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Covid-19: Hospital Patient Referrals

Volume 813: debated on Monday 28 June 2021


Tabled by

To ask Her Majesty’s Government what assessment they have made of the proportion of hospital patients referred to residential accommodation during the pandemic that were tested for COVID-19 prior to discharge.

My Lords, on behalf of my noble friend Lady McDonagh, and with her permission, I beg leave to ask the Question standing in her name on the Order Paper.

My Lords, there was limited testing capacity in March and early April 2020 and this was prioritised to those with symptoms. On 15 April 2020, the adult social care action plan instituted a policy of testing for all patients prior to discharge to a care home. All clinical guidance issued by the department, Public Health England and the NHS received clinical sign-off, following the best scientific advice available at the time.

My Lords, I want to understand whether the deaths in care homes, which were absolutely tragic, were down to the incompetence of the Government or just a disregard for the elderly. We all understand the need to free up acute beds in hospitals and it has been long understood that the safe way to do that is through isolation. If that was known by the care homes, were the individuals Covid positive or not being tested? Can the noble Baroness agree to publish all the emails, letters and other correspondence with the care home sector so that we can all see what the Government were doing at a particular time during the pandemic?

My Lords, prior to the publication of the Government’s hospital discharge service requirements on 19 March last year, engagement was sought from, for example, NHS England, Public Health England, Care England and the Local Government Association—I could go on. I am not sure about the practicalities of everything that the noble Lord requested, but I reassure him that proper engagement has been undertaken with the sector throughout the pandemic.

My Lords, I think that this Question is asking what proportion of those referred to residential accommodation were tested for Covid-19 and, therefore, what proportion were not. The Question is not asking what proportion of those tested were positive and negative—and testing should be required of all care home staff. When hospital discharge guidance was released on 19 March, why was there no requirement to test people for Covid-19 before release and, if positive, to segregate them from those testing negative? However, 30% of those tested for Covid-19 while in hospital did not receive their results when they left. This was particularly problematic for care homes, given the transmission risk. Why did 30% of those tested while in hospital not receive their test results before they left?

My Lords, my noble friend has asked a number of questions. The policy shifted post 15 April and that was based on our understanding of asymptomatic transmission. It was also based on the availability of testing capacity at the time. Prior to that date, those who were symptomatic were tested and every effort was made to ensure that those results were also passed on to the care homes so that they could take the appropriate action needed.

My Lords, given the awful experiences that residents of care homes had when they were deprived of all contact with their loved ones while patients were being discharged from hospital without having been tested, could the Minister assure the House that there is absolutely no prospect now of patients being transferred from hospital into care homes without having been fully tested and fully vaccinated?

My Lords, I can absolutely make that assurance in the case of testing. In the case of vaccination, there may be individual circumstances for a patient that make vaccination not appropriate at that point—for example, if you are symptomatic with Covid, you may not then be vaccinated. If you test positive, you are not discharged into a care home setting; you are discharged into an approved setting that has the right processes in place so that you can get the care that you need while being appropriately isolated.

My Lords, while the Minister is doing a really excellent job at answering these questions, it does raise the question as to why the Minister responsible—the noble Lord, Lord Bethell—is in hiding. Is it because, unlike the noble Baroness, he is one of the guilty people responsible for the care home scandal, or is it because of his links with Gina Coladangelo?

My Lords, given the number of times my noble friend has appeared at this Dispatch Box to answer questions from noble Lords during this pandemic, the noble Lord’s question is without any merit. I am sure that he will welcome the fact that he will see my noble friend at this Dispatch Box two or three times tomorrow.

My Lords, in recent weeks, Ministers have quoted from the Public Health England report published in May, which claimed that only 1.6% of outbreaks in care homes potentially came as a result of hospitals discharging patients who had Covid—this despite the report having been widely criticised by independent experts in the sector as presenting an unrecognisable picture of the impact that hospital discharges in the absence of testing had had. Last week, the noble Lord, Lord Bethell, in response to a question from the noble Baroness, Lady Wheeler, said that he was not aware that the report was being revised. Will the noble Baroness now commit to investigating this issue properly and publishing the outcome?

My Lords, I will absolutely take that point away. My understanding is that there is the Public Health England report, while a number of other retrospective studies in Scotland and Wales have looked specifically at the impact of discharge policies. Although there has been a slight variation in the policies implemented across the four nations and the evidence is not as yet conclusive, the studies have indicated that discharge policies were not responsible for a significant number of outbreaks in care homes in the UK. We look at a number of pieces of evidence and we always look to make sure that that evidence is up to date. I will take back the noble Baroness’s specific point on the revision of that data and see what I can write to her in response.

My Lords, we know that the Government’s interpretation of throwing a protective ring around care homes is not what most of us would see as protection, nor was there upfront recognition from the start of the pandemic of the vulnerability of care home residents. The extra resources from the infection control fund have been crucial in helping care homes to keep going and deal with their extra PPE, staffing and huge administrative costs, but it runs out on Wednesday, as the Minister will know, with only an obscure notice on the government website on 15 June to announce its demise. What are care homes to do now with their ever-escalating costs, infections increasing and a minority of care home workers not vaccinated?

My Lords, we continue to support the social care sector in its efforts to control infections. The noble Baroness raised the question of vaccinations, which will be crucial in protecting care homes. We have laid the statutory instrument that will require all members of staff working in CQC-approved care homes to get their vaccination.

Can the Minister confirm that this was an error, because care homes were not properly staffed or equipped?

My Lords, I do not agree with that assessment of the situation. We have been providing support to care homes since the start of this pandemic, including ensuring that proper staffing is in place to help with, for example, infection control methods.

What consideration have the Government made of utilising currently unused NHS land and buildings for care accommodation? This type of hospital accommodation, similar to that in Scandinavia and other parts of continental Europe, has been a better solution than discharging hospital patients into care homes and other residential accommodation, especially given the challenges of testing for Covid-19 in early 2020.

My Lords, in our response to the pandemic, we have introduced a policy of designated settings, where if someone in hospital who is otherwise ready to be discharged tests positive for Covid, they can be discharged to a designated setting. More broadly, the noble Baroness is right: the use of step-down accommodation can be very useful in discharging people from hospital to social care. The point about NHS land is, I am sure, one that we will want to take away.

My Lords, going back to last March, was any assessment at all made of the disastrous policy of discharging patients with Covid into care homes? If it was, will the Minister publish that assessment?

My Lords, I am aware of the Public Health England report to which noble Lords referred earlier and of reports in Scotland and Wales that have been published. Those are the reports that I am aware of and they have all been published.

My Lords, SAGE minutes from the end of January 2020 identified that asymptomatic cases were emerging, so why, out of half a million tests carried out until mid-April 2020, were the vast majority of the 25,000 people discharged from hospital to care homes not tested?

My Lords, while there was an acknowledgement of the potential risk of asymptomatic transmission, there was no scientific consensus on the matter. In fact, the WHO did not recognise asymptomatic testing for a number of weeks after that point. However, the first group prioritised for asymptomatic testing was those who were going to be discharged into care home settings.