At the height of the crisis patients were simply being discharged into care homes with covid symptoms, thus infecting other patients. Care homes had little or no PPE, no advice on how to look after these patients and had many temporary and part-time staff moving between care homes and therefore transmitting the virus unwittingly. There are still inadequate supplies of PPE, testing kits and detailed advice on how care home management should react when a care home patient shows covid symptoms. It seems that older people were just left to die. A suspicion that was heightened last week when the govt appointed an ex Australian Prime Minister Tony Abbott as a trade advisor despite Abbott publicly telling a think tank that some elderly older patients ‘could be left to die naturally’! At HAFSON we deplore these sentiments and are particularly worried as we approach winter where the mortality rate amongst older people goes up steeply.

The Governments own blog, Public Health Matters, has singled out our own council, Hammersmith and Fulham, for its excellent work on keeping its population, including those in care homes, safe during the Covid pandemic. Duncan Selbie, founding chief executive of Public Health England, wrote:

Hammersmith and Fulham

An exemplar of this has been the work of Hammersmith and Fulham Council and the leadership of Director of Public Health, Dr Nicola Lang and Lisa Redfern, Strategic Director of Social Care. They moved early and fast to put an enhanced level of protection around social care ahead of national guidance and based on the strength of their local relationships and knowledge about what works. Their achievements include enhanced testing, financial support to prevent loss of income for care home staff should they need to isolate, and as a social services director group in North West London, the development of ‘hot hubs’ – transitional beds for people being nursed in isolation until they test negative and can safely return to their own home or care home. There is even more to be recognised on their work delivering PPE, setting up a Community Action Network to support vulnerable residents, and on academic collaboration with Imperial College London.

I thank them and the whole council for a thoroughly instructive and enjoyable virtual visit this week. They have much to be proud of and have undoubtedly saved lives.

The article below discusses the number of deaths in care homes at the height of the pandemic.

More than 400 deaths involving Covid-19 occurred each day in UK care homes at the height of the coronavirus outbreak, new analysis shows.

At the height of the pandemic in care homes, almost 500 residents died in one day. There were more than 3,000 care home deaths involving coronavirus in one week in mid-April, according to the first UK-wide review of daily deaths by the PA news agency. Deaths rose five-fold between the start of the month and the care home peak on April 17, when nearly 500 residents died. At this time, testing for all staff and residents – regardless of symptoms – was not available in England, Scotland, Wales and Northern Ireland, while providers had not yet been advised to restrict staff movements between homes.

Carl Heneghan, professor of evidence-based medicine at the University of Oxford, believes staff movement was of “huge” significance in aiding infection spread in the absence of effective testing. Thousands of hospital patients were discharged into care homes from mid March, and there were struggles to access personal protective equipment (PPE). PA analysed data from the UK’s statistics agencies to reveal the day-by-day death toll up to the end of July.

It comes ahead of Sunday – six months since the first care home resident death involving Covid-19 – and also found:

  • More than 400 deaths involving Covid-19 took place in UK care homes on 11 days in April.

  • Deaths increased more than five-fold in just over two weeks, from 93 on April 1 to 490 on April 17 – the highest daily total.

  • By April 26, when the first UK nation announced that providers should restrict staff movements, 9,074 care home deaths had occurred across the UK – 51% of the total up to July 31.

  • By April 28, when the first UK nation announced testing for all care home staff, regardless of symptoms, 9,776 care home deaths had occurred across the UK – 55% of the total up to July 31.

England’s Chief Medical Officer, Professor Chris Whitty said in July “major risks” in social care settings were not considered early on, including staff working in multiple residences and those not paid sick leave.

Asymptomatic testing was first announced in England on April 28, despite Public Health England (PHE) saying it was a concern from the end of March.

The first nation to advise care home providers to restrict staff movements between homes was Northern Ireland, on April 26.

There was a gap of around two months between guidance from PHE advising care homes to share workforces in mid-March, to fresh advice to restrict staff movement announced on May 13 alongside funding to control infection spread in care homes in England.

Prof Heneghan said this was due to a lack of clinical experience in the government’s advisory team and an absence of leadership. Acknowledging care homes faced high levels of staff off-sick or self-isolating, he told PA: “The Government should have advised that agency staff, if used, should be employed in a single care home and not travel between multiple care homes. “That advice should have been given in the middle of March.” This should have been accompanied by funding to increase staffing levels, he added. He believes this should be applied going into winter, but has seen no “sense of urgency” about protecting care homes.

Care England chief executive Professor Martin Green said guidance has been “slow to come to fruition” and addressing this, particularly with regards to visits, is a matter of urgency.

He said: “Many care homes locked down before national guidance came into force. “Unfortunately patients were discharged from hospital without testing and this, compacted with insufficient PPE, created huge challenges for care homes.

“Routine testing is absolutely essential in order to establish confidence in the system for residents, staff, relatives and beyond.”

The potential risks of staff movement were first discussed at a meeting of the Scientific Advisory Group for Emergencies (SAGE) on April 21.

Dr Ian Hall co-authored the paper discussed, which was not made public until June 19.

The University of Manchester academic said concerns around staff movement should have been made public as soon as possible and that, given capacity issues, he believes staff should have been prioritised for testing over symptomatic residents.

But he said: “What we weren’t aware of at the time back in April and May was the complexity of the staffing situation, and so one of the concerns was, I know, ‘if we go too hard on the potential for staff being a vehicle for transmission, then a lot of staff might be absent and that might affect the care needs of the otherwise healthy but vulnerable residents’.

“So it’s a very delicate balancing act between trying to limit infection introduction and ensuring care is still provided.”

MHA, a UK care home provider, said mistakes must not be repeated and called for more funding, regular tests and “no slip ups or delays”.

Chief Executive Sam Monaghan said: “What this analysis does is confirm that during the peak of the virus the sector, despite following all of the best infection control measures, were not supported with what turned out to be the additional critical tools we needed to manage the spread of the virus.”

Unison senior national officer Gavin Edwards said social care must be treated as an “essential public service” with pay and workforce conditions prioritised, to avoid a repeat of the first wave.

He said: “Social care workers are often paid poverty wages, employed on zero hours contracts and given no sick pay. In addition, many have faced a massive drop in income if they follow guidance and self-isolate. This clearly helped to drive infection rates in the sector.”

A Department for Health and Social Care spokesperson said: “We have been doing everything we can to ensure care home residents and staff are protected, including testing all residents and staff, provided 200 million items of PPE, ring-fenced £600 million to prevent infections in care homes and made a further £3.7 billion available to councils to address pressures caused by the pandemic – including in adult social care.

“As a result of actions taken, almost 60% of England’s care homes have had no outbreak at all and the proportion of coronavirus deaths in care homes is lower in England than many other European countries.”

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