Health and Social Care – Page 19 – The NEN

Jeane Freeman: Fair benefits for care workers

Statement given by the Health Secretary Jeane Freeman at a media briefing in St Andrew’s House yesterday (Sunday 24 May):

Good afternoon, and thank you for joining us for today’s briefing.

I want to start this afternoon by updating you on some of the key statistics in relation to COVID-19 in Scotland.

As at 9 o’clock this morning, there have been 15,101 positive cases confirmed – an increase of 60 from yesterday.

A total of 1,329 patients are in hospital with COVID-19 –845 who have been confirmed as having COVID, and 484 who are suspected of having the virus. That represents a total change of 24 from yesterday, including an increase of four in the number of confirmed cases.

A total of 44 people last night were in intensive care with confirmed or suspected COVID-19. And that is a decrease of six since yesterday.

I am also able to confirm today that since 5 March, a total of 3,560 patients who had tested positive for the virus have been able to leave hospital, and I wish all of them well.

Regrettably, I also have to report that in the last 24 hours, nine deaths have been registered of patients who have been confirmed through a test as having COVID-19 – that takes the total number of deaths in Scotland, under that measurement, to 2,270.

It is worth bearing in mind that fewer deaths tend to be registered at the weekend than on other days of the week – and that is almost certainly part of the reason why today’s figure is relatively low.

And, as always, I want to stress that these numbers are not simply statistics. They represent individuals who were loved, who were valued, and whose loss is a source of grief to very many. So I want to send my deepest condolences to everyone who has lost a loved one to this virus.

As Health Secretary, I also want to once again thank those working in our health and care sectors. That thanks is due to all staff – in care homes, in GP practices and COVID assessment centres, emergency dental and eyecare, paramedics, procurement staff, people working in NHS 24; and the many cooks, cleaners, porters and maintenance staff who make all of this possible.

What you do is essential to the health and wellbeing of our country. And all of us owe you a huge debt of gratitude.

I have one issue that I want to update you on, before I remind everyone of the guidance in place right now – and it is directly relevant to the point that I have just made, about the importance of frontline workers.

Social care workers have always played a vital and valuable role – but the importance of what they do has never been more apparent than during this emergency period.

Several employers already offer employment contracts to social care workers which are broadly in line with the Scottish Government’s fair work principles – but it is clear that others do not.

At this time, even more than is usually the case, that cannot be justified. It is not acceptable for any social care worker to be faced with the impossible situation of testing positive for the virus, knowing that their weekly income will reduce to only the level of statutory sick pay.

So we have intervened to ensure that social care workers do not face that situation, but receive better levels of sick pay. It is also the case that for some social care workers, their contract of employment offers no cover for death in service. Again, that is not acceptable, so our intervention will also ensure that in the tragic circumstances of this pandemic, when a social care worker dies their next of kin will receive financial support.

That sick pay fund will ensure that care workers who test positive for COVID-19 will receive sick pay above the current statutory level of £95.85 a week.

The death in service benefit will see a one-of payment of £60,000 made to a named survivor of any social care worker who dies without death in service cover in their contracted pension arrangements. And both these arrangements will be retrospective.

Over the course of the next week, we will work with local government, social care providers and trades unions on the details. But our aim is clear. This Scottish Government will provide fair benefits for care workers. They have continually shown, in recent weeks, how vital their work is. And we must help them, as they provide help to those who need it.

The people in our health and social care services are doing a tremendous job, but they need us to play our part. And part of that is by following the rules that we have put in place.

So I think it is essential today to remind everyone – because it is hugely important – what we mean by Self-Isolation, and what we are asking you to do.

That message may have become confused in the last 24 hours because of events in other parts of the United Kingdom, so let me be clear what we mean here in Scotland.

Self-isolation means the following – if you think you have the virus – if you have a persistent cough, a fever or loss of taste and / or smell, you should self-isolate at home for a minimum of seven days. In that time you should get tested if you can – bearing in mind that testing is now open to anyone over the age of five who have symptoms.

At the same time – anyone in your household should self-isolate for 14 days – to see if they develop the virus, and if they do, they should isolate for seven days from that point.

On the eighth day, if you do not have any more symptoms, you can go back out, back to the lockdown measures that apply across the country.

Self-isolation is not the same as lockdown. When you are self-isolating you should not go to the shops, or out for exercise or to help others. You should not leave the house for any reason.

Instead if you need anything you should have it delivered to you, whether that’s by family and friends, local volunteers, supermarket delivery services or by phoning the National Helpline on 0800 111 4000.

If you are concerned about vulnerable people who are with you or that you care for – again – phone the National Helpline – 0800 111 4000.

I cannot emphasise enough how important self-isolation is, as part of our efforts – your efforts – to tackle the virus. It is all about breaking that chain of transmission, and I encourage everyone who has symptoms to follow these rules completely.

We hope, as the First Minister indicated, that later in the week we will be able to confirm that some lockdown restrictions – especially relating to outdoor activities – will be relaxed.

But even if those restrictions are relaxed, some key advice – including what I’ve just read out on isolating if you have symptoms of COVID, as well on physical distancing, washing your hands and the use of face coverings – will remain the same. In fact, they will become even more important – to avoid undoing all the progress that you have made through your sacrifices and your compliance with the rules, particularly as we move into Test and Protect.

For the moment, however, all our key public health guidance remains unchanged.

So please stay at home – except for essential purposes, such as daily exercise; buying essential items such as food or medicine; or going to essential work which you cannot do from home.

You can exercise more than once a day – but when you do leave the house, stay more than 2 metres from other people. And do not meet up with other households other than your own.

Please wear a face covering where appropriate – for example if you are in a busy shop or on public transport. And wash your hands thoroughly and regularly.

I know that this is a bank holiday weekend – and that talk of emerging from lockdown probably makes following these restrictions even harder. But the fact that we have stuck with them so far, that is what makes it possible to think about relaxing them.

By doing the right thing, all of us – all of you – are helping to slow the spread of the virus, protecting our NHS, and you are saving lives.

So thank you to every single person who is doing that.

I am now going to turn to Professor Leitch, our National Clinical Director, to say a few words.

Half a million lost bed days are symptom of poor care integration, says disability charity

‘in many areas of Scotland, the integration of health and social care is happening in name only’

The loss of over half a million bed days in Scotland’s hospitals over the past year is a symptom of the failure to integrate health and social care, according to the disability charity Leonard Cheshire in Scotland.

Figures published by ISD Scotland show that a total of 542,204 bed days in 2019/20 were occupied by people delayed in their discharge from Scotland’s hospitals.

This represents a 4% rise in the number of bed days lost due to delayed discharges between 2018/19 and 2019/20. A daily average of 1,481 beds were occupied by people delayed in their discharge over the past year.

A delayed discharge occurs when a person, clinically ready for discharge, cannot leave hospital because the necessary care, support or accommodation required is not readily accessible or funding is not available, for example to purchase a care home place.

The main reasons for patients being delayed in their discharge in 2019/20 were awaiting completion of care arrangements (35%), awaiting place availability (23%) and awaiting community care assessment (17%).

ISD Scotland estimates that in 2017/18 alone, the cost of delayed discharges in NHS Scotland was £122 million – with an estimated average bed day cost of £248.

Reacting to the figures, Leonard Cheshire in Scotland’s Director Stuart Robertson said: “These figures demonstrate that in many areas of Scotland, the integration of health and social care is happening in name only.

“More than half a million bed days have been lost over the past year in Scotland’s hospitals due to delayed discharges and it’s time the Scottish Government finally tackle this issue. Over half of patients who experienced a delayed discharge have been impacted by a lack of care arrangements, availability and assessments.

“Delayed discharges are costing the Scottish Government over a hundred million pounds every year and are badly letting down disabled people and those receiving health and social care.

“Investment on the frontline is urgently required if we are to end delayed discharges and create a person-centred health and social care system that truly meets the needs of the Scottish people.”

Care sector ‘safety net’ proposed

New measures have been proposed to ensure swift intervention if care home residents are being put at serious risk due to services failing.

The move comes after the Care Inspectorate began legal action which could prevent operator HC-One running the Home Farm Care Home in Portree, where nine residents have now died.

The planned emergency powers are being put forward as a Scottish Government amendment to the Coronavirus (Scotland) (No. 2) Bill ahead of Stage 2 next week.

The amendments make clear that, if there was a significant risk to the life, health or wellbeing of individuals, or that a provider was unable to deliver care due to failure, that strengthened emergency powers will be available to ensure continuity of care.

If passed by the Scottish Parliament, the emergency powers will provide assurance to those who depend on care services, their families, and the staff that deliver care, that additional oversight and support is available in the rare circumstances that it may be required.

Health Secretary Jeane Freeman said: “The coronavirus pandemic has significantly impacted social care services around the world. In the face of this challenge, staff in care homes across Scotland have been working incredibly hard to care for their residents.

“It is of paramount importance that anyone living in a care home or using other care services, as well as those supporting them, are provided with the best possible care. We will do everything we can to ensure that remains the case. We are fortunate that this high standard of care is the norm for the vast majority of care home residents in Scotland.

“However, for the duration of this pandemic I believe that it is critical that a clear safety net is in place to ensure that if a care provider was unable to continue to deliver services, that the people who depend on those services should not be impacted. Our proposals build on established powers and would put beyond doubt that immediate action can be taken if continuity of care was jeopardised for any reason.

“The Care Inspectorate has a robust inspection regime for the care sector and the further steps we are hoping to take, if the parliament agrees, help bolster that work and would only be exercised as a last resort. There is guidance available for care providers on how to manage the current situation, which the Scottish Government expects to be followed.

“Every resident in our care homes, their family and the staff who work there should be kept safe from harm and we are prepared to take action where this is not the case.”

Health and social services staff to get free access to mental health apps

Daylight and Sleepio apps available to everyone working in health and social services in Scotland to support their mental health during the crisis
Staff can download mental health apps for free to help with sleep and anxiety during COVID-19 pandemic
Announcement part of nationwide drive to digitise healthcare, starting with workforce mental health

All health and social services staff in Scotland can now access free apps to cope with insomnia and anxiety as part of a nationwide effort to support the mental health of key workers during the COVID-19 pandemic.

NHS Scotland has this week launched a national programme to provide those working in health and social services with access to practical, everyday advice and support, as well as mental health apps and tips on self-care to help staff cope with the challenges they are facing with the pandemic.

As part of the PRoMIS National Wellbeing Hub, the apps on offer include programmes designed to help maintain healthy and restorative sleep, reduce anxiety and worry, and to help staff learn evidence-based techniques to address mental health issues when they arise.

The NHS-accredited apps Daylight – designed to help with worry and anxiety – and Sleepio – a digital sleep improvement programme featuring Cognitive Behavioural Therapy (CBT) techniques – are both developed by digital therapeutics company Big Health.

Sleepio has already been made available to almost 30,000 residents in the Western Isles, and both Sleepio and Daylight were recently made available at no cost to all NHS employees across England thanks to a partnership with NHS England.

As the UK’s response to the COVID-19 pandemic continues, health and social services staff remain at the frontline and are being placed under mounting pressure. The news comes as first Minister Nicola Sturgeon has stressed that the “stay at home” message remains in place in Scotland after Boris Johnson announced his “conditional plan” to reopen society.

Big Health co-founder and Professor of Sleep Medicine at the University of Oxford, Professor Colin Espie, has praised NHS Scotland’s timely response in protecting the mental health of NHS staff as well as their physical health during the pandemic.

Commenting on Big Health’s partnership with NHS Scotland Professor Espie said: “I’m honoured that Big Health is able to support our colleagues in NHS Scotland to help safeguard their mental health during these most challenging of times.

“NHS staff are working under enormous pressure whilst also experiencing significant changes to their lives at home as a result of COVID-19. We built Sleepio and Daylight to help people effectively manage their mental health whether the challenges occur during the night or day.”

Dr Sandra Ferguson, Associate Director Psychology and Lead for National Trauma Training Programme at NHS Education for Scotland added: ““There is increasing evidence that insomnia and sleep difficulties is an area that staff in health and social care are increasingly reporting.

“We are delighted to have worked with Sleepio who have designed this evidence-based app to support staff in resolving these difficulties. A good night’s sleep is a central part of overall wellbeing.”

Sleepio and Daylight are available at no cost to everyone working in the NHS to support their mental health during the COVID-19 pandemic.

These solutions aim to support staff to maintain healthy and restorative sleep, reduce anxiety and worry, and to help them learn evidence-based techniques to address mental health issues when they arise.

Getting help for people at risk from harm

It’s vitally important during these unprecedented times that people know where to turn to if they feel someone is vulnerable in their communities.

We should all be following government guidance to stay at home to limit the spread of Coronavirus – however, being at home can increase tensions and affect mental health, meaning some people in our communities are more vulnerable now.

Children and adults can be at risk of harm, and some people will be experiencing financial difficulties or struggling with addiction – but help is available.

If you think a child or adult is at risk of harm, you should report your concerns so that professionals from social work, police, NHS and the voluntary sector can help.

The Council has already put in place measures to support people staying at home like support from our educational psychologists for families who may be struggling with home learning and wellbeing.

Depute Council Leader Cammy Day said: “Now more than ever in these challenging times we should all be reaching out to anyone we think may be suffering and requires support. Many people may be unaware that there’s a wide range of networks in the city for those in need.

“We’ve all heard of many amazing tales of kindness and selfless acts in Edinburgh during this pandemic. It’s so important we raise awareness among our communities of the help that is out there. So, our appeal is … please if you have concerns about someone then contact the appropriate organisation to get them support – you can make a real difference just by making that vital phone call.

“As a Council we work really closely with partner organisations like the NHS, police and voluntary sector to support the most vulnerable in our society.

“A great example is our All of Us campaign with the NSPCC which encourages people to get in touch if they’re finding it hard to look after children, a family needs some extra help or someone they know could do with more support.

“It’s vital people know who to turn to if they have concerns – don’t hesitate to make your voice heard and change people’s lives for the better.”

You can get help if you’re worried about the safety of a child, neighbour, friend or relative. Call any of these numbers or find out more about how to get in touch on our website https://t.co/Z1EyiNiLfw. If you think there’s immediate danger, call Police Scotland on 999. pic.twitter.com/2gpC72tBqa

— The City of Edinburgh Council (@Edinburgh_CC) May 9, 2020

If you’re concerned about your own safety or someone you know like a relative, friend or neighbour then you should contact Social Care Direct on socialcaredirect@edinburgh.gov.uk or call 0131 200 2324.

If you’re concerned for the immediate safety of a child or adult, phone the police on 999.
If an adult or child needs medical attention with or without COVID-19 symptoms, phone NHS on 111 or if it’s an emergency 999.

There are various forms of support such as Scotland’s Domestic Abuse and Forced Marriage helpline on 0800 027 1234, Edinburgh Women’s Aid on 0131 315 8110 and our All of Us campaign, with NSPCC Scotland.

Greens raise concerns around home-care support

Lothian MSP Alison Johnstone has called on the region’s Health and Social Care Partnerships to urgently address concerns around the reduction in provision of home-care support, which has left many disabled people in an extremely difficult position.

Reports suggest that the Lothian region’s Health and Social Care Partnerships have reduced their visits by 356 in total, leaving many vulnerable people struggling to cope – a matter the Scottish Greens raised in parliament this week.

Alison Johnstone MSP said: “The figures published this week raise major concerns, There is huge disparity around the country, with the City of Edinburgh Health and Social Care Partnership reducing their clients by 240, East Lothian by 44, Midlothian by 24, and West Lothian by 48, while at the same time Angus increased its by 80.

“The Scottish Government confirmed that extra support is available and that if more is needed it will be provided, so our Health and Social Care Partnerships must confirm that they will immediately access this support and restore home care visits.

“I’m extremely concerned about the impact of these changes, which result in some people having their support packages dramatically reduced, and others losing support entirely, with many then forced to rely on family members for personal care, meals and medication.

“The impact on the mental wellbeing of disabled people, particularly in terms of social isolation which can disproportionately affect disabled people, is a huge concern. While its vital that care is restored as quickly as possible, the immediate roll-out of online or remote mental health resources would be really valuable right now.”

https://www.bbc.co.uk/news/uk-scotland-52415302

“Some Promising Signs”: Jeane Freeman updates Holyrood

Statement given by the Cabinet Secretary for Health and Sport Jeane Freeman to Scotland’s Parliament yesterday:

Thank you very much Presiding Officer, and thank you for the opportunity to update the chamber on several key areas around our response to COVID-19, and to say something about our future planning.

Today is International Workers’ Memorial Day, and across Scotland many people observed a minute’s silence to particularly honour health and social care staff who have tragically died during this pandemic. A number of our own colleagues in Scotland have lost their life to COVID-19 and my thoughts, and I know those of members across the chamber, are with their families and loved ones.

In the last 24 hours, 70 deaths have been registered of patients who have been confirmed as having COVID-19 – and that takes the total number of deaths in Scotland, under that measurement, to 1,332.

As always, it is so important to remember that behind each one of those numbers is the loss of someone loved and now much missed and I offer my sincere condolences to their families and friends.

Presiding Officer, notwithstanding all of that, we are starting to see some promising signs that the efforts and the sacrifices that the overwhelming majority of people across Scotland have made are having an impact.

The number of patients in hospital with confirmed or suspected COVID-19 has been broadly stable in recent days, and the number of people in ICU with COVID-19 has shown signs of decline.

We should not read too much into all of this yet – these are early days – but these trends are both welcome and cautiously hopeful.

As of today, 50% of adult care homes have reported an outbreak of suspected COVID-19. Last week I set out a series of additional steps to support those who live and work in our care homes.

These steps increase the clinical support focussed on preventing COVID-19 infection and transmission in care homes. Our NHS Directors of Public Health are now providing enhanced clinical leadership and have contacted every care home in Scotland. They are assessing how each home is managing infection control, staffing, training, physical distancing and testing.

We have provided a direct delivery of PPE to care homes and have worked with local partners to significantly improve the operation of local PPE hubs. Whilst the supply of PPE is primarily the responsibility of care home providers in both the private and the public sector, we will continue to provide both top up and emergency provision to ensure staff have what they need and they and the residents have that protection.

Work is also underway to ensure that all COVID-19 patients being discharged from hospital should provide two negative tests before discharge, and that all new admissions to care homes, and all residents who are symptomatic should be tested and those new admissions should be isolated for 14 days.

Social Care and care home staff continue to be priority key workers for testing and I have written to all care homes reminding them of this and asking them to make sure that as employers they follow through where this testing is required.

As members know we also have over 21,000 returning health and social care staff alongside student nurses, student midwives, AHPs and newly graduated doctors, all willing to apply their skills and experience to the collective effort. Many of them are able to work in both the care and the primary care setting. And, as of today, 185 applicants have been matched into roles in care homes and care at home services, and a further 218 are ready and available. I expect the number of matches to increase rapidly in the coming weeks.

As well as those working in care homes to protect our most vulnerable people, I know there are many carers – both paid and unpaid – who are supporting people to stay in their own homes and they, too, must be protected. So we have extended the provision of PPE to Personal Assistants and unpaid carers.

From the start of this week, the local PPE Hubs for the registered social care sector are receiving enhanced supplies and support so that they can distribute to the whole of the social care sector where normal supply routes have failed.

We have published advice for unpaid carers on the appropriate use of PPE and how to access it, and will be publishing equivalent guidance for Personal Assistants shortly.

I have asked the National Carer Organisations and local carers’ centres to discuss with carers their needs, and help us with directing them to their local Hub where they need PPE.

We will ensure Hub locations are clearly signposted on the Scottish Government website and Health and Social Care Partnerships are working with local carers’ centres to make clear how individuals can get the necessary Personal Protective Equipment.

Throughout this difficult time, it is critical that social care support is maintained to ensure the safety, dignity and human rights of people who already receive that support.

In addition to the funding directed towards social care from the 2020-21 budget, I reached agreement some weeks ago with COSLA that we would meet additional costs incurred because of the impact of the pandemic.

That agreement was specifically reached to ensure that both existing and new demand and need could be met. Alongside this, those additional returning staff I mentioned a moment ago are also available for deployment to these services to ensure staffing resilience.

So it is not acceptable to me that care packages are cut – in some instances by 100%.

I expect the steps I have already taken to be used and if there is more that needs to be done to ensure existing packages are not cut and new demand is met, then I hope that colleagues in the sector know that my door is always open and I expect them to come to me with those additional requirements.

I want to turn now to testing. By 22 April, 17,800 health and social care staff, or symptomatic household members, had been tested. 21 per cent of those tested were social care staff.

By the end of April, all 14 Health Boards should have local testing capacity. In terms of testing capacity, we are on track to reach at least 3,500 tests available per day by the end of this month, making steady progress from the start of this pandemic, where capacity was 350 tests per day, from two labs.

We also continue to work with the UK Government on its testing programme, which is expanding both capacity and access in Scotland.

Four UK Government drive-through testing facilities are already operational, with a fifth due to open in Perth this Thursday.

Five mobile testing units manned by army personnel are going live in Scotland this week, and it is anticipated that a further eight units will be live in Scotland within the next week or two.

This increased capacity in our own NHS labs and through that participation in the four nation testing exercise has ensured that we are able to expand the areas and the groups whoa re being tested. So we have increased availability to key workers beyond the Health and Social Care sector using the categories that we have outlined before, and have today also increased testing to all 70-year-old and over admissions to a hospital setting.

In terms of access to the UK four nation exercise, this is controlled through the queueing system managed by the UK Government and through their digital portal.

I want to touch on now on two other issues before I conclude: research and ongoing changes to healthcare delivery.

The pandemic has required fundamental change to how health and care is accessed and delivered. This has involved a significant reorientation of resources, and the incredible support and efforts of local leaders, planners, clinicians – in fact the entire workforce. The work has included:

preparing to quadruple ICU beds and ensuring there is sufficient hospital bed capacity
significant increases in digital access for health services – with around 60% of GPs now using “Near Me”, and weekly digital consultations increasing from around 300 to over 9,000
the reshaping of primary care to support COVID-19 hubs with 24/7 access
shielding almost 150,000 clinically vulnerable people and focusing multi-disciplinary teams working on anticipatory care planning with them
and expanding mental health support by moving towards a 24/7 NHS24 mental health hub and digital therapies

What is clear is that, in line with our framework for decision making that was published last week, we need to achieve a careful balance in managing our healthcare capacity going forward including our commitment to continue to treat emergency, urgent and maternity cases.

So we will continue to work closely with Health Boards and their partners to ensure there are robust plans in place to safeguard local resilience and responsiveness, whilst we also consider how and when we can increase the business as usual work of our NHS.

The incredible levels of compliance with social restrictions that we’ve seen show a clear willingness on the part of the people of Scotland to think beyond individual health to population health. As we move to introduce the test, trace and isolate measures required, we will need that focus on population health to continue.

Finally, I want to update you on research proposals for COVID-19 that we launched on 25 March.

139 proposals were received from across Scotland’s Universities and Research Institutes.

Following an independent expert review process, 55 projects have been selected for funding.

This has resulted in a Pan-Scotland portfolio of research, with 15 different institutions leading on projects.

In summary, the outcome of the call is a programme of projects meeting the aim of establishing a broad Scottish programme of high quality research on COVID-19 that will be delivered rapidly and inform policy and clinical practice in responding to the pandemic.

Presiding Officer, I continue to be grateful for the tremendous resilience of our health and social care staff, our key workers, and most importantly people all across Scotland.

Together, we are making progress, we are suppressing the virus, we are saving lives and we are showing that we can continue to rise to the challenges of this pandemic.

Thank you.

PPE access extended to all social care providers

Everyone who provides social care will have access to appropriate PPE under new arrangements announced by the Scottish Health Secretary.

From Monday (27 April), local Hubs will distribute PPE supplies to the whole of the social care sector where normal supply routes have not been successful. These hubs will extend their provision to include all social care providers, and unpaid or family carers and personal assistants.

During the coronavirus (COVID-19) pandemic, global supply chains have been put under immense pressure and that is why the Scottish Government has set up supplies of PPE to support the social care sector from the national stock.

Health Secretary Jeane Freeman said: “The Scottish Government values the importance of everyone who is providing social care and we want to ensure they have access to appropriate PPE.

“As we respond to the challenges from global scarcity of PPE, we have worked with partners to agree an improved model that will ensure all social care providers have access to supplies from national NHS stock.

“This has only been possible because of a shared aim to ensure the right PPE gets to the right people at the right time and to keep everyone safe.

“In the coming weeks, we will collectively monitor how this model is operating, identifying challenges quickly and taking action as we deal with the evolving nature of the pandemic.”

Health and Social Care spokesperson for COSLA, Councillor Stuart Currie said: “COSLA welcomes this announcement which will ensure PPE provision for unpaid and family carers and personal assistants.

“Local Government has worked with partners across the sector to develop this model to ensure those who are supporting vulnerable people within their communities and all parts of the workforce have access to the PPE they need.”