Reporting of Covid-19 deaths to Procurator Fiscal

The Lord Advocate is making a statement to Parliament today (13 May) at 2.15, to announce that he will issue guidance to the effect that the following deaths should be reported  to the Procurator Fiscal:

(a) the deaths of any care home residents due to COVID-19 or presumed COVID-19 and

(b) any deaths due to COVID-19 or presumed COVID-19 where the virus may have been contracted in the course of the deceased’s employment.  Whilst not exhaustive, this will include deaths of care home workers, frontline NHS workers and emergency services personnel.

According to current guidance on reporting deaths to COPFS, one of the functions of reporting deaths to the Procurator Fiscal is to provide additional scrutiny where the circumstances of the death may cause public anxiety. The rationale for this proposed change is to clarify that two categories of deaths from COVID-19 fall within that remit, to enable reporting of these, and to ensure that they can be investigated as appropriate, with a view to assisting in allaying any public anxiety which may exist.

Once COPFS have clarified guidance and decided on a date for implementation, the Chief Medical Officer will issue a letter to all doctors, informing them of this change and highlighting where guidance is available.

Scottish Care welcomes the announcement that the Lord Advocate will use his powers to investigate all deaths of staff who in the course of their work for the NHS, emergency services, care providers and others may have contracted COVID-19.

We further welcome that consideration of deaths which occur in care homes should fall under this category.

Care Home providers always work closely with local parties including the Procurator Fiscal where there is an unexpected or unexplained death.

In the midst of a global pandemic we are eager to continue to give public assurance that the actions of care homes have been entirely in accordance with Guidance issued at the time and that all appropriate clinical intervention has been undertaken.

Such an engagement will help to support staff and providers. We welcome the assurance that will be given to families and residents through an exploration of the circumstances of any particular case, not least in that it will give a clear indication of the degree to which national policy around the use of appropriate PPE, the implementation of testing and other national interventions have impacted on individual deaths.

We are surprised that the same assurances are not being offered for deaths that occur in hospitals, NHS specialist units or community settings .  The Scottish public deserves assurances that regardless of place of support, care and treatment, all appropriate measures have been undertaken.  We call on the Lord Advocate to extend reporting of COVID deaths to the Procurator Fiscal to these areas.

Scottish Care believes that the time is now right to call for a public inquiry into the handling of the COVID-19 pandemic in our care sector.  This inquiry will be an opportunity for all stakeholders – Scottish and UK Government, the NHS, local government, social care providers, individuals and families – to explore issues in order to ensure we are collectively better placed for further pandemics.  

Finding a way through – achieving a balance between risk and protection

Finding a way through – achieving a balance between risk and protection.

 

It is now over eight weeks since Scotland’s care homes went into lockdown. Overnight they changed from places of busy interaction and banter, entertainment and encounter, into environments living under strict infection control and with limited interaction with the outside world. They became quieter places, with people no longer sharing common spaces, meeting up with friends, having a laugh with neighbours, gossiping has given way to silence. Care home staff have tried their hardest to keep life going as close to normal as possible, to give special attention to those who need it, to support through encouraging smile and contact, to encourage and even to entertain. Technology has been used well to maintain contact and to keep connection going but there are many who cannot use it or don’t understand how to.

Frontline staff in many care homes have fought tirelessly to keep the pandemic at bay and through their skill and dedication have nursed many hundreds back to health despite Covid. But as this week yet again bears testimony they have also lost to the virus many people who have died before their time.

Despite all the hard work of staff, care homes are living in a twilight zone, a place of unreality and a place of real discomfort.

I have written before about the aching sadness felt by families who feel that they are slowly losing a grip on the lives of loved ones who are slipping away from memory with each passing day. I have spoken about the tears that are felt as significant birthdays pass by with only a knock on a window or a wave through an iPad by way of family celebration. I have affirmed the importance of being present at the end of life to say goodbye.

At the start of the pandemic the strict infection control measures introduced included a reduction in foot-fall into care homes with an aim of reducing that by 75% to all but ‘essential visits.’  Through time we have seen enhanced measures for PPE, improved testing regimes, stricter admission criteria and now in the latest Guidance published last night, a much greater appreciation of the impact of all these measures on the lives of people with dementia. Over time I think we will come to appreciate that infection control protocols which work in a clinical institutional environment like an acute hospital or unit need to be adapted much more sensitively to fit a place which is primarily someone’s home, where people are not patients and the environment is non-clinical. I am personally very clear that the area where there needs to be much more appreciation and adaptation of infection practice is in the realm of human contact – especially for the vast majority of care home residents  (perhaps as many as 90%)  who live with some form of dementia.

At the start of the pandemic I wrote to a few folks who questioned the appropriateness of some of the early strict exclusion measures and who voiced concern at the impact on the human rights of those involved. My argument at the time was that the measures were appropriate in that they were a proportionate response to achieve a legitimate aim which was the preservation of life. Now that we are eight weeks into those measures and after countless emails, messages and conversations with families and with some residents, I think we all collectively need to reflect on whether our restrictive measures are enabling us to  continue to uphold the human rights of residents and their families, or whether we need urgently to review some of our measures and to adopt more flexibility.

What may have been a proportionate restriction at the start of a crisis and considered acceptable action for a period of time may no longer be appropriate months into the pandemic. I am couching what I am saying very carefully in questions because I do not think we are in the territory of hard and fast answers but in a place where we need to nudge and feel our way forward to solutions.

I think we all of us need to find our way through to a better way of being and living especially for individuals with dementia in our care homes. I am not convinced the current processes are sustainable or remain justifiable. John put the dilemma to me quite clearly – he is nearly 100 with months to live by any calculation, and he wants to spend that time not ‘imprisoned in his room’ (his words) but being with his family even if at a distance. Quality of life matters more for him than quantity of life. He said to me “It is my human right to decide to take the risk!”

For perhaps the overarching concern in all the correspondence I get is the loss of connection and relationship felt by individual residents and their families. No matter how attentive and creative care home staff are there is simply no substitute for physical interaction with family.

The current Guidance rightly states that in situations of ‘distress’ that it is important that families of people with dementia and learning disabilities are allowed contact under strict criteria. Over the weeks it has become clear to me that such distress is not just seen in behaviour which becomes angry, frustrated and challenging but in what I have called a ‘quietism’ where the person withdraws into their skin and self, where they turn their face to the wall despite all the positive measures around them, where they have started to dis-engage and switch off – because connection with those who matter is not there. Many individuals with dementia even if they do not remember the name of loved ones intuitively know they are connected, that they are part of another, related and linked, loved and wanted.

We all of us collectively need to find a better balance between individuals knowing the risk, the requirements to wear PPE, the importance of encounter and the desire to prevent infection at all costs.  But when I speak to care home managers and staff, especially in care homes where there has been no infection, they are terrified that enabling people to re-connect risks putting others at danger. They are also after days of external blame and finger-pointing at the care home sector, terrified of becoming the object of scapegoating if something were to go wrong after they allowed a family member to visit. I think we urgently as a whole society from politician to media, from commentators to citizen, need to empower our care home staff and providers to feel they have the confidence to re-connect people with one another.

And there are ways of doing this. People have spoken of getting permission to have a family member escorted into the building following defined footways and of bringing together individuals at a safe distance in an outside space. Hearing of these ‘reunions’ and the comfort they have brought has been very moving indeed. But we need to do more. For instance, we need to explore the use of testing as a way of connecting people up to their household ‘bubbles’.

It feels really uncomfortable as the rest of the world becomes fixated on ending lockdown that there is a presumption that in care homes this unreal form of existence and dis-connection will go on for much longer. We must, I believe, give trust to professional care staff to find new ways – safe ways – to connect family.

Scottish Care has established a clinical care group which over the last two weeks has been  actively exploring how we can work better in this area and develop models and approaches to get the balance right and to better restore the human rights and choices of residents. But it needs the rest of society to embed trust, give confidence, and permission to the care home sector to restore relationships. We urgently need to find a way through from where we are which is no longer tenable to something resembling human connection, with families being together and re-united with residents in compassion and love.

Donald Macaskill 

75th Anniversary Victory in Europe (VE) Day Commemorations

The 8th May 2020 marks the 75th anniversary of Victory in Europe (VE) Day, the end of the Second World War in Europe.

In commemorating this anniversary, it has been the Scottish Government’s aim to help the people of Scotland recognise that the relative freedoms and liberties which they now take for granted, despite our current circumstances, are due to the many personal sacrifices of our Second World War generation.

As such we have been working in partnership with Legion Scotland and Poppyscotland, and in collaboration with the other Governments across the UK, to mark this historic day.

We would like to take this opportunity to share VE Day themed activity resources with you. These include 1940s recipes, dance steps and music playlists, all of which have been created by Poppyscotland and English Heritage.

These virtual resources, along with a programme of virtual content to be hosted online by Legion Scotland throughout the day, have been made to ensure we are all still able to mark the end of the Second World War in Europe across the nation, whilst still adhering to current physical distancing restrictions in place due to the Covid-19 pandemic.

These resources can be found at the following links –

https://www.english-heritage.org.uk/visit/inspire-me/ve-day/

https://www.poppyscotland.org.uk/get-involved/ve75/virtual-ve-day-party/

International Nurses Week (6-12 May) commences today

Today (6 May) sees the start of International Nurses Week, this celebration week will run until Tuesday 12 May, which marks International Nurses Day

This year’s theme is compassion and throughout this week, Scottish Care are collating and sharing stories from care homes and individuals. You can read the stories or videos we have shared so far here.

 It is important to share these positive stories to recognise all the work nurses and care home staff do, especially during these difficult times.

On Tuesday 12 May, to mark International Nurses Day, we are encouraging care homes to take part in a “Take a T break” – with the T standing for thank you. This is a chance to say thank you for our dedicated nurses, carers and teams for all the work they do and for stepping up to the challenges of Covid-19.

If you want to get involved, please share your compassionate stories through social media using the hashtag #carenursescot. If this is not possible, you can email your stories to [email protected].

To start of this week,  Jacqui Neil, our Transforming Workforce Lead for Nursing has recorded a video message.

Scottish Care statement on face protection in care services

Last week, in light of national statistics and international clinical evidence Scottish Care called for an extension of Covid-19 testing and the use of face protection in care services. We welcomed the decision of the Scottish Government to implement testing extensions for all care home residents and staff where a case of COVID-19 is identified as well as wider and more regular precautionary testing for monitoring purposes. We continue to call for the testing of all care home residents and staff as the optimum measure to enhance prevention and safety.

As we so sadly continue to see, care homes are being hit extremely hard by this virus and we need to constantly review and revise our national approach to best support residents, relatives and staff. Distressingly, we may still not have reached the peak of the virus in care homes and anything that can be done to protect individuals and services and reduce risk of infection spread and deaths must be implemented with urgency.

As knowledge and advice in relation to the virus develops, we are seeing particular spread risks associated with pre-symptomatic and asymptomatic cases.

That is why we are again calling for a change to national guidance so that all staff in care homes and providing care at home – regardless of role, Covid status or proximity to others – wear face protection in order to reduce the transmission of the virus.

If it is appropriate for face protection to be worn when citizens go shopping then it seems even more important that face protection is worn when providing support of any nature to individuals who are particularly vulnerable to Covid-19. This includes the use of face masks when within a two-metre distance and when providing direct care and support, regardless of Covid status.

This approach can help to minimise asymptomatic or pre-symptomatic spread of the virus and provide some additional assurances to understandably worried residents, relatives and staff. We acknowledge that some Health & Social Care Partnerships have implemented this approach but it is crucial that we see a consistent, unambiguous national directive in this regard.

We recognise that for services which do not normally require masks for this level of use, this will be a massive increase in demand for PPE. It will be necessary for supply challenges and increased, unsustainable costs to be addressed as a matter of urgency.

We also recognise the challenges posed by supporting people with dementia, hearing impairment and other conditions which can mean that the constant wearing of face coverings can cause additional distress. Scottish Care remains committed to working with providers and partner organisations to ensure a ‘new care normal’ can be developed which recognises both the urgent need to protect life as well as to promote and sustain quality of life.

5 May 2020

Updated HPS Covid-19 guidance

Health Protection Scotland has recently split the Social, Residential and Community setting guidance into 3 areas to increase accessibility for users. Please see below for the links to the guidance.

Covid-19 Information & Guidance for Care Homes: https://hpspubsrepo.blob.core.windows.net/hps-website/nss/2980/documents/1_covid-19-information-and-guidance-for-care-homes.pdf

Covid-19 Guidance for Domiciliary Care: https://hpspubsrepo.blob.core.windows.net/hps-website/nss/3046/documents/1_COVID-19-guidance-domiciliary-care.pdf

Covid-19 Information & Guidance for Social, Community & Residential Care: https://hpspubsrepo.blob.core.windows.net/hps-website/nss/3045/documents/1_COVID-19-Guidance-Social-Community-Residential-Care.pdf

 

 

 

The Forgotten Frontline: homecare during the pandemic

The Forgotten Frontline

As I sit here writing this I am looking out of my window and seeing two workers who have become a familiar sight as I work from home in the last few weeks. They are homecare staff coming to do their early morning shift in the sheltered housing complex beside which I live. They are there like clockwork morning, noon and late evening. They drive in two separate cars, get out, put their PPE on and enter the building. Their laughter and humour punctures the silence of the street. Their humanity is obvious, their care compassion needing no badge.

According to the latest data there are 71,000 women and men who work in Scotland’s care at home and housing support sectors. They work for local authority, charitable, voluntary and private providers.

In some senses during this pandemic they have been the forgotten frontline. The devastating impact of the virus on residential and nursing homes and the acute loss of life has rightly gained public and media attention and focus. But we should not forget as I think we have been prone to do, the impact of this virus on the lives of those who are supported in their own homes.

Perhaps one of the reasons for this forgetfulness is the reality that many individuals do not actually know what happens in homecare. Yet more people are supported in their own home every day of the year than in our NHS hospitals and care homes combined. Homecare services are a lifeline to thousands of our neighbours.

So why is homecare important? Why is it that thousands of women and men are putting their lives on the line, leaving their families, donning their PPE to go into the homes of others to deliver care and support?

This pandemic has shone a light on the extent to which, so few people understand what homecare is. For too many there is still an outdated image of homecare as ‘mopping and shopping,’ as a set of practical activities designed to make people feel better but not much more than that. As almost like an added luxury!  The truth could not be further than that.

Too often there is a convenient and wrong conflation of social care with health care. So at Scottish Care we have stated that social care should be seen as :

‘The enabling of those who require support or care to achieve their full citizenship as independent and autonomous individuals. It involves the fostering of contribution, the achievement of potential, the nurturing of belonging to enable the individual person to flourish.’

Homecare is that care and support which enables and empowers an individual to be free, autonomous and independent in their own home. It is the energy which gives purpose to someone wanting to remain in their own space and place, it is the structure of support and care which enables citizens to remain connected to their families and friends, their neighbours, streets and villages. It is not an added extra but the essential care that enables life to be lived to its fullest.

The best of homecare is a care that changes life and gives life.

Some of my blog readers may know that I am a bit of a Bruce Springsteen obsessive. In an interview which he gave around the time he launched his autobiography in 2016, Springsteen said that:

‘You can change a life in three minutes with the right song.’

At the time the sense of words and music changing and transforming a life struck me as being a powerful description of the musicality of one of the greats of his genre. But I also think that it is a description of the essential life changing and enabling power which lies at the heart of all care. It is this ability to change a life through care and support which has become so evident in this pandemic.

The women and men who work in homecare are life-changers. The reason that statement is true is that by their acts of personal care, by supporting someone to take their medicines, to get up in the morning; by making sure their space and place is tidy and safe, that hazards are controlled or removed; in ordinary times by taking someone to a club or to their family, to an activity or simply to belong somewhere, these women and men who are the workers of care are the gifters of purpose and meaning to so many. This is not incidental it is essential. It is this work that binds a community together, that truly creates neighbourhood, and moulds togetherness in the midst of our cities, towns and villages.

Most of us are able to be independent – to get around on our own, to have control so that we need not be dependent upon another. As life changes through age or illness the loss of that independence and the forming of bonds which make us reliant upon another can be both challenging and difficult for our sense of identity and self-worth. It is in this territory that the marvellous work of support and care locates itself and comes to the fore.

Good care is not about taking over another person’s autonomy, good support is not about creating dependency – they are both the total reverse. They are the actions and deeds, the words and encouragement that enable others to either re-discover or find for the first time, the abilities to make decisions, to exercise choice, to be in control and to be independent even if support is needed to achieve that goal.

This is why homecare is important –  this is why during this pandemic we cannot forget this frontline force of life and change.

Yet homecare has always existed on the knife-edge of economic sustainability. Delivering care and support is a costly exercise and for too long as a society we have sought to buy care on the cheap. Before the pandemic you could earn more money for walking a dog in Edinburgh than you could for caring for a fellow human being in their own home. During this pandemic faced with extortionate cost rises in PPE equipment homecare organisations would never ordinarily use, there is a real danger many of our small Scottish organisations may go out of business. As families have been on lockdown hundreds of care packages have been cancelled because folks are home looking after brother, sister, mum or dad. Some local authorities have cancelled contracts prioritising what they have termed as critical support. This has had a profound impact on care organisations.

We urgently need to ‘wrap our arms of care’ around those who care in our streets and the homes of our neighbours, the providers and workforce alike.

The autonomy that homecare gives a supported person enables them to flourish to their best and continue to grow into the person they want to be.

I hope we will all of us grow in valuing and recognising the work and the workers who I see every morning. If a good song can change a life in three minutes then good care and support changes a future forever. Yet if we forget this frontline during the pandemic the song will be silent and lives will not be lived to their full potential.