Hospitals may have broken the law by sending patients with Covid-19 back to care homes without telling their managers they had the virus.
The Care Quality Commission (CQC) has been told that several hospitals returned people despite suspecting – or even knowing – they were infected.
Tragically, these patients triggered outbreaks in the homes, claiming the lives of other vulnerable residents. Staff at the care homes would have not realised they had the virus so may not have been wearing adequate protective clothing or taken other infection control precautions.
The CQC is investigating several cases after being informed by care home managers that hospitals discharged patients into their premises without telling them they had the disease.
Kate Terroni, the watchdog’s chief inspector of adult social care, said: ‘We have heard of a few incidents where this has happened and it has resulted in infections spreading to other residents in the care home.
Hospitals may have broken the law by sending patients with Covid-19 back to care homes without telling their managers they had the virus.
‘In cases where it looks like the information wasn’t disclosed by the hospital, we are looking at whether the hospital breached their regulations and whether we can take action. It’s an issue we take really seriously.’
The CQC enforces a series of regulations, enshrined in law, that health and adult social care services in England must comply with. Breaching some of these rules is a criminal offence and the watchdog can bring prosecutions.
The CQC is also investigating whether care home residents have died from noncoronavirus conditions due to a lack of visits from GPs.
The latest figures from the Office for National Statistics (ONS) show that the current death rate in care homes is four times higher than the five year average, and only a third are directly linked to the virus.
The watchdog’s warnings come after Boris Johnson admitted he ‘deeply’ regretted the situation in care homes, which experts say have become the new epicentre of the virus.
Latest ONS figures show care home deaths increased by 36 per cent in a week – as hospital deaths started to fall. There have been 5,890 coronavirus deaths registered in care homes in England and Wales so far, including 2,794 in the week to April 24, the most recent figures available.
They are likely to be an underestimate as GPs do not always record coronavirus on death certificates, especially if residents have not been tested. The CQC would not disclose the names nor the locations of those hospitals accused of failing to inform care home staff that patients had coronavirus.
But last month whistleblowers in Manchester said they knew of patients being discharged from hospitals into homes after testing positive without doctors or nurses disclosing their condition.
‘It’s really important for other residents of the care home, it’s really important for social care staff, that they have the information to keep people safe and knowing whether someone has Covid or not is a key bit of information.
‘We know that it led to the spread of infection within the [particular] home. We’re working to understand what the impact was.’
Hospitals could particularly be in breach of the watchdog’s Regulation 9, which requires providers to ensure patients receive ‘appropriate person-centred care and treatment that is based on an assessment of their needs and preferences’.
Failure to comply is not a crime, but the CQC can use its civil powers to bring enforcement action and impose conditions on the provider, or suspend or cancel their registration.
Hospitals have been under pressure to free up beds since the start of the coronavirus outbreak in anticipation of a surge of very sick patients.
They were given specific guidance from NHS England on March 7 to ‘urgently’ make available 15,000 beds nationally by discharging anyone who was medically fit to leave.
Some experts are concerned this led to hospitals sending patients into care homes without testing them for the virus, even if staff suspected they had symptoms. The Department of Health issued separate guidance on April 2 that negative tests were ‘not required’ before discharging people into a care home.
This document was signed jointly by the CQC, the NHS and Public Health England. Miss Terroni, who has worked in social care for 20 years, said some care providers have a quarter of staff off sick.
Others are still struggling to source personal protective equipment (PPE), with some managers paying ten times the usual cost as suppliers put up prices.
‘Some providers are telling us they don’t have enough PPE and where that happens we are escalating it to get that resolved as soon as possible,’ she said.
She warned that some homes fear they will go out of business due to soaring PPE bills and the cost of agency staff to cover sickness.
Miss Terroni stressed that the CQC has done a huge amount to help homes source PPE, access tests and help care workers get priority online delivery slots at supermarkets so they can obtain enough food for residents.
While vulnerable groups and NHS employees get these slots already, social care workers are excluded.
Care home outbreaks ‘leaking’ out to public
Coronavirus outbreaks in care homes are now ‘leaking’ back into the community and driving the epidemic, Government advisers have said.
Experts say widespread cases in care homes are pushing up the UK’s average transmission rate and are providing one of the biggest barriers to lifting the lockdown.
The stark warning highlights how the failure to protect Britain’s care homes from the virus has not only cost the lives of thousands of elderly residents, but has also had devastating consequences for the entire population.
Senior officials warned yesterday that levels of coronavirus infection are likely to be at least five times higher among hospital and care home staff than in the wider population.
They are ‘particularly worried’ about healthcare workers picking up the disease and spreading it among the wider community or to other patients. Ministers have been told they need to ‘get on top’ of this urgently before the lockdown can be lifted.
Scientific advisers are calling for basic steps to be taken to reduce the spread of the virus from care homes. This could include banning carers from visiting multiple care facilities and making sure cases are properly isolated.
Care home bosses have accused the Government of neglecting elderly residents and failing to produce an adequate strategy to prevent the virus taking hold. Figures from the Office for National Statistics (ONS) show that more than a quarter of coronavirus deaths in England and Wales have occurred in care homes.
Latest estimates from the Scientific Advisory Group for Emergencies (SAGE) put the R value – showing the average number of new cases resulting from one infected person – at between 0.5 and 0.9. Sir Ian Diamond, head of the ONS, said on Thursday that the R number has probably gone up in the past fortnight, adding: ‘That is driven by the epidemic in care homes.’
Another leading official said yesterday that the failure to get the virus under control in care settings means that the virus is ‘leaking’ back into the community.
They added: ‘We are particularly worried about people who work in health and caresettings getting infected then going home and driving parts of the wider community epidemic.’
Initial data from a sampling survey by the ONS suggests that around 200,000 people – 0.3 per cent of the population – are infected with the virus. Experts say that this is significantly lower than at the peak of the epidemic, but add that it shows there are still likely to be around 20,000 new cases a day.
Meanwhile, survey results from blood tests which detect antibodies, showing whether people have had the virus, suggest that around 4 per cent of the population has been infected with coronavirus at some point.
Is lack of GP visits costing more lives?
Care home residents may be dying from conditions unrelated to coronavirus due to a lack of GP visits, the care watchdog’s chief inspector has warned.
Kate Terroni said she was ‘very concerned’ about a huge rise in non-Covid related deaths, which may have resulted from residents ‘not getting the medical attention they need’.
Latest figures from the Office for National Statistics show the weekly number of deaths in homes is nearly four times higher than the five-year average – but only around a third are Covid-related.
The Care Quality Commission, along with the ONS and NHS England, is investigating why these residents may have died. Ms Terroni said some care homes had reported the cover from GPs had been ‘reduced’ since the start of the outbreak.
She said: ‘An obvious explanation is that people who would normally be dying in hospital are dying in care homes. However, we’re also concerned that in some cases people may not be getting the medical attention they need.’
GPs would normally visit homes if a resident is unwell and some carry out routine check-ups once or twice a month. But Care England, the leading representative body for homes, has claimed some family doctors have refused to attend homes since the outbreak started.
One explanation is that GPs are overworked trying to assess patients with coronavirus, while others might have been diverted to look after patients with complex health needs who were discharged from hospital earlier than normal as part of an NHS drive to free up beds.
The ONS figures show there were 7,911 deaths in homes for the week to April 24, compared to a fiveyear average of just 2,070 for that week.
Only 2,794 of those deaths were Covid-related, though this is likely to be an underestimate as not all patients were tested.
200 key health care workers have died
At least 200 frontline health workers are thought to have lost their lives to coronavirus. The tragic milestone came as the country’s overall death toll yesterday passed 31,000.
NHS staff and care workers have cited a lack of personal protective equipment and failures on testing as the biggest factors leading to the figures.
Among the dead are at least seven nurses and care workers who were in their 20s – including Mary Agyapong, 28, who was heavily pregnant – and at least eight NHS hospital consultants.
The toll includes nurses, doctors, paramedics and care home workers as well as in-house hospital pharmacists, porters, cleaners and patient drivers.
On Thursday, the Office for National Statistics revealed that black men and women are almost twice as likely to die from coronavirus than white people in England and Wales.
People from Indian, Bangladeshi and Pakistani communities also have a significantly higher risk of dying. The vast majority of frontline health workers who have died are from a black, Asian and minority ethnic (Bame) background.
Yesterday, more than 70 leading British Bame figures, along with the GMB union, called for an independent public inquiry into the disproportionate amount of BAME deaths.
Commenting on the toll, Dame Donna Kinnair, of the Royal College of Nursing, called on the Government to publish full, accurate reports of all health and care worker victims, adding: ‘We cannot wait for the data to catch up while people are dying.’
The 200 milestone was revealed by nurse-run website Nursing Notes. Meanwhile the Daily Mail has independently confirmed the deaths of 185 frontline health and care workers.