Mike Padgham, chair of the Independent Care Homes Group (ICHG), responds to a new report from NHS Providers which rejects any responsibility on the part of the NHS for the high number of novel coronavirus (COVID-19) cases and fatalities among social care residents.
Padgham, who runs four care homes, says that the ‘fragmented’ nature of social care in the UK, combined with panic over the pandemic at the NHS and a lack of support from government made the situation far worse than it otherwise would have been.
Sputnik: NHS officials reject any responsibility for COVID-19 infections or excess mortality in the care homes in the UK. The latest NHS Providers report states that at no point did NHS Trust Leaders “knowingly and systematically discharge COVID-19 positive patients into care homes”.
How do you respond to these claims?
Mike Padgham: There is no doubt that care providers have been left as the poor cousins of the NHS during the coronavirus and that they have been overwhelmed and put under suffocating pressure. However, I cannot see NHS Trust leaders “knowingly and systematically” discharging patients into care homes with COVID-19 and I don’t believe things were done deliberately.
But colleagues are telling me that things happened at the sharp end that shouldn’t have happened. This was a fast-moving situation and patients were at first discharged into care homes before coronavirus test results were taken or known, for example.
From my own experience, I can say that even in the past few days, we have had to insist that a test was done on a patient before we would agree to admit them to our home.
There was enormous pressure on care homes to accept discharged patients to prevent NHS hospitals from becoming overwhelmed. There was an assumption that providers would be willing and able to cope with whatever was thrown at them.
Early modelling work suggested that the NHS would be overwhelmed with COVID-19 cases and particularly critical care capacity; and at this early stage, the main priority was to create capacity in the secondary care sector. There was an element of panic in the NHS and this led to a focus on rapidly discharging any patient who no longer needed care in hospital to all parts of the community and social care sectors.
Looking back, it is obvious that at that stage the consequences for the social care sector were neither understood nor anticipated.
Homes have been short of protective equipment, short of tests and starved of financial support.
In short, care and nursing homes were left brutally exposed and the Government should admit that it got it wrong in terms of supporting care providers who were on the front line against COVID-19 from the off.
Sputnik: The same report says that NHS facilities tested patients for COVID-19, whenever possible, before releasing them to care home providers. And that if a care provider was unable to facilitate the isolation of patients then it was local authorities that “needed to lead the local system” with funding from the COVID-19 NHS Budget.
Has this system worked in practice as described by the report?
Mike Padgham: What the response to coronavirus has demonstrated more than anything is that it is impossible to react to a pandemic like this whilst operating under the fragmented system our care services currently have.
Whilst NHS care is run nationally but social care managed locally by local authorities and clinical commissioning groups, continuing care will never run smoothly, and that is what we have seen during coronavirus.
It has felt like the greatest emphasis, certainly in the early days of coronavirus, was on freeing up NHS beds and preventing hospitals from being overwhelmed. Little thought seemed to be given to the impact this would have on care homes and those providing homecare.
If we had had an integrated system, with NHS and social care merged and managed together, I am sure we would have seen a more joined-up approach and that is what we have to strive for in the future.
Sputnik: Trust leaders have said that they “only discharged known or suspected COVID-19 patients if the relevant care home agreed they had the capacity to treat and isolate them”.
Is that accurate from your experience?
Mike Padgham: Again, the picture is a varied one. Certainly, care homes were placed under enormous pressure to accept discharged patients. It is reported that increased fee payments from commissioners were linked to whether or not a home would accept discharged patients, regardless of whether they had COVID-19 or not. At the same time homes felt under pressure morally to accept discharges as they wanted to “play their part” in the national effort to keep the virus under control.
Sputnik: Are care homes now getting the support that they require from the NHS as well as from local or central government; if not, what else is needed?
Mike Padgham: Sadly, the answer is no and despite all the promises and rhetoric, care providers are still playing second fiddle to the NHS. However, in the last couple of weeks the Government has recognised that social care is on the front line and begun to support it better. We have to make sure that it remains central to the Government’s thinking going forward.
Care homes found it hard to get proper access to adequate personal protective equipment, because the emphasis was placed on NHS providers.
Similarly, care homes could not access proper testing. Despite £3.2 billion extra being paid to local authorities some weeks ago and a further £600 million last week, many care providers are not seeing any financial support to help them survive. They are facing falling admissions and rapidly increasing staff and PPE costs which are pushing them to the brink.
Support for care providers from the Government has been slow in coming, isn’t reaching the front line in many cases and isn’t having much impact as yet.
Sputnik: Do you have any other responses regarding the conclusions of the NHS Providers report in relation to their interaction with COVID-19 patients and care homes?
Mike Padgham: Coronavirus has exposed a social care system that, due to historic chronic under-funding, was ill-prepared to cope with something as serious as this. The Government response concentrated wholly on the NHS initially and forgot the impact COVID-19 would have on care providers who look after the country’s most vulnerable and therefore most susceptible to the virus.
A lack of integration between NHS healthcare and social care led to a fragmented and strained response, rather than a joined up one. Huge lessons will need to be learned, not least that we have to bring NHS and social care together to provide proper, seamless care.