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The @scotgov's new guidance for care home staff is far better than anything @DHSCgovuk has produced for care home staff in England. This thread compares the 
and 
approaches. https://www.gov.scot/publications/coronavirus-covid-19-clinical-guidance-for-nursing-home-and-residential-care-residents/
and approaches. https://www.gov.scot/publications/coronavirus-covid-19-clinical-guidance-for-nursing-home-and-residential-care-residents/
Like all good policy documents, starts by setting out the purpose, which is to provide "advice and support for those working with adults in care homes during this pandemic". It is "based on the emerging evidence UK and international experiences of COVID- 19". Impressive.
starts by setting out the purpose, which is to provide "advice and support for those working with adults in care homes during this pandemic". It is "based on the emerging evidence UK and international experiences of COVID- 19". Impressive.
The equivalent is this https://www.gov.uk/government/publications/coronavirus-covid-19-admission-and-care-of-people-in-care-homes which "is intended for care homes, local health protection teams, local authorities, clinical commissioning groups (CCGs) and registered providers of accommodation for people who need personal or nursing care".
equivalent is this https://www.gov.uk/government/publications/coronavirus-covid-19-admission-and-care-of-people-in-care-homes which "is intended for care homes, local health protection teams, local authorities, clinical commissioning groups (CCGs) and registered providers of accommodation for people who need personal or nursing care".
Note that the guidance is for "for those working with adults in care homes". It's for *people*. The document is "for care homes" (inanimate objects). Second, note that while describes the intended audiences, it contains no purpose 
guidance is for "for those working with adults in care homes". It's for *people*. The document is "for care homes" (inanimate objects). Second, note that while describes the intended audiences, it contains no purpose
The guidance sets out context on age and disability. It contains clinical info about co-morbidities leading to increased mortality. E.g. it says that people with learning disabilities have "higher prevalence of asthma and diabetes". Useful and important info for carers.
guidance sets out context on age and disability. It contains clinical info about co-morbidities leading to increased mortality. E.g. it says that people with learning disabilities have "higher prevalence of asthma and diabetes". Useful and important info for carers.
In contrast, the document contains the following info about increased mortality risks of older people and people with learning disabilities:
document contains the following info about increased mortality risks of older people and people with learning disabilities:
(Yes, that was a blank page) The guidance acknowledges "the emergence of increased spread within the care home sectors". That's diplomatic. The High Commissioner for 
@UNHumanRights warned weeks ago that the Covid-19 risks "rampaging" through institutions.
guidance acknowledges "the emergence of increased spread within the care home sectors". That's diplomatic. The High Commissioner for @UNHumanRights warned weeks ago that the Covid-19 risks "rampaging" through institutions.
Yes you've guessed it, the guidance doesn't acknowledge the inherent risk of congregate care. Talking of "risk", that word appears 38 times in the document and 11 times in the document. Make of that what you will.
guidance doesn't acknowledge the inherent risk of congregate care. Talking of "risk", that word appears 38 times in the document and 11 times in the document. Make of that what you will.
The guidance says older people may not have a fever or cough, but present with "loss of appetite or smell, vomiting and diarrhoea, shortness of breath, falls, dehydration and increased confusion, delirium or excessive sleepiness". Potentially life-saving info!
guidance says older people may not have a fever or cough, but present with "loss of appetite or smell, vomiting and diarrhoea, shortness of breath, falls, dehydration and increased confusion, delirium or excessive sleepiness". Potentially life-saving info!
In contrast, the guidance says that older people "may present with Influenza Like Illness (ILI), respiratory illness, new onset confusion, reduced alertness, reduced mobility, or diarrhoea and sometimes do not develop fever". Lots of signs and symptoms are missing 
guidance says that older people "may present with Influenza Like Illness (ILI), respiratory illness, new onset confusion, reduced alertness, reduced mobility, or diarrhoea and sometimes do not develop fever". Lots of signs and symptoms are missing
While the guidance offers zilch advice on identifying new illness in older people, the guidance endorses the RESTORE2 tool to be used by nurses or trained senior carers (I guess it'd be useful for untrained carers to read too) https://westhampshireccg.nhs.uk/restore2/
guidance offers zilch advice on identifying new illness in older people, the guidance endorses the RESTORE2 tool to be used by nurses or trained senior carers (I guess it'd be useful for untrained carers to read too) https://westhampshireccg.nhs.uk/restore2/
The guidance says nothing about DNACPR, while the guidance says the following, including a prohibition against a blanket approach:
guidance says nothing about DNACPR, while the guidance says the following, including a prohibition against a blanket approach:
As for PPE, the guidance does not mention eye protection or the difference between single or sessional use. The guidance explains clearly:
guidance does not mention eye protection or the difference between single or sessional use. The guidance explains clearly:
What about "clinically extremely vulnerable" residents? They should be shielded. The document tells care home staff what to do:
document tells care home staff what to do:
Yes, they need to click through to another document. That hyperlink goes to this page https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19 which tells the person:
So you're a carer working in a care home and you're told that the resident should not leave their house. Eh? Meanwhile in , care homes are given this practical advice:
, care homes are given this practical advice:
And it goes on! The document hyperlinks to this 26-page document by @P_H_S_Official on "COVID-19: Information and Guidance for Care Home Settings (1 May 2020) https://hpspubsrepo.blob.core.windows.net/hps-website/nss/2980/documents/1_covid-19-information-and-guidance-for-care-homes.pdf. In the equivalent is the 11-page @PHE_uk document https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/881329/COVID-19_How_to_work_safely_in_care_homes.pdf
document hyperlinks to this 26-page document by @P_H_S_Official on "COVID-19: Information and Guidance for Care Home Settings (1 May 2020) https://hpspubsrepo.blob.core.windows.net/hps-website/nss/2980/documents/1_covid-19-information-and-guidance-for-care-homes.pdf. In the equivalent is the 11-page @PHE_uk document https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/881329/COVID-19_How_to_work_safely_in_care_homes.pdf
Side by side, here is the advice on shielding in care homes. is on the left and is on the right. Which in your view provides clearer guidance? 
is on the left and is on the right. Which in your view provides clearer guidance?
Also contrast the difference in approach to visits by family. Again, left and right. Note the use of the term "loved one". Read the last bullet point in the document 
The guidance seems bereft of humanity.
left and right. Note the use of the term "loved one". Read the last bullet point in the document The guidance seems bereft of humanity.
While the guidance has no references to workforce and only 2 references to staffing (weird, as that's a major issue), the guidance has 8 paragraphs on workforce planning:
guidance has no references to workforce and only 2 references to staffing (weird, as that's a major issue), the guidance has 8 paragraphs on workforce planning:
On staff wellbeing, the guidance says "At such unprecedented times of anxiety and uncertainty, it will be important that staff feel supported and connected with their colleagues." and then provides a load of resources. Yup, you've guessed it, the guidance says jack sh*t.
guidance says "At such unprecedented times of anxiety and uncertainty, it will be important that staff feel supported and connected with their colleagues." and then provides a load of resources. Yup, you've guessed it, the guidance says jack sh*t.
I've written previously about how the policy is inconsistent with @WHO standards. The @DHSCgovuk said last week in the "Sunday People" that it disagrees. Feel free to make up your own mind. https://insights.doughtystreet.co.uk/post/102g58h/the-uk-governments-guidance-on-combating-coronavirus-in-care-homes-is-inconsiste:
policy is inconsistent with @WHO standards. The @DHSCgovuk said last week in the "Sunday People" that it disagrees. Feel free to make up your own mind. https://insights.doughtystreet.co.uk/post/102g58h/the-uk-governments-guidance-on-combating-coronavirus-in-care-homes-is-inconsiste:
In conclusion, the @DHSCgovuk guidance is inadequate in scope and unclear in message. Embarrassing in ordinary times, in a pandemic its policy failure may amount to a systemic breach of the right to life. May the memory of those who have lost their lives be a blessing.
