The families of the 43,000 care home residents in the UK whose deaths between March 2020 and July 2022 were either caused by, or contributed to, by the Covid pandemic, have waited a long time for the official verdict on the way they were treated. The report published on Tuesday confirmed what many have been saying for a long time. In the first, panicked stages of lockdown, residents and their care workers were “something of an afterthought”. The “protective ring” around care homes referred to by Matt Hancock, the former health and care secretary, was a fiction.
These are scathing judgments. What actually happened, starting in March 2020, was that about 30,000 people were discharged from hospital to care homes in order to free up beds for Covid-19 patients. Since there were not enough tests for all of them, those without symptoms were moved without being tested. In England, Wales and Northern Ireland, there was no instruction to isolate newly arrived residents until the second half of April (in Scotland, this happened earlier).
As Heather Hallett, the inquiry chair, pointed out, there is no way of knowing how many cases of Covid-19 were transmitted in this way. But this was one of a series of decisions that enabled the virus to “spread like wildfire”. Mr Hancock’s misleading description of the government’s policy has thus been firmly rejected. Plans for isolating newly arrived care home residents in any future pandemic are among the report’s key recommendations.
Better overall planning is another one. The report highlights the fact that the social care minister at the time, Helen Whately, played no role in the decision to order the discharges, and calls for increased clarity around roles and responsibilities, along with new guidance around visitors. While there is no “ideal solution” in a situation where the risk of infection must be balanced against the benefit to residents of being visited, it concludes that restrictions were inappropriate and harmful in some cases.
Two further recommendations address deaths explicitly. The report suggests that there could be exceptional circumstances in which an end-of-life visit is not allowed, but it is hard to imagine what these might be. Ministers must decide whether they agree. Lady Hallett’s call for mandatory end-of-life training for care home staff is more straightforward. Her finding that this was lacking is disturbing, given the rise in “do not resuscitate” orders on care home residents in 2020. While the inquiry found that there was no government policy of denying treatment to people based on age or disability, it confirms that such orders were applied inappropriately. Ministers must ensure that this never happens again.
This is a report about a pandemic. But Andy Burnham, who has made social care reform an urgent priority, will surely recognise its wider implications. Arguably the report’s most important finding is the harm caused by the division between the NHS and social care, and the way that care home residents, and workers, became a kind of collateral damage in the battle against the pandemic. A recommendation for a transformed relationship between the centralised health system and the locally led care system would have sat outside this inquiry’s remit. But when confronting many of the problems it describes, one obvious conclusion to be drawn is that social care needs a stronger voice at the heart of government.
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