While the media’s attention was focused on the answers of Permanent Secretary Leslie Evans in the first day of the Holyrood-Salmond inquiry yesterday, Health Secretary Jeanne Freeman came up with some pretty curious answers of her own in response to questioning about the care homes crisis in parliament on Tuesday.
Asked about the Sunday Post’s revelations that 37 patients who had tested positive for Covid-19 had been moved from hospitals to care homes, and that not all local authorities have released their data so that number could in fact be higher, Freeman said that she was instructing Public Health Scotland to release all of the data. But she also said that the decision to release people from hospitals to care homes was made by clinicians, not government.
“The Government did not send people to care homes, these are clinical decisions,” Freeman said. “It is entirely wrong to say the government sent people to care homes. We did not.”
Freeman added that she will “defend that on and on and on, and support clinicians in taking those decisions. That is what they are qualified to do.”
But clinicians discretion has not always been the line of the Scottish Government. On 10 May, Freeman said that “both I and the First Minister have been clear that before you are discharged from hospital to go to a care home, you must have been given two negative tests”.
That statement came after new care home guidance was quickly removed from the Scottish Government website, which had said: “The patient may be discharged to the care home prior to the test result being available.”
When the new guidance eventually was confirmed, it said the “presumption should be that all residents being admitted to a care home should have a negative test before admission unless it is in the clinical interests of the person to be moved and then only after a full risk assessment”.
So the guidance contradicts Freeman’s 10 May statement that discharge “must” be based on negative tests, but it is also a lot more nuanced than her statement yesterday, which sought to distance government from decision-making on discharge altogether. The official guidance shows that the government infact has strict parameters in which clinical discretion on hospital discharge takes place. To say the government is not part of the system of hospital discharge to care homes is clearly misleading.
Even then, we are talking here about new guidance published in May, after the period in which the Sunday Post has identified patients with covid-19 discharged into care homes, which was from 1 March to 21 April. The government guidance in March was chiefly concerned with avoiding movement from care homes to hospitals, stating that: “It is not advised that residents in long term care are admitted to hospital for ongoing management but are managed within their current setting”. So while Freeman insists on the virtues of clinical discretion for movement from hospitals to care homes, the same does not appear to be true the other way around.
The guidance also states that “where a long term care facility has a resident who has tested positive for coronavirus, further admissions should be halted.” So even before May, there was official guidance on the movement of hospital patients to care homes, it simply did not account for the issue of testing patients, which in itself is pretty damning.
The health secretary cannot seriously say that hospital discharge to care homes during a pandemic is nothing to do with the government. Not only is it wrong to seek to put all responsibility on to the shoulders of clinicians, who cannot be expected to know everything (or even very much at all) about the care home they are discharging patients to, it is not consistent with what Freeman has previously said nor with the official guidance, either now or in March.
We know that 1,431 untested patients were moved from hospitals to care homes between 1 March and 21 April. We also know at least 39 patients who tested positive for covid-19 were also moved from hospitals to care homes in that time. The Scottish Government is accountable for the discharging of every one of those patients, and no attempts to wash their hands of that decision should be accepted.
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