Carnage in care homes
The discharge of up to 25,000 hospital patients into care homes during the pandemic’s height was becoming a highly controversial move. By Friday April 17 there had been almost 10,000 excess deaths in the homes and yet the policy of allowing patients to be transferred into them without first being tested for the virus had only ceased the day before.
Indeed hundreds of patients were also being sent to homes even though they had tested positive. In response to a request from the department of health to make more beds free in hospital, councils such as Bradford instructed the care home sector to bear the responsibility for looking after hospital patients for the duration of their illness.
Such policies wreaked havoc in the homes where staff had even less protective equipment than the hospitals and would often spread the virus as they worked shifts in different premises. A third of all care homes declared a coronavirus outbreak, with more than 1,000 homes dealing with positive cases during the peak of infections in April, according to the National Audit Office. During the three months of the first wave of the pandemic, 26,500 more people died in care homes than normal.
Many of those who died were simply refused care. David Crabtree, an owner of two care homes in West Yorkshire, is angry about the way many of his residents were left to die and were denied access to hospital.
A hospital patient had been forcibly discharged back into one of his homes without a test and developed symptoms for Covid-19 at the beginning of April. As the patient’s condition deteriorated, the home called an ambulance but a clinician on the end of the phone refused to send one.“We were told there was a restriction on beds and to treat as end of life,” Crabtree said. The resident died a few days later in the second week of April.
The single infection had already spread quickly to others in the home. In the days that followed a total of seven more residents died from the virus and not one was admitted to hospital. “I couldn’t believe what we were being told,” he said, “they were denying people because of age.”
But in the middle of the month, the policy of the hospital changed and infected residents were admitted. “The peak dropped so I don’t think there was pressure on beds. After April 15 we were able to get people into hospital.” He said five infected residents from his home were admitted to hospital at the end of the month and they all survived — raising the question as to whether the other eight would have still been alive if only they had been treated.
An Amnesty International report published this month found that the numbers of care home residents admitted to hospital decreased substantially during the pandemic, with 11,800 fewer admissions during March and April in England compared to previous years.
Medics have also described how the care home sector was left to fend for itself. An intensive care doctor in the Midlands said: “I can’t remember seeing anybody from a care home who had tested positive who was brought into hospital, not a single one.”
Turned away
At Johnson’s first prime minister’s questions in the Commons on Wednesday May 6 after his return to work the previous week, he conceded that there had been a tragedy in the care homes. “There is an epidemic going on in care homes, which is something I bitterly regret,” he said.
However, there were still very sick people who were being turned away from hospitals. Betty Grove, 78-year-old grandmother from Walthamstow, northeast London fell ill at the end of April with a cough and low oxygen levels and went to Whipps Cross Hospital in east London on the advice of her GP.
The hospital found she had pneumonia and a collapsed lung and, yet, still sent her home four hours later because, according to her daughter Donna, they feared she might become infected with Covid-19. She may well have already had the virus, especially given her symptoms. But, Donna says the hospital refused to test her mother because they would have to admit her to do so. It was a Catch-22.
Over the next ten days, Betty, a retired Co-op worker of 25 years, “grew weaker” and began struggling for breath. Donna says she called her local trust’s rapid response team repeatedly — sometimes twice a day — asking for help for her mother. “I was insisting that they needed to come out and check her,” she said.
Betty died at home of pneumonia on May 15. Her family believes she would have survived if she had been admitted when she first went to hospital. Barts Health NHS Trust has since apologised to the family for Grove’s treatment and launched an internal investigation.
Donna said: “I get that they did have enough on their plate. They had Covid … but it doesn’t mean to say they can push these people aside and just let them go home to die.”
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Tragic delay
The first wave’s death toll left tens of thousands of families across the country in mourning. But for many that sadness has turned to anger as they have learned more about how their loved ones died and question whether they could have been saved with better medical care.
The families who spoke to this newspaper have great sympathy with NHS staff who worked night and day risking their own lives while isolating themselves away from their own families. More than 600 health service staff have themselves died from Covid-19. A mental health crisis is now feared within the NHS because of the emotional strain of being forced into making so many harrowing life and death decisions.
Instead the focus of the relatives has fallen on the government whose late lockdown allowed so many to become infected. More than 2,000 families have formed the Covid-19 Bereaved Families for Justice UK group and in the summer they wrote to the prime minister and the health secretary demanding an immediate statutory inquiry into their handling of the pandemic. They asked to meet Johnson and Hancock to put their questions in person. Both requests have been refused by the government’s lawyers.
Elkan Abrahamson, the human rights lawyer representing the group, said the families are driven by a desire to prevent more unnecessary deaths during this second wave of the pandemic. But, he added, the government’s legal department had “clearly been told to ferociously fight any attempt to elicit the truth about the first wave”.
The government’s reponse
In response to this article, a statement for the Department of Heath said:“From the outset we have done everything possible to protect the public and save lives.
“Patients will always receive the best possible care from the NHS and the claim that intensive care beds were rationed or that patients were prevented from receiving necessary care is false. Doctors make decisions on who will benefit from care every day, as part of normal clinical decision-making.
“Since the beginning of this pandemic we have prioritised testing for health and care workers and continuously supplied PPE to the frontline, delivering over 4.2 billion items to date. We have been doing everything we can to protect care home residents including regular testing and ring-fencing over £1.1billion to prevent infections within and between care settings.”
Professor Stephen Powis, NHS national medical director, also issued a statment saying that the health service “cared for more than 110,000 severely ill hospitalised Covid patients during the first wave of the pandemic” and older patients had “disproportionately received NHS care - over two thirds of our Covid inpatients were aged over 65.”
He said: “The NHS repeatedly instructed staff that no patient who could benefit from treatment should be denied it and, thanks to people following Government guidance, even at the height of the pandemic there was no shortage of ventilators and intensive care.
“We know that some patients were reluctant to seek help, which is why right from the start of the pandemic the NHS has urged anyone who is worried about their own symptoms or those of a loved one to come forward for help.”
