Adult social care - winter preparedness plan: 2021-22

Protecting those who use social care support from the direct impact of COVID-19 and other winter viruses

Infection Prevention and Control continues to be of paramount importance as we come to terms with the impact of the pandemic and apply lessons learned. It is also important to consider other infections that have outbreak potential within care homes. Respiratory infections such as influenza and RSV, and gastro intestinal infections such as Norovirus and C.diff, will all become more prevalent as physical distancing restrictions are eased.

In order to mitigate against these risks there will be continued support at NHS board level for IPC in care homes. The launch of a new national IPC manual for care homes in May 2021 and implementation supported by a series of webinars delivered with partners:

Antimicrobial Resistance and Healthcare Associated Infection (ARHAI), the Care Inspectorate, Health Care Improvement Scotland (HIS) and Health Facilities Scotland over the summer months should support the consistent application of standard infection control precautions (SICPs). The Care Inspectorate will be inspecting against the manual and this will provide assurance at national level. Providers and visiting health and social care professionals should continue to follow the Scottish COVID-19 Community Health and Care Settings Infection Prevention and Control Addendum. Providers will be informed of any changes and updates to guidance.

The IPC sub group of the Clinical and Professional Advisory Group for adult social care continues to monitor progress against the Outbreaks in care homes: root cause analysis review and action plan that was produced last winter. As part of this, tools for local assurance of IPC are being developed with national agencies and sector partners represented on this group.

The 'Kind to Remind' campaign developed as part of the COVID behavioural insights work will be adapted to be more health and social care specific to support best practice in relation to staff behaviours that might contribute to the spread of infection. The pandemic has highlighted a number of variations in the process for reporting of outbreaks and reporting systems across Scotland. CPAG has supported a proposal for a task and finish group to develop a standardized outbreak reporting process to be included in the national IPC manual for care homes and used across Scotland. IPC advice has also been updated for Care at Home, housing support and supported housing.

The primary objective of the COVID-19 booster programme is to maintain protection against severe COVID-19 disease, specifically hospitalisation and deaths, over winter 2021/22, and is aimed at maintaining protection in those most vulnerable, and to protect the NHS. The booster programme will run alongside our biggest ever flu vaccination programme. The booster dose can be offered any time at least 6 months after the second primary dose.

NHS Scotland are offering a booster dose to those most at risk first. For residents and staff in care homes for older people, local health boards are making arrangements with care homes to give flu and COVID-19 booster vaccines at the same time. Staff and residents will be vaccinated in the care home setting. If you are a member of staff working in a care home for older adults, you will likely be offered both vaccinations on site. You are able to book an appointment online if you were unable to be vaccinated on site. Frontline Health and Social Care Workers are eligible for the COVID-19 booster, and a wider group of Health and Social Care Workers are eligible for flu vaccination. These can be booked via the NHS Inform portal. Employers in all parts of the health and social care system will be supported to communicate with their staff groups around eligibility and encourage uptake.

For flu-only vaccinations, in previous years, employers circulated the offer of local clinics in their work locations and offered workplace-based peer to peer vaccination programmes. While this type of workplace clinic will continue to be offered by some Health Boards this year, social care staff delivering direct care and support will also be able to use the online self-registration portal to register and self-declare that they meet the criteria for vaccination and book a time and venue closer to home or work that suits their individual needs. The NHS helpline will also be available for those who prefer to speak to someone by phone, and NHS Health Boards have flexibility to put in place a model of delivery which suits local planning and delivery.

Unpaid carers aged 16+ are also eligible for the COVID-19 booster vaccine. All unpaid carers and young carers are eligible for the free flu vaccine. Young carers in primary and secondary schools will be offered the flu vaccine as part of the schools programme. Those aged 70 or over will be contacted by their local NHS health board with details about their appointment. Information about how to arrange your flu vaccination for all other eligible individuals will be available soon. We want to ensure that all unpaid and young carers know they are eligible for the free flu vaccine. Some carers will be contacted directly to encourage them to book and there will also be a public marketing campaign to raise awareness and encourage people to come forward.

Testing to Protect against COVID-19 for those most vulnerable to severe harm, through routine asymptomatic testing, remains a priority. Routine weekly PCR testing and twice weekly LFD testing continues to be available for all care home staff in Scotland. Testing has now expanded to include residents entering or returning to a care home, all professionals entering a care home, and family visitors. Social care testing has also been extended to include care at home, sheltered housing, and a large number of community based services through a blend of LFD and PCR testing. Social care testing will continue to operate until at least the end of December 2021.

We continue to provide information, advice and support to enable and empower people at highest risk from COVID-19 to make decisions about managing their own risks and circumstances and responding to population advice, as well as recovering and re‑connecting with daily life and activities. Local authorities continue to provide local advice and support where needed. The Scottish Government is continuing to fund the National Assistance Helpline (NAH) until the end of 2021, which connects people, especially those at highest risk, to their local authority to provide local advice and support where needed. This includes access to food and medicine, as well as practical and emotional support. We continue to liaise with Regional Resilience Partnerships on demand and capacity for local support for those at highest risk from COVID-19. Last year, we gave those on the highest risk (shielding) list an opportunity to receive a free, 4 month supply of Vitamin D over the winter months. We have not asked people

on the highest risk list to stay indoors this year, whereby they may have had less exposure to the sun. Our policy remains that everyone should consider taking a daily 10 microgram supplement of vitamin D to protect bone and muscle health, particularly during the autumn and winter months. Further action to raise awareness of current vitamin D advice, particularly amongst at risk groups, is being considered and kept under regular review.

Across Scotland care home staff have worked incredibly hard to implement the principles of Open with Care visiting guidance, to support people who live in care homes to connect with their loved ones within and outwith the home. We will build on this progress and work with partners, including the Care Inspectorate and local oversights teams, to ensure that care homes continue to be supported to normalise visiting opportunities for people. Recognising the success of the vaccination programme, and with the range of other protective measures in place, a named visitor can visit during controlled outbreaks unless there are exceptional circumstances. The principle of allowing limited visiting in a managed COVID-19 outbreak situation takes account of the fact that social contact (with a family member, friend or representative) is essential to a resident's health, wellbeing and quality of life.

Throughout the pandemic, our overriding priority in care homes has been to safeguard and protect staff and residents from infection – but at times, that meant that residents were cut off from their loved ones, causing anguish for many. As outlined within the Fairer, Greener Scotland: Programme for Government 2021-22 published on 7 September, we will strengthen residents' rights in adult residential settings and bring in 'Anne's Law' – giving nominated relatives or friends the same access rights to care homes as staff while following stringent infection control procedures.

Our efforts to protect people from the virus and the rights of those we are seeking to protect are equally important and individual rights, wishes and preferences should be foremost in decision making. Access to advocacy services is available to help individuals express views, including support to communicate their decisions, wishes and concerns. A wide range of legislation is in place to protect, support and provide care to vulnerable adults, including the Adult Support and Protection (Scotland) Act 2007 and the Adults with Incapacity (Scotland) Act 2000. Both Acts are underpinned by the principles of actions or decisions being of benefit to the individual, and furthermore be the least restrictive option. In addition, both Acts highlight the importance of taking into account the views of those with a close interest in the welfare of the individual, such as families, guardians and those with Power of Attorney. To increase awareness of the duties of an attorney we will be updating the Codes of Practice for Continuing and Welfare Attorneys. Support is delivered and assessed consistent with the rights-based Health and Care standards.

Links to training, funding and guidance for protecting those who use social care support

• Infection prevention & control
• Preventing infection in care
• Scottish Infection Prevention & Control Education Pathway – Foundation
• Testing
• Coronavirus (COVID-19): social care testing – gov.scot (www.gov.scot)
• Coronavirus (COVID-19): getting tested in Scotland – gov.scot (www.gov.scot)
• Presentation of infections in the older person
• Open with Care – supporting meaningful contact in care homes: guidance – gov.scot (www.gov.scot)
• Coronavirus (COVID-19): named visitor during outbreaks – letter and guidance for care home sector – gov.scot (www.gov.scot)
• Covid-19 advice note v14 28 Aug 2020.pdf (mwcscot.org.uk)
• Covid-19 vaccine
• Vaccination Programme
• Seasonal Flu vaccine
• Vaccinations for health and social care workers | NHS inform