Care home patient families should become 'key workers'

Relatives of care home residents will be treated as key workers and get tested for Covid-19 weekly to enable safe visits as part of a new trial

  • The Health Minister Helen Whately said a trial will launched ‘shortly’ 
  • It would see relatives tested regularly and wearing PPE to see their loved ones
  • But a care home manager said the test is ‘only as good’ as the day its done
  • Theresa Steed said the home had had several-day delays in test results  
  • Comments were made at an inquiry into the handling of the crisis in care homes
  • Ms Whately claimed homes could not have been protected from the disease

Relatives of care home residents will be treated as key workers and get tested for Covid-19 weekly to enable safe visits as part of a new trial. 

Health minister Helen Whately today told MPs a pilot scheme would be launched ‘shortly’ to see if the strategy would work. In a meeting with MPs today, she said she wants to enable visiting ‘but it must be safe’. 

Dozens of care homes have already shuttered their doors to visitors in the face of a ‘second wave’ of Covid-19, reminiscent of the distress caused at the height of the pandemic in the spring when visits were completely banned across the UK.

Campaigners have been calling for a designated relative to be given ‘key worker’ status and regularly tested for the coronavirus to make visits safer, amid concerns for residents who are deteriorating in isolation. 

Ms Whately today revealed ministers have seemingly caved into demands, telling the Science and Technology, and Health and Social Care Committees that Number 10 was ‘moving forward’ on plans to grant relatives key worker status, so they can get regularly tested and receive PPE.

Tens of thousands of vulnerable care home residents died from coronavirus in Britain’s first wave of the pandemic in the spring. 

This was partially blamed on agency staff moving between care homes, and homes being pressured to take in elderly patients being discharged from hospital without proof they did not have Covid-19. Ms Whately said changes had been made to avoid this moving forward.  

And in a stark warning of the dangers, Ms Whately today claimed care homes could not have been protected from the disease. She argued evidence from around the world shows no country with large outbreaks has managed to protect their most vulnerable residents. 

However, workers in the care sector invited to give evidence in the same briefing this morning warned of a lack of access to PPE and speedy tests, which scientists say are crucial to containing the virus. 

Theresa Steed, the manager of Tunbridge Wells Care Centre, said she welcomed any scheme that allowed relatives to see loved ones. But she said tests are ‘only as good as the day they are issued’, and that her staff had experienced delays in test results of more than a week.  

And Jane Townson, chief executive, UK Homecare Association, said there was ‘not enough PPE supplies behind the scenes’.

Urgent calls for relatives of care home residents to be treated as key workers and be tested weekly to enable safe visits has led to the launch of a pilot scheme. The Health Minister Helen Whately, pictured today at the joint Science and Technology Committee and Health and Social Care Committee meeting, said a trial will launched ‘shortly’ 

Campaigners have been calling for a designated relative to be given ‘key worker’ status and regularly tested for the coronavirus to make visits safer (stock)

Committee chairman Jeremy Hunt questioned Ms Whately on the idea of a named ‘key worker’ relative this morning. 

She said: ‘To the point of treating a care worker as a key worker, and therefore them being trained to wear PPE and be tested, I am planning for us to launch a pilot on that shortly. 

‘I can’t give a date, but I can say we are moving forward with it and we are piloting it.’ 

Ms Whatley previously said in the House of Commons she was ‘very sympathetic to the idea of a named relative being treated as a key worker and being tested on a regular basis so they can carry on visiting a loved one’, according to Mr Hunt.

CARE HOME DEATHS WERE LINKED WITH HIGH CASES IN THE COMMUNITY

Ms Whately suggested it would not have been possible to ever save care homes from the coronavirus devastation because transmission in Britain was already high.

She said looking at countries internationally, ‘the most common factor when there have been many deaths in care homes, has been the extent of community transmission’. 

‘When you have widespread transmission in the community, it is really hard to keep it out of care homes,’ she said. 

USE OF AGENCY WORKERS WAS NOT BANNED IN FEAR OF STAFF SHORTAGES  

Mr Hunt grilled Ms Whately on why the use of agency workers was not banned in April, considering countries like Canada and Israel banned agency workers at the start of the pandemic, to which Ms Whately raised concerns of staff shortages.

She said: ‘There was a great concern if you did an outright and immediate ban, you might have care homes that simply didn’t have enough staff to look after their residents.

‘We did see early in the pandemic, I remember looking at other countries like Spain for instance which was ahead of the curve on the rates, you had people dying in care homes because staff had just walked away. And the military were finding abandoned care homes.

‘We did not want to see anybody suffer from neglect in that way. We had to make sure there was sufficient staff to look after people.’  

GUIDANCE ALWAYS SAID TO QUARANTINE DISCHARGED HOSPITAL PATIENTS TO AVOID SPREADING THE VIRUS

In March and April at least 25,000 people were discharged from NHS hospitals into care homes without getting tested for coronavirus, a report by the National Audit Office found.

This move came at the peak of the outbreak and has been blamed for ‘seeding’ Covid-19 outbreaks in the homes which later became impossible to control.

But Ms Whately claims guidance always said any elderly hospital patient discharged to a care home should have been quarantined for 14 days to avoid spread of the infection.

She said: ‘I recognised early on we didn’t have a large volume of tests available, and therefore it is true to say that people were being tested in hospital if they had symptoms, but there wasn’t blanket testing brought initially, but at that time, and it continues to be the case in fact, that anyone discharged from a hospital should be quarantine for 14 days.’

CARE HOMES DO NOT NEED TO TAKE HOSPITAL DISCHARGES IF THEY CAN’T COPE

Ms Whately said the Adult Social Care Action Plan published on April 15 said ‘someone should only be discharged to a care home if that care home felt they had the facilities in order to really effectively quarantine someone’. 

‘And if they didn’t, the local authority should step forward and provide alternative facilities using the funding available to support discharges, until that isolation period concluded’, she said.

However, care homes have repeatedly spoken of the pressure they felt to accept patients, who they often were clueless about whether they were carrying the coronavirus, regardless of if they had capacity to cope.  

Ms Whately said this should not have happened, and the Winter Plan now says there is a specific requirement to involve the local authority in the event someone is being discharged into a care home.  

‘We are also now working with CQC on actively inspecting and designate facilities that have the highest levels of infection and prevention control for people to be discharged into,’ Ms Whately said. 

Although Ms Whatley said it was important for care home residents to start seeing their families again, she is concerned of the risks. 

She said: ‘Visiting is incredibly important for residents and their families in care homes, I really want us to enable visiting but it must be safe. 

‘I think you have to recognise that should a visitor take Covid in, they are not just endangering the individual visiting, but actually it’s very hard to control Covid within a residential setting. So it’s not as simple as an agreement between resident and visitor.’

A ban on care home visits were lifted in the summer as long as infection control was in place. But there are still obstacles for families to see each other.

Theresa Steed, the manager of Tunbridge Wells Care Centre, said her home was now offering half-hour visitor slots to be booked in advance.

‘We’ve opened up and they’ve tried to book a whole week of visits, but we have to limit that because we’ve also got to try and fit other people in. And that’s hard to say to somebody you can have that one.’

She added: ‘We do Zoom, WhatsApp. But for somebody with dementia, looking at WhatsApp on a tablet, it’s like looking at a picture but it’s actually moving, but it’s not like seeing your loved one. It’s not like getting a hug, or a kiss.’     

Asked by MP for Sevenoaks, Laura Trott, if she would support a named-relative scheme, Ms Steed said she would support anything that allows visits.

However, she said: ‘That’s something I would support, but the test is only as good as the day it is issued.’

Ms Steed said her staff were being tested weekly, but she had experienced delays in getting test results returned, essentially voiding the result.

One male staff member tested positive for Covid-19 in September nine days after he had been tested. In that time, he worked in the home without showing symptoms. 

Other social care experts have shared concerns about being able to access personal protective equipment (PPE), and about the test and trace system.

If there are not enough supplies of PPE for relatives, and the testing and trace system is not working efficiently, the named-relative scheme is set to fail. 

Jane Townson, chief executive, UK Homecare Association, said: ‘Providers are unable to access the quantities [of PPE] that we are told they should be able to order through the portal, because there just aren’t enough supplies behind the scenes.

‘So that really needs to be addressed, because the PPE is, at the moment, the major additional cost apart from staffing.’

Asked if she has confidence in the Government’s test and trace system, she replied: ‘Unfortunately not.’

Kathy Roberts, chairwoman of the Care Providers Alliance, said she lacked confidence in NHS Test and Trace, adding: ‘No, I think testing has still got quite a way to go.’

The care minister was questioned during the first joint inquiry hearing into the impact of coronavirus on the social care sector, and what lessons have been learned.

In a chilling admission, Ms Whately suggested it would not have been possible to ever save care homes from the coronavirus devastation because transmission in Britain was already high.

She said looking at countries internationally, ‘the most common factor when there have been many deaths in care homes, has been the extent of community transmission’. 

‘When you have widespread transmission in the community, it is really hard to keep it out of care homes,’ she said.

She added: ‘I think that is a really important point and timely right now when there has been some debate about the level of restrictions that should be in place, and suggestions that you could essentially mothball those that are more vulnerable.

‘But what we know and other countries have seen is that but care homes are essentially part of your community.

‘It is not clear that where countries have been very strict on banning visitors, they have necessarily had fewer deaths in care homes.

‘For instance Spain introduced a very early ban on visiting but actually had a huge problem in their care comes.’ 

Moving forward into the winter, Ms Whately said that as of September, staff must now only work in one setting in an effort to reduce the spread of infection.

Agency staff who fill the gaps of staff shortages were poinpointed as a driver of Covid-19 outbreaks in care homes because they were able to take the coronavirus from one home into another.  

Ms Whately told MPs it has now been ‘mandated’ and no longer just guidance for agency staff to stick to one site.

‘We have gone from guidance position to now saying this must be the case, and this is again supported by the second round of the infection control fund recognising the extra costs,’ She told the committee.

Mr Hunt grilled Ms Whately on why this was not the case before, considering countries like Canada and Israel banned agency workers at the start of the pandemic, to which Ms Whately raised concerns of staff shortages.

She said: ‘There was a great concern if you did an outright and immediate ban, you might have care homes that simply didn’t have enough staff to look after their residents.

‘We did see early in the pandemic, I remember looking at other countries like Spain for instance which was ahead of the curve on the rates, you had people dying in care homes because staff had just walked away. And the military were finding abandoned care homes.

‘We did not want to see anybody suffer from neglect in that way. We had to make sure there was sufficient staff to look after people.’  

WHAT WENT WRONG FOR CARE HOMES? A TIMELINE OF FAILINGS

FEBRUARY – SAGE scientists warned Government ‘very early on’ about the risk to care homes

Britain’s chief scientific adviser, Sir Patrick Vallance, revealed in April that he and other senior scientists warned politicians ‘very early on’ about the risk COVID-19 posed to care homes.   

He said: ‘So very early on we looked at a number of topics, we looked at nosocomial infection very early on, that’s the spread in hospitals, and we flagged that as something that the NHS needed to think about. 

‘We flagged the fact that we thought care homes would be an important area to look at, and we flagged things like vaccine development and so on. So we try to take a longer term view of things as well as dealing with the urgent and immediate areas.’

The SAGE committee  met for the first time on January 22, suggesting ‘very early on’ in its discussions was likely the end of January or the beginning of February. 

MARCH – Hospital patients discharged to homes without tests

In March and April at least 25,000 people were discharged from NHS hospitals into care homes without getting tested for coronavirus, a report by the National Audit Office found.

This move came at the peak of the outbreak and has been blamed for ‘seeding’ Covid-19 outbreaks in the homes which later became impossible to control.

NHS England issued an order to its hospitals to free up as many beds as they could, and later sent out joint guidance with the Department of Health saying that patients did not need to be tested beforehand. 

Chair of the public accounts committee and a Labour MP in London, Meg Hillier, said: ‘Residents and staff were an afterthought yet again: out of sight and out of mind, with devastating consequences.’ 

MARCH – Public Health England advice still did not raise alarm about care home risk and allowed visits

An early key error in the handling of the crisis, social care consultant Melanie Henwood told the Mail on Sunday, was advice issued by Public Health England (PHE) on February 25 that it remained ‘very unlikely’ people in care homes would become infected as there was ‘currently no transmission of Covid-19 in the UK’.

Yet a fortnight earlier the UK Government’s Scientific Pandemic Influenza Modelling committee had concluded: ‘It is a realistic probability that there is already sustained transmission in the UK, or that it will become established in the coming weeks.’

On March 13, PHE advice for care homes changed ‘asking no one to visit who has suspected Covid-19 or is generally unwell’ – but visits were still allowed.

Three days later, Mr Johnson said: ‘Absolutely, we don’t want to see people unnecessarily visiting care homes.’

MARCH/APRIL – Testing not readily available to care home residents

In March and April coronavirus swab tests – to see who currently has the disease – were rationed and not available to all care home residents suspected of having Covid-19.

Government policy dictated that a sample of residents would be tested if one showed symptoms, then an outbreak would be declared and anyone else with symptoms presumed to be infected without a test.

The Department of Health has been in control of who gets Covid-19 tests and when, based on UK testing capacity. 

MARCH/APRIL – Bosses warned homes didn’t have enough PPE 

Care home bosses were furious in March and April – now known to have been the peak of the UK’s epidemic – that their staff didn’t have enough access to personal protective equipment such as gloves, masks and aprons.

A letter sent from the Association of Directors of Adult Social Services (Adass) to the Department of Health saw the care chiefs accuse a senior figure at the Department of overseeing a ‘shambolic response’. 

Adass said it was facing ‘confusion’ and additional work as a result of mixed messaging put out by the Government.

It said the situation around PPE, which was by then mandatory for all healthcare workers, was ‘shambolic’ and that deliveries had been ‘paltry’ or ‘haphazard’.

A shortage of PPE has been a consistent issue from staff in care homes since the pandemic began, and the union Unison revealed at the beginning of May that it had already received 3,600 reports about inadequate access to PPE from workers in the sector.

APRIL – Care home deaths left out of official fatality count

The Department of Health refused to include people who had died outside of hospitals in its official daily death count until April 29, three weeks after deaths had peaked in the UK. 

It started to include the ‘all settings’ measure from that date and added on 3,811 previously uncounted Covid-19 deaths on the first day.

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