The need to make additional plans for care homes was raised in a discussion of the New and Emerging Respiratory Virus Threats Advisory Group (Nervtag), which advises the government on pandemics. Minutes from June 2017 setting out “lessons learned” from Operation Cygnus, a major cross-government test of its ability to handle a severe pandemic, list four “key issues”, including: “The need to strengthen the surge capability and capacity in operational resources in certain areas. If demand outstrips local supply, there will be a need to scale up the response, for example to regional level. This was particularly true for excess deaths, social care and the NHS.”
Last week, Liz Kendall, the shadow care minister, said: “We have to provide alternative care. There’s a real urgent need to look at any spare capacity there is at facilities like the Nightingale hospitals to see if they can care for residents.
“Care home staff are being asked to do extraordinary things. They’re very skilled – but we need to make sure that care homes are not turned into hospices because that’s not what they are there for.”
A Telegraph investigation also found that whilst the Government drew up plans telling care homes how they should handle pandemics and flu outbreaks, these centred on ensuring infection did not escape the homes – not on ensuring it never got into them.
One such paper, “Guidelines on the management of outbreaks of influenza-like illness in care homes”, published in 2018, advises that “care home… closures to new admissions may be considered for at least five days after the onset of the most recent case to avoid transmission risk”.
But, it adds, the decision to re-open would hinge on “how easily the home could maintain isolation for such individuals while re-opening to new admissions” – that is, how well it could contain the infection already present.
Other documents – including the 2012 “Health and Social Care Influenza Pandemic Preparedness and Response” – make it clear that at least some care homes would remain open to infected residents.
In a harbinger of the disaster still unfolding up and down the country, the same document also instructs care homes to ensure they have plans in place to manage “additional deaths, including storage of bodies if necessary”.
The Government preparations for a pandemic also devote considerable time to the question of what to do when demand for NHS resources outstrips supply, and there is an urgent need to free up capacity.
In paragraphs that will make bitter reading for families whose relatives are included in the care home death toll, Whitehall officials attempted to set out a framework to help doctors choose between patients.
Those who have been taken into care because of prior health problems – as is the case with many care home residents – inevitably come lower down the list.
“The potential medical benefits to incoming patients should ideally be greater than the potential risks of not receiving care for those discharged,” says a 2009 policy document on “surge capacity” in a pandemic. “There has to be a level of risk tolerance of a consequential medical event as a result of discharge.”
As has now been demonstrated with horrifying decisiveness, the “consequential medical events” that followed ultimately affected a much wider pool of care home residents than just those being discharged from hospital.
Experts commenting on Tuesday’s CQC figures warned that – given the lag in data – the number of coronavirus deaths in care homes may already outnumber those in hospitals.
As the Government prepares for next week’s count, it will be under pressure to strengthen its defence. Mr Hancock may insist that they have been a priority from the start, but to many families with relatives in care homes, it feels like they have been forgotten.