Official figures released this week give more information on the presence of Covid19 in our Care Homes.

The Care Inspectorate amended their notification system to ask services to notify each individual suspected case of COVID-19 on the basis that the potential presence of COVID-19 in a care home should be notified as soon as possible. 

Here are the figures for Care Homes in Orkney.

Cumulative number of suspected COVID-19 cases per 1,000 registered places in Orkney

Cumulative % of adult care homes with a suspected COVID-19 case in Orkney

A spokesperson for Orkney Islands Council said:

“We would reassure the public that there have categorically been no positive Covid19 tests in Orkney’s care homes, whether that be staff or residents. 

“The data published by the Care Inspectorate is for suspected cases i.e. where someone has shown one or more potential symptoms of Covid19  – a temperature or cough for example –  but they have all tested negative.

“The rise in suspected cases simply accounts for the fact that this is cumulative data gathered across a number of weeks, an increased precautionary testing regime for care home staff and residents in accordance with Scottish Government guidance and a change in the type of data that the Care Inspectorate have asked us to provide.

The results should be viewed as very reassuring by Orkney’s communities”

For the whole of Scotland, cases are self-reported by care providers and should be considered suspected COVID-19. Some cases may subsequently have a formal positive test, other cases after testing may prove not to be COVID-19 and some cases will not be tested.

It is possible not all cases have been reported by all care homes, or there may be a delay in reporting.

The number of care homes with suspected cases using the Care Inspectorate definition may therefore be higher than figures held locally.

Cumulative numbers are counts since data was first reported and will include cases which are no longer active.

To set this in context here are the tables for Local Health Board Areas

As you can see from this although the figures for Orkney are low in comparison to other areas they have shot up in just one week. The * means the figures were so small that to report them might have meant the people could be identified – below 5.

What will also not be surprising from the figures is that small Care Homes are better at reducing the risk of the spread of infection. Figures also show that 71% of Private Care Homes have had at least one suspected case of Covid19 but Public Care Homes are also worryingly at 59% with the best results being in the Voluntary/Not For Profit sector at 40%.

It is rather simplistic to look only at the record of private Care Homes and not at the whole service provision. When Scotland eventually emerges from the pandemic’ reviewing  how we care in our communities for our older citizens must be a priority.

Given that many Care Homes stopped visiting by relatives 3 months ago it is extremely concerning that these figures of  are so high. In Orkney to see suspected figures surge in one week means either that there was under reporting previously or that Covid19 or other viruses, for example flu,  may have been transmitted into the Care Home.

This is further evidence that regular testing of Care Workers should be a priority alongwith all the other measures which have been put in place in Care Homes to protect residents.

Testing

Scotland continues to have under capacity of testing. This week NHS Orkney announced that it had Test and Protect up and running in the islands. Test and Protect Underway in Orkney

Tests must be booked in advance and will only be provided to those people experiencing the symptoms of Covid19 .

On the 4th of June there were only 4,180 tests carried out by NHS Scotland in hospitals, care homes or the community. Drive through and mobile tests carried out by the Regional Testing Centres in Scotland added a further 1,346. Still well below the numbers which need to take place.

Clear Communication

Finding information is not always easy. NHS Shetland is providing excellent information to its islanders.

This graphic explains quite clearly the recent testing data for Shetland. This is what the public need to see from local Health Boards to have confidence in and understanding about what is happening in their communities.

The Orkney News has mentioned before The New Zealand Ministry of Health which from the start of the pandemic reaching the country has provided easy to access information on its website.

When dealing with a major public health issue like the Covid19 pandemic, quality easily accessible information is essential. This needs to be one of the many lessons to be learned.

Operation Iris

On 12 March 2018, Operation Iris took place, delivered  by the  Scottish Government Health Protection Division. The aim of the exercise was to assess the readiness of NHS Boards in Scotland’s structures, facilities and systems to respond to a suspected outbreak of MERS-CoV.

You can download the report here: Exercise Iris -Final report

This comment is from the start of the pandemic scenarios set to the participants.

much of the discussion around patient handling centred on the need for, and availability of, Personal Protective Equipment (PPE) and the challenges in ensuring members of staff are correctly trained and prepared

This was a table top set of scenarios where the participants discussed strategies that should be adopted, the actions that need to be taken so that should Scotland face a future pandemic – like the one we are in the midst of now – that we are prepared. That was 2 years ago.

Conclusions from the Exercise

Exercise Iris was well received by the participants who engaged positively and constructively in support of the aims and objectives of the day.

The exercise identified 14 actions across a broad range of themes. Despite the breadth of discussion, there were no great surprises in the issues identified as priorities.

In the event of a large scale crisis, Boards will appreciate strong, national coordination and clear guidance.

Scottish Government and Health Protection Scotland should endeavour to ensure that relevant guidance is up to date and communicated effectively and that processes are in place for standing up and accessing national coordination structures and that these processes are widely agreed and understood.

Amongst frontline staff there is unease at the lack of clarity on PPE availability, training and testing. This is a clear gap in Scotland’s preparedness for MERS-CoV and other outbreaks and needs to be addressed as soon as possible.

Participants also commented on the welcome opportunity Exercise Iris presented to network with colleagues in other Boards and organisations to discuss the challenges presented by MERS-CoV. Many commented on the similarities with ongoing work on pandemic flu planning. It will be important to deconflict and avoid duplication of effort in taking forward work on MERS-CoV.

The most telling comment is from the frontline workers:

there is unease at the lack of clarity on PPE availability, training and testing

Participants were to take their experiences back to their local health area and the exercises were to be repeated at that level. Only a few people had been able to take part in the national event. How much of that happened? How many local Health Boards continued with the pandemic training? Were other issues considered more of a priority? Was there insufficient funding to follow through on this training?

Let us hope that in the future inquiry that will be held into the handling of the Covid19 pandemic in Scotland that lessons will be learned and action taken. This is not about apportioning blame but about changing what we do so that we are ready in the future.

Reporter: Fiona Grahame