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Revealed: Care homes were told outbreak 'very unlikely' even as coronavirus cases hit 800
Public Health England advice for care homes on how to protect elderly residents from coronavirus was not updated until mid-March
When Health Secretary Matt Hancock tried to placate growing anger over the spiralling death toll in care homes last week, he told journalists: “Making sure that care homes have the support they need has been absolutely at the front of mind right from the start.”
However, The Sunday Telegraph can disclose that the Government was still telling care homes that the risk of infection from coronavirus was “very unlikely”, even when there were nearly 800 confirmed cases of the disease in Britain.
Public Health England’s ‘Guidance for social or community care and residential settings on Covid-19’ was published at the end of February and remained the only government advice for care homes on how to protect elderly residents from coronavirus until mid-March.
In unequivocal language, it stated: “It remains very unlikely that people receiving care in a care home or the community will become infected.”
At the point it was issued, there were still just a handful of coronavirus cases in Britain, thought to have been contracted abroad.
But in the two weeks it took Whitehall officials to withdraw the guidance, that tally quickly escalated. Some 798 cases of coronavirus had been confirmed in Britain by the time it was withdrawn on March 13. Ten people had died.
For those two weeks, care homes were advised, “Currently there is no evidence of transmission of Covid-19 in the United Kingdom. There is no need to do anything differently in any care setting at present.”
The document also told staff they did not need to wear masks during "day-to-day activities", and that these were only required by “infected individuals” if specifically advised to do so by a health worker.
Perhaps unsurprisngly, care home owners now claim that the Government advice issued in February gave them a “false sense of security”.
Mike Padgham, chair of the Independent Care Group which represents care homes across north Yorkshire and owner of Saint Cecilia’s Care Group, said: “The advice we have been given since the outset of coronavirus has been unclear and at times inconsistent.
“At the beginning we followed the experts and we had a false sense of security. As time went on we could see what was happening in Europe so we locked down much earlier than the government said."
On Saturday, the Government defended its record, saying that it had changed its early advice as soon as there was evidence of “widespread transmission”.
A spokesman for the Department for Health and Social Care said: “The initial advice accurately reflected the situation at the time when there was no community transmission, meaning there was a limited risk of the infection getting into a care home.”
“Once there was evidence of widespread transmission and we moved into the ‘delay’ phase on March 12, new guidance was immediately put in place. Any suggestion that we said that infections in care homes would be unlikely in the current phase of the outbreak is wrong.”
Meanwhile, Public Health England stressed that all of its guidance is based on the latest scientific evidence.
Professor Paul Johnstone, National Director, said: “As the pandemic develops, evidence and advice evolve and guidance is actively updated to reflect that. The care homes guidance we produced in February was related to what we knew at the time, and with further evidence, it was updated in March.”
However, the revelation that the advice remained in place for so long is the latest evidence of a series of missteps which may have contributed to the spiralling coronavirus death toll care homes now face.
Last week, the Care Quality Commission confirmed by April 24 that it had already counted 4,343 Covid-19 deaths in care homes in England. It was grim news made grimmer by warnings from experts that the peak was yet to come.
As revealed by The Telegraph last week, care home operators have linked the scale of the outbreaks to two policy documents which together ordered NHS hospitals to transfer hundreds of elderly patients to care homes without necessarily being tested.
In guidance since branded “reckless”, Whitehall officials also reassured care homes that they could take in coronavirus patients as long as certain measures were put in place.
However, the Government may never have needed the extra care home beds at all if ministers had heeded advice they were given as part of pandemic planning.
The Sunday Telegraph can disclose that they were warned three years ago of the need to bolster the ability of care homes to cope with a pandemic.
In 2017, government advisers identified the need to bolster the "surge capability" and "operational resources" of both the NHS and social care sector.
While giant Nightingale hospitals have been set up across the country to help provide thousands of additional intensive care beds, MPs have questioned why an equivalent scheme was not put in place for care home residents who contract the disease.
The need to make additional plans for care homes was raised in a discussion of the New and Emerging Respiratory Virus Threats Advisory Group (Nervtag), which advises the government on pandemics. Minutes from June 2017 setting out "lessons learned" from Operation Cygnus, a major cross-government test of its ability to handle a severe pandemic, list four "key issues", including: "The need to strengthen the surge capability and capacity in operational resources in certain areas. If demand outstrips local supply, there will be a need to scale up the response, for example to regional level. This was particularly true for excess deaths, social care and the NHS."
Last week, Liz Kendall, the shadow care minister, said: "We have to provide alternative care. There's a real urgent need to look at any spare capacity there is at facilities like the Nightingale hospitals to see if they can care for residents.
"Care home staff are being asked to do extraordinary things. They're very skilled - but we need to make sure that care homes are not turned into hospices because that's not what they are there for."
A Telegraph investigation also found that whilst the Government drew up plans telling care homes how they should handle pandemics and flu outbreaks, these centred on ensuring infection did not escape the homes – not on ensuring it never got into them.
One such paper, “Guidelines on the management of outbreaks of influenza-like illness in care homes”, published in 2018, advises that “care home... closures to new admissions may be considered for at least five days after the onset of the most recent case to avoid transmission risk”.
But, it adds, the decision to re-open would hinge on “how easily the home could maintain isolation for such individuals while re-opening to new admissions” - that is, how well it could contain the infection already present.
Other documents – including the 2012 “Health and Social Care Influenza Pandemic Preparedness and Response” – make it clear that at least some care homes would remain open to infected residents.
In a harbinger of the disaster still unfolding up and down the country, the same document also instructs care homes to ensure they have plans in place to manage “additional deaths, including storage of bodies if necessary”.
The Government preparations for a pandemic also devote considerable time to the question of what to do when demand for NHS resources outstrips supply, and there is an urgent need to free up capacity.
In paragraphs that will make bitter reading for families whose relatives are included in the care home death toll, Whitehall officials attempted to set out a framework to help doctors choose between patients.
Those who have been taken into care because of prior health problems – as is the case with many care home residents - inevitably come lower down the list.
“The potential medical benefits to incoming patients should ideally be greater than the potential risks of not receiving care for those discharged,” says a 2009 policy document on “surge capacity” in a pandemic. “There has to be a level of risk tolerance of a consequential medical event as a result of discharge.”
As has now been demonstrated with horrifying decisiveness, the “consequential medical events” that followed ultimately affected a much wider pool of care home residents than just those being discharged from hospital.
Experts commenting on Tuesday’s CQC figures warned that - given the lag in data - the number of coronavirus deaths in care homes may already outnumber those in hospitals.
As the Government prepares for next week’s count, it will be under pressure to strengthen its defence. Mr Hancock may insist that they have been a priority from the start, but to many families with relatives in care homes, it feels like they have been forgotten.