates, demand on services and staff testing.

This will mean care home managers, health and social care organisations and the Scottish Government can monitor trends, identify risks and take early action both during the current pandemic and in the future.

The care management tool, developed by the Scottish Government in collaboration with the Care Inspectorate, Scottish Care and NHS Education Scotland (NES), will provide:

  • a clearer national picture of conditions in care homes
  • earlier warning of emerging trends and issues, allowing earlier interventions
  • easier reporting to free up care home resources

The tool is for care home management use and only identified staff will be able to access the information.

Health Secretary Jeane Freeman said:

“The health, safety and wellbeing of care home residents both during the current pandemic and in the future is critically important.

“This new web-based tool allows care homes to store information in one central place, whereas before they were required to report in different formats and through many channels, which tied up resources and made trend-spotting more difficult.

“Importantly, this means care home managers, health and social care organisations and the government will now be able to identify risks earlier and quickly take action during the current pandemic and in the future.”

Care Inspectorate Chief Executive Peter Macleod said:

“The care sector has worked tirelessly under the most challenging circumstances to care for some of the most vulnerable people in Scotland during the pandemic.

“This new approach to gathering data and information will help us to better understand what support the sector needs to ensure that people experiencing care are supported in the best possible way in the future.”

For more information and guidance for care homes, please follow this link: https://learn.nes.nhs.scot/34427/turas-care-management-user-guides 

Funding to prepare practitioners for non-medical prescribing

I am delighted to advise that we have secured 5 places on the non-medical prescribing course (see letter below for more information) This will be funded up to £1000, with individual universities setting their own cost per module. This module requires the support of a GP or advanced nurse practitioner who has already completed this, and must be confirmed before commencing the course.

This opportunity has the potential to make and shape the future role of care home nursing and therefore requires a high commitment to ensure successful completion.

Applicants can apply directly to the university.

There are 2 cohorts being funded starting September/Oct 2020 and Jan/Feb 2021.

A nomination form is attached and should be completed and submitted by the 26th Aug. Once funding agreed staff can apply to the university.

Apologies for the short timescales as this has only now been released.

If you require any further assistance please feel free to contact NES at [email protected] .

 

Jacqui Neil

Transforming Workforce Lead