The latest data release by NHS England and the updated analysis from NHS Providers has renewed interest into the impact of discharges into care homes as Covid-19 took hold.
Given the widespread outbreaks, it is inevitable that significant concerns have been raised about the rapid discharges of people from hospital into care homes and their own homes during the COVID 19 pandemic; about the safety of those discharges (due to an extreme shortage of PPE and a lack of pre-discharge testing), as well as concerns about whether people were actually discharged to the place that was right for them, and best placed to meet their needs.
The data released shows fewer discharges to care homes from hospitals. We certainly acknowledge the work of social work teams and local health discharge colleagues in ensuring that as many people as possible got home with care services, avoiding the need for residential care. We want to understand more about how these numbers relate to lower admissions and lower occupancy in hospitals that have taken place over the last couple of months.
We are aware that local health and social care staff have been pulling out all the stops to respond to the pandemic and many are now in a state of exhaustion. We remain deeply concerned that the national priority of protecting NHS Trusts was not matched by a similar commitment to equally protect social care from the outset. Specifically, the guidance, which established the framework for hospital discharges during the initial stages of the Covid-19 outbreak, was not developed from a perspective of looking at the impact on care provision in the round. It systemically led to the discharge of people, untested, into care settings, without fully thinking through the consequences. This was evident in the top-down nature of the guidance, and in the many changes of approach. The priority in the very first few weeks of the pandemic was to relieve pressure on NHS hospitals. A better approach would have been one that equally prioritised social care along with the NHS from day one. Thankfully this is being developed, but it has come at a price.
History and the inevitable inquiries will determine the impact of this direction and guidance for care homes and the spread of Covid-19. The reality is that today older people and disabled people continue to be disproportionately affected by the pandemic. The death rate in care homes has been shocking and social care staff have died at a far greater rate than health care staff.
Our shared priority now should be to learn from this for future waves of the pandemic and to protect people needing and working in social care. This will not only save lives of those directly affected, but will also impact on the speed of transmission and number of deaths amongst the wider population.