Dominic Cummings criticism of Mat Hancock handling of the COVID crises in care homes last week has once again opened up the running sore of what actually happened that resulted in so many people losing their lives.
It is on record that thousands of hospital patients were allowed to return to their care homes without a COVID test despite a direct plea to the government from major care providers not to allow the practice.
Providers urged government not to force them to accept untested residents
As the crisis began to unfold in early March 2020, providers held an emergency meeting with department of health officials in which they urged the government not to force them to accept untested residents. However, weeks later, official advice remained that tests were not mandatory, and thousands of residents are thought to have returned to their homes without a negative COVID result.
Some 25,000 people were discharged to care homes between 17 March and 15 April, and there is widespread belief among social care workers and leaders that this allowed the virus to get into the homes.
Once inside a care home, the coronavirus often spread to other residents, with devastating consequences. During the first wave, at least 20,000 care home residents died – about a third of deaths where COVID-19 was mentioned on the death certificate.
Sam Monaghan, the chief executive of MHA, the largest charitable provider of care homes in the UK, said: “On 12 March, there was a meeting of a number of large care-home providers with the department to talk about the pressure that the NHS could come under, and whether or not we could facilitate and support the NHS by taking patients who we could care for. We were very, very clear right from the get-go, even before we knew the worst ravages of COVID that we couldn’t take people unless they were tested.
“On 2 April, rules on discharge to care homes from hospitals clarified that negative tests were not required before discharge. By then, a significant number of people had already caught COVID and we were starting to have concerns about asymptomatic presentation, yet rules on discharge from hospital issued out to care homes were that we couldn’t expect to have a test.”
Department of Health response
In response, the Department of Health and Social Care referred to a press conference by Hancock last week, when he said: “When it comes to the testing of people who left hospital and went into care homes, we committed to building the testing capacity to allow that to happen. Of course it then takes time to build testing capacity. There will be a time when we go back over all this in detail, but my recollection of events is I committed to delivering testing of people going from hospital into care homes when we could do it. I then went away and built the testing capacity for all sorts of reasons, including this one.”
Delivering tests when they could be done
The decision to discharge patients without testing into care homes was knowingly reckless. The commitment of Mat Hancock to deliver testing when he could do it leaves the crucial question ‘what happens in the meantime’.
Everyone knows that at the time the testing system was in such disarray. Nor was any priority for testing given to care homes but deemed more essential to the frontline staff of the NHS.
According to Professor Jackie Cassell, deputy dean of Brighton and Sussex medical school and a member of the government’s COVID social care working group, says “What is really striking about the care home setting is that you get very few individual cases and some of those indeed were people who had come home from hospital,” she said. “But you get outbreaks because it is such a dangerous setting in terms of contact patterns and frailty. Surely then the DOH would have known this.
Vic Rayner, the chief executive of the National Care Forum, said that the conclusions of the PHE report seemed “highly unlikely”. She said the report only considered those who had tested positive, and it barely acknowledged that the vast majority of the 25,000 people who were rushed out of hospital in March 2020 were not tested for COVID at all.
Summary
The debate on the decision to discharge patients from hospital to care homes without testing is set to continue. The government need to answer the question what happened in the meantime between discharge of patients and the availability of an efficient testing system.
The government could help by listening to Liz Kendall, shadow social care minister who says “instead of using partial data to try to rewrite history and avoid responsibility for the tragedy in our care homes, ministers should be straight with people about what happened, learn the lessons from what went wrong, and put in place the long-term reforms to social care that families desperately need to make sure these terrible mistakes never happen again.”
Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy