NHS trusts deny discharging Covid-19 patients into care homes

19 May 2020, 10:30

Care worker visiting a UK residents home
Care worker visiting a UK residents home. Picture: Getty
Nick Hardinges

By Nick Hardinges

Any suggestion that NHS trusts knowingly discharged Covid-19 patients into care homes to free up beds is "damaging and mistaken", according to a report.

Trust leaders dismissed the idea that they systematically moved people into care homes and "strongly refuted" suggestions that their actions have led to excess mortality in care homes.

They told NHS Providers they repeatedly followed government advice and would only let a known or suspected coronavirus patient go back into a care home if it had the capacity to safely look after them.

On 17 March, NHS England and Improvements told trusts to urgently discharge all medically-fit patients from hospital as soon as it was clinically safe to do so.

By 2 April, the Department for Health and Social Care (DHSC) said some patients may be symptomatic or asymptomatic but could be safely admitted into care homes.

It also said that negative tests were not required prior to transfer.

However, it was not until 15 April that trusts were instructed to test every single person prior to being discharged into a care home.

Although trust leaders recognised that a small number of asymptomatic patients may have been transferred into nursing homes, they said this would not have happened knowingly and on purpose.

NHS Providers believes that the "substantial majority" of trusts agreed to new discharge arrangements with care sector partners, which went above and beyond the advice at the time.

After quickly becoming aware of this risk, and within days of the 17 March guidance, trust leaders said they had agreed to test all discharges and for those awaiting test results to be isolated using the options available for people with confirmed or suspected Covid-19.

The report said: "It is impossible to tell at this point how much of an impact this has had, but trust leaders are clear that any such discharges were unwitting and in line with the national guidance at the time."

It added: "There were, and still are, some places where trusts have been discharging confirmed and suspected Covid-19 patients into care homes, but this is on a planned and agreed basis and our understanding is that the numbers of these discharges are small."

Between February and mid-April, care homes were a "minority destination", with around three in 20 patients discharged to a care home from a hospital, according to data referred to by NHS England and Improvement and the DHSC.

NHS Providers acknowledged it cannot verify every discharge across all 217 trusts and that there have been reports of some care homes being pressured to accept patients.

But based on its conversations with NHS leaders, it believes that trusts have not systematically and regularly discharged confirmed or suspected coronavirus patients into care homes

Deputy chief executive Saffron Cordery said the NHS has done "everything it can" to support the care sector, and will continue doing so.

She said: "It is a damaging and mistaken belief that trusts knowingly and systematically discharged Covid-19 patients into care homes.

"Health and care staff are doing their absolute best in incredibly challenging circumstances with the resources available at the time, so the blame game must stop.

"It will be for a public inquiry to establish why mortality in care homes has run so high.

"But we can see that the failures of testing to date and the supply of PPE have hit the care sector particularly hard and remain problematic.

"We also note the care sector's view that the government didn't focus on its concerns sufficiently or soon enough, and that additional funding is taking too long to get to the frontline.

"Beyond that, it has long been clear that the sector has suffered from years of under-investment despite repeated government promises to resolve the crisis in social care."

The report highlighted examples of NHS trusts supporting care providers with personal protective equipment, opening up their lab testing capacity and redeploying staff.

It also noted that the failure to act on repeated promises from governments to resolve the social care crisis has had "devastating consequences" during the pandemic.

Any future public inquiry should consider whether the government gave enough priority and support to the care sector at the right time, it added.

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