Asked by
To ask Her Majesty’s Government (1) on what date, and (2) in
which policy document, testing for COVID-19 was offered as a
matter of policy to those leaving hospitals and going to care
homes.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
My Lords, the Covid-19 hospital discharge service requirements
were published on 19 March 2020. They stipulated that patients’
Covid-19 test results, negative or positive, should be included
in their discharge documents. On 15 April, we built on this with
the adult social care action plan, including a policy of testing
all patients prior to discharge to a care home. I remind noble
Lords that the WHO acknowledged the threat of asymptomatic
transmission on 9 July 2020.
(LD)
My Lords, last week the Secretary of State said that a policy of
testing patients going to care homes was brought in
“as soon as we had those tests available”.
That was in mid-April 2020, and more than 500,000 tests were
carried out to mid-April 2020. Only 25,000 would have been
required to test all patients being discharged to care homes. Can
the Minister explain these figures and the contradiction in the
Secretary of State’s statement that they highlight?
(Con)
My Lords, I do not quite understand the noble Lord’s figures. As
of 14 March 2020, the seven-day rolling average showed that there
were 51,741 discharges a day from hospital, of which 1,123 were
from hospitals specifically to care homes. That was at a moment
when our testing capacity was 3,000 a day. A month later, on 15
April, the rolling average was 22,000, of which 548 were
discharges from hospitals specifically to care homes. By that
date, the testing capacity was 38,766.
(Non-Afl)
My Lords, we need granular details such as dates and
decision-making processes not to play the blame game but because
we need to understand precisely how Covid got into care homes. In
that context, can the Minister tell us when and why the policy
decision was made to make vaccines mandatory for care home staff,
going against the Government’s stated opposition to jabs for jobs
and against the crucial ethical principle of medical consent?
Does the Minister understand that for care home workers,
vaccinated and non-vaccinated, this looks like decisively
shifting the blame from official culpability for the scandal of
how Covid got into homes on to hard-pressed front-line workers?
(Con)
My Lords, we are in the middle of a consultation on mandatory
vaccinations for care home staff. One thing I would remind the
noble Baroness of is that the vast majority of infections in care
homes last year were through staff, not through discharge.
(Con)
I think the question the public want the answer to is why so many
people died in care homes. Will there be an inquiry which will
try to get to the bottom of that simple fact?
(Con)
My Lords, PHE has published a report on that. It calculates that
around 1.6% of the deaths in care homes were directly
attributable to discharge. That number is very sad, but it is a
relatively low proportion. This will, of course, be a subject
covered in the government inquiry that the Prime Minister has
already announced.
(CB) [V]
My Lords, I feel sure that the Minister will agree that it was
extraordinary that, when relatives were prevented from visiting
their loved ones in residential care, and many of the residents
could not understand why they had been abandoned, at that very
time patients were being admitted from hospital without having
been tested for this virus.
(Con)
My Lords, I completely sympathise with the point on those in care
homes receiving a very tough challenge when they have been
prevented from seeing loved ones. We have had to take extremely
severe infection control measures, many of which are still in
place for the reasons that have been discussed in this Chamber
before. But I challenge the noble Lord’s point on testing. We
brought in testing when asymptomatic infection was recognised and
when the capacity was available.
(Lab)
My Lords, can the Minister explain why the Secretary of State
continues to justify himself by quoting the seriously
underestimated PHE January to October 2020 data assessment on
hospital discharges to care homes of 286 Covid deaths? The
National Care Forum of care providers has repeatedly made clear
how fundamentally flawed and incredibly partial that data is.
Only limited numbers of symptomatic patients in hospitals and
care homes were tested, and cases not tested before death are not
included. Even the chair of the House of Commons Science and
Technology Committee has said that relying on this for a full
picture of the situation is a stretch of the imagination. We owe
it to the people who have died, their relatives and care home
providers to have full, accurate and independent information. How
is the Minister going to ensure that it is urgently provided, so
that we can genuinely learn from what happened?
(Con)
My Lords, I acknowledge the noble Baroness’s concerns, but the
PHE report is extremely thorough. I am not aware of it being
revised, but if it is, I would be glad to share that information
with the noble Baroness.
(LD) [V]
My Lords, respected health commentators and statisticians say
that excess deaths—that is, deaths above the expected number—is a
more accurate way of looking at the scale of deaths in care homes
due to Covid. Care home residents make up just 0.7% of the
population. In the first wave of the pandemic, deaths in care
homes accounted for 44% of all excess deaths for that period in
England and Wales. What does the Minister think this says about
the effectiveness of the so-called protective ring thrown around
care homes and what lessons have been learned?
(Con)
My Lords, we were never in any doubt from the very beginning that
the virus presented a huge threat to care homes. They are where
the elderly and the vulnerable are housed, in conditions where it
is extremely difficult to enforce infection control and where
there is a large amount of intimacy between residents and staff.
We knew from the experience of other countries that care homes
were very likely to be an area where infection and severe
illness, and potentially death, would be highly prevalent. There
is no doubt that care homes suffered the brunt of this virus, and
for that matter I am extremely sad indeed. Noble Lords should
realise that we put every measure in place that we humanly could
have done. We gave a huge amount of resources, including £2.8
billion via the NHS specifically to support enhanced discharge
processes and the implementation of the discharge to assess
model.
(Con)
My Lords, I apologise to my noble friend for adding to the burden
that he bears in answering this question. I know he cares deeply
about this situation. However, it is important for lessons to be
learned, so that we have no similar experience in future. The
letter sent by the NHS to care homes on 15 April 2020 states:
“Where a test result is still awaited, the patient will be
discharged … pending the result ... This new testing requirement
must not hold up a timely discharge”.
I do not believe any of this was a deliberate attempt to infect
care homes, but I do believe that care homes need infection
control and that there was a lack of follow-up for patients who
were discharged positive.
(Con)
My Lords, I am grateful for the tone of the question, but its
assumption is, I am afraid, quite wrong. Before April 2020, there
was very little evidence and no scientific consensus whatever
that asymptomatic transmission posed any risk. For example, the
World Health Organization said on 2 April:
“to date, there has been no documented asymptomatic
transmission.”
My noble friend may remember that differently. They were very
difficult times, and we made decisions on very limited
information. We made the best decisions we could have done under
the circumstances.
(Lab) [V]
My Lords, as late as March last year there was clear evidence
coming from Italy about people dying in nursing and care homes
there. Surely if we had been half-awake we would have realised
that what was happening in Italy was a solemn warning to us, and
we should have acted accordingly. Why did we not do so?
(Con)
I saw the images the noble Lord refers to and was shocked and
moved by them. That is why we moved massively, including, in
March, announcing £594 million in order to support care homes,
and massively supporting them through the NHS. We did an enormous
amount from the beginning. The effects on care homes have been
profound and are extremely sad, but I am afraid to say that this
presumption that we either did not enough or took the wrong
advice is not supported by the facts.
(CB)
My Lords, let us focus on what government can do now. My concern
is that the Government are overcompensating for the very high
early death rate in care homes, for whatever reason, by imposing
wildly disproportionate controls over double-jabbed, tested
visitors. For example, they have to wear PPE and social distance,
as we know, and there is no hugging—thus wrecking the final
months for these people in care homes. I ask again: will our
excellent Minister—I mean that; he is an excellent Minister—put
to the Prime Minister the risks and benefits of scrapping these
controls?
(Con)
My Lords, I am extremely sympathetic to the noble Baroness’s
point and conscious of her specific point that we could be in
danger of overreaching or in some way emotionally
overcompensating for perceived mistakes in the past. We are
conscious of that possibility, but I would like to reassure the
noble Baroness that it is not the case. The decisions we have
made on infection control and on visiting in care homes are
tough—they are hard—but in recent weeks there have been outbreaks
in care homes in London and Bolton in which vaccinated residents
have caught the disease and had serious symptoms. That is
something we are extremely wary of. When the vaccination has
reached a higher proportion of the population and R is below 1,
we will be in a position to change these policies. We will do so
at pace and as quickly as we reasonably can, but until that
moment arrives we have to take these tough decisions.
