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Care Homes: Guidance

Volume 811: debated on Wednesday 21 April 2021


Asked by

To ask Her Majesty’s Government what assessment they have made of the impact of their guidance Visits out of care homes, last updated on 7 April, and in particular the requirement that residents making a visit out of a care home should isolate for 14 days on their return.

My Lords, the Government do not underestimate the heavy burden of infection protocols on those who live in social care and on their loved ones. However, the public health advice is clear: once an infection enters a closed environment such as a social care home, it spreads far and fast, as we found out last year. We hope that the vaccines will change this and we keep the policy under review but, until the evidence is conclusive, the safety of residents remains our priority.

My Lords, care home residents have been cooped up for more than a year. Most of them have received two doses of the vaccine and many are becoming depressed at not being allowed to go for a walk with a family member, or even to vote in person at the polls. At a recent sitting of the Joint Committee on Human Rights, the pressure group Rights for Residents told the committee that

“the Government’s guidance on visiting out of care homes … is blatant human rights abuse”.

As the situation is easing somewhat, when do the Government expect to reassess that guidance?

My Lords, the noble Baroness puts the case extremely well. I do not deny her suggestion that this is a huge burden on those involved. However, data from the ONS makes it clear that, across care homes, when one case of coronavirus is reported, an estimated 20% of residents typically subsequently test positive for Covid—even under the current state of the vaccine rollout. We remember Holmesley care home in Sidford, Devon, where there were 11 deaths because of a major outbreak. We are still in the middle of the pandemic. The vaccine is making progress, but we have to take things one step at a time.

Can the Minister explain why the visiting out guidance is not aligned with the road map for the national lockdown? Is there not a gaping discrepancy between the advice for care home residents, who are advised to keep the number of contacts to a minimum, and the advice for care workers, who can go to the hairdresser’s, sit outside a pub, meet up in groups of six and then go back into a care home to provide personal care?

My Lords, these protocols are not tied to the road map because we hold them under constant review. We hear loud and clear the case made by the noble Baroness and others who make the case for change. We are open to making that change when the evidence says that the situation is ready. We expect care home workers to behave in a way that is responsible and keeps infections to a minimum, but we cannot have protocols for every aspect of their lives.

My Lords, I declare an interest: I have a close family member who is a care home resident. People living in care have endured over a year of rules keeping them separated from family and friends, with the double isolation of relatives being unable to go into the home and residents being unable to leave. Although I welcome the recent relaxation of the rules on visiting out of care homes, the guidance states that the requirement for a 14-day isolation period on return

“is likely to mean that many residents will not wish to make a visit out of the home.”

What is the point of pretending that it is being allowed? Does the Minister understand why imposing a blanket quarantine on visits out feels to many arbitrary, unfair and as though it is interfering with their liberty? Can he explain why it is not possible for a resident who has been outside for visits to be tested on return and again after a specified number of days, rather than enduring a 14-day isolation during which they are often confined to a small room?

I can only express complete sympathy for the noble Baroness’s points. She puts them extremely well. Undoubtedly, the pressure put on residents and their family members is profound and I regret it enormously. However, this is not an arbitrary or thoughtless measure from the Government; it is to protect residents who have shown themselves to be highly susceptible to the disease. We have instances of serious illness and death to remind us how important these measures are. The noble Baroness is entirely right that the protocols are in place in order to deter external visits. In terms of testing, the unfortunate truth is that the virus can harbour in someone’s body, undetectable, for days. We know from protocols around international travel that pre-travel testing catches only about 15% or 20% of those with the disease and it is for that reason that we cannot turn to testing as an alternative.

My Lords, grass-roots relatives’ campaigns such as Rights for Residents, John’s Campaign and Care Unlocked describe this guidance as “false imprisonment”, “barbaric”, “cruel”, “treating residents as second-class citizens” and “more scandalous than any Greensill revelations”. I want to press the Minister. Can he really explain from a virus control point of view, as the noble Baroness asked, what the risk difference is between care home workers who leave those care homes, go about their business and then return and give personal care in the same home and a vaccinated care home resident who, after a family day out to the seaside, has to endure 14 days of solitary confinement? From a risk point of view, it makes no sense.

My Lords, there are two points of difference. One is that we can take certain measures to guide the behaviours of care home workers but we cannot mandate for every aspect of their lives. Secondly, care home workers wear PPE and that significantly reduces their infectiousness. We do not ask care home residents to wear PPE. Were we to do so, I think it would provoke suitable concern among residents and their families. As a result, we have to have these isolation protocols in place to avoid the spread of the virus.

My Lords, I am a member of the Joint Committee on Human Rights, which has been concerned about the treatment of care home residents over the past year. It is continuing its inquiry with an evidence session this afternoon. As colleagues have asked, are not the Government sabotaging the chance for care home residents to have a trip outside, especially given that staff are coming and going without quarantine? The Government’s guidance says that they “recognise how important” outside trips are

“for residents’ health and well-being”.

At the same time, and as the Minister has affirmed in his answers today, they recognise that their requirement for a 14-day isolation period

“is likely to mean that many residents will not wish to make a visit out of the home.”

This is insulting and treats care home residents and their families like children, not as responsible adults.

I completely sympathise with the noble Baroness’s point. She is right: this puts huge pressure on residents and their families. I am heartfelt when I say that I completely agree with her that this has an impact on the mental health and well-being of residents. However, their health, their safety and their actual lives take priority, I am afraid. We are at a moment where, even with the rollout of the vaccine, there is still a high infection rate in the country. If the virus gets into a home it has a potentially devasting effect, spreading very quickly within the confined spaces of the home among people who, typically, are highly vulnerable. That is why we have to put in place these serious protocols. This is done with huge regret and we review it constantly. It is my sincere hope that we can lift these protocols as soon as we possibly can, but until the day when the evidence is conclusive, we have to have them in place in order to protect lives.

Sitting suspended.