Workers' Weekly On-Line
Volume 50 Number 40, November 7, 2020 ARCHIVE HOME JBCENTRE SUBSCRIBE

Care Homes and Covid-19

Irresponsibility of Government Instructions to Discharge Covid Patients into Care Homes

The experience of those involved in the health workers' movement, in the campaigns to save and protect services, shows that the government and many of the health and local authorities have been unwilling to learn the lessons of discharging Covid-19 patients into care homes.

On October 27, it was reported [1] that Reading Council had refused such a government request. Councillor Tony Jones, the council's lead member for Adult Social Care, announced the decision. He said: "Reading Council will not be complying with the government instruction to identify care homes where Covid-19 positive patients can be discharged from hospital. We fundamentally disagree that this is the best approach for those patients or, indeed, for existing care home residents."

Tom Surrey, Director for Adult Social Care Quality at the Department of Health and Social Care (DHSC) had sent a letter as late as October 21 to all directors of adult services saying that "anyone with a Covid-19 positive test result being discharged into or back into a registered care home setting must be discharged into appropriate designated setting (i.e. that has the policies, procedures, equipment and training in place to maintain infection control and support the care needs of residents) and cared for there for the remainder of the required isolation period." [2] The deadline for every local authority to have access to at least one CQC designated accommodation was the end of October, only nine days later.

In a reply to the DHSC, Reading Council [3] expressed its disappointment at the request to local councils. The letter, signed by Seona Douglas, Reading Borough Council's executive director for Social Care and Health, alongside other adult social care directors, states: "In Berkshire West we consider that it is not acceptable to ask care homes to take new admission patients who are tested positive for Covid-19 and are potentially infectious. This is based on our experiences earlier in the pandemic, which have left many care settings very worn down with the impact that this has had for the residents and their families, some suffering significantly. Many of our care homes would struggle to convert their premises to accommodate safely such patients without this affecting others, despite the measures many have put in place to manage the risks."

The letter goes on to say: "The 'Home First' principle is embedded in our system as the most appropriate way to encourage independence and well-being for our residents, hence we wish to consider alternatives to those proposed in your letters in order to manage Covid-19 positive discharges." The council's Home First policy enables patients to return home with a tailored package of "wrap around" support and re-ablement. Reading Borough council says it will, along with West Berkshire Council and Wokingham Borough Council, work with health partners on the basis of the Home First principle.

Reading Council's is far from being an isolated opinion. For example, at the May Board meeting of the South Tyneside Clinical Commissioning Group, Paul Cuskin, a lay member of the board, whilst acknowledging the statistics presented, put forward that warranted conclusions must be drawn from analysing these trends, rather than simply following what are said to be the national guidelines. He said that "the care workers were doing extraordinary things in coping with patients going into care homes and that was at the cost of 'protecting the NHS', which is in my opinion a flawed strategy, because if you have 70% capacity free in the NHS and the mantra is to discharge people into care homes, who have got Covid, or who are asymptomatic then shouldn't we be using those facilities such as the Nightingale Hospital which has capacity to be utilised to help these individuals convalesce and recover from Covid. The issue I have is we put the most poorly people among the most vulnerable in societ y."

Similarly, in another area where the same questions were put to the council, the response admitted that, while untested patients were discharged into the care homes, "however, the practice occurred in many care homes within England, up until the government declared on April 15, 2020, that all service users would be tested for coronavirus, prior to being discharged from hospital to care homes (but that they must self isolate for 14 days on admission)". It has to be recognised that the April government guidelines still meant no actual change in the practice of discharging patients. As one care home nurse put it: "Many patients are confused on admission and sometimes acutely, due to and infection, or chronically due to dementia and it is not possible to stop them wandering. Also, many elderly patients become anxious and depressed when isolated which makes them more vulnerable to illness and this can often cause confusion and indeed that is what happened, all helping to spread the viru s among the patients in our care home." The outcome has been disastrous.

For instance, Amnesty International director Kate Allen said: "The discharge of Covid-19 patients into care homes full of vulnerable residents is widely regarded as one of the biggest and most devastating mistakes of the government's handling of the pandemic. Yet the same deadly policy is being pursued despite the knowledge of how disastrous it was."

In the case of Reading, care home providers and care leaders have also said that they are "highly concerned" about the scheme and are calling for "more clarity", and this is true for care home providers and care leaders in general [3]. But the government has not thought to consult at all with the health and care workers, or their trade unions, on what is the best way forward, even given the fact that the government was fully aware of the position in April. They were unwilling and unable then to make changes to the privatised and capital-centred system in health and social care, which has reduced bed capacity and human resources in health and social care to such a disastrous level that they focused on "protecting the NHS" rather than the welfare of all the people, the NHS and social care staff and the vulnerable in this pandemic. In this case, "protecting the NHS" means that the crisis of health care is such that the NHS is struggling not to be overwhelmed by the pandemic.

Since May, the government has continued down its criminal and arrogant path that does not admit the need to learn these lessons, or even to claim to be dealing with them itself. There have been no major statements from Matt Hancock, Secretary of State for Health, even in face of the condemnation by Amnesty International UK in its Report As If Expendable on October 4 [4]. The top-down instructions, issued in the name of the DHSC rather than directly from the government, appears to be a last-minute attempt to deflect the blame onto the health and local authorities, when it is the government and state that are responsible.

Many things are being revealed about our society as a result of the Covid pandemic, such as the fact that the old normal of a corporate-led health and privatised social care system attempts to wreck the outlook of the health workers and people and attempts to stop them being involved in sorting out the difficult problems to be solved. The elite then demands that everyone follow their system, a system that cannot sort out the problems and has such disastrous consequences for the people. People speaking out and acting in their own name against such criminal negligence is a starting-point in bringing into being a new human-centred system of health and social care.


Notes

1. Reading Council had refused government request to send Covid patients into care homes - The Reading Chronicle
https://www.readingchronicle.co.uk/news/18825076.reading-council-refuses-government-request-send-covid-patients-care-homes/

2. Winter discharges: designated settings
https://www.gov.uk/government/publications/designated-premises-scheme-letter-to-directors-of-adult-social-services/winter-discharges-designated-settings

3. Carehome.co.uk - Sue Learner
https://www.carehome.co.uk/news/article.cfm/id/1635984/reading-council-government-request-covid-patients-care-homes
4. Amnesty Report - As if Expendable: Report on the Government's Shockingly Irresponsible Decisions Which Abandoned Care Home Residents to Die
http://www.rcpbml.org.uk/wwie-20/ww20-38/ww20-38-03.htm


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