This month we have been considering the impact of the Covid-19 pandemic on care homes. Back in early March the Government was clear that even before a decision had been taken to introduce extreme social distancing that it would be necessary to shield vulnerable people and, in particular, older vulnerable people with additional underlying health conditions.
It is clear now that both the planning and execution of this shielding strategy has failed in relation to care homes. Indeed, the latest data would appear to indicate that not only has the strategy failed to protect people in care homes from dying from Covid-19 but that the strategy of shielding may also have contributed to additional early deaths.
There is already research underway looking to see if the discharge of untested patients back into care homes occurred, and looking at the possible spread of the virus via the use of agency staff, the quality of the advice on how to safely isolate and limit transmission of the virus, and the extremely low rates of testing of both staff and residents.
One factor which is not in dispute is access to Personal Protective Equipment (PPE) which appears to have been exceptionally poor in the early part of lockdown when the NHS was struggling to get sufficient equipment. Arguably the NHS need for PPE was pursued at the expense of PPE for social care.
Deaths in care homes are falling and no doubt will return to the expected levels over the next six weeks or so. However, with no vaccine and limited access to a reliable antibody test the need for regular and possibly weekly testing of both staff and residents is pressing. Without a large scale and sustainable testing regime care homes will have to wait probably for nearly a year to return to anything like normal operation.
It is important not to forget that people living in care homes and the staff that support and care for them have paid a heavy price for this failure. It will be many months before the final tally is known but at the time of writing there have been excess deaths of some 21,800 people living in care homes and 131 of the staff that support them.
It is not too early to ask why this has happened, and to try to understand in forensic detail the specifics of what occurred in some homes, and it is certainly not too early for the government to start to account for the decisions and action it has taken.
There will almost certainly be flare ups of infection. If this does happen, nothing can be done for the thousands who have already lost their lives, but there is an opportunity through effective action to ensure this tragedy is not repeated.
As is so often the case, the problem is not about knowing the answer but making sure that it happens. The minimum performance standard for care homes must now be:
- Regular systematic testing of staff and residents
- Secure a reliable supply of PPE
- World class evidence-based advice and training on how to isolate and limit transition of the virus.
Anything less risks further avoidable deaths.