By Jeane Freeman, Cabinet Secretary for Health and Sport
Today I want to set out the steps that we have taken, including the additional action that we set out at the weekend and yesterday, to support residents and staff in care homes across Scotland as they deal with the impact and challenges of Covid-19.
Although the majority of people who contract the virus experience mild to moderate symptoms, for our most vulnerable citizens Covid-19 is a vicious virus. Among those who are most vulnerable to its impact are people who are older, who are frail and who have existing health conditions. Many live in care homes. Care homes are not just institutions, of course—they are people’s homes.
Not all care homes are the same. The care home sector in Scotland is provided primarily by private sector businesses, with a smaller proportion of owners from the independent and third sectors and public authorities.
However, there can be no doubt that the staff who work in all care homes and in community social care are, like our staff in the national health service, committed to doing their very best every day, and they are being sorely tested by the risks and challenges with which they are dealing as they care for their residents in the face of this pandemic.
In early March, we issued clinical and practice guidance for care homes that set out what we believed to be the risks and the resultant clinical and practical steps to be taken, including the ending of communal activities, communal dining and unrestricted visiting. That guidance was updated on 26 March and again on 15 May. Each iteration is a reflection of our growing understanding of the virus and the situation on the ground in some of our care homes.
As global supply chains for personal protective equipment became increasingly challenged and the normal private supply routes to the care home sector were disrupted, the NHS National Services Scotland social care triage helpline was launched on 19 March, so that, at national level, we could step in and respond to urgent requests for PPE from social care providers, including care homes. We increased our NSS order volumes to make sure that we could cope with the additional demand from the social care sector and primary care and pharmacy, as well as the additional demand from acute care.
To make sure that we could get the right PPE to the right people, we created direct distribution routes, including local PPE hubs for social care providers—which covered care homes—and direct distribution, where that was needed. That was and continues to be a remarkable logistical achievement by the people who were involved and I thank NSS and local health and social care partnerships for their considerable and continuing work in the area.
For care homes, as for the NHS, an area of concern was the sustainability of the workforce. Alongside NHS staff, social care workers have been the priority group for testing from the outset. In many cases, staff were absent because a member of their household had Covid-19 symptoms, so the testing was designed to ensure that a positive confirmation or not of the presence of the virus would either confirm the need for absence or allow staff to return to work. That must also mean that there is availability of a back-up workforce, to ensure that rotas are stable. Following the call to social care and NHS staff who had left the profession to volunteer to return, the Scottish Social Services Council national accelerated recruitment portal went live on 29 March, so that people with relevant skills and experience could come forward and be ready for deployment.
By yesterday, 18 May, 895 individuals had been cleared to work in a variety of social care settings, including care homes. Of those individuals, 254 have been matched with employers so far. Several hundred additional checked, cleared and skilled employees are ready to begin work. Today, as I have already been doing, I am urging providers to make full use of that significant additional resource.
We also recognised that it was inevitable that the pandemic would impose additional costs on the social care sector, as it has done on health. Working with the Convention of Scottish Local Authorities, the trade unions, Scottish Care and the Coalition of Care and Support Providers in Scotland, we were able to announce a national uplift of 3.3 per cent in the total hourly contract rate for adult social care providers, starting from 1 April.
We also reached agreement with COSLA to meet other additional costs incurred, including additional payment to third sector and independent care providers who are working on local government contracts, to cover sick pay, in line with terms and conditions, for all staff who are off work because they are ill or self-isolating.
On 12 May, I announced an initial £50 million to support social care provision that is commissioned by health and social care partnerships in care homes and for care-at-home services, to provide resilience in the sector and to deal with increased need as a result of Covid-19.
As I have said, social care workers have been in the priority 1 group of key workers from the outset, and to date, around 30 per cent of key workers tested have been from social care. However, I am also aware that there are social care workers who, because of their employment contract, are anxious about being tested, because if they test positive and go off work—as they should—their weekly income will be reduced to the level of statutory sick pay. For those workers, that is an intolerable position to be in. It is a terrible choice between their commitment to the care of residents, their own health and that of their family, and the risk of a significant and unmanageable reduction in their income. That arises solely from the contract that the employer has put in place, so it is not the case for all social care workers. For those who are affected, however, it is an impossible choice that we need to resolve.
Yesterday, I spoke to Donald Macaskill from Scottish Care, and I know that he and COSLA are meeting today to discuss how the matter can be resolved. I have asked for an update following that meeting, but I have been clear to him and to the unions that have raised it with me that I will help to resolve the matter where I can.
On 15 April, the First Minister announced that all symptomatic patients in a care home would be clinically assessed and offered testing for Covid-19. Two days later, the chief medical officer wrote to ask all health boards to make testing available to all residents and staff in a care home that has an active case of the virus. We have taken steps to ensure that admissions to care homes are tested in advance of admission and, in the case of community admissions and admissions from hospital when the patient was not in hospital for Covid-19, residents are also isolated for a period of 14 days on admission.
Yesterday, I announced that all care home staff will be offered testing, regardless of whether the care home in which they work has a Covid-19 case. That will be an iterative process, with testing undertaken every seven days. We will begin that work from next week, and are working now with our NHS testing capacity, senior NHS staff and Scottish Care to plan the implementation of the process, including the prioritisation of care homes for testing. Every effort will be made to ensure that testing can be undertaken as close to a care home as possible.
Just as the virus is new to scientists and clinicians around the world, it is also new to the social care sector. Like us, they are having to learn, adapt and improve their response as their understanding grows. That includes increasing the level of clinical oversight and practice expertise that we provide to ensure the welfare of residents and staff during this time. We already have an effective system of inspection for social care in Scotland, and the Care Inspectorate, now with its partners in Healthcare Improvement Scotland, is actively engaged in the direct inspection of individual care homes and providing support and guidance, as well as escalation when that is required.
From 20 April, NHS directors of public health took on enhanced and urgent clinical leadership for care homes in their board area, working closely with the Care Inspectorate, local authorities, general practitioners and district nurses, and being supported by the care homes clinical and professional advisory group, overseen by the chief medical officer and our chief nursing officer, and by the care homes rapid action group.
On 17 May, I set out a further enhancement of those arrangements, including the requirement that each board’s medical director and nursing director, each local authority’s chief social work officer, and the chief officer of each health and social care partnership should work to provide direct and frequent engagement with each care home in their area. That was to ensure effective infection prevention and control practice; testing in the way that I have set out; the adequacy of PPE, and its appropriate use; and the robustness of staff rotas. It was also to ensure the provision of direct NHS staff support where that was required. Such arrangements are not about medicalising the provision of care in care homes, which, as I said earlier, we should remember are people’s homes. Rather, they are a necessary response to a national emergency that has to be centred on public health and clinical need.
Members will be aware of the important amendments to the coronavirus emergency legislation at stage 2 that will be considered by the Parliament tomorrow. I will not encroach on that debate, but I will say, firmly, that I consider those amendments to be necessary to provide the necessary level of safety by taking immediate action in particular circumstances to secure the safety, well-being and continuity of care of care home residents.
I have set out, as best I can, all the key steps that we have taken to ensure the safety, protection and well-being of residents and staff in our care home sector. This is not the end of our work by any means. I am certain that we will have more to do and more improvements to make. When that is the case, I assure members that that is what we will do.
- More than 40 residents of care homes in West Dunbartonshire died over the past three months after contracting corona virus. Editor