LESSONS need to be learned from mistakes made in attempts to protect care homes’ residents and staff from coronavirus, according to industry voices.

 Donald Macaskill, chief executive of Scottish Care, which represents the largest group of independent health and social care providers across Scotland, said with the benefit of hindsight some things would have been done differently.

So far 39% of all fatalities through the virus in Scotland have been in care homes.

 “If I had known eight weeks ago what I know now we would have reacted differently ... but nobody did,’’ said Macaskill.

The National:

“At the start we were following one set of infection control guidance for the Government re PPE, testing etc – that guidance has changed nine times since it came out – so today we know more about the virus and how to protect from it than we did six weeks ago. Obviously if we knew six weeks ago what we know today we would have done things differently – but that is hindsight.”

He said that when it became obvious that care homes in Spain were being badly hit, Scottish care homes were already beginning to respond by going into lockdown.

“If you think about what was happening in Spain, what we saw was the abandonment of people, we saw the army going in to rescue people, we saw lots of people left without medication and we saw loads of people dying in agony.

‘‘That has not happened in Scotland because with the regulator we set in a system that immediately escalated concerns if staff were short or not able to deliver care. We also worked with the chief pharmacists to identify where there might be medication shortages and address that.

“But we know that this virus kills mainly individuals who are old and who have suppressed immunity and that has proven to be the case.

“It is the case the world over and is sadly the case in Scotland, with 74% of people in the death statistics over the age of 75 and tragically most of those over that age are living in care homes.”

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Macaskill said there was a general misunderstanding about the nature of the care home population, which is highly vulnerable and consists of people who are being supported to stay alive by the “care and compassion” of staff.

He pointed out that care homes were not filled with epidemiological experts and had to follow guidance just as politicians had to follow guidance. “The First Minister has made it very clear she will have made mistakes and the care home providers will have made mistakes,” he said.

“We are all of us in completely uncharted territory and the care home sector has more than done what it could have done – actually almost to a sacrificial extent.”

Macaskill said that in future the sector would be “much more aware” of measures that could be taken with regard to testing, PPE and restrictions.

However he said it was important to also think carefully about what matters most – the quality of life or the quantity of life.

“I was speaking to a care provider yesterday who has a resident aged 103. Statistically that means he is only going to have months of life left. It is more important to him and his daughter that they are together and can see each other – not that they communicate through a window or Skype from an iPad. He wants to spend time with family even if it means shortening his life. By the second scope of this virus we are in danger of having people survive the pandemic but lose the battle to have quality of life.”

He said that infection control practices which work in hospital were not necessarily appropriate for a care home.

“I think there are lots of lessons we can learn,’’ said Macaskill. ‘‘One of them is that we develop infection control that acknowledges that we are dealing with someone’s home and not a hospital.

“We need to realise that most people in the care homes have dementia and they will wander around, short of locking them up and pumping them full of drugs.”

THE GMB union has condemned the “shocking” number of deaths in care homes not just as a human tragedy but as a failure by both the Government and care employers to prepare properly. It says it called for a National Care Plan as early as March 19 but claims no response was given.

“The shocking number of fatalities in Scotland’s care homes isn’t just a human tragedy, it also represents failure on the part of government and the care employers – it doesn’t look like they planned properly for the social care sector,” said GMB Scotland organiser Rhea Wolfson.

“Events support this in the fact that workers had to wait five weeks after the first confirmed case in Scotland for clear guidance on PPE and until this weekend to bring forward a testing regime for residents and staff in homes with confirmed cases.

“Everyone knew the underlying weaknesses in the social care sector and we knew by the end of January that we were facing a serious public health crisis. We needed a clear national plan social care – GMB Scotland made such proposals to the First Minister – but nothing emerged.

“Instead we have been playing catch-up in trying to get the proper protection and testing in place while service users and staff are dying.

“It really is the crisis within a crisis and the treatment of our most vulnerable and the people who support them has been a scandal.” She added: “If we want to learn from this first peak in order to mitigate sickness and death in any future waves, then ministers must tell us what has gone wrong in the planning and preparation process concerning social care in Scotland and why.”

READ MORE: Covid-19: BBC sorry for incorrect Scots care home death figure

In a letter detailing how a National Care Plan would work, the union said it was essential that private and public providers were brought together to plan for the continued delivery of social care services and to co-ordinate the deployment of the social care labour force.

It said the Scottish Government should act immediately to establish from public bodies and representatives of the providers and the workforce, an authority which could take the decisions that would be necessary to ensure the continued delivery of social care and ultimately, if required, direct the labour force to where it was needed most.

In return, the letter said, the labour force available for this task should also benefit from the standardisation of minimum terms and that would mean an immediate uplift in pay for many.

Macaskill agreed testing had been too slow. “If we had enough capacity we probably would have been testing ages ago so, yes, testing has been too slow,” he said.

Adam Stachura, Age Scotland’s head of policy, said efforts to ensure care homes have everything they need to protect and treat residents and staff need to be redoubled.

He added: “Full-scale testing is crucial, before new residents are admitted and when suspected cases arise.

“Readily available and effective personal  protective equipment is central ... we know that the social care sector has had real difficulty getting the supplies they need in the past, but it appears that this has now become more straight-forward.

“There is no denying the devastating impact Covid-19 can have on older people. But there are cases every day of people in their 80s and 90s recovering from this virus and being reunited with family and friends. There is no excuse for anyone being ‘written off’ because of their age.”

A SPOKESPERSON for the Scottish Government told the Sunday National: ‘‘We recognise those who reside in care homes are at particular risk of Covid-19 and a series of additional steps to support those who live and work in them have been set out, with the focus on preventing infection and transmission of the virus.

Therefore, in addition to guidance on infection prevention and control for social or community care and residential settings which was published by Health Protection Scotland, in March the chief medical officer developed targeted clinical advice for nursing home and residential care residents and Covid-19. We regularly review this and have been updating it as evidence emerges throughout the pandemic.

“Directors of public health are providing enhanced clinical leadership and have contacted every care home in Scotland. They are assessing how each home is managing infection control, staffing, training, physical distancing and testing.

“We already test care home residents with symptoms, those being admitted to care homes and symptomatic care home staff and we will now expand that approach to undertake enhanced outbreak investigation in all care homes where there are any cases of Covid-19. This will involve testing, subject to individuals’ consent, all residents and staff, whether or not they have symptoms.

“In addition, where a care home with an outbreak is part of a group or chain and staff might still be moving between homes, we will also carry out urgent testing in any linked homes.

“We will also begin sampling testing in care homes where there are no cases.

By definition this will also include testing residents and staff who are not symptomatic.

“The Scottish Government also stepped in to provide both top-up and emergency provision of PPE to care homes and social care organisations to ensure staff have what they need and they and residents are fully protected.

“All Covid-19 patients should not be discharged from hospital until they provide two negative tests, and that all new admissions to care homes, and all residents who are symptomatic, are tested and those new admissions should be isolated for 14 days.

“Social care and care home staff continue to be priority key workers for testing and the Health Secretary has written to all care homes asking them to make sure that as employers they follow through where this testing is required.”