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Covid-19: Care Homes

Volume 812: debated on Thursday 17 June 2021


Asked by

To ask Her Majesty’s Government (1) on what date, and (2) in which policy document, testing for COVID-19 was offered as a matter of policy to those leaving hospitals and going to care homes.

My Lords, the Covid-19 hospital discharge service requirements were published on 19 March 2020. They stipulated that patients’ Covid-19 test results, negative or positive, should be included in their discharge documents. On 15 April, we built on this with the adult social care action plan, including a policy of testing all patients prior to discharge to a care home. I remind noble Lords that the WHO acknowledged the threat of asymptomatic transmission on 9 July 2020.

My Lords, last week the Secretary of State said that a policy of testing patients going to care homes was brought in

“as soon as we had those tests available”.

That was in mid-April 2020, and more than 500,000 tests were carried out to mid-April 2020. Only 25,000 would have been required to test all patients being discharged to care homes. Can the Minister explain these figures and the contradiction in the Secretary of State’s statement that they highlight?

My Lords, I do not quite understand the noble Lord’s figures. As of 14 March 2020, the seven-day rolling average showed that there were 51,741 discharges a day from hospital, of which 1,123 were from hospitals specifically to care homes. That was at a moment when our testing capacity was 3,000 a day. A month later, on 15 April, the rolling average was 22,000, of which 548 were discharges from hospitals specifically to care homes. By that date, the testing capacity was 38,766.

My Lords, we need granular details such as dates and decision-making processes not to play the blame game but because we need to understand precisely how Covid got into care homes. In that context, can the Minister tell us when and why the policy decision was made to make vaccines mandatory for care home staff, going against the Government’s stated opposition to jabs for jobs and against the crucial ethical principle of medical consent? Does the Minister understand that for care home workers, vaccinated and non-vaccinated, this looks like decisively shifting the blame from official culpability for the scandal of how Covid got into homes on to hard-pressed front-line workers?

My Lords, we are in the middle of a consultation on mandatory vaccinations for care home staff. One thing I would remind the noble Baroness of is that the vast majority of infections in care homes last year were through staff, not through discharge.

I think the question the public want the answer to is why so many people died in care homes. Will there be an inquiry which will try to get to the bottom of that simple fact?

My Lords, PHE has published a report on that. It calculates that around 1.6% of the deaths in care homes were directly attributable to discharge. That number is very sad, but it is a relatively low proportion. This will, of course, be a subject covered in the government inquiry that the Prime Minister has already announced.

My Lords, I feel sure that the Minister will agree that it was extraordinary that, when relatives were prevented from visiting their loved ones in residential care, and many of the residents could not understand why they had been abandoned, at that very time patients were being admitted from hospital without having been tested for this virus.

My Lords, I completely sympathise with the point on those in care homes receiving a very tough challenge when they have been prevented from seeing loved ones. We have had to take extremely severe infection control measures, many of which are still in place for the reasons that have been discussed in this Chamber before. But I challenge the noble Lord’s point on testing. We brought in testing when asymptomatic infection was recognised and when the capacity was available.

My Lords, can the Minister explain why the Secretary of State continues to justify himself by quoting the seriously underestimated PHE January to October 2020 data assessment on hospital discharges to care homes of 286 Covid deaths? The National Care Forum of care providers has repeatedly made clear how fundamentally flawed and incredibly partial that data is. Only limited numbers of symptomatic patients in hospitals and care homes were tested, and cases not tested before death are not included. Even the chair of the House of Commons Science and Technology Committee has said that relying on this for a full picture of the situation is a stretch of the imagination. We owe it to the people who have died, their relatives and care home providers to have full, accurate and independent information. How is the Minister going to ensure that it is urgently provided, so that we can genuinely learn from what happened?

My Lords, I acknowledge the noble Baroness’s concerns, but the PHE report is extremely thorough. I am not aware of it being revised, but if it is, I would be glad to share that information with the noble Baroness.

My Lords, respected health commentators and statisticians say that excess deaths—that is, deaths above the expected number—is a more accurate way of looking at the scale of deaths in care homes due to Covid. Care home residents make up just 0.7% of the population. In the first wave of the pandemic, deaths in care homes accounted for 44% of all excess deaths for that period in England and Wales. What does the Minister think this says about the effectiveness of the so-called protective ring thrown around care homes and what lessons have been learned?

My Lords, we were never in any doubt from the very beginning that the virus presented a huge threat to care homes. They are where the elderly and the vulnerable are housed, in conditions where it is extremely difficult to enforce infection control and where there is a large amount of intimacy between residents and staff. We knew from the experience of other countries that care homes were very likely to be an area where infection and severe illness, and potentially death, would be highly prevalent. There is no doubt that care homes suffered the brunt of this virus, and for that matter I am extremely sad indeed. Noble Lords should realise that we put every measure in place that we humanly could have done. We gave a huge amount of resources, including £2.8 billion via the NHS specifically to support enhanced discharge processes and the implementation of the discharge to assess model.

My Lords, I apologise to my noble friend for adding to the burden that he bears in answering this question. I know he cares deeply about this situation. However, it is important for lessons to be learned, so that we have no similar experience in future. The letter sent by the NHS to care homes on 15 April 2020 states:

“Where a test result is still awaited, the patient will be discharged … pending the result ... This new testing requirement must not hold up a timely discharge”.

I do not believe any of this was a deliberate attempt to infect care homes, but I do believe that care homes need infection control and that there was a lack of follow-up for patients who were discharged positive.

My Lords, I am grateful for the tone of the question, but its assumption is, I am afraid, quite wrong. Before April 2020, there was very little evidence and no scientific consensus whatever that asymptomatic transmission posed any risk. For example, the World Health Organization said on 2 April:

“to date, there has been no documented asymptomatic transmission.”

My noble friend may remember that differently. They were very difficult times, and we made decisions on very limited information. We made the best decisions we could have done under the circumstances.

My Lords, as late as March last year there was clear evidence coming from Italy about people dying in nursing and care homes there. Surely if we had been half-awake we would have realised that what was happening in Italy was a solemn warning to us, and we should have acted accordingly. Why did we not do so?

I saw the images the noble Lord refers to and was shocked and moved by them. That is why we moved massively, including, in March, announcing £594 million in order to support care homes, and massively supporting them through the NHS. We did an enormous amount from the beginning. The effects on care homes have been profound and are extremely sad, but I am afraid to say that this presumption that we either did not enough or took the wrong advice is not supported by the facts.

My Lords, let us focus on what government can do now. My concern is that the Government are overcompensating for the very high early death rate in care homes, for whatever reason, by imposing wildly disproportionate controls over double-jabbed, tested visitors. For example, they have to wear PPE and social distance, as we know, and there is no hugging—thus wrecking the final months for these people in care homes. I ask again: will our excellent Minister—I mean that; he is an excellent Minister—put to the Prime Minister the risks and benefits of scrapping these controls?

My Lords, I am extremely sympathetic to the noble Baroness’s point and conscious of her specific point that we could be in danger of over- reaching or in some way emotionally overcompensating for perceived mistakes in the past. We are conscious of that possibility, but I would like to reassure the noble Baroness that it is not the case. The decisions we have made on infection control and on visiting in care homes are tough—they are hard—but in recent weeks there have been outbreaks in care homes in London and Bolton in which vaccinated residents have caught the disease and had serious symptoms. That is something we are extremely wary of. When the vaccination has reached a higher proportion of the population and R is below 1, we will be in a position to change these policies. We will do so at pace and as quickly as we reasonably can, but until that moment arrives we have to take these tough decisions.