Jeane Freeman, Jackie Baillie, Jonathan McColl, Castleview and Crosslet care homes, where there have been multiple virus-related deaths .
By Bill Heaney
The crisis in Scotland’s care homes has been exacerbated by a patchwork approach to tackling Covid-19, with constantly changing guidance, and made even worse by the fact that the Care Commission had “gone missing,” Labour deputy leader Jackie Baillie said today.
She was replying to the Cabinet Secretary for Health Jeane Freeman’s statement on care homes at Holyrood yesterday.
The Dumbarton, Vale of Leven and Helensburgh MSP, said “We are relieved the Scottish Government has listened to calls from experts and Scottish Labour to expand testing to every care home.
“But we need a clear timetable for care home testing as a matter of urgency. This must include a date by which testing facilities have been taken to every care home in Scotland.
“The Cabinet Secretary has conceded that at a time when people were dying in their hundreds in care homes, the Care Inspectorate adopted a light-touch approach.
“The reality is that the Care Inspectorate has been posted missing during this crisis, and this is confirmed by the Cabinet Secretary’s statement that inspections have only just recommenced.”
Tory member Brian Whittle told MSPs: “The Care Inspectorate instigated an unannounced inspection of Home Farm care home on Skye, which, as the cabinet secretary said, resulted in the Care Inspectorate applying for the NHS to take over the running of that nursing home.
“Unfortunately, there are many tragedies throughout Scotland that have not led to similar action. What are the protocols for such interventions by the Care Inspectorate and the Scottish Government in care homes?”
The Cabinet Secretary pointed out: “The Care Inspectorate is independent, and it is largely responsible for determining which care homes it wishes to inspect, either announced or—this is important—unannounced.
“It has taken the view that it should do what I would call live inspections of care homes, in which it physically goes to the care home, with the appropriate PPE and so on, and undertakes an inspection.
“In doing so, it largely looks at two things: the care homes that it has already assessed as having a red-amber-green status of red or amber; and the care homes in which there is an active case.
The Scottish Parliament at Holyrood in Edinburgh.
“Whether the inspection is announced or unannounced is for the Care Inspectorate to decide. It has a means by which it did does that, and it is largely independent in acting in that way.
“In recognition of its particular role, the Care Inspectorate is actively engaged with us in all the care home work that I described in my statement.
“For care home inspections, it has formed a partnership with Healthcare Improvement Scotland, which has very particular expertise in infection prevention and control.
“In many cases, those inspections will be joint inspections by the Care Inspectorate and HIS.”
Labour’s Jackie Baillie seemed far from content with the reply. She said: “I welcome the cabinet secretary’s announcement on testing, but it is months late. We have witnessed a lack of testing for staff—there was really nothing in place until the third week in April—the reluctance of care homes to send their staff for testing because of concerns about staff absence, and a lack of PPE, with PPE locked in cupboards while coronavirus raged through care homes.
“Why was none of that done sooner? Why have we had a patchwork approach to care homes, with constantly changing guidance? Where has the Care Inspectorate been? The truth is that it has been posted missing. Instead of stepping up to the plate, it has stepped back and taken a light-touch approach at a time when people are dying in their hundreds in care homes. Did the Scottish Government agree to the Care Inspectorate stepping back?”
Jeane Freeman explained: “Part of the difficulty—I mentioned this early in my statement—is that the care home sector is primarily delivered by private business. Some 70-odd per cent of care homes are private businesses, whether they are individual small businesses or part of a much larger chain.
“There are also, of course, independent, third sector and public authority care homes, but they are in the minority. In such circumstances, my capacity—or any health secretary’s capacity—to direct and instruct is limited in a way that it is not in the health service.
“As Jackie Baillie will recall, some time ago—in early March, I think—I put the national health service in Scotland on an emergency footing in order to ensure that, regardless of individual board opinion, I could be sure that it was doing the things that I thought that it needed to be doing in a consistent way across the country.
“The care home sector is not like that, so there is, of necessity, a different approach. Whether that is the right place for us to be and whether we want to be in a different place in the medium to longer term are important issues for debate for a different day. I have to deal with the current reality of the sector.
“I would not dispute any of the points about the reluctance of providers to send staff for testing and PPE in cupboards. The point of the significantly enhanced clinical guidance, direction and intervention is to overcome those problems as best I can.
“The Care Inspectorate took the view—as it was entitled to—that, in the face of the pandemic, it was safest for residents of the care homes for it to undertake inspections and engagement with care homes that did not involve its directly appearing in the home.
“It has now changed that position in order to directly inspect what is happening in those care homes, and I am glad that it has done that. That is a welcome change of decision.”
Sandra White (Glasgow Kelvin) (SNP) said: ” Yesterday, HC-One care homes reported 1,002 suspected cases and 207 Covid-19 deaths in its care homes. Considering the number of homes and beds that HC-One has, those numbers seem to me and others to be disproportionately high. Will there therefore be a review of the practices of large care home operators, and does the cabinet secretary agree that the future of elderly care must be a priority for change?”
Jeane Freeman said this would be a priority: “The Covid-19 advisory group to the chief medical officer and, obviously, to the Government, which is led by Professor Andrew Morris, is focusing on that area. That involves consideration of emerging views from the Care Inspectorate about whether there is a difficulty in large care homes—that is, physically large care homes as opposed to groups of care homes—compared to small care homes in relation to effective infection prevention and control, and in relation to proper support, training and guidance for staff who work in those care homes.
“It is important to make clear that that question is not yet decided and that there is not a concluded view. Members need to be aware that the debate has begun, and that some aspects of both sides of that argument are backed by data and evidence.”
In relation to whether there should be a review of large care home operators that have more than one care home, she told Jackie Baillie that there is “an emerging and genuine need for consideration in the medium to longer term—by the Parliament and the Government—of what our care home sector should be, how it should be funded, who should provide it and what we require of it in providing care to our older and more vulnerable citizens, which many of us will be at some point.
“However, that is for the medium to long term. My focus just now has to be on dealing with the reality that I face given the way in which the sector is constructed as it stands. I need to navigate my way as best I can through that to ensure that, where possible, we maximise the well-being, care and support for residents and staff in the current circumstances.”
Cllr Jonathan McColl, SNP leader of West Dunbartonshire Council, which works together with the local Health and Care Partnership, refuses to comment to The Democrat.