Discharging hospital patients to care homes at the start of the pandemic

I follow the blog of a barrister who comments on current legal issues, and he addressed exactly this topic the other day: davidallengreen.com/2022/04/the-key-paragraph-in-the-significant-covid-and-care-homes-judgment/

Well worth a read, I think.

There was a clear policy to empty hospital beds. It was known at the time that asymptomatic transmission was a possibility but Johnson's government ignored that. They claimed to have thrown a protective ring around care homes - a complete lie in my view. I think t okhe underlying policy was obviously to sacrifice older patients in the interests of saving those with economic value. Later it seems the government realised it might be a vote loser so they started sending PPE to homes - too little, too late. It's true that vaccines saved many but most of the government's other decisions were very poor and partying won't go away - 78% of the people believe Johnson lied about it to the Commons. He should go.

Germanshepherdsmum

People running some care homes seem to have shown little or no understanding of the situation. Temporary staff were hired with no care as to where they had been working previously and they transferred covid from one home to another. Some care home owners were shown to have little or no idea of how to deal with the pandemic, many were just investors who were just in it for the money. In a few homes staff recognised the problem and lived in the homes rather than going home. The blame cannot be laid solely at the door of the government. The last pandemic the UK had to deal with was in 1918 and nobody could have predicted the onslaught of covid. So easy to be wise after the event, like Captain Hindsight. What a good opportunity to bash the government. I have yet to hear how any other party would have dealt with it,

So why did the government and the then health Secretary Jeremy Hunt completely ignore the findings of Operation Cygnus that showed we were ill prepared for a future pandemic?

Discharge policies are bizarre. A relative with PD and dementia was discharged last week to our local hospital and social care is formulating. a home care package. Yesterday a doctor told him alone that he was being discharged to a care home. He phoned his wife in a state, she phoned her son (at work) in a state and her son had to phone the hospital and ask to speak to the doctor why and what possessed him to tell a man with dementia that before telling his wife. He did apologise and explain the whole conversation which was a short term care home while care package set up but really! Unfortunately the doctor did not inform the nurses about what he was going to say as they would have suggested waiting till his wife was there before explaining it both.

JenniferEccles Thu 28-Apr-22 23:28:59
What I could never understand at the time was why the care home owners/managers themselves didn’t provide PPE for their staff.

It was as plain as it could be that all PPE had been directed to the NHS. There was the occasional muttering that the government would use some of this for Care Homes but little was available to them and, as OakDryad has said, much was done by communities to provide what they could of homemade PPE.

So why didn't you understand that? It was out there in the public domain and yet you are still posting something that a bit of factchecking would tell you is just what you want to believe, rather than the truth.

MissAdventure

Ppe was prioritised for the nhs.

Indeed it was.

www.theguardian.com/world/2020/mar/30/protective-equipment-being-diverted-from-care-homes-to-hospitals-say-bosses

Local care homes here had no PPE. A friend who has a fabric shop and wholesale contacts organised our local craft group to sew masks and scrubs. We churned out hundreds on our home machines. Similar community efforts were happening all over the country.

www.theguardian.com/world/2020/apr/23/the-volunteers-making-ppe-on-the-homefront-for-uk-healthworkers-coronavirus

Ppe was prioritised for the nhs.

What I could never understand at the time was why the care home owners/managers themselves didn’t provide PPE for their staff.

As for discharging people back into their care home it was obviously done out of desperation to free up beds for the anticipated huge influx of patients which actually didn’t happen.
I expect each elderly person was viewed in terms of their on-going care, so for instance someone living alone would possibly be kept in, but those who had somebody at home to care for them would be discharged.

Germanshepherdsmum

The threads would consist largely of withdrawals. And everyone can find a ‘fact’ to suit their argument.

I don't think that is true. As an example (and not to suggest this is just about Maw). Maw said,

We did not know Covid could be asymptomatic ...

There is has been so much information put on here to show that this isn't true. What has been put on to show that it is? Yet still that comment sit here as if it was a known fact.

It wouldn't stop the discussion to remove or update such a comment, I agree. However, certain facts would have been uncovered and accepted. I do worry about fake news taking this country somewhere we wouldn't want to go if we knew the truth.

Although I agree with GSM that many of the owners of care homes are investors, another wonderful legacy of Thatcher, her criticisms of the managers and the staff are incredibly unfair. Many of these people were left to get on with it, with sick residents, worried and demanding families, staff who were often opting to live in, and little or no PPE with which to deal with it. No, we don't know how a Labour government would have dealt with it, but we had a Tory government who had chosen to ignore Operation Cygnet as being too expensive, and who spent billions giving contracts to their pals for PPE, much of which is now rotting in warehouses. The treatment of the elderly in care homes, and the staff in those care homes, however you wish to spin it, was disgraceful.

Yes! We DID know that covid may be asymptomatic. Any student nurse and most parents know that when germs are incubating in the body, that is an infectious stage.

It must have been desperation to clear hospital beds for covid patients.

It takes only a slight layman's knowledge of the use of quarantine to know that you don't place possible sources of acute infectious fever where they may infect others. Who does not know that the incubation stage of an infectious fever is an infectious stage?

The government should have commandeered hotels as places of quarantine for old people removed from places where they may have become infected.

The threads would consist largely of withdrawals. And everyone can find a ‘fact’ to suit their argument.

MawtheMerrier

Not making apologies for anybody but hindsight is a wonderful thing.
We did not know Covid could be asymptomatic and it made sense to “clear the decks” for the anticipated waves of Covid patients.
I remember my friend, whose husband had Alzheimer’s and was admitted to hospital for tests after a stomach problem, being delighted and relieved that he was “out of that place” and comfortable in his care home.

GNHQ really should have a rule on the Politics thread that says, like Parliament, people should have to come back and withdraw what they put forward as fact when it is shown not to be true.

As early as 28 January 2020 – three days before the first confirmed UK case of coronavirus – the SAGE committee of advisors warned: “There is limited evidence of asymptomatic transmission, but early indications imply some is occurring.”

A study published in the Lancet on 24 February 2020 described its own findings as “suggesting that infected individuals can be infectious before they become symptomatic”, so-called “pre-symptomatic transmission”.

NHS guidance for clinicians from 3 March recommended: “A person that is asymptomatic […] with a Coronavirus travel history or contact with a confirmed coronavirus case” should be “advised to stay indoors” and “avoid contact with other people”. The implication being that even those who do not currently display symptoms could have the virus and infect others.

Throughout March several other sources (including the European and US Centers for Disease Control) acknowledged evidence of pre-symptomatic and asymptomatic transmission.

On 26 March, Professor Yvonne Doyle of Public Health England was asked by MPs on the Health Select Committee whether “people could be spreading the virus to others for up to five days before they show any symptoms”. Professor Doyle replied: “Yes, that is correct.” She added: “we are still learning about that. It ranges over quite a long range, but in the majority of cases that we are analysing, about five days is the period.”

Nevertheless, on 2 April, the UK government issued guidance to care homes in England that said: “Residents may also be admitted to a care home from a home setting. Some of these patients may have COVID-19, whether symptomatic or asymptomatic.”

[Source: FactCheck]

It’s not to do with “hindsight”. Scientists did indeed know that covid could be transmitted asymptomatically, and the government must surely have been aware of this before people were moved into care homes.
Any trawl of the internet will show this, and I think this was mentioned by judges in the recent court case.
Care homes could not have been expected to barrier nurse, with the appropriate PPE, the influx of residents.

In January 2020, doctors knew that asymptomatic transmission was occuring. I posted about this upthread with a link to an NYT article which explains what was going on. WHO were aware as were SAGE. The Diamond Princess cruise ship which was barely out of the news in February 2020 contained 100s of passengers who were infected and infectious but asymptomatic.

While Jeremy Hunt is being flagged as a potential successor to Johnson it's worth remembering he was Health Secretary in 2016 when Exercise Cygnet too place, lessons from which were ignored:

www.bmj.com/content/372/bmj.n335/rr-1

The Cygnus report was frank about the state of the UK’s readiness. “The UK’s preparedness and response, in terms of its plans, policies and capability, is currently not sufficient to cope with the extreme demands of a severe pandemic that will have a nationwide impact across all sectors,”

www.theguardian.com/world/2020/may/07/what-was-exercise-cygnus-and-what-did-it-find

Not making apologies for anybody but hindsight is a wonderful thing.
We did not know Covid could be asymptomatic and it made sense to “clear the decks” for the anticipated waves of Covid patients.
I remember my friend, whose husband had Alzheimer’s and was admitted to hospital for tests after a stomach problem, being delighted and relieved that he was “out of that place” and comfortable in his care home.

Everyone was obliged to do as the government instructed (except the government, of course!)

Of course owners of care homes and private landlords are both investors but the requirements for care of a care home resident and a private tenant are radically different. Many care home owners and managers proved woefully inadequate in caring for their residents. They shouldn’t have found it necessary to rely on the government for everything. A modicum of common sense might have been helpful in some cases.

@ Germanshepherdsmum Thu 28-Apr-22 08:56:03

Many care home owners are simply investors and the standard of management varies.

Isn't that what is being said of buy-to-let owners. The "market" in Care Homes was changed during and after Thatcher in just the way the market in housing was. Care Homes were to become a commodity to be bought and sold to make money. The Conservative party did not care about those living there or those working there. They are the "market gang" and to them, the only thing that makes money is the constant trading of goods. In this case the "good" is the home.

Attacking those running the homes, which went unsupported by the government for most of the pandemic, is still, in my view, a low blow.

DaisyAnne

@Germanshepardsmum Wed 27-Apr-22 18:36:34

What a horrible snipe at the Care Home staff, GSM. It really is everyone out of step but your lot, isn't it.

My mother was in a Care Home as we went into the pandemic. They knew exactly what needed doing. She died before we went into lockdown from old age not covid thankfully. However, I had to be glad that she didn't have to go through all the rubbish the homes had to take from this government and it felt like I was wishing her away. Heaven knows how those who saw preventable deaths must feel.

The blame is solely at the door of the government. They signed up for the responsiblility and then couldn't handle it. From being unprepared to gross incompetence, they let the frail elderly down.

Strangely, you can't find acceptable evidence to post on here. All countries knew about the possibility of a pandemic. And all you can do to justify the governments empty arguments is to call people names. I bet that used to go down well in court.

No one was "bashing" the government. They were coming to a legal conclusion. Just as the Public Accounts Committee did when they said that the government “exposed limitations in how the government manages risks” and also a “failure to learn”, from both simulation exercises and actual incidents.

It's time for those who appear to worship the ground Johnson walks on to admit it was a mistake and open their eyes to just how disastrous this government has been and looks like continuing to be.

It’s a snipe, if you must call it that, at the owners and managers of care homes who continued to employ agency staff who could bring covid into the homes. In a few homes the staff decided to live in, a big sacrifice but it worked. Many care home owners are simply investors and the standard of management varies. It’s very easy to say what should have happened with the benefit of hindsight but when did the UK last have to deal with a pandemic, a disease which was a complete unknown?
Btw I have said many times that I may be a Conservative voter but I am not and never have been a supporter of Johnson.

Matt Hancock claims that Public Health England bears the responsibility for this.

news.sky.com/story/matt-hancock-blames-public-health-england-for-care-home-covid-failings-in-2020-but-thats-not-what-he-told-me-12600140

"The Secretary of State for Health will remain ultimately responsible to Parliament for the delivery of the functions for which Public Health England is responsible".

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.

My mother was in a Care Home as we went into the pandemic. They knew exactly what needed doing. She died before we went into lockdown from old age not covid thankfully. However, I had to be glad that she didn't have to go through all the rubbish the homes had to take from this government and it felt like I was wishing her away. Heaven knows how those who saw preventable deaths must feel

Yes, it happened in the care home where my SisIL is and they had to be locked down in their rooms because other people were sent back there with Covid.

X post, I was responding to MissAdventure