On Monday 13 July 2020 Scottish Government reported that no COVID-19 (C-19) deaths had been registered in Scotland on any of the five preceding days. However – on the same day – Scottish Government also reported that public health teams were investigating after seven new cases of coronavirus – picked up by routine testing – had been traced to a single care home in the greater Glasgow area. All seven people who tested positive were asymptomatic at the point of testing.
On 10 June 2020, the Court of Appeal handed down its judgment on the case of Maguire v Her Majesty’s Senior Coroner for Blackpool and Fylde and ors. This landmark judgment considered the engagement of Article 2 of the European Convention on Human Rights (ECHR) in the context of inquests relating to vulnerable adults who lack capacity living in state-funded care homes.
The deceased, known as Jackie, had learning disabilities, behavioural difficulties and some physical limitations. She lived in a care home supervised and funded by the local authority which provided accommodation and care for vulnerable adults, like Jackie, who lacked capacity to make decisions about their living arrangements and welfare. Jackie was subject to Deprivation of Liberty Safeguards (DoLS) and had a history of objecting to medical treatment.
Jackie died in hospital on 22 February 2017. The cause of death was 1) perforated gastric ulcer and peritonitis and 2) pneumonia. A number of failures by care staff and medical professionals were identified and investigated during the inquest. Jackie’s family were critical of actions taken during the 48 hours prior to her death including:
- the GP’s decision to triage Jackie by telephone instead of attending in person
- a failure by an NHS call handler to relay a full account of Jackie’s history to the paramedics and
- the absence of a care plan to address Jackie’s refusal to attend the hospital.
There has been no shortage of commentary on the challenges facing care homes during the pandemic, from the number of infections and fatalities to the risk of further waves and lack of testing and PPE, along with the loss of income due to lower occupancy and reduced staff levels and reputational implications. There is speculation that some 25% of care homes may go out of business.
However, whilst these matters are real threats to businesses in the care sector, there are nevertheless some things that are well worth you considering as part of your plan for sustainable growth for a viable care business. The following are just some examples.
At the government’s daily COVID-19 briefing yesterday, the Health Secretary Matt Hancock announced a further expansion of its testing programme for COVID-19 in care settings. Previously the focus had been on care homes providing care for over 65s and for those with dementia. Testing will now be available for all residents and staff in England whether or not they have symptoms of COVID-19. Testing will also be extended to under 65s and to encompass for example adults with a learning disability or with mental health problems.
In the past few months, one of the dominant news stories has been that of the effect of the COVID-19 pandemic on the social care sector. This has mostly focused upon the issues surrounding elderly care.
However, the Care Quality Commission (CQC) has this week published an analysis regarding deaths of persons with a learning disability and/or autism. The analysis is based upon notifications from providers registered with the CQC where the death certificate indicates the deceased had a learning disability. This shows in the period 10 April to 15 May there was a 134% increase in deaths in comparison to the same period in 2019.
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.
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.
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.