Coronavirus (COVID-19) care home outbreaks - root cause analysis: progress report November 2020 to September 2022

11. Guidance and Local Adoption

The RCA report acknowledged that guidance is complex and changing in light of emerging evidence for COVID-19 which makes it challenging for staff to keep appraised of updates. The importance of effective local leadership within the home and access to expertise and support from local NHS Boards was seen as essential to support adoption. The RCA reported on good examples of where this has taken place. However the report noted difficulties for staff in accessing timely advice through lack of access to online systems for learning, emails, or general communication; guidance issued too close to the weekend; expectation of families following announcements for updates to be implemented immediately; challenges in accessing advice and support from the Health and Social Care Partnerships (HSCPs), the HPTs and where applicable the care home group. Fundamentally the report indicated that experience of COVID-19 has illuminated a care home system which is not IPC-resilient and needs considerable investment to ensure its future preparedness. Recommended steps to ensuring resilience included the use of the World Health Organisation (WHO) multimodal improvement strategy for IPC in health and care settings^[36] to support standardisation, improvement, monitoring and reporting. In practice, this means the use of multiple approaches as part of quality improvement programmes that in combination contribute to influencing the behaviour of the staff towards the necessary improvements that will impact on outcomes and contribute to organisational culture change.

Recommendations:

11.1 HSCP planning using a multimodal approach to IPC is required; this may be supported by national IPC lead organisations such as ARHAI Scotland

11.2 The new national care home manual for IPC planned for completion in December 2020 should be produced with a multimodal strategy plan for dissemination and implementation

Progress

Health and Social Care Partnerships (HSCP) planning using multimodal approach

Local oversight groups and public health HPT teams have provided public health and IPC advice and support for care homes. The Scottish Government also made available supportive materials including posters, video clips and online webinar sessions. In addition to individual advice and support, many local areas have developed a range of initiatives to support area-wide improvements for IPC and other issues through peer learning networks collaborative. Support for interpretation and implementation of guidance updates has also been provided through newsletters and seminars.

Care Home Infection Prevention and Control Manual:

As noted earlier, the new national Care Home Infection Prevention and Control Manual (CHIPCM) ^[37] was published in May 2021. Implementation was supported by a series of webinars delivered with partners: ARHAI, the CI , HIS and Health Facilities Scotland with the aim of promoting consistent application of SICPs. The CI takes account of the CHIPC annual and all good practice documents at inspections, IPC is a core assurance of the self-evaluation framework for care homes for adults and older people. Providers and visiting health and social care professionals continue to follow the Scottish COVID-19 Community Health and Care Settings Infection Prevention and Control Addendum as highlighted in section 2.1. The Care Homes Cleaning Specification^[38] published in May 2021 provides a guide to planning, and implementing cleaning services. It provides tools to help with the planning, and implementing, and recording of cleaning activities and with the overall management activities. Workshops and letters were provided to the sector. The CI take account of the CHIPCM and the Safe Environment cleaning specification continues to be promoted during learning events to reinforce the importance of SICPs in everyday activity.

The CI developed and made available the COVID compendium to support providers and managers to have access to the most up to date guidance. The use of resources of compendium and Quality framework^[39] in maintaining IPC standards are detailed in section 2.1.

The CI have IPC as a core assurance for every inspection visit. They established a separate quality indicator and ensure that IPC practice is part of induction and training for all staff.

11.3 National organisations should be mindful of the impact of publication of guidance on days towards the end of the week or over weekends, and the availability of senior managers to support interpretation, dissemination planning should be considered as part of the guidance development process

11.4 Most recent versions of guidelines should clearly highlight the additional information or changes from the previous version

Progress

Guidance has evolved and been updated rapidly in response to the emerging situation. In view of feedback from the sector around timing of and updates to guidance, there was considerable engagement with the social care sector to improve guidance development, publication and communication. Discussions were held with a range of care at home, care home and supported housing providers, involving Association for Real Change (ARC) Scotland, Coalition of Care and Support Providers in Scotland (CCPS), Scottish Care, Health and Social Care Partnerships (HSCP) care home managers.

In response to feedback from the sector about the need for other forms of communication around guidance, Open with Care visiting guidance comprised a principles document with – concise, plain English; easy read version, family leaflet and other communications. More recently the Scottish Government extended use of face mask guidance published in September 2022 included a poster and video.

For the most part, national organisations have tended to avoid publishing guidance on Fridays following feedback from the health and social care sectors. This has broadly been welcomed by the sector however there were exceptions, most notably when guidance was issued by the Scottish Government to coincide with the discontinuation of test and protect before the May 2022 holiday in order that staff were aware of arrangements. Considerable work has been done by a range of organisations to highlight forthcoming and actual changes to guidance to make it clearer for social care providers.

The CI continues to support the sharing of guidance across the sector and use of COVID Compendium as detailed in Section 2.1 and also send out provider updates weekly or as required. Feedback suggests that care services find them useful and informative. As noted in section on the First Wave, some progress has been made in streamlining COVID guidance but there is still work to do.

Going forward

• National local partnership areas should continue to consider what support care homes require to enable adoption of guidance using the multimodal approach

• The Scottish Government will continue to ensure that updated guidance is provided in a timely manner, liaising with relevant stakeholders to ensure coordination and alignment.