Winter is coming – a brief word on the adult social care winter plan

There is so much guidance coming out at the moment that it is almost impossible to keep on top of it. I’m not even going to try to comment on every bit of it as it comes up. And I’ve already read Alex Ruck-Keane’s walk-through of the latest MCA guidance, I’m sure most of you have too. But I do want to, briefly, mention the winter plan.

If you haven’t seen it, it’s here. I hadn’t really paid it much attention, because it reads, largely, like a the script for a game of ‘buzzword bingo’. Don’t get me wrong, I love a good euphemism but ’empowering local decision-making’ really means ‘passing responsibility to overworked local government’ and we all know it.

What prompted me to write this post was the letter that was sent last week to local authorities about designated settings. It made the news last week, because it is advising local authorities to set up designated settings for covid-19 positive individuals to be discharged to, before they enter ‘general population’ as it were.

There are a lot of opinions on this out there. I confess that this was suggested in my area some time ago, and the reaction was almost instantaneously negative. The emotional response people had to the suggestion that covid-19 positive people will be shut away together is easy to understand. Let’s be honest, it does sound a little victorian. It harks back to plague colonies and lunatic asylums in the public consciousness.

Personally, I see what they are trying to accomplish with this. Care homes don’t want to accept covid-19 positive residents. Local authorities can’t make them. But there is nowhere for a lot of these people to go, and they are left in hospital. Everybody gets very unhappy about bed blocking, after all, and we’re all supposed to be doing everything that we possibly can to get people discharged from hospital as quickly as possible. And there isn’t really an easy answer, right now, to the question of how these people can be safely discharged, if they need ongoing support. The intention is good, and I truly understand what they intend to accomplish.

But putting aside emotions, for a moment, I see a logical flaw in this plan.

You see, in my experience, the reason homes aren’t admitting people who have tested positive is that they aren’t set up and staffed in a way that enables individuals to be safely isolated from other residents, putting other residents at risk. Which is a fair point. If its not been possible to figure this out by now, then I’m not sure what will change just by labelling somewhere a designated placement.

And if isolation, particularly for those with impaired understanding continues to be an issue, then how is anyone to ever get out of one of these places? Because they can go there for 14 days, but is someone else is admitted on day 13, and the two aren’t isolated, then does the person remain a risk, or can they still be admitted safely to a care home? After all, it might be true that once over the infection, a person isn’t capable of carrying the virus and infecting others. But I’m not sure we know that yet, do we? So will a care home be anymore likely to accept this person after they’ve been in a designated setting than they were straight from hospital?

Something needs to be done. That is clear. The news is full of stories of how this infection is ravaging care home populations. At the least, the public relations machine needs to be kicking in, because panic is beginning to spread.

But there seems to be a worrying pattern of protectivism, to the expense of individual rights. Its evident in the designated settings proposals, it’s evident in the failure of large chunks of the guidance to acknowledge that testing cannot be forced on care home residents, without court orders of use of the compulsory powers that all parties seem reluctant to use, it’s evident in the guidance about visiting care homes.

Is it just me, or is there a pattern of saying that rights are important, but then quietly stomping all over them? Nobody wants to use the compulsory powers to test and isolate people because of the human rights implications, but health and social care staff are still expected to make sure people are tested and do follow guidance. How can they do so without infringing on the same rights that police and public health don’t want to be seen to be ignoring. Yet we should do it quietly, so they don’t need to publicly.

That is what frustrates me. There are countless considerations to be taken into account, at the moment. Yet the government guidance tries to simplify these issues, and distill them to broad rules to be applied in all circumstances, which leaves local authorities to grapple with the complexities blindly. Which means local authorities get the brunt of the complaints and challenges. And then they look to people like me.

As if I have the answers…

In case it isn’t obvious from the fact I still haven’t identified the authority I work for, the views expressed on this blog are my own opinion and not the opinion of that local authority

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