It has been revealed that the Government rejected a PHE proposal on 28 April to “use NHS facilities and other temporary accommodation to quarantine and isolate residents before returning to their care home”.
So PHE was advocating part of what I have been suggesting since mid-April. But PHE doesn’t appear to have realised that it isn’t just residents who are returned, but ANY patients, including Covid-positive patients, who have been in a potentially Covid-infected hospital environment, who need temporary care until they return to their own homes.
Anyone doubt that hospitals are major centres of infection – Weston has been closed because of an outbreak among staff. If hospitals find this difficult to prevent, why are we pushing the task onto care homes?
Ministers told councils to “ensure that there is sufficient alternative accommodation as required to quarantine and isolate residents” – why isn’t Devon NHS using part-empty community hospitals, including Seaton and Axminster, for this purpose?
I was promised a written explanation of Devon CCG’s policy 11 days ago, but am still waiting.
Update on the pandemic in Devon, track and trace, and my campaign to end all hospital discharges into care homes
Exeter Nightingale Hospital site. Photo: Midweek Herald
I took part in an NHS webinar on 27 May. The latest situation is that the epidemic is waning in Devon, with about 50 Covid beds in use at the moment, compared to 200 at the peak 6 weeks ago. The Weston closure was due to an outbreak among hospital staff and is not impacting Devon.
In the short term, the Clinical Commissioning Group expect further improvement. Indeed it has been reported that there have been several consecutive days without cases in East Devon. However even a modest opening up over the summer could increase the ‘R’ level and they are planning for a second peak in September or October.
In the worst case for which they are planning, if R rose to 1.2, all 1200 beds available in Devon, including the new Exeter Nightingale hospital, could be occupied. This would mean many hundreds of extra deaths in Devon, far more than we have had so far.
This is the reason why it is essential to do as the Government says, not as it does, and keep up social distancing. ‘Shielding’ people are being asked to isolate at least until 30th June.
Track and trace
Together with some other county councillors, I have been pressing since mid-April for Devon to trial a new track, trace and isolate system. We argued that in view of the relatively low level of infection here, it would be possible to make it work more easily than in most areas.
Finally, we now have the Government’s agreement that Devon can be in the first group of areas for their new system, and I look forward to hearing the details of this. When this is working, we will have greater certainty than any local return of the virus can be eliminated.
Discharges from hospitals into care homes
The greatest national scandal of the last three months is the mass death in care homes. There have been over 70 outbreaks in Devon, about a dozen of which are still ongoing. In our local area, there are likely to have been more deaths in care homes than in the community.
Particularly outrageous was the national policy of discharging hospital patients, including those who had had Covid, into care homes without testing. Since mid-April, the rules have specified testing and also quarantining of Covid patients before discharge, which is a big improvement, but I remain concerned about the whole policy of discharges, since tests can give false negatives, and since the disease can last 7-8 weeks, flaring up after being dormant.
I have therefore continued to press the NHS and DCC to stop all discharges into homes, and set up separate ‘step down care’ for patients who are not ready to go home, e.g. in a community hospital. This should be organised now, rather than see problems return when there is a new peak of infections.
Newton Abbott hospital is to be a ‘Covid-free site’ – now can we have Covid-free step-down care, and stop discharges of people who’ve had Covid from hospitals into care homes?
I welcome this announcement by Torbay & S Devon NHS Trust: ‘We have been putting plans in place to provide care in other places such as at Newton Abbot Hospital which is a ‘covid-free’ site, this means that we are not using the hospital to treat people with the virus. As part of this at Newton Abbot we are now piloting thermal imaging with the help of the University of Plymouth to support keeping all our patients and staff safe. Anybody going into the hospital will pass a scanner that will detect a raised temperature, a key sign of infection.’
Now can we have the same consideration for care home residents, by creating special Covid step-down care and stop pressurising care homes to take people who have had Covid? This is particularly important in view of new information that some people suffer Covid for two months or more, with periods in which it appears to go away followed by ‘recrudescence’ of the disease. In this case, a 14-day quarantine may be insufficient. Separate intermediate care will also assist with the specialist rehabilitation which it is increasingly apparent many hospitalised Covid patients require.
70 Covid outbreaks in Devon care homes: nearly half are still active –
Today we commemorate the Allied victory over Nazi Germany in 1945, the Britons who gave their lives to liberate Europe, and the three quarters of a century without war between the major states in Europe which the victory produced.
That historic year was a moment of peace and unity in Europe, whose spirit continues to inspire people in Britain and across the continent to this day.
Seaton had played its part. Soldiers from the town died during the war, Seaton had been bombed, and British, American, Canadian, Free French and other forces were based at Seaton and other south coast towns until 1944, preparing for the D-Day invasion of Normandy, which began the liberation of Europe from Nazi rule.
They included, I think, some Czechoslovaks, since several are remembered in Seaton’s Remembrance Day commemoration each November. Ted Gosling, now aged 91 and possibly the only survivor of the town in the Second World War, will know the details. If Seaton Museum were open now it would be showing a special new WWII display which Ted has organised, and which I funded from my locality budget.
After 1945, European unity soon gave way to the Cold War between East and West, which divided the continent again. But since Germany and France were now part of the same Western alliance, and would never again fight each other, they together with other countries were able to begin the process of European unification which has now produced a European Union of 27 proud, independent nations.
It is a shame that Britain in 2020 is no longer together with the rest of Europe. But we can still remember that day in 1945 as a common achievement which has brought us all peace.
The only reliable way to safeguard care homes from hospital-introduced infection is to stop all discharges direct from hospital
15,500 more deaths registrations than normal occurred in England and Wales’ care homes between mid March and April 24. On average in weeks 11-17 in the last 5 years there were 15,670 care home deaths. In 2020, there were 31,200 deaths.
It has been widely acknowledged that sending patients discharged from hospitals into care homes has been one contributory factor to this tragic crisis. Yet even now, the Government are still asking care homes to take patients who can be discharged from hospitals but are not ready to go home.
Implementing this policy, Devon County Council is offering homes which take these patients an extra 4 per cent on their commissioned placements. I have been told that important safeguards have been introduced:
- All patients are tested before hospital discharge, and the care home notified of the test result. In many cases the individual will have been in hospital for the full 14 day isolation period already. Even if the test is negative but patients are showing symptoms they are likely to remain in the hospital for the isolation period.
- In all cases of people discharged from hospital to care homes, even if tested negative, the home is advised to isolate the individual for 14 days for the safety of other residents.
- Care homes continue to have the right to refuse any admission if they don’t feel able to provide the right care and support.
However the fact remains that homes are being encouraged to introduce patients who have been in a hospital environment, where Covid is present, and who may have had the disease themselves, into care homes.
The terrible tragedies of the last two months have shown that care homes are not suitable environments for discharged hospital patients in this pandemic. Care home staff are not trained to manage highly infectious diseases and buildings are not adapted for this purpose.
- While the new testing and transfer arrangements are a real improvement, as many as 30 per cent of tests may give false results, and it could be that false negatives are particularly likely to occur in asymptomatic patients.
- There are confirmed reports of infection after 21 as well as 14 days.
Equally, while it is good that care home managers have discretion, they may well feel pressured to take patients. Given the financial difficulties of the sector, the incentive may be difficult to resist.
Advising care homes to isolate the patients is not the same as the NHS keeping them in a properly managed clinical environment. Since I gather that numbers of Covid patients in hospitals and of new cases are declining, I do not see the need for any patients to be discharged to care homes during this pandemic.
If patients cannot be kept in the non-Covid areas of acute hospitals, they should be transferred to dedicated wards in separate facilities, such as community hospitals or private hospitals, where proper clinical control can be maintained.
We are probably only at the beginning of the pandemic, which could last at least a year. It is therefore essential that we adopt the best possible procedures now to avoid any repetition at all over the coming months of the disastrous spread of Covid among vulnerable care home residents which has happened since March. This surely follows from our duty of care.
I have therefore asked the Council to request the NHS to develop procedures which avoid any discharge of patients direct from acute hospitals into care homes, and to withdraw the proposed incentive.
The epidemic hit some local care homes badly after developing in East Devon in March – but the lockdown stopped a wider spread.
I am now in a position to report further on the Covid situation in care homes and the local community.
Outbreaks occurred in several care homes in Seaton and surrounding towns at the end of March/beginning of April, reflecting people having become infected earlier in March before the lockdown was imposed. A number of people are believed to have died. (The national graph above shows the drastic acceleration of deaths in care homes in the first two weeks of April; most ‘other excess deaths’ are probably Covid-related but not recorded as Covid.)
More critically ill in their 50s than 70s, according to hospital data. Overall Covid mortality TWICE the Public Health England figures, i.e. 30,000+.
The Government has belatedly changed its advice in its new TV ad, aired since Easter. it now says that Covid-19 is ‘life-threatening to people of all age groups’. Previously it had said that ‘the over-70s’ and people with serious conditions were ‘the vulnerable group‘.
No explanation has been given for this change, but the diagram above says it all. According to a report from the Intensive Care National Audit and Research Centre, up to 3rd April there were more people in their 50s critically ill with Covid-19 than in their 70s, and more in their 30s and 40s than 80s.
The figures will underestimate the number of 80+, because many are dying in care homes or at home without making it to hospital. However the message is still clear – and sobering.
Overall death toll now over 30,000, headed for 50,000
Indeed, the Cumulative Mortality Investigation (CMI) of the Institute and Faculty of Actuaries estimates (page 5) that overall there have been TWICE the number of deaths reported in the daily hospital counts. When Public Health England reported 15,400 deaths, the CMI estimates that had been 26,000-32,000 excess deaths.
Now that PHE are reporting 18,000 deaths, the likely real total would be in the range 29,000-35,000, and heading to over 50,000 for this wave.
The excess deaths include many people who have died of Covid but where Covid has not been put on the death certificate.
Our proposal for mass testing and tracing in the SW is gaining traction. Time for Devon MPs and councils to act.
- We are NOT pressing for a regional release of the lockdown at this stage.
- What we ARE arguing is for a large-scale return to testing, tracing and monitored quarantining of those who are infectious and their contacts, as advocated by Exeter University’s infectious disease expert Dr Bharat Pankhania.
- This would need not only a lot more tests but also rapid expansion of testing and tracing teams beyond the Public Health team, using district Environmental Health staff, and recruiting many others.
Beer-based Pecorama are making these ear guards, free of charge, to help carers wearing face masks for lengthy periods. They are being used and much appreciated in one local home where a resident has had the virus.
Email me firstname.lastname@example.org if you are a carer or care home manager and would like Peco to supply you with some.
They are based on a design produced by an enterprising school in Scotland and a video explaining them can be found at https://www.youtube.com/watch?v=QVpMvQpwgVM