Government rejected radical lockdown of England's care homes

Public health officials proposed a radical lockdown of care homes last month to stem surging coronavirus deaths, including staff moving in for four weeks and deploying NHS Nightingale hospitals – but it was rejected by the government, the Guardian has learned.

An 11-point plan proposing “a further lockdown of care homes” was submitted to Downing Street on 28 April by officials at Public Health England (PHE), as fatalities peaked in care homes and the virus spread to half of homes in the worst-affected areas.

They urged ministers to “use NHS facilities and other temporary accommodation to quarantine and isolate residents”, and to “consider whether staff can move into the care home for the next four weeks”.

But neither of the proposals, recommended as “high impact”, were included in a subsequent action plan on infection control announced by the health secretary, Matt Hancock, last week.

Some 16,000 care home residents are confirmed or suspected to have died from Covid-19, according to official UK figures, amid outbreaks in 38% of homes in England and 59% of those in Scotland.

default

Care homes have faced a triple threat of virus spread which the measures sought to address: Covid-19-positive discharges from hospitals; staff coming and going from the wider community and between care homes; and building layouts designed to encourage socialising not isolation.

Staff in a few care homes have moved in on a voluntary basis – one dementia home in Sheffield made the decision in March – and successfully protected residents, reducing the risk of transmission through care workers coming in and out on shifts who may be carrying the virus asymptomatically.

This measure was recommended as “high impact” by the PHE officials but the government decided that not all care homes had the facilities to offer suitable accommodation to staff who wanted to stay on site.

While some care providers had reservations about its feasibility, one care industry source said: “If there was 24-hour pay, you would have had a flood of applications.”

Care staff have been working round the clock to try to help elderly residents who have been dying in far higher numbers than usual, even when their deaths are not attributed to Covid-19.

(February 25, 2020)

Public Health England issues guidance stating that it was “very unlikely” care homes would become infected. The guidance was not withdrawn until 12 March.

(March 31, 2020)

Despite a lack of official statistics about fatalities, care homes warn that they are at “breaking point” and MHA, the country’s biggest charitable provider, says it has suspected cases in more than half of its facilities.

(April 2, 2020)

The Department of Health and Social are guidelines on discharging hospital patients into care homes states: “Negative tests are not required prior to transfers/admissions into the care home.”

(April 14, 2020)

Chief medical adviser Chris Whitty says that more than one in ten care homes (13.5%) now has at least one case of Covid-19. Whitty says: “Care homes are one of the areas where there are large numbers of vulnerable people and that is an area of risk and therefore we would very much like to have much more extensive testing.”

(April 15, 2020)

Testing is expanded into care homes but only for people with symptoms.

(April 21, 2020)

Five of the largest care home providers say they have now recorded a total of at least 1,052 deaths

(April 28, 2020)

Care home deaths are included alongside deaths in hospitals after a sharp rise of more than 4,300 deaths over a fortnight in England and Wales. Testing is extended to staff and residents without symptoms.

(May 3, 2020)

Launch of a national delivery system for personal protective equipment to care homes is hit by a delay of up to three weeks

(May 13, 2020)

Academics report that more than 22,000 care home residents in England and Wales may have died as a direct or indirect result of Covid-19 – more than double the number stated in official figures.

In England, Wales and Scotland, 12,597 more people died in care homes during the pandemic than the five-year average, bringing the number of excess deaths in care homes to 27,591 – more than half all excess mortality, according to a study released on Thursday by academics at the London School of Economics.

The government decided against the live-in plan and issued guidance last week to care operators on infection control that said only staff “who proactively choose it should be offered accommodation on site or in hotels”.

Rather than the recommendation to “require care home workers to isolate to reduce risk of picking up Covid-19”, possibly with higher pay, the government has told operators to help staff “minimise risk of picking up Covid-19 outside of work”.

PHE’s proposal to “use NHS facilities and other temporary accommodation to quarantine and isolate residents before returning to their care home” was also declined.

It suggested “use [of] the facilities available in the NHS where capacity exists”, making reference to the NHS Nightingale hospitals that were built with military help at the start of the crisis but which have been barely used.

But officials concluded many of the Nightingale sites were not suitable for providing care to elderly people and ministers told councils to “ensure that there is sufficient alternative accommodation as required to quarantine and isolate residents”.

Piecemeal attempts to do that have run into some problems. For example, efforts by Somerset county council to create a “pop-up” home in Yeovil to house infected care residents was delayed for weeks because commercial insurers declined to underwrite the risk.

The Guardian has revealed that outbreaks in care homes in London from 11-13 April were confirmed to have been spread by temporary staff moving from home to home, but results from the PHE study were not revealed until last week.

Another of the recommendations was to “stop staff from Covid-19 positive homes being rotated to those who are Covid-19 free”. The health officials argued this was already happening in NHS hospitals but could be extended to social care and agency staff, and while it might cost more in wages to maintain staffing levels it would be “very high impact”.

The government’s later guidance was that “subject to maintaining safe staffing levels, providers should employ staff to work at a single location”.

A spokesperson for the Department of Health and Social Care said: “We have worked tirelessly with care homes to reduce transmission and save lives, and almost two-thirds have had no outbreaks at all [62% in England to 11 May].

“We announced £600m to help tackle the spread of coronavirus, including by limiting staff movement between care homes, as well as £1.3bn to cover alternative accommodation to isolate residents. We are also testing all care workers and residents, regardless of symptoms, and delivering millions of items of PPE to the frontline.”