Health Secretary Jeane Freeman is set to take questions today from MSPs on the care homes crisis, the eye of the Covid-19 storm in Scotland.
Yesterday’s weekly National Records of Scotland statistics revealed that there are now more deaths in care homes than the rest of Scotland combined, a tragic outcome three months into a pandemic which we knew long before it reached Scotland was a threat to the elderly most of all. On the last census count (in 2017) there are 35,989 residents in Scottish care homes, so 1,818 deaths is just over 5 per cent of the total care home population. Whatever 5 per cent is, it’s not a successful ‘shielding’ operation.
The Scottish Government has admitted that mistakes were made in the early phase, but its reasoning for this has generated more questions than answers.
Here are four questions on Scotland’s care home crisis for Freeman:
1) On what advice specifically was the decision made to discharge people into care homes untested?
921 people were discharged into care homes in March without being tested. The 2016 Operation Cygnus Report into a pandemic clearly raises warnings about discharging patients into care homes before testing. Had a pandemic plan been in place prior to this crisis, as recommended by Cygnus, surely part of that plan would have led to clear warnings about discharge by the time the virus is a live issue in hospitals. But there is no such pandemic plan to refer to.
The reasons given now by First Minister Nicola Sturgeon for the early discharges lack credibility. She said on Sky News that “back then, the view was that people who didn’t have symptoms, either because they were pre-symptomatic or asymptomatic, didn’t shed the virus.” Who was advising the First Minister of this, and what was there advice based on? A summary of a 4 February Sage meeting states clearly: “Asymptomatic transmission cannot be ruled out”. So the First Minister wasn’t getting this information from Sage. On 16 March a paper from the Center of Disease Control and Prevention confirmed incidences of pre-symptomatic transmission. But it was not until over a month after then that the First Minister changed guidance on hospital discharges to care homes (21 April).
2) Is it not true that the early government strategy was singularly focused on protecting the NHS, and that was put above all other concerns, including the protection of care homes?
James Urquhart, a former NHS Scotland statistician, was the first to raise the alarm bell over the “Protect the NHS” slogan.
“Surprisingly, perhaps, nowhere will you find a clear statement that reducing the total number of deaths figures large on the UK Government’s agenda. In fact, the only true strategic objective held up to scrutiny at successive press conferences is: preventing the NHS from being overwhelmed,” he said.
The First Minister said herself on 16 March that there was “no substantive difference” between the Scottish Government and UK Government approach to the crisis, and therefore the evidence points to a prioritisation of freeing bed space in NHS hospitals over keeping the virus out of care homes and stopping the spread of Covid-19 as much as possible, at least until the ‘Framework for Decision-making’ document was published on 23 April which for the first-time laid out the Scottish Government’s own strategic objectives.
As Urquhart argues, it’s not that keeping the NHS operational was not a vital objective, but it should have been one of many objectives, with the overall aim of halting the virus in its tracks. Given the chronic lack of PPE for social care workers in the early stages of this crisis as well, it’s hard to believe that a singular focus on the NHS by government did not contribute to where we are now.
3) Are care home residents being confined to their rooms?
It is unclear whether there is a consistent approach to social isolation of care home residents across care homes now, and what measures are being taken to prevent physical and mental deterioration of residents if they are in social isolation. Nick Kempe, former head of services of elderly people in Glasgow, has argued on Source that turnover in care homes is the real challenge to keeping the virus out, and that if that problem is resolved there should be “no need to confine residents individually”.
There is human rights issues here. No resident signed up for being locked in their room, and they have little means of making their voice heard about their situation. While the spread of the virus must be stopped, it can’t be a trade off between that and the general physical and mental health of residents.
4) Does the Scottish Government regret the growth of the private sector in care homes ownership?
With a significantly higher number of Covid-19 cases in the private sector (70 per cent) than in not-for-profit and local authority care homes (38 per cent), and with the private sector having generally lower quality ratings from the Care Inspectorate, there is question marks over why the trend towards privatisation in Scotland was allowed to continue under the SNP’s watch. Local authority care homes dropped by 31 per cent from 2007-2017, with 59 per cent of those in care homes now in the private sector.
Freeman has said there should be a review of care homes in light of the crisis and has implied that she believes the sector should be nationalised, but if that’s the case the SNP must take responsibility for its own record in this respect.
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