Tag: Health and Social Care

RCEM: Emergency care ‘in dire crisis’

Devolved governments call for more cash for NHS pay

The UK Government has been urged to increase the amount of funding available for NHS pay.

Ahead of the Autumn statement, Scottish Health Secretary Humza Yousaf and Welsh Health Minister Eluned Morgan have written to UK Health Secretary Steve Barclay to ask for additional funding to help avert strike action this winter in the NHS.

The letter reads:

“We wanted to write to you in advance of the Chancellor’s Autumn Statement on 17th November to once again make the case for additional funding for our hardworking NHS staff.

“In recent weeks the Deputy First Minister of Scotland and the Welsh Government Minister for Finance and Local Government have written to His Majesty’s Treasury to make clear the need for additional funding for public services.

“The Royal College of Nursing have announced a sweeping legal mandate for industrial action across the UK. In Scotland, they have joined several other unions representing NHS staff in gaining a legal mandate for industrial action with ballots expected to confirm a mandate in the rest of the UK.

“The risk to the NHS of industrial action this winter is profound, and we all need to do all we can to avert industrial action in any form. The NHS across the UK continues to feel the effects of the pandemic as it recovers and remobilises, and any action is likely to have catastrophic effects in all parts of the UK.    

“We are experiencing a cost of living crisis and the anger of NHS staff is entirely understandable. Sky rocketing inflation combined with high interest rates, a direct result of the havoc caused by the UK Government’s mini-budget, means that we are simply unable to come close to matching the expectations of NHS staff across the country. While the support provided by the UK Government on areas such as support for energy bills is welcome, it has not gone nearly far enough.

“Media reports suggest that the Chancellor is considering reimposing austerity on the people of the UK again, for which there is no mandate, through extensive spending cuts. That would be a disaster for our public services, including the NHS, at a time when they need more investment, not less.

“We would therefore implore you to work with us to make the case to the Chancellor in advance of his Autumn Statement for increased funding for the NHS and the devolved governments as a whole, primarily to pay our hard working NHS staff a fair pay rise in the face of the cost of living crisis this winter, and avoid what could be catastrophic industrial action in the NHS.”

Responding to the latest Emergency Department performance figures published by NHS England for October 2022, Dr Adrian Boyle, President of the Royal College of Emergency Medicine, said: “The crisis in Emergency Care is dire. October saw nearly 44,000 patients face a 12-hour DTA wait – we know 12-hour waits measured from decision-to-admit are just the tip of the iceberg and hides the reality.

“We know far more patients wait for 12-hours measured from their time of arrival. NHS England and the Department of Health and Social Care will still not commit to publishing this data, despite it being collected by all Trusts. We believe this is a barrier to tackling the root of the crisis.

“We know excessively long waits and dangerous crowding are associated with patient harm and increased risk of mortality. Scientific studies have shown that there is one death for every 67 patients waiting between eight and 12-hours from their time of arrival in the Emergency Department.

“The ONS continue to report worryingly high excess mortality figures and we believe that dangerous crowding, long delays, and the crisis in urgent and emergency care are contributing to a significant proportion of these excess deaths.

“We are increasingly concerned about the winter and the health system’s ability to cope. We are already at 94.3% bed occupancy for all general and acute beds and each month patients face the longest waits on record. The system is failing in its core function – the quick and effective delivery of emergency care.

“We need meaningful action now – sticking plasters like setting up tents or handover units will do nothing to resolve these long-waits and may actually cause more harm to patients. We know we need to be able to admit patients, we know ambulances need to handover patients quickly, we agree that it is vital that ambulances must return to Urgent and Emergency calls in the community – but to achieve this we must tackle the issue of poor flow in our hospitals.

“Many patients in hospital no longer meet the criteria to reside, they are occupying beds to which we could be admitting patients. Around 13,000 people are in hospital unable to be discharged. We urgently need an effective social care workforce to help with the discharge of these patients, so we can admit patients, receive patient handovers promptly, and get ambulances back out to the community.

“It is crucial that those in power understand that this is not a demand issue, attendances are not causing crowding and long waits. Crowding and long waits are a consequence of the inability to move patients through the hospital, a consequence of patients who are unable to be discharged because of severe cuts to social care.

“If you can’t discharge patients, beds are indefinitely occupied and the whole system is blocked. The government must get a grip of the social care crisis to fix flow.”

Commenting on the news that the RCN have voted in favour of strike action, Dr Adrian Boyle said: “In Emergency Medicine there is a retention crisis, particularly amongst our nursing colleagues.

“Emergency Medicine nurses are a critical part of the workforce – EM is a team sport. We know and understand that many EM staff, including nurses, are burned out, exhausted and overwhelmed.

“They are skilled, competent professionals who deliver excellent care for our patients. It is vital that our nursing colleagues feel valued and appreciated.”

The latest Emergency Department performance figures published by NHS England for October 2022 for show:

  • There were 1,399,916 attendances at major Emergency Departments
    • This represents a 7.5% increase compared with September 2022, and a 1.7% increase compared with pre-pandemic levels (October 2019)
    • There were 2,000,493 attendances at all Emergency Care facilities
  • 43,792 patients were delayed for 12-hours or more from decision to admit to admission
    • This is the highest number of 12-hour waits on record
    • It is 520% higher than the same month last year, October 2021, and it is 5932% higher than October 2019
    • There have now been 255,334 12-hour DTA stays recorded so far in 2022 – three times as many as were recorded in the 137 months prior to 2022
  • Four-hour performance at major Emergency Departments was 54.8%, this is the worst four-hour performance on record
    • This is a 7.1 percentage point decrease from October 2021, and a 19.7 percentage point decrease compared with October 2019
  • Type 1 admissions stood at 366,964 (a daily average of 11,838)
  • 26.2% of type 1 attendances were admitted, this is a one percentage point decrease from September 2022
  • 150,922patients spent more than four hours in an Emergency Department from decision to admit to admission (also referred to as ‘trolley waits’)
    • This is the highest figure on record and is a 14.5% increase from September 2022
  • Delays to admission stood at 29.8%, this is the highest on record and a 2.8 percentage point decrease from September 2022

The latest beds data for October 2022 show:

  • Last month there were 97,350 general and acute beds available, an increase of 0.71% from September. The occupancy rate was 94.3%, 0.7 percentage points higher than September, the highest monthly figure on record
  • The occupancy rate for adult general and acute beds was 95.6%, also the highest figure on record.

The latest Hospital Episodic Statistics published by NHS Digital for September 2022 show:

  • Patients leaving the department before being seen stood at 5.2%. This is a decrease of 0.2 percentage points from August 2022, but a decrease of 0.7 percentage points from September 2021. 
  • Unplanned reattendance rate was 8.5%. This is 0.4 percentage points lower than September 2022, but 0.3 percentage points higher than September 2021.  
  • Median time in department for admitted patients was 404 minutes. This is an increase of 29% compared with September 2021 (314 minutes). For all patients, the median wait was 192 minutes. 

Invitation to help shape the new National Care Service

Adults with first-hand experience of social care services in Scotland are being invited to help design the new National Care Service (NCS).

Applications are now open for both the Lived Experience Experts Panel (LEEP) and Stakeholder Register, which will bring together people from across the country to help develop a care system that puts people first, in one of the biggest co-design exercises the Scottish Government has ever undertaken.

The new National Care Service will provide the national oversight and guidance that ensures community healthcare and social work services can be delivered locally in a way which best meets the needs of those who use them.

The panels launched today will allow people with direct experience of community health and social care the opportunity to help design these future services.

Anyone over the age of 18 living in Scotland who has views on how the future NCS should look can apply to take part in the Lived Experience Experts Panel.

Over the next few years the design work will consider a number of themes, the first of which are:

  • Information sharing to improve health and social care support
  • Realising rights and recognising responsibilities
  • Keeping health and social care support local
  • Making sure my voice is heard
  • Valuing the workforce

Organisations in Scotland with an interest in health and social care can note their interest in specific themes by joining the Stakeholder Register.

In the future, there will be additional targeted ways for people get involved – for example children and young people under 18, care experienced people, and young carers.

Minister for Social Care Kevin Stewart said: “As we build a National Care Service that best fits the needs of everyone in Scotland, we need to hear from people directly.

“The new National Care Service will set the standards and guidance to support the design and delivery of community healthcare and social work services locally.

“The complexities of getting this right should not be underestimated. People with experience of the current system, whether in receipt of health and care support or delivering it, are the experts. We particularly need to hear those voices.

“These reforms are the biggest since the creation of the National Health Service almost 75 years ago and these Lived Experience Experts and Stakeholder Panels will make sure we deliver a service that puts people at its very heart. I encourage anyone with direct experience of social care to take part.”

How to join the Lived Experience Expert Panel or the Stakeholder Register

The first NCS Forum on 3 October in Perth will be another opportunity for individuals to engage and shape the NCS co-design process. Register to join the event online

This is not the only opportunity to get involved in co-design work. In the future, there will be additional ways for specific groups to get involved – for example children, young people and families, care experienced people, and young carers.

For this reason, we’re not asking children (under the age of 18) to join the Lived Experience Experts Panel right now. Instead, we will work with organisations that represent different groups of young people to make sure we reach as many different groups as we can and undertake research work in a way that best suits their needs.

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Facemasks no longer recommended in social care

Guidance relaxed in line with latest clinical advice

Social care staff and visitors are no longer being advised to wear facemasks at all times under new guidance published today (7 September).

The recommendation has been lifted due to a sharp drop in coronavirus infections and a reduction in severity of illness, which has been driven by Scotland’s successful vaccination programme which has so far seen more than 12 million Covid-19 vaccine doses administered in Scotland.

Care home residents and their loved ones will benefit from these more relaxed visiting arrangements. Masks and face coverings in social care may still be worn if recommended in certain situations, such as a local outbreak of COVID, or if staff deem it necessary. Staff and visitors remain free to wear one if they choose.

This guidance balances the risk of harm from COVID-19 with the impact masks can have on communication, mental wellbeing and rights and choices of those working in and using social care services.

Social Care Minister Kevin Stewart said: “Our phenomenally successful vaccination programme has driven down infections and saved the NHS from untold pressures.

“Removing the need for facemasks in social care settings including care homes is the latest step in our path to recovering from the pandemic.

“This will make communication and relationships easier in care settings, benefiting mental health and promoting the rights and choices of those working in and using social care.”

 Read the new guidance for face mask use in social care settings.

NHS Lothian consults on the future of local healthcare

Local health and care services are asking for the public’s views on the future of care in Lothian.

The Lothian Health & Care System (LHCS), which is made up of NHS Lothian and the four local health and social care partnerships, is urging people to help shape healthcare in their region.

The pandemic has forced a major re-think across all services and systems, including healthcare. The NHS as a whole is facing sustained pressures and the LHCS wants people to have their say around the future of services over the next five years.

Together, the LHCS works to plan, commission, and deliver health and care services locally to a population of nearly one million which is projected to grow by 8% in the next decade.

Colin Briggs, Director of Strategic Planning, NHS Lothian, said: “We’re all aware that health and social care services are under significant and sustained pressure at the moment. That is why the LHCS is setting out its strategic direction for the next five years.

“Our Lothian Strategic Development Framework (LSDF) describes what we’re trying to achieve, now and in the future, the challenges we face and the direction we want to take over the next five years. It also lays out what we think the people of the Lothians can expect from us over that time, some of which will be hard for all of us”

“However, we can’t do this in isolation. Health and care belong to us all and we really want people to tell us their thoughts and ideas, their priorities, and their expectations, and also for us to be able to work together to find the best way forward.”

Through a combination of consultations, question and answer sessions and online feedback, NHS Lothian and partners are asking for the public’s feedback on the LSDF.

More than 400,000 postcards have been landing on doormats of households across Edinburgh, West Lothian, East Lothian and Midlothian giving details of how people can get involved and share their views. This builds on a successful initial engagement period during April, May, and June.

Mr Briggs added: “We’ve tried to be as accessible as possible in how we enable people from across our communities to give us their views.

“We want our patients, their families, our staff and the population we serve to be as involved as possible, both now and going forward.

“We are also being candid with our communities by saying that our performance and outcomes are not what we would want them to be. We need a new direction of travel in a post-pandemic world.

“The priorities currently outlined in the LSDF include moving care closer to home, supporting self-care, learning lessons from the pandemic, working closer with partners, improving our facilities, better utilising technology and reducing waiting lists.

“If you think we’re going in the right direction, or if you think we’re not, we’d really like to hear from you. Please get involved and tell us what you think the future of health and care should look like.”

Go here to give your feedback now.

Adult Social Care needs immediate funding injection and long-term plan, says Levelling Up Committee

The UK Government urgently needs to come forward with additional funding this year to help the ravaged adult social care sector meet immediate pressures, including inflation and unmet care needs, says the cross-party Levelling Up, Housing and Communities (LUHC) Committee in a report published last week.

Examining the Government’s charging reforms and local government finance, unpaid carers and workforce challenges, the report says the “message rang clear throughout our inquiry: the adult social care sector does not have enough funding either in the here and now, or in the longer-term”.

The Committee’s report outlines that:

  • On adult social care, the Government currently has nothing more than a vision, with no roadmap, no timetable, no milestones, and no measures of success.
  • The Government should come forward with 10-year plans for how it will achieve its vision outlined in the People at the Heart of Care White Paper and for the adult social care workforce
  • The Government should provide a multi-year funding settlement to give local authorities what they need in terms of their own sustainability and their ability to help shape sustainable local care markets.

Clive Betts, Chair of Westminster’s Levelling Up, Housing and Communities Committee, said: “As Prime Minister, Boris Johnson said he would fix the crisis in social care once and for all.

“The Government deserves credit for attempting reform and for acting to try to prevent the unpredictable and catastrophic costs which can be inflicted upon people for their care. However, the Government should be under no illusions that it has come close to rescuing social care and it needs to be open with the public that there is a long way to go.

“Ultimately, whether it relates to immediate cost pressures or on wider structural issues in the sector, the fundamental problem is that there continues to be a large funding gap in adult social care which needs filling. Those who need care, their loved ones, and care workers deserve better.

“The NHS and adult social care provision should not be pit against one another. The two systems are interdependent and each needs to be adequately funded to reduce pressure on the other. Wherever the money comes from—from allocating a higher proportion of levy proceeds to social care, or from central government grants—the Government urgently needs to allocate more funding to adult social care in the order of several billions each year.”

The report notes the additional pressures of Covid-19 as having exacerbated the underlying structural challenges of rising demand, unmet need, and difficulties in recruiting and retaining staff.

It also notes severe current pressures arising from increases in the National Living Wage and the National Minimum Wage, and from rising inflation. That most of the funding from the Health and Social Care Levy Levy will go to the NHS, and the money that will go to adult social care is for reforms, not cost pressures, is also highlighted in the report.

Addressing the Government’s sector reforms, the report notes the positive stakeholder reception to the vision outlined in the Government’s White Paper on long-term reform of adult social care, titled People at the Heart of Care.

The report commends the Government for introducing many welcome initiatives such as those relating to housing and data which could make a significant difference in the long-term to people’s lives.

The report calls on the Government to publish a 10-year plan for how its vision in the People at the Heart of Care White Paper will be achieved, taking into account how the different policies interweave and affect one another. The Government should also publish a 10-year strategy for the adult social care workforce which includes a clear roadmap with core milestones, outcomes, and measures of success.

The report expresses concerns about the sheer number of reforms and new ways of working in respect of adult social care that involve and affect local authorities. To help local councils deliver the numerous social care reforms, it’s important the Government provides a multi-year funding settlement to give local authorities what they need in terms of their own sustainability and their ability to help shape sustainable local care markets.

The report also calls on the UK Government to publish a new burdens assessment by the end of the year to determine the level of resource needed by local government in terms of staff, expertise, and funding to deliver the full package of adult social care reforms.

The Scottish Government has committed to establishing a functioning National Care Service by the end of this parliamentary term in 2026:

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Edinburgh’s golden oldies enjoy their own summer music festival!

Care home residents in Edinburgh were boogying on down to silent discos, live performances and an ABBA tribute act last week as part of Music Festival Week in the homes.

Residents and staff in both Renaissance Care’s Letham and Milford Care Home’s were working together to give TRNSMT a run for its money with a week-long Music Festival initiative. From ice-cream vans and transfer tattoos, to glitter and bucket hats, staff pulled out all the stops to give the residents a summer to remember.

The care group which runs 16 homes across Scotland is known for its fun and inventive campaigns that engage residents and focus on bettering their health and wellbeing, as well as encouraging fun and physical activity.

Each home had its own bespoke musical line up throughout the week, all taking place around the homes and gardens which were especially decorated in a festival theme, as well as playing a range of games and enjoying festival style grub.

Music has proven to be an effective tool in boosting mood and memory, especially for those living with dementia and Alzheimer’s. The number of people living with dementia and Alzheimer’s has increased substantially over the past two decades, and  this initiative offered a fun way for residents of all abilities to enjoy some time together and let loose their inner-ravers.

Norma Liston (90), resident at Renaissance Letham Care Home, said: “I’ve been hearing a lot about the summer festivals from Glastonbury to TRNSMT, then of course The Fringe coming up too, so it was great that we could have our own celebration and enjoy a song and a dance together this summer.

“Renaissance Care never does anything by halves, the staff did a fantastic job at making this as much like a real festival as it could be without actually going to one – and thankfully there’s no camping involved!”

Yvonne Mackenzie, Operations Director at Renaissance Care, said: “Music has universal appeal, and we know from experience how much our residents enjoy a bit of a boogie and a song. This concept has been another brilliant way to get everyone involved, up and active in whichever way they feel comfortable.

“We have recently introduced a new danceSing platform across the homes for staff and residents to use to stay fit and healthy, so this has been the perfect complement to its launch which is part of a wider effort to further improve the culture within the business.

“Bucket hats and glow-sticks were in full swing and it was great to see everyone up and having a good time this July.”

Renaissance Care recently introduced a range of new benefits as part of its culture review including danceSing, a flexible approach to working and free period products in all staff bathrooms.

SCOTLAND’S SOCIAL CARE RIP OFF

STUC: WHY SCOTLAND CAN’T AFFORD PRIVATISED SOCIAL CARE

The Scottish Government’s approach to their new National Care Service has been declared “untenable” by Scotland’s largest trade union body.

Launching their report ‘Profiting from care: why Scotland can’t afford privatised social care’, the Scottish TUC (STUC) has accused the Scottish Government of “falling glaringly short” in their plans for a transformative National Care Service.

The trade union organisation, representing unions from across health and social care, is calling for the Scottish care home estate to be transferred out of private ownership in totality.

Research within the STUC report reveals that Scotland’s large private social care providers are associated with lower wages, more complaints about care quality, and higher levels of rent extraction than public and third sector care providers.

Under current Scottish Government plans, the proposed National Care Service would remain “ownership neutral”, embedding a role for the private sector in social care.

The research finds:

• Nearly 25% of care homes run by big private providers had at least one complaint upheld against them in 2019/20, compared to 6% of homes not run for profit.

• In older people’s care homes, staffing resources are 20% worse in the private sector compared to the not-for-profit sector. • Privately owned care homes only spend 58% of their revenue on staffing, compared to 75% in not-for-profit care homes.

• Over the last six years, the public sector has paid on average £1.60 more per hour to care workers.

• The most profitable privately owned care homes take out £13,600 per bed (or £28 of every £100 received in fees) in profits, rent, payments to the directors, and interest payments on loans. This compares to £3.43 in every £100 in fees for the largest not-for-profit care home operators.

The report argues that a truly transformative National Care Service must be based on a not-for-profit public service, delivered through local authorities with an ongoing role for the voluntary sector.

Roz Foyer, STUC General Secretary, said: “Our new STUC research clearly shows that large privately owned care homes perform worse than not-for-profit care homes at almost every level. They are worse for those receiving care, worse for the workers providing care and worse for the taxpayer.

“It simply isn’t the case that Scotland can’t afford to buy out private care homes, we can’t afford not to. As it stands, the Scottish Government are falling glaringly short in offering the transformative shake up to social care Scotland badly needs.

“As the National Care Service Bill makes its way through Parliament, politicians must focus their attention on the kind of organisations we want to provide care for our citizens, not as seems to be the case just now, the centralisation of commissioning and outsourcing procedures.”

The recommendations have been backed by Care Home Relatives Scotland. The influential group, set up during the pandemic, have been working to strengthen relatives rights as a result of care home visitation restrictions during COVID-19.

Catherine Russell, Care Home Relatives Scotland: “This report should be essential summer reading for every member of the Scottish Parliament.

“The research findings endorse everything Care Home Relatives Scotland said in our response to the NCS consultation. Our fear is that millions will be spent on upheaval and reorganisation when the priority must be to focus on improvements and with resources on the frontline where they are desperately needed.

“We also share the STUCs grave concerns about the further marketisation of social care and community health services.

“As the report demonstrates, private homes are not the most cost effective or highest quality. They are extremely costly for residents who need to pay and the profit motive tends to drive down staff conditions.

“Scotland can and should find a better, fairer way to do things and this research will be a very useful contribution to that debate.”

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Scottish Government’s National Care Service plans will not work: COSLA

The Scottish Government’s plans for a National Care Service as they currently stand will not work for service users or communities, COSLA said yesterday.

COSLA also warned that, as the Bill stands, it would have a significant impact on councils’ ability to deliver not only social care services but other critical councils services that our communities rely on.

In a meeting of Council Leaders yesterday there was unanimous and cross-party concern that the National Care Service (Scotland) Bill as published will see decisions around locally delivered social care services moved from communities to Scottish Government Ministers in Edinburgh.

The powers set out in the Bill would potentially lead to the transfer of 75,000 local government employees from local authorities to care boards.

It was the strong view of Leaders that local authority services, staff and resources should remain the responsibility of locally elected members, a view that has been echoed by all the main Local Government trade unions.

COSLA Leaders also fear that the transfer of public protection duties from local authorities risks losing local expertise and knowledge, with implications for safety within our communities.

COSLA, which represents every council in Scotland, has also cautioned that the Scottish Government’s National Care Service Bill will create significant uncertainty and further division for the Local Government workforce, at a time when there are already significant recruitment and retention challenges.

Councillor Paul Kelly COSLA’s Health and Social Care Spokesperson said: ““All Council Leaders were in agreement that as it stands, the National Care Service Bill with the power to transfer local authority functions, staff, property and liabilities to a National Care Service, poses a serious risk to councils’ ability to deliver a wide range of services for communities including non-social work and care services.

Leaders were very clear that this approach would result in destabilising the Local Government workforce and potentially impacting on the sustainability of some councils to carry out their functions and responsibilities.

COSLA is committed to the change, improvement and investment needed in our social care system and will continue to work with the Scottish Government and partners to better the experiences of both those using and delivering social care services now and in the near future and not wait until a National Care Service is in place.

COSLA will seek further engagement with the Scottish Government in an attempt to ensure that there is no disruption to local services by ensuring that local authority staff remain in local authorities.”