By 999 Call for the NHS, Apr 17 2020 06:02PM
NHS Wonderland is not looking so good.
Never mind “Care in the Community”, the forced exodus of 15,000 acute care patients from hospitals, following instructions from NHS England on 19th March, has created a potential “catastrophe in the community” that we are only just beginning to witness. Four weeks later the mainstream media has finally recognised that moving untested patients into the community is having a huge impact on death rates (not counted in the Daily Lies at 5pm) for the UK. First the clearance of 15,000 acute beds and now the trickle of Covid19 Survivors being returned to big wide world where "Care Closer to Home" awaits.
The big problem lies with what is known as PATHWAY 3 - the road for those patients who, due to injuries or life-changing illness, require follow-up nursing care not just family and an occasional visiting health worker. This care must be in a care home - largely provided by the private sector these days and NHSE will pay for it.
So what’s the problem?
These patients were not tested on leaving and although care homes have bedspace available how can they accept potential covid19 carrying patients into their buildings - inhabited predominantly by elderly, infirm and vulnerable adults? Plus there are now the COVID19 Survivors needing rehabilitation space.
The problems facing NHS Staff in hospital Intensive Care Units - lack, shortage of WHO Personal Protection Equipment and no strategic testing - is the same in the care sector which, it’s fair to say has been seen as the lesser service but where the impact of Covid19 could explode at any moment. The Care Home sector is yet one more maze of private providers who operate mostly out of profit seeking and are financed by hedge funds and corporate investors. And the definition of what these homes do has become confusing for many.
As one Care Home nurse told us: “Some are residential homes, which means residents don't need a nurse looking after them. Nursing homes require a nurse on duty 24/7. Many homes are dual registered, so take residential and nursing clients. District Nurses still go visit the residential (more well) residents to do dressings, etc and the nurses employed by the home look after their nursing residents, those who have more complex needs....insulin controlled diabetics, severe dementia with psychoses or unpredictable behaviour, requiring medications to stabilise for example. That's why the favoured term is "Care Home" nowadays, because not all residents are ‘nursing needs’”.
NHS England seemed to be issuing instructions to the (largely private) social care sector that they should take patients who may or may not have COVID19. NHSE will fund this - it says in the 19th March instructions. But care homes are not being supported to quarantine the new patients - requiring designated space, equipment and nurses. And there has been little or no clear guidelines from NHS England or Public Health England about procedures. The nurse continued:
“We are simply carrying on as normal as possible and trying to maintain normality for our residents, but we are receiving admissions from hospital, who are likely infecting the rest of the home and staff and so it goes on. Freeing up hospital beds, which have been cut to the bone, hence the reason we are in this mess in the first place”.
Carrying on as normal, as best they can, with a duty to care for their patients and residents - but putting themselves, their families and the entire care home community at risk. The reports are emerging thick and fast. The 13 residents in Glasgow who passed away in 2 weeks due to COVID19. The 15 care home residents in County Durham. Another ten in Cornwall to name a few.
COME INTO THE GARDEN MATT
While the Government continue to paint a rosy picture of everything going to plan and providing sufficient PPE for NHS Staff it is not clear if they include District Nurses and Care Home Nurses in this scenario - or even if they are aware of the calamity. It is apparent though to many community groups around the country who are busy making home made visors, scrubs, and raising money to purchase face masks and visors for their local teams of community health workers.
Asked why they were taking on this challenge, one group representative in Grantham said:
“We have care homes who have been in the local press due to having covid patients and their staff of 30 are sharing around 10 face shields! This is clearly dangerous and it upsets me to hear our local heroes crying out for help but finding their cries are falling on deaf ears from higher management and government organisations. Locally we’ve have raised money to ensure that our community and NHS health workers have as much protection as possible and staff are so grateful for our efforts.”
Unless full PPE and quarantine conditions are in place how can a care home manager, with any conscience (and let's be honest has to protect their shareholder interests), introduce a potential COVID19 carrier into a residential home with a community made up of those most susceptible to it? And it is clear now that the complex nature of the privatised, largely unmonitored and uncoordinated care sector is a breeding ground for chaos not just a virus.
April 15th, in the face of open and widespread criticism of the lack of planning regards the Care Home and Social Care sector the Government issued a Press Release which sounded promising:
Government to offer testing for “everyone who needs one” in social care settings
All care home residents and social care staff with coronavirus (COVID-19) symptoms will be tested as capacity is built up, the government is announcing today.
All symptomatic care residents will be tested for COVID-19 as testing capacity continues to increase
All patients discharged from hospital to be tested before going into care homes as a matter of course
All social care staff who need a test will now have access to one with the Care Quality Commission (CQC) to contact all 30,000 care providers in the coming days to offer tests
Matt Hancock said quite clearly: "Testing is key in our battle against coronavirus, and as part of our plan to prevent the spread and save lives we will ensure that everyone in social care who needs a test can have a test."
However we will be digging into this as already staff are finding, on reading the testing application forms, that "everyone in social care who needs a test" comes with eligibility criteria attached. More to come in another post.
Returning to our care home nurse we wanted to find out if the new Royal College of Nursing guidelines - advising nurses not to work in situations without PPE that they felt were dangerous - applied to the care home setting too.
She replied: “Of course they do. I've already told my manager that I will not be treating residents with confirmed COVID 19 without appropriate PPE. Some of our residents survived two world wars and have sold their own homes and pay on average £1000 per week to stay in these homes. We must protect our current residents. The CQC drum it into us that this is the residents home. It is not ok to bring a threat into their home Without appropriate reduction in risk. So be it.”
Matt Hancock was asked this morning at the Health Select Committee "How will you support staff to feel safe in their work environments?" It was astonishing to hear the Secretary of State for Health say with no shame or embarrassment...
"Well I'm very pleased that the Care Badge has been received with enthusiasm".
That's alright then . No PPE but you can have a little green enamel badge. Is it any wonder staff are angry?