The Integrator: No clear answers in care home blame game

A public inquiry into the government’s handling of coronavirus is looking more inevitable by the week, and at the centre of it will be the questions of whether care home residents were adequately protected.

For the week ending 27 April, 38 per cent of care homes reported a confirmed or suspected outbreak. The latest ONS death certificate data, up to 22 May, showed that 29 per cent of all covid-19 deaths in England took place in care homes.

Although the NHS assertion that discharges to care homes dramatically dropped is correct, this was not put into the context of overall discharge rates, which were falling further and faster until mid-April.

It seems a stretch to agree with Boris Johnson who told a parliamentary committee last week: “It’s just not true there was some concerted effort to move people out of the NHS into care homes”.

Indeed, NHS instructions on 17 March were to clear acute beds as quickly as possible, with the aim of freeing up 15,000 acute beds within 10 days. After seeing what was happening in Italy at the time, there was an understandable panic about NHS hospitals being overwhelmed. Not doing so might well have created a different scandal.

David Oliver, a former national clinical director for older people and president of the British Geriatrics Society, told HSJ: “Imagine what would have happened if we had kept large numbers of residents who did not need acute treatment stranded in acute beds in the early stages of a pandemic… [there was] not sufficient capacity of the acute site to quarantine large numbers of care home residents.”

What may now be seen as a crucial failing is that trusts were not required to systematically test people for covid before being discharged to care homes until 15 April.

But analysis of discharge data demonstrates just how difficult it is to understand what is causing the high number of deaths in some care homes, while not in others.

Sally Warren, director of policy at the King’s Fund, said the high infection rates in the care sector are down to a “wide range of factors”. She said residents had a greater susceptibility to the virus, and there had been worrying delays in care homes accessing testing and much needed PPE.

NHS Providers, which has been very vocal in defending its members in what is quickly becoming a blame game over whether covid was seeded into care homes, said in a public statement: “Trust leaders recognise that, in the first few days after the publication of the discharge guidance on 17 and 19 March, small numbers of asymptomatic covid-19 patients may have been discharged into care homes.”

The organisation agreed there might be “variation across the country” in the discharge process… but said the data suggests trusts “did not ‘systematically’ and ‘knowingly’ transfer the risk of covid-19 from the hospital sector into care homes.”

Both these positions get to the core of the problem. The data around social care in general and during the covid-19 pandemic in particular is not good enough to work out why some areas have had much worse infection rates in care homes than others.

Billy Palmer from the Nuffield Trust, said on Twitter: “Only when more detailed data is released (plus qualitative insights) can we better unpick what happened”.

This in itself might never be truly possible, as Ms Warren added: “Many clinicians acknowledge that discharge from hospitals to care homes was a contributing factor, but the lack of widespread testing at the time means we cannot know the scale of its impact for certain.”

This lack of insight is incredibly troubling because it makes it very hard to learn lessons for any future second wave of covid-19, or another unrelated pandemic.

Annemarie Naylor, director of policy and strategy at Future Care Capital, said: “The frustration is that the pandemic has shone a light on the challenges that social care commissioners and providers – and the people who rely upon them – face but, at present, it’s like looking into a black hole when seeking data to understand them.”

Working out what happened and when should primarily be about saving lives in the immediate future. The idea of apportioning blame is a very divisive one but, if pursued, it must come second to the life-critical need to protect future care home residents.