Our recent blogs have consistently focused on this developing saga as COVID-19 continues and as we as a nation compare ourselves to our counterparts, we are increasingly coming up short. There is a stark message coming through that our most vulnerable have been forgotten: the elderly in care homes, the detained in mental health units and those with learning disabilities.
In response to the COVID-19 pandemic, the Care Quality Commission (CQC) established the Emergency Support Framework (ESF) to ensure the CQC could continue to practice its regulatory function in maintaining safety across health and social care settings. Although all routine inspections are currently on hold, the CQC aims to use the ESF for the purpose of collating information and intelligence from a number of sources to assist the CQC with issues such as monitoring risk, identifying where support is required and delivering safe care.
Despite early Government promises to the contrary, it always seemed obvious that the pandemic would hit care homes (residents, relatives and staff) with some force. A letter dated 22 May 2020 from the Relatives and Residents’ Association (RRA) to the CQC makes very clear the views of the RRA, who accuse the CQC of failing to protect care homes.
The RRA letter describes the following failings on the part of the CQC, and demands action :-
- Inadequate provision of data on care home deaths to the Government. Failing to do so resulted in the Government having inaccurate data and under-estimating the seriousness of the situation.
- Showing a lack of urgency, and instead complacency. For example, the CQC did nothing to rebut the early statement from Public Health England that it was “very unlikely” that care homes would be affected by the pandemic.
- Failing to represent the needs of care homes for PPE, testing and tracing.
- Providing guidance for care homes (the “Emergency Framework) only on 1 May, over six weeks after lockdown was announced, and even then, providing no guidance for care homes on how to deal with anxious families.
- Allowing standards to fall due to the decision to suspend inspections of care homes from 16 March 2020. (The CQC have said they would still arrange an inspection wherever they are aware of “significant risks” such as allegations of abuse, but otherwise, any monitoring is being carried out remotely. We understand that approximately 2000 checks of care homes have not been carried out in the last two months that otherwise would have been.)
As part of the guidance from the British Geriatrics Society in relation to managing patients with or suspected to have COVID -19 in a care home setting, care home staff should be trained to check the temperature of residents displaying possible signs of COVID-19 using a tympanic thermometer. The guidance states that care home staff, where possible, should also be trained to measure other vital signs including blood pressure, heart rate, pulse oximetry and respiratory rate. This information can then be used by external healthcare practitioners such as GPs during virtual ward rounds and will help to triage and prioritise support of the care home residents and their care staff according to patient need.
During yesterday’s daily Downing Street briefing, Matt Hancock was asked by the BBC about his party’s election manifesto promises concerning social care reform.
Prior to the December general election, the Conservative party manifesto promised to reform social care. Matt Hancock was asked at the briefing yesterday by the BBC whether the government was still planning a cap on care fees that have to be met directly, and whether he accepted that social care reform could not be put off again.
On 20 May 2020, the CQC published its first COVID-19 Insight document, said to be the first of its regular discussion documents on key issues affecting health and care.
The full document can be found here.
In the last few weeks, the COVID-19 related issues concerning care homes have become increasingly more apparent and a light has been shone on the pressures homes have faced. There has been suggestion that care providers have somewhat been missed by the Government, in respect of PPE, testing of staff and residents, or those returning from hospital. Sadly, since the beginning of April, the number of COVID-19 related deaths which took place in homes among residents overtook the number of care home resident deaths within hospitals. Many have suggested the main factor in respect of this has been the lack of testing of those with COVID-19 symptoms, when they have been returning to their care homes, having been receiving treatment externally.
Release of online portal
Within some of our more recent blog posts, we have commented upon the crisis of COVID-19 deaths within care homes, together with the growing concern that the official figures for the number of these deaths could be a lot higher than that reported.
In response to this crisis, on the 28 April, the Government announced that testing would be prioritised and expanded in the care sector, to include both symptomatic and asymptomatic care home staff and residents. As a result, all care home staff and residents are now eligible for testing with priority for those in homes that look after the over-65s. To aid this additional testing, an online portal has now been released within care homes, enabling care homes to arrange deliveries of COVID-19 tests.
The COVID-19 pandemic has shone a light on the resourcing of care homes that is long overdue.
Following exchanges in the commons and a study by LSE it appears that 22,000 care home residents have died in England and Wales to date as a result of COVID-19 but statistics will no doubt continue to be debated with the lack of testing being a stumbling block for absolute clarity.
Following the Prime Minister’s address on Sunday 10 May, detailed guidance has been published today on the Government’s Covid-19 recovery strategy, which includes a fresh emphasis on the importance and needs of the social care sector.
Particular emphasis is given to the NHS and capacity and how to protect care homes. In particular, given the widely reported problems with the supply of PPE, the guidance sets out a specific strategy for PPE, including increased domestic manufacturing capability and more robust supply lines.
The Government also commits to bolstering and investing in the social care sector, recognising that an efficient social care sector will free up pressure on the NHS, as patients can be discharged from NHS care more efficiently to care and nursing homes.