As a GP in the NHS I witnessed first-hand the catastrophic way Matt Hancock failed the old and vulnerable in care homes
The Health Secretary claims he “tried” to throw a protective ring around care homes but, from my experience in the early days of the pandemic, he couldn’t have come up with a more disastrous and deadly policy.
As a GP working mainly with elderly patients in care homes and intermediate care I witnessed, at first hand, the absolute disaster that was the government policy at the start of the Covid-19 outbreak. Elderly patients who were Covid-19 positive, or not tested, or perhaps even negative, were simply shovelled out of hospitals and into care homes. ‘The hospitals must be cleared out… nothing else matters.’
At the time there was no PPE available… at all. In fact, in many care homes staff were actually ordered by the management not to wear PPE. This was also the case in hospitals. Not that it would have made a great deal of difference in most care homes where patients with dementia often wander happily from room to room without masks, and oblivious to any potential danger. I had to usher one or two out of the nurse’s office from time to time.
In my work with intermediate-care patients, looking after those who were too well to be in an acute hospital bed, but not yet well enough to be at home, we were placed under massive pressure to just send everyone home. That is, if they were Covid-19 positive, or not, or untested, where they could spread it to their – often elderly – relatives. Alternatively, they could infect their carers who would then travel to the homes of other elderly people they were looking after – without PPE.
In fact, if you wanted to design a system of ensuring that every single vulnerable person in the country gained full exposure to Covid-19, you could not have done a better job. I wrote various increasingly frustrated emails to various managers, but they simply stated they were just following policy so ‘you can’t blame me’. Policy set at the very top.
Here is an example of the type of email I was sending in April 2020. You may sense the frustration (I have changed the names of the unit and wards, for confidentiality reasons).
"I think this is very simple, Unit A is currently ‘hot’. We have five patients and four staff ‘Covid positive’ swabbed. Eight patients have now died of Covid.
"If we admit Covid negative patients into Unit A this is putting them at great risk of being infected. So, we should stop admissions. The only ones that should come in are those found positive, recovered, and 14 days post positive swab – at least.
"Equally if we discharge patients, we are, almost certainly, spreading Covid around the entire care community. Until fourteen days have passed.
"There is also a plan to send Covid positive patients to ward B, and keep Unit A as green (no Covid). The only way Unit A can be green is if we stop admitting patients. Because, once new patients reach Unit A they are likely to get infected, then another 14 – 21 days must pass. So, we will go round and round, forever.
"Also, another plan is to send high risk staff to Unit A, and have low risk staff in ward B, so the staff will be swapped around. Again, Unit A is currently red hot. We will be endangering high risk staff if we send them to Unit A. Some of them will get infected. Then, they will incubate for 7 – 14 days. They will infect patients, and other staff, then they will go off sick. Then, some of them may well die.
"The current plan seems to be to admit elderly vulnerable patients into a high risk Covid ‘hot’ environment and hope they don’t get Covid. We have already seen staff to patient transmission in Unit A. So, some of these patients will get infected, with a very high risk of dying…."
In a way, it is hard to blame management who were trying to follow every changing edict from above. Edicts often directly contradicting what they had been told the day before. It was chaos. Now, we have Matt Hancock, the UK Health Secretary, stating, amazingly without being struck down by a lightning bolt, that he threw a ring of steel around care homes and elderly hospital units at the time. A… ring… of… steel. This was presumably to stop anyone escaping somewhere safer. Of course, he now says that the most important word in his statement is ‘tried’ as in ‘We tried to throw a ring of steel…’
This will now be his perfect defence. I didn’t say we succeeded, I only said that we tried. How completely pathetic. First, he did the exact opposite of trying. He put in place policies that were directly responsible for the massive number of deaths in care homes. He commanded hospitals to be emptied of elderly patients. What’s his next excuse? ‘Lots of the other countries did the same thing.’ Which is true. But you can hardly claim you are a leader, if all you managed to do was follow others down a disastrous policy failure.
How many deaths did this cause? Well, during the first wave of Covid-19 it has been estimated that 40% of deaths occurred in care homes. Here from the Nuffield trust:
“The burden of the virus fell much more severely on care homes (relative to the population generally) in the first wave. Of the 48,213 Covid deaths registered between mid-March and mid-June, 40% were care home residents.”
There are around half a million residents in care homes, which is 0.7% of the entire population. Yet they had 40% of the deaths. Yes, the elderly, especially those in care homes, were most likely to die from Covid-19. But this was known very early on. In Italy, where Covid-19 first hit Europe, the average age of death was 82, and almost all of those who died had other significant diseases.
If there was one population that needed to be protected it was elderly, vulnerable care home residents. Matt Hancock presided over policy decisions that threw care home residents under a bus. Now he is trying to claim he did all he could to protect them. Anyone who works in the health service, or in the care sector, knows exactly what he did.
At the time there was no PPE available… at all. In fact, in many care homes staff were actually ordered by the management not to wear PPE. This was also the case in hospitals. Not that it would have made a great deal of difference in most care homes where patients with dementia often wander happily from room to room without masks, and oblivious to any potential danger. I had to usher one or two out of the nurse’s office from time to time.
In my work with intermediate-care patients, looking after those who were too well to be in an acute hospital bed, but not yet well enough to be at home, we were placed under massive pressure to just send everyone home. That is, if they were Covid-19 positive, or not, or untested, where they could spread it to their – often elderly – relatives. Alternatively, they could infect their carers who would then travel to the homes of other elderly people they were looking after – without PPE.
In fact, if you wanted to design a system of ensuring that every single vulnerable person in the country gained full exposure to Covid-19, you could not have done a better job. I wrote various increasingly frustrated emails to various managers, but they simply stated they were just following policy so ‘you can’t blame me’. Policy set at the very top.
Here is an example of the type of email I was sending in April 2020. You may sense the frustration (I have changed the names of the unit and wards, for confidentiality reasons).
"I think this is very simple, Unit A is currently ‘hot’. We have five patients and four staff ‘Covid positive’ swabbed. Eight patients have now died of Covid.
"If we admit Covid negative patients into Unit A this is putting them at great risk of being infected. So, we should stop admissions. The only ones that should come in are those found positive, recovered, and 14 days post positive swab – at least.
"Equally if we discharge patients, we are, almost certainly, spreading Covid around the entire care community. Until fourteen days have passed.
"There is also a plan to send Covid positive patients to ward B, and keep Unit A as green (no Covid). The only way Unit A can be green is if we stop admitting patients. Because, once new patients reach Unit A they are likely to get infected, then another 14 – 21 days must pass. So, we will go round and round, forever.
"Also, another plan is to send high risk staff to Unit A, and have low risk staff in ward B, so the staff will be swapped around. Again, Unit A is currently red hot. We will be endangering high risk staff if we send them to Unit A. Some of them will get infected. Then, they will incubate for 7 – 14 days. They will infect patients, and other staff, then they will go off sick. Then, some of them may well die.
"The current plan seems to be to admit elderly vulnerable patients into a high risk Covid ‘hot’ environment and hope they don’t get Covid. We have already seen staff to patient transmission in Unit A. So, some of these patients will get infected, with a very high risk of dying…."
In a way, it is hard to blame management who were trying to follow every changing edict from above. Edicts often directly contradicting what they had been told the day before. It was chaos. Now, we have Matt Hancock, the UK Health Secretary, stating, amazingly without being struck down by a lightning bolt, that he threw a ring of steel around care homes and elderly hospital units at the time. A… ring… of… steel. This was presumably to stop anyone escaping somewhere safer. Of course, he now says that the most important word in his statement is ‘tried’ as in ‘We tried to throw a ring of steel…’
This will now be his perfect defence. I didn’t say we succeeded, I only said that we tried. How completely pathetic. First, he did the exact opposite of trying. He put in place policies that were directly responsible for the massive number of deaths in care homes. He commanded hospitals to be emptied of elderly patients. What’s his next excuse? ‘Lots of the other countries did the same thing.’ Which is true. But you can hardly claim you are a leader, if all you managed to do was follow others down a disastrous policy failure.
How many deaths did this cause? Well, during the first wave of Covid-19 it has been estimated that 40% of deaths occurred in care homes. Here from the Nuffield trust:
“The burden of the virus fell much more severely on care homes (relative to the population generally) in the first wave. Of the 48,213 Covid deaths registered between mid-March and mid-June, 40% were care home residents.”
There are around half a million residents in care homes, which is 0.7% of the entire population. Yet they had 40% of the deaths. Yes, the elderly, especially those in care homes, were most likely to die from Covid-19. But this was known very early on. In Italy, where Covid-19 first hit Europe, the average age of death was 82, and almost all of those who died had other significant diseases.
If there was one population that needed to be protected it was elderly, vulnerable care home residents. Matt Hancock presided over policy decisions that threw care home residents under a bus. Now he is trying to claim he did all he could to protect them. Anyone who works in the health service, or in the care sector, knows exactly what he did.
