Discharge from Hospital During the Pandemic
Nick Kempe - 5 May 2022
Discharge from hospital during the pandemic – implications for the National Care Service
Last week, the High Court in England found that the UK Government’s policy not to isolate people discharged from hospital to care home at the start of the Covid pandemic “failed to take into account the risk to elderly and vulnerable residents from non-symptomatic transmission” and was therefore unlawful.
If the discharge of asymptomatic people, which was also driven by the Scottish Government, was unlawful what does that say about the legality, let alone common sense, behind the decisions that led to 106 Covid-positive people in Scotland being discharged to care homes between 1st March and 31st May? Or even worse, the people who had tested negative but were then discharged to care homes with Covid outbreaks against their families’ wishes and then died from disease?
While legal attention has been directed at hospital discharge, that is only half the story. As I argued in a Predictable Crisis, the decision by the Scottish Government to focus on saving the NHS while deliberately leaving care homes to fend for themselves at the start of the pandemic played an equally important part in the geronticide.
The care home sector was totally unprepared to cope with Covid or any other pandemic. That should have been obvious to anyone in the Scottish Government who cared to look: understaffed, poorly trained, lacking PPE and appropriate infection control facilities, the un-unionised workforce in the private sector, the miracle is that some care homes either managed to avoid Covid (often through closing their doors) or managed to contain outbreaks through swift staff action (e.g. by isolating Covid patients and using dedicated staff to contain them). Many care home owners, however, were more interested in the money that had suddenly become available to fill empty beds and paid little regard to existing residents or whether proper safety arrangements were in place.
All this should have major implications for the design of the National Care Service. The Scottish Government decisions which drove the exodus from hospital and bunged money at the private care home sector while leaving it to fend for itself was an absolute disaster. The Integrated Joint Boards (IJBs), which manage adult care and are accountable only to the Scottish Government, did what they were told, almost without question, and trampled over all the normal checks and balances designed to ensure people are safely discharged from hospital.
Evidence for this can be found in the very revealing report on hospital discharge produced for Health and Social Care Partnerships in July 2020 . This found Covid:
“has removed some of the historic barriers [to hospital discharge] as well as providing the enablers and incentive for progress. It has in a perverse way created the necessary conditions to make the sort of significant progress that had long proved difficult to achieve. This progress has come at a speed that has never before been possible”.
The report completely glosses over the tragic consequences for older people but instead bemoans the one thing that prevented even more people being discharged to unsafe places:
“One of the biggest challenges was the media coverage of care home deaths, with the alarmist reporting of care homes as “COVID rife” turning families against co-operating in the placement of their relatives. This was coupled with the care home providers’ fear of taking people from hospital to possibly infect the home. This was exacerbated with the announcement of police investigations in to deaths, leading to fear of negligence claims, litigation or prosecution.”
You could not make a better case against the dangers of a top-down National Care Service under the control of Scottish Ministers and the need for checks and balances. Without investigative journalism rediscovering itself during the pandemic even more people would have died.
This is one of the reasons why Common Weal’s Care Reform Group argued in Caring for All that while a National Care Service should be centrally funded, it should be managed by democratically elected local authorities rather than unelected joint boards. Councillors have the potential to speak out for what is right – to provide checks and balances - in a way that unelected boards subject to central government management diktat don’t.
There have been two good recent examples . The first was in Edinburgh last year where the IJB was all set to close the Council run and public sector care homes without consultation until challenged by local people who took up the case through their local councillors. Those plans are now on hold. The second was in Glasgow, which was covered by Leo Plumb two weeks ago, where councillors voted to increase allowances for foster carers – for the first time in 10 years and the right thing to do – only to be overruled by the Glasgow IJB which claimed to be awaiting guidance from central government. If we want a National Care Service fit for purpose, local democratic control really is important. It provides safeguards that centralised control won’t.
But we also need to go further than that and empower social workers and frontline care staff, who were generally side-lined and overruled during the pandemic, to speak out for what is right and against management diktats whereever they come from. And then in turn empower the people who use services and their carers, whose rights were ignored during the pandemic, to have real control over how services are managed. It is important, therefore, to develop checks and balances within local authorities too.
Key to the success of a National Care Service in our view will be more democracy, not less, and the extent to which the power to manage care is devolved to those who deliver and depend on it. While such control would not have prevented all the unnecessary death during the pandemic– we knew then far less then about how Covid is transmitted – it would have provided a check against some disastrous central government decisions, as illustrated by the High Court judgement.