A damaging blame game will not help us learn the lessons we need to from the coronavirus pandemic

We may never now how many patients were discharged from hospitals to care homes before routine testing was available – but trusts tell us it was the vast majority

Saffron Cordery
Friday 05 June 2020 16:45
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Hospitals are being forced to re-design care in the wake of the coronavirus outbreak
Hospitals are being forced to re-design care in the wake of the coronavirus outbreak

There is a long way to go with coronavirus. With no proven treatments, no vaccine, and the real risk of a second surge in cases, we can not say with any certainty how many more lives will be lost, and where.

It’s right that we focus on the future, to prevent transmission and minimise the deadly impact of Covid-19, while moving cautiously towards a new normal.

That means taking a clear-sighted view of what’s happened so far, learning the right lessons in a spirit of openness and honesty rather than buck passing and recrimination.

One of the key areas of concern – and understandable anger - is the high number of Covid-related deaths in social care settings. It will be for a future public inquiry to examine in detail why this happened and who, if anyone, is to blame.

What we need to avoid now is a damaging, divisive and misleading blame game. Unfortunately that is exactly what we are seeing, with the suggestion that in the weeks the virus took hold NHS trusts knowingly and systematically transferred the risk by discharging Covid positive patients into care homes.

There’s an obvious temptation here to put two and two together to make five. On 17 March trusts were told to urgently discharge all medically fit patients as soon as it was clinically safe to do so. But it wasn’t until 15 April that the government said they would need to test every patient prior to discharge.

We know that during this period more than 25,000 patients were discharged into care homes. No one is disputing that. But some are saying, implying or suggesting that, because the formal requirement to test prior to discharge was only announced in mid-April, no patients discharged before that date (ie all 25,000) were tested.

That is factually incorrect and it’s a complete travesty because trusts tell us that they tried to ensure that every patient was tested prior to discharge in the mid March to mid April period, well before the formal requirement to test was introduced.

Nobody knows how many discharged patients were transferred without being tested in this period – we’re not sure we ever will know - but trusts tell us the vast majority were tested. There is no evidence anywhere to indicate that all 25,000 patients discharged between mid March and mid April were discharged without being tested - is true.

The further implication is that these discharges were the main or principal reason for the level of care home deaths.

There are a number of possible factors here including access to personal protective equipment (PPE) and testing in care homes, and the challenges they face in infection control and workforce shortages that led to agency staff working across a number of homes. Again, it is impossible to know the balance of the factors here.

The reality is that working in close partnership with local authorities and care homes, and in accordance with the guidance, trusts took a range of steps with known and suspected covid patients to minimise the risk of transmission. These included 14-day isolation in hospital, transfer to community hospitals as an intermediary step or supporting their return home with a care package.

They only discharged known or suspected covid patients to care homes when those homes agreed they had the capacity to treat or isolate them

Trusts acknowledge there may have been a small number of asymptomatic patients discharged after the instruction to discharge medically fit patients on 17 March, but this was quickly identified as an issue and appropriate arrangements put in place.

So there’s no evidence that the NHS systematically and knowingly transferred the covid risk to care homes and that this was the main or principal driver of care home mortality.

The suggestion is damaging and misleading, and detracts attention from the fundamental neglect of social care by successive governments that made the sector so vulnerable.

Saffron Cordery is deputy chief executive of NHS Providers

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