Open letters

Dear Mr Murray,

On behalf of more than 500,000 nurses and doctors – who are working above and beyond in incredibly challenging environments to respond to COVID-19 – we are writing to you to highlight concerns around the production of personal protective equipment (PPE), which disproportionately does not fit female users.

Nurses and doctors are unwavering in their professionalism and dedication to protecting the health and wellbeing of us all in this time of worry and uncertainty. However, their safety and ability to care for patients is being fundamentally compromised by the lack of adequate and correct supplies of vital PPE. Our members are reporting that the specialist FFP3 masks do not securely fit smaller, often female face shapes.

Without properly fitting face protection, female staff are putting themselves at risk. This is despite 89% of the UK nursing workforce being female and 48% of doctors. They must not be forced to choose between their personal safety, and the safety of their families or their sense of duty to provide the very best care. One-size-fits-all protective equipment has been a problem for frontline healthcare workers who must wear this specialist life-saving equipment for up to 12 hours at a time.

A number of brands are not producing masks which fit female faces. The shape and design of the masks are too big, causing many female nurses and doctors to fail the FIT testing process.
There are patterns arising which suggest supplies of masks are being made and created for men; there is an emerging gender imbalance to the equipment being provided in terms of how
best it fits the face of the user, yet this has not been addressed reactively by industry.

All staff, in all settings, must have a supply of suitable and sufficient PPE that meets the required specifications.

While the primary duty to provide suitable and sufficient PPE lies with the employer, in the context of the pandemic and to future proof FFP3 provision in the longer term, we ask that industry review the design of PPE, including masks, to ensure that equipment supplied to nurses and doctors fits both male and female users. It is vital for the health and safety of female staff that there is a good selection of FFP3 masks suitable in fit for a predominantly female nursing workforce.

Yours sincerely,

Dame Donna Kinnair
RCN Chief Executive & General
Secretary

Dr Chaand Nagpaul CBE
BMA Chair of Council

Dear Mr Temple and Ms Albon,

Further to the oral evidence you presented to the Work and Pensions Select Committee in Parliament on Wednesday 13 May, I am writing to ask for clarification on two aspects. First in relation to the definition of responsible person within the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR), and the process for recording occupational deaths of health and care staff from COVID-19. 

Responsible person
RIDDOR sets out that, on notification by a registered medical practitioner, the responsible person has to report a workplace fatality to the Health and Safety Executive (HSE) under Regulation 6 of RIDDOR. Under regulation 2 of RIDDOR a responsible person is either the employer, self -employed person or a person in control of a premises. HSE’s guidance on reporting states “If you are an employer, you must report any work-related deaths, and certain work-related injuries, cases of disease, and near misses involving your employees wherever they are working”. As explained during your Committee evidence, the responsible person could now be the hospital/setting where the health care worker was treated and died, rather than their employer. This is not our understanding. We have been clear that the duty to RIDDOR report lies with an employer so please can you clarify the statement made.

Reporting of occupational health and care worker deaths from COVID-19
As you may know, the true numbers of health and care staff who have contracted COVID-19 including those who have died remains unreported and based on media accounts. We have written to the Secretary of State for Health and Social Care to demand that accurate collection, recording and reporting of health and care worker deaths in all settings is made publicly available. 
At the time of your evidence session, you confirmed that there have only been 71 health and care worker deaths related to COVID-19 reported to you so far. When a nurse at work contracts COVID-19 it may be difficult to establish whether the exposure occurred inside or outside of work. However, since tighter public restrictions were put in place on 16th March to reduce community exposure, the balance of probabilities is that the nurse was exposed to the infection at work. We also are acutely aware of problems with adequate and correct protective personal equipment being made available to protect staff caring for vulnerable or COVID-19 patients. 

We expect that all health and care employers RIDDOR report all cases of health and care workers contracting COVID-19 as disease incidents where they have been exposed to patients with suspected or confirmed COVID-19, and to report fatalities for all health and care worker deaths related to COVID-19. This is vital if we are to understand the true impact that COVID-19 has had on the life of health and care staff. It is concerning that HSE do not have higher numbers of reports considering the emerging evidence suggests more than 200 health and care workers have died. 

We ask that you act to ensure that all frontline staff deaths related to COVID-19 are reported to you as occupational fatalities as a precaution. 

I look forward to your substantive reply. 

Yours sincerely, 

Dame Donna Kinnair 
Chief Executive and General Secretary 

Dear Prime Minister,

You have recently seen first-hand the professionalism and dedication of this nation’s nursing staff.

You will also know that we entered the pandemic with a substantial shortage of nursing staff – at least 40,000 registered nurse vacancies in the NHS England alone, not accounting for social care.

Nursing staff were struggling to cope with the pressures caused by the shortage, already starting to leave before retirement, and many may not feel able to stay in the profession after the potentially intolerable pressures they will have faced during this crisis.

This is not the time to be complacent. The two nurses who saved you are part of a highly-skilled workforce that must be made to feel recognised, supported and valued. And those making career choices must see nursing as an attractive option.

The nation has never better understood or recognised our contribution to society, and we welcome the public interest in nursing pay.

But the majority of nursing staff will not recognise the 15% figure quoted by the UK Secretary of State for Health and Care at the daily press briefing (Friday 15 May 2020). Discussing pay out of the context of costs of living, combined with a suggestion elsewhere last week of a pay freeze, are totally out of step with nursing need and public support.

In 2018, we said that the pay deal was the bridge out of austerity that was needed. It would be right to acknowledge now what we said at the time – that more is needed to bring earnings in line with the cost of living, following so many years of pay restraint.

Our research confirms that the average earnings for NHS staff have not kept pace with the cost of living since 2010. This is the reality that must be fully recognised in the public conversation about recognising and valuing nursing staff. Any “fight for that fair reward”, as your Health Secretary said, must begin on the basis of facts. This is the reality for current and future nursing staff making career choices.

We urge you to recognise in public conversation that this is where nursing pay is today. An honest dialogue in preparation for the future pay round is the first step in valuing the nursing workforce we rightly celebrate.

Yours sincerely,

Dame Donna Kinnair, Chief Executive and General Secretary
Dee Sissons, Chair of RCN Council

CC: Secretary of State for Health and Social Care

Dear Home Secretary,

I am writing to you following your Department’s confirmation this weekend (17 May 2020) that it is not actively reviewing the Immigration Health Surcharge (IHS) for health and care workers. I am alarmed to hear that your Department now denies that such a review was ever considered, having indicated that this was the case. I am writing to you again to urge you to reconsider and waive this charge as a matter of urgency.

Currently there are 77,065 non-EEA internationally educated nurses working in health and care across the UK. Their value and skills, though brought to the fore through the current pandemic, have always been essential.

The IHS represents an unfair and unjust additional financial burden on our international workforce. Not only do healthcare professionals make a significant contribution towards our health and care system by virtue of their work, but they also already pay taxes and national insurance that pay toward our services. The proposed increases will serve to exacerbate hardships and will act as a significant barrier to individuals considering working in the UK at precisely the time that they are needed most.

We have made repeated calls for the fee to be waived completely for health and care staff and were therefore extremely disappointed by Government’s proposals to increase the charge to £624 and £470 per year for adults and children respectively. This represents a 56% increase since its inception in 2015 and we are yet to see any evidence or cost modelling that supports these revised figures.

The current pandemic has served to highlight and reaffirm the importance of our internationally educated staff. Without them here, patient care would be at risk. This fee undermines the incredible and lifesaving work health and care staff provide to us all. As the Immigration and Social Security Bill receives its second reading by Parliament, this is the opportune moment to reflect on the experiences of our international workforce and explore ways to strengthen and maintain their extraordinary and vital contribution.

Yours sincerely,

Dame Donna Kinnair
Chief Executive and General Secretary 

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Sent via Email 

Dear Secretary of State, 

I am writing to express concern that there is still no UK wide public reporting of the number of COVID-19 deaths or infection rates amongst the health and care workforce. This is despite repeated calls by the Royal College of Nursing for this data to be made available.  

Health and care staff across the country are putting themselves at risk every day to protect the population, and the loss of any one of them is a tragedy which deserves public recognition. Accurate data is needed in order to better understand the impact on staff, scrutinise the safe working environments of all staff, and to compare the level of risk which staff are facing compared to the general population. This data is also important to be able to assess the impact upon at-risk groups and address inequalities. 

The current approach taken in each of our four nations on recording the deaths and infection rates of health and care workers is inconsistent and unclear. Consistency across all parts of the UK is required to allow robust data analysis, facilitating a better understanding of the issues leading to more effective policies and implementation. We therefore urge all relevant bodies to work more closely and better align the publicly available data around COVID-19. 

We expect to see, as a minimum, weekly public updates from each of the UK Governments of health care workers who have:

• Tested positive for COVID-19 
• Been admitted to hospital, after testing positive for COVID-19
• Received intensive care, after testing positive for COVID-19
• Died after testing positive for COVID-19 

It is now apparent that underlying health conditions, as well as age, are the two major variables for recovery from Covid-19. There is also increasing concerns that black, Asian and minority ethnic staff are facing a more significant risk of both the infection and of death, and so information about ethnicity is vital to assess trends and make recommendations for future action as necessary. 

Therefore we ask that all of this data must include, for each health and care worker:

• Role and setting 
• If they have been on the frontline treating patients of the virus
• Ethnicity
• Nationality
• Details of any underlying health conditions 

We will continue to publicly call for all Governments in the UK to resolve this outstanding issue, until a robust, comprehensive system for data collection and public reporting is in place.
Should you have any questions or would like to set up a meeting to discuss our concerns, please contact our Public Affairs Manager at Beth.Knight-Yamamoto@rcn.org.uk who will be happy to set this up. 

Yours sincerely, 
 
Dame Donna Kinnair 
Chief Executive and General Secretary 

Dear Secretary of State

We know that you would agree with us, as the four unions representing the majority of nursing, midwifery and allied healthcare students, that the way in which so many of them have stepped up to offer their skills and knowledge to assist with the response to the pandemic is a source of great pride. For those in the earlier stages of their professional education, they have adapted to the significant disruption with courage and a continuing commitment to their future careers.

Our opposition to the introduction of tuition fees for nursing, midwifery and allied healthcare students in England is well-documented and our concerns, in terms of the exacerbation of nursing shortfalls and financial hardship, have been borne out. However, the current crisis – and the impact on those students, whether joining the workforce or continuing with their education – has placed the unfairness of this policy into even starker focus.

It is time to recognise the value and commitment of our nursing, midwifery, and allied healthcare students.

We are therefore asking you to:

• reimburse tuition fees or forgive current debt for all current nursing, midwifery, and allied healthcare students;
• abolish student-funded tuition fees for all nursing, midwifery, and allied healthcare students starting
  in 2020/21 and beyond, in recognition that they will be supporting vital public services; and
• introduce universal, living maintenance grants that reflect actual student need.

Thousands of healthcare students have joined the NHS and social care frontline since this pandemic began, eager to support their qualified colleagues. We ask that you acknowledge their selfless service, not only with words, but in a tangible and quantifiable way.

Yours sincerely

Gill Walton
General Secretary
Royal College of Midwives

Dave Prentis
General Secretary
UNISON

Dame Donna Kinnair
General Secretary
Royal College of Nursing

Eva Crossan Jory
Vice-President Welfare
National Union of Students

Dear Prime Minister,

As you know, there have been deaths within the health and care workforce due to COVID-19, with over thirty nursing staff having passed away at the time of writing. Each one was a huge loss to our profession, to their communities and their loved ones. I cannot begin to imagine how their families and friends are feeling.

All of these staff have died in the service of our health and care system. However, despite repeated representations by the RCN, other unions and professional bodies, I wish to raise our concern that there is yet to be an announcement from the UK government on death in service benefits and financial support for the families of those who have died fighting the pandemic.

Our members deserve immediate reassurance from the UK government that it is committed to supporting families whose loved ones have died protecting us. I am deeply concerned that there is yet to be an announcement on this issue, particularly as some of these families will be facing financial difficulty as well as the loss of their loved one.

It is our position that these benefits need to be retrospective, in effect, from the start of the pandemic and must apply to all health and care staff, regardless of their length of service or the setting in which they were working. This must include those who have bravely returned to service, and all students who join the fight against the pandemic.

The families of those who have died in service deserve reassurance that the UK government is supporting them at this difficult time.

Yours sincerely,
Dame Donna Kinnair
Chief Executive & General Secretary

Dear Ms. Albon,

Thank you for your response dated 1 April 2020.

Regrettably I feel compelled to write to you again regarding the government’s continuing failure to provide sufficient and suitable personal protective equipment (PPE) to our members in all health care settings. Our members tell us they simply cannot obtain enough equipment, as evidenced in our latest survey findings.

As I am sure you are aware, the number of mortalities of health and social care staff is steadily increasing and I am very concerned that the Secretary of State for Health publicly stated during the Select Committee on the 17 April 2020 that employers should investigate these deaths and not your organisation. Have you been consulted about this and is there an exemption to the RIDDOR process in relation to these deaths? I would query the veracity and independence of any investigation devolved to the organisation in which it occurred rather than yourselves.

I note you have been working with the Department of Health and Social Care (DHSC), Public Health England (PHE), the NHS and all government departments regarding the supply chain issues impacting on the availability of PPE. However, it appears a number of employers are still not able to provide suitable and sufficient PPE as the supply chain remains defective and in practice this is meaning our members are working at risk.

In this context we remain deeply concerned and request that you provide advice to employers who are without the necessary equipment required to protect their staff. This letter is a formal request for HSE’s intervention and enforcement to prevent further unnecessary harm.

We also understand that in order to circumvent the lack of disposable gowns specifically, guidance may be adapted to accommodate this lack of resource. You will be aware this disregards all current WHO and HSE infection control guidance. We also request information of any advice given on infection control guidance and on alternatives to PPE when the items are not available.

While I am confident you are taking the issues presented by this pandemic seriously, I feel the actions of the Health & Safety Executive to date have not been visible enough directly with employers to protect all health and social care staff. I implore your organisation to intervene immediately.

Yours sincerely,
Dame Donna Kinnair
Chief Executive & General Secretary

Dear Secretary of State,

The Royal College of Nursing (RCN) is professional body and trade union, representing over 450,000 nursing staff across the UK. For years internationally educated nursing staff have played a vital part in sustaining our health and care services, and in improving the health and wellbeing of the UK’s population. During this emergency, their importance as key workers has never been greater, and it is essential that we explore all avenues to both strengthen and maintain their valuable contribution.

I am writing in relation to the recent decision by your Department to automatically extend the visas of all healthcare professionals employed by the NHS due to the COVID-19 emergency. As we said at the time of the new points-based system being published, we are concerned that it closes the door to lower paid healthcare workers and care assistants from overseas, who currently fill significant numbers of posts in the health and care workforce. While recruitment of overseas staff should not be used as a replacement for domestic workforce supply, it is clear that it will need to continue in the short to medium term so that social care services can continue to function.

We were also disappointed to see the Immigration Health Surcharge remain in place. Nursing staff from abroad, who already pay their taxes, should not have to pay this extra amount for the NHS, which applies whether or not they access services.

We therefore recognise as a helpful measure the temporary extension of visas of healthcare professionals employed by the NHS and the temporary exemption of these individuals from the Immigration Health Surcharge, the result of which will ensure the continued support of thousands of overseas healthcare professionals in this time of unprecedented need. Without them here, our health and care services would be unsafe which is why we are concerned that these measures do not go far enough.

However, responding to COVID-19 is truly a national effort and it is important that there is parity amongst all overseas staff. Limiting the visa extensions to just those employed in the NHS means that many key workers will still be at risk of breaching their visa requirements, and sanctioned yet their work supports some of the most vulnerable in society.

We ask that you publicly confirm that action will be taken to extend the visas of all health and care workers includes our colleagues working in non NHS settings. I ask also that you permanently exempt all health and care staff from the Immigration Health Surcharge. The current emergency has undoubtedly served to highlight and reaffirm the importance of internationally educated nursing staff within our health and care system. I therefore urge you to take this opportunity to reconsider your department’s current proposals for the future points based immigration system, which provides no appropriate immigration route for social care workers, care assistants and support workers who are so vital to our population’s health both in this time of emergency and beyond.

Yours sincerely,
Dame Donna Kinnair
Chief Executive & General Secretary

Dear Minister,

As the Chief Executive and General Secretary of the Royal College of Nursing – the largest professional body and trade union for nursing staff in the world, with 450,000 members – I am writing to ask that you do everything possible to support our health and care teams working in care homes and our communities to comply with recently announced guidance. Our members are on the frontline – they visit patients in their own homes, care homes, hospices and other social care settings, supporting them with what are often complex conditions in close proximity.

In the UK care home network alone, more than 19,000 care homes provide care to over 270,000 residents. We have welcomed the clarity provided by updated IPC guidance on when and how personal protective equipment should be used in order to keep both staff and patients safe. We were heartened to see the recommendations and advice from the government on infection prevention measures ensured that it was extended to support health care teams in the community, including care homes.

However, our members working in care homes and other social care settings are reporting that they do not have sufficient or clinically adequate supplies of PPE, or to antigen testing. This means that they are risking their own lives and the lives of their families as well as the lives of people in their care. This is unacceptable and must be resolved immediately.

The UK government has been clear that millions more PPE items are being made available and that national supply is well stocked, but our members in care homes are not seeing these commitments reflected in their reality. Distribution of PPE to care homes and the wider social care sector must be resolved so that they are supported to follow guidance that has been released.

We have also heard concern from our members regarding the support they will receive to plan care, including potential resuscitation or CPR, in line with best clinical practice, and to exercise their professional judgement in line with the nursing code of practice. It is paramount that employers and commissioners support nursing staff to maintain best practice, and ask that you promote this at every opportunity.

We stand ready to work with you to make sure that our members, all staff and residents of care homes are protected during this time.

Yours sincerely,
Dame Donna Kinnair
Chief Executive & General Secretary

Dear Prime Minister,

In my role as the Chief Executive and General Secretary of the largest nursing union and professional body in the world, I am writing to you to express the serious concerns of our members – and the wider health and care workforce – regarding the lack of personal protective equipment (PPE) and COVID-19 testing for staff.

Our members have been unstinting in their dedication and professionalism to protecting the health and wellbeing of United Kingdom – they must be supported by the government and health sector in return.

Over the weekend, there were increasing reports of a lack of PPE available to frontline staff - not just in hospitals, but in GP surgeries, care homes and community nurses visiting people in their homes. Our members tell us that they simply cannot obtain enough equipment, in particular face masks that offer a higher level of respiratory protection (FFP3 masks).

While we welcome the announcement of further stocks being distributed to health and care settings, we will be closely monitoring the situation to make sure these stocks are reaching the right places.

We are also receiving reports from members regarding the confusion over the guidance on what PPE to use and in what circumstances. We are aware that the UK NHS Pandemic Infection Prevention and Control (IPC) Guidance does not completely align with that of the World Health Organisation (WHO), specifically guidance on the use of eye protection and gowns. Nursing staff across the country are working around the clock to deal with this crisis and deserve absolute clarity on how the government and their workplace are protecting them from the virus given discrepancies between the UK and WHO infection prevention guidance.

Finally, priority COVID-19 testing for health and social care workers is an absolute must. Our members need this in order to do their job while keeping themselves, and their patients, safe.

Nursing staff across the country are rising to the challenge of this unprecedented situation. Our members are coming out of retirement, students interrupting their studies, and nursing staff are deploying from non-clinical settings, all to support the frontline in the battle against COVID-19.

We ask you to personally intervene and act to ensure enough supply of PPE and testing for COVID-19 is available for all nursing staff and our colleagues across the health and care system.

Sincerely,

Dame Donna Kinnair
Chief Executive and General Secretary
CC: Matt Hancock, Secretary of State for Health and Social Care

Dear Sarah, 

As the Chief Executive and General Secretary of the largest nursing union and professional body in the world with 450,000 members, I am writing to you as a matter of urgency to report the ongoing lack of personal protective equipment (PPE) supplied to RCN members during this pandemic.

I continue to receive reports of a lack of suitable and sufficient PPE available to all nursing staff including hospitals, GP surgeries, care homes, hospices, and community nurses visiting people in their homes. In particular, our members cannot obtain equipment such as face masks, eye protection and hand sanitisers.

I am concerned that some NHS and social care employers are failing to follow statutory obligations in relation to the provision of PPE.

Our members are reporting a number of organisations which are in fundamental
breach of:

• Health & Safety at Work Act 1974
• Regulation 4 of the Personal Protective Equipment at Work Regulations 1992
• Control of Substances Hazardous to Health Regulations 2002
• Management of Health and Safety at Work Regulations 1999
• The implied terms to provide a safe place of work and reasonable support in all our members’ contracts of employment.

Regulation 4 states:

Every employer shall ensure that suitable personal protective equipment is provided to his employees who may be exposed to a risk to their health or safety while at work except where and to the extent that such risk has been adequately controlled by other means which are equally or more effective.

The accompanying guidance states:

Employers should, therefore, provide appropriate personal protective equipment (PPE) and training in its usage to their employees wherever there is a risk to health and safety that cannot be adequately controlled by other means.

In order to provide PPE for their employees, employers must do more than simply have the equipment on the premises. The employees must have the equipment readily available, or at the very least have clear instructions on where they can obtain it.

By virtue of Section 9 of the Health and Safety at Work etc Act 1974, no charge can be made to the worker for the provision of PPE which is used only at work. Section 9 of the Health and Safety at Work etc. Act 1974 states: "No employer shall levy or permit to be levied on any employee of his any charge in respect of anything done or provided in pursuance of any specific requirement of the relevant statutory provisions". Section 9 applies to these Regulations because they impose a 'specific requirement' - i.e. to provide PPE.

Nursing staff across the country are rising to the challenge of this unprecedented situation. RCN members are coming out of retirement, students interrupting their studies, and nursing staff are deploying from non-clinical settings, all to support the frontline in the battle against COVID-19 and yet they lack access to basic health and safety equipment in order to do so. 

I expect you to issue instructions to all providers of care where patients are being treated for, or are suspected of COVID -19 infection. I am willing to supply you with specific examples to support addressing this issue immediately if required.

The situation is unconscionable.

With this letter, I call on the Health and Safety Executive to intervene.

I look forward to receiving your response.

Yours Sincerely
Dame Donna Kinnair
Chief Executive & General Secretary

Scotland

Dear Cabinet Secretary,

Re – Personal Protective Equipment (PPE) for community health and social care workers

We are writing to you jointly during this unprecedented time to raise our continued concerns about the level of Personal Protective Equipment (PPE) being provided to health and social care staff who are providing vital care within communities during the Covid-19 pandemic.

These are unprecedented times for our health and social care workforce and this challenge has been met with resilience, adaptability and perseverance from all those working within the NHS and social care services. However, those that we represent – GPs, community nurses and social care staff – have never been more concerned, not just for the safety of themselves and their teams, but for patients too.

Our members tell us that their confidence to care for the public during this time is being impacted by uncertainty over the level of PPE being supplied to them. This is particularly relevant for aprons and eye protection, which many believe to be providing inadequate protection. We welcome the recent announcement, following similar concerns raised by medical professionals across the UK, that guidance on PPE will be updated. It is imperative that this updated guidance recommends a consistent approach to the level of PPE required across both acute and community settings, in particular in terms of what constitutes an ‘aerosol generating procedure’ (for example, taking throat swabs from symptomatic patients). We also call for this guidance to consider lessons which may have already been learned in other countries regarding the protection of community-based health and social care teams when caring for unwell Covid-19 patients who present a high viral load.

As the number of patients with Covid-19 increases, our members will increasingly be caring for the most sick and vulnerable within their own homes in communities across Scotland. Many of these people will already be showing advanced symptoms of Covid-19, but many more may be asymptomatic, although are likely still be infectious. Providing this vital care has never been more important, but our members tell us that they are apprehensive about delivering this care, given the current level of PPE that they have been provided with. In short, they are fearful that the level of protection that they have been provided with will not be enough to shield them from the worst effects of Covid-19.

While we welcome news that further stocks of PPE are being distributed to frontline services, our members are continuing to get in touch to raise concerns over the levels of PPE available in GP surgeries and out into the community. This PPE needs to reach those areas of the health service that need it most, with community care receiving an equitable distribution of these supplies. In particular staff caring for those in nursing and care homes as well as sheltered housing complexes will require supplies as many of their patients will continue to receive care within the community should they fall ill.

We are calling for assurances to be provided and urgent action to be taken to protect those who are going above and beyond to care for the most sick and vulnerable within the community at this incredibly difficult time. We need our health and social care workforce to be healthy and protected as they deal with the greatest public health challenge of our lifetime.
We would be more than happy to discuss this further with you and your team in the coming days.

Yours sincerely,

Dr Carey Lunan Chair, RCGP Scotland

Theresa Fyffe Scotland Director, RCN

Donald Macaskill CEO, Scottish Care

Wales

Dear Gillian,

Re: Protecting Care Home Residents 

I am writing to you as the Director of the Royal College of Nursing in Wales regarding your function to provide assurance on the quality and safety of care homes for older people in Wales during the outbreak of COVID-19 virus.

Our members providing nursing service in care homes in Wales are deeply concerned and alarmed by the impact of the COVID-19 virus on the quality, safety and provision of care. Many care home residents are over the age of 75 and have chronic and complex needs, these individuals are vulnerable and require shielding through additional measures.

In order to protect residents, and nursing staff in care homes, there should be access to and the use of correct Personal Protective Equipment (PPE). 

Care home staff should also be able to promptly access testing facilities. This will allow for the timely identification of potential cases and reduce the negative impact of staff absences on the care provided. I can see from your website that you require all confirmed and suspected cases of both staff and residents to be notified to you. I am therefore inquiring as to whether testing of COVID-19 infection has begun on care home residents?

Care home residents should be tested in their home, to identify potential cases and limit the spread. It would not be appropriate to move vulnerable patients often with a chronic condition and suspected COVID-19 symptoms into a hospital setting for testing. Regulation 38 of the Care Homes (Wales) Regulations 2002 places a duty on registered persons to notify Care and Social Services Inspectorate Wales without delay if there is an occurrence of the following; ‘a death of any service user and the circumstance of their death and any outbreak in a care home of any infectious diseases’. I would be grateful if you could share this information with the Royal College of Nursing.

Your website states that you are not undertaking routine inspections at the moment. While this is an understandable and sensible decision in the circumstances of the social isolation guidance, I am concerned by the statement “when the pandemic is over and we resume inspections, we will not be considering retrospectively actions taken in the best interests of people who use services. We would only take action where we identify wilful neglect or deliberate harm.” I would welcome clarification of the thinking behind this statement and how it will be applied in practice.

There are actions from Welsh Government, local authorities, health boards, care home owners and care home staff that are being taken and will be taken to mitigate the negative impact of COVID-19. There will also be actions that are sadly not being taken which could potentially constitute ‘wilful neglect and deliberate harm”. How is this being identified in the absence of inspections and residents protected?

Most importantly, I ask that the Care Inspectorate Wales launches a review into the actions taken and not taken. A retrospective account will undoubtedly identify significant lessons for us all about best practice, best policy and avoidable harm. This seems to be a very appropriate exercise to be undertaken considering the remit of your organisation and your strategic ambition to be an “expert voice to influence and drive improvement”.

The safety of our members in the community is very important, and it is vital that our nursing staff feel safe to care for residents in a hygienic environment, having followed the appropriate guidance. This is also true for care home residents. Residents should feel safe and protected and comfortable in their home environment.

I would be grateful for a reply to this letter.

Yours sincerely,

Helen Whyley, RN, MA
Director, RCN Wales

cc: Vaughan Gething AM, Minister for Health and Social Services
Heléna Herklots CBE, Older People’s Commissioner for Wales
Angela Burns AM
Rhun ap Iorweth AM

Dear First Minister,

As you know, there have been deaths within the nursing health and care workforce due to the COVID-19 virus. Each one was a huge loss to our profession, to their communities and their loved ones and I know you have joined us in sending condolences to their families. All of these staff have died in the service of our health and care system.

I am aware that we have made representations on this issue through both the Welsh Partnership Forum Business Committee and at the Health and Social Services Ministers’ weekly trade union meeting, with an understanding that this sensitive matter extends across the Welsh Government and the UK Treasury. However, I felt compelled to raise with you my concern that there is yet to be an announcement from the Welsh Government on Death in Service benefits and financial support for the families of those who have died fighting the pandemic. It is important that the matter is addressed in a timely manner to provide comfort for the workforce and their families.

The Scottish Health Secretary Jeane Freeman announced on 21 April 2020 that the Scottish Government would guarantee that: “all staff affected by COVID-19 as a result of providing frontline treatment for COVID-19 patients will receive the full lump sum and survivor’s pension benefits available under the terms of the NHS pension scheme: this includes permanent and fixed-term staff who are not members of the pension scheme, NHS Bank and NHS Locum staff”.

With Scotland forging ahead with initiatives to support all members of the healthcare workforce it is important that the Welsh workforce, who do not have an NHS pension do not feel disadvantaged. In these unprecedent times, all members of the health and care workforce should be supported.

I believe that the Welsh Government should ensure there are measures in place that will provide Death in Service benefits, including a lump sum and pension benefits, to members of the workforce that are not on the NHS pension scheme.

Therefore, I seek your reassurance that the Welsh Government is committed to supporting the families whose loved ones have died whilst fighting the pandemic, whether they had an NHS pension scheme or not.

I would appreciate a response to this letter.

Yours sincerely,
Helen Whyley, RN MA
Director, RCN Wales

9 April 2020

Dear First Minister

I am writing to you as the Director of the Royal College of Nursing (RCN) in Wales to ask you to raise the issue of testing of healthcare workers for presence of or previous infection of COVID –19.

The RCN represents over 25,000 registered nurses, nursing students and healthcare support workers in Wales who are currently risking their health to work long and stressful hours in hospitals, care homes and community settings. Our members deserve to know how the Welsh government plans to protect people and have their anxiety and stress reduced by being able to access to latest guidance and plans.

I need to know what plans are in place to test health and social care.

On the 18th March 2020 the Chief Medical Officer issued an alert bulletin advising the NHS on “Coronavirus (COVID-19) – Key changes to testing criteria”.

This contained the following paragraph:

Interim criteria for testing key frontline Healthcare Workers (HCWs)

Providing a negative test result to key frontline HCWs will allow them to return to work much sooner than the 7/14 day self-isolation periods which have been specified. Therefore, based on careful risk assessment, HCWs involved in frontline patient facing clinical care working in the following areas will be considered for testing:

a. Acute Medical Assessment Units
b. Emergency Departments
c. Critical Care Units/Intensive Care Units
d. Primary Care
e. EMS frontline NHS Ambulance staff

On the 5th April 2020 the Welsh government stated: “More than 1,500 tests have been carried out on NHS staff since March 18 – three-quarters of the tests were negative.

The Welsh government statement on the 7th April states: “we have been testing frontline NHS staff for COVID-19 since 7 March”.

The questions I need answering are these:

1. How many of the tests undertaken have been on registered nurses and nursing staff?
2. How many of the tests undertaken were on health and social care workers employed out with the NHS? E.g. from care homes?
3. How do employers of nursing staff or nursing staff as individuals apply or is their a process of invitation?
4. Do you have an estimated schedule of this testing process?

Our members are telling us of their increasing frustration in not receiving any information on the testing process. It is critical that we act together to provide reassurance. Personal Protective Equipment (PPE) provision is directly affected by the lack of testing, as with asymptomatic patients or staff it is unclear whether the individual nurse or HCSW should be wearing PPP or not – and this uncertainty leads to stress.

Our members in care homes are under particular pressure because in homes with a small number of staff, having several staff off work having a negative impact on the care that can be provided to vulnerable older people – and may result in the closure of beds or the home itself and the need to transfer vulnerable patients elsewhere at a time of great pressure on the whole health and social care system.

I would be extremely grateful for a reply to this letter.

Yours sincerely

Helen Whyley, RN MA

Director, RCN Wales

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