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Study - Movement of staff between care homes unwittingly spread infection

Further evidence that the lack of government transparency may have contributed to the spread of coronavirus in care homes has emerged. According to an unpublished government study which used genome tracking to investigate outbreaks found that temporary care workers transmitted COVID-19 between care homes as cases surged.

In evidence that raises further questions about ministers’ claims to have “thrown a protective ring around care homes”, it emerged that agency workers – often employed on zero-hours contracts – unwittingly spread the infection as the pandemic grew, according to the study by Public Health England (PHE).

The genome tracking research into the behaviour of the virus in six care homes in London found that, in some cases, workers who transmitted coronavirus had been drafted in to cover for care home staff who were self-isolating expressly to prevent the vulnerable people they look after from becoming infected.

At least 22,000 people are estimated to have died in care homes in England and Wales directly or indirectly from COVID-19. While the peak appears to have passed, the crisis is far from over for the country’s 400,000 care home residents, with some providers reporting fresh outbreaks and hospitalisations last weekend.

Adult social care directors

During flu pandemic planning in 2018, a report from social care directors warned ministers that frontline care workers would need advice on “controlling cross-infection”. A 2019 PHE document about flu pandemic preparations called “Infection prevention and control: an outbreak information pack for care homes” urged operators to “try to avoid moving staff between homes and floors”.

But the DHSC’s social care plan, published on 16 April, mentions nothing about restricting staff movements between homes in its chapter on “controlling the spread of infection in care homes”.

Results from the PHE study, conducted over Easter weekend from 11 to 13 April, have been known about inside the Department of Health and Social Care (DHSC) since at least the end of last month, but were only circulated last week to care home providers, councils and local directors of public health.

It was referenced as part of a £600m infection control plan, which adult social care directors said came “tragically late in the day” given the peak of deaths in care homes appeared to have already passed.

Infection is spreading from care home to care home

The study warned: “Infection is spreading from care home to care home, linked to changed patterns of staffing, working across and moving between homes.” The infection could be introduced by “bank staff” – floating workers used to fill temporary vacancies in different homes – it said, adding that workers were often asymptomatic so “by the time local health protection teams are informed of an outbreak substantial transmission may already have taken place.

Infection control fund

The infection control fund for care homes is designed to allow providers to pay extra to carers who normally work in several homes in exchange for working in only one facility.

The new plan to cut infection rates in care settings included instructions to councils and operators to “take all possible steps to minimise staff movement between care homes, to stop infection spreading between locations” and that “subject to maintaining safe staffing levels, providers should employ staff to work at a single location”.

The £600m funding is “intended to help providers pay for additional staff and/or maintain the normal wages of staff who, in order to reduce the spread of infection, need to reduce the number of establishments in which they work”.

DHSC said “We are working around the clock to make sure care homes, and our frontline social care workforce, are getting the support they need to protect their residents and tackle coronavirus,” a spokesperson said. “Our help to care homes, which includes financial support, infection control training and supplies of PPE, has meant that two-thirds of England’s care homes have had no outbreak at all.”

This statement has now been superseded. According to data collected by Public Heath England and the Care Quality Commission On the 17th May 38% of care homes have been infected.

Summary

Why is it that this government continues to leave itself open to criticism and shooting itself in the foot in its handling of the social care crises? I would suggest firstly it lacks transparency. If the report on the movement of care workers between care homes had been made available to care home providers when it was published, then many lives could have been saved. Secondly, the time when the government becomes aware of critical information and the time lag in making providers aware of it. Thirdly, too many apologies that are not followed by urgent action, and the need for more honesty.

The infection control fund although welcome was an all too late response which could have been implemented prior to the peak of the pandemic. As Vic Rayner, the executive director of the National Care Forum, which represents charitable care providers, said: “Staff have always been extremely concerned with the potential for spreading the virus. It would be the last thing any of them want to do.

Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy

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