Written Question · S5W-31050 · Session 5
Who was the author of the policy to advise care homes that residents who were showing symptoms of COVID-19 should not normally be admitted …
The question
To ask the Scottish Government who was the author of the policy to advise care homes that residents who were showing symptoms of COVID-19 should not normally be admitted to hospital.
The answer
Clinical advice is provided through the offices of the Chief Medical Officer (CMO) and the Chief Nursing Officer (CNO). Early on in the pandemic the CMO and CNO commissioned a Clinical and Professional Advisory Group for Care Homes to combine advice from medical, nursing, social sectors including Scottish Care working alongside the sector to develop it jointly. This group provides advice to Government through the offices of CMO and CNO. No piece of guidance has a single author and Scottish Care has been involved in the development of the guidance that group produces.
The national clinical and practice guidance makes it very clear that anyone who would benefit from additional support should receive this. If an individual would benefit from hospital care, and if it is in their best interests, and their expressed wishes, then the necessary steps to do so should be taken. Decisions to admit a person to hospital should always be made on an individual basis, irrespective of whether they are a care home resident or someone living in their own home, and take account of the person’s needs and wishes. These decisions are not always straightforward and require careful consideration by all involved. They frequently require careful clinical judgement about the potential benefits and unintended distress or harms that may arise from moving people who are often frail or vulnerable. The ways that these decisions are made should not be any different to normal, non-pandemic times. The guidance also recognises that in some cases it would not be appropriate for a hospital admission and in those instances additional support may need to be provided within the care home depending on availability of local services.
At the time the initial guidance was written (during the delay phase) the advice was that any individual with COVID-19 symptoms (regardless of how minor) should be transferred to a regional Infectious Disease facility of which there are four in Scotland. In the context where many people in care homes have dementia and are extremely frail or even in the last months of their life, if this transfer would not offer a benefit to the resident, it was not in the residents interests for a blanket policy to transfer all people with Covid-19. Subsequent iterations of the guidance have provided more clarity particularly around the need to make sure that care is tailored to an individual’s needs and takes into account their wishes and the risks and benefits of any decision.
The guidance states that in many instances it is helpful to bring clinical care to the resident so as to minimise the disruption of a hospital transfer and provide elements of hospital care such as oxygen and clinical advice which can be safely supported in a care home setting. In support of such in-reach care provision for care home residents, a letter was issued from the Chief Medical Officer (CMO), Royal College of General Practitioners and British Medical Association on the 17 April which emphasised that there will still be times when a face to face consultation is clinically necessary, and makes clear our expectation that health and care professionals will continue to enter care settings such as care homes to provide ongoing care and support when required, with appropriate safety measures such as PPE in place.
Furthermore, on the 20 May the CMO wrote to boards encouraging them to provide secondary care support to care homes including where they could through the provision of Hospital at Home services. In Scotland currently over 40% of the population has access to Hospital at Home services and this proportion has risen in recent months – delivering hospital level care in the patient’s own home – including care homes. In addition, specialist palliative care support is available in many boards across Scotland as well as other forms of hospital specialist support to GPs and care homes.
The national clinical and practice guidance makes it very clear that anyone who would benefit from additional support should receive this. If an individual would benefit from hospital care, and if it is in their best interests, and their expressed wishes, then the necessary steps to do so should be taken. Decisions to admit a person to hospital should always be made on an individual basis, irrespective of whether they are a care home resident or someone living in their own home, and take account of the person’s needs and wishes. These decisions are not always straightforward and require careful consideration by all involved. They frequently require careful clinical judgement about the potential benefits and unintended distress or harms that may arise from moving people who are often frail or vulnerable. The ways that these decisions are made should not be any different to normal, non-pandemic times. The guidance also recognises that in some cases it would not be appropriate for a hospital admission and in those instances additional support may need to be provided within the care home depending on availability of local services.
At the time the initial guidance was written (during the delay phase) the advice was that any individual with COVID-19 symptoms (regardless of how minor) should be transferred to a regional Infectious Disease facility of which there are four in Scotland. In the context where many people in care homes have dementia and are extremely frail or even in the last months of their life, if this transfer would not offer a benefit to the resident, it was not in the residents interests for a blanket policy to transfer all people with Covid-19. Subsequent iterations of the guidance have provided more clarity particularly around the need to make sure that care is tailored to an individual’s needs and takes into account their wishes and the risks and benefits of any decision.
The guidance states that in many instances it is helpful to bring clinical care to the resident so as to minimise the disruption of a hospital transfer and provide elements of hospital care such as oxygen and clinical advice which can be safely supported in a care home setting. In support of such in-reach care provision for care home residents, a letter was issued from the Chief Medical Officer (CMO), Royal College of General Practitioners and British Medical Association on the 17 April which emphasised that there will still be times when a face to face consultation is clinically necessary, and makes clear our expectation that health and care professionals will continue to enter care settings such as care homes to provide ongoing care and support when required, with appropriate safety measures such as PPE in place.
Furthermore, on the 20 May the CMO wrote to boards encouraging them to provide secondary care support to care homes including where they could through the provision of Hospital at Home services. In Scotland currently over 40% of the population has access to Hospital at Home services and this proportion has risen in recent months – delivering hospital level care in the patient’s own home – including care homes. In addition, specialist palliative care support is available in many boards across Scotland as well as other forms of hospital specialist support to GPs and care homes.
In the Official Report
No contribution in the Official Report cites S5W-31050 by reference.