Learning from evidence to protect people who use social care support from the direct impact of COVID-19, and wider winter viruses
The continued provision of high quality adult social care for all services current and future is a priority. Public health measures will be deployed to protect people from the direct harm of all viruses this winter.
Enhanced winter measures:
We have already made significant progress with successful infection prevention and control (IPC) practices. These require action by all organisations involved in the delivery of health and social care. It is vital that all staff have the necessary knowledge, understanding and skills to help them continue to improve the overall safety and quality of care. Employers have a duty to safeguard the health and safety of their staff. Services that can safely and effectively be delivered digitally, for example some mental health services, will support reduced transmission. To augment current arrangements the Clinical Professional Advisory Group will lead work for updated IPC in adult residential settings including care homes and community care practice guidance. This will further enhance the existing requirements for all individuals to have a single negative test on admission to residential care settings from the community, requirements for admissions following hospital discharge are covered later in the plan. As highlighted within the Root Cause Analysis (RCA) of 4 sample care homes, this will be accompanied by a dissemination and implementation plan. This will be further enhanced by an additional £7 million to enable IPC support and training for adult social care staff led by Health Board Nurse Directors.
The additional risks of COVID to individuals living in a communal setting are now widely understood and the RCA reaffirmed that all care homes are vulnerable to outbreaks. We are now asking providers to introduce a daily review of COVID symptoms in care home residents and staff. The Clinical and Professional Advisory Group will shortly provide and issue a checklist of the broader COVID symptoms common to the care home cohort. The pandemic has highlighted that the clinical complexity of people residing in care homes requires significant nursing input. Steps should be taken by partners to increase nursing provision in care homes or, where more appropriate, increase nursing support to care homes.
Vaccinations are the most effective method of preventing infectious diseases. When a safe and effective Covid-19 vaccine becomes available at a national level, we will work to ensure that priority is given to: care homes, vulnerable people cared for in their own homes including housing support and residential settings as clinically appropriate, and care workers, paid and unpaid.
The seasonal flu vaccination programme remains a key part of our plan to protect the most vulnerable and those at risk people during the pandemic this winter. We are working to secure maximum uptake for all eligible social care workers (including unpaid carers and personal assistants) and for those eligible groups who are in receipt of social care support.
The pandemic has affected every single person in Scotland, including recipients of adult social care. Many of us will have been anxious or worried about our health, our family and friends, and the effect of changes to our way of life. The Transition and Recovery Plan for Mental Health has been developed to address emerging evidence and with expert stakeholder input to respond to the current mental health needs of the population: https://www.gov.scot/publications/mental-health-scotlands-transition-recovery/.
Visiting is vital to the wellbeing of residents in residential care and their loved ones and should continue to be supported as safely as possible. It is essential that we achieve a balance between the need for safety and the need for family and visitor contact to address individual feelings of isolation and loneliness. We are actively monitoring the adoption of Stage 3 visiting across Scotland and will work with partners to ensure the consistent adoption of guidance. Essential visits where they will benefit the resident’s health and wellbeing, or allow families and friends important time with loved ones in circumstances approaching end of life should be generously and sympathetically accommodated at all-time throughout the pandemic. Visiting arrangements to care homes are updated on the basis of evidence. As at 3 November, where the care home is COVID free visiting guidelines recommend 1 designated visitor, indoors for up to 4 hours once a week, and up to 6 people outdoors from no more than 2 households for one hour once a week. We will also provide further advice and options to opening up care home visiting to support more people to connect with their loved ones where it is safe to do so. To support this further we will expand testing to include designated visitors to care homes as soon as possible. This is likely to involve increased delegation and local ownership and oversight of care home visiting, within a national framework of guidance and principles. This will be supported by local oversight teams and aligned with the new Strategic Framework that supports Scotland’s approach to tiering. To improve information and engagement we will shortly publish a website to provide information and advice for families on visiting.
A significant proportion of individuals accessing adult social care support will also fall within the shielding category. Information and advice are crucial for those with a higher clinical risk from COVID-19. The national helpline is maintained for people seeking further information or advice about shielding and use of risk assessments is promoted for people who are at high risk and cannot work from home, to ensure their safety. This ensures that they understand the risks, both for their individual condition and of local virus transmission. This supports informed choices about individual protection, particularly over the winter months. Where appropriate, a daily 10 microgram supplement of Vitamin D is recommended to keep bones and muscles healthy, and a free supply is being offered to people shielding in the community. For those in care homes Vitamin D will be recommended on an individual basis, based on clinical assessment.
Our efforts to protect people from the virus and the rights of those we are seeking to protect are equally important. Decisions on care must involve the individual as much as possible. Where an individual does not have the full capacity to make decisions, it is critically important that families, guardians and those with Power of Attorney are fully involved in decision making.
New winter measures:
The RCA and the Evidence paper both reinforce that minimising staff movement within and between care settings is critical to reducing the risk of transmission. The evidence is clear that reducing the number of people in close contact reduces the risk of infection of COVID-19. Measures to support the adoption of staff cohorts, working in smaller viable units within care homes must be implemented wherever possible. Similarly, in the delivery of care at home and in other settings, staff cohorting or increased continuity of carers should be adopted where possible.
We will explore whether new regulations are required to support this in the coming weeks. However, providers will now be required to demonstrate they have done everything they can to limit staff movement. In addition, agency staff who are asked to support care homes with COVID will be required to self-isolate for 14 days, before moving to another setting. We will keep this requirement under review and update guidance as our knowledge and wider technology develops. Where staff movement is unavoidable it is vital that there is robust recording of all and any staff movement.
The RCA report highlighted the need to ensure sufficient workforce capacity to manage demand and provide continuity of safe care. Implementation will therefore require planning and co-ordination across partners at a local level. We will work with nurse and care agencies, trade unions and wider partners to consider winter staff deployment to support this aim. To support implementation of the requirements to restrict staff movement we will make up to £50 million available for care providers. It will be important that every effort is made to ensure any measures do not negatively impact on individual members of this vital workforce.
Testing will remain critical in limiting transmission of COVID-19. The Coronavirus (COVID-19): review of testing strategy sets out our approach to expanding routine testing. Within the priority groups identified are health and care staff who visit care homes, and other residential settings as appropriate; designated visitors to those who live in care homes; and care at home staff. More detail on this is set out later in the Plan.