The Coronavirus (Extension And Expiry) (Scotland) Act 2021: report to the Scottish Parliament (September 2021)

6. Section 5(1)(b)(v), section 5(2) (e) and section 7 - social care services

Section 5(1)(b)(v) – effect of the Act on social care services

6.1 Section 5(1)(b)(v) requires Ministers to provide their view of the effect of the Extension and Expiry Act on social care services.

Care Homes - Emergency directions and emergency intervention orders (Section 2 and schedule 1: paragraphs 16 – 17 of the Coronavirus (Scotland) (No.2) Act 2020)

6.2 Section 2 of the Coronavirus (Scotland) (No 2) Act 2020 gives power to Health Boards to direct care home providers to take specific steps where they consider there is a material risk to health of persons within the specified care home due to Covid-19. These specified steps must relate directly to reducing the risk to the health of persons at the accommodation. Where the Health Board is not satisfied that the steps have been complied with, it can, subject to the Sheriff Court's approval, take steps to ensure they are carried out. The Sheriff may grant the warrant to enter the premises and take the specified steps only if satisfied that there are reasonable grounds for entering the care home and entry has been refused.

6.3 Ministers may apply to the court to appoint a nominated officer to temporarily enter, occupy and direct and control the provision of service at the care home and do anything the nominated officer considers necessary to ensure the service is provided to an appropriate standard. Such an order is an Emergency Intervention Order. The court must make the order if it appears to the court that, for a reason relating to Covid-19, there will be a serious risk to life, health or wellbeing within the home unless the order is made. Where the Scottish Ministers are satisfied that it is essential to do so for a reason relating to Covid-19 to prevent an imminent and serious risk to the life or health of persons at the care home, they can exercise the powers before making an application to the court. If Ministers do exercise these powers before going to court, they must seek an Emergency Intervention Order within 24 hours of having done so.

Powers to purchase care home services and care at home providers (Section 2 and schedule 1: paragraphs 18 to 21 of the Coronavirus (Scotland) (No.2) Act 2020)

6.4 Part 8 of Schedule 1 to the Coronavirus (Scotland) (No 2) Act 2020 sets out temporary powers available to local authorities to acquire, by agreement, a care home or care at home services. It also sets out the powers available to relevant Health Bodies (a Health Board, the Common Services Agency and Health Improvement Scotland) to acquire a care home, by agreement, on behalf of the Scottish Ministers. Circumstances where this can take place are where, for a reason relating to Covid-19: the provider is in serious financial difficulty; the local authority or relevant health body (where relevant) is satisfied there is a threat to the life, health or wellbeing of people receiving the service; or where a provider has recently stopped providing the services.

Effect of provisions – care homes

6.5 The Extension and Expiry Act extends the operation of the Emergency Directions, Emergency Intervention Orders and Powers to purchase social care services provisions until 2022. In the view of the Scottish Ministers, the extension of these provisions recognises that Covid-19 is still circulating and that the above noted powers can be utilised if they are necessary to protect public health and safeguard the life, health and wellbeing of care homes residents and people who use social care services.

The use of such a power for example in the case of a failing care home service would mean that residents, many of whom may be frail, would not need to be moved to another care home thereby ensuring continuity of care.

The provisions have not been used to date, however their continuing availability provides a safety net and assurance while Covid-19 is still circulating that there are additional mechanisms in place should they be required.

6.6 Bi-monthly reporting on the use of these provisions will continue to be adopted.

Social care staff support fund - Social care staff support fund (Section 2 and schedule 1: paragraph 7 of the Coronavirus (Scotland) (No.2) Act 2020)

6.7 A description of the Social Care Staff Support Fund can be found at paragraphs 5.3 and 5.4.

Effect of Provisions – Social care staff support fund

6.8 The Extension and Expiry Act extends the power for the Scottish Ministers to maintain the Fund and make regulations in relation to it until the end of March 2022 with the possibility for Ministers to extend that further until September 2022. The Act does not, in itself, change the support available to people under the Fund.

Care homes – further provision

6.9 Paragraph 22 of schedule 1 of the Coronavirus (Scotland) (No. 2) Act 2020 requires that the Care Inspectorate must lay a report before the Scottish Parliament every two weeks during the emergency period. These reports must set out which care home services it has inspected in that two week period as well as the findings of those inspections.

6.10 Paragraph 23 introduces new duties about the reporting of deaths in care home services from or attributable to Covid-19. Care home service providers must provide certain information to the Care Inspectorate each day in relation to the numbers of deaths of residents in the care home from Covid-19, the number of deaths of residents in the care home which are suspected to be from Covid-19 and the number of deaths of residents in the care home, whether or not those are attributable to Covid-19.

6.11 The Extension and Expiry Act suspends these reporting duties at the end of 30 September 2021. The expectation is to safeguard the ability of the Care Inspectorate to discharge their statutory duties without hindering or diverting resources from wider scrutiny activity, including support to those care home services that fall short of the expected quality of care; and to ease the burden of weekly reporting on care home staff.

6.12 By suspending and not expiring these provisions, reassurance is provided that if there is a significant rise in Covid-19 cases in the future, and subsequently an adverse impact on care homes, that Scottish Ministers will have power under section 8 of the Coronavirus (Scotland) (No 2) Act 2002 to bring forward regulations to revive the original provisions, if there is clear evidence that this is necessary.

Section 5(2)(e) – Measures to restore social care services to 1 March 2020 level

6.13 By virtue of section 5(2)(e) the report must include information on the measures in place to restore social care services to their level as at 1 March 2020 and any plans for further measures the Scottish Ministers propose to put in place to secure this.

Financial support for social care sector

6.14 Financial support has been provided to the social care sector in order to support the remobilisation of services and to ensure safety is considered a priority at all times.

6.15 A total of £561 million was allocated to Integration Authorities for 2020-21, including funding for sustainability payments, in addition to wider social care support, for example for reducing delayed discharges, or for loss of income and for other staff costs. This included £112 million allocated to Integration Authorities as additional funding committed through the Adult Social Care Winter Preparedness Plan.

6.16 The Scottish Government has committed to providing funding for reasonable additional costs incurred by social care providers in line with the financial support for social care providers guidance, for costs such as additional staffing and non-staffing costs, recognising the exceptional efforts made by all who work in the sector to support people and providers during this period, and the need to support sustainability of the sector and the workforce.

6.17 The Social Care Staff Support Fund is also delivered through the Financial Support for Social Care Sector mechanism. The Social Care Staff Support Fund is discussed above.

Alignment with NHS remobilisation plans

6.18 The Scottish Government have encouraged NHS boards to ensure the remobilisation plans reflect how they are ensuring the effective remobilisation of Adult Social Care services and the continued support of the safe provision of these services.

6.19 The Scottish Government have provided a range of policy priorities for NHS boards to report on and will continue to monitor the plans to see how these priorities are being met and provide support to the boards as required.

Day service re-opening

6.20 Guidance to support the re-opening of adult social care building-based day services was published on 31st August 2020. This guidance is linked to a range of other national Covid guidelines - including guidance on PPE, physical distancing, and transport - which are updated regularly.

6.21 The Minister for Mental Wellbeing and Social Care wrote to the health and social care sector on 7th June 2021 to encourage the reopening of building-based day services. We are continuing to engage with Local Authorities and Health and Social Care Partnerships to support the remobilisation of these vital services for those who need them. These measures have seen the vast majority of day services and respite centres re-open across the country.

6.22 Staff testing and vaccination, plus the vaccination of people attending services, is also helping reduce risk levels in building-based support and so enabling their services to be restored safely.

Recruitment campaign

6.23 Attracting and retaining the right people, and raising the status of social care as a profession, is key to delivering quality care and building a sustainable workforce. In February 2021, the Scottish Government ran a second phase of the social care marketing campaign to address the recruitment and retention issues in the sector and build up a resilient, sustainable workforce. The Scottish Government is working closely with the sector to continue this, helping to attract more people into caring roles – through ongoing recruitment campaigns in MyJobScotland.

6.24 The Scottish Government has also committed to invest £50 million over the life of this Parliament to support the regulation and development of the social services workforce through the Scottish Social Services Council.

Wellbeing of the social care workforce

6.25 Over the past year, the Scottish Government has worked with partners to put in place a range of resources to support the mental health and wellbeing of our health and social care workforce. The National Wellbeing Hub (www.promis.scot) signposts staff, unpaid carers, volunteers and their families to relevant services, and provides a range of self-care and wellbeing resources designed to support the workforce. There is also a national wellbeing line for the health and social care workforce, based within NHS 24, which provides a 24/7 service to those who need further psychological support, including in light of the pandemic.

6.26 The Workforce Specialist Service (WSS) specialises in treating and supporting those who, due to their professional role, experience difficulty accessing confidential assessment and treatment for mental health. The Service covers staff groups across health and social care and, as such, is the most comprehensive service of its kind in the UK. It is delivered by a multi-disciplinary team of mental healthcare providers, and is supported by the continued delivery of digital wellbeing resources through the National Wellbeing Hub and the Helpline.

Supporting unpaid carers

6.27 During the pandemic a further £1.1 million was added last year to the annual £3 million voluntary sector Short Breaks Fund and the Scottish Government has committed an additional £570,00 this year, enabling more families/carers and young carers to take a break from caring. The Scottish Government has launched a £1.4 million holiday voucher scheme for tourism businesses to sign up to help low income families, unpaid carers and disadvantaged young people enjoy a break. The scheme will open for applications from these groups this Autumn.

Plans for further measures the Scottish Ministers propose to put in place

6.28 The Scottish Government plans to put in place several immediate measures to support social care services, as follows:

• Recruitment: The Scottish Government is working with social care partners to address long running recruitment and retention challenges in the sector, which are likely to be have been exacerbated by the end of freedom of movement following the UK's exit from the EU, and the impact of the Covid-19 pandemic.

Furthermore, we are working closely with the social care sector to continue a social care recruitment marketing campaign. The campaign will run for at least three months in autumn 2021, and aims to attract more people into caring roles. The campaign will be supported by a streamlined process for pre-employment checks, as facilitated by Disclosure Scotland.

• Workforce: The Scottish Government wanted to ensure there was no delay in the annual uplift being received by the workforce, which is why we have agreed a national approach to implementing the Real Living Wage for adult social care workers for 2021/22. The Scottish Government has made clear that, for the first time, union representatives should be involved in the discussions on the national care home contract.

The Social Care Staff Support Fund, the powers for which have been extended to the end of March 2022, ensures workers receive their expected income if ill or isolating as a result of Covid.

Work through the Fair Work in Social Care Implementation Group has now developed a set of recommendations for minimum standards for terms and conditions, and a minimum standards framework to enable effective voice for the workforce at a local level, reflecting key Fair Work principles.

• Staff wellbeing: The Scottish Government is working with NHS National Services Scotland on the long-term hosting arrangements for the stand-alone Workforce Specialist Service (WSS). As described above, WSS specialises in treating and supporting those who, due to their professional role, experience difficulty accessing confidential assessment and treatment for mental health.
• SiRD: The Scottish Government plans to extend the Support in the Right Direction (SiRD) programme into 2021-22 with £2.9m to ensure support and advocacy for those who have social care needs to help them access the social care they need, and to explore creative and flexible solutions

Section 7 report on social care services

6.29 Section 7(1) requires the Scottish Ministers to prepare and publish a report on the effect that the extension and expiry of provisions by the Extension and Expiry Act is likely to have on social care services. Section 7(2) requires that the report must set out in particular whether the Scottish Ministers consider that further measures are required to ensure the early restoration of the availability of social care support packages and respite services to at least the level available prior to 1 March 2020.

The effect that provisions by this Act is likely to have on social care services (section 7(1))

6.30 See the information provided above.

Whether the Scottish Ministers consider that further measures are required to ensure the early restoration of the availability of social care support packages and respite services (section 7(2))

6.31 Scottish Ministers do consider that further measures – both short and medium term measures – are required to ensure the early restoration of the availability of social care services. The measures proposed are described in the information provided above.