Hansard

Every winter, our social care and health systems face significant pressures from seasonal flu and norovirus, but this year the Covid-19 pandemic magnifies those challenges as never before.

Last week, I set out how we will support our national health service to respond, and today I am publishing the interrelated plan for adult social care. Delivery of that will be backed by £112 million of additional investment to support the sector in providing care to some of the most vulnerable members of our communities.

Approximately 245,000 people in Scotland receive social care and support; that is one in 20 of the population. Of those, approximately 60,000 people are receiving home care at any one point in time.

People who use social care support in residential and community settings and in their own homes have felt the significant impact of Covid-19 this year. Many of them have lost their lives to the virus and many have become seriously ill. I again express my heartfelt condolences to all those who have been affected and to their families and their loved ones.

That impact has also been felt by the staff and the unpaid carers who provide care and support. Some of them have also lost their lives and some have become seriously ill, with long-lasting effects. I express my condolences to their families and loved ones, and my sincere gratitude to them.

The plan that was published today is supported by the evidence paper and the independent care home review that I commissioned using root cause analysis methodology. Both of those, together with the independent report from Public Health Scotland, the University of Glasgow and the University of Edinburgh, and the Care Inspectorate’s care-at-home inquiry, have informed the thinking and conclusions of the plan. The winter preparedness plan that is being published today supports safe care and protection by continuing the effective measures that are already in place and by applying learning from those published reports and from our direct experience and that of our partners to additional measures that we will introduce and require.

The plan is centred on four key principles: learning from evidence to protect people from the direct impact of Covid-19 and winter viruses; ensuring that people can benefit from good physical and mental health and wellbeing through the provision of high-quality integrated health and care services; supporting the social care workforce to deliver safe support and care and their own positive mental health and wellbeing; and collaborative working to both plan and deliver high-quality care.

The adult social care sector brings together organisations, providers and people from across the health and social care sectors from private, public and independent providers. The plan has been produced with their engagement and input, and I am pleased to say that it has the support of the Convention of Scottish Local Authorities, our key partner. I want to thank local government colleagues and others from across that wide sector for their constructive, pragmatic and positive approach.

The role of local government and health and social care partnerships in direct delivery and in commissioning from the third and independent sectors is critical to successful delivery. The NHS, health and social care partnerships and local authorities need to be able to take the lead in ensuring the successful delivery of the plan at a local level. We have set out shared values of communication, cohesion and collaboration, nationally and locally, and those must be in place and enacted if we are to have the positive impact that is needed on the lives and wellbeing of every adult who needs social care support.

I want now to set out briefly some of the key steps that are detailed in the plan against those principles. Of people receiving social care services or support, 77 per cent are aged 65 or over, and 90 per cent of people living in a care home are over 65 with one in two of that number aged over 85. We have already made significant progress with effective infection prevention and control, which protects not only against Covid-19 but against all winter viruses. However, we need not only to maintain that but to strengthen it, as the evidence tells us. We will issue new clinical guidance for care homes and community care through the clinical and professional advisory group, supported by an additional £7 million, to support increased infection prevention and control nursing support and training for social care providers.

All care homes are vulnerable to Covid-19 outbreaks, so our focus has to be threefold: preventing the virus from entering the home, early identification of cases and prevention of transmission. For older people in the population, we now understand that there are a broader range of Covid-19 symptoms, so we are asking providers to introduce a new daily review of Covid symptoms in care home residents and staff. To support that, the clinical and professional advisory group will provide and issue a checklist of those broader Covid symptoms and we will look to provide support to staff so that they can confidently undertake that daily review.

Minimising staff movement within and between care settings is also critical to reducing the risk of transmission. The evidence is clear that reducing the number of people in close contact reduces the risk, but we need to do that in a way that does not negatively impact on individual members of this vital workforce. Therefore, to support the sector to implement necessary limitations and restrictions on staff movement, we will make funding of up to £50 million available. We need to work together across the social care sector to deliver that, working through the practical steps that are needed and ensuring that our trade union colleagues are fully engaged with us in that work.

Public Health Scotland’s analysis of discharges from hospital to care homes reinforces the requirement that hospital discharge to home or to a care home is as safe as possible, so the current national testing requirements for people coming into hospital, and being discharged from it, remain and must be followed. Ensuring that that is the case is a responsibility that rests with boards, HSCP partnerships and providers, but also with Government.

Securing the physical and mental wellbeing of care home residents is critical, and I know only too well the impact that the early phase of the pandemic has had on many. Reintroducing health and care services for residents is vital. To do that as safely as possible, it is important to introduce testing for the professionals who are involved, and that will be implemented in the coming weeks.

We will continue to review visiting guidance. My aim is to maximise the quality time that families can safely spend together. We will apply additional protection through the introduction of testing for designated care home visitors and work to secure more localised, evidence-informed decisions that take into account the new strategic framework protection level arrangements, community prevalence, outbreaks and care home circumstances. We will increase our available wraparound care and continue to support social, community and primary care teams to work alongside each other.

Today, we are making up to £50 million available for the staff support fund and for sustainability payments for the sector this winter. We are committed to working with COSLA and wider partners immediately to support the development of effective and timely allocation mechanisms for those funds. I will say more about that in a moment.

There can be no doubt about the scale of the challenge that the adult social care sector has faced. At the forefront of that and in many ways bearing the brunt of it have been its professional, compassionate and skilled workforce. We owe them our thanks and the support that they need.

We will continue to improve weekly testing for care home staff by completing the transition of the programme to our NHS labs, which will build in greater certainty of fast turnaround times. That reduces the Covid risk to staff, their families and those they care for. We will prioritise testing for care-at-home staff, with the recognition that that might be phased in as capacity allows and targeted in the first instance at those who work in areas of high prevalence.

Testing is important, but infection prevention and control also critically requires the provision of PPE to the right standard and as set out in the guidance. The Government will meet the additional costs that health and social care partnerships and providers incur for PPE and will support the provision of and access to PPE for staff, visitors and—when necessary—care recipients over the winter period.

In May, we introduced increased collaboration and oversight across partners, which involves multidisciplinary enhanced oversight arrangements to support the delivery of adult social care during the pandemic. Those arrangements remain vital to supporting safety and improvements in care, and they will continue.

We have introduced the safety huddle tool for care homes, which 100 per cent of care homes have now signed up to. That provides care homes and local partners with the real-time information that they need to manage risk effectively, prevent issues from arising and seek support when they need it. In the coming months, we will look to expand that.

In the coming weeks, we will work with Scottish Care and the Coalition of Care and Support Providers in Scotland to identify opportunities to engage with providers on the plan.

Continuing to support technology and digital improvements is important. We have provided tablets to care homes and we now commit a further £500,000 to digital support, which will ensure that all care homes have access to digital devices, connectivity and support.

All that work and more requires our commitment, collaboration and—most of all—the skill and professionalism of staff, but it also requires money. I have agreed with COSLA that, for the month of November, we will continue the sustainability funding for social care at the level that was set for October. Over this month, we will work with COSLA and other partners to take a more targeted approach to sustainability funding to ensure that people get the support that they need, that organisations that need support can access it quickly, that services can be sustained and that value for money is secured. During November, with COSLA, we will engage intensively with commissioners and providers to ensure a smooth transition and clarity about financial support until March 2021.

This is the first national winter plan for the adult social care sector. Like all plans, it is not set in concrete and will have to adapt as circumstances change and new pressures and demands arise. That is all the more certain as we deliver on its requirements in the middle of a pandemic. However, the principles that it rests on will remain. The plan is built on partnership, and it can be delivered only in partnership, with collaboration, clear leadership, investment and pragmatism.

Our challenges are many, but our advantages are all that we have already learned, the developing and deepening evidence that informs our decisions, the relationships and leadership that we have at local level across the country and nationally, and—most of all—the skill, care and dedication of all who work in adult social care. I commend the plan and its supporting papers to members.