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

Appendix 1

Summary of Further Suggestions

1. Care home risk factors

• There should be greater clarity and transparency on commissioning of guidance related to IPC (including testing) and national local partners are able to give timely and responsive advice on social care.
• The Scottish Government will work with policy areas across Government and stakeholders to ensure that there is alignment with publication of guidance from various sources.

2. First wave

• The Scottish Government need to ensure the purpose of the SHT on quality and safety is achieved and we work with the care home sector, and other key stakeholders, to realign the focus of the tool towards improvement.
• In doing so national local partners need to support care homes and the sector to realise the benefits of robust quality and safety information.
• National local partners need to actively continue to address the data reporting burden on care homes to ensure that information is reported once but shared when needed multiple times.
• As highlighted in section 1 we need to continue to ensure there is transparent, timely and easy to access guidance for the sector in relation to COVID-19 but also other infectious pathogens.
• Work should continue on streamlining and where possible aligning IPC guidance for social care settings
• The national local partners need to ensure care homes have the confidence to continue to implement the relevant IPC guidance in a local context.
• The Scottish Government will continue to review collaborative improvement partnership with the sector
• The CI will continue to advise individual services about ways to reduce infection risk while maintaining connections between residents and their relatives. For example, by providing information about how visits could be safely managed and providing practical assistance to connect digitally.
• The CI will continue to work with the Scottish Government and relative groups in preparation for the introduction of Anne's Law that will protect people's rights.

3. Data and Digital infrastructure

• The Scottish Government need national statistics which are consistent with respect to care homes. We need all national bodies to use the same definition of what constitutes a care home (i.e. that defined by the care regulator, the CI ) and we need consistent recording of care home residency in CHI and institution coding.
• The Scottish Government is currently undertaking a Care Home Data Review with partners which will appraise the quality, frequency of reporting and content of the current data landscape with a view to determining the future requirements.
• The Scottish Government will work with care homes, CI, Scottish Care and the wider sector to develop the tool so it has an improvement focus in the context of the wider data landscape.
• To supplement this learning we will work with care homes and Health and Social Care Partnerships (HSCPs) to test the use of the SHT for improvement and to align with the requirements of the national data and digital strategies.
• the Scottish Government will re-engage with the sector to showcase how the current information captured in the tool can be used by care homes for planning and early warning. In doing so consider the issue of data duplication as highlighted above.
• National local partners need to ensure that the resource invested in data collection produces data that is of sufficient quality, consistency and completeness to enable comparisons between areas over time and for local improvement also.

4. Early warning signs

• The Scottish Government will work with national bodies to understand the appropriate role for TURAS (SHT) as a mechanism for reporting COVID-19 ( or other outbreaks).
• The Scottish Government also need to clear who is primarily responsible for reviewing/analysing the data on outbreaks and the flow of data from SHT to those who need to see/act upon that information.

5. Testing

6. IPC knowledge and Expertise

• The Scottish Government will consider ways to implement at local level IPC SICPs capacity in context of Health and Social Care Partnerships (HSCPs) and to ensure consistency of messaging on IPC in the care home context.
• The Scottish Government will work with partners to consider the development an IPC strategy for social care settings setting out vision, aims priorities including around workforce development and capacity building.
• Consideration should be given to whether this should be combined with an overall integrated strategy for health and social care settings.

7. IPC Indicators

• There will be a continuing need for further training and support for care homes to adopt and sustain robust IPC monitoring as per HIS IPC standards - standard 4
• Given the high turnover of social care staff, it will be important for organisations supporting care homes to continue to promote and embed SICPs for example through promoting the NES SIPCEP resources.
• Enhancement of staff access to development opportunities such as webinars and learning events, peer support networks providing time and appropriate IT equipment.

8. Leadership

• The Scottish Government with the sector will continue to recognise the importance of investment in leadership, support and wellbeing. SSSC will provide peer support, reflective practice and leading in crisis sessions to allow staff, who could not attend the early 2022 sessions the opportunity to do so.
• Supervision and learning resources are to be revised by SSSC – including how supervision can be used as wellbeing support for workers.
• The Safe staffing Programme at the CI to support the sector to prepare for enactment of the Health and Care (Staffing) (Scotland) Act 2019. Part 1, the guiding principles, includes staff wellbeing to ensure safe and high-quality services.
• The Scottish Government will continue to support the development and promotion of the national wellbeing hub for health and social care staff.
• NES and their delivery partner, HULT Ashridge will deliver the Developing Senior Systems Leadership programme to the first cohort in September 2022 – a further two are also planned.
• 'You as a collaborative leader' programme is scheduled for late 2022. This is a product of the leadership of integration activity between NES and RCGP Scotland and the SSSC.
• Queen Margaret University is creating a course that is centred on nurses, enhanced leadership training. This includes 'business in care' and 'kindness - person catered framework for organisations.

9. Training and Education

• The SSSC and NES to continue stakeholder testing and involvement in development of the remaining resources.
• Enhancement of staff access to development opportunities such as webinars and learning events providing time and appropriate IT equipment.
• SSSC to remind employers of the Code of Practice for Employers that includes induction and staff having dedicated time for training.

10. Relationships

11. Guidance and Local Adoption

• 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.

12. Inspection Arrangements

• The Quality Frameworks^[69] for Support Service (day care) will be updated to include learning from COVID and have quality indicators for IPC.
• The CI should continue to monitor the impact of practices across whole provider organisations through the relationship manager, available data and intelligence.
• The IRISR will look at how social care services are regulated and inspected across health and social care support services in Scotland to ensure that scrutiny keeps up with an evolving landscape and changing skills required of the workforce
• It will be important to ensure formalisation of the process for ensuring IPC expertise availability between ARHAI and CI
• The CI continue to engage with subject matter experts as required.
• The CI collaborate with partners to develop and contribute to learning events for the sector and stakeholders based on intelligence and feedback from sector.

13. Carer's Perspectives

• The Scottish Government will continue to work with the Anne's Law and Open with Care Oversight Group alongside the CI, local partners and relatives to monitor visiting in care homes and the adoption of the new H&SC standards, and to prepare the sector for the introduction of Anne's Law.
• The Scottish Government will work with the Anne's Law and Open with Care oversight group to develop visiting Directions to ensure they capture the lessons learned from the COVID-19 pandemic and deliver on Anne's Law.

14. Built Environment

• Consideration should be given to further advice on ventilation for social care settings for example by adapting the Scottish Government's guidance for employers on improving ventilation and the supply of fresh air into the workplace, taking account the availability of other guidance e.g. the Health and Safety Executive

Consideration should be given to the emerging evidence base around use of systems to support monitoring of ventilation in settings.