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The care homes catastrophe - File on Four

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If anyone hasn't listened to File on Four on Radio 4 but is interested in the (mis-)management of the pandemic they should certainly listen to this. https://www.bbc.co.uk/programmes/m000j81c

For anyone like me lucky enough to not have loved ones in a care home currently, as either a resident or worker, (or of course to work in one) it has felt a bit like they have become 'black boxes' where quite possibly dire things were happening but hidden away from everyone's view. The programme just brings some light to the situation and it is pretty damning. 250 outbreaks of Covid19 in care homes the week before lockdown, 500 more the week of the lockdown. NHS trusts putting significant pressure, paramedics threatening to call the police in one case, on care homes to take back discharged patients who either were suspected of having coronavirus or confirmed as such.

It feels very hard to escape the sense that the policies implemented successfully protected the NHS by actively condemning people to die in care homes. If that's not fair, why isn't it?

Post edited at 11:14
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In reply to TobyA:

> It feels very hard to escape the sense that the policies implemented successfully protected the NHS by actively condemning people to die in care homes. If that's not fair, why isn't it?

It's pretty hard to avoid that conclusion.  It was either a deliberate cynical policy of shipping elderly COVID patients out to die in care homes, irrespective of the risk to all the other residents, or a reckless indifference to what was an obvious possibility.  

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 Bob Kemp 22 May 2020
In reply to TobyA:

It certainly looks like there was a deliberate decision to offload cases onto the care homes to protect the NHS. Were they actively condemning people to die, or was that an unintended consequence? I'm ambivalent here... they are clearly less than competent and the latter is a distinct possibility. But I remember Johnson's 'take it on the chin'. I also wonder about Cummings' fascination with genomics and its eugenics possibilities, and that alleged remark about letting a few old people die.

(This is interesting on the Cummings-genomics-eugenics connections:

https://bylinetimes.com/2020/05/14/whitehall-analytica-the-ai-superstate-part-2-is-covid-19-fast-tracking-a-eugenics-inspired-genomics-programme-in-the-nhs/ )

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 Al Randall 22 May 2020
In reply to TobyA:

It was most definitely a questionable policy but the bit I don't understand is what was happening at an individual level?  Presumably Doctors had to sign off on this on a case by case basis. What were their motives?  Were they aware of what they were doing?

Al

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 jethro kiernan 22 May 2020
 baron 22 May 2020
In reply to Dave Garnett:

> It's pretty hard to avoid that conclusion.  It was either a deliberate cynical policy of shipping elderly COVID patients out to die in care homes, irrespective of the risk to all the other residents, or a reckless indifference to what was an obvious possibility.  

Given that most care homes are privately operated what mechanism would allow the NHS to offload people if the care homes were against that policy?

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 The Lemming 22 May 2020
In reply to TobyA:

Care Homes  and Nursing Homes are a true disaster and were sacrificed, or deliberately overlooked at the expense of the NHS.

Some may say, for the greater good.

With the speed that Corona virus swept through the world and the slow response and actions of a government focused on a generational change of trading with the world, then things had to be prioritised at the expense of others.

Sadly the elderly, weak and poor were at the bottom of that priority list in a rush to protect a nation.

Messy stuff for Pinky and the Brain.

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In reply to Bob Kemp:

I can't remember what it was based on but I read up on Byline Times after they published something earlier this year or last, and they are in my "suspicious" category now. I'll read the article carefully later, but definitely with a pinch of salt.

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In reply to baron:

Listen to the programme - as it covers that. From memory, LA funding agreements seemed one way and the fear that hospitals would refuse to take ill residents was another.

The report of a "stand off" at the front door of one home, with the paramedics saying they were going to call the police sounded troubling. According to the reporter, the care home manager was legally in the right - but was "emotionally blackmailed" is the term they use.

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 baron 22 May 2020
In reply to TobyA:

> Listen to the programme - as it covers that. From memory, LA funding agreements seemed one way and the fear that hospitals would refuse to take ill residents was another.

> The report of a "stand off" at the front door of one home, with the paramedics saying they were going to call the police sounded troubling. According to the reporter, the care home manager was legally in the right - but was "emotionally blackmailed" is the term they use.

So care homes themselves might be part of the problem?

This might not fit in with the theory that the government alone let old people die.

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In reply to Al Randall:

> It was most definitely a questionable policy but the bit I don't understand is what was happening at an individual level?  Presumably Doctors had to sign off on this on a case by case basis.

I think the policy was "clear the decks" in hospitals and care homes were told they would be safe taking covid19 patients out of hospitals, by PHE and the Ministry of Health. If true you can see that's the type of thing that would go from a public inquiry to criminal charges.

PHE have been "having a bad crisis" in the view of some experts, but I've read some saying the govt. is setting them up as the scapegoat, in the original sense. I suspect when senior people there start seeing Abraham, sorry, Boris sharpening his knife, a lot more info might start coming out rapidly.

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 mik82 22 May 2020
In reply to Dave Garnett:

I'd go for the Hanlon's razor approach.

Discharging people out of hospital as quickly as possible has been the blanket approach across the NHS for a long time pre-covid. Mainly this is due to lack of capacity, and partly due to the knowledge that the longer elderly people are in hospital, the more likely they are to pick up a hospital-acquired infection and die. (In "normal" times it is usually better for more frail residents, particularly those with more advanced dementia to stay in care/nursing homes, not be admitted at all, and to be cared for in the home)

I suspect this pre-existing approach of quick discharge to free up beds continued blindly without consideration of the risks of institutional spread and the inability of many care homes to reduce risks due to lack of facilities and PPE.

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In reply to jethro kiernan:

Heartbreaking. Who is our equivalent? And 'Break the chain' seems a rather more meaningful and inspiring slogan than 'Stay Alert'.

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In reply to Dave Garnett:

Yes, I'll listen to the programme again, but the bit about the 250 outbreaks in care homes BEFORE the lockdown seemed central because the point was PHE knew this and told ministers. Now I'm not certain from listening WHEN PHE knew and WHEN they told ministers - but in the best traditions of political scandals what did he know and when did he know it, might be the central question here.

BTW, just whatsapped you on a climbing related matter!

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 neilh 22 May 2020
In reply to The Lemming:

Do posters understand there are differences between residential, residential nursing and residential dementia .The average life expectancy of any person in a residential nursing home  is 3 years.

I would like to see the stats broken down  as to where the deaths in care homes occured..I will have a bet that it will be in nursing where most residents have alot of other medical issues.

They will in alot of cases have signed up for do not recusitate agreements.

Its not pretty in these environments. Most get a reasonable and competent standard of care.There are of course exceptions.But ultimatley if you have an active brain you figure out you are whiling away your time to pass away.You say it evry couple of weeks, another resident passing on, empty room, then a new person moving in.

Having had the experience of having my parents in these environements, it is not whichever way you look at it a nice peaceful way of passing on in your home in a family environment anyway.

Post edited at 12:15
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In reply to baron:

Have you listened? That's not what is implied. If care home groups are responsible for something it may well be it is for the death of workers who contracted covid19 after being asked to care for residents with the disease, but not given PPE.

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 baron 22 May 2020
In reply to TobyA:

> Have you listened? That's not what is implied. If care home groups are responsible for something it may well be it is for the death of workers who contracted covid19 after being asked to care for residents with the disease, but not given PPE.

I’m trying to determine if, as implied by several posters, the NHS/Government forced care homes to take patients knowing that they were Covid positive.

I’m coming from the viewpoint that responsibility for people in care homes comes from the care home providers in that while the NHS/Government has its own agenda care home providers can’t use that as an excuse, especially when they (care homes) are hardly novices at handling infections on a regular basis.

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 The Lemming 22 May 2020
In reply to baron:

>  care home providers in that while the NHS/Government has its own agenda care home providers can’t use that as an excuse, especially when they (care homes) are hardly novices at handling infections on a regular basis.

Problem solved, the NHS should have employed Care Home expertise to plan how to deal with the Corona Virus and patients with Covid 19, because they are hardly novices at handling infectious diseases.

Maybe they could have replaced COBRA and SAGE meetings as well?

Post edited at 12:53
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 neilh 22 May 2020
In reply to baron:

Prior to a resident being accepted, a senoir nurse at the care home will have visited the person and carried out an assessment. This will have identified the patients needs and whether the care home has the capacity/expereince to deal with it.

But for a long time now, hospitals have used nominated care homes as if you like wards for patients who are in need of long term care, to free up beds at hospital. So for example our local trust has an arrangement with 2 care homes where patients are moved to the care home, whilst future funding and future care plans are resolved.For example the person may be allowed to go home after improvements have been made to their  home environments. It would not surprise me if those care homes were put under pressure to take people. There again these homes are usually excellent. One that is used locally , was the most expensive in Cheshire if you went private.So not cheap and top of the range in terms of care quality.

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 baron 22 May 2020
In reply to The Lemming:

> >  care home providers in that while the NHS/Government has its own agenda care home providers can’t use that as an excuse, especially when they (care homes) are hardly novices at handling infections on a regular basis.

> Problem solved, the NHS should have employed Care Home expertise to plan how to deal with the Corona Virus and patients with Covid 19, because they are hardly novices at handling infectious diseases.

> Maybe they could have replaced COBRA and SAGE meetings as well?

So you don’t have anything sensible to add.

That’s OK, this is, after all, UKC.

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 baron 22 May 2020
In reply to neilh:

That’s my understanding of the situation in some homes.

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 The Lemming 22 May 2020
In reply to baron:

> So you don’t have anything sensible to add.

> That’s OK, this is, after all, UKC.

As much sense as you for saying that Care Homes and Nursing Homes should have the facilities in place to deal with an infectious disease and that a pandemic should be run of the mill stuff.

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 neilh 22 May 2020
In reply to baron:

All homes will do an assessment prior to accepting a resident.

It is not " some " homes.

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In reply to baron:

'’m coming from the viewpoint that responsibility for people in care homes comes from the care home providers in that while the NHS/Government has its own agenda care home providers can’t use that as an excuse'

Technically I understand where you are coming from; but practically and morally, of course the government had and has responsibility for what is going on in care homes, particularly in these extreme circumstances. For practically the whole of March the care sector was invisible, never mentioned in evening briefings, yet it was patently obvious that the residents were in the highest risk categories and would be decimated if action wasn't taken, action that individual care homes were unlikely to be able to achieve by themselves.

Well it wasn't and 10s of thousands have died sooner than they need to have done. It might only be by a few months - I think that was pretty much the Cummings view, he just couldn't find a felicitous way of expressing or selling it - but with additional training, testing, adequate PPE and assistance with quarantine arrangements - surely that number could have been significantly reduced.

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 baron 22 May 2020
In reply to The Lemming:

> As much sense as you for saying that Care Homes and Nursing Homes should have the facilities in place to deal with an infectious disease and that a pandemic should be run of the mill stuff.

Don’t care homes deal with infections like flu all the time?

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 Eric9Points 22 May 2020
In reply to baron:

In Scotland anyway, care homes are regulated by a government body called the care inspectorate who are responsible for making sure minimum standards of working practices are adhered to. 

Carnage has been wreaked in care homes, in Scotland at least, because of a lack of testing and a lack of PPE. The governments know this. In Scotland at least but probably also in England guidelines on PPE were issued to reflect the shortage of material, not best working practice. A senior manager in the care inspectorate estimates that deaths in Scottish care homes due to C19 are twice what they could have been if sufficient PPE were available and a proper test regime implemented.

We should have thrown up virtual ring fences around each home so that they started free from C19 and no one allowed in without having been tested. That hasn't happened. In order to test every worker in a care home on a regular basis, 90000 tests a day are required for the UK. Given that we are struggling to meet 200000 in total at the moment you will see the problem.

What baffles me though is why the unused Nightingale hospitals can't be repurposed as safe havens rather than sending old people back into unsafe environments.

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 baron 22 May 2020
In reply to neilh:

> All homes will do an assessment prior to accepting a resident.

> It is not " some " homes.

So some care homes must have evaluated people as suitable to enter their homes when they weren’t yet there doesn’t seem to be much criticism of these failures just it’s the government/NHS at fault.

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 fred99 22 May 2020
In reply to baron:

> Don’t care homes deal with infections like flu all the time?


You're seriously comparing CV-19 with the flu ??

God help us.

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In reply to neilh:

My understanding is that these patients were from those care homes and then had gone into hospital. The NHS's position was that they were returning the patients to their homes. The care homes accepted that these were residents, so the care home was their home, but they have an obligation to protect the other residents of the home and not accept the former residents returning from hospital back. This led to the standoff that is discussed in the programme.

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In reply to baron:

Not "evaluated" but rather "were forced" or perhaps were misled in some cases. Just listen to the programme.

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 Bob Kemp 22 May 2020
In reply to TobyA:

There was one piece that Byline Times produced that was controversial* but they're generally a serious source in aim if not actuality. Not like The Canary etc. although they do have an anti-establishment lean. A key problem seems to be that they're under-resourced so they can't do fact-checking, and I think they sometimes get a bit over-excited. They need to be a bit more circumspect. 

*This one...

https://fullfact.org/economy/short-positions/

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 neilh 22 May 2020
In reply to baron:

Yep. They insist on vaccinations. 

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 Bob Kemp 22 May 2020
In reply to baron:

> I’m trying to determine if, as implied by several posters, the NHS/Government forced care homes to take patients knowing that they were Covid positive.

According to the Telegraph they did:

"In two damning policy documents published on 19 March and 2 April, officials told NHS hospitals to transfer any patients who no longer required hospital level treatment, and set out a blueprint for care homes to accept patients with Covid-19 or who had not even been tested."

https://www.telegraph.co.uk/news/2020/04/24/care-homes-ordered-take-patients-suspected-coronavirus-nhs-hospitals/

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 BnB 22 May 2020
In reply to mik82:

> I'd go for the Hanlon's razor approach.

> Discharging people out of hospital as quickly as possible has been the blanket approach across the NHS for a long time pre-covid. Mainly this is due to lack of capacity, and partly due to the knowledge that the longer elderly people are in hospital, the more likely they are to pick up a hospital-acquired infection and die. (In "normal" times it is usually better for more frail residents, particularly those with more advanced dementia to stay in care/nursing homes, not be admitted at all, and to be cared for in the home)

> I suspect this pre-existing approach of quick discharge to free up beds continued blindly without consideration of the risks of institutional spread and the inability of many care homes to reduce risks due to lack of facilities and PPE.

This seems a very credible interpretation. Otherwise you have to reconcile the conflicting notions that the government was happy to accelerate the death of the over 70s by seeding care homes with the infection while simultaneously protecting the same cohort with a draconian lockdown of the working population at an astronomical cost to the state and the livelihoods and careers of the most productive members of society. It makes no sense. More likely this is a tragic lack of forethought on the part of all concerned.

Post edited at 14:03
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 The Lemming 22 May 2020
In reply to baron:

> Don’t care homes deal with infections like flu all the time?

FFS

This is not the Flu

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 neilh 22 May 2020
In reply to TobyA:

In those cases the family of the residents are usually involved as well.It is more complicated than portrayed.

I suspect there was the odd standoff, but implying this was nationwide and widespread practise is a bit a drift.Its not I would suggest normal practise, far from it.

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 baron 22 May 2020
In reply to The Lemming:

> FFS

> This is not the Flu

Obviously not but I was using an example of how care homes deal with infections on a regular basis.

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 The Lemming 22 May 2020
In reply to baron:

I think I will continue this line of discussion with the brick wall beside me.

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 baron 22 May 2020
In reply to The Lemming:

> I think I will continue this line of discussion with the brick wall beside me.

Please yourself.

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 neilh 22 May 2020
In reply to BnB:

Does not normally happen like that with the elderly who need nursing even before Covid. They are not discharged quickly out. . You cannot just go dumping people out in the community, irrespective of what people think.

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 The Lemming 22 May 2020
In reply to neilh:

Really?

Happened/happens quite a lot where I live and work.

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 freeflyer 22 May 2020
In reply to thread:

I'm broadly with the Lemming on this, but it's not a black and white picture. I've had two parents go through the care process in the last five years, and it's by no means all bad - at least, the patient is the focus at all times.

If the resident is 'not right', the home are usually anxious and want to send them to hospital to get an expert check-up. Early on this happens, much to the annoyance of the resident usually. The hospital fix whatever is wrong, monitor, do a discharge assessment, and send them back; often takes weeks.

Later, further visits may be avoided by push-back either from the family or on advice from the attending paramedic if it's relatively clear that the quality of life of the resident is becoming more important than the beneficial effect of any medical interventions; this gets tricky if the resident has dementia and is unable to say for themselves what they want, but in my experience the right thing happens.

So as a result you end up with a pretty large contingent of elderly occupiers of hospital beds who are there for fairly marginal reasons. These are the ones that would mostly have been sent back to their homes at the beginning of the crisis.

No doubt there may have been some infected patients discharged to care homes, but I'm pretty sure this wasn't the main vector.

It was, and is, the care staff.

These astonishing workers perform daily miracles on zero hours and minimum wage. The residents need to be got up, washed, dressed, breakfasted, sat in the lounge, cuddled, taken to the toilet, lunched, TVed, taken back to their rooms, undressed, put to bed, reassured, looked after.

There is very little spare time as there's always a staff shortage. There is no PPE that you haven't made yourself. You have no infectious control training at anywhere near the level required for the pandemic. If you get sick, you have the choice: go to work and infect the care home, or let your children go without supper.

These people need support; until they get it, I predict there will be few customers for care homes.

I'm a volunteer for one, and have lately been doing some door to door marketing armed with cup-cakes. The universal response has been a smile, a chat and a thankyou, and no, there is no chance of me going in there. Problem is, they will need to, or things will get bad and they'll spend ages at home in lonely misery and pain and either die at home uncared for, or end up somewhere that they haven't chosen.

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 neilh 22 May 2020
In reply to The Lemming:

Really?

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 neilh 22 May 2020
In reply to freeflyer:

I guess you are talking about their normal home. As distinct from a residential home?

Most of us at that age would prefer to be in our own home. 
 

 Nice volunteering. 

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 Offwidth 22 May 2020
In reply to neilh:

Try reading this.

https://twitter.com/lewis_goodall/status/1263219921124720640?s=20

When the CQC threatened care home owners who tried to isolate early (to protect their clients and staff) this is well beyond an unfortunate error and a clear government led scandal. 

In reply to TobyA 

Byline Times are small, so lack resources (and do sometimes make mistakes)  but so do big serious media outlets sometimes as well. I think they have been good and usefully independant on C19.

Post edited at 20:26
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 krikoman 22 May 2020
In reply to TobyA:

Mate of mine, who's daughter works in a care home, told me yesterday, they had a woman sent to her home who was CV-19 positive. Something Boris said doesn't happen anymore, just the other day.

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 yelotango 22 May 2020
In reply to TobyA:

As an `Allied Healthcare Professional` in the Welsh NHS for 30 years I`ve never seen so many elderly patients discharged to n/homes etc as quickly as I did in the short period pre-Covid (90+ beds emptied in the area I work, not including a large teaching hospital `down the road`). A few of these patients with asymptomatic C19 would have been the vector to infect other residents & workers at the discharge destination.

I`ve seen patients transferred from our 2 main sites to 3 other `peripheral sites` that have infected many others, one ward had >8 deaths & at least 14 staff infected as a result of these unscreened transfers. This was with trained staff & `approved PPE`, shudder to think what that R number was and how this would have affected a homecare setting.

I`ve also now seen a number of patients screened pre-discharge that have tested positive for C19 despite being asymptomatic. These patients have infected other patients & staff. I find it hard to believe we have not discharged asymptomatic C19 +ve patients to n/homes that went on to infect others.

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 wercat 22 May 2020
In reply to baron:

> So some care homes must have evaluated people as suitable to enter their homes when they weren’t yet there doesn’t seem to be much criticism of these failures just it’s the government/NHS at fault.


That really does not fit with the care home managers I heard on R4 when this hit the news several weeks ago.  At least 2 I heard in interviews were almost in tears at having to take people from hospital untested but with symptoms.  Emotion at the fanger to the people they were responsible for caring for and for the danger to their own workers.  They seemed to be saying they weren't being given a choice, perhaps lying?

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 wercat 22 May 2020
In reply to Bob Kemp:

that fits with the care home owners I've heard interviewed on R4 and seen talking on Look North, all pretty distressed.

> "In two damning policy documents published on 19 March and 2 April, officials told NHS hospitals to transfer any patients who no longer required hospital level treatment, and set out a blueprint for care homes to accept patients with Covid-19 or who had not even been tested."

but it seems government apologists are insisting that they are making it up.

Post edited at 22:32
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In reply to TobyA:

I'm going to get a lot of flak for saying this, but...

...care homes are where old people go to pass their final years. None of them are going to 'recover' and get young again and go back to how they were before. These are places we park people whilst we wait for them to die. It feels horrible to say it like that when it's your mum or dad - but from a national, policy-making level, that is what care homes are.

Now imagine you are preparing the NHS for an incoming flood of Covid19 cases. Some of these people can be saved from dying if they receive adequate hospital care - and go on to live for decades more if they do.

Do you

a) allow hospital beds and facilities to be taken up by old people from care homes most of whom will die anyway in the next 3 years

b) send them back to care homes, so that the NHS can treat the younger, more likely to live in the long-term, Covid patients who are incoming?

Remember that if you choose a), you are condemning many people from b) to die. Vice versa, of course. But this is the choice the was faced: just as doctors in Italy had to make decisions about who to ventilate and who not to ventilate using 'battlefield tactics', so the NHS basically has to do a version of the same. When making that assessment, they chose the young over the old. 

I suggest that this was indeed policy - and indeed was the right policy, given how things were in March. 

Now of course, maybe it should never have been allowed to get to that point in the first place. At which moment, I note that many of the people clapping at 8pm on a Thursday voted in the Tory Party at the last 4 times of asking. Ho hum.

But to say it's a scandal that the NHS sent care home patients back to care homes to protect the NHS - sorry, I don't see it. A gruesome Hobson's Choice, yes. But that is different.

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 wintertree 22 May 2020
In reply to wercat:

> but it seems government apologists are insisting that they are making it up.

I’ve been blown away by the effort the apologists have  gone to on UKC and beyond.  They’ve been notably absent from the last few threads.

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 freeflyer 23 May 2020
In reply to neilh:

> I guess you are talking about their normal home. As distinct from a residential home?

> Most of us at that age would prefer to be in our own home. 

It's not really relevant to their care where they are looked after, other than the cost of the care, and their mental state. Their physical and mental capabilities, as well as their wealth, determine how they are looked after. 

So Dad was looked after at home as his physical abilities allowed it, and Mum was in a home for two years after she had a fall, and was unable to stand thereafter owing to dementia. Dad was happy as Larry, even when he had to go to hospital. He was a bit worried at one point on the ward, and confided in me that we would need to consult the lawyers as they had converted one floor of his house into a hospital ward. We got through it.

Mum ended up in a home after her fall, and from the start, was desperate to go home again; this is the situation for 90% of care home residents. I would visit for a couple of hours and she would tell me how much she wanted to be at home; I recorded one of these rants for my family, however I hope they didn't listen to it. She was utterly unable to cope with her loss of control over her life and her situation, and her dementia meant that we were unable to explain it to her.

Dad once said to me: "Son, don't get old. It's shit."

We have a choice. We can block all this stuff out, and we can live forever. That is a rational choice.

If you decide not to do that, then you get to face up to getting old and dying, and deal with the consequences.

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 baron 23 May 2020
In reply to wercat:

> That really does not fit with the care home managers I heard on R4 when this hit the news several weeks ago.  At least 2 I heard in interviews were almost in tears at having to take people from hospital untested but with symptoms.  Emotion at the fanger to the people they were responsible for caring for and for the danger to their own workers.  They seemed to be saying they weren't being given a choice, perhaps lying?

I know bugger all about care homes.

I do have a brother who has been a nurse for nearly 40 years.

For a lot of that time he’s worked with old people and for 25 years he’s been a manager at a succession of care homes.

Currently he’s working in Cornwall.

His home has negotiated a few beds which are accessible to the NHS for people who are being discharged from hospital but are not fit to be at home alone. He, as the manager, decides if a person is suitable for admission to his home and if he deems a person to be unsuitable then the available bed stays empty.


My brother believes that some care homes, the not very good ones as he described them, have had a surplus of empty beds and have been all too willing to take people from hospitals in order to fill those beds and to make some money.

His home has a firmly established policy of not taking anyone who hasn’t been tested and because it’s possible to be tested negative but still have Covid 19, any people admitted from hospital are isolated for 14 days.

While my brother was on sick leave for a few days the owner of the care home admitted several untested people into the home and didn’t isolate them. Against the home’s policy but a nice moneymaker.

My brother resigned in protest.

Which I thought was very honourable but apparently my brother reckons that he can make as much money as a nurse in a nursing home as he did as a manager. So maybe not quite as honourable as I first thought.

This is my experience of care homes, not exactly extensive but it’s an account of the situation from a person that I know and trust. Whether or not it’s a true representation of what’s been happening across the care home sector I don’t know.

My point being that criticism of care homes seems to be limited to their failure to protect their staff when they should be under far greater scrutiny for their failures to protect their residents.

Of course this doesn’t excuse the NHS or Government failings nor does it apply to all care homes.

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In reply to yelotango:

Thanks for sharing - that's just shocking. Or not shocking at all because it's so obvious? God - I really don't know what to think.

So little of this makes sense - did the government think lots of younger people were going to get this and die, and they had to protect the NHS to have ITU capacity for them to try and stop that? Did because of lack of testing they have no idea that there were people in hospital with the virus and sent them back to care homes without really thinking about it?

They've tanked the economy, closed the education system and so on to protect... what or who exactly? But the steps to protect the "something" that I don't really get, seems to have led to the deaths of tens of thousands of people mainly in their 80s.

Sorry, that's me just thinking by typing - not aimed at you yelotango, or anyone else really.

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In reply to Paul Sagar:

But who got saved? Of course we all know of the tragic cases of people below age 65 dying - but people younger than 65 just aren't dying in big numbers. Whilst old people and particularly very old people are dying in large numbers.

Can we say lots of people under the age of 65 have been saved because there was capacity in ITUs? Maybe that's true, but if it is the case, that capacity was gained at the cost of literally tens of thousands of lives of people in their 80s and 90s. You seem more confident in that being a justifiable trade off than I am.

Photo snipped from https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsinvolvingcovid19englandandwales/deathsoccurringinapril2020

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 Offwidth 11:41 Sat
In reply to Paul Sagar:

Sorry Paul but that apparent dichotomy just isn't true. There was always the potential to rapidly set up facility for elderly patients discharged from hospital that did not involve going back to care homes (the vast majority of which were not set up to deal with those infected with C19). Something like Nightingales or even, as happened in some areas, repurposed empty hotels.

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 neilh 11:43 Sat
In reply to TobyA:

A couple of years ago I had to deal with both my parents who had after a good life to go into residential nursing and residential dementia homes.Both passed away in their respective homes.I became interested in it as it absorbs your life when you deal with elderly relatives.

Posters on here who have shared their respective similar experiences would probably understand that the social care system is complex, bewildering and varied.In some part of the country it has been revolutionised by the integration of social care with the NHS.Dorset I believe is a shining example.It has also been started in Greater Manchester.

Govts have for years shoved the issue on the back burner.We as a society shovel pass on our family responsibilitys onto the Govt. Nobody wants to pay for it.Pay is poor, but not probably as bad as alot of people make out( care homes run by say the Methodist church pay above minimum rates) and as their is a labour shortage care homes are having to up their rates.Nurses get good pay.It is a bewildering system.

Covid was clearly going to sweep through the sector. Its a target group for the virus. 60% of care homes have had no infections. That is impressive.I bet those in the sector could have identified before hand which homes are badly managed and it was those that were probably hit.There are about 53,000 homes in the UK, that is a hell of alot.

I am not surprised at the death toll to be honest. With such a virulant disease for that age and there being 400,000 or so in that category I am amazed its not more.

I do not think the govt made a deliberate policy, the high death numbers were going to happen.The only good thing that may come out is that the Gov may address the shortcomings in the sector.But it is a poisoned chalice as nobody will want to pay the true cost.Its going to take real political balls to sort it out.

Its not as though the UK is an exception in this for Covid. France, Spain and others have also had a terrible time of it.

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 Offwidth 11:49 Sat
In reply to TobyA:

We would have faced carnage if hospitals had been overwhelmed. In Italy C19 mortality rates soared where that happened and many more people died from normal medical emergencies. The old blocking beds had to be moved but not to care homes. As bad as the UK response has been an order of magnitude more people would have died from C19 with no response and all those others non C19 as they had no emergency access to a functioning NHS.

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 Offwidth 11:52 Sat
In reply to neilh:

The ONS show the UK terrible time in Care Homes has been the worst in the western world.

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 baron 12:01 Sat
In reply to Offwidth:

> The ONS show the UK terrible time in Care Homes has been the worst in the western world.

Nobody has a clue as to how many people in care homes have died from Covid 19.

People die, someone puts a cause of death down, might be Covid might not be. No proof or evidence needed.

How can anyone know what the exact numbers are when such a process exists?

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 Offwidth 12:09 Sat
In reply to baron:

The ONS numbers categorise all care home deaths with C19 on the death certificate and excess care home deaths. Other European countries have varied reporting but the data is there. The UK has the highest number of C19 deaths, the highest number of excess deaths and highest number of C19 care home deaths in Europe.

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 baron 12:14 Sat
In reply to Offwidth:

> The ONS numbers categorise all care home deaths with C19 on the death certificate and excess care home deaths. Other European countries have varied reporting but the data is there. The UK has the highest number of C19 deaths, the highest number of excess deaths and highest number of C19 care home deaths in Europe.

I’m not disagreeing about the number of deaths in care homes.

Just the way that attributing deaths to Covid 19 is done.

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 neilh 12:35 Sat
In reply to Offwidth:

Still shows that others have similar issues. It is not unique.

Theresa May was the only politician who recent committed to addressing the funding issue. She got completely roasted as a result. It was a reasonable idea.

The U.K. public is just not willing to face up to its responsibilities for the elderly.  

It will not change imho .

Bojo will run a mile from it when push come to shove. Too many other issues like the now defunct  economy to  deal with. 
 

Heartbreaking. 

Post edited at 12:37
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 Offwidth 12:36 Sat
In reply to baron:

Any way you argue it or look at state comparisons on totals, the UK is clearly top by a long way so what is your point exactly? Who claimed the numbers are exactly right?

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 Offwidth 12:40 Sat
In reply to neilh:

Well I care that we have done far worse than anywhere else on C19 in Care homes and I haven't lost a relative or friend to it.

Every PM in my memory has said reform is vital and they will do something about it.

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 baron 12:44 Sat
In reply to Offwidth:

My point is that the recording of causes of death in care homes is so hit and miss that trying to determine the actual number of deaths due to Covid is difficult if not impossible.

To then use such flawed data as though it’s an accurate picture might not help alleviate the problems that some care homes are facing.

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 Offwidth 12:49 Sat
In reply to baron:

In the hit and miss stakes it's more miss than hit. You can look at excess deaths to compare any gaps in C19 attribution. The UK also has the biggest unexplained gap 

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In reply to Offwidth:

BBC World Service's "The Documentary" had an episode on the Madrid care homes that got so badly hit a few weeks ago, very sad. And the Swedish health authority have publicly said they failed to protect care homes, but we need to know what any other country that has care homes on a similar scale to us, but who hasn't seen the sector hit like this, did. Germany? Do old people live in homes in South Korea, or more normally with families?

There does seem though from Italy and parts of the UK with big South Asian origin communities, that multi-generational families weren't necessarily safe either. It's so desperately sad.

edit: the Newsnight correspondent's twitter thread you linked above was very good. This is the report on Newsnight that came out of it for anyone else interested. https://www.youtube.com/watch?v=U8Rzc__mE7U&

Post edited at 12:54
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In reply to Offwidth:

> We would have faced carnage if hospitals had been overwhelmed.

I understand that but I'm trying to get my head around the question of did they way that we protected the NHS not just move the carnage elsewhere? To care homes? When you hear stories of homes where 60% of the residents die of covid19 or at least die with obvious symptoms - all within a matter of weeks of each other - and even in some cases their carers catching the disease and dying too - the "carnage" word seems appropriate.

I accept Neilh's point that it wasn't the government's policy to kill the elderly, I have a very low opinion of Cummings - but I wouldn't even attribute that to him - but when they said "protect the NHS - save lives" which lives were they trying to save?

If the Blair government bore at least some the moral culpability for the civilian deaths in Iraq that came in the civil war and occupation post-invasion (their intention was to bring freedom to the people of Iraq), does the current government not bear moral culpability for the death of tens of thousands of British elderly people? They intended to save as many lives as possible but their policy seems to have led to the opposite.

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 freeflyer 13:19 Sat
In reply to TobyA:

I think the Newsnight team are doing very good work at the moment, by and large. Perhaps that is because no government spokespersons are ever available for comment, and so rather than a barren series of accusations and denials, they are forced to find expert interviewees who provide information and insight.

Lewis Goodall and James Clayton have both done excellent investigative work; Goodall on excess deaths, and lately the issues in care homes, Clayton on whistle-blowing and PPE in the NHS.

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 neilh 13:28 Sat
 Offwidth 13:29 Sat
In reply to TobyA:

I agree we avoided a much worse situation with deaths in hospital by causing way more deaths in care homes. The solution would have been a temporary holding site as was implemented in parts of the UK using all that spare capacity (hospitals and hotels). This isn't just a current government issue, SAGE got things badly wrong, the previous government should have left us better prepared after Cygnus.

In contrast Blair knew the evidence on WMD was overblown and overruled advice. He's just plain guilty, alongside Bush.

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 Offwidth 13:34 Sat
In reply to neilh:

Again, so what? The excess unexplained care home deaths in the UK are much larger than France or Spain so there is no way we are not currently the largest number of C19 care home deaths in the world, even if numbers were more accurate.

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 baron 13:39 Sat
In reply to Offwidth:

> Again, so what? The excess unexplained care home deaths in the UK are much larger than France or Spain so there is no way we are not currently the largest number of C19 care home deaths in the world, even if numbers were more accurate.

If they are unexplained deaths how does anyone know what caused them?

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 BnB 13:47 Sat
In reply to Offwidth:

> Again, so what? The excess unexplained care home deaths in the UK are much larger than France or Spain so there is no way we are not currently the largest number of C19 care home deaths in the world, even if numbers were more accurate.

Depends where you take your data from. The European centre for disease prevention and control this week published the following figures for care home deaths as a proportion of the total:

UK 21%

Sweden 45%

Spain 66%

Belgium 51%

Norway 61%

Usual caveats around different statistical methodologies of course, but not supportive of your claim in any way.

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 Offwidth 11:52 Sun
In reply to BnB:

That's because I was talking about numbers not proportions. For proportions Spain and Belgium classify a much wider range for a C19 related death. Most of UK care home deaths are still not in UK official numbers from ONS.

Another key point is like much of the UK delayed response we failed to react to obvious advance warning from those countries hit really hard in their care homes on the continent, especially France and Spain.

Including Norway in your list, where very few have died, is plain idiotic.

Post edited at 12:00
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 BnB 12:23 Sun
In reply to Offwidth:

> Including Norway in your list, where very few have died, is plain idiotic.

I'll pass your comment to the FT, where the data was reported.

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 Offwidth 13:45 Sun
In reply to BnB:

I'm sure the FT would be delighted to know how you are misusing their excellent reporting.

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 BnB 14:02 Sun
In reply to Offwidth:

> I'm sure the FT would be delighted to know how you are misusing their excellent reporting.

Not so fast, Offwidth. Quoting the FT verbatim with inclusion of their caveat is not misuse. It’s responsible posting.  Read the article which entertains (I wouldn’t say asserts, it isn’t the thrust of the article) the idea that the media has been exaggerating the care home catastrophe.

Is Covid-19 a nosocomial infection?
https://on.ft.com/2yuhgZv

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 Offwidth 17:24 Sun
In reply to BnB:

England and Wales alone have now had over 20,000 excess deaths during the C19 epidemic in care homes according to latest data and you are idiotically comparing this with 235 C19 deaths in total in Norway; just because the percentage of deaths in care homes there is high. Why do you insist on deflecting from this UK disaster in such a way?

Post edited at 17:29
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 BnB 17:35 Sun
In reply to Offwidth:

> England and Wales alone have now had over 20,000 excess deaths during the C19 epidemic in care homes according to latest data and you are idiotically comparing this with 235 C19 deaths in total in Norway; just because the percentage of deaths in care homes there is high. Why do you insist on deflecting from this UK disaster in such a way?

I’m not. I’m providing a counterpoint brought to my attention by the rather authoritative FT, a newspaper which you today gave high praise and which presumably you’ve now read and recognised that I’ve not distorted the quoted article in any way, for which you still owe me an apology. Not that I’m holding my breath.

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 Offwidth 18:13 Sun
In reply to BnB

It's not a counterpoint, other than Spain, it's a distraction, as they are talking about something else (official percentage deaths in care homes of the country totals). I was comparing estimated total deaths in care homes where we almost certainly lead the world despite the lower official numbers. In per capita terms  Spain are similar and might have higher death rates in care homes, given the possible error ranges, but they were caught off guard. By that time we had advance warning of just how serious things could be, from them, we used it to continue to export infected patients into care homes and to get the CQC to threaten care home owners trying to isolate to protect their clients and staff. We also failed care homes on advice, PPE and testing. If you are going to compare government responses you need to look at all factors not just cherry pick the best lookng stats.

Show me where the FT contradict any of that. The FT have other articles that complain that the UK register a much lower proportions of excess care home deaths to C19 than other European nations.

Post edited at 18:39
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