Care home report criticised for not including frontline experiences


At least 78 older people were discharged from NHS hospitals to Scottish care homes after testing positive for covid-19 in the early months of the pandemic, a new report has found.


Public Health Scotland said that just 650 of the 3,599 people discharged from care homes between 1st March and 21st of April were tested for covid-19. Eight in ten people discharged were never tested.


Of those tested, 78 received a positive result while in hospital before being discharged to a care home.


However, the report does draw a link between the risk of outbreaks and the size of a home.


Nicola Sturgeon insisted that the report found no statistical relationship between hospital discharges and outbreaks in care homes.


But Scottish Care, which represents different social care providers, said:


“We should have initiated testing for all discharges much earlier than we did. The report makes it clear that there are real benefits from this testing process.”


CEO Dr Donald Macaskill described the report as “only part of the story” because it misses the experience of frontline care workers who believes hospital discharges led to the virus being introduced in their care home.


The report covers discharges that took place as hospitals attempted to free up capacity ahead of an anticipated surge in covid patients. At the time there was no requirement to test patients before sending them to a care home.


Advice changed on the 21st April to specify residents should receive two negative tests before discharge and that any new admissions to care homes should be isolated for 14 days.


Between this date and the end of May more than 90% of patients discharged to care homes were tested. Although the majority tested negative, 278 tested positive.


However 45 of these patients did not get a negative test result prior to their discharge, the figures suggest.


More than three-quarters of the 1,084 care homes in Scotland received a resident from hospital between March and May.


Just under half of the 4,482 covid-19 deaths in Scotland have happened in care homes.


Responding to questions today, Nicola Sturgeon said: “One of the things that the report does seem to find which is the most significant factor in outbreaks was the size of care home.


“That is not blaming care homes and it is not blaming staff it is simply recognising that bigger care homes, there are perhaps more interactions, there is perhaps more of the risk of community transmission getting into the care homes, so we have to think about how we work with and support larger care homes to better mitigate that.”


The First Minister added: “Let me be clear that this does not say that hospital discharge in all circumstances was not a factor at all, it just says that it wasn’t a statistically significant one.


“That doesn’t take away from the need for us to learn about what did happen in care homes so that we can make sure we make the changes that are designed to minimise and mitigate that for the future.”


The issue of hospital discharges rose up the agenda after a Sunday Post investigation found dozens of patients who had tested positive for covid were sent from hospitals into care homes near the beginning of the pandemic.


The true figure was thought to be higher as not all NHS boards responded to requests for information from the newspaper.


UK scientific advisors have previously said that outbreaks in care homes cannot be pinpointed to one single cause, with one top Scottish medic telling they were “complex and multi-factorial” and likely to be different for each facility.


Dr Macaskill of Scottish Care said:


“At the start of the pandemic all the emphasis was on the preservation of the NHS. Our politicians and medical advisors stood in front of posters which read ‘Protect the NHS’.


“The care home sector and its workforce played its part in that protection, and can be assured that in the majority of instances that support through enabling people to come home or be admitted, was not a significant risk factor for outbreaks.


“However, we need to ensure that where people are convinced there was a direct relationship between discharge and outbreak that this belief needs to be investigated.”


Dr Macaskill added: “Some of our members and staff who work in care homes in a few cases believe that Covid-19 was introduced into their care home community as a result of discharges. I hope the researchers can take some time to listen to the experience of staff in care homes where there have been significant outbreaks.


“At the moment we have one side of the story, what is missing is the frontline experience of our care sector and its staff, the voices of those who received care and their families.”


by Henry Anderson


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Scottish hospital to care home discharge data published


Public Health Scotland (PHS) has published a report on discharges from NHS hospitals to care homes in Scotland.


Health Secretary Jeane Freeman commissioned the report in August to identify and report on discharges from hospitals to care homes during the first wave of the COVID-19 pandemic.


The report found the strongest association with outbreaks of COVID-19 was care home size, even when taking account of hospital discharges and other factors such as care home type, in line with findings observed by Public Health Wales in a similar report.


PHS found that while hospital discharge is associated with an increased risk of an outbreak when considered on its own, the estimated risk of an outbreak was reduced and not statistically significant after accounting for care home size and other care home features.


Of the care homes with more than 90 residents, 90.2% had an outbreak, compared to just 3.7% of homes with fewer than 20 residents.


Health Secretary Jeane Freeman said:


“This is the biggest public health crisis we have faced in our lifetimes and the impact on care homes around the world has been profound. Every life lost to the virus is a tragedy and a loss that will be deeply grieved by their loved ones.


“I commissioned this report because it is right that residents, families, staff, and Parliament, have accurate data and independent analysis on the transfer of patients to care homes and the impact that had in those care homes.


“Care home staff have a critical frontline role and I want to pay tribute to all staff involved for their compassionate and skilled work to overcome the many challenges presented by this pandemic.


“The data from this report gives us a better understanding of the impact of discharges on outbreaks in care homes. We will be taking forward the recommendations that PHS make in their report, and we will continue to adapt our guidance and the steps we are taking to protect care home staff and residents in line with the latest data, scientific evidence and clinical advice.


“Keeping COVID under control requires a continued collective effort and we only succeed if we all play our part. That is why I ask again that everyone across Scotland abides by the current restrictions. Please do the right thing and help to keep our country safe.”


You can access the full report here. 


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How will a Scottish national care service be paid for?


Scotland’s Health Secretary Jeane Freeman has said politicians and the public face “important decisions” about how the country pays for social care.


Ms Freeman pledged that people using care services would be at the heart of a review of social care in Scotland announced last week and which is set to report in January 2021, three months before the next Scottish Parliament election.


She said the question of what the public is prepared to pay for “absolutely goes to the heart of reforming adult social care”.


The comments came in a wide-ranging interview for the Health and Social Care ALLIANCE’s online annual conference.


Ms Freeman, who recently announced her intention to stand down as an MSP in 2021, admitted that 20 years of efforts to tackle health inequalities in Scotland were not “reaching all the people we really need to reach”.


She paid tribute to the work of community links workers, who are embedded in GP practices in deprived areas and can put patients in touch with support services to help with a wide range of non-medical problems.


In a recent report these ‘Deep End’ GPs called on the Scottish government to seize a ‘once in a generation opportunity’ and bring in more of these support workers across the country.


Although this is under “active consideration” resources are “hard-pressed” because of the pandemic, Ms Freeman said.


Looking ahead, the Health Secretary said it was important to forge better links between primary, community and social care – as well as raise the profile of services outside of hospital.


An “exemplar” public health system and a “forensic” focus on population health were identified as key priorities for the future.


“That is more than about, important though it is, no smoking campaigns or eating healthily and exercise,” Ms Freeman said.


“That’s about what do we do about diabetes and respiratory conditions and all those other things that people are struggling to live with, and need help and support to be able to do that.”


Nicola Sturgeon unveiled the review of social care in her Programme for Government last week.


She said it would “examine and set out options for the creation of a national care service.”


Speaking at the ALLIANCE conference, Ms Freeman said:


“The intention is that this is not a long-term exercise, this is a relatively quick exercise.


“It is important to hear from the receivers of adult social care, regardless of where they receive that.


“And it will build on work that had begun, particularly using the receivers of adult social care, the users’ panel, the work that was well underway before the virus appeared.”


In the early months of the outbreak, there were reports of cuts to care packages across the country, including in Glasgow and the Highlands.


Ms Freeman said she was “absolutely determined” that these should be reinstated.


Although the Scottish government announced a one-off payment for unpaid carers to help them during the pandemic, this payment only went to around one in ten people providing care because of Carers Allowance eligibility rules set by Westminster.


There is no taper in place for the Carers Allowance benefit, meaning carers lose all the support if they work over a certain amount, go into education or claim a pension.


The Scottish government is examining making the eligibility for carers support “fairer than it currently is,” Ms Freeman revealed, as more welfare powers come to Holyrood from Westminster.


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Web based care home COVID-19 monitoring system launched


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 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.


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.”


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Care home visiting expanded in Scotland


Care home residents will be able to receive more outdoor visitors from Monday, 10 August, Health Secretary Jeane Freeman has confirmed.


From this date care home residents will be able to have up to three outdoor visitors from no more than two households provided their home meets strict criteria, with infection control measures remaining in place.


Since 3 July care homes which have met this criteria have been able to allow residents to meet with one designated visitor outdoors.


A care home will only be able to permit visiting if they have been COVID-free throughout the pandemic or if all affected residents have fully recovered and no residents or staff have had symptoms for 28 days and the home is actively participating in weekly staff testing.


Visitors will need to wear face coverings throughout their visit and physical distancing and hand and cough hygiene will need to be adhered to at all times.


Care home providers have also been asked to develop plans on how they can safely allow one designated indoor visitor for residents within their homes. These plans must be submitted by 24 August and will be signed off by the relevant health board’s Director of Public Health once they are satisfied with the plan and the home meets all the criteria for indoor visiting.


Essential visits, including those involving end of life care, and visits for residents who are experiencing distress have been permitted throughout the pandemic and should continue to be supported by care homes.


Ms Freeman said:


“This has been, and continues to be, a very challenging time for care home residents, their families and staff. Care homes are first and foremost people’s homes and we are committed to reintroducing measures that allow residents to connect with their family and friends. But this must be done safely and with precautions.


“Progress has been made since we reintroduced one designated outdoor visitor earlier this month, and I am pleased the clinical advice is now that care homes that meet the strict criteria can now allow residents to have up to three outdoor visitors from no more than two households.


“It is important that we continue to monitor this situation and that all changes within care homes happen incrementally and with real caution to protect residents and staff.


“At this point in time clinical advice is not to restart indoor care home visiting until the necessary plans are in place and signed off by the Director of Public Health. This is being continually monitored and I hope we can give a further update on this in the coming weeks.


“We are also working to identify the necessary steps needed to restart communal activity within care homes and to reintroduce external outings by residents. This is a complex piece of work and we will, of course, include key partners in this.”


Scottish Care Chief Executive Donald Macaskill said.


“The last few months have been exceptionally hard for folks in our care homes and for their families, being separated with only limited, often virtual, contact. At the beginning of July we opened up care homes to outdoor visiting and I am very pleased that in our slow journey back to normal life we can shortly allow the careful start of a degree of indoor visiting subject to local sign off by Public Health Officials. As well as this, it is positive that an increase in the numbers able to visit residents outdoors is now possible.


“Throughout the restoration of family visiting, we have tried to strike the hard balance between getting people back to seeing and being with their families and keeping residents, staff and others safe from the virus. We are very aware of how pernicious this virus is so guidance and measures will remain in place to protect everyone.”


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New community pharmacy care home service launched


A community pharmacy out-of-hours palliative care service has also been introduced in Northern Ireland, which will provide greater access for COVID centres and out-of-hours medical services to palliative medicines.


The service has bee designed to give Care Homes an additional level of community pharmacy support offering pharmaceutical advice.


In a letter to all community pharmacy contractors in Northern Ireland the Assistant Director of Integrated Care Head of Pharmacy and Medicines Management Joe Brogan said the following:


“Many community pharmacies are currently contracted with HSCB to provide the “Advice to Nursing Home and Residential Homes” service to individual Care Homes. In many situations the pharmacy contracted to provide this service is also the pharmacy that dispenses medicines for the patients in that Care Home, so the Home will already have an established working arrangement with the pharmacy.


“Pharmacies are being asked to consider agreeing on a mechanism to provide additional pharmaceutical support to those Care Homes they are currently aligned with. This agreed additional support could include:


  • Providing additional pharmaceutical advice where necessary, possibly during the out-of-hours period when the pharmacy is closed.
  • Dispensing an urgent prescription during the out-of-hours period.
  • Sign-posting and referring staff to other health care providers as necessary.


“It is recognised that the same model of additional support will not be applicable in all pharmacies. Any arrangement, for example, availability and means of contact, would be agreed between the pharmacy and the Care Home directly.


“The service will run until the end of June in the first instance. The need for the service will be reviewed on a monthly basis.


“This service is an interim measure to provide further support to nursing homes at this time; work will continue to scope a revised Community Pharmacy Nursing Home Service in order to address medicines management issues in care homes.”


“Pharmacies may claim £500 per Care Home they are contracted to provide service to, for the initial surge of the pandemic; up to a maximum of claim £2,500 per pharmacy.


“Please note that Drug Tariff fees payable for dispensing urgent prescriptions have been revised:


  • Fees for urgent prescriptions before 11pm – £30
  • Fees for urgent prescriptions after 11pm – £50


“Pharmacists are asked to contact appropriate Home(s) and agree on the process for the provision of additional pharmaceutical support. We request that you complete the enclosed form indicating the Homes you have made an agreement with to provide additional pharmaceutical. Please return this form to HSCB by Friday 12th.


“The next working day the pharmacist should provide details of any calls from homes during the out-of-hours period via the usual sit rep process. This will enable any issues with regard to particular care homes to be flagged and dealt with as soon as possible.”