In an open letter sent by Care England and four other leading charities to the health secretary, Matt Hancock, one shocking paragraph stands out. “We’re seeing people in [care homes] being abandoned to the worst that coronavirus can do,” it reads. “Instead of being allowed hospital care, to see their loved ones and to have the reassurance that testing allows; and for the staff who care for them to have the most basic of PPE, they are told they cannot go to hospital, routinely asked to sign ‘do not resuscitate’ orders, and cut off from families when they need them most.”
The anger and despair contained in these lines is palpable; the words convey a sense of betrayal felt in a longsuffering sector. Care home employees are used to being underpaid, under-resourced and undervalued: there has, over the past decade, been wilful neglect of the social care crisis by governments wary of the financial costs of reform. But given the disproportionate impact of Covid-19 on the elderly, it was surely legitimate to expect a new focus and grip from Westminster as the virus took hold. Instead, care homes continue to lack basic essentials as the disease sweeps through a vulnerable elderly population of 410,000.
The chief medical officer, Chris Whitty, has said that 13.5% of care homes have now reported coronavirus outbreaks. Following the publication of new Office for National Statistics figures, the work and pensions secretary, Thérèse Coffey, estimated onTuesday that “about 1,000” residents had died during the epidemic. These statistics are dismal enough, but they may well be underestimates. In the absence of adequate testing, it is impossible to be certain of the extent of the crisis, or to properly monitor its progress. MHA, a major provider which runs 131 homes, has said that coronavirus is present in half of its facilities. Data from European countries, including Ireland, Belgium, Spain and Italy, suggests that roughly half of all Covid-19 deaths there have taken place in residential care. We may only be at the beginning of understanding the depth of a crisis taking place behind closed doors.
In their defence, government officials and advisers stress the complexity of attempting to supply and respond to the varying needs of over 11,000 homes dispersed across the country. But from the beginning of the crisis, this task has at times seemed a second-order priority, as the drive to ramp up NHS capacity preoccupied ministers. The failure to foresee the importance of testing kit in care home environments, where fatal cluster effects were particularly likely, was a serious mistake. Almost unbelievably, it was reported on Tuesday that only 505 social care workers had been tested for coronavirus by Easter Monday, compared with nearly 48,000 tests of NHS staff and their families.
The continued patchiness of the provision of personal protective equipment, despite Mr Hancock’s pledge to solve this problem by the end of last month, has compounded the risks being run by residents, carers and their families. There have been reports of frightened employees refusing to come to work. Others are self-isolating, unsure whether they have the virus or not. In a sector already facing a recruitment crisis as a result of long hours and low pay, a moment of maximum peril is being confronted with a bare minimum of resource.
Last month this column described the social care sector as the neglected frontline of the Covid-19 epidemic. Three weeks on, the evidence suggests that its needs and priorities are still not being met, in the gravest of contexts. On Tuesday, the Care Quality Commission said it will begin to record the number of Covid-19 deaths in residential homes. How it will do so given the low rate of testing is unclear. But the commitment is at least welcome for the belated message it sends. The former work and pensions minister, Ros Altmann, said on Tuesday that the mark of a civilised society lay in how it treated its most vulnerable and oldest citizens. Many of those citizens live in our care homes; they, and the dedicated people who look after them, have been let down.
