• Trusts desperately trying to discharge patients ahead of expected covid-19 surge
  • Some care homes refusing to accept discharges unless they have been tested for virus
  • Care England boss tells NHS to “up its game” on getting PPE to social care sector

Significant tensions are emerging between hospitals and care homes around patients who are ready to be discharged but have not been tested for coronavirus and also around personal protective equipment.

NHS trusts have been desperately trying to discharge patients to free up capacity ahead of an expected surge in covid-19 cases.

But in some areas, HSJ has been told care and nursing homes have refused to accept discharges unless they have been tested for the virus. Testing is not a requirement under the discharge guidance issued by the government on Thursday.

However, figures in the social care sector said there were huge concerns about the virus being brought into residential homes, and about the lack of PPE for their staff.

A senior director at a London acute trust, who asked not to be named, told HSJ: “There’s a real problem with private care homes refusing to take patients back unless they’ve been tested for covid-19. But [testing] is not the national guidance currently and there just aren’t enough testing kits to do it.

“I’m now on calls with commissioners about getting more people out of hospital and into the community, and they’re saying ‘yes, that’ll be done in the next week’, and I’m on the verge of screaming at them.”

Another acute sector director in the north west of England said: “We need care homes to be really robust. We’ve been hearing from colleagues that nursing homes won’t accept their residents back after they’ve been discharged from hospital, unless they’ve been fully swabbed [tested] for coronavirus. This is not the national guidance, and we aren’t able to do that right now. This could cause a huge issue.”

Paul Brant, Cabinet member for adult health and social care for Liverpool City Council, said: “Some care homes have stopped taking new admissions as they are worried about bringing infected people into [the] home. They feel they have a moral obligation to existing residents and [are] concerned that they would be putting them at risk.”

He said he had asked the NHS if new admissions could be tested, but said he had “not had a positive response”.

The problems do not appear to be universal. HSJ has also spoken to hospital leaders in other parts of the country who have not experienced the same issues.

Earlier this week, the government announced an additional £2.9bn to help local authorities and NHS providers increase the numbers of people able to be cared for in the community.

The Department of Health and Social Care said the money would pay for “follow-on care costs for adults in social care, or people who need additional support” and to speed up the NHS discharge process. But the department did not respond when asked if any of this money would go towards testing patients for covid-19 prior to hospital discharge.

The Care Provider Alliance, which represents independent adult social care providers in England, said the sector was seeking reassurance and clarity from the government around PPE for staff, and rapid access to testing.

Martin Green, chief executive of Care England, told HSJ: “Unless the NHS ups its game on this and gives us immediate access to the [PPE] we need, there will be no discharges from hospitals into care homes.”

In a letter to social care staff earlier this week, DHSC said all care and nursing home providers would receive at least 300 facemasks. It said it hoped distribution would be finished by Tuesday 24 March.

However, a senior council official in the East of England said this did not resolve concerns over domiciliary care workers.

They said: “One of our priorities is getting PPE to providers which I know is starting to move now. However, we are still in the dark as to how we can get PPE to personal assistants. We have over 2,000 [in our region] providing vital support to vulnerable adults and I know other local authorities will be in the same position.”