The Crown Office and Procurator Fiscal Service has refused to comment on whether it will look into a dramatic rise in deaths among people using home care services, while it continues to investigate 90% of covid care home deaths.

In May of this year, investigative journalism cooperative The Ferret reported that Care Inspectorate figures showed a 71% rise in deaths among people who received social care support in their own home between 2019 and 2020.

The increase prompted concerns cutbacks in care provision during the pandemic rather than the virus itself could lie behind the sharp rise.

But despite calls for an inquiry into home care deaths, the Crown Office and Procurator Fiscal Service (COPFS) told healthandcare.scot it was only looking at care homes and some hospital covid deaths.

Its decision has been described by one home care provider managing director as “unjust” and “imbalanced”, while disabled people’s representative body Inclusion Scotland said an inquiry is needed to examine home deaths.

Reductions to care and support in the early days of the pandemic have previously been defended by Nicola Sturgeon as “essential and inevitable”. The Scottish Human Rights Commission however concluded reductions or even the complete withdrawal of support had had a ‘direct and detrimental’ impact on people’s rights.  

According to the latest Scottish government figures, 10,168 deaths have been registered in Scotland where covid-19 was mentioned on the death certificate.

While 60% of covid-registered deaths have taken place in hospital, 33% relate to care homes and 7% at home or in non-institutional settings.

In May last year Scotland’s Lord Advocate told NHS clinicians not to report covid-related deaths to the COPFS except in exceptional circumstances.

But all covid deaths in care homes were to be reported, with the COPFS citing “public anxiety” as the reason.

Despite this focus solely on care homes, healthandcare.scot revealed last month that medical staff had, nevertheless, made nearly 800 reports to the COPFS of deaths in hospital that they judged to meet the criteria for investigation.

Asked by healthandcare.scot if they intended now to investigate home care deaths, given the new figures, the COPFS did not give a substantive answer.

A spokesperson said: “Following review by COPFS officials and having considered the public anxiety in relation to covid-19 or presumed covid-19 deaths in care homes or where the deceased may have contracted the virus in the course of their employment the Lord Advocate instructed that these deaths be reported to COPFS.”

One of the country’s largest care at home providers says it is not right to treat deaths differently on the basis of where they happened.

Managing Director of Highland Home Carers, Campbell Mair, said the lack of any commitment to investigate care at home deaths “seems to point to a further example of lack of parity of esteem in our health and social care landscape.”

“It is absolutely right that we recognise and capture learnings, and seek to bring our learning in to improving practice in all health and care settings,” he said.

“To see what appears to be a narrow focus, and one driven by the COPFS, would seem unjust and imbalanced, potentially received as threatening and blame-seeking, rather than as having a focus on learning and improvement.

“There is a real risk of widening inequalities and creating further disparity across our sector; a sector that surely must, in these past 15 months more than ever, have learned some mutual respect for the many essential moving parts in our complex world.”

Dr Pauline Nolan, Director of Leadership and Civic Participation at the disabled people’s organisation Inclusion Scotland, said an inquiry is needed into the scale of home deaths related to covid.

“Many disabled people have still, over a year later, not had their social care support reinstated. This has a plethora of implications including putting them at risk of catching covid but also possibly setting people back mentally and physically.

“There’s been some talk of the effects of long-term isolation and this changing and increasing these people’s home and social care support needs.”

Scottish Care – the body representing independent care providers – told healthandcare.scot it felt the COPFS investigation of deaths in the care home sector had been wholly disproportionate:

“Although it is essential and critical that assurance is given to families, these investigations have been intrusive, causing distress within care homes and amongst staff, whilst doing little to enhance community assurance or indeed professional confidence.

“Scottish Care has long argued that the homecare sector has not been given sufficient attention, especially when compared to the care home sector or hospitals.

“However, given the lack of assurance and large amount of distress caused by the Crown Office's investigations, we do not advocate for deaths in homecare to be investigated in the same manner as care homes. We believe that the focus should be on learning lessons in a transparent way and this is why we are calling for a public inquiry to be held urgently on the pandemic and all the sectors.”

 

Read more: Double standards claim over NHS & care home deaths; Prosecutors probe hundreds of hospital covid deaths; Dramatic rise in deaths among care home recipients; Care at home “Achilles heel” of pandemic response

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