Coronavirus patients were pushed into underprepared care homes

The scandal over how government policy contributed to the high number of deaths in care homes continues to escalate. An investigation by Sky News appears to show the government was unprepared for the crisis and offered limited support to care homes. Another report shows that care homes were put under heavy pressure to take in patients confirmed to have coronavirus, or who had not been tested for the disease, despite the known vulnerability of their elderly residents to the disease.

The Prime Minister came under pressure on the subject in the Commons today from Sir Keir Starmer, the Labour leader. At PMQs, the pair clashed over advice given to care homes.

Is the critique of the government’s approach justified? Analysis of figures from the Office of National Statistics by The Health Foundation suggests that the number of people dying in care homes has risen faster than in any other location since the start of the coronavirus crisis. Deaths care homes made up 40.4% of coronavirus deaths in England and Wales in the week to 1 May. The Health Foundation believes even this grim figure to be an underestimate, and that a number of the other 3,938 deaths recorded that week were related to coronavirus either directly or indirectly. In addition, a large number of social care workers have died due to the virus – 131 by 20 April and more since then – giving the profession a fatality rate far higher than that of the general population’s.

Lack of preparation and the relationship between the NHS and care homes seem to have contributed the scale of this crisis. Up until 13 March official government advice to care homes was that coronavirus posed little risk to them, and that they should carry on as usual.

Care homes, while privately run, are a vital adjunct to the NHS which discharges patients into them. On 2 April, the government asked care homes to help stop the NHS being overwhelmed by accepting large numbers of discharged patients. In return, the government promised care homes additional funding, help with PPE supplies, and stressed that all patients discharged into care homes would be first tested for coronavirus.

But there were insufficient PPE and tests even as this funding was used to push care homes into accepting patients who were coronavirus positive, or who had not been tested.

A number of councils threatened to withhold extra funding aimed at helping care homes deal with coronavirus, unless the care homes agreed to accept confirmed coronavirus patients. A National Alzheimer’s Society survey of 105 care homes found that 32% had been forced take hospital patients with coronavirus, despite over 50% not having the resources to isolate them.

Promises by the government not just to test patients discharged from hospitals, but also that all care home staff and residents would have access to a test if necessary also appear were also broken. Care home workers have spoken of the difficulty of accessing a test, and the National Care Forum estimates only a fifth of care workers have been tested.

Despite government promises to help with PPE many care homes struggled to obtain sufficient supplies, apparently in part as the government prioritised supplying the NHS. Supplies that did seem to be available to care home staff in the Sky report were not high quality – flimsy plastic aprons, gloves, and a surgical (not N95) masks.

This lack of adequate PPE and testing seems to have contributed to the toll that coronavirus has taken on careworkers, as well as residents. In addition to the high fatality rate among care workers large numbers took sick leave after contracting the disease or ceased to go in to work because they were afraid of catching the virus. The inevitable result was staffing shortages. In some cases, care had to be rationed.

Even as some care homes struggled to look after all their residents with coronavirus, they also found limited support from the NHS. The Alzheimer’s society survey found that 75% of care homes said that GPs were reluctant to visit, and 25% said that hospitals had not been keen to take the seriously ill. According to one doctor quoted anonymously in The Daily Telegraph there was even a policy for doctors not to visit care homes.

Now, it seems care home residents and workers are paying the price.