What did we learn from discharging patients into care homes?

By Cllr Tony Jones | 02 November 2020

My 87 year-old father died in a care home in May. He had been hospitalised during Christmas 2019 following a fall at home and he never came home. His treatment had been further complicated by a broken hip he had sustained while in hospital care. Until March we had sustained him with daily visits to the hospital, even though his mental and physical decline was significant and rapid. But then, as the challenges of COVID-19 began to overtake us all, we were not able to visit him in the last two months of his life and he died a confused, lonely, husk of the man we had known and loved.

Those of us who work in adult social care, in whatever role we play, must never forget when we deal in plans and strategies, guidelines and rules, compiling budgets of thousands or millions of pounds, that our first and last responsibilities must always lie with the care of those the state entrusts us to protect. Right now, in the growing COVID confusion, I feel that local government adult social care services are being forced further and further away from being able to meet our core responsibilities by a series of ill-considered, heavy handed government diktats.

There will be other times and places for us all to account and review for what we did during this COVID crisis – a national inquiry promised -  ‘but not now’. So we must learn lessons as we go along. But are we?

Despite the repeated over-promising and under-delivery of nationally organised initiatives – personal protective equipment (PPE) supplies or track and trace in all its human or IT forms – it is left to local hospital wards and care homes to form the front-line of facing this ugly virus. In the Spring we saw huge efforts up and down the country to free up hospital beds for COVID care – with apparently little thought as to the impact this would have on care homes. In Reading we saw over 40% of COVID-related deaths – residents and staff – occur in these privately-run settings.

As we drew breath in the summer a national consensus seemed to emerge that the rapid exporting of patients from hospitals without COVID testing was a mistake, which had fertilised much of the spread of the disease in the care home sector.

There is no doubt that, by my observation at least, the care home sector has been traumatised by the outbreak of the COVID pandemic – facing death and emotional upheaval on an unprecedented scale, logistic and financial strains at breaking point, and under-occupation and vacancy levels now undermining longer term sustainability.

So as we seek to deal with the rise in COVID cases this autumn what has the government learned about what has gone on earlier in the year and what can we do better?

In all my years as a councillor, dealing with various arms and agencies of central government across education, housing, transport and the environment, the response from the Department of Health and Social Care (DHSC) is heavy-handed and ill considered, lacking any of the sensitivity or nuance the continuing COVID tragedy requires.

The latest requirement for each council to identify care homes where COVID positive patients can be despatched is too blunt an instrument to work well everywhere and is not acceptable to us in Reading. We at Reading Council think that it is not acceptable and is neither the safest option, nor provides the best outcome for patients themselves. 

Many of our care homes are very worn down from the first wave of COVID cases and would struggle to convert their premises to accommodate safely such patients without this affecting others.

Instead the ‘Home First’ principle, which enables patients to return home with a tailored package of ‘wrap around’ support and reablement, is embedded in our system as the most appropriate way to support the well-being for our residents, hence we wish to pursue alternatives to those proposed by the DHSC to manage COVID-19 positive discharges.

We firmly believe that is the safest and most effective way forward in Reading and we have said that to government. 

We are also surprised to note that while councils are being asked to provide care homes places for COVID patients, the funding for this work is instead allocated to health partners. This makes no sense at all.

We will work with the DHSC to find the best outcomes for our vulnerable residents this winter – but the government needs to show us some trust and flexibility to deliver local solutions to meet our local needs. My father would expect nothing less.

Tony Jones is lead member for adult social care at Reading Council

@TonyJonesLab

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