United Kingdom

Up to two thirds of elderly were discharged from hospitals to care homes without a Covid-19 test

Up to two thirds of elderly patients discharged from hospitals into a care home at the height of the pandemic were not tested for Covid-19, it was claimed today.

NHS England data shows at least 25,000 patients were moved from hospitals to care homes between March 17 and April 15. 

But 16,000 weren't tested to ensure they were coronavirus-free before being moved in with other elderly and vulnerable people, The Times reports.

Until April 15, the government said testing was only a requirement if patients being discharged had obvious symptoms.

The controversial guidance has been partly blamed for the severity of Covid-19 in care homes, where around 20,000 people have died. 

Sir Ed Davey, acting leader of the Lib Dems, said today's figures 'confirms our worst fears', adding that the UK had 'one of the worst care home crises in the world'. 

Up to two thirds of elderly patients discharged from a hospital into a care home at the height of the pandemic were not tested for Covid-19 (Stock)

The figures come from a freedom of information request (FOI) sent by The Times to 155 NHS trusts in the UK.

Fifty answered the FOI and revealed 4,300 patients weren't Covid-19 tested between March 17 — when hospitals were told to free up beds — and April 15.  

The 4,300 were two-thirds of all patients discharged. Another 759 swabbed positive and 1,548 received a negative result.

If applied to all 155 NHS trusts, it would suggest around 13,330 went untested when they were discharged during this crucial period.

But separate NHS England statistics show at least 25,000 patients were moved from hospitals to care homes between March 17 and April 15.

Using that data, it would suggest around 16,000 patients weren't tested for Covid-19 when they were discharged from hospitals. 

CARE HOMES 20 TIMES MORE LIKELY TO HAVE A CORONAVIRUS OUTBREAK 

Coronavirus outbreaks are up to 20 times more likely to occur in large care homes, according to the biggest study of its kind in the UK.

Researchers analysed 189 care homes in the NHS Lothian area in Scotland where more than 400 people died from the disease in total.

The data — not yet published — found the chance of clusters of cases tripled with every additional 20 beds. 

Edinburgh University researchers found the risk of an outbreak was as low as 5 per cent in homes with fewer than 20 residents.

But for facilities home to more than 60 elderly people it soared to between 83 and 100 per cent, according to the scientists.

More visitors and a revolving door of care staff, often agency workers who do shifts at other homes, are thought to be the driving factor behind the increased risk.

The research is thought to be the broadest analysis yet of coronavirus cases in care homes in the UK. 

But the figure could be lower or higher because there is no official national data to show the scale of the problem.  

Liz Kendall, Labour's shadow minister for social care, said the figures proved care homes were 'an afterthought' during the pandemic. 

'Rigorous testing on discharge and sufficient supplies of PPE came too late to stem the spread of the virus through care homes,' she said.

Martin Green, chief executive of Care England, said that 'unfortunately the focus on the NHS was to the detriment of the adult social care sector'. 

There have been accusations the NHS was prioritised over care homes in terms of protecting it from being overwhelmed.

In May, Health Secretary Matt Hancock claimed Government had thrown a 'protective ring' around care homes 'from the start' - which has rattled chiefs in the care home sector. 

The figures show some places in the UK discharged more untested elderly people than others.

For example, North Lincolnshire and Goole NHS Foundation Trust discharged 370 untested patients to care homes.

But all patients from several trusts in the Midlands, Harlow and elsewhere were tested.

It is not clear why these differences exist, but it is possible those trusts took it upon themselves to test all patients if they had the capacity to. 

Northern Lincolnshire and Goole NHS Foundation Trust said it had 'followed government guidance on testing'. 

The same response was given by The North Bristol NHS trust, when an investigation last week revealed one Bristol hospital, Southmead Hospital, transferred 213 untested patients into care homes in March and April without checking whether or not they were infected. 

However, the the trust's chief operating officer Evelyn Barkerthat added that the hospital 'only ever discharged people when our doctors believed it was safe'. 

Official guidance issued by NHS England and the Department of Health said: 'Negative tests are not required prior to transfers/admissions into the care home.'

This was in place until April 15, when new NHS England guidance that came into effect on April 16 required hospitals to test patients being discharged into care homes.

But the 'peak' of the virus had already passed — infections were at their highest in the last week of March, and deaths in the second week of April, official figures show.

The move has been blamed for 'seeding' Covid-19 outbreaks in the homes which later became impossible to control. 

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.' 

Care home managers also complained that they had been 'pressured' into taking the patients, and families said their loved ones had been moved out of hospital like 'sacrificial lambs'.  

It has since become clear that patients without symptoms of the virus (asymptomatic) are able to spread the infection to others.

And elderly people are more likely to show atypical signs of the virus without the usual cough and fever, including delirium and diarrhoea.  

It comes after Care England, which represents 4,000 providers, warned Boris Johnson must carry out his promise to fix the care crisis to prevent thousands of vulnerable residents being placed in danger.

In its letter, Care England states: 'With a second wave on the horizon, it is imperative that the Government fixes the stark social care crisis now.

'With such a large majority in Parliament, now is the time to put an end to all the past inertia and make changes.

A spokeswoman for the Department of Health and Social Care said: 'At every stage we have been guided by the latest scientific advice, and on March 13 care homes received advice, setting out actions around infection control and isolating residents or staff displaying symptoms.'

She added: 'Regular testing for staff and residents has now begun starting with homes for the over 65s and those with dementia before extending to all adult care homes.'

Saffron Cordery, deputy chief executive of NHS Providers, which represents NHS trusts, said that 'trust leaders have consistently adhered to public health guidance' and added that 'a public inquiry will be required to establish the reasons behind the number of deaths in care homes during the pandemic'. 

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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