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Manchester authority tells care homes to accept Covid patients being discharged from hospital

A Manchester authority has reportedly told care homes to accept Covid-19 patients being discharged from hospitals to free up beds when a second wave hits.

Trafford council in Greater Manchester, a coronavirus hotspot in England, says care homes will need to be prepared to take elderly people, regardless of if they are infected, because ‘hospitals need to have enough beds’.

In some cases, care homes may be expected to take patients just two hours after they are deemed ready for discharge by a hospital, even if they have tested positive for Covid-19.

In that time care home bosses will need to rapidly ensure the home has infection control in place to protect dozens of other vulnerable residents. Over-80s are most at risk of dying from the coronavirus.

The guidance is in line with that from the Government, which says ‘the care sector also plays a vital role in accepting patients as they’re discharged from hospital… some of these patients may have Covid-19’.

Experts slammed the move and said the Government had ‘not learnt its lessons’ from the peak of the pandemic, when some 15,000 care home residents died of the coronavirus.

This has partially been blamed on official guidance which said a negative Covid-19 test was not needed on discharge, effectively seeding the infection into the most vulnerable parts of society.

The Relatives & Residents association said it was ‘perverse’ allowing Covid-19 positive people to live in a care home while also banning relatives from visiting their loved ones.

The council of Trafford in Greater Manchester, a coronavirus hotspot in England, says care homes will need to be prepared to take elderly people regardless of if they are carrying the coronavirus. Picture from Channel 4 News, which saw the report

The council of Trafford in Greater Manchester, a coronavirus hotspot in England, says care homes will need to be prepared to take elderly people regardless of if they are carrying the coronavirus. Picture from Channel 4 News, which saw the report

The contract from Trafford Council was seen by Channel 4, which said the council ‘outlines how eligible care homes will receive COVID-positive patients within just two hours of the patient being identified by the hospital as ready for discharge’.

It sets out terms for the ‘Rapid Discharge’ of patients from hospital, and states that ‘some of these patients may have COVID-19, whether symptomatic or asymptomatic’.

The paper says ‘all of these patients can be cared for safely in the care home’ if it follows stringent measures.

VULNERABLE PEOPLE ‘DYING OF LONELINESS’ 

Vulnerable people living in care homes are ‘dying of loneliness,’ as they’re deprived from seeing families due to lockdown, while delays in testing have exposed ‘huge staff shortages,’ in the sector, it has been claimed.

Baroness Ros Altmann, a former Minister of State for pensions, welcomed Matt Hancock’s announcement yesterday that care home residents would receive free PPE during the winter to curb the spread of Covid-19.

The Health Secretary announced a £500million ‘infection control fund’ will help pay workers full wages when they are self-isolating and ensure carers work in only one care home, thereby reducing the risk of spreading the virus.

Mr Hancock unveiled his winter action plan, which will also include guidance on whether care homes should restrict visits from family members.

Baroness Altmann warned restrictions could put lives at risk.

Speaking on Good Morning Britain today, she said: ‘Some people in care homes are more likely to die because of loneliness from lockdown and that is a real problem.

‘Many of those people were unable to see their relatives and were desperately, desperately in need of their family visits and the family themselves needed to see the older people.

‘One has to wonder whether it’s right for the Government to say they can’t go and see their loved ones.

‘Some people died on their own, other people in care homes aren’t necessarily vulnerable, so I just wonder if depriving people of their “visitation rights” as it were, is the best way to go.

‘I hope it won’t be too draconian that therefore people in care homes aren’t just left totally isolated from their families and loved ones if they desperately need to see them.’

It is not clear who the contract was sent to, exactly, or when.

The guidance is in line with official UK Government guidance, updated on September 16.

It says care homes in England should be prepared to accept Covid-19 positive patients from hospitals as ‘part of the national effort’.

Covid-19 hospital admissions have begun creeping up again. And if they reach levels seen during the peak of the pandemic, there will be an urgency to free beds once again.

Health bosses today revealed the temporary NHS Nightingale hospital in Birmingham’s NEC arena – officially opened by Prince William via videolink during the darkest days of the outbreak in April – has been placed on standby so it can start treating patients within two to three days. 

Professor Adam Gordon, of the British Geriatrics Society, said: ‘If we see similar pressures on the hospital sector this time around then it will be commonplace under the current guidance that people who are COVID positive will be discharged back into care homes.’

The Government guidance says: ‘As part of the national effort, the care sector also plays a vital role in accepting patients as they’re discharged from hospital, because recuperation is better in non-acute settings.

‘Some of these patients may have Covid-19.’

Martin Vernon, who was the NHS England National Clinical Director for Older People from 2016 until 2019, said it was clear the Government had not learnt its lessons from the first wave of the pandemic in March and April.

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.

Mr Vernon said it’s not necessarily a bad thing that the elderly are discharged to a care home, rather than being kept in a hospital for a long period of time.

‘But it has to be done in a way that is safe and appropriate for all people,’ he told Channel 4.

‘Particularly I think the rapid discharge into care homes suggests that the earlier lessons about managed and safe discharge have not been learned at all.

‘I think the new criteria put forward by government are really not particularly well thought through.’

Helen Wildbore, who is head of the Relatives and Residents association, said the news will be ‘very concerning for people living in care and their families in what has already been a very challenging period’.

She said: ‘It raises questions not least what kind of safeguards and protections will be in place to support the person being discharged and the home to ensure that the person with Covid gets access to the right treatment and support in the home, to protect the staff at risk of catching the virus, and presumably these are homes with other residents in them.

‘So how will these homes protect other people and avoid spreading the infection around the home?’

Helen Wildbore, who is head of the Relatives and Residents association, said the news will be 'very concerning for people living in care and their families in what has already been a very challenging period' (stock photo)

Helen Wildbore, who is head of the Relatives and Residents association, said the news will be 'very concerning for people living in care and their families in what has already been a very challenging period' (stock photo)

Helen Wildbore, who is head of the Relatives and Residents association, said the news will be ‘very concerning for people living in care and their families in what has already been a very challenging period’ (stock photo)

HOSPITALS BEING WARNED TO FREE UP BEDS 

Hospitals have been warned they must clear beds and brace themselves for a rise in coronavirus patients in the next few weeks.

Covid-19 cases, hospital admissions and deaths are all on the rise, government figures revealed yesterday as more than 10 million people will soon be living under local lockdowns as the North East became the latest to impose restrictions.

Yesterday another 3,395 Covid-19 infections were recorded, meaning the rolling seven-day average number of cases has risen 2 per cent in a day and 33 per cent in a week to 3,354.

The uptick is prompting concerns the country is moving towards a second peak of the virus. MPs in London have been informed of plans to increase ‘step down’ beds in the capital, as reported by The Telegraph.

The beds will be made available to coronavirus patients who no longer need any hospital treatment, but can recover from the disease while isolating.

One MP who has seen the plans told the newspaper: ‘I was told hospitals have reserved beds for people coming out of hospital who need somewhere to re-cover.

‘At the start of lockdown they were having to send people back to care homes or back to other facilities, with dire consequences, so they’ve booked places in respite care or empty care homes, so people will go out of hospital, but won’t return to their normal place of living.’

Another source said that councils have also been asked to find extra beds.

 

Care homes across England have been tightening rules on visitors since they re-opened temporarily in the summer because of the recent uptick in coronavirus infections.

A worker at a national care home provider, who asked to remain anonymous, said there was ‘pressure’ from local authorities to take patients, including those carrying the virus, despite guidance suggesting no care home will be forced to do so.

‘They are aiming now for patients to be out of hospital into a care home within a few hours from the decision to discharge them. That process used to take about a week.

‘We have contracts with local authorities for block beds and you have to have a very good reason to reject a referral.’

The source said the care home sector was ‘relying on the testing system to help keep our residents and staff safe’.

However, testing in the UK has spiralled into chaos this past week, with shortages blocking thousands from getting a test.

Yesterday testing tsar Baroness Dido Harding said the number of people calling 119 or visiting the website to try to book tests was ‘three to four times the number of tests that we currently have available’ – although that would involve some double counting.

Baroness Harding – head of NHS Test and Trace – acknowledged that demand was significantly outstripping capacity as pressure continued to mount on the Government over the chaos in the testing system.

Care home and the NHS will be the top of the priority list for testing, drawn up by the Government and expected to be unveiled imminently.  

But the insider said current problems with testing in the UK meant care homes could not know whether the virus was circulating in the home after accepting Covid-19 positive patients.

‘When you’re bringing Covid positive patients into a care home many will die. We have strong procedures to prevent the spread, but this virus is extremely contagious,’ they said. 

It comes after the Health Secretary yesterday unveiled his winter action plan, including a £500million ‘infection control fund’.

It will help pay workers full wages when they are self-isolating and ensure carers work in only one care home, thus preventing spread of the coronavirus.  

A spokesperson for Trafford Council said: ‘The discharge of patients from hospital is a carefully co-ordinated process in line with national government guidance.

‘At all times, the health and wellbeing of the person being discharged is our primary concern and, if they are discharged to a care home, we make sure it is one that meets their health and social care needs.

‘We appreciate that there is a quick turnaround but our contracts reflect the national requirements to ensure people are discharged safely and quickly. The alternative to doing this would be to leave the person in hospital. This would mean that the person’s recovery may take longer in an inappropriate setting, leaving them at higher risk of infection while also preventing seriously ill people being admitted to hospital to receive critical care when they need it.

‘It is also in the contract that care homes have the right to refuse to accept a patient – and no patient is transferred to a care home without discussion and agreement of the care home. It would be totally against our values simply to turn up at a care home without the care home’s prior agreement. It would also be against the interests of both the care home and the person.

‘It is also important to note that we insisted from the start of the pandemic that any patients ready for discharge were tested for coronavirus beforehand to reduce the risk of infection within the community.

‘The care homes in Trafford who provide the Rapid Discharge to Assess service have been extremely supportive throughout this pandemic and we are very proud to be working alongside them to ensure our residents are well looked after at all times.’

A Department of Health and Social Care spokesperson said: ‘Our priority is to ensure that people are discharged safely from hospital to the most appropriate place, and that they continue to receive the care and support they need.

‘No care home will be forced to admit an existing or new resident to the care home if they do not feel they can provide the appropriate care.’

‘Today we announced over half a billion pounds extra funding for care providers to reduce Covid-19 transmission and help protect residents and staff throughout winter.’

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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