Care homes with more than 60 residents are twenty times more likely to have an outbreak of covid-19, a study has found.

NHS Lothian and University of Edinburgh researchers analysed infection patterns within 189 Lothian care homes that had a total bed capacity of 5,843.

In homes where there were less than 20 residents, the likelihood of an outbreak stood at 5%.

However, the chance of an outbreak soared to between 83 and 100% in homes with 60 to 80 residents.

A total of 852 cases of the virus occurred within the pool of homes considered in the study, with 419 covid-related deaths registered.

In terms of any action that could reduce the risk of an outbreak, the report states: ‘Although care-home size cannot be altered without losing places for existing residents, there may be potential to create discrete units within care-homes where smaller numbers of staff and residents are effectively cohorted to create self-contained units.

‘Such efforts will be complicated by individual care-home built environment, and will be difficult to sustain without rapid outside support during any large covid-19 outbreak when staff illness and absence may risk compromising safe care.’

Numerous public health experts and practitioners have warned of a second wave of the virus as winter approaches.

‘Many care-homes for older people and virtually all other care homes do not yet appear to have had an outbreak,’ the report continues.

‘There is therefore considerable risk of further outbreaks with large number of deaths in care-homes if community covid-19 incidence increases again.’

One quarter of the total number of covid-related cases and deaths occurred in just five care homes, and half in 13 care homes.

First Minister Nicola Sturgeon has promised a public inquiry will be held into “every aspect” of the pandemic, including care homes.

In May the health secretary Jeane Freeman said the mixed model of social care provision in Scotland should be subject to a review. Her comments followed an outbreak of covid-19 in a care home in Skye where allegations were made that the virus had been spread in part by staff being moved between care homes during the height of the pandemic.

“Serious human rights concerns” have already been raised in relation to the experiences of older and disabled people in care homes.  

The Scottish Human Rights Commission said that a failure to act on the part of the state could mean some residents’ right to life under the European Convention were denied to them during the course of the covid-19 crisis.

The Scottish Government has insisted care homes were not overlooked during the pandemic in favour of the NHS, but guidance on how to deal with coronavirus issued to care homes has come under fierce criticism, with some calling it “confusing and at worst contradictory”.

Calls for not just a review of social care provision in Scotland, but for the nationalisation of care home and care at home services have been mounting in recent weeks.

Last month former SNP cabinet secretary Angela Constance called for a national care service to be created in the aftermath of covid-19 that was “on a par” with the NHS.

Head of the Coalition of Care Providers in Scotland, Annie Gunner Logan, has however cautioned against any rush to a “glib solution” like nationalising services, instead calling for adequate funding of third sector providers that often out-perform council-run or private care facilities.

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