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Volume 50 Number 38, October 10, 2020 ARCHIVE HOME JBCENTRE SUBSCRIBE

Amnesty Report - As if Expendable

Report on the Government's Shockingly Irresponsible Decisions Which Abandoned Care Home Residents to Die

On October 4, Amnesty International UK released a report titled As if Expendable [1] condemning the British government's "failure to protect older people in care homes during the Covid-19 pandemic" and as "cases of coronavirus are rising again in the build-up to winter, the government must learn lessons from its disastrous decisions and not repeat the same mistakes".

In addition, the current experience of those involved in the health workers' movement, in the campaigns to save and protect services, shows that the government and the health authorities have not learnt these lessons. Current protocols do not fully address the practice of discharging patients who are untested, or who have Covid-19 from hospitals into care homes, or where other vulnerable residents live. Their measures are incoherent and, as Amnesty points out, do not protect the vulnerable and "notably their right to life, their right to health, and their right to non-discrimination" and not to be isolated from their families. On this, Amnesty said that "regular testing can help break the isolation that is so damaging to people's physical and mental health and could mean the difference between families being torn apart for months again".

In launching the report, Kate Allen, Director of Amnesty International UK, said: "The government made a series of shockingly irresponsible decisions which abandoned care home residents to die. ... The appalling death toll was entirely avoidable - it is a scandal of monumental proportions."

Donatella Rovera, Amnesty International's Senior Crisis Response Adviser, said: "It is as if care home residents were seen as expendable. Despite thousands of empty beds (in hospitals), they were de-prioritised when it came to getting access to hospital care and had blanket do not resuscitate orders imposed on them without due process. Such abuses are deeply disturbing."

Care home managers reported to Amnesty International that they were pressured in various ways to accept patients discharged from hospital who had not been tested or who were Covid-19 positive. Also, under the privatised care home system, and with block-purchased beds in care homes, and under government direction, managers stated that they had no choice but to honour their care home companies' contractual obligations to accept patients in these unsafe circumstances, a system which continues to date.

The report says that between March 2 and June 12, 18,562 residents of care homes in England died with Covid-19, including 18,168 people aged 65 and over, representing almost 40% of all deaths involving Covid-19 in England during this period. Of these deaths, 13,844 (76%) happened in care homes themselves; nearly all of the remainder occurred in a hospital. During the same period, 28,186 "excess deaths" were recorded in care homes in England, representing a 46% increase compared with the same period in previous years. These excess deaths likely include undiagnosed Covid-19 deaths, but also "underscore the broader impact of the pandemic on older people in care homes" from inability to access hospital and GP treatment services and to the devastating impact of long term isolation of residents on their physical and mental health.

The report says that since January, when the National Health Service (NHS) declared a Level 4 National Incident, the highest level of emergency, a number of decisions and policies adopted by authorities at the national and local level in England increased care home residents' risk of exposure to the virus. This violates their right to life, to health, and to non-discrimination. Furthermore, it is contrary to the claim by the secretary of state for Health and Social Care that a so-called "protective ring" was put around care homes "right from the start". These decisions dangerous and reckless decisions have notably included [1]:

The report then presents evidence, on among other important questions, of the denial of access of patients to hospital and other medical services, misuse of DNAR forms, inadequate access to testing, insufficient PPE and poor and late guidance, failure to respond to gaps in staffing, the suspension of visits and failure of oversight, and the devastating impact of long term isolation of residents on their physical and mental health.

The report also condemns the government for withholding information, saying that "to date, the government and responsible public bodies, including NHS England and the CQC, have failed to make public crucial data and information relating to the spread of Covid-19 in care homes. This information will be crucial to assessing the impact of their decisions on the human rights of care home residents, as well as to ensure that failures are identified and addressed, that lessons are learned, and that as the pandemic continues the correct measures are taken to avoid the recurrence of past mistakes."

Withholding and hiding crucial information has been the government's hallmark throughout the pandemic crisis. In April, the government admitted for the first time that the figures of the deaths of people in care homes and the community from Covid-19 were false [2]. Matt Hancock, Secretary of State for Health, confirmed that the figures had been "substantially underestimated" as he appeared before the Commons Select Committee. He admitted that the share of deaths taking place in homes was higher than so far reported.

As part of the research, the report notes the significance of the background to the failure of the privatised and fragmented care system in England. It says: "Private companies own and run 84% of beds in care homes for older people, while 13% of beds are provided by the voluntary sector and 3% by local authorities. Care home places can be funded by local authorities, the NHS or privately. Around 41% of residents in care homes fund themselves (self-funders)." It further notes that "care homes have been hit hard over the years by UK government austerity measures, and cuts have continued even recently. Spending per person on adult social care fell by some 12% in real terms between 2010/11 and 2018/19, while the number of older people in England who were estimated to have an unmet need for social care had grown to 1.5 million by 2019. Unmet need places significant pressure on England's 5.4 million informal care givers, many of whom provide over 50 hours of care per week."

In July, Prime Minister Boris Johnson agreed to an independent inquiry on the pandemic "in the future". The report calls in its response for a full, independent public inquiry, which "must be set up without further delay, with an interim phase to commence immediately and report its findings and recommendations by November 30 - so that lessons can be learned and measures swiftly taken to ensure older people in care homes are protected. Certain disproportionate restrictions on care home visits which are causing so much distress to residents must be urgently addressed, including by making testing available to visitors."

Yet since the report was published, the government has continued down its criminal and arrogant path and does not intend to learn these lessons, or even to claim to be dealing with them. It was reported that the only response from Health Secretary Matt Hancock was to claim that "the situation in care homes is improving" and that government pandemic policy has meant care homes have been "offering a better service".

The truth for the working class and people is that many things have been revealed about our society as a result of the Covid pandemic, things which make it impossible for any thinking person to want a return to this old normal of a corporate-led health and social care system, which has led to such tragic outcomes for the most vulnerable in society during the pandemic. The "new normal" is pointing the people towards the necessity that not only are those responsible for these reckless decisions which abandoned care home residents to die are brought to account, but that a new human-centred system of health and social care is brought into being. A modern public health and care system is required, provided as of right and that meets the needs of all, and that is capable to dealing with such health emergences as the coronavirus pandemic.

[1] As if Expendable - the UK government's failure to protect older people in care homes during the Covid-19 pandemic - Amnesty International, UK.
[2] The Outdated and Unacceptable Arrangements As Government Ignores People Who Die in Care Homes - April 18, Workers' Weekly


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