In care homes across Britain, a silent crisis is unfolding. While the Government has focused its attention and resources on protecting the NHS, the 433,000 older and vulnerable people living in social care have largely been abandoned.
The true scale of that neglect was laid bare this week when the chief medical officer, Professor Chris Whitty, admitted that outbreaks had occurred in 13.5 per cent of the nation’s 11,000 care homes.
Sir David Behan, a former chief executive of the Care Quality Commission (CQC) and now the executive chairman of Britain’s largest care home operator, HC-One, has said the figure could be higher. Some 232 care homes run by the firm – two-thirds of the total – have confirmed or suspected cases of Covid-19.
Like cruise ships, care homes are a hothouse for disease because of their frail populations, itinerant workforce and limited facilities for isolating those who become infected.
Therese Coffey, the Work and Pensions Secretary, said around 1,000 care home residents have died so far, but there are fears that figure is just the tip of a very big iceberg.
Sadly, the situation was all too predictable.
On March 3 – two days before the first coronavirus death was recorded in Britain and when just 51 people had tested positive for the virus – the Care Provider Alliance issued urgent guidance advising care homes to consider restricting visits from all relatives until the outbreak was over.
Recognising the imminent danger, the industry body also told homes to restrict the use of new agency staff to lessen exposure to the virus, and to isolate residents if they were suspected of having it.
Yet the Government prevaricated and it was not until 10 days later that official guidance was issued, stopping anyone who was “generally unwell” from visiting residents.
Full lockdown for the over-70s and vulnerable was not imposed until March 16, even though data from China had suggested early on that the death rate was far worse for that group.
By March 26, it was clear that serious trouble was brewing. Cases were rising at more than 100 a day for the first time, and 578 people had died. The National Care Forum wrote to Matt Hancock and Boris Johnson warning of a serious lack of personal protective equipment (PPE) in care homes.
Suppliers had started cancelling orders because PPE was being requisitioned by the NHS, they wrote, saying that imported goods were being confiscated at the border for use in the health service.
They also warned that care homes were being pressured into taking hospital discharge patients who had not been tested for the virus, even though they were exhibiting symptoms.
Manager Rachel Beckett, of Wellburn Care Homes, near York, said she was forced to play “Russian roulette” with her residents because of a lack of testing of discharged patients. “The instruction from Public Health England said that ‘because of the lack of testing available, the readmissions may or may not have Covid-19’,” she said.
“To expect us to comply with these instructions is tantamount to playing Russian roulette with the lives of our most vulnerable, the very people we’re here to keep safe and protect.”
By April 10, industry bodies were reporting that 1,000 people may have died in care homes, even though official statistics showed just 20. The Alzheimer’s Association said it believed around 50 per cent of homes had infection numbers far greater than the Government estimates.
On that day, the National Care Forum wrote again to the Government, this time to Helen Whatley, the Minister of State for Care, pleading for PPE and calling once more for discharged patients to be tested to avoid risking litigation over the “avoidable deaths” of residents who subsequently became infected.
Finally, on Sunday, Mr Hancock guaranteed regular coronavirus testing for the care sector but said providing a timescale for that was “nuanced and complicated”.
Care homes have struggled to receive the same help as hospitals because they do not feature in the Government’s pandemic planning and so are not automatically entitled to emergency supplies. The majority are privately run, so have been forgotten in public sector handouts.
Even when protective equipment is available, it is being sold at inflated prices which care homes cannot afford. The National Care Association has warned that PPE was being marketed at four times its usual price, and called for the Treasury to remove VAT on essential items.
Care Homes England claims the coronavirus crisis has exposed a culture of “ageism” in Britain, with the old and infirm allowed to die, while the Alzheimer’s Society warned that social care has “yet again fallen to the bottom of the pile”.
Kathryn Smith, the chief operating officer at the Alzheimer’s Society, said: “They’re being told they won’t be admitted to hospitals, they’re being asked to sign Do Not Resuscitate orders and being discharged from hospitals to care homes without being tested.
“At least half of care homes are reporting coronavirus cases, and 70 per cent of people in care homes have dementia – the Government must give them better support and protection.”
Age UK said more effort should have been given to creating “step-down hospitals” to act as a halfway house for people leaving hospitals rather than sending them to care homes.
Caroline Abrahams, the chief executive of Age UK, said: “They put loads of effort into Nightingale hospitals, which are so far not full, and in hindsight we should have been putting it in step-down facilities rather than acute ones.
“It slightly feels like care homes are a second class citizen, not quite at home and not quite the NHS, and so are very easily overlooked, which is really very sad.
“The question a lot of families are asking is: ‘Is mum or dad safer with me at home than in a care home?’ It’s a question I would be asking myself. We are getting emails and calls from families absolutely distraught and feeling family members are sitting ducks and they can’t go and see them, and it’s absolutely agonising.”
A one-off emergency drop of PPE is in the process of being delivered to local resilience forums across the country, but, according to the Local Government Association (LGA), it will not currently be enough to meet demand.
Leaving care homes to fend for themselves has already proved to be a deadly and unconscionable decision.
But if the true measure of society is found in how it treats its most vulnerable members, Britain is likely to be found wanting.