Covid: What happened to care homes early in the pandemic? Reality Check

Testimony from the prime minister’s former chief adviser, Dominic Cummings highlighted the issue of care homes during the first wave of coronavirus.

By Reality Check team www.bbc.co.uk

“We were told categorically in March [2020] that people would be tested before they went back to care homes. We only subsequently found out that that hadn’t happened,” Mr Cummings told MPs. He claimed it was Health Secretary Matt Hancock who said this.

Mr Hancock said: “My recollection of events is that I committed to delivering that testing for people going from hospital into care homes when we could do it…I then went away and built the testing capacity… and then delivered on the commitment”.

So, what actions did the government take and what guidance did it give the care sector in England, where there have been more than 40,000 deaths involving Covid-19.

Moving patients from hospitals to care homes

On 19 March 2020, NHS guidance said that “unless required to be in hospital, patients must not remain in an NHS bed”.

This policy was implemented to free up beds in advance of an expected surge in coronavirus patients.

On 2 April, the rules on discharging to care homes were clarified, saying “negative [coronavirus] tests are not required prior to transfers/admissions into the care home”.

Even elderly patients who tested positive could be admitted to care homes, according to the document, if measures – such as wearing personal protective equipment (PPE) and isolation – were used.

From 15 April, the government said that all patients discharged from hospitals would be tested for coronavirus.

By this time, an estimated 25,000 patients had been discharged to care homes. In July, Panorama gathered data from 39 hospital trusts, which showed three-quarters of people discharged were untested.

Up to this point more than 5,700 care home residents had died in England and Wales (either in homes or in hospital).

Public Health England has published research into the impact of hospital transfers. It found that 1.6% of the lab-confirmed outbreaks in care homes that they knew about by mid-October 2020, had come from people discharged from hospitals.

But it is not clear what percentage of outbreaks up to 15 April (when the testing policy changed) were the result of patients being moved to homes.

And it is important to note that, at this time, there was a lack of testing so not every outbreak may have been recorded. Also, the figures do not count people who were not previously care home residents who were transferred into them from hospitals.

The government has repeatedly said that decisions to discharge patients from hospitals during this time were made by medical professionals on a case-by-case basis.

Testing

On 14 March 2020, the government began prioritising the most vulnerable individuals for testing, including those in hospitals and care homes.

If an outbreak was suspected, a handful of residents at a home could be tested.

Reality Check understands that some care providers found access to testing to be very limited at this time.

Chart showing coronavirus deaths

Figures for March to May 2020

On 15 April, the social care action plan was launched, as care home deaths in England were peaking at around 400 a day. This included a pledge to test all care staff who needed one, for example if they were in a household that was self-isolating.

At that point, just 1,000 care staff had been tested out of an estimated half a million who work in care homes.

All care home residents with coronavirus symptoms would also be tested.

On 28 April, this was extended to all care staff and residents, regardless of whether they had symptoms.

It’s important to remember that early in the pandemic it wasn’t widely understood that people who didn’t have symptoms could pass on coronavirus.

Personal Protective Equipment (PPE)

In March 2020, specific guidance related to coronavirus said that the PPE in care homes should be similar to that used in hospital settings.

The government launched the National Supply Disruption Response on 13 March, a centralised line for care and health providers to raise concerns.

This was followed on 19 March by a promise to deliver 300 masks to each care provider.

Concerns over PPE peaked at the end of March and early April, as bodies such as Unison, the Royal College of Nursing and care homes themselves highlighted shortages.

Because care homes are generally privately-run, they are responsible for purchasing their own PPE. Many found their local suppliers were running low and that they were competing with better-funded hospitals.

A letter from the government on 2 April recognised “the challenges providers may have experienced in obtaining PPE supplies over recent weeks,” and promised that the supply chain would be bolstered, with support from the armed forces.

On 10 April the government announced a PPE action plan, which included freeing up up 34 million pieces of equipment to “local resilience forums” who would then distribute it to care homes through local authorities.

By this point, 3,100 care home residents had died in England and Wales.

Visiting care homes

General guidance produced on 25 February 2020 included advice for carers on what to do if they came into contact with someone with Covid-19 – but there was nothing advising against visits to care homes.

In one section it said: “It remains very unlikely that people receiving care in a care home or the community will become infected.”

Another section said: “Currently there is no evidence of transmission of Covid-19 in the United Kingdom. There is no need to do anything differently in any care setting at present.”

However, the government’s own Scientific Advisory Group for Emergencies (SAGE) had advised on 10 February that “it is a realistic probability that there is already sustained transmission in the UK, or that it will become established in the coming weeks.”

Updated chart

Figures for 2020

On 3 March, the government released its coronavirus action plan – the document did not mention restricting visits to care homes.

By 5 March, England had had 273 cases of people with the virus.

That day the Chief Medical Officer for England Prof Chris Whitty told a committee of MPs that as there were cases that could not be traced back to people who had come from abroad, it was “highly likely therefore that there is some level of community transmission in this virus in the UK now”.

Italy suspended visits to care homes at this point, five weeks after recording its first case. A day later, Nursing Homes Ireland, which represents hundreds of care homes in Ireland, banned non-essential visits, just six days after the first confirmed case in the country.

On 10 March, Prof Martin Green, head of Care England which represents independent care providers, directed criticism in an Independent article at the government for its response.

At this point in England nearly 800 people had caught the virus, but the article noted that the generic guidance published by Public Health England appeared out of date, as it said there was no evidence of transmission within the UK. Prof Green said: “There is no evidence of a plan. I’m not even certain they have these plans and aren’t just making them up as they go along.”

Nevertheless, some homes were deciding to close their doors to visitors, with care groups Barchester and HC-One stopping non-essential visits on 10 March and 12 March.

Scottish Care – a representative body for social care in Scotland – advised care homes to close to visits on 11 March.

On 13 March, the government’s guidance from 25 February was updated to say that “care home providers are advised to review their visiting policy, by asking no-one to visit who has suspected Covid-19 or is generally unwell, and by emphasising good hand hygiene for visitors”.

On the same day Bupa and Four Seasons care homes stopped non-essential visits.

It wasn’t until 16 March that it was announced that social distancing should be carried out by everyone, in particular those aged over 70 and vulnerable people.

That day, the prime minister was asked about care homes and said: “We don’t want to see people unnecessarily visiting care homes.” By this point there had been 3,200 cases in England (although the figure given by the authorities at that point was less than half of that; positive cases are now dated to the day the sample was given).

In the period between 25 February and 16 March, 14 deaths of care home residents were reported along with 30 outbreaks in England’s 15,000 care homes.

On 21 March, guidance was introduced to encourage medically vulnerable people to remain indoors as much as possible until the end of June – a process known as shielding.

On 24 March, lockdown began with people ordered not to leave their homes at all except for “essential” reasons, which didn’t include visits to care homes.

Finally, on 2 April another document from the Department of Health and Social Care said that “family and friends should be advised not to visit care homes, except next of kin in exceptional situations such as end of life”.

Speaking on 15 May, Health Secretary Matt Hancock said that on the basis of the 13 March guidance “many of the care home providers, for instance Care UK, at that point stopped visitors”.

There have since been extensive changes to the guidance, with restrictions relaxed as lockdown eased.

This piece was originally published in July 2020 and has been updated to include the findings of the PHE report into the impact of patients discharged from hospitals to care homes in 2020.

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