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Care Homes: Covid-19 Testing

Volume 803: debated on Thursday 14 May 2020

Private Notice Question

Tabled by

To ask Her Majesty’s Government which department or non-departmental public body is responsible for the programme of COVID-19 testing in care homes in England; and when they expect all care homes to be offered COVID-19 tests.

The Question was considered in a Virtual Proceeding via video call.

My Lords, I assure the House that the provision of tests for care home staff and patients is a number one priority for the Department of Health and Social Care. We are currently making available 30,000 tests a day through satellite, mobile and at-home channels. By early June we aim to have offered tests to all care home residents and staff specialising in the care of older people and those living with dementia.

My Lords, the Minister will be aware that there have been stark warnings from across the sector that, unless testing of staff and residents in care homes is urgently and significantly improved, there could be a second peak in deaths, potentially coinciding with the autumn flu season. Lives are being put at risk and conditions for dementia sufferers have worsened because of the continued failure to test hundreds of thousands of staff and residents. While the DHSC, the CQC and Public Health England will squabble over who is responsible and what each has or has not done, the Government’s own recovery strategy document now admits that they cannot even guarantee that every care home will be offered testing until 6 June, so we have yet another false and misleading promise. The Government themselves admit that only tens of thousands of tests have so far been done in care homes, and over 1.5 million are needed to cover staff and residents. Will the Minister explain to the House how he plans to get to grips with the total and tragic chaos that currently prevails?

My Lords, I completely acknowledge the threat of a second peak. It focuses the mind and is very much a priority for the Government, but there is no squabble of the kind the noble Baroness describes. I pay tribute to colleagues at the CQC, Public Health England, the NHS and the private care providers with which we work. Care home testing is offered to all care home staff and patients who need it. We are prioritising those who ask for it first and working through the list for any who need it by early June.

My Lords, given the press briefing by Dr Jenny Harries on Wednesday 13 May, when can we expect testing of all residents and staff in care homes? Covid-19 infects older people in care homes at different times. Therefore, a test is valid only on a specific day. Do the Government understand that one test per resident is not enough? Repeat tests are often required. Can my noble friend the Minister say what steps have been taken to increase the number of tests in care homes to save lives?

The noble Lord is correct: it is one test per resident for each infection. I pay tribute to the many care homes which have no infection at all, which have applied the correct disciplines and systems and for which no demand for the tests is currently present. We are prioritising homes that have infection and working through all their residents and staff, offering second and regular testing until the infection is eradicated. That logical prioritisation is exactly the right way to use the resources of both time and supplies, which are necessarily limited.

My Lords, I welcome the Minister’s reassurances, but is it not the case that this Question had to be asked because it was not clear whether the issue in care homes was a priority at the beginning of this crisis? That is shown by both the release of hospital patients into care homes and the failure to provide testing and PPE for their staff and residents. Was it true that the list of priority sectors at the beginning of this crisis did not include care homes?

My Lords, it is not true that the list of priorities did not include care homes. In every epidemic, care homes are always a priority. History has taught us that and we knew it from the beginning. We have focused on them enormously; that is why care homes are a number one priority at the moment. We are determined to reduce the rate of infection so that infection does not leak into the community.

In a reply during Oral Questions earlier today to my noble friend Lady Barker, the Minister said that test results for the care sector are turned around within 48 hours. Yesterday, care home organisations told the APPG for Adult Social Care that many are not getting any results back—a big black hole—that those which do say that 10 days is not unusual, and that local resilience forums are not being allowed to get the results either. They cannot plan support. While 6 June is three weeks away, the crisis in our homes is now. Given his previous Answer, can the Minister give a date by which all care sector results will be returned within two to three days?

I think the noble Baroness casts the situation unfairly. There are undoubtedly cases where test results have taken longer. Last weekend, a laboratory let us down and we had some delays, but I pay tribute to the team who turned around a very difficult situation. By far the vast majority of tests are turned around within our target time, and we are currently trying to reduce that time by using mobile and satellite units to take the tests to residents. That work is showing great and encouraging signs of improvement.

My Lords, will the Minister assure us that the department accepts that residential care homes exist for those who suffer from multiple and serious health problems? That being so, can he help us understand better why, when we have known for months that Covid-19 was a severe threat to residents and staff, it is still not possible to guarantee either testing or essential equipment?

I completely acknowledge that one of the most horrible aspects of this disease is that it targets those who are most vulnerable and live closely to each other. Care homes are therefore a priority. I also acknowledge that we started with a very low base of diagnostic testing and have had to work extremely hard to build that up. But now that that capacity is there, we are focusing it on care homes and using innovative methods to get those tests directly to people. We could not be working harder to get the right people tested in the care home sector.

NHS England recommends to staff that if they have symptoms after a negative coronavirus swab test they do not return to work, given the estimates of false negatives of up to 30%. But the Government’s official advice to someone with a negative test, in Our Plan to Rebuild, says:

“If a negative test is returned, then isolation is no longer required.”

What is the Minister’s advice to care home workers after a negative coronavirus swab test?

No one working in the NHS should go to work if they feel ill or have a temperature. That is true for anyone working on the front line, but it is not necessarily true for people who work in normal workplaces.

Is my noble friend aware of the guidance released to the NHS on 24 April announcing that all residents of care homes must be tested before admission? In paragraph 1.30, the guidance specifically states that:

“Where a test result is still awaited, the patient will be discharged and pending the result, isolated in the same way as a COVID-positive patient will be”.

Even now, this has resulted in care homes being required to take people out of hospital without knowing whether they have the virus and without necessarily having the appropriate PPE.

I am aware of that guidance. It is sensible guidance. It is necessary to free beds in our NHS hospitals to make them available to those who need them more. It is also necessary to isolate people when we are not sure whether they have Covid. These are uncomfortable truths and I do not deny that this will result in uncomfortable outcomes for some patients. One aspect of the disease is that it targets care homes and I make no apology for those arrangements.

Following the question asked by the noble Baroness, Lady Altmann, why in an English care home where a close relative of mine lives do staff and patients—including, astonishingly, patients discharged from hospital—still have to wait up to 21 days for the results of their Covid-19 tests?

The noble Lord gives powerful personal testimony. I cannot possibly argue with the details of his story, but I reassure him that the data I have is that the turnaround time for tests is, in the vast majority of cases, radically less than what he described. We are on course for hitting the target of 48 hours for a very large number of tests and 24 hours for a lot of tests.

My Lords, the time allowed for this Question has elapsed. The Virtual Proceedings will now adjourn until a convenient point after 1 pm for the Motion in the name of Baroness Boycott. Proceedings in the Chamber will be taken at a convenient point after 12.30 pm.

Virtual Proceeding suspended.