Scottish Health Secretary Jeane Freeman has admitted that Ministers did not understand the social care sector well enough when the decision was made to discharge patients into care homes as the NHS prepared for the first wave of covid-19.

Ms Freeman said the government ‘didn’t take the right precautions to make sure that older people leaving hospital going into care homes were as safe as they could be and that was a mistake.’

This was despite a review of discharges from hospitals to care homes in the early days of the pandemic finding there was no significant causal link to infection outbreaks.

Around a third of the 10,000 covid deaths in Scotland took place in care homes.

Speaking to the BBC, Ms Freeman said a lack of understanding of the social care sector meant the government was slow to respond to the crisis in care homes as well as issues in the community.

The Health Secretary said: “We wanted people who didn’t need to stay in hospital any longer because they’d been treated and they were clinically well to be discharged as quickly as possible so we freed up those beds for covid patients.

“Remember, the early predictions about the number of people going into hospital were terrifying actually.”

Ms Freeman added: “Now, I might argue we couldn’t do anything other than we did and all the rest of it, but it still created a real problem for those older people and for the others who lived in care homes and for the staff who worked in care homes.”

Ian Cummings, CEO of Erskine, which runs four care homes for veterans and their families, suggested the comments were not a surprise.

“We have been consistent in our view that care homes are not well understood by our colleagues in government and the NHS. The past year has demonstrated that care homes and hospitals have mutually supportive and interdependent roles, whilst being entirely different care settings, for people with entirely different needs and expectations,” he said.

“There are nearly three times more care home bedrooms in Scotland than there are hospital beds. Therefore, much talking and learning is required now and in the future to agree how we plan, deliver and resource the most appropriate care and support of our older and potentially most vulnerable citizens.

“As one of Scotland’s largest charitable provider of such services, Erskine stands by to be involved in this national conversation.”

More than three quarters of the 1,084 care homes in Scotland received a resident from hospital between March and May 2020, according to analysis by Public Health Scotland.

The agency said that just 650 of the 3,599 people discharged to care homes between the 1^st March and 21^st April were tested for covid-19 – meaning eight in ten never received a test.

Advice changed on the 21^st April to specify residents should receive two negative tests before being admitted to hospital and that any new residents should be isolated for 14 days.

The same month, Hugh Pennington, Emeritus Professor of Bacteriology at the University of Aberdeen, told a Scottish Parliament committee the problem of viruses spreading in care homes “is not new”.

“…The only way that we can protect [residents] is to prevent the virus from getting into the care home in the first place...we have to make sure that no person, of any kind, who goes into a care home has the virus, because they might unwittingly spread it,” he said.

It was not until 18^th May that regular testing of care home staff was promised by the Scottish government; by then care home deaths had reached more than 1,800.

Professor Pennington today told healthandcare.scot he struggled to understand Ms Freeman’s comments:

“Long before covid-19 it was abundantly clear to anyone who knew anything about the impact of infectious diseases in Scotland today that care homes could be very dangerous places for their residents when infectious agents such as E.coli O157 (commoner in Scotland than anywhere else in the UK) and influenza get into them, because of the susceptibility of the residents to these infections, and because conditions like dementia create very great difficulties for staff trying to implement infection control policies.

“And it didn't take long after the start of the pandemic for evidence to emerge about the devastating effect of covid-19 infections in the elderly and the high transmissibility of the virus.”

Dr Donald Macaskill, of Scottish Care, said that care homes and their staff had been learning lessons throughout the virus – with the result that the second wave, while still traumatic, was “very different in its impact”.

“The painful insights brought about by such a terrible and tragic loss of life have resulted in many dramatic changes to the care sector. There has been a huge increase in support and in many instances real partnership working to keep people safe,” he said.

But he pointed out that errors, and a lack of attention from politicians, stretched back before the pandemic.

“The shameful failures of the last decades are at the root of social care’s fragility in the pandemic not just the mistakes of the last year.

“Those culpable for the failure to enact progressive legislation which was designed to give citizens real control over their care cannot be allowed to block a desire to not just learn the lessons of the pandemic but to hear the voices of all those who have worked in and used social care support.

“We need to elevate our social care system so that no-one will ever again have to acknowledge a failure to understand a sector which gives life and meaning to so many of our fellow citizens.”

Robert Kilgour, Executive Chairman of Renaissance Care says everyone has to learn lessons for the future from what happened:

“Sadly, the Scottish government did – both before and during the first wave – seem to have a policy of NHS first and social care a poor second which was not at all helpful to our brave and hard-working front line staff who were battling hard and doing an amazing job against an invisible enemy caring for our vulnerable elderly residents.

“There is also no doubt that hospital discharges to care homes without testing was a big mistake as was not introducing the weekly testing of all care home staff much earlier. This sadly only happened at the very end of the first wave - too late to make a real difference but, yes, in time to help us fight the second wave.

“We do need to have an urgent independent public inquiry into all aspects of the last year’s journey from all points of view - in hindsight, yes - but it is absolutely essential so we can all learn lessons and move forward together."

In response to widespread reports of Ms Freeman’s comments, the SNP said the Scottish government had admitted mistakes had been made, and raised the prospect that any public inquiry into covid-19 would take a UK-wide approach.

A spokesperson said: “The Scottish government commissioned extensive work to review the links between hospital discharges and the impact of covid in our care homes.

“The First Minister has committed to establishing a public inquiry into the handling of covid, in which the voices of families would be heard, by the end of the year.

“We hope other governments across the UK will come together to support such an inquiry on a four-nations basis.”

 

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