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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.


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?

By 999 Call for the NHS, Mar 28 2020 04:33AM

The new COVID19 Discharge Service Requirements issued last week to Foundation Trusts and other NHS England Management had one very clear message - “forget the usual Discharge Process - get the beds empty within the week by Friday 27th March”.

15,000 beds to be exact. Hospital beds cleared ready for the aniticipated rush of Coronavirus cases. A mantra found throughout the guidelines is “ The default assumption will be discharge home today”.

This week the Health Service Journal announced that a senior health policy spokesperson told them the guidance “basically amounted to orders which say: whatever it costs, get people out of hospital.

"Don’t worry about the rules, just do it.”

We asked a recently retired Senior Nurse “Could the beds be cleared in a week?”

Their reply: “Possibly, ward nurses are used to this sort of pressure and there will be a relentless push from the top down. I don’t see this as being very different in practice for ward staff - the discharge co-ordinator will bear the brunt because they will have to really push for discharges, but ward staff are used to that.”

So where are these patients to be transferred to?

Well 1% for whom there has been a life-changing event( car crash etc) and HOME is not an option they will be found a bed in a nursing home or residential care home. But there is a problem there lurking... more of that later.

According to the Discharge Assessment guidelines Pathways 0,1, 2 those heading for home will be met by vast teams of smiling, able and willing nurses and carers, supported by coordinators and managers.

In the Hospital there will be :

Dedicated staff to support and manage

Social care colleagues

Case managers responsible for ensuring individuals and families are fully informed of the next steps, arranging transport and ‘settle in’ support

Senior clinical staff to support with positive risk-taking

Out in the community there will be:

A single coordinator which is the community provider

A case manager allocated by the single provider

Assessment of longer term care packages

Social care and community staff

Multispecialty Community Teams

Voluntary organisations and their volunteers

It’s a miracle really. Out of nowhere there are suddenly a wealth of bodies to take up the challenge - like pulling rabbits out of Top Hats.

So wondrous is it that you even get a leaflet to help you cope with one thing.

“Due to these pressures, once you no longer need care in hospital, as decided by the health team looking after you, will be discharged. You will not have a choice over your discharge, but it is always our priority to discharge people to a safe and appropriate place”.

“Is your HOME truly a safe and appropriate place?”

Well 99% of those being pushed out this week are about to find out. Anyone who has tried to care for a terminally ill or seriously sick patient in a living room without proper equipment, space or adequate training will tell you that lifting, turning, feeding and toileting and medicating in the home is a painful and almost impossible task.

For the 1% - those pesky difficult patients who can’t go home and require bed treatment to continue on Pathway 3, the NHS will cover costs and pay nursing/care homes to take the patients. The sticking point has proven to be that patients are not being routinely tested on leaving hospital. Ethically speaking how can a care home/facility - inhabited by elderly and vulnerable residents - take a possibly infected patient into their home?

The same troubled scanerio is playing out in California It’s a real risk and tensions have already emerged as care and nursing homes have refused to accept discharges unless the patient has been tested for the virus. Testing is not a requirement under the new Discharge Service Requirements. WHY?

The former Senior Nurse continued: “Nursing homes will be forced to take people on the basis of this new process, they will have a stick to make it happen somewhere in those guidelines, community nurses will absorb the volunteer force to get people home and set up... definitely not something I approve of”.

Money may also be a concern for GPs and their community teams - already in short supply with new recent contracting cutting their funding - but a bigger concern right now is whether they are supported by functional and required standard Personal Protective Equipment.

Some NHS Staff have resorted to SCREWFIX and paying for their own masks - which is a disgrace. And GPs say they and their staff are being placed in danger with no quality equipment in their possession and little sign (despite ‘sincere’ announcements from Health Secretary Matt Hancock) of new supplies coming anytime soon.

Ironically one Nurse Practitioner in a Community Surgery setting was struggling with this week’s activities on a very different front - going digital has meant surgery doors are shut and there are no face to face appointments. She is only too aware that there are patients in her community suffering because of this - including cancer patients who are now facing cancelled operations due to hospitals being instructed to focus only on COVID19

“I’m feeling guilty because I’m not actually doing anything. Lots of online planning meetings but in terms of helping patients - nothing. Safety nets and ordinary practice standards are at an all time low and that is a big risk. The strain on the system as a whole and our already strained response times and access issues are at crisis in terms of patient safety. And of course next week we are being asked to run ‘hot and cold’ surgeries - hot meaning face to face appointments with little or no safety equipment”.

So hospital staff struggling with stressful 80hr weeks don’t feel supported.

GPs and their staff don’t feel supported.

What about the new Army of 405,000 volunteers who are now stepping into the warzone? Will they feel supported? 405,000 is a big number - and just what NHS England have been pushing for in their Long Term Plan.. more volunteers!

The Nurse Practitioner is not impressed. “It’s another huge worry. Who's going to vet them? Who’s going to train them? Who's going to manage the potential draw of "unsuitables”? For sure, many genuine folk will want to help but potentially it’s a magnet for trouble.”

She is not alone in being concerned about the New Model Army of Volunteers. This Community Pharmacist is in a state of shock after an NHS England online webinar on the new measures. Volunteers bring with them enthusiasm, eagerness and an ability to not understand protocols... and he is genuinely worried they could (through lack of understanding) harm people and themselves.

So the year 2020... Enter Covid19

This article is not intended as a moan about the faults of how this pandemic is being dealt with by the establishment - the misinformation, the ambiguous statements about what to do, what the medical facts are etc. Dealing with this pandemic is surely consuming huge amounts of energy, stamina, nerve and a lot of failure, especially when we are at the mercy of politicians whose ‘dead behind the eyes’ behaviour is the result of never having dreamt their comfortable power could be threatened by a spiky little virus.

A new, spiky little “clever virus” that has raised the issue of the need for properly funded preparedness and a distinct need for hospital space, acute beds with strong robust teams of staff. So much so that, following Italy and Spain, we too are now setting up a ‘field hospital’ - in the shell of ExCel Exhibition Centre with 4000 beds. Since this article began it now appears Birmingham, Manchester are also to get their own field hospitals. What about the rural areas? Shame all those community and cottage hospitals that dotted the land have been got rid of - sold at a low price to developers of bijou apartments for the wealthy.

This must be at the back of Simon Stevens’ mind too. Last year, June 2019 NHS England CEO, Simon Stevens, had a wobble and claimed, ironically, that bed cuts “had gone too far” in a presentation to NHS Confederation “the membership body that brings together and speaks on behalf of the whole NHS”.

Stevens was having an ironic wobble because he knew only too well about the cuts. He’s helped lead and design them since his appointment in 2014. His 5 Year Forward View and recently a ten year NHS Long Term Plan have created an axe-wielding wolf dressed up in a little pink frock chopping beds and hospitals in every direction called “Moving Healthcare Closer to Home” .

He probably learnt all about “Care Closer to Home” during his 9 year residency with (wait for it)... United Healthcare, USA’s largest health insurance company and major global health market player. There he was CEO of UH Medicare and President of Global Strategy. Stevens is the hatchet man for a process that has been going on since the 90’s as we have drifted quietly toward the USA model. It relies on what it calls “prevention” and “integrated care” and the tools are community care, preferably in your own bed, digitech and data and a big push to find more use of volunteers (free labour) in the system. That won't mean saving money it will just mean more of the public money going into the hands of the providers controlling the system.

We have to face the fact that our NHS, a once world-leading public health system, available to all, that set global health standards in mid-20th Century is now, in 2020, a fragmented and broken system as a direct result of three decades of continual neglect by successive governments who have fallen for the corporate philosophy of the likes of McKinsey, KPMG, Price Waterhouse Coopers and Deloitte. Fallen for the lie that public services are ineffective, expensive and bureaucratic and that business and the ‘free’ commercial market know better and could drive down costs and improve quality.


Lies that have motivated massive spending cuts, hospital closures, restrictions to the comprehensive menu of treatments, sold off public assets to developers, and reduced hospital beds by over 50% over thirty years. That’s a lot of beds that might have come in handy at this point in time.

Kathryn H Jacobsen, summed up her Global Health Report “Will COVID-19 generate global preparedness?” for the George Mason University with:

“The COVID-19 outbreak is yet another reminder of the necessity of intensified and sustained commitment to global public health preparedness. The world does not need more evidence of the health, social, economic, environmental, and other problems that arise when we fail to invest adequately in global health security. What is required to break this panic-then-forget cycle is to follow through on prioritising, funding, and implementing preparedness interventions.”

Here in the UK we must not panic then forget. We must remember that the NHS that bloomed in 1948 onwards offered everyone protection and support in such times as this. The NHS before outsourcing, contracting and corporate profiteering, with a coordinated and connected relationship to a Public Health Department and Social Care Department, would be dealing with this pandemic in a very different and more effective manner.

And looking to the future we need a service like that again. We don’t need a health industry or market run by businessmen obssessed with growth and shareholder profit.

We need a health service that knows and respects the human “Art of Caring”.

The world needs that again.


In one week of lockdown this pandemic has enabled this corporate slave government to push through exactly what it has been pushing for the last eight years since the 2012 Health & Social Care Act - Non-hospital Care, Digitech and Charity volunteers.

You might think we’re crazy but the question we have to ask ourselves is:

“Are NHS England using this pandemic to justify their Long Term Plan?”

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